Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 15517

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3524 - 3533

Females Of The Reproductive Ages Who Have Never Used A Condom With A Non-Steady Sexual Partner

PAUL A BOURNE*

West Indies, Mona, Kingston, Jamaica)

Correspondence Address :
Socio-Medical Research Institute, Kingston, Jamaica (Formerly Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the author: Paul Andrew Bourne, Director, Socio-Medical Research Institute, Kingston, Jamaica. Email: paulbourne1@yahoo.com. Tel: (876) 457-6990.

Abstract

Background: Previous studies have demonstrated that those with multiple sexual partners are more likely to be unmarried, younger (in adolescence years), and have a greater risk of contracting a sexually transmitted infection than those with single sexual partners. Yet, no studies have examined the females who are involved in multiple sexual relationships, who have never used a condom with their non-steady partners.
Aims: The aim of the current study is: to elucidate (1) the socio-demographical characteristics of the females who have never used a condom with a non-steady partner, (2) the factors which account for their method of contraception, and (3) the factors that explain the age at the first sexual intercourse of this cohort.
Methods: The data for this analysis was taken from the 2002 Reproductive Health Survey. The current study extracted a sample of 109 female respondents who were aged 15-44 years, who indicated having never used a condom with their non-steady sexual partners, from a sample of 7,168 individuals. Results: One and one half percentage of the females aged 15-49 years indicated having never used a condom with a non-steady sexual partner. Almost 81% of the sample had sex in the last 30 days, and the mean age was 30.4 years (SD = 8.1 years). Two variables emerged as the statistically significant factors of the ages at the first sexual intercourse of the samples, and they explained 38.8% of the variance. Three variables emerged as the statistically significant factors which explained the ages at which the females never used a condom with their non-steady sexual partner and this explained 40.1% of the variability.
Conclusion: A multi-level approach to intervention has to be used to address polygamy and the inconsistent condom use among females who have non-steady partners in Jamaica; otherwise this risky behaviour will not be changed.

Keywords

Condom use, reproductive health matters, sexual relationship, non-steady sexual partner, transactional sexual relationship, age at first sexual intercourse, age at which the females began using a method of contraception

How to cite this article :

PAUL A BOURNE. FEMALES OF THE REPRODUCTIVE AGES WHO HAVE NEVER USED A CONDOM WITH A NON-STEADY SEXUAL PARTNER. Journal of Clinical and Diagnostic Research [serial online] 2010 December [cited: 2019 Oct 14 ]; 4:3524-3533. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=December&volume=4&issue=6&page=3524-3533&id=1096

Introduction
According to Edwards, “Unmarried American women who had their first intercourse when they were younger than 17 and those who were born in the western United States, are more likely than other women to have recently had more than one sexual partners, ...”(1). While Edwards’ research provides pertinent information on the statistical association between the age at first sexual intercourse and multiple sexual partners, the exclusion of married and widowed females from the sample may create a perspective that they are not involved in extra-marital relationships or polygamy. Another reality of multiple sexual relationships is the high risk of contracting sexually transmitted infections (STIs), particularly HIV/AIDS and human papillomavirus [2-4], thus suggesting that the exclusion of any cohort will be detrimental to the public health policy intervention outreach. The recognition that risky sexual behaviour is open to humans, and so the exclusion of heterosexuals (3) is similar to that of married females as sexual intercourse is a practices of all and not a specified human population. If public health practitioners need to institute programmes that will effectively address and change behaviour, then, the fact as to why people with multiple sexual partners do not use a condom with non-steady sexual partners, cannot be left unresearched.
Previous studies have demonstrated that those with multiple sexual partners are more likely to be unmarried, younger (in adolescence years), and have a greater risk of contracting a sexually transmitted infection [1-4] than those with single sexual partners. One group of researchers found that only a small percentage of female undergraduate students in China, with multiple sex partners, were having unprotected sexual relations (5). Such a reality is a public health concern within the general context of the association between unprotected sexual intercourse and the risk of contracting an STI. Furthermore, according to Yan et al. (5), 5.31% of the female undergraduate students in China had multiple sexual partners, and although the percentage of the people who were at a high risk of contracting an STI was low, the reality is that STIs, in particular HIV/AIDS, have been increasing in the young aged cohort in the developing world, and this is moreso among young women [6-9]. HIV is the 2nd leading cause of death in the World (8), the 1st in the Caribbean (among 15-49 year olds) (8) and the 2nd in Jamaica (9), thus indicating that inconsistent condom usage and promiscuity have accounted for the HIV statistics in the developing nations.
By using a stratified probability sample of 2,848 Jamaicans who were aged 15-74 years, Wilks et al. (10) found that 24.4% indicated having at least 2 sexual partners (females, 8.4%; males, 41.0%). Furthermore, 11% of the female population reported having had an STI (3.4% in the last 12 months) as compared to 18.2% of the males (1.3% in the last 12 months). While Wilks et al. (10) did not state the prevalence of STIs among those with multiple sexual partners as compared to those with a single sexual partner, it can be extrapolated from their study, that inconsistent condom usage, premarital sex and multiple sexual relationships are a reality among Jamaicans. Despite the positive association between multiple sexual partners and STIs, as well as between inconsistent condom usage and STIs (11) and earlier sexual relationships and the risk factors for contracting STIs, no empirical studies exist, that have examined the females in the reproductive ages, who never used a condom with a non-steady sexual partner in Jamaica and their reproductive health matters.
There is high importance in wanting to understand the females in the reproductive ages who never used a condom with a non-steady partner, the factors which account for their method of contraception, and the factors that explain the age at first sexual intercourse of this cohort. The aim of the current study is; to elucidate (1) the sociodemographical characteristics of the females who never used a condom with a non-steady partner, (2) the factors which account for their method of contraception, and (3) the factors that explain the age at first sexual intercourse of this cohort.

Material and Methods

Sample
The data for this analysis was taken from the 2002 Reproductive Health Survey (RHS) (12). The RHS is an annual household interview survey of the civilian, noninstitutionalized population aged 15-44 years for females and 15-24 years for males. Since 1997, the National Family Planning Board (NFPB) has been collecting information on women (ages 15-49 years) in Jamaica regarding contraception usage and/or reproductive health. Stratified random sampling was used to design the sampling frame from which the sample was drawn. By using the 2001 Census sector (or sampling frame), a three-stage sampling design was used. Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts, EDs). This was calculated, based on a probability proportion to size. Jamaica is classified into four health regions. Region 1 consists of Kingston, St. Andrew, St. Thomas and St. Catherine; Region 2 comprises Portland, St. Mary and St. Ann; Region 3 is made up of Trelawny, St. James, Hanover and Westmoreland, with Region 4 being St. Elizabeth, Manchester and Clarendon. The 2001 Census showed that region 1 comprised 46.5% of Jamaica, as compared to Region 2 (14.1%); Region 3 (17.6%) and Region 4 (21.8%). (12).
Stage 2 saw the clustering of households into primary sampling units (PSUs), with each PSU constituting an ED, which in turn consisted of 80 households. The previous sampling frame was in need of updating, and so this was carried out between January 2002 and May 2002. The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use. Stage 3 was the final selection of one eligible female and this was done by the interviewer on visiting the household.
The Statistical Institute of Jamaica (STATIN) provided the interviewers and the supervisors who were trained by the McFarlane Consultancy to carry out the survey. The interviewers administered a 35-page questionnaire. The data collection began on Saturday, October 26, 2002 and was completed on May 9, 2003. The data was weighted in order to represent the population of women who were aged 15 to 49 years in the nation (12).
The current study extracted a sample of 109 female respondents who were aged 15-44 years, who indicated having never used a condom with their non-steady sexual partners, from a sample of 7,168 individuals (1.5%). A questionnaire was used to collect the data from the respondents. It was a 154-item instrument. The questions were demographical characteristics, sexual history (including number and type of partners and having/not having sexual relationships with commercial sex workers), and condom usage. The interviewers were trained for a 5-day period, of which 2 days were devoted to field practices. The interviewers were assigned to a team which comprised of two females, two males and a supervisor. Oral consent was sought and given before the actual interview would commence. The interviewees were informed of confidentiality and their right to stop the interview at any time if they so desired. No names, addresses or other personal information was collected from the respondents in order to ensure anonymity and confidentiality.
Statistical analyses
The data were entered, stored and retrieved by using SPSS for Windows, Version 16.0 SPSS Inc; Chicago, IL, USA). Descriptive statistics were performed on particular sociodemographical characteristics of the sample. Multivariate logistic regressions were fitted by using one outcome measure: self-reported confirmed positive HIV test results. We examined the correlation matrices to examine multicollinearity. Where collinearity existed (r > 0.7), the variables were entered independently into the model to determine those that should be retained during the final model construction (13). To derive the accurate tests of statistical significance, we used the SUDDAN statistical software (Research Triangle Institute, Research Triangle Park, NC), and this adjusted to the survey’s complex sampling design. A p-value < 0.05 (two-tailed) was used to establish statistical significance.
Measurement
Crowding was the total number of persons in a dwelling (excluding kitchen, bathroom and verandah). Age was the number of years a person was alive, up to his/her last birthday (in years). The contraceptive method was derived from the question, “Are you and your partner currently using a method of contraception? …”, and if the answer was yes, the question,“Which method of contraception do you use?” was asked. The age at which contraception use was begun, was derived from the question, “How old were you when you first used contraception?” Area of residence was assessed by asking, “In which area do you reside?” The options were rural, semi-urban and urban. The current sexual status was assessed by asking, “Have you had sexual intercourse in the last 30 days?” Education was measured from the question, “How many years did you attend school?” Marital status was measured from the following question, “Are you legally married now?”, “Are you living with a common-law partner now? (that is, are you living as man and wife now with a partner to whom you are not legally married?)”, “Do you have a visiting partner, that is, a more or less steady partner with whom you have sexual relations?”, and “Are you currently single?” Age at first sexual intercourse was measured from. “At what age did you have your first intercourse?” Gynaecological examination was assessed by asking, “Have you ever had a gynaecological examination?” Pregnancy was assessed by, “Are you pregnant now?” Religiosity was evaluated from the question, “With what frequency do you attend religious services?” The options ranged from at least once per week to only on special occasions (such as weddings, funerals, christenings, et cetera). The subjective social class was measured from, “In which class do you belong?” The options were lower, middle or upper social hierarchy.

Results

(Table/Fig 1) presents information on the sociodemographical characteristics of the study population. Almost 81% of the sample had have sex in the last 30 days, and the mean age was 30.4 years (SD = 8.1 years). Further examination of the age composition of the population revealed the percentages of the sample (their mean ages) who had sex in the last 30 days ie; 8.3% (mean age 15-19 years) s; 19.3% (mean age 20-24 years) ; 17.4% (mean age 25-29 years) ; 20.2% (mean age 30-34 years); 19.3% (mean age 35-39 years); 10.1% (mean age 40-44 years), and the remaining was 45-49 years (mean age). All the respondents indicated that they have had sexual relationships in the past. One and one half percentage of the females aged 15-49 years (based on the sample size for the 2002 Reproductive Health Survey) indicated having never used a condom with a non-steady sexual partner. (Table/Fig 2) shows information on the fertility and other reproductive characteristics of the study population. Six percentage of the respondents indicated that they have had at least 2 sexual partners in the last 3 months. Of those who were sexually assaulted over their lifecourse (22%), 41.7% indicated that it occurred once; 37.5% mentioned that it was 2-5 times; 4.2% stated that it was 6-10 times and 12.5% reported that it was at least 11 times. When they were asked, ‘By whom?’, most of them stated that it was by their boyfriends (45.5%), followed by close friends (22.7%), husbands or common-law partners (13.6%), visiting partners (9.1%) and lastly, by casual acquaintances (4.5%) and other individuals (4.5%).Forty-nine percentage of the respondents stated that they began using a method of contraception before having their first child; 43.1% indicated that it was after their first child; 4.6% reported that it was after their second child, 1.8% stated that it was after their third child and 0.9% said that it was after their fourth child. Although the study did not used a condom with their non-steady sexual partner during sexual intercourse, 51.4% stated that they always used one with their steady partner; 38.5% mentioned that they used one most of the times and 10.1% revealed that they had seldom used one. Forty-three percentage of the respondents indicated that they wanted to have more children in the future and 9% stated that they were uncertain about this. When they were asked as to which method of contraception they were using, most said that they were on the pill (56.8%), followed by injection (32.4%), tubal ligation (8.1%) and IUD/coil (2.7%). Only 2% of the sample was commercial sex workers. Fifty percent of the respondents have had a gynaecological examination in the last 12 months, and 27% had done a Pap smear in the same period.

Multivariate analyses
(Table/Fig 3) examines those variables which explain (or not) the age at the first sexual encounter of the study population. Two variables emerged as statistically significant factors of the age at the first sexual intercourse of the sample (F-statistic = 4.324, P < 0.0001), and they explained 38.8% of the variance (R-squared) in the dependent variable (age at first sexual intercourse).
(Table/Fig 4) presents information on the variables which explain (or not) the age at which contraceptive use was begun in the study population. Three variables emerged as statistically significant factors which explained the age at which the females (15-49 years), who had never used a condom with their non-steady sexual partner, began using a method of contraception (F-statistic = 4.564, P < 0.0001), and these explained 40.1% of the variability in age at which the females began using a contraceptive method.

Discussion

This study found that although the sample never used a condom with a non-steady partner, they used one with their steady partner (always- 51.4%; most times- 38.5%; seldom- 10.1%); 2% of the sample was commercial sex workers; 43% wanted more children; 47% of the sample was in the middle class; 47% of the sample was in the rural areas; 49% was in visiting unions; 13.8% had urinary tract infections; 22% was forced into sexual encounters; 17.6% was forced into sexual intercourse for their sexual debut; and that the mean age at the first sexual intercourse of the sample was 16.5 years, while the mean age of the person that the sample had the sexual debut with, was 29.7 years. The factors which accounted for the age at first sexual intercourse were the area of residence and the age at which contraceptive use was begun ; and the variables which accounted for the age at which contraceptive use was begun, were marital status, age of the respondents and the age at the first sexual intercourse.As in the case of the undergraduate students in China (5), only a small percentage of the female Jamaicans who were aged 15-49 years, indicated having never worn a condom with a non-steady sexual partner. The current study provides a thorough examination of the reproductive health practices of those individuals, unlike the study in China (5).

Females with multiple sexual partners, who did not wear a condom with their non-steady partners, 1 in every 2 of them consistently, used a condom with their steady partners. It can be extrapolated from the current study that (1) these females did not see their current partners as the possible parents of their future child/ren, (2) the sexual promiscuity was such that the rush of the encounter over-rode the logistics of the high risk of sexually transmitted infections, and that the (3) desire to have child/ren was a rationale which explained this activity. Clearly, the multiple sexual partnerships and polygamy among females is due to their desire to become parents, which is so dominant that their sexual urge overshadows the high risk of sexually transmitted infections as well as the cultural role of polygamy, while they are trapped within economic and material deprivation. It can be deduced from this study, that childbearing is used by females are economic leverage over males, and that some children would be illegitimate for the females’ steady partners.

Another issue which is embedded in this study, is the sexual dissatisfaction of the females about their steady partner and otherwise, which is supported by literature (14). When the respondents were asked as to who was responsible for the sexual assault, 46 out of every 100 indicated a boyfriend; 23 of every 100 indicated a close friend; 14 out of every 100 stated that it was a husband or common-law partner and 9 out of every 100 mentioned a visiting partner. The sexual dissatisfaction of the females is therefore embodied in their reduced sexual autonomy with their steady sexual partner, and the facts that their choice of having sexual relations with a non-steady partner was a choice, and that this could also be autonomous and financial. Clearly, sex is important to humans, but the role of economical reasons is critical (14) and this has overridden the risk of pregnancy. Sexual promiscuity appears to be more economical on the part of the females, as most of them were using a second method of contraception to prevent pregnancy and as the non-usage of a condom could be a part of the economic plan that would be used to exhort money from the non-steady sexual partner.

This study revealed that as the females become older, they are more likely to wear a method of contraception as well as get married, in common-law unions and age at first sexual debut. The fact that as females become older, they are more likely to use a method of contraception supports the literature findings which demonstrate that young people are less likely to use a method of contraception. The present work highlights that females begin having sexual relationships with males who are at least 13 years their senior, thus suggesting the importance of economical reasons in sexual relationships. It should be understood that this transactional sex is not commercial, as only 2% of the respondents indicated being commercial sex workers. According to Shelton (14), “Rather than a specific fee-for-service sex, transactional sex describes a social norm of expectation of gifts and economic support from men as part of a sexual relationship, in part expressing value, commitment, love, and respect.” Thus, multiple sexual relationships and the non-usage of a condom by some of females is a transactional encounter that is used by women to assist themselves economically from their financial and material deprivation; and this is the rationale for the choice of older men. Older men in these types of sexual relationships provide luxury goods, gifts and money to younger females that they are sexually engaged with, and the younger females offer sexual favours (15), (16).

Polygamy, within the context of the transactional sexual relationship, clearly is a low risk activity for many females, as only 14 out of every 100 of them indicated having urinary tract infections. Although this research did not have information on the prevalence of STIs among the study population, Wilks et al.’s study (10) demonstrated that 11 out of every 100 females aged 15-74 years had STIs, even though 8.4% had multiple sexual relationships. Furthermore, they found that 4.2% of the females who were aged 15-24 years, had STIs, 5.5% of those who were aged 25-34 years had STIs, 3.9% of the females who were aged 35-44 years had STIs, 1.1% of females who were aged 45-54 years had STIs and 0% of those who were aged 55-74 years had STIs, thus suggesting that younger females, in particular adolescents, may be more vulnerable to STIs than the older females, which is demonstrated by the literature (11), (17). The results revealed that 41 in every 100 females in the study sample were employed, which indicates a high dependency on a partner, family or relative for survivability. While there were clear economic benefits for females who were being involved with older men, the opportunity cost of being sexually engaged with them was STIs, particularly HIV/AIDS and human papilomavirus (6), (17).

Inconsistent condom usage, promiscuity and multiple sexual relationships account for the high incidence of HIV infections in South Africa (6), and women in rural South Africa, on an average, begin having sexual relationships at 18.5 years. While the prevalence of HIV in South Africa is greater than that in Jamaica, inconsistent condom use among females with non-steady partners in Jamaica is exposing many of them to the virus, and this means that the public health department must immediately address this reality. A study by Nnedu et al. (18), which demonstrated that 1.5% of the females who were aged 15-49 years had HIV/AIDS is not any solace for the reproductive health matters of females aged 15-49 years who were having risk sexual relations with their non-steady partners. Empirically, it has been established that HIV is greater among heterosexuals (19) and young risk taking individuals (20), which means that the females who do not use a condom with their older non-steady sexual partners could be at high risk of contacting any STIs in the future. It is evident from this work, that futuristic challenges of public health can rest without using a multi-level approach to alleviate and change the sexual behaviour of these females.

Human behaviour is a complex phenomenon and so is human behavioural change. People will not change a particular behaviour just because outsiders are indicating that it is best to do so. Thus, people’s participation in healthy behaviour and changing risky behaviour is embedded in risk perception. People have to live, and the desire is such that the culture and economic deprivation may not be enough for them to practice behaviour modification despite the threat to survivability. Risk perception is different between age and gender, which can account for the motivation (or lack of) in lifestyle changes (21). By using the results from Wilks et al;s study (10), it was suggested that the risk of females contracting an STI in Jamaica was low and the findings from the current work equally demonstrate this fact, as only 14 out of every 100 females who did not use a condom with a non-steady partner indicated that they had urinary tract infections and only 1 in every 100 indicated that they had pelvic inflamatory disease. According to Gibbison (22), the cumulative AIDS prevalence in Jamaica was 100 per 100,000 in rural areas to about 1000 per 100000 in urban zones, which validates the self-reported statistics. Clearly, the results from these findings and from that of the literature support the fact as to why people would have a low risk perception to change their risky behavioural practices.

It was not because of lack of knowledge that the females in this study did not want to use a condom with a non-steady partner, as they were cognizant of the risk factors such as HIV/AIDS and human papillamavirus among other STIs. According to Goldberg et al. the awareness about the condom is high in Latin America and the Caribbean (23), thus demonstrating the role of risk perception in the behavioural choices of women in the study. The reality is that the probability of sexual violence among females is greater than the risk of contracting an STI, particularly HIV, AIDs or a pelvic inflamatory disease. The aforementioned findings can be supported by a study which was conducted on sex workers in Jamaica. The study found that 9% had HIV, 90% had an easy access to a condom and that 30% used a condom with a non-paying partner (24).

Outside of the previous mentioned rationale for the behaviour of the study population, another issue which must be examined is sexual unions. According to Ebanks “Firstly, women believe that children in themselves add more stability to a union, than is achieved merely by a companionate relationship; and secondly, women want these additional children because the men want them and if they (the women) do not comply, the men will go elsewhere” (25). This is a potent Outside of the previous mentioned rationale for the behaviour of the study population, another issue which must be examined is sexual unions. According to Ebanks “Firstly, women believe that children in themselves add more stability to a union, than is achieved merely by a companionate relationship; and secondly, women want these additional children because the men want them and if they (the women) do not comply, the men will go elsewhere” (25). This is a potent explanation for the risky behaviour which was exhibited by the study population, as 49 out of every 100 females were in a visiting union and although the average number of the children that they had was 2, the premarital sexual relationship could be a sexual union transition seeking mechanism for these women. It is for this reason that many of the females in the study still desired to have another child, because of the current instability of unions. With visiting unions being the shortest in duration in Jamaica (26), historically, fertility has been a part of the approach which was used to change sexual unions and this clearly had some merit in contemporary Jamaica. Drayton (27) provides an apt explanation for the need to have children in Caribbean societies, when he opined that “In the Caribbean, however, many pregnancies may be unplanned, but few babies are unwanted”, because the babies are the opportunity of stable unions, financial assistance and a leverage over the males. Hence, there is a need to have a multifaceted approach to the public health intervention strategies which are geared towards countering the issues which have been raised here.

Conclusion

Multiple sexual relationships, polygamy and inconsistent condom usage are practiced by females who have non-steady partners in Jamaica. These individuals include married, rural, employed, wealthy, educated, religious and sexually assaulted females, and some whom are currently pregnant. Therefore, delaying the public health intervention for this cohort will only add to the number of individuals who will comprise future HIV/AIDS cases. Thus, these results provide pertinent information which public health and policy specialists can use to remedy some of the issues which are raised herein. In Jamaica, transactional sex is not construed by females in the same way as commercial sex is and so, the practices that emerged in this study highlight how this should be addressed in order to reduce STI infections and risky sexual behaviours.

Adolescents and adults learn and fashion an elaborate set of norms, practices and ideas about their culture, including sexuality and their sexual roles, well in advance of their engagement in sexual relationships. Although people are somewhat knowledgeable about risky sexual behaviours, particularly the link between STIs and infertility, ectopic pregnancy, preterm birth, foetal abnormality, HIV/AIDS, and premature mortality, there is a degree of understanding in ignorance about the probability of contracting a STI, particularly HIV/AIDS, from the risk perception which they would have also learnt. Even though this is not scientific with regards to their risk perception, this guides their sexual involvements. The challenge of public health therefore, is not to increase the access to contraceptive methods and to provide more knowledge about the risk factors, but it forms the linkage between personal risk, further economical reasons and social deprivations that are likely to result from contracting an STI that is life treating, which causes infertility and which removes the vetoing power of sexuality from the male partner.

In summary, evidence exists, which showed that socioeconomic deprivation accounts for the aspects of the transactional sexual relationship between females and males in Jamaica. Clearly, in order to address polygamy, inconsistent condom use and risk perception among the females who have non-steady partners in Jamaica, a multi-level approach to intervention must be used; otherwise, the risky behaviour that emerged in this study will not be modified.

Conflict of interest
The authors have no conflict of interest to report.
Disclaimer
The researchers would like to note that while this study used secondary data from the Reproductive Health Survey, none of the errors in this paper should be ascribed to the National Family Planning Board, but to the researchers.

Acknowledgement

The authors thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies, the University of the West Indies, Mona, Jamaica for making the dataset, and the National Family Planning Board for commissioning the survey.

References

1.
Edwards S. Having multiple sexual partners is linked to age at first sex and birthday. Family Planning Perspectives 1994;25:126-132.
2.
Eversley RB. AIDS risk among women with multiple sexual partners: HIV risk screening data from a family planning population. Int Conf AIDS 1989; 5:750.
3.
Van Doormum GJ, Prins M, Juffermans LH, et al. Regional distribution and incidence of human papillomavirus infections among heterosexual men and women with multiple sexual partners: a prospective study. Genitourin Med 1994; 70:240-246.
4.
Santelli JS, Brener ND, Lowry R, et al. Multiple sexual partners among U.S. adolescents and young adults. Family Planning Perspectives1998; 30:271-275.
5.
Yan H, Chen W, Wu H, et al. Multiple sex partner behaviour in female undergraduate students in China: A multi-campus survey. BMC Public Health 2009; 9:305.
6.
McGrath N, Nyirenda M, Hosegood V, et al. Age at first sex in rural South Africa. Sex Transm Infect 2009; 85:i49-i55.
7.
World Health Organization (WHO). World health statistics, 2009. Geneva: WHO; 2009.
8.
Rawlins J, Crawford T. Women’s Health in the English-Speaking Caribbean: The Case of Trinidad and Tobago. Journal of Social and Economic Studies 2006; 55:1-31.
9.
Thomas T. Youth Reproductive and Sexual Health in Jamaica. Washington DC. Advocates for Youth; 2006.
10.
Wilks R, Younger N, Tulloch-Reid M, McFarlane S, Francis D: Jamaica health and lifestyle survey 2007-8. Kingston: Tropical Medicine Research Institute, University of the West Indies, Mona; 2008.
11.
George C, Alary M, Otis J. Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica. West Indian Med J 2007; 56:433-438.
12.
Jamaica, National Family Planning Board (NFPB). Reproductive Health Survey 2002. Kingston: NFPB; 2005.
13.
Polit DF. Data analysis and statistics for nursing research. Stamford: Appleton & Lange Publisher, 1996.
14.
Shelton JD. Why multiple sexual partners. Lancet 2009; 374:367-369.
15.
Leclerc-Madlala S. Transactional sex and the pursuit of modernity. Soc Dynam 2004; 29:1-21.
16.
Moore AM, Biddlecom AE, Zulu EM. Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. Afr J Reprod Health 2007; 11:44-61.
17.
Caribbean Task Force on HIV/AIDS. The Caribbean Regional strategic plan of action for HIV/AIDS. Caribbean Task Force on HIV/AIDS; 2000.
18.
Nnedu ON, McCorvey S, Campbell-Forrester S, et al. Factors influencing condom use among sexually transmitted infection clinic patients in Montego Bay, Jamaica. The Open Reproductive Sci J 2008; 1:45-50.
19.
Vickers IE, Alveranga H, Smikle MF. Clinical and epidemiological characteristics of adult and adolescent patient newly diagnosed with the human immunodeficiency virus at a Jamaican clinic for sexually transmitted infections. West Indian Med J 2005; 54:360-363.
20.
Penfold SC, Van Teijlingen ER, Tucker JS. Factors associated with self-reported first sexual intercourse in Scottish adolescent. BMC Research Notes 2009; 2:42.
21.
Deeks A, Lombard C, Michelmore J, et al. The effects of gender and age on health behaviours. BMC Public Health 2009; 9:213.
22.
Gibbison GA. Attitude towards intimate partner violence against women and risky sexual choices of Jamaican males. West Indian Med J 2007; 56:66-71.
23.
Goldberg HI, Lee NC, Oberle MW, et al. Knowledge about condoms and their use in less developed countries during a period of rising AIDS prevalence. Bulletin of the World Health Organization 1989; 67:85-91.
24.
Duncan J, Gebre Y, Grant Y, et al. HIV prevalence and related behaviours among sex workers in Jamaica. Sexually Transm Dis 2010; 37:306-310.
25.
Ebanks GE. Fertility, union status, and partners. Int J of Sociology of the Family 1973; 3:48-60.
26.
Wright RE. The impact of fertility on sexual union transition in Jamaica: An event history analysis. J of Marriage and Family 1989; 51:353-361.
27.
Drayton VLC. Contraceptive use among Jamaican teenage mothers. Pan Am J Public Health 2002; 11:150-157

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com