- HealthDay News -- Rates of early death and disability
that can be attributed to sexual behavior are three times higher in the
United States than other so-called developed nations, a new study finds.
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- This finding precludes the AIDS epidemic in many African
countries.
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- American men still die more often as a result of having
a sexually transmitted disease, researchers from the U.S. Centers for Disease
Control and Prevention said, but more cases are reported in American women.
The findings were published in the Jan. 27 issue of the British journal
Sexually Transmitted Infections.
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- "It certainly is disturbing," said Dr. Cynthia
Krause, assistant clinical professor of obstetrics/gynecology at Mount
Sinai School of Medicine in New York City. "The challenge is how to
represent this in a way that's not alarmist, to make women aware of the
real risks."
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- An earlier survey had found that half of all deaths in
the United States in 1990 were attributable to nine risk factors that included
sexual behavior. That category alone accounted for 30,000 deaths. The researchers
behind the new study didn't think this provided a complete picture of the
health toll, given that sexually transmitted diseases are associated with
other problems such as infertility, psychological trauma and stigma.
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- They set out to quantify the public health burden of
sexually transmitted diseases in 1998 by looking at national data on sexual
health and reproduction, surveillance systems for infectious diseases,
hospital and outpatient statistics, birth and death records as well as
published research.
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- They then calculated "adverse health consequences,"
such as infertility, cervical cancer, and HIV infections. They also factored
in premature deaths and "disability adjusted life years" (DALYs),
a figure indicating years of life cut short by premature death and loss
of healthy living years as a result of disability.
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- In 1998, sexual behavior accounted for about 20 million
"adverse health consequences" (equivalent to more than 7,500
per 100,000 people) and 29,782 deaths (or 1.3 percent of all deaths in
the United States), the study found.
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- Sixty-two percent of the "adverse health consequences"
and 57 percent of "disability adjusted life years" were among
women. Curable infections and their consequences accounted for more than
half of these health problems. Viral infections -- mostly HIV/AIDS -- and
their consequences accounted for almost all deaths among men and women.
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- In terms of percentages, more men (66 percent) than women
died due to sexually transmitted diseases. But if HIV/AIDS were not considered,
then 89 percent of deaths attributed to sexual behavior would have been
among women.
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- HIV/AIDS was the leading cause of death among men, while
cervical cancer and HIV/AIDS were the leading causes of death among women.
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- These estimates are probably conservative, the authors
stated.
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- The study did not address why the United States was hit
so hard by sexually transmitted diseases, although the study's lead author,
Dr. Shahul Ebrahim, said that behavior was only part of the equation.
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- "Everybody is having sex in the world, but some
places have a low HIV prevalence," said Ebrahim, who is a medical
epidemiologist with the CDC's National Center for Birth Defects. "Behavior
is just one indicator. Another issue is transmission risk factors."
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- Researchers are planning to use the data to increase
the public's awareness of the problem.
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- "The two most important issues are HIV and cervical
cancer [which can occur from having numerous sexual partners]," Ebrahim
said. "For cervical cancer, we have a national program to screen all
women of a certain age group and risk, but not everybody is accessing that.
We've reached the 80 percent mark but we still have 20 percent remaining."
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- A similar problem exists for HIV. "Not everybody
is getting tested for HIV. Once you get tested, you can access treatment
and probably prolong life," Ebrahim said.
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- None of this is going to happen overnight, he added.
The consequences of "sexual behavior are totally preventable,"
he said. "If you have protected or safe sex, you are not going to
have these."
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- SOURCES: Shahul Ebrahim, M.D., medical epidemiologist,
National Center for Birth Defects, U.S. Centers for Disease Control and
Prevention, Atlanta; Cynthia Krause, M.D., assistant clinical professor
of obstetrics/gynecology, Mount Sinai School of Medicine, New York City;
Jan. 27, 2005, Sexually Transmitted Infections~INFC~~AIDS~~STD-~~DEAD~
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- Source: HealthSCOUT
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