RESUMO
The high prevalence of HPV in men's genitalia and the low frequency of virus-associated lesions gave rise to questions on the influence of infection-site on the HPV antibody profile. In a cross-sectional study, HPV infection in penis and urethra, and serum antibodies against HPV-16 E4 and E7 proteins were evaluated in 288 Mexican soldiers. The results showed that HPV prevalence was 31% (51% in penis, 11% in urethra and 38% in both sites), while 47% were multiple infections. Overall, seroprevalence was 13% for anti-E4 antibodies and 6% for anti-E7. However, the highest prevalence of anti-E4 antibodies was observed in men with HPV infection in urethra (30%), while for E7 antibodies, the highest prevalence (10%) was found in men who tested positive for HPV in penis. The prevalence of IgG and IgA anti-E4 was related to HPV-16 urethral infection, while detection of HPV-16 in penis was related to IgG anti-E7 prevalence. In conclusion, the high-risk sexual behavior observed in this population might be responsible for high HPV prevalence and multiple infections. However, the seroprevalence of E4 and E7 was similar to that observed in healthy Mexican women. These results suggest that the humoral immune response against HPV infection in men differs, depending on the site of infection.
Assuntos
Anticorpos Antivirais/sangue , Doenças dos Genitais Masculinos/epidemiologia , Papillomavirus Humano 16/imunologia , Proteínas Oncogênicas Virais/imunologia , Infecções por Papillomavirus/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Doenças dos Genitais Masculinos/imunologia , Doenças dos Genitais Masculinos/virologia , Papillomavirus Humano 16/isolamento & purificação , Humanos , Masculino , México/epidemiologia , Militares , Proteínas E7 de Papillomavirus , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Pênis/virologia , Estudos Soroepidemiológicos , Comportamento Sexual , Uretra/virologiaRESUMO
INTRODUCTION: At the beginning of 1999, Mexico occupied third place, after USA and Brazil, in the number of accumulated cases of AIDS (38,390 notified cases) in America. More than 80% of the cases corresponded to men between 20 and 44 years old. The transmission by sexual route has increased in both sexes, the proportion of men infected by sexual contact increased from 85% in 1991 to 90% in 1998 and in women this proportion increased from 41% in 1991 to 57% in 1998. The ratio male/female of cases of AIDS has varied from 17:1 in 1983 to 6:1 in 1998. Condom use is considered an effective method for the prevention of the transmission of STI's/HIV and therefore the availability is of paramount importance to promote use with the finality of combating these diseases. METHOD: A simple randomized sampling was done in 612 establishments that included: drugstore, bars and nightclubs, hotels and motels, self-service shops and health centers in Mexico City, where am cross sectional study was performed during June and July of 1995, to evaluate the availability of condoms considering three important items: a) percent per capita required to buy an annual endowment of 100 condoms in comparison with this same indicator reported in other countries; b) physical availability, on behalf of the Secretaría de Salud, Mexico City, that considers the volume of existing condoms to be utilized for a year by the public sector in this city; c) physical availability of condoms in different evaluated locations. RESULTS: In order to purchase an annual supply of condoms an individual needs the assign $500 (Pesos) which represents 2.3 to 2.6% of the annual GNP per capita for 1998 and 1997 respectively. The physical availability of condoms, on behalf of the Secretaría de Salud, Mexico City, was 94.9% in health centers. In drugstores, hotels and motels, self-service shops, bars and nightclubs the availability of condoms was 100%, 82.9%, 75% and 1.2%, respectively. CONCLUSIONS: It has been documented that the adequate use of condom is an effective strategy for the prevention of STI's/HIV, therefore the availability of this method of prevention is important to decrease the incidence of these diseases The results of this study indicate that the price for this method of prevention represents an important expense for the homes, which is a limiting factor for condom use, especially for those populations that include adolescents and young adults. It then becomes necessary for Government Institutions to implement programs that will subsidize this method of prevention. Availability is less in self-service shops and practically non-existent in bars and nightclubs. It is suggested that the availability of condom should be mandatory in public places, like bars and nightclubs, where the risk to start casual sexual contact is eminent.
Assuntos
Preservativos/provisão & distribuição , Adolescente , Adulto , Estudos Transversais , Humanos , México , Pessoa de Meia-Idade , Distribuição Aleatória , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine the major features of sexual behavior in men from Mexico City, such as the number of sexual partners, history of sexually transmitted disease (STD) and beliefs on AIDS. MATERIAL AND METHODS: A transversal epidemiologic study was conducted in 1995 based on multistage sampling with conglomerates. A total of 1,377 males from 15 to 49 years of age was interviewed by means of a structured questionnaire. Statistics such as Student's test and chi 2 were applied to determine significance. RESULTS: Subject mean age was 17.7 years (SD = 2.8 years) Overall proportion of condom use in the last intercourse was 24.6% depending on the type of partner: 18.8% used it with regular partners and 62.5% with multiple partners. Symptoms suggesting gonococcal uretritis were found in 2%. Finally, 97.5% understood the meaning of AIDS and knew some protective measures against infection. CONCLUSIONS: Some risky characteristics of sexual behavior were identified concerning the transmission of STD such as multiple sexual partners, not using condom and STD antecedents.
Assuntos
Comportamento Sexual , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Fatores Etários , Preservativos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores de Risco , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/transmissão , Inquéritos e QuestionáriosRESUMO
Sexually transmitted diseases (STDs) are an important public health problem, due to their medical, social and economic repercussions. Therefore, more knowledge is needed about the sexual behaviour that promotes their spread, in order to improve control and prevention strategies. Our aim was to determine the frequency of male condom use associated with sexual behaviour factors, a history of and knowledge about STDs in a sample of the male population in Mexico City. During 1994 a cross-sectional epidemiological study was carried out, using multi-stage sampling with conglomerates, in 1377 men from 15 to 49 years old. The mean age was 34.5 years (SD 7.5 years). Mean age at first sexual relations was 17.7 years (SD 2.8 years). The global proportion of condom use during the last sexual relation was 24.6%; use according to type of female sex partner in the last year was 18.8% with regular partners and 62.5% with occasional partners. The principal predictors of male condom use, identified through statistical modelling, were: younger age (<25 years), middle and high education level (>9 years), middle and high socioeconomic level and type of sexual partners (occasional and regular). This population has risk factors for acquiring and transmitting some STDs, such as occasional sexual partners and a history of STDs. Characteristics which are important in relation to male condom use were identified, such as age (younger than 35), education (complete junior high school or more) and type of sexual partners (occasional and regular).
PIP: A cross-sectional epidemiological study was conducted in 1994 to determine the frequency of condom use in Mexico City among sexually active men aged 15-49 years old, and the association with sexual behavior and a history of or knowledge about STDs. The 1377 men interviewed were of mean age 34.5 years, and experienced their first sexual intercourse at mean age 17.7 years. 47% of the men reported using a condom at least once in their lives and 81.6% were married. 79.4% reported having a formal partner, 14.6% had relations with occasional partners, and 6.1% with both regular and informal partners. 26.4% used a condom during their most recent sexual intercourse, 18.8% with formal partners and 62.5% with casual partners. Condom use with formal partners was largely to prevent pregnancy, while condom use with casual partners was to prevent the transmission of STDs. Young and single men were almost twice as likely to use condoms as older married men. The main predictors of male condom use were therefore being under 25 years old, having more than 9 years of formal education, being of middle to high socioeconomic status, and type of sex partners.
Assuntos
Preservativos/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Parceiros SexuaisRESUMO
OBJECTIVE: To determine the main factors associated to participation in an early detection program of cancer (DPC), in a population with a high cervical cancer (CC) mortality rate. MATERIAL AND METHODS: A population-based, cross-sectional study was performed in the state of Morelos, which included 3,197 women aged between 15 and 49 years, randomly selected from a household sample frame of the 33 municipalities of the state. RESULTS: Awareness of the utility of the Papanicolaou (Pap) test (OR 29.6, 95% CI 23.6-37) and a former history of gynecological symptoms (OR 1.7, 95% CI 1.2-2.4) predisposed to greater use of the DPC. Factors associated to the use of the Pap test were precedents of using one contraceptive (OR 1.4, 95% CI 1.1-1.8) or two or more contraceptives (OR 2.1, 95% CI 1.6-2.8). CONCLUSIONS: In the state of Morelos, Mexico, screening for cervical cancer is offered opportunistically in the context of health care use. Therefore, the precedent of using health care services is the main determining factor for use of the DPC program. These results reveal the need to design alternative strategies to promote participation among women who have no access to health services, since they constitute the population group at highest risk of developing CC.
Assuntos
Programas de Rastreamento/organização & administração , Cooperação do Paciente , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , México , Pessoa de Meia-Idade , Teste de Papanicolaou , Cooperação do Paciente/estatística & dados numéricos , Distribuição Aleatória , Fatores de Risco , Fatores Socioeconômicos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricosRESUMO
INTRODUCTION: Although the incidence of syphilis is generally low, it remains an important global public health problem, given its interaction with other sexually transmitted diseases (STDs). It has been shown that syphilis, due to the genital ulcers it produces, is a co-factor for acquiring other STDs, principally those of viral origin such as herpes simples type 2, hepatitis B and HIV. Many female commercial sex workers (FCSW) in Mexico have been found to have acquired good levels of knowledge about STD prevention. Nevertheless, they constitute a heterogeneous group in terms of socio-economic level, health status and type of work site; these factors in turn appear to determine their attitudes, knowledge and behavior related to acquiring and transmitting STDs, including syphilis. This study, therefore, focused on the factors associated with Treponema pallidum infection in this group of women. METHOD: Based on a sample frame of sites where female commercial sex work takes place within Mexico City, a sample of 807 FCSWs was selected; after providing informed consent, they completed a structured questionnaire. A blood sample for identifying serologic markers for STDs was collected and analyzed according to a procedure manual for STD diagnosis. Treponema pallidum was diagnosed using the RPR (Bigaux Diagnostica) screening test, and FTA-ABS (Pasteur Diagnostics) for confirmation. RESULTS: The prevalence of syphilis in this sample of FCSWs was 6.4% (52/807), and was higher among women who worked at street sites than among those who worked in massage parlors. The age of the women interviewed ranged from 17 to 58 years, with a mean of 29.2 years (SD 7.3 years); syphilis was more prevalent among women over 30 years of age. Age at first sexual intercourse ranged from 11 to 30 years, with a mean of 16 years (SD 3.1 years), which is similar to that of the general female population in Mexico. Predictive factors for T. pallidum infection, determined adjusted logistic regression, included: tupe of by work site (bar and street sites); socio-economic level (middle and low); age (over 30 years); duration of involvement in sex work (> 5 years) and number of clients per week (> 10). CONCLUSION: In spite of some limitations regarding statistical precision, this study shows that FCSWs are heterogeneous in terms of risk of acquiring STDs, including syphilis; the principal differentiating factor was shown to be the type of work site. Given that it is not belonging to a risk group but rather participating in risky practices that leads to acquiring STDs, situations that facilitate riskier or safer practices (such as type of sex work site, for sex workers) should be taken into account when studying people's risk level. STD prevention campaigns must also consider these factors, in addition to focusing on FCSWs and their clients and personal partners, so that all involved assume their responsibility for safer sex.
Assuntos
Sífilis/epidemiologia , Adolescente , Adulto , Feminino , Humanos , México/epidemiologia , Prevalência , Fatores de Risco , Infecções Sexualmente Transmissíveis/epidemiologia , Fatores Socioeconômicos , Sífilis/sangueRESUMO
OBJECTIVE: Previous researches pointed out the critical changes needed to increase the efficiency of the National Screening Programme of Cervical Cancer in Mexico. These changes were assessed through a cost-benefit analysis. This paper presents the results of that appraisal. Figures are presented as US Dollars of 1996 valued as 7.5 pesos for each dollar. RESULTS: The operational unitary cost of the integral process of the cytology-the obtention of the Pap smear, its transportation to the interpretation centre, its analysis, and the notification of results to users-was estimated in US$ 11.6. If the proposed changes are operated, the cost of each citology would increase by 32.7%. The benefit/cost ratio would be 2 and the net benefit of 88 millions of US dollars for the next five years. CONCLUSIONS: The operation of the proposed changes is socially desirable, but should be supported the training activities of the personnel, the increase of the coverage of women at risk, the quality control activities, the monitoring of the program and the communication with women detected as positive cases.
Assuntos
Carcinoma in Situ/prevenção & controle , Programas de Rastreamento/economia , Avaliação de Programas e Projetos de Saúde/economia , Neoplasias do Colo do Útero/prevenção & controle , Carcinoma in Situ/economia , Análise Custo-Benefício , Reações Falso-Negativas , Feminino , Humanos , México , Teste de Papanicolaou , Neoplasias do Colo do Útero/economia , Esfregaço Vaginal/economiaRESUMO
Cervical cancer (CC) is one of the principal public health problems in Mexico. The national mortality rate due to CC was estimated at 21.8 per 100,000 among women over 15 years old during 1994. Despite this high incidence little is known in Mexico about the risk factors for CC. The objectives of the study were to evaluate the association between CC and HPV types 16 and 18 in women living in Mexico City. From August, 1990 to December, 1992, a case-control study was carried out in the metropolitan area of Mexico City. HPV 16-18 types were determined in a sample of 148 CC cases and 204 controls randomly selected from a sample frame representative of the metropolitan area of Mexico City. Sixty cases corresponded to in situ CC and 88 cases to the invasive phase. Determination of HPV 16 and 18 types was done by polymerase chain reaction using primers specific to E6/E7. Results showed that 48.3% of in situ CC cases and 48.8% of invasive CC cases were positive for HPV 16 while only 13.2% were positive among the 204 controls. Association between HPV 16 infection in the in situ cancer cases had an estimated odds ratio (OR) of 5.17 (95% CI 2.60-10.51). In the invasive cervical cancer cases, association between HPV 16 infection and invasive CC in this sample had an OR of 3.84 (95% CI 2.04-7.22). For the total sample, the estimated OR was 5.48 (95% CI 3.07-9.62). In the total sample, those women with a strong positive reaction to PCR were associated with a large increase in the risk, OR of 38.0 (95% CI 8.66-167.1). The prevalence the HPV 18 was 6.7%, only observed in the invasive cervical cancer cases. At present there is general consensus that HPV is the principal causal agent in C C etiology. This study intends to contribute to the knowledge concerning the etiology of cervical cancer. However, it is necessary to consider that the single most effective tool in the reduction of mortality due to cervical cancer has been the Pap test. Secondary prevention has proven to be highly effective in other populations, and this should be viewed as a priority activity for all at-risk populations. Although a vaccine for HPV may be available in the near future its efficacy in primary prevention has yet to be demonstrated.
Assuntos
Carcinoma/epidemiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Idoso , Carcinoma/etiologia , Carcinoma/virologia , Estudos de Casos e Controles , Comorbidade , Sondas de DNA de HPV , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/classificação , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , História Reprodutiva , Fatores de Risco , Comportamento Sexual , Infecções Tumorais por Vírus/virologia , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologiaRESUMO
OBJECTIVES: To study the seroprevalence of syphilis, herpes simplex-2, hepatitis B and HIV, and main sociodemographic characteristics and sexual behavior in women seeking testing for human immunodeficiency virus (HIV) in Mexico City. METHODOLOGY: A self-applied questionnaire was used in 454 women; and a blood sample was taken for the detection of markers for syphilis, herpes simplex virus-2 (HSV-2)), antibodies against core and surface antigens for hepatitis B virus (HBV), and ELISA and Western blot for HIV. RESULTS: Seroprevalences for antibodies against T. pallidum, HSV-2, HBV and HIV were 4.6%, 29.3%, 3.5% and 4.0%, respectively. Forty-six percent of the women were 20 to 29 years old; 70% reported complete junior high school or higher education level; 75% were sexually active; 56% reported at least one stable male sexual partner, 17% reported at least one occasional male sexual partner in the last three months, and 60% had had at least one sexual relation in the last three months; of these, only 18% (n = 82) reported the use of a condom as a preventive measure. Almost 30% of the HIV positive women had a history of blood transfusion, while less than 10% of the HIV negative women had received a transfusion. In addition, 10.6% said that one of their sexual partners was infected with HIV or had AIDS. CONCLUSIONS: Risks of HIV/STD transmission for this group of self-selected women were linked to blood transfusion, low education and, most important, the risk from male sexual partners who were HIV seropositive. It is expected that these results will contribute to the improvement and development of strategies for the control and prevention of STD among this population group, as well as the general population in Mexico.