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AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Limited changes in sexual behaviour of heterosexual men and women with multiple partners in the Netherlands a
a
a
C. Hooykaas , D. M. M. van der Linden , J. G. J. van Doornum , a
b
W. F. van der Velde , J. van der Pligt & R. A. Coutinho
a
a
Municipal Health Service of Amsterdam, Department of Public Health , b
University of Amsterdam, Faculty of Psychology , Department of Social Psychology, Amsterdam, The Netherlands Published online: 25 Sep 2007.
To cite this article: C. Hooykaas , D. M. M. van der Linden , J. G. J. van Doornum , W. F. van der Velde , J. van der Pligt & R. A. Coutinho (1991) Limited changes in sexual behaviour of heterosexual men and women with multiple partners in the Netherlands, AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV, 3:1, 21-30, DOI: 10.1080/09540129108253044 To link to this article: http://dx.doi.org/10.1080/09540129108253044
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 3, NO. 1, 1991
21
Limited changes in sexual behaviour of heterosexual men and women with multiple partners in the Netherlands
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
c. HOOYKAAS, M. M. D. VAN DERLINDEN, G. J. J. VAN
DOORNUM,F. W. R. A. COUTINHO
VAN DER
VELDE, J.
VAN DER
PLIGT' &
Municipal Health Service of Amsterdam, Department of Public Health and 'University of Amsterdam, Faculty of Psychology, Department of Social Psychology, Amsterdam, The Netherlands
Abstract To study chmges in sexual behaviour, heterosexuals with multiple sexual partners were recruited through an STD-clinic and asked to return every 4 months for follow-up. Between October 1987 and June 1989, 512 heterosexuals entered the study and 140 men and 200 women had at least one follow-up visit. No changes were found between 3 visits in the kind of sexual techniques practiced. Condom use during vaginal intercourse with commercial partners (prostitutes or clients) was relatively high and remained high, but was low and remained at that level with private partners. Men and women reduced their number of private sexual partners by SO%, but the decline in the number of commercial partners was nonsignificant. Although more information is needed about the underlying social-psychological aspects of behavioural change, it seems necessary to redesign prevention activities to stress the effectiveness of condoms and to encourage condom use especially among heterosexuals with multiple private partners. Introduction
In Western countries to date, the majority of adult AIDS cases have been among men with homosexual contacts and intravenous drug users (IVDUs). Only a small proportion can be attributed to heterosexual transmission (Curran et al., 1988; Centers for Disease Control, 1989; Anonymous, 1990; Stoneburner et al., 1990). In Africa on the other hand, the human immunodeficiency virus (HIV) is almost exclusively transmitted through heterosexual contact (Piot et af., 1987; Piot et al., 1988). Heterosexuals who have sexual contact with persons from high-risk groups, are at an increased risk for infection with HIV (Piot et al., 1987; Haverkos & Edelman, 1988; Stoneburner et al., 1990). Multiple sexual partners and a history of sexually transmitted diseases (STDs), especially genital ulcerations, have been identified as major risk factors for heterosexual transmission of HIW in Africa (Centers for
Address for correspondence: Christa Hooykaas, MSc, Municipal Health Service of Amsterdam, Department of Public Health, Room 416, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
22
C. HOOYKAAS ET AL.
Disease Control, 1988; Greenblatt et al., 1988). Only limited information is available about the potential spread of heterosexually transmitted HIV-infection in Western countries (Centers for Disease Control, 1989; Stoneburner et al., 1990). Since 1982, when the first AIDS case in The Netherlands was reported, much effort has been invested in different kinds of prevention activities. The national AIDS campaign-which started in April 1987-was designed to inform the general population about AIDS and to encourage, or stimulate safe sex. At the same time: prevention activities were directed towards more specific groups, such as prostitutes and their clients. Recommendations about safe sex were expected to have some impact on sexual behaviour. At present, however, the risk for heterosexually acquired HIV-infection in the Netherlands is still very low, compared with the risk for homosexual men and lVDUs (Hooykaas et al., 1989a, Hooykaas et al., 1989b; Dutch Health Inspection, 1990). Therefore, becoming infected with HIV and developing AIDS are probably not perceived as real threats by most sexually active heterosexuals, despite the message of safe sex for all. T o investigate whether heterosexuals with multiple partners are at risk for HIV infection and to assess the possible effects of prevention campaigns on their sexual behaviour, we designed a longitudinal study. This study focuses on heterosexual men and women with multiple partners, and consists of a sizeable sample of prostitutes and clients of prostitutes. In this paper, we present data on changes in sexual behaviour-i.e. type of partner, number of partners, sexual techniques and condom use-during one year of followUP. Subjects and methods Study group Heterosexuals with 5 or more sexual partners in the preceding 6 months, were recruited from visitors to one of the STD clinics of the Municipal Health Service of Amsterdam, The Netherlands. Haemophiliacs, men with homosexual contacts and IVDUs in the preceding 5 years were excluded. Participation was on a voluntary basis, based on written informed consent after extensive counseling. All participants were asked to return every 4 months for follow-up. Data collected at entry and two follow-up visits (referred to as visit 1, visit 2, visit 3 ) will be presented. All participants were examined for STDs with a standard protocol and interviewed at each visit about (1) the number of private and/or commercial partners (men with commercial partners are referred to as clients, female prostitutes being their commercial partners; women with commercial partners are referred to as prostitutes, clients being their commercial partners), (2) frequency of practising different sexual techniques with private and/or commercial partners, ( 3 ) frequency of using condoms with private and/or commercial partners, and (4) demographic characteristics. From approximately 1,000 eligible clinic attenders between October 1987 and June 1989, 512 heterosexuals (44% male) entered the study (Van der Linden et al., 1990). At the end of 1989 all participants who entered the study could have had at least one follow-up visit. Despite all efforts to motivate participants to follow-up, 172 participants (34%) did not return (87 men, 85 women). The reasons for not returning are unknown in most cases. One man (only multiple private partners as risk factor) and one woman (IVDU more than 5 years ago and working as a prostitute at time of the study), were found to be HIVpositive on entry to the study. Therefore, an HIV-prevalence of 21512 (0.4%) was found at the beginning of the study. During follow-up, another man seroconverted for HIV who reported sexual contact with intravenous drug using prostitutes.
CHANGES IN SEXUAL BEHAVIOUR IN THE NETHERLANDS
23
Stepwise discriminant analysis (significant change in Rao’s V as criterion) was used to select variables to distinguish participants still in follow-up from those who were lost. Men lost to follow up belonged more often to ethnic minorities (Surinam, Turkey, Morocco) and were younger than those still in study (Table l), but no differences were found with respect to several aspects of sexual behaviour. Women lost to follow-up were also more often from ethnic minorities (especially from Latin American countries), more likely to have had less than 10 year’s education and had no history of STDs in the preceding 5 years (Table 1). They had more commercial partners than those followed up (139 vs 86 clients per month; ptO.Ol), but did not differ on the other variables concerning sexual behaviour.
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
Table 1. General characteristics at entry to the study of participants still in the study vs those lost to follow-up (column percentage in brackets) Men In s t u 3 Lost n (%) n (%) 140 (100) 87 (100) Mean age (S.D.) in years Born in The Netherlands
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Limited changes in sexual behaviour of heterosexual men and women with multiple partners in the Netherlands a
a
a
C. Hooykaas , D. M. M. van der Linden , J. G. J. van Doornum , a
b
W. F. van der Velde , J. van der Pligt & R. A. Coutinho
a
a
Municipal Health Service of Amsterdam, Department of Public Health , b
University of Amsterdam, Faculty of Psychology , Department of Social Psychology, Amsterdam, The Netherlands Published online: 25 Sep 2007.
To cite this article: C. Hooykaas , D. M. M. van der Linden , J. G. J. van Doornum , W. F. van der Velde , J. van der Pligt & R. A. Coutinho (1991) Limited changes in sexual behaviour of heterosexual men and women with multiple partners in the Netherlands, AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV, 3:1, 21-30, DOI: 10.1080/09540129108253044 To link to this article: http://dx.doi.org/10.1080/09540129108253044
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 3, NO. 1, 1991
21
Limited changes in sexual behaviour of heterosexual men and women with multiple partners in the Netherlands
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
c. HOOYKAAS, M. M. D. VAN DERLINDEN, G. J. J. VAN
DOORNUM,F. W. R. A. COUTINHO
VAN DER
VELDE, J.
VAN DER
PLIGT' &
Municipal Health Service of Amsterdam, Department of Public Health and 'University of Amsterdam, Faculty of Psychology, Department of Social Psychology, Amsterdam, The Netherlands
Abstract To study chmges in sexual behaviour, heterosexuals with multiple sexual partners were recruited through an STD-clinic and asked to return every 4 months for follow-up. Between October 1987 and June 1989, 512 heterosexuals entered the study and 140 men and 200 women had at least one follow-up visit. No changes were found between 3 visits in the kind of sexual techniques practiced. Condom use during vaginal intercourse with commercial partners (prostitutes or clients) was relatively high and remained high, but was low and remained at that level with private partners. Men and women reduced their number of private sexual partners by SO%, but the decline in the number of commercial partners was nonsignificant. Although more information is needed about the underlying social-psychological aspects of behavioural change, it seems necessary to redesign prevention activities to stress the effectiveness of condoms and to encourage condom use especially among heterosexuals with multiple private partners. Introduction
In Western countries to date, the majority of adult AIDS cases have been among men with homosexual contacts and intravenous drug users (IVDUs). Only a small proportion can be attributed to heterosexual transmission (Curran et al., 1988; Centers for Disease Control, 1989; Anonymous, 1990; Stoneburner et al., 1990). In Africa on the other hand, the human immunodeficiency virus (HIV) is almost exclusively transmitted through heterosexual contact (Piot et af., 1987; Piot et al., 1988). Heterosexuals who have sexual contact with persons from high-risk groups, are at an increased risk for infection with HIV (Piot et al., 1987; Haverkos & Edelman, 1988; Stoneburner et al., 1990). Multiple sexual partners and a history of sexually transmitted diseases (STDs), especially genital ulcerations, have been identified as major risk factors for heterosexual transmission of HIW in Africa (Centers for
Address for correspondence: Christa Hooykaas, MSc, Municipal Health Service of Amsterdam, Department of Public Health, Room 416, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
22
C. HOOYKAAS ET AL.
Disease Control, 1988; Greenblatt et al., 1988). Only limited information is available about the potential spread of heterosexually transmitted HIV-infection in Western countries (Centers for Disease Control, 1989; Stoneburner et al., 1990). Since 1982, when the first AIDS case in The Netherlands was reported, much effort has been invested in different kinds of prevention activities. The national AIDS campaign-which started in April 1987-was designed to inform the general population about AIDS and to encourage, or stimulate safe sex. At the same time: prevention activities were directed towards more specific groups, such as prostitutes and their clients. Recommendations about safe sex were expected to have some impact on sexual behaviour. At present, however, the risk for heterosexually acquired HIV-infection in the Netherlands is still very low, compared with the risk for homosexual men and lVDUs (Hooykaas et al., 1989a, Hooykaas et al., 1989b; Dutch Health Inspection, 1990). Therefore, becoming infected with HIV and developing AIDS are probably not perceived as real threats by most sexually active heterosexuals, despite the message of safe sex for all. T o investigate whether heterosexuals with multiple partners are at risk for HIV infection and to assess the possible effects of prevention campaigns on their sexual behaviour, we designed a longitudinal study. This study focuses on heterosexual men and women with multiple partners, and consists of a sizeable sample of prostitutes and clients of prostitutes. In this paper, we present data on changes in sexual behaviour-i.e. type of partner, number of partners, sexual techniques and condom use-during one year of followUP. Subjects and methods Study group Heterosexuals with 5 or more sexual partners in the preceding 6 months, were recruited from visitors to one of the STD clinics of the Municipal Health Service of Amsterdam, The Netherlands. Haemophiliacs, men with homosexual contacts and IVDUs in the preceding 5 years were excluded. Participation was on a voluntary basis, based on written informed consent after extensive counseling. All participants were asked to return every 4 months for follow-up. Data collected at entry and two follow-up visits (referred to as visit 1, visit 2, visit 3 ) will be presented. All participants were examined for STDs with a standard protocol and interviewed at each visit about (1) the number of private and/or commercial partners (men with commercial partners are referred to as clients, female prostitutes being their commercial partners; women with commercial partners are referred to as prostitutes, clients being their commercial partners), (2) frequency of practising different sexual techniques with private and/or commercial partners, ( 3 ) frequency of using condoms with private and/or commercial partners, and (4) demographic characteristics. From approximately 1,000 eligible clinic attenders between October 1987 and June 1989, 512 heterosexuals (44% male) entered the study (Van der Linden et al., 1990). At the end of 1989 all participants who entered the study could have had at least one follow-up visit. Despite all efforts to motivate participants to follow-up, 172 participants (34%) did not return (87 men, 85 women). The reasons for not returning are unknown in most cases. One man (only multiple private partners as risk factor) and one woman (IVDU more than 5 years ago and working as a prostitute at time of the study), were found to be HIVpositive on entry to the study. Therefore, an HIV-prevalence of 21512 (0.4%) was found at the beginning of the study. During follow-up, another man seroconverted for HIV who reported sexual contact with intravenous drug using prostitutes.
CHANGES IN SEXUAL BEHAVIOUR IN THE NETHERLANDS
23
Stepwise discriminant analysis (significant change in Rao’s V as criterion) was used to select variables to distinguish participants still in follow-up from those who were lost. Men lost to follow up belonged more often to ethnic minorities (Surinam, Turkey, Morocco) and were younger than those still in study (Table l), but no differences were found with respect to several aspects of sexual behaviour. Women lost to follow-up were also more often from ethnic minorities (especially from Latin American countries), more likely to have had less than 10 year’s education and had no history of STDs in the preceding 5 years (Table 1). They had more commercial partners than those followed up (139 vs 86 clients per month; ptO.Ol), but did not differ on the other variables concerning sexual behaviour.
Downloaded by [Temple University Libraries] at 21:43 05 January 2015
Table 1. General characteristics at entry to the study of participants still in the study vs those lost to follow-up (column percentage in brackets) Men In s t u 3 Lost n (%) n (%) 140 (100) 87 (100) Mean age (S.D.) in years Born in The Netherlands
