AccessMatters

Is active (vs expectant) management of a persistent PUL more effective?

To determine whether women who collect self-collected vaginal swabs at home demonstrated a higher positivity of Chlamydia trachomatis than women in family planning clinics. Collection kits for vaginal swabs were internet requested, collected at home, and mailed to a laboratory for testing; questionnaires were completed about acceptability and sexual risk history. Infected women received treatment at participating clinics. Age-specific prevalences were compared to those from family planning clinics. Chlamydia positivity was 10.3% for 1171 females mailing swabs; prevalences ranged from 3.3% to 5.5% in family planning. Positivity for internet age groups was much higher than those for family planning age groups. The positivity for internet participants ranged from a low of 4.4% in Baltimore in 2005 to a high of 15.2% Baltimore in 2007. Family planning clinic prevalence in Baltimore and Maryland ranged from a low of 3.3% in Baltimore in 2006 to a high of 5.5% in Baltimore in 2008. The median age for all years for internet users in Baltimore and Maryland combined was 23 years; the median age for all years for attendees to family planning clinics who had chlamydia testing performed was 23 years. Internet recruited women demonstrated higher positivity of chlamydia than those in family planning, providing new options for chlamydia screening programs.

Chlamydia trachomatis (CT) infections are common among adolescents attending high and middle schools. The study objective was to determine the reinfection rates of CT for females attending school-based health centers. Adolescents attending school-based health centers who reported they were sexually active were screened for CT using nucleic acid amplification tests on cervical or urine samples. Between 1996 and 2003, 10,609 female students were tested. The overall annual prevalence for unduplicated students in a calendar year ranged from 15.1% to 19.5%. Reinfection was defined as a positive test result occurring between 30 and 365 days after an initial positive result. There were 897 female students who tested positive for CT and returned for at least 1 subsequent test between 30 and 365 days later. Of these, 236 had 1 or more subsequent positive tests for a cumulative incidence of reinfection in 1 year of 26.3% (95% confidence interval = 23.4-29.2%). Young age at first infection was significantly associated with increased risk of subsequent infection (P <0.01). Across sites, the cumulative incidence of reinfection in these female students ranged from 14.3% to 38.9%. The chlamydia cumulative incidence of reinfection in these female adolescents attending high and middle schools was high and supports the Centers for Disease Control and Prevention recommendation to screen adolescents frequently, especially those with a history of a previous chlamydia infection.

ABSTRACT This study prospectively evaluates the effect of child-bearing motivation and contraceptive attitudes on consistency of condom use among at-risk women enrolled in an HIV prevention intervention. Women (age 15–40, 85% African-American) were recruited from homeless shelters, drug treatment facilities, and public housing developments and assigned to standard or enhanced intervention conditions. Among the eligible study group of nonsterilized women with a main partner (n = 312), 24.4% wanted to have a baby at baseline; 43.5% believed their partner wanted them to have a baby. Women who reported a desire for a baby, compared to all others, were less likely to be at a higher level of condom consistency six months later (OR = 0.66; .48–.90). Women who perceived partner support for contraceptive use showed a higher level of condom consistency (OR = 1.20; 1.03–1.41) at 6-month follow-up. Many women in this study wanted to have a baby and this desire interfered with subsequent consistency of condom use. We also found that condom use increased toward consistency of use among women whose partner supported contraceptive use. HIV prevention interventions should include screening for reproductive motivation, so that prevention messages can be tailored to the realities of women's lives. Women who want a baby can be educated about disease prevention in the context of pregnancy planning and linked with appropriate services. Women who want to avoid childbearing can be given messages that emphasize the contraceptive benefits of condom use and that help strengthen partner support.

Introduction Theory-based models of HTV prevention need to be tested using appropriate measures with populations at high risk. Data from interviews with 4036 women recruited from facilities and randomly sampled from high-risk communities were used to examine the mediating variables specified by the Transtheoretical Model (TM). The analysis aimed to test the reliability of brief self-efficacy and decisional balance measures, assess the relationships of these measures to stages of change for condom and contraceptive use, and examine the extent to which these findings are consistent for women interviewed in different settings. The results indicated that the scales measuring self-efficacy and advantages (pros) of the behaviors were moderately to highly reliable, while those measuring disadvantages (cons) were much less reliable. Results were similar for women recruited from community and from facility settings. Possible explanations for the low reliabilities for cons were examined. Significant differences in mean scores by stage of change were found for all measures of self-efficacy , pros and cons. These findings are consistent with patterns predicted byTM.

This is an overview of disabled women's reproductive health status. It focuses on the politics of eugenics, which explains why disabled women are devalued as sources of reproduction, have little access to women's health services, and are faced with methods of contraception which continue to pose a threat to their reproductive health and freedom. The ultimate goal of the author is to bring forth questions for research, and to help set the reproductive rights agenda for the aspiring disabled feminist movement.

No abstract available for this article.

Judge Alexander's plan for a new method of handling at an earlier stage requests for divorce and perhaps also other family problems is now familiar to many groups. This proposed plan for court procedure contains a basic requirement, first, that a problem of marital discord should be carefully investigated by a committee of experts before a petition for divorce be permitted to come into the courts, and second, that the court then should be guided in its decision by the recommendations of this committee as to what is for the best interest of the family as a whole. From the point of view of a social worker and marriage counselor such an attempt appears to be a step well in advance of much current legal court practice. If such a therapeutic approach to the divorce problem should be put into effect, I believe that the social worker and marriage counselor should be a part of this approach and would be able to contribute to it. My assignment is to consider in some detail what this part might be-first in broad context, and second under the reality limitations of present conditions. Some understanding of the basic tenets of social work should help in orientation to the point of view that social work could contribute to the suggested therapeutic approach to divorce. Social work generically is concerned with human behavior and human relationships. Marriage and divorce are admittedly vital processes in human relationships. Casework, as one branch of social work, prepares its workers primarily to deal with the emotional growth and security of the individual. An emotionally mature and reasonably secure individual can usually handle the run-of-themill problems of marriage and family living. According to Dr. Hertha Kraus,1