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HealthMED

Volume 5 / Number 2 / 2011

Journal of Society for development in new net environment in B&H

EDITORIAL BOARD

Editor-in-chief Mensura Kudumovic Execute Editor Mostafa Nejati Associate Editor Azra Kudumovic Editorial assistant Jasmin Musanovic Technical editor Eldin Huremovic Members Paul Andrew Bourne (Jamaica) Xiuxiang Liu (China) Nicolas Zdanowicz (Belgique) Farah Mustafa (Pakistan) Yann Meunier (USA) Forouzan Bayat Nejad (Iran) Suresh Vatsyayann (New Zealand) Maizirwan Mel (Malaysia) Budimka Novakovic (Serbia) Diaa Eldin Abdel Hameed Mohamad (Egypt) Zmago Turk (Slovenia) Bakir Mehic (Bosnia & Herzegovina) Farid Ljuca (Bosnia & Herzegovina) Sukrija Zvizdic (Bosnia & Herzegovina) Damir Marjanovic (Bosnia & Herzegovina) Emina Nakas-Icindic (Bosnia & Herzegovina) Aida Hasanovic(Bosnia & Herzegovina) Bozo Banjanin (Bosnia & Herzegovina)

Address of the Editorial Board

Sarajevo, Bolnicka BB phone/fax 00387 33 956 080 [email protected] http://www.healthmedjournal.com

Published by DRUNPP, Sarajevo Volume 5 Number 2, 2011 ISSN 1840-2291 HealthMED journal with impact factor indexed in: - Thomson Reuters ISI web of Science, - Science Citation Index-Expanded, - Scopus, - EBSCO Academic Search Premier, - Index Copernicus, - getCITED, and etc.

Sadržaj / Table of Contents

Multiple sexual partnerships among young adults in a tropically developing nation: A public health challenge ........................................................................... 243 Paul A. Bourne

Adult spontaneously hypertensive rats from the same laboratory present different baroreflex gain . .............. 258 Vitor E. Valenti, Oseas Moura Filho, Luiz Carlos de Abreu, Celso Ferreira

Left pulmonary agenesıs . ............................................... 265 Vedat Sabancıoğulları, Cesur Gümüş, F. Hayat Erdil, Mehmet Çimen

Effects of gender, age, and body parameters on eyeball volume of Korean people ................................................ 269 Beob-Yi Lee, Su-Jeong Lee, Jae-Woong Yang, Mi-Hyun Choi, Ji-Hye Kim, Jang-Yeon Park, Byung-Chan Min, Dae-Woon Lim, Gye-Rae Tack, Soon-Cheol Chung

Evaluation of prognostic parameters in patients with Intracerebral Hemorrhage at admission to hospital . .. 274 Zoran Peric, Stevo Lukic, Mirjana Spasic, Dejan Savic

Association between HER-2/neu status and clinicopathological characteristics of breast cancer ...... 281 Ammar Imad Hazim, Gurjeet Kaur

Computerized tomography appearance of Influenza A (H1N1) complicated with severe pneumonia in two typical cases .............................................................. 288 Wei Wang , Bo Qiu, Qiang Li, Hong Chen, Wanhai Xu

Ureterosıgmoıdostomy and secondary Amyloıdosıs ..... 292 Kubra Kaynar, Sukru Ulusoy, Yavuz Ozoran, Gulsum Ozkan, Adem Demırel

Outcomes of newborns admitted in the intensive care unit at a public hospital .......................................... 295 Márcia Fujiko Torigoshi, Luiz Carlos de Abreu, Vitor E. Valenti, Alberto O. A. Reis, Claudio Leone, Arnaldo A. F. Siqueira

Sadržaj / Table of Contents Occurrence of hepatitis B and C infection among Application of direct immunofluorescence technique in hemodialyzed patients with chronic renal failure detection of recurrent genital herpes ............................ 390 in Qazvin, Iran: a preliminary study ............................ 301 Vesna Milosevic, Gordana Kovacevic, Ivana Hrnjakovic-Cvjetkovic, Jalaleddin Hamissi, Sasan Mosalaei, Jabrael Yousef, Adeleh Ghoudosi, Hesameddin Hamissi

Vera Jerant-Patic, Jelena Radovanov, Gorana Cosic, Marina Djermanov

Choosing partners without the presence of emotions: The determination of the perception, approach and behaviour of teachers towards organic foods .............. 307 multicriteria quantitative approach . ............................ 397 Nevin Sanlier, Murat Kizanlikli, Serdar Cöp

Milan Nikolic, Zilijeta Krivokapic, Drazen Jovanovic, Mirko Savic, Dragica Ivin

A comparison of HIV/AIDS-related knowledge, Serious rash after prolonged use of lamotrigine attitudes and risk perceptions between final year medical and pharmacy students: A cross sectional study . .......... 317 report of four cases . ........................................................ 409 Syed Imran Ahmed, Mohammad Azmi Hassali, Nadeem Irfan Bukhari, Siti Amrah Sulaiman

Ksenija Bozic, Ksenija Gebauer-Bukurov, Marina Jovanovic, Ljuba Vujanovic, Petar Slankamenac

Synthesis control of 2-(4-benzoylphenyl)-2-methyl A Survey on Children Plays and Movement preferences in Pre-school Centers ...................................................... 327 propanoic acid by TLC in diethyl ether-cyclohexane and petroleumether – ethyl acetate system .................. 413 Zynalabedin Fallah, Hamid Janani, Fariba Mohammadian, Amir Mallahi, Sakineh Sadat Jamali

Ekrem Pehlic, Husein Nanic, Aida Sapcanin, Bozo Banjanin, Halid Makic, Sefkija Muzaferovic, Melita Poljakovic, Majda Srabovic, Haso Sefo

Consanguineous marriages, and the relationship between consanguineous marriages and abortion, infant mortality in Acipayam, a rural area of Denizli, Turkey ................ 334 Consumption Trend of Psychotropic and Antibiotic Drugs in Clinical Centre of University of Sarajevo Nazan Keskin, Ali İhsan Bozkurt, Ali Keskin (CCUS) ............................................................................. 419 Svjetlana Loga-Zec, Slobodan Loga, Nedzad Mulabegovic, Seroprevalence and risk factors for Toxoplasma Mensura Asceric infection in a large cohort of pregnant women in Rural and Urban areas ................................................... 338 The role of primary percutaneous coronary interventions Mohammad Rostami Nejad, Koroush Cheraghipour, in acute coronary syndrome . ......................................... 427 Ehsan Nazemalhosseini Mojard, Kobra Moradpour, Maryam Razaghi, Hossein Dabiri

Sosevic A, Kulic M, Spuzic M

Technical Efficiency of Public Hospitals in Mongolia .... 344 Early discharge and readmission to hospital in first six days of life . ....................................................................... 433 Sodnom Munkhsaikhan, Alan C Tsai, Ming-Cheng Chang Jadranka Dizdarevic, Hajrija Maksic, Sabina Terzic,

Almedina Mrkulic, Goran Stojkanovic Relationship between Parental Smoking and Respiratory Illness in Infants . ....................................... 350 Cytogenetic aspects of mental retardation in children Ayşe Gürol, Cantürk Çapik, Serap Ejder Apay, Çiğdem Köçkar with special needs ............................................................ 438 Azra Koljenovic- Metovic Job diagnostic survey of the employees of teaching hospital affiliated with Mazandaran medical university-2009 ................................................................ 356 The incidence of micronucleus in patients with Cancer of the Cervix ....................................................... 443 Mahmood Moosazadeh, Mohammadreza Amiresmaili, Atefeh Esfandiari

Nora Gorani, Isa Elezaj, Daut Gorani, Kasum Letaj, Shehrezade Islami, Shefqet Lulaj

Fast food and snack food consumption of adolescents in Turkey .......................................................................... 362 Preoperative staging of rectal carcinoma by endorectal ultrasound: is there a learning curve? .......................... 450 Semra Akar Sahingoz Amra Puhalovic, Rusmir Mesihovic

Self-perception of being overweight in Serbia adults . .. 372 Grujic V, Dragnic N, Ukropina S, Niciforovic Surkovic O, Cankovic D

As a family physıcıan ın Turkey: our current standıng for patıent satısfactıon and what we can do to ımprove the system . ........................................................ 383 Umit Aydogan, Oktay Sarı, Halil Akbulut, M.Aytug Dikililer, Kenan Saglam, Kurtuluş Öngel

Instructions for the authors ........................................... 459

HealthMED - Volume 5 / Number 2 / 2011

Multiple sexual partnerships among young adults in a tropically developing nation: A public health challenge Paul A. Bourne 1

Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica Abstract

Background: In Jamaica, there is a ‘silent’ epidemic called lowered age of sexual initiation which continues to decline with time. With HIV being the second leading cause of mortality in the world and the first in the Caribbean among ages 15-49 years, there is an obvious need to examine the reproductive health matters among young adults who are involved in multiple sexual partnerships in order to guide policy formulations. Objectives: This research seeks to elucidate (1) characteristics of young adults with regard to them having sexual intercourse with recent, next recent and second next recent partner;(2) consistent condom usage in multiple sexual relationships; (3) number of sexual partners over different time intervals; (4) factors which account for consistent condom usage, and (5) factors which account for multiple sexual concurrent relationships. Methods and material: The current study extracted a sample of 274 participants’ aged 1524 years who indicated having 2+ sexual partners from a nationally representative survey of 1,800 respondents. Setting and design: A multi-staged sampling design was used to collect the data. Each of the 14 parishes in the country is stratified into electoral constituencies, and sample was drawn proportion to size. Statistical analyses used: This study used the Statistical Packages for the Social Sciences (SPSS) for Windows, Version 16.0 (SPSS Inc; Chicago, IL, USA). Frequencies and means were computed on the sociodemographic characteristics. Stepwise multiple logistic and multiple linear regressions

were used to analyze factors that explain consistent condom usage and why young people have multiple sexual concurrent relationships. Results: One in every 50 young adults aged 15-24 years reported being infected with AIDS or the HIV virus; 74.3% consistently used a condom (male, 77.3%; female, 61.7%), and 4.3 times more young males indicated having 2+ sexual partners than females. One variable emerged as statistically significant explanation of consistent condom usage: age of respondents (OR = 0.80, 95% CI = 0.68 – 0.94; Model chi-square = 23.2, P = 0.039). Conclusion: Gender differential in economics is accounting for aspects of the risky sexual behaviour, and the masculinity ideology forms the platform for the sexual script used by young adults. Key words: First sexual initiation, sexual debut, masculinity, multiple sexual relationships, HIV, transactional sex, sexual-economic activity, reproductive health matters, consistent condom use, Introduction Many ethnographic studies which have been conducted, particularly in the English-speaking Caribbean nations, identified that contemporary sexual behaviour of males as having historical antecedents [1, 2]. This makes for the understanding of sexual expressions, sexual relations, sexual identities and the disparity in role gendered sexuality [3]. Despite the revolution in knowledge through the use of the internet, media and educational achievements; promiscuity, transactional sex, and sexual-economic exchange, particularly among young people, peoples’ behaviours are the by-pro-


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duct of the traditional beliefs on masculinity and provide insights into why males are less likely to engage in healthy lifestyle practices and more likely to be involved in risky sexual behaviours than females. In a three-island study, Chevannes [1] noted that that males are given sexual freedom, sexual autonomy and sexual promiscuity is a part of the social setting. Thus, traditional masculine ideology is such that it retards healthy lifestyle choices and promote premarital sexual behaviour among males, which is not supposed to be the case among females. These cultural values and social settings in the Caribbean as well as many African nations are such that they foster public health problems such as HIV/AIDS infections, other sexually transmitted infections and multiple sexual relationships. Douglas posited that the major cause of mortality among women aged 15-44 years in the Caribbean is AIDS (acquired immunodeficiency syndrome), and that 1 in every 50 Caribbean national was infected with HIV (human immunodeficiency virus)/AIDS [4]. Another study noted that “the HIV epidemic in Latin America is highly diverse. Several Caribbean island states have worse epidemics than any country outside of sub-Saharan Africa.” [5] In 2007/2008, Wilks et al. conducted a study of some 2,848 Jamaicans between the ages of 15-74 years and found that sexually transmitted infections (STI) is greater among males (18.1%) than females (11.0%) [6], which demonstrates some aspect to the beliefs of the masculinity ideology and its influence on choices and health status. Greater promiscuity among males than females was noted by Wilks et al [6] who found that 41% of males had 2+ partners compared to 8.4% of females, and again this reinforces the risk-taking behavioural lifestyle of males, which emerged from the traditional masculinity ideology. With human immunodeficiency virus (HIV) being the second leading cause of mortality in the world [7-9], the first in the Caribbean (among 1549 year olds) [10], the fact that 48.7% of young males aged 15-24 years reported having multiple sexual partners (2+) compared to 15.2% of females of the same age, and 42.4% of young males had sex once per week compared to 41% of their female counterparts, the reality that sexual relation is primarily the medium through which most pe244

ople contract HIV/AIDS [5], promiscuity among young people must be comprehensively examined in order to effectively guide public health planning in addressing those realities. While culturally Jamaican females with multiple sexual partners have been called names, including whores, prostitutes, promiscuous, commercial sex workers and ‘bitches’, males who practice the same lifestyle are called macho, ‘gallis’, ‘girlie-girlie’ and these convey positive cosmologies. They are also called womanizers, but not the number of negative constructions which are ascribed to females who are engaged in multiple relationships or in promiscuous activities. This is a cultural bias which demonstrates male power, male dominance in ideology, and the cultural disparities between the sexes with regard to sexuality. The cultural bias with regard to sexuality is captured in a study conducted by Eversley and Newstetter [11] and consequences of respondents’ actions were noted in the findings. Eversley and Newstetter [11] that found “…females who are exposed to multiple partners do have a significantly higher chance of encountering a male in a high risk category...” [11]. Yet, males are alluded for their sexual prowess, and females decried for their socially unacceptable and ‘whoring’ behaviour. Undoubtedly from the aforementioned studies, in 2007, with Jamaica’s youth’s population being about 20% [12], an extensive literature search revealed no empirical evidences that have examined the reproductive health behaviour of youths with multiple sexual partners. However, studies have examined commercial sex workers [13-15]; inconsistent use [16]; early sexual initiation [17]; multiple sexual partners [18-20], trends in HIV risk perception, condom use, sexual history, HIV testing and sexual behaviour [21-23], but in Jamaica there are paucity of studies among youths in multiple sexual relationships on their reproductive health behaviour. Studies which have investigated those whom have multiple sexual partners [24-26] have failed to explore (1) characteristics of young adults with regard to them having sexual intercourse with recent, next recent and second next recent partner;(2) consistent condom usage in multiple sexual relationships; (3) number of sexual partners over different time intervals; and (4) factors which



account for consistent condom usage. Thus, this research seeks to elucidate (1) characteristics of young adults with regard to them having sexual intercourse with recent, next recent and second next recent partner;(2) consistent condom usage in multiple sexual relationships; (3) number of sexual partners over different time intervals; (4) factors which account for consistent condom usage, and (5) factors which account for why people have multiple sexual concurrent relationship. Method Sample The current study extracted a sample of 274 participants aged 15-24 years old, from a nationally representative survey, who indicated having had 2+ sexual partners [27]. The survey (HIV/ AIDS/STD National KABP) comprised 1,800 participants 15-49 years of age who resided in Jamaica at the time of the survey (May-August, 2004). The data was collected by Hope Enterprises Limited on the behalf of the Ministry of Health. A multi-staged sampling design was used to collect the data. Each of the 14 parishes in the country is stratified into electoral constituencies, with each constituency stratified into three areas – rural areas, parish capitals (urban areas) and main towns (semi-urban areas). The areas which comprised a constituency were then stratified into primary sampling units (PSUs) or electoral enumeration districts (EDs). A random sample of each PSU was then selected based on probability proportional to size (PPS). Seventy-two EDs were selected for the study – 23 EDs in the urban areas, 25 EDs in the semi-urban areas, and 24 EDs in the rural areas. Twenty-five households were systematically chosen from each ED, and cluster sampling was carried out with all the people living in the household of the designated ages interviewed for the survey [27]. Data sources A questionnaire was used to collect the data from the participants. Trained interviewers used

face-to-face interviews to collect the data. The interviewers were trained for a 5-day period, of which 2 days were devoted to field practices. Interviewers were assigned to a team comprising two females, two males and a supervisor. Verbal consent was sought and given before the interviews commenced. The participants were informed of their right to confidentiality and their right to stop the interview at any time. No names, addresses or other personal information was collected from the participants to ensure anonymity. The instrument used in the survey utilized indicator measures and definitions consistent with UNAIDS and the USAID Priority Prevention Indicator [27]. Statistical methods This study used the Statistical Packages for the Social Sciences (SPSS) for Windows, Version 16.0 (SPSS Inc; Chicago, IL, USA). Frequencies and means were computed on the sociodemographic characteristics. Chi-square tests and F-tests were performed to evaluate associations and differences among mean scores. Stepwise multiple logistic and multiple linear regressions were used to analyze factors that explain consistent condom usage and why people have multiple sexual concurrent relationships. Odds ratios were determined from the use of a binary logistic regression model, and r-square for the weight of each significant variable in the multiple linear regressions. Where collinearity existed (r > 0.7), variables were entered independently into the model to determine those that should be retained during the final construction of the model. To derive accurate tests of statistical significance, the researcher used SUDDAN statistical software (Research Triangle Institute, Research Triangle Park, NC), and this was adjusted for the survey’s complex sampling design. A P-value < 0.05 (two-tailed) was used to determine statistical significance. Measurement Age is the number of years a person is alive up to his/her last birthday (in years). Contraceptive method is any device or approach that is used to


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prevent pregnancy. These methods include tubal ligation, vasectomy, implant (Norplant), injection, emergency contraceptive protection, pill, condom, foaming tablets, creams, jellies, diaphragm, abstinence, withdrawal, the rhythm method, and calendar or Billings (1= yes, 0 = otherwise). The dependent variable for this study was a contraceptive method which was coded as a binary variable from those who indicated yes to any of the aforementioned methods of contraception. Consistent condom usage is taken from the question “How often did you use a condom with this person over the last 12 months?” The responses ranged from every time, most times, occasionally and never. Consistent condom usage comprised of only those who chose every time (1= yes or consistent use, 0 = otherwise). Education is taken from the question, ‘How many years did you attend school?’ This is coded as primary or below (0 – 9 years), secondary (10-12 years) and tertiary (13+ years). Shared facility is taken from ‘Are these [sanitary conveniences] shared with another household? The options are shared, not shared or not stated. This was coded as 1 = shared and 0 = otherwise. Number of sexual partners is taken from the question, ‘With how many persons have you had sex during the: (1) last 4 weeks, (2) last 3 months, and (4) last 12 months? Age of sexual debut or first sexual intercourse (or initiation) is taken from the question “At what age did you first have sex?” Responses were recorded in years. Sexually transmitted infections (STIs) recorded from “Have you ever had an STI (sexually transmitted infections)?” (1=yes, 0 = otherwise). HIV infection was measured using “Did you go back for the results yourself or were you contacted by a health worker?” If the individual indicated that he/she was contacted by a health worker, this was used to indicate a positive HIV result (1= HIV infected, 0 = otherwise). Early sexual initiation (or debut, intercourse) is having sexual relations before ones 18th birthday (i.e. legal age of individual consent on sexual practices). Analytic models Using logistic regression, this study seeks to examine factors associated with consistent con246

dom usage among young Jamaican adults aged 15-24 years old. Different social factors influence young people’s choices, and their decision to consistently use a condom. This study used Bourne et al.’s model [28], which established a connection between social variables and contraception usage among women, using econometric analyses. In keeping with the age cohort, Bourne et al.’s model has been modified to reflect those factors that are likely to influence consistent condom usage. The current research will use the theoretical framework of Bourne et al.’s econometric analysis to examine factors that are associated with the consistent condom usage among young people aged 15-24 years in Jamaica. The variables used in this econometric model are based on the literature as well as the dataset. The researcher will test the hypotheses that (1) consistent condom usage among young people aged 15-24 years is determined by particular sociodemographic variables, and (2) Sociodemographic correlates of number of sexual partners in the last 3 months. Based on the literature, the following variables were examined using logistic regression: Dependent – consistent condom usage. Independent age of respondents; educational level; employment status of young adult man; social class of young adult man; area of residence; someone currently pregnant for respondent; forced to have sex; had STI; age of first sexual relations; currently had sexual intercourse in the last 30 days; number of sexual partners; religiosity; currently in a sexual union; hearing family planning message; age at which began using contraceptive method; involvement in family planning programme, chance of contracting the HIV virus, and having had sexual intercourse in the last 30 days. The second analytic model used stepwise multiple linear regressions to examine factors which account for number of multiple sexual relationships. Bourne et al.’s model [28], which established a connection between social variables and contraception, was used to establish this model. The dependent variable was logged by number of sexual partners (2+ partners) in the last 3 months, and this was done in order to remove the skewness in the variable.



Results Table 1 presents demographic characteristics of the study population. A sample of 247 individuals was used for this study, representing 13.7% of the survey from which the sub-sample was extracted. The findings revealed that consistent condom usage was high among the sample (74.3%; males, 77.3%; females, 61.7%) and that 4.3 times more young males indicated having 2+ sexual partners compared to females. Of the study population, 22% had done a HIV test in the last 12 months. Two percentage of the sample had positive HIV results, which represents 9.3% of those who were tested for the virus. Only 9.1% of young adults with multiple sexual partners indicated having been engaged in commercial sexual encounters. Although the mean age of those who had their first sexual intercourse was 13.3 years, 36% had this experience before 13 years. Of those who indicated that they consistently used a condom, 50% of them stated they had no chance of contracting the HIV virus, 28.6% said they had a low chance, 9.5% mentioned a moderate chance and 11.9% reported a high chance. Furthermore, there was no statistical association between consistent condom usage and HIV status (χ2 = 0.142, P = 0.706): 11.4% of those who consistently used a condom were HIV-positive compared to 7.7% of the inconsistent condom users. Forty percentages of HIV-positive young adults were 24 years, the same percentage was 18-20 years, and 20% were 15-17 years. The occupational statuses of the study population were domestic helper (or office attendants), 50.5%; security guards, hairdressers, taxi drivers, machine operators, and cosmetologists, 29.7%; labourers, construction workers or farmers, 9.8%; managers, assistant managers, and entrepreneurs 1.0%; supervisors and accountants, 3.0%; teachers, police officers, nurses or nurse technicians, 3.0%; and no response, 3.0%. Almost 4% of the men were engaged in homosexual relationships, 0% bisexual and 96% heterosexual relationship. Among the females, 11.4% were lesbians, 4.5% were bisexual and 84.1% were in heterosexual unions. Substantially more men were in heterosexual unions than females, and more females in homosexual relationships

compared to females and this was also the case in bisexual unions (χ2 = 155.9, P < 0.0001). Table 1. Demographic characteristics of study population, n = 247 Characteristic n % Sex of respondents Male 200 81.0 Female 47 19.0 Educational level Primary or below 2 0.8 Secondary 225 91.1 Tertiary 20 8.1 Union status Married or common law 21 8.5 Visiting 183 74.1 Single 43 17.4 Commercial sex worker Yes 22 9.1 No 219 90.9 Current partner has other partner(s) Yes 114 55.9 No 90 44.1 Sexually assaulted (ever) Yes 29 14.2 No 175 85.8 Ever had sexually transmitted infections (STIs) Yes 38 15.5 No 206 84.4 Ever done a HIV test Yes 54 22.0 No 192 78.0 Positive HIV test result of those tested Yes 5 9.3 No 44 81.4 Did not respond 5 9.3 Condom usage (with current partner) Inconsistent usage 182 25.7 Consistent usage 63 74.3 Was HIV testing done in last 12 months Yes 35 64.8 No 19 35.2 Age of respondents mean 20.0 years (2.8 years) (SD) Age of first sexual debut 13.3 years (2.7 years) mean (SD)

A cross tabulation between educational status and gender of respondents showed no statistical association (χ2 = 1.8, P = 0.41).


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Table 2. Particular socio-demographic and reproductive health variables by sex of respondents, n=247 Characteristic Positive HIV test results No Yes Commercial sex encounter (or worker) No Yes Sexually assaulted (ever) No Yes Forced someone to have sexual intercourse (ever) No Yes Used a condom the first time with most recent partner No Yes Little chance of contracting HIV No Yes Ever had STI No Yes Employment status Employed: Full-time Part-time Unemployed Student Age at first sexual intercourse mean (SD)

All the HIV-positive cases were reported by young males. Of those who were HIV-positive, 60% stated that they had no chance of contracting the virus and 40% indicated that they had a little chance. And all the respondents had sexual intercourse in the last 30 days. Table 2 shows information on HIV status, commercial sex workers, sexually assaulted individuals, condom usage, chance of contracting HIV, STI and employment status by sex of respondents. The findings revealed that young adult females were 2.4 times more likely to reported having had a STI than males. Figure 1 shows the number of sexual partners of the study population over different time periods. Moreover, there are young adults who have had sexual intercourse with more than 15 individuals 248

Male n (%) 28 (84.8) 5 (15.2)

Female n (%) 16 (100.0) 0 (0.0)

175 (90.2) 19 (9.8)

44 (93.6) 3 (6.4)

173 (87.8) 24 (12.2)

36 (76.6) 11 (23.4)

156 (79.2) 41 (20.8)

44 (93.6) 3 (6.4)

55 (27.6) 144 (72.4)

19 (40.4) 28 (59.6)

132 (71.4) 53 (28.6)

21 (53.8) 18 (46.2)

173 (87.8) 24 (12.2)

33 (70.2) 14 (29.8)

55 (27.5) 39 (19.5) 57 (28.5) 49 (24.5) 13.0 years (2.8 years)

2 (4.3) 5 (10.6) 27 (57.4) 13 (27.7) 14.7 years (1.8 years)

P value χ2 = 2.7, P = 0.100

χ2 = 0.53, P = 0.468

χ2 = 3.9, P = 0.049

χ2 = 5.3, P = 0.021

χ2 = 6.6, P = 0.013

χ2 = 4.6, P = 0.033

χ2 = 8.9, P = 0.003

χ2 = 20.1, P = 0.001

t-test = -5.1, P < 0.0001

in the last 12 months (3.6%), 3 months, 1.2%, and 0.4% in 12+ months.

Figure 1. Number of sexual partners over different time periods (in %) Figure 2 shows individual who are having sexual intercourse with most recent, next most recent



and second next most recent partner by gender and total. Almost 48% of the sample indicated having sexual relations with most recent partner, 37.2% with the next most recent partner and 37.6% with the second next most recent partner. There were no significant statistical association between having sex with recent partner and gender of respondents (χ2 = 0.29, P = 0.593) and having it with the second next most recent partner and gender (χ2 = 1.17, P = 0.280). However, there existed a significant statistical association between having sex with the next most recent partner and gender of respondents (χ2 = 6.2, P = 0.013). Furthermore, statistically more females were having sexual intercourse with their next most recent partner (53.3%) compared to males (33.5%).

last time they had sexual intercourse compared to 58.9% who reported inconsistent condom usage (χ2 = 42.4, P < 0.0001). Likewise 89% of those who indicated consistent condom usage used one the first time with their current partner compared to 15.9% of those who stated inconsistent condom usage (χ2 = 119.0, P < 0.0001). An examination between frequency of condom usage (i.e. consistent and inconsistent usage) by age cohorts of respondents revealed no statistical association (χ2 = 5.2, P = 0.160). However, 78.8% of individuals aged 15-17 years consistently used a condom compared to 79.8% of those 18-20 years; 70.0% of those aged 21-23 years and 63.6% of those aged 24 years. Of those who had sexual intercourse with their most recent partner, 42.5% of them consistently use a condom compared to 32.8% of those who had sexual relations with their next most recent partner and 33.1% with their second most recent partner. Furthermore, Figure 3 shows consistent condom usage by particular typology of sexual relationship controlled for gender of respondents. Of those who consistently used a condom with their most recent partner, 41.4% were females compared to 42.8% males.

Figure 2. Having sexual intercourse with most recent, next most recent and second next most recent partner by gender and total Males were significantly more likely to indicate consistent condom usage (77.3%) than females (61.7%; χ2 = 4.8, P = 0.028). On the other hand, no statistical association existed between an individual reporting that his/her partner has other partner(s) and gender of respondents (males, 55.2%; females, 58.8%; χ2 = 0.15, P = 0.700). When the aforementioned was disaggregated by frequency of condom usage, 54.6% of males who indicated that their sexual partner(s) had consistently used a condom compared to 52.2% of females (χ2 = 0.04, P = 0.880). Cross tabulations between condom usages last time had sexual intercourse with frequency of condom usage, and condom usage first time had sexual intercourse with current partner by frequency of condom usage showed statistical associations. Ninety-three percentages of those who indicated consistent condom usage, used one the

Figure 3. Consistent condom usage with most recent, next most recent and second next most recent partner by gender and total Figure 4 presents information on occasion with which an individual indicating having sexual relations at particular time, with a typology of partner by gender of respondents. The findings revealed that condom usage declines over time with any typology of relationships. Furthermore, condom usage falls more substantially for females among the typology of partner and occasion of sexual activity compared to that of males (Figure 4).


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significant predictive power (Hosmer and Lemeshow goodness of fit test, χ2 = 4.4, P = 0.819), and correctly classified 78.0% of the sample. Table 5 presents information on the explanatory factors which account for number of sexual partners of an individual with multiple concurrent sexual partners. Figure 4. Occasion having sexual intercourse with typology of partners and by gender of respondents Table 3 presents information on positive HIV test results, commercial sex encounter, sexual violence, consistent condom usage, ever had STIs, employment status and risk of contracting HIV by age cohort controlled for by gender of respondents. Using logistic regression analyses, only one variable emerged as statistically significant explanation of consistent condom usage with respondents’ current partners (Table 4): age of respondents (OR = 0.80, 95% CI = 0.68 – 0.94; Model chi-square = 23.2, P = 0.039). The model had statistically

Discussion The findings revealed that 74.3% of the sample consistently used a condom, and that this was greater among males (77.3%) compared to females (61.7%). However, consistency in condom usage was lower with having sexual intercourse with most recent partner (42.5%), next most recent partner (32.8%) and second next most recent partner (33.1%) compared to current partner. Consistent condom usage was only greater for females having sexual relations with their next most recent partner (60.7%) than males in the other partnership typology. Four and 3-tenth times more young

Table 3. Particular socio-demographic and reproductive health variables by sex of respondents, n=247 Characteristic Positive HIV test results Yes Commercial sex encounter (or worker) Yes Sexually assaulted (ever) Yes Consistent condom usage Yes Used a condom on last sexual intercourse Yes Low chance of contracting HIV Yes High chance of contracting HIV Yes Ever had STI Yes Employment status Employed: Full-time Part-time Unemployed Student

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Age group (in years) Age group (in years) 15-17 18-20 21-23 24 15-17 18-20 21-23 24 Male (in %) Female (in %) 20.0 18.2 0.0 33.3 0.0 0.0 0.0 0.0 4.8

4.2

19.0

15.8

0.0

0.0

12.5

20.0

7.0

16.9

8.9

13.2

11.1

35.3

13.8

20.0

79.1

83.3

77.3

64.1

77.8

64.7

50.0

60.0

81.4

72.2

73.3

61.5

88.9

64.7

43.8

40.0

29.3

30.3

20.0

34.3

37.7

53.3

38.5

66.7

9.8

1.5

25.6

28.6

12.5

13.3

23.1

0.0

2.3

8.5

20.0

21.1

0.0

47.1

25.0

40.0

2.3 2.3 14.0 81.0

15.1 23.3 45.2 16.4

48.9 22.2 24.4 4.4

53.8 28.2 17.9 0.0

0.0 0.0 11.1 88.9

0.0 11.8 64.7 23.5

6.3 6.3 81.3 6.3

20.0 40.0 40.0 0.0



Table 4. Logistic regression analysis: Possible variable(s) which account for consistent condom usage with current partner Variable

Coefficient

Std. error

Odds ratio

CI (95%)

Age at sexual debut

0.02

0.08

1.02

0.87 - 1.19

Age of respondents

-0.22

0.08

0.80*

0.68 - 0.94

Gender (1=males)

0.61

0.53

1.85

0.66 - 5.17

-0.47

0.69

0.62

0.16 - 2.41

Commercial sex worker (1=yes)

0.51

0.80

1.67

0.35 - 7.92

Partner have other partner (1=yes)

0.22

0.44

1.25

0.53 - 2.97

Religiosity (1=attend religious service at least once per week)

0.63

0.46

1.88

0.76 - 4.64

Married

-1.01

0.96

0.36

0.06 - 2.36

visiting

-0.80

0.69

0.45

0.12 - 1.71

Ever had STI (1=yes)

Single

1.00

Tertiary

-19.05

40192.98

0.00

0.00 – 0.00

Secondary

-19.27

40192.98

0.00

0.00 – 0.00

Primary

1.00

Moderate chance of contracting HIV High chance of contracting HIV

0.29

0.91

1.34

0.22 - 8.06

-0.45

0.58

0.64

0.21 - 2.01

Low chance of contracting HIV 1.00 *P < 0.05 Model chi-square = 23.2, P = 0.039 -2 Log likelihood = 144.4 Nagelkerke r-squared = 0.213 Hosmer and Lemeshow test, χ2 = 4.4 P = 0.819, Overall correct classification = 78.0% Correct classification of cases of frequent condom usage with current sexual partner = 96.5% Correct classification of cases of non-frequent condom usage with current sexual partner = 21.6%

Table 5. Multiple linear regression: Explanatory factors of respondents of logged number of concurrent sexual partners in last 3 months Explanatory variable

Unstandardized B Standard error

CI (95%)

R2 change

Constant

0.59

0.13

0.32 - 0.85

Gender (1=males)

0.58

0.13

0.32 - 0.84

0.116

Partner having other partner(s) (1=yes)

0.39

0.11

0.18 - 0.59

0.079

Good chance of contracting the HIV virus

0.60

0.16

0.30 - 0.91

0.056

Commercial sex worker

0.57

0.19

0.20 - 0.95

0.045

Married

-0.41

0.20

-0.80 - -0.02

0.020

No chance of contracting the HIV virus (reference)

Single (reference) R-squared = 0.316 F-statistic = 13.212, P < 0.0001


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males indicated having 2+ sexual partners compared to females. Of the study population, 22% had done a HIV test in the last 12 months. Two percentage of the sample had positive HIV results, which represents 9.3% of those who were test for the virus. Only 9.1% of young adults with multiple sexual partners indicated having been engaged in commercial sexual encounters. Twenty-two out of every 100 of the respondents had done a HIV test, and only 10.2% of those tested had positive HIV test results (i.e. 2% of the sample). HIV is the second leading cause of mortality in the world [7-9] and one group of scholars opined that it was the first in the Caribbean among 15-49 year olds [10]. With the current findings revealing 1 in every 50 young adults aged 15-24 years had positive HIV results, which is equally comparable that for the Caribbean [4] and for the adult population in Jamaica [29], young adult promiscuity is, therefore, a public health challenge. Statistics from the Jamaican Ministry of Health showed that 19.8% of Jamaicans aged 10-29 years have been infected with the HIV virus compared to 33.4% of those aged 30-39 years, 22.6% of those aged 40-49 years, which are greater than that for this sample. Unlike the Jamaican Ministry of Health published statistics on HIV-positive individuals, the present work disaggregated ages 15-24 years and revealed that 20% of the HIV-positive individuals were 1517 years. It should be elaborated here that 60% of HIV-positive young adults had stated that they had no chance of contracting the virus, while none of the high risk individuals reported having the virus. There are a plethora of reasons; including sexual naivety, consequence of inconsistent condom usage, a single sexual encounter with an exposed individual without a condom and correctness of condom usage, that are factors which can account for the high HIV-positive cases among those who thought they had a no-to-low chance of contracting the virus. Although positive HIV results are low among promiscuous young adults aged 15-24 years, with mean age of first sexual intercourse being 13.3 years (SD = 2.7 years), which concurs with the literature that early sexual initiation commences during adolescence [25, 26, 30], and the fact that early sexual relation is positively associated with a high probability of contracting STIs [31,32], it follows that the 252

risky behaviour will eventually result in an increase in teenage pregnancies, STIs, HIV/AIDS and other public health problems will abound if age of first sexual intercourse is not increased and condom usage is not consistently used among this cohort. While Yan et al’s work showed that age of coitus commenced in the later adolescence years among university students in China (18.7 years) and that 5.3% were engaged in multiple sexual relationships [25], this study revealed that Jamaican adolescents began having sex 5.4 years early and 2.6 times more likely to be involved in polygamous relationship. However, multiple sexual relationships were about the same among young adult Jamaicans and US adolescents [24]. Another disparity between undergraduate Chinese students and young adult Jamaicans aged 15-24 years was that the former reported a greater inconsistent condom usage (38.6%) [25] compared to the latter (25.7%). Based on the aforementioned findings, there are evidences to support a present public health problem as 10.2% of those who have had a HIV test in this study had a positive test result compared to 3.6% of the adult Jamaican population according to the Jamaican Ministry of Health [29]. Clearly this work reinforces and highlights the traditional masculinity ideology which is accepted as the natural state of affairs in many Caribbean societies. It is this masculine ideology which accounts for even male youths more likely to have multiple concurrent sexual relationships than females, based on disparity in social construction of gender roles. Within this culture, young males who become engaged in multiple sexual relationships are lauded for their sexual prowess, but this is not the same for their female counterparts. A part of the justification of this promiscuity among males is embodied in them seeking to prove their manhood, coming of age, and these account for the risk taking behaviour that they will become involved in only because of the constructions of masculinity in the society. The risk taking behaviours which emerged from the present work are the multiple sexual partners, inconsistent condom usage, and transactional sex. More young adult males used a condom than their female counterparts as well as a greater percentage of them reported consistent condom usage among most typology of sexual partnerships. The care with which the males are



engaged is demonstrated in fewer of them reporting having had STI (12.2%) compared to 29.8% of females. However, all the HIV-positive cases were reported by young males, supporting the strong association between promiscuity and contracting the AIDS or HIV virus. Males’ promiscuity is more guarded away from contracting a STI, but not HIV compared to females. Unlike their young male counterparts, young females who are economically disadvantaged are engaged in sexual-economic exchange, this is rarely defined as prostitution, sex work or commercial sex activities. The sexual-economic exchange with which these young females are engaged means that their sexual partners determine choice of family planning, use of method of contraception and consistency of usage in exchange for material, luxurious, other goods (including “basic” items such as groceries, housing, electricity, and clothes as well as educational expenses, et cetera), and security (i.e. social status). The evidence unequivocally states that young males are involved in multiple sexual relationships than young females; females in this study are less economically independent compared to males, which reduces their sexual autonomy. The findings highlighted that 6.4 times more young males had full-time employment than females and that 1.8 times more young males were employed on a part-time basis compared to females. Clearly being employed provides some level of economic independency which is more a case for the males, and therefore the females must leave the vetoing power of reproductive health matters to their males partners, which gives power to the males in this sample compared to their female counterparts. Herein is a subtle male authorization of family planning measures which reside with males, while its removal will increase contraception usage as was observed in Ethiopia [33], such a reality is unlikely without economic independency, and higher level of education. On average, young males begin their sexual debut about 2 years earlier than young females, but because of economic independency they are able to stipulate condom usage which is reduced among females. Thus, the health risk of young males is greater even though they have a high consistent condom usage, and so traditional masculine ideology of having many children, male dominance and prowess

are responsible for this high HIV prevalence among than young females. Young males are not necessarily more knowledgeable about reproductive health matters, less sexually active or more conscious on sexually transmitted infections than young females, so to argue for the introduction of a campaign to promote responsible sexual behaviour [34] will not alleviate, abate or reduced the high prevalence of STIs among young females compared to males. The reality is they (males) are having sexual intercourse at an early age, consistently using condoms more than their females’ counterparts, which means that any behavioural modification among young females must to tied to education as this has been found to positive reduce fertility among women [35]. This brings into question, access to methods of contraception for minors and a change in attitude of health practitioners in providing them with family planning choices as a result of the reality of these findings. The realities are 29.8% of young females aged 15-24 years have had a STI compare to 11.0% of females aged 1574 years [6], and that 12.2% of young males (ages 15-24 years) indicated having had STI compared to 18.2% of males aged 15-74 years [6]. Interestingly 14.3% of the study population had been sexually assaulted, 23.0% were females and 12.2% were males, indicating the vulnerability of young males to sexual violence and particular health outcome which emerged from the present findings. Another fact which was unearthed in this research is the vast disparity between those who consistently and inconsistently use a condom and those having had a STI. Almost 2 times more young adults who inconsistently use a condom reported having had a STI compared to those who consistently use one, and these were mostly economically deprived young females who are unemployed, and social vulnerable. In Jamaica, public health intervention programmes are primarily responsible for the drastic reduction in total fertility rates from 6.0 children per women in 1960, 5.5 children per women in 1970, 3.5 children per women in 1983 to 2.5 children per women in 2006 [12, 29, 36, 37]. Undoubtedly the contributions of the Jamaican Ministry of Health and the Jamaican National Family Planning Board are paramount to the aforementioned lifestyle practice modifications, and increases in method of contraception usage that are the crux of decline in


253


fertility. The present findings revealed that 35 out of every 100 young adults with multiple sexual partners begin having sex before 13 years, and that more young males (15-24 years) reported having STI compared to men (15-74 years). Interestingly what emerged from this work is that 99.8% of the study population has had at least secondary level education, all respondents indicated being knowledge of HIV and AIDS, yet these individuals practice risky behaviour. All this time, public health interventions seem to have done very little towards the continuous lowering of the age of sexual debut, and increases in STIs, particularly HIV among Jamaican youths. It is an undeniable fact that there are some economically vulnerable groups such as children, elderly, orphans in the society as well as vast economic disparity between the sexes [38, 39]; the evidence supports a very limited success for public health intervention programme as it relates to aforementioned findings. Like Forrester [40], the researcher wonders whether the evidences are not (something missing) in that demonstrate the need for public health practitioners to change their modus operandi as individuals may not like the strategies used, want the product offerings, dislike how programmes are implemented, and that the strategies are bi-dimensional, regardless of the glowing benefits. A finding which cannot be understated here which emerged in this work is the negative association between being in a stable union and number of multiple concurrent partners. It can be extrapolated from this finding that young people are searching for stability in a sexual union, and so short term relationship (visiting) is not finality, therefore the individuals continue to be engaged in many sexual relationships before a stable union is attained. Marriage has many socio-economic securities and with women entering into it earlier than men [41,42], the price of this security is reduced sexual autonomy, family planning choices and men being given the vetoing power over reproductive health matters. The men, on the other hand, are allowed the choices of number of fertility, condom usage, less multiple concurrent sexual relationships by their partners and a domesticated woman. The gendered-(socio-economic)-asymmetric position of young females in Jamaica means that they are in a weaker negotiation state than males 254

in a sexual relationship. This unmatched economic situation allows the males to dictate many issues including reproductive health matters in relationship, which are adhered to by the young females as they seek to satisfy needs, desires and security. Despite the gendered-(socio-economic) disparity and the reduced sexual rights owing to the inequalities, it does not hold true that young females totally subscribed to the masculine ideology or their weakened position make them submissive to the dictates of the males. The positive association between one partner having other partner and the individual having multiple sexual partners is an indication that females are departing from the masculine ideology and seeking other avenues to supply their needs, desire and independency. The reality here is that multiple sexual relationships are begetting other such encounters, which is a make for the furtherance of not only promiscuity, but also STIs, particularly HIV/AIDS. Conclusion The evidences are in on the sexual behaviour of young adults who have multiple sexual partners. The findings provide a comprehensive understanding of the risky behaviour and choices of young people, and the results can be used to change young people’s engagement in multiple sexual encounters and reproductive health matters. Understanding the behaviour of these individuals is the first defense in the way forward, and how intervention strategies should be coalesce with the present realities in order to effectively address the public health challenge that emerged from this work. With regard to the sexual behaviour and reproductive health matters of young adults aged 15-24 years in Jamaica, these individuals have developed an elaborate set of ideas about sexuality and their sexual roles long before the adolescence years. The culture is responsible for the masculinity ideology and sexual script that are given and followed by young adults. Thus the continuous lowering of age of sexual debut is simply a bi-product of the glorification of sex and intimacy. The young adult is forwarded with dual messages as to sex, infertility, abstinence, and a macho ideology which embodies promiscuity, fertility, risk taking



and the social disability biases against homosexuality. Young males do not want to be seen as homosexuals, which dictate their promiscuity with females, fertility, and inconsistent condom usage. The next side to this reality, they are expected to abstain from sexual activity, consistently use a condom, and not have children. While the society condemns high fertility and promiscuity among females, there is a paradox in that multiple sexual relationships are looked down upon for females; yet young women and men are subtly pressured psychological to have more than one child and adopt the sexual script that is laid out for them. The findings are astounding and must be used by public health policy practitioners. Merely using social marketing programmes in the media on reproductive health matters to address risky sexual behaviour, and consequences of inconsistent condom usage are well expounded upon, economically vulnerable young females will always leave reproductive health matters to their males’ partners because of financial inadequacies. The gender economic-differential, thus, is resulting in risky sexual behaviour as young vulnerable females as well as males are expected to follow the script of morality during food, material and social deprivation. The masculinity ideology forms the platform for the sexual script used by young men, and these must be incorporated into any intervention strategies. In summary, the culture is the backdrop that fashions sexuality, sexual behaviour, reproductive health and risky behaviour among young adults who are engaged in multiple sexual relationships. Clearly, sexual naivety and perception about risk factors are accounting for the high prevalence of HIV virus in young adults who have multiple sexual partners. Economics is important to women, which means that young adult females are trapped by economic deprivation and this justifies their higher inconsistent condom usage than young males. Public health needs to coalesce economics, educational advancement, and the findings that emerged from this study in order to adequately change the exhibited behaviours. As young adult Jamaicans are fueling the HIV/AIDS epidemic, reducing the multiple concurrent sexual relationship, premarital sexual activities, and increasing consistency of condom usage as well as educating

them on sexual practices, proper usage of the method of contraception, and counseling them about HIV testing are the realities on moving forward. There is a need to oppose, revamp and modernize the masculine ideology that encourage multiple concurrent sexual relationship as this as well as economic deprivation is account for the public health challenge of increased HIV/AIDS, other STIs, increased health budget and mortality in developing countries’ population. Gendered imbalance in power must be brought into the strategies to address HIV, promiscuity and sexual-economic exchanges among young people in Jamaica. Disclaimer The researcher would like to note that while this study used secondary data from the Jamaican Ministry of Health (KABP Survey), none of the errors in this paper should be ascribed to the Ministry of Health and/or Hope Enterprise Limited, but to the researcher. References 1. Chevannes B. Learning to be a man: Culture, socialization and gender identity in five Caribbean communities. Kingston, Jamaica: The Univer. of the West Indies Press; 2001. 2. Murray D. Positively limited: Gender, sexuality and HIV and AIDS discourses in Barbados. In: Barrow C, de Bruin M, Carr R. eds. Sexuality, social exclusion and human rights: Vulnerability in the context of HIV. Kingston: Ian Randle; 2009. 3. Barrow C. Caribbean Gender Ideologies: Introduction and Overview. In: Barrow C. Ed. Caribbean Portraits: essays on Gender Ideologies and Identities, Kingston, Jamaica: Ian Randle Publishers; 1998. pp.xi-xxxviii. 4. Douglas DL. Perspectives on HIV/AIDS in the Caribbean. In: Morgan O. ed. Health issues in the Caribbean. Kingston: Ian Randle; 2005:pp. xv-xxi. 5. Barnett T, Whiteside A. AIDS in the twenty-first century: Disease and globalization. London: Palgrave MacMillan; 2002: p.11.


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19. Shelton JD. Why multiple sexual partners? Lancet2009; 374:367-369. 20. Santelli JS, Brener ND, Lowry R, et al. Multiple sexual partners among U.S. adolescents and young adults. Fam Planning Perspective 1998; 30:271-275. 21. Norman L, Figueroa JP, Wedderburn M, et al. Trends in HIV risk perception, condom use and sexual history among Jamaican youth, 19962004. International Journal of Adolescent Medicine and Health 2007; 19: 199-207. 22. Hendriksen ES, Hlubinka D, Chariyalert S, et al. Keep talking about it: HIV/AIDS-related communication and prior HIV testing in Tanzania, Zimbabwe, South Africa, and Thailand. AIDS and Behavior 2009; 13: 1213-1221. 23. Jamaica, National Family Planning Board (NFPB). Reproductive Health Survey, 2002. Kingston; NFPB: 2004. 24. Santelli JS, Brener ND, Lowry R, et al. Multiple sexual partners among US adolescents. Fam Planning Perspect 1998; 30:271-275. 25. Yan H, Chen W, Wu H, et al. Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey. BMC Public Health 2009; 9:305. 26. Shelton JD. Why multiple sexual partners. Lancet 2009; 374:367-369. 27. Hope Enterprise Limited. HIV/AIDS Knowledge, Attitudes and Behaviour Survey, 2008. Kingston: Jamaica, Ministry of Health, National HIV/STI Programme; 2008. 28. Bourne PA, Charles CAD, Crawford TV, et al. Current use of contraceptive method among women in a middle-income developing country. Open Access J Contraception 2010; 1:39-49. 29. Jamaica, Ministry of Health (MoHJ). Annual report, 2006. Kingston; MoHJ: 2007. 30. Resnick M, Bearman P, Blum R, et al. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997; 278:823-832. 31. Andersson-Ellstrom A, Forssman L, Milsom I. Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls. Acta Obstet Gynecol Scand 1996; 75:484-489.



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Corresponding author Paul A. Bourne, Research Fellow and Biostatistician, Dept of Community Health and Psychiatry, UWI, Mona, Jamaica, Email: [email protected]

34. Hernandez-Giron CA, Cruz-Valdez A, QuiterioTrenado M, et al. Factors associated with condom use in the male population of Mexico City. Int J STD AIDS 1999; 10:112-117. 35. Martin TC, Juarez F. The impact of women’s education on fertility in Latin America: Searching for explanations. Int Fam Planning Perspect 1995; 21:52-57. 36. Statistical Institute of Jamaica (STATIN). Statistical Digest 1960-1992. Kingston; STATIN: 19611993. 37. Statistical Institute of Jamaica (STATIN). Demographic statistics, 1970-2006. Kingston; STATIN: 1971-2007. 38. Planning Institute of Jamaica (PIOJ), Statistical Institute of Jamaica (STATIN). Jamaica Survey of Living Conditions, 1989-2007. Kingston; PIOJ, STATIN: 1989-2008. 39. Planning Institute of Jamaica (PIOJ). Social and Economic Survey of Jamaica, 1980-2008. Kingston; PIOJ: 1981-2009. 40. Forrester C. Marketing public health: Can you hear me? In: Bacallao J, Pena M, Kidd E, et al. eds. Proceedings of the 8th International Conference on Diabetes and Obesity. UDOP/PAHO, Ochi Rios, Jamaica. 7 March 2002; pp 50-60. 41. Cremin I, Mustati P, Hallett T, et al. Measuring trends in age at first sex and age at marriage in Manicaland, Zimbabwe. Sex Tranm Infect 2009; 85:i34-i40. 42. Bourdillon MFC. Where are the ancestors: Changing culture in Zimbabwe. Harare: University of Zimbabwe; 1993.


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Adult spontaneously hypertensive rats from the same laboratory present different baroreflex gain Vitor E. Valenti1, Oseas Moura Filho1, Luiz Carlos de Abreu2, Celso Ferreira1,3 1

2 3

Departamento de Medicina, Disciplina de Cardiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil Departamento de Fisiologia, Faculdade de Medicina do ABC, Santo André, Brasil Departamento de Clínica Médica, Disciplina de Cardiologia, Faculdade de Medicina do ABC, Santo André, Brasil

Introduction

Abstract Background: A subset of normotensive Sprague-Dawley rats show lower baroreflex sensitivity; however, no previous study investigated whether there are differences in baroreflex sensitivity within this subset. Thus, we compared baroreflex among adult spontaneously hypertensive rats (SHR). Methods: Cannulas were inserted through the femoral artery and vein to measure mean arterial pressure (MAP) and heart rate (HR) and to make drug infusion in male SHR (16 weeks old), respectively. Baroreflex gain was calculated as the ratio between variation of HR in function of the MAP variation (ΔHR/ΔMAP) tested with sodium nitroprusside (SNP, 50µg/kg, i.v.) and phenylephrine (PE, 8µg/ kg, i.v.). Rats were divided in: 1) Low bradycardic baroreflex (LB), BG between 0 and -1 bpm/mmHg; 2) High bradycardic baroreflex (HB), BG < -1 bpm/ mmHg; 3) Low tachycardic baroreflex (LT), BG between 0 and -1 bpm/mmHg and; 4) High tachycardic baroreflex (HT), BG < -1 bpm/mmHg. Results: Approximately 1/10 of rats presented increased bradycardic baroreflex while around 1/5 showed attenuated tachycardic baroreflex. Rats with higher bradycardic baroreflex presented higher basal HR. Conclusion: There is significant alteration regarding baroreflex sensitivity among SHR from the same laboratory. Key words: Baroreflex; Rats, Inbred SHR; Sympathetic Nervous System; Parasympathetic Nervous System; Autonomic Nervous System. 258

Among many kind of animal models evaluated to investigate hypertension and sympathetic activity [1], the spontaneously hypertensive rat (SHR) is the most usually studied animal model of spontaneous hypertension, which shows similar characteristic to great part of hypertensive humans [2]. Moreover, we have already demonstrated that cardiac hypertrophy is a stress model of heart disease [3-6] and it is another feature of SHR [7]. As controls for the SHR, most investigators have employed normotensive descendants of Wistar rats that NIH investigators obtained from the colony from which the SHR strain was originally derived (Wistar-Kyoto rats, WKY) [2]. The baroreflex system is one of the most powerful and rapidly acting mechanisms for controlling blood pressure and autonomic activity [8]. When impaired, it may be indirectly associated with target organ lesions, since the removal of the carotid sinus and aortic arch baroreceptors leads to the inability to buffer moment-to-moment changes in pressure, which in turn results in increased blood pressure variability and decreased heart rate variability [9, 10]. In 1987, it was evidenced that SHR from two different laboratories presented significant difference with respect to growth rate and blood pressure [11]. Although a portion of normotensive Sprague–Dawley [9, 11] and WKY [12, 13] rats spontaneously exhibit lower baroreflex sensitivity, no preceding investigation evaluated if there is



difference of baroreflex sensitivity among SHR. Furthermore, in view of the importance of baroreflex in clinical routine [8], it has received much attention. Hence, in this study we compared the baroreflex sensitivity among adult SHR from the same laboratory in order to verify if there are intra strain differences. Methods Animals The experiments were performed in 16 weeks old male SHR rats from the same laboratory and the same source (these rats were bred at the laboratory). Rats were housed individually in plastic cages under standard laboratory conditions. They were kept under a 12 h light/dark cycle (lights on at 06:30 h) and had free access to food and water. Housing conditions and experimental procedures were approved by the Institution’s Animal Ethics Committee. Efforts were made to minimize the number of animals used. Surgical Preparation One day before the experiments, the rats were anesthetized with ketamine (50 mg/kg i.p.) and xylazine (50 mg/kg i.m.) and a catheter was inserted into the abdominal aorta through the femoral artery for blood pressure and heart rate recording. Catheters were made of 4 cm segments of PE-10 polyethylene (Clay Adams, USA) heat bound to a 13 cm segment of PE-50. The catheters were tunneled under the skin and exteriorized at the animal’s dorsum. After surgery animals were treated with penicillin (171.425 µ/kg) [14, 15]. Arterial pressure and heart rate recording in awake rats Approximately 24 hours after surgery, the animals were kept in individual cages used in the transport to the experimental room. At day, animals were allowed 60 min to adapt to the conditions of the experimental room such as sound and

illumination before starting blood pressure and heart rate recording. The experimental room was acoustically isolated and had constant background noise produced by an air exhauster. At least another 30 min period was allowed before beginning experiments. Pulsatile arterial pressure (PAP) of freely moving animals was recorded using an HP7754A preamplifier (Hewlett Packard, USA) and an acquisition board (MP100A, Biopac Systems Inc, USA) connected to a computer. Mean arterial pressure (MAP) and heart rate (HR) values were derived from the PAP recordings and processed on-line [12, 13]. Baroreflex test The baroreflex was tested with three pressor doses of phenylephrine (PE-bolus-8 μg/kg i.v.; Sigma Chemical) and three depressor doses of sodium nitroprusside (SNP-bolus-50 μg/kg i.v.; RBI). Baroreflex gain was calculated as the ratio between variation of HR in function of the MAP variation (ΔHR/ΔMAP). There was an interval of at least 15 minutes between the infusions to allow the recovery of basal values. We also evaluated bradycardic and tachycardic peak and HR range, the difference between bradycardic and tachycardic peak. We considered the mean of the three infusions of each drug. We separated rats in groups according to baroreflex gain (BG): 1) Low bradycardic baroreflex (LB), BG between 0 and -1 bpm/mmHg tested with PE; 2) High bradycardic baroreflex (HB), BG < -1 bpm/mmHg tested with PE; 3) Low tachycardic baroreflex (LT), BG between 0 and -1 bpm/ mmHg tested with SNP and; 4) High tachycardic baroreflex (HT), BG < -1 bpm/mmHg tested with SNP. We compared LB group with HB group and LT group with HT group. We defined the values for bradycardic and tachycardic baroreflex gain according to a previous study [12, 13]. Statistical Analysis Values are reported as the means ± standard error of means (S.E.M.). HR, MAP, ΔHR, ΔMAP and ΔHR/ΔMAP were compared between LB and HB groups as well as between LT and HT gro-


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ups. After the distributions were evaluated through the Kolmogorov normality test, the Student’s T test was used to verify differences between normal distributions and the Mann-Whitney test was applied to assess differences between non-parametric distributions. Differences were considered significant when the probability of a Type I error was less than 5% (p < 0.05). Results Among all the 19 SHR analyzed, based on parasympathetic baroreflex gain, around 10% presented higher bradycardic baroreflex gain (HB; < -1 bpm/mmHg). On the other hand, great part of the animals presented lower bradycardic baroreflex gain (LB; between 0 and -1 bpm/mmHg). In order to verify whether another cardiovascular parameter would be different between LB and HB groups we compared baseline MAP and HR, bradycardic and tachycardic peak, HR range and baroreflex gain tested with PE and SNP. Based on Table 1, it was observed no significant difference between the both groups regarding bradycardic and tachycardic peak, HR range and the sympathetic component of baroreflex gain. On the other hand, we noted significant difference with respect to basal MAP and HR and the parasympathetic component of baroreflex gain. According to Figure 1, PE-induced increase in MAP was not different between HB and LB (p=0.6454). However, bradycardic reflex responses to intravenous PE was significantly decreased in LB group (p=0.0033).

Figure 1. Increase in mean arterial pressure (MAP, mmHg) and decrease in heart rate (HR, bpm) in response to phenylephrine (PE, 8mg/ kg i.v.) in HB (n=2) and LB (n=17) groups. * p