***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives To describe the association between religion and factors related to sexually transmitted diseases (STD)/AIDS in a country where religious leaders were involved early in prevention . Design A cross-sectional study conducted in a rural area in central Senegal . Methods Question naire-based interviews of a r and om sample of 858 adults from the general population aged 15–59 years and in-depth interviews of four religious leaders and 50 people . Results Seventy-six per cent of the respondents were Muslim , 24 % Catholic , 1 % Animist and 0.2 % Protestant . A total of 86 % of men and 87 % of women reported religion to be very important to them . Important prevention-related variables were inversely associated with the importance of religion . Men who considered religion to be very important were less likely to cite AIDS as a major health problem [ odds ratio ( OR ) 0.4 , P = 0.008 ] and were less likely to feel at risk of getting HIV ( OR 0.5 , P = 0.0005 ) . Women who considered religion to be very important were less likely to report an intention to change to protect themselves from AIDS ( OR 0.2 , P = 0.0001 ) , less likely to report having discussed AIDS with others ( OR 0.4 , P = 0.01 ) and much more likely to feel at risk of getting HIV ( OR 9.3 , P = 10−4 ) . Individuals who considered religion to be very important were not more likely to report intending to or actually having become faithful to protect themselves from AIDS . Conclusion These findings stress the need to intensify the involvement of religious authorities in HIV/STD prevention at the local level Environmental influences on sexual behavior are difficult to examine given their temporal distance from the sexual act and the cost of long-term longitudinal studies . We examined environmental influences on risky sexual behavior in young gay men using the Situational Presentation ( Sitpres ) methodology , where situations in which relevant environmental variables are presented as computer vignettes with the variables r and omly allocated , and participants rate the likelihood of their engaging in unsafe sexual behavior . A total of 100 gay men aged between 18 and 26 years of age completed 20 situational presentations  with the outcome being the likelihood of engaging in unprotected anal intercourse . On regression analysis , 3 environmental variables significantly predicted safer sex : perceived gay/bisexual men 's norms toward condom use ; availability of HIV prevention messages ; and what one 's religion says about gay sex . Not significant were family , media , legal , and work/school attitudes to homosexuality . Demographic variables that were predictors included education , age , sexual orientation , and degree of being “ out ” about sexual orientation . These data suggest that environmental factors can be approximated using the Sitpres methodology , and that more proximal environmental variables have a stronger impact than distal ones Abstract This paper reports on an exploratory study investigating links between sexual health and social capital in a South African mining community . In this study , social capital is defined in terms of people 's membership of voluntary community organizations ( e.g. church , residents ' associations , youth groups ) . Using biomedical and social survey data from a stratified r and om sample of 1,211 Carletonville residents , we tested the hypothesis that organizational members were less likely to have HIV . Multivariate analysis of variance sought to identify significant associations between nine organizational memberships and HIV infection , as well as three risk factors for infection ( casual partners , condom use with casual partners and alcohol consumption ) . Analysis yielded a range of significant results , but findings varied across age and gender , and were not all in the hypothesized direction . For example , young men and young women who belonged to sports clubs were less likely to be HIV-positive , and young women who belonged to sports clubs were more likely to use condoms with casual partners than non-members . Amongst members of stokvels ( voluntary savings clubs accompanied by social festivities ) , however , young men were more likely to be HIV-positive , women of all ages were more likely to have a casual partner , and both young men and young women were more likely to drink alcohol than non-members . While our exploratory study has produced sufficient evidence to justify the need for further research in this area , it also highlights that the interface between HIV infection and social capital is a complex area that defies easy generalization Objective To study in depth sexual history and sexual behaviour variables as risk factors for HIV-1 infection in a rural Ug and an population . Methods Following a socioeconomic and serological survey of a rural population in Masaka District , south-west Ug and a , 233 r and omly selected HIV-1-positive cases and 233 negative controls matched on age and village of residence , were invited in October 1990 to participate in a case-control study . A total of 132 cases and 161 controls attended for in-depth investigation including an interview about sexual behaviour . Results The factor most strongly associated with increased risk of infection was a greater number of lifetime sexual partners , with odds ratios ( OR ) of 2.1 and 4.9 for those reporting 4–10 and 11 or more partners , respectively , compared with those reporting less than four partners . Having only one sexual partner did not provide complete protection , a total of seven ( one male , six female ) subjects reporting only one sexual partner were HIV-1-positive . Other significant factors were a history of genital ulcers |OR , 2.9 ; 95 % confidence intervals ( CI ) , 1.0–9.1 ) and not being a Muslim ( OR , 5.4 ; 95 % Cl , 1.8–16.5 ) suggesting a possible protective effect of circumcision . There was a suggestion that those who married within the last 7 years ( OR , 2.4 ; 95 % Cl , 0.9–6.1 ) and men exposed to menstrual blood ( OR , 5.7 ; 95 % Cl , 0.7–49.8 ) were at an increased risk of HIV-1 infection . Conclusions These results confirm the predominant role of sexual behaviour in the HIV-1 epidemic . Of particular concern is the observation of HIV-1 infection among those reporting only one partner . Where HIV-1 infection is widely distributed in the general population , risk reduction strategies should , in addition to the promotion of partner reduction , place strong emphasis on safe-sex techniques Whereas college students are not identified as a high-risk group for acquiring the HIV infection , they exhibit high-risk behaviors consistent with their age group , including multiple sexual partners and high rates of unprotected intercourse . This study was conducted to determine levels of HIV-related sexual behavior , along with knowledge and attitudes among students attending community colleges in a relatively affluent multiethnic community . This study used a  r  and  om sample survey ( N = 319 ) of students attending selected classes at four community colleges in Orange County , California , to assess HIV/AIDS knowledge , attitudes , and patterns of past and present sexual behavior . The level of student knowledge concerning HIV disease was found to be relatively high , and pronounced differences in knowledge and sexual permissiveness were identified as a function of ethnicity and religion , with Asians showing lower knowledge and lower concern about HIV , and religion/religiosity related to these variables and also to levels of sexual permissiveness . Respondents ' comfort in asking a partner about his/her sexual history was positively associated with their level of self-esteem , and negatively related to peer pressure in this population . As in previous studies of college population s , HIV knowledge per se does not confer a protective effect against high-risk behavior . However , knowledge was found to be an enabling factor with regard to students ' comfort levels in asking about their partner 's sexual histories , and in requesting that partners take an AIDS test This study set out to investigate the influence of  male circumcision  and other factors on  sexually transmitted infections in Botswana . A syndromic approach , which diagnoses a sexually transmitted infection based on the presence of urethral discharge or genital ulcers rather than on laboratory tests , was used . The data were from the 2001 Botswana AIDS Impact Survey where a nationally representative , r and omly selected sample of men and women aged 10 - 64 years were interviewed in both urban and rural areas . The sample selected for this study consisted of 216,480 men aged 15 - 64 years who had ever had sexual intercourse . The logistic regression technique was executed to examine the association between male circumcision and self-reported urethral discharge or genital ulcers , while controlling for all other independent variables in the analysis . The main finding of this study was that among men who are circumcised , the odds for self-reported urethral discharge or genital ulcers are significantly lower than for those men who are not circumcised in both urban and rural Botswana . The analysis also showed that the odds in favour of self-reported urethral discharge or genital ulcers , for men who drink alcohol , are twice as large as those for men who do not drink alcohol , controlling for all other independent variables in the analysis . Religion and ethnicity also came through as factors exerting a protective influence against self-reported symptoms of sexually transmitted infections . The conclusion is that while male circumcision appears to be significantly associated with the risk for self-reported urethral discharge or genital ulcers , it is man 's behaviour , irrespective of ethnicity or religious dictates , that continues to play a vital role in protection against self-reported symptoms of sexually transmitted infections in Botswana In view of the developmental approach to sexual behavior , this article presents the stages of sexual behavior leading to coitus in four grade s of high school students in Israel and the sociodemographic factors associated with initiating coitus . Analyses were based on data from the first national study dealing comprehensively with sexuality in 30 years . A self-administered question naire was completed by a r and om sample of 4,609 students of the General Educational ( secular ) system that included 68 % of the Hebrew-speaking sector or 55 % of all students in Israel . Our findings indicated a progressive set of stages of sexual behavior forming a Guttman scale , from kissing and petting over the clothes though petting under the clothes and genital touching to coitus . In comparison to results of a 1970 Israeli survey , we found an increase in practice in all Guttman scale stages of sexual behavior , as well as a diminished gap between genders . The gap fully disappeared in the three lower stages . Predictive variables of coitus initiation included gender , religiosity , immigration status , family structure , perceptions of academic achievements , and the proportion of peers practicing coitus . In addition to gender , perception of the proportion of peers that already practice d intercourse was the best predictor followed by grade , perception of academic achievement , and family structure . Marked differences were noticed between genders regarding associations with religiosity and immigration status . The discussion focused on comparisons to findings in other countries , the contribution of the findings to the underst and ing of Israeli adolescents ’ sexual behavior , and practical educational implication OBJECTIVES To assess differences in sexual health behaviors , outcomes , and potential sociocultural determinants among male college students in the United States and the Netherl and s. METHODS Survey data were collected from r and om sample s of students from both national cultures . RESULTS American men were more likely to report inadequate contraception , HIV/STD infection , and unintended pregnancy than were Dutch men . Religiosity and sexuality education were able to explain national differences in these sexual health outcomes . CONCLUSIONS Findings suggest that sexuality education seems to decrease , rather than increase , sexual risk in heterosexually active male college students Background The risk factors for sexually transmitted diseases ( STDs ) and having casual sex among the Chinese people are unknown . Goal The goal of the study was to estimate the prevalence of STDs and to develop a profile of risk behavior among patients attending STD clinics in Hong Kong . Study Design In a clinic-based , cross-sectional study , 448 patients attending two government STD clinics were r and omly sample d and interviewed by means of a structured question naire . Results The prevalence of STDs was 51 % ( 70 % of men and 35 % of women ) . Attendees who had STDs diagnosed were more likely to be male , never married , and smokers and alcohol users ( ever ) and to have had casual sex or sex during travel with someone not their usual partner . Those who did not always use condoms were more likely to be male and never married . Having had casual sex was reported by 63 % of the respondents . Those who reported having had casual sexual encounters were more likely to have the following characteristics : male ; never married ; no religious belief ; ever smoker and alcohol user ; current STD ; had sex during travel ; history of STD ; inconsistent condom user ; and perception of being at low risk for STD . After adjustment , only male gender was associated with casual sexual encounters . Conclusion The results of this study indicated several risk factors among Chinese patients for the acquisition of STDs , for not using condoms , and for having casual sex . This information is useful in strengthening and evaluating currently available STD prevention and control strategies for the Chinese population in Hong Kong and elsewhere Background : Data from sentinel serosurveillance are useful to estimate HIV infection in population s but may not be representative of the general population . General population ‐based surveys attempt to avoid selection bias and are the most appropriate for tracking changes in exposure to risk of HIV infection over time and assessing changes in behavior following prevention campaigns . Objectives : To provide baseline data for targeted sexually transmitted infection ( STI ) and HIV infection prevention interventions by study ing parameters of sexual behavior and knowledge of HIV infection and STIs , measuring health‐seeking behavior related to STIs , and measuring gonorrhea , Chlamydia , syphilis , and HIV‐1 prevalences . Design : Population ‐based survey with stratified sampling by age group from r and omly selected households in a suburb of Mombasa , Kenya . Methods : A st and ard question naire was administered to 1497 consenting adults between the ages of 15 and 49 years who lived in r and omly selected households . Urine and blood sample s were obtained for the estimation of gonorrhea , chlamydial infection , syphilis , and HIV‐1 infection prevalences . Results : Sexual activity in the past 12 months was limited to one 
    Output:
    
This finding persists but is weaker when the outcome considered is condom use .