Suriname and sex

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View the profiles of people named Suriname Sex. Join Facebook to connect with Suriname Sex and others you may know. Facebook gives people the power to. Sexual mixing between the Surinamese migrants and the Dutch and Surinamese natives occurred frequently. Yet, the MLST cluster distribution. Here we show that dry-sex practices are not limited to Africa. Afro-Surinamese women frequently use genital steam baths that contain drying.

Sex sells in Suriname. An impoverished population and anti-prostitution laws that go unenforced make this former Dutch colony a popular. Suriname is principally a destination and transit country for men, women Some of these children are trafficked into the sex trade. Here we show that dry-sex practices are not limited to Africa. Afro-Surinamese women frequently use genital steam baths that contain drying.

Dry sex in Suriname. van Andel T(1), de Korte S, Koopmans D, Behari-Ramdas J, Ruysschaert S. Author information: (1)National Herbarium of. Sexual mixing between the Surinamese migrants and the Dutch and Surinamese natives occurred frequently. Yet, the MLST cluster distribution. Here we show that dry-sex practices are not limited to Africa. Afro-Surinamese women frequently use genital steam baths that contain drying.

It covers an area ofkm 2. Suriname gained its independence from the Netherlands in It is a constitutional democracy based on the Constitution. The President appoints the Council of Ministers.

The country suriname divided into 10 administrative districts: the two urban districts include Paramaribo the capital city and Wanica, there are six rural districts in the coastal area, and two districts in the interior. The urban districts occupy 0. According to the most recent census inthe total population was , with sdx male-to-female ratio of almost 2.

Relative growth of the population since the census of was 9. The population increased Inthe population structure had an expansive structure. Bythe pyramidal structure had shifted to ages older than 55 years; at younger age groups, the population structure shows lower expansion, becoming regressive surinzme the sex groups younger than 15 years. These changes are a result of a greater decrease ane birth rate and mortality, especially in the last two decades. The census estimated the unemployment rate at between The economy in Suriname was stable during the — period, with an average annual growth of 4.

The main suriname of the economy are the mineral sectors of gold and oil Economic growth and this period benefited government spending and subsidies to the social sectors, including the health sector. The drop in international prices of the major export commodities gold, oil, and alumina and the closure of the alumina refinery in late caused substantial fiscal deficits, and resulted in a recession of suriname economy. Andd addition, financial loans were negotiated with other multilateral institutions, such as the Caribbean Development Bank, the Inter-American Development Bank, the Islamic Development Bank, and the World Bank Group, to support economic growth and social security 4.

The population has been confronted by skyrocketing prices of virtually all goods and services and increasing costs for gasoline, electricity, and other essential commodities. The government presented the Stabilization and Recovery Plan for — 6which delineates an emergency investment program, financed by the various loans.

The IMF program will finance social cash transfer programs to provide financial assistance to lower-income households, the disabled, and the elderly. The negative effects of the economic recession have already severely affected ssex population. However, domestic violence rates are among the highest in the subregion. To address illegal mining activity, the government established the Commission sex Regulation of the Gold Sector.

The potential health hazards related to gold mining and mercury use require interventions, monitoring, evaluation, and research 7. Diseases resulting from deforestation and disturbances in ecosystems e. The threat of the resurgence of malaria due to the constant influx of migrant and in the gold and logging sector in the interior needs to be addressed. In some rural districts and in the interior, people rely mainly on rain, creek, or river water 2. Threats to the freshwater ecosystems include pollution from urban-domestic and industrial waste, changes in land use, agricultural runoff, droughts and floods due to climate change, and sea level rise saltwater intrusion 1.

Inthe National Basic Health Insurance Law 9 was passed, providing access to a basic package of primary, secondary, and tertiary care services for all residents of Suriname. To alleviate the shortage of doctors and nurses, admissions to the Faculty of Medicine at Anton de Kom University and to the School of Nursing have increased since Decentralization of health facilities, and hospital facilities, was started with the construction of a hospital at the eastern border of the country with financial aid from the Suriame Development Agency AFD.

Another hospital, with a nursing home, was planned for the Wanica district, financed by the Chinese government, but construction has been delayed. The Multiannual Development Plan for — of the government of Suriname states that economic development forms the basis xnd social security and that social suriname stimulates economic growth The plan stresses policies to enable social protection for the population, especially for certain priority groups such as youth.

Inthe Ministry of Sports and Youth was established and one of its accomplishments has been the construction of sports fields in various neighborhoods. In addition to the law on basic health insurance 9two other major pieces of and regarding social security were enacted in the law expanding pension benefits 11and the law establishing a minimum wage To address persisting inequities between urban, rural, and interior regions, and to tackle slum formation in peri-urban areas, the Multiannual Development Plan proposed several large investment projects to increase affordable housing, improve access to piped water, and promote local agricultural production.

However, implementation was seriously hampered by the financial ssx inand a esx, five-year plan is being developed 6. The Multiannual Development Plan for — states that ans government policies will increase social security for the most vulnerable segments of the population. The policies focus on groups with reduced access to basic commodities such as safe water and electricity—particularly inhabitants of the interior, including Maroons and Amerindians— or limited access to health care and social services—which includes the inhabitants of the interior, the poor, elderly, pregnant women, children, and people with a disability.

Between andthe State alleviated some of the needs of the most deprived. Inall children under 16 and senior citizens 60 years and older were entitled to free health surinxme paid by the government 9.

Between andgeneral child support has increased tenfold and the general pension provision was raised twice 6. An after-school program was introduced in for all elementary schools nationwide, which provided free meals, mentoring, and activities. Due to the financial recession this program was terminated in To help protect the constitutional rights of the lesbian, gay, bisexual, and transgender LGBT community, which suffers from discrimination, there is ongoing dialogue between advocate groups and the government.

The Regional Suriname Services receives public funds to operate some 43 primary health clinics in the coastal area. In addition, there are some private primary care clinics that are only accessible to the and in the coastal area. Medical Mission, a faith-based and, receives government funding to manage about 56 primary health clinics in the interior districts. There are five hospitals, four of which are located in Paramaribo and one in the district of Nickerie at the western border.

The only psychiatric hospital is located in Paramaribo. The Bureau of Public Health known as the BOG, for its Dutch acronym is responsible for the public health programs, including environmental health and sanitation, and also operates a public health laboratory. Access to specialized and emergency care for those living in the interior remains a challenge because of the organization of services, coverage of care, and high transportation costs either by air, road, or boat to a hospital in the capital.

Access to secondary care occurs through referrals by primary care physicians. During the — period of economic growth, the health care infrastructure improved nationwide.

Medical Mission and Regional Health Services expanded and and their facilities. This period also saw an expansion and decentralization sex private laboratory diagnostic services, and private primary care, dental care, and other paramedic practices.

The two private and three public hospitals, especially the Academic Hospital Paramaribo, renovated and expanded their facilities and invested in equipment and staff for specialty care gastroenterology, oncology, esx care, renal dialysis, etc. The national radiotherapy center, a department of the Academic Hospital, became operational inresulting in a substantial decrease in the number of patients sent abroad mainly to Colombia and Cuba for cancer treatment.

The main threat affecting the entire health care system is the financial suriname. The Medical Association and Parliament have urged the government to intervene to prevent the health care system from collapsing, putting the health and lives of residents at risk.

The endemicity of all four serotypes of sex dengue virus and the outbreaks of chikungunya and Zika fever in all regions of Suriname rural, coastal, and interior illustrate the failing vector-control measures against the Aedes aegypti mosquito. An entomological survey by the BOG in revealed high Ae. The survey found that informal waste suriname and inadequately covered water containers, used primarily where there is limited piped water supply, particularly in rural areas and the interior, are important breeding sites.

Another concern is the presence of Ae. Malaria has been virtually eliminated in the residential villages of the interior since ; the main risk groups are migrant, small-scale gold miners, mainly from Brazil.

Government and donor funds will be used to reach malaria elimination byensuring that the areas with low or no transmission remain malaria-free and scaling up the control activities in the migrant populations Cutaneous leishmaniasis is an increasing public health problem. The number of cases diagnosed and treated at the Dermatology Services Clinic of the Suriname of Health in sex capital increased over the — period, sex is related to gold and timber extraction in the interior of Suriname Similarly to malaria, people working in these areas mainly Brazilian gold miners are at greatest risk, xex men are affected nine times more than women.

Others who visit the interior armed forces, teachers, tourists are also at risk, but at a lower level than miners Preventive messages targeted at the various risk groups need to be scaled up, as does the dissemination of diagnostic and treatment protocols among health workers in order to prevent a continued rise in the spread of leishmaniasis. Some rural and interior districts continue to experience incidence levels above the elimination level, however. The guidelines stress the importance suriname screening and active contact tracing, specifically in rural areas and in the interior.

Providing universal access sxe health care for mothers and their newborns remains a challenge, and disparities in access are often related to geographic location, health care, literacy, and insurance coverage Although all insurance schemes cover some access to preconception, antenatal, and delivery care for women older than 16 years, there is often no full coverage of the required care package.

Health insurance companies have restrictions with regard to hospitalized newborns, leaving parents with catastrophic out-of-pocket costs The Safe Motherhood and Newborn Health Action Plan was developed to address the lack of uniformity in protocols ante- intra- and postpartum and emergency obstetric carexex has limited monitoring of the quality of services, especially in primary health care According to the MICS results 18the use of modern esx has hardly increased over the past five years, with some types of sex being not covered or only partly covered e.

Abortion is illegal in Suriname, and the Safe Motherhood Action Plan addresses the fact that because abortions are not registered, it is not possible to track actual numbers. HIV and AIDS present the largest burden surinamme a single disease in Suriname, representing the main cause of premature death and years lived with disability Prevalence is more than five times the national average for subgroups including men who have sex with men and sex workers, although incidence in these populations is declining.

The plan addresses the problem of teenage pregnancies one in every six live births is to a teenage motherwhich is an indication that condom use among youth is still insufficient. Adolescents 10—19 years old in the rural interior, from mostly Amerindian and Maroon villages bordering areas with gold mining activities, are more at risk than others.

Men have higher readmission hospitalization rates due to Surriname 20 and lower viral suppression than women, which is indicative of less adherence to treatment and care The National Strategic Plan for HIV highlights the importance of strengthening the continuum of care for people living with HIV and Znd between the different levels of the health system by using a and, multidisciplinary team approach that also addresses the stigmatization of those with the disease Another priority area amd the plan is the elimination of mother-to-child transmission of HIV.

The problem of repeat pregnancies in HIV-positive pregnant women indicates a need for the integration of effective sexual reproductive health and family planning services. Among suriname tuberculosis TB cases, more men than women are being diagnosed 2.

Another priority area in the Tuberculosis Plan is outreach to migrant populations. Brazilian miners sex in Suriname have been found to have sputum smear—positive TB, and positive contacts; some prefer to seek treatment in French Guiana. The main risk factors of the NCD epidemic in Suriname are unhealthy diet, overweight and obesity rates, sedentary lifestyle, and high smoking rates in men The STEPS survey conducted in shows that CVD risk in rural areas does not significantly differ from urban areas as might be expected 23 ; this sex suriiname an indication that urbanized lifestyle e.

The interior region still has significantly lower CVD risk factor rates. The Parliament passed comprehensive tobacco control legislation inwhich was an important step by the government to curtail the detrimental effects of at least one NCD and factor Other legislation and regulations regarding healthy foods and the promotion of sport and recreation are still pending.

The recently established Health in All Policies HiAP initiative, an sex platform involving government, private sector, and civil society, is designed to address the social determinants of health through the adoption adn targeted policies The NCD Action Plan for — includes actions for several priorities and emphasizes the importance of an intersectoral approach

Other legislation and regulations regarding healthy foods and the promotion of sport and recreation are still pending. The recently established Health in All Policies HiAP initiative, an intersectoral platform involving government, private sector, and civil society, is designed to address the social determinants of health through the adoption of targeted policies The NCD Action Plan for — includes actions for several priorities and emphasizes the importance of an intersectoral approach The high rate of suicide and suicide attempts is considered one of the main public health problems by the government.

Each year more people die from suicide than from traffic accidents and homicide combined, and Suriname ranks sixth in the world for the number of suicides committed It has been the policy of successive governments to scale up the number of health workers to address shortages.

Concrete measures in training and education are under way. In , the Ministry of Health approved the development of a residency training program in family medicine and a revolving fund was established to support residents to continue their training abroad mainly in the Netherlands. In , the Scientific Research Center of the Academic Hospital Paramaribo was established to improve research capacity among health workers Limited progress has been made in developing an integrated health information system, including electronic medical records.

The implementation of telemedicine and telehealth, especially for remote areas, remains a priority. The government has developed an eGovernment Strategy for — that is in its implementation phase One result is that many government documents and audio and video productions, including from the Ministry of Health, are now available online.

Climate change and sea level rise will result in increased storm surges, wave attacks on the shoreline, land loss, salinization, and loss of biodiversity on the coast The National Biodiversity Action Plan provides a framework for incorporating biodiversity, cultural, and nature conservation measures and values into national development plans and sector plans Moreover, the country does not have a dedicated facility to store or dispose of hazardous waste and no regulations for the safe use and storage of pesticides.

The government recognizes that a sustainable agricultural sector is a priority to ensure food security for the population, and several agricultural development plans are in progress These relate to policy and regulation, as well as standardization and licensing; inspection and surveillance are fragmented and laboratory capacity needs strengthening.

Moreover, food technology and public information and education are poorly developed. To tackle these problems the report recommends the establishment of an inter-ministerial National Food Safety Platform to provide the framework for overall coordination and integration of food safety management Investments have been made in providing economic and health security for the elderly in Suriname. The government increased the general pension allowance and has enrolled every citizen over 60 years of age in the national basic health insurance scheme.

In its effort to improve specialized health care for the elderly, the Ministry of Health supported training for the first clinical geriatrician in the country, and the nursing school has developed a geriatric nurse training program Legislation regulating the qualifications of staff and facilities for institutional care, including care of the elderly, came into effect in Most registered labor immigrants are Chinese, employed in large and small businesses, particularly restaurants.

The need for highly skilled workers, e. The National Basic Health Insurance Law requires that all residents, including registered immigrants, have health insurance 9.

Legally employed migrants in Suriname have a right to public pensions but do not have access to other social welfare payments. All children, irrespective of their legal status, have a right to education Estimates are that the numbers of undocumented immigrants, especially from Brazil and Guyana, are far higher than documented immigrants.

Undocumented immigrants are not entitled to any social benefits, including free health care, which poses barriers for their access to health care. A decline in spending for public social programs is ongoing as a result of the financial downturn, but a recovery to previous levels is projected after 4.

In , the Basic Health Insurance Law came into effect, ensuring that every resident has access to basic health insurance. The government subsidizes children under 16, those over age 60, and pregnant women 9. The basic health care package as defined in the law includes access to primary health care services, secondary care, and a defined package of tertiary services e.

The law sets payment caps for specialized services such as renal dialysis, MRI, cancer medication, etc. This limits accessibility to the full treatment course for some diseases, forcing patients and their families to spend considerable amounts of money to initiate or continue lifesaving treatments.

Legislation regarding blood supply was also enacted in , with the aim to safeguard and secure the safety of blood supply in the country. The law passed in to regulate the qualifications of staff and facilities for institutional care for the elderly also applies to human resources in organizations caring for children and people with disabilities. A report on Health in All Policies was the result of a first-time assessment conducted in 19 to compile evidence regarding inequity, risk factors, and social determinants for disease in Suriname.

The first National Consensus Workshop on HiAP followed the assessment, and the 15 largest contributors to disease were grouped into six policy domains that addressed common social determinants. The maternal mortality ratio averaged deaths per , live births over the — period and remained above the Millennium Development Goal MDG target.

The ratio was deaths per , live births in and in According to the MICS , antenatal coverage was around The survey also reported that in , The main causes identified for the high maternal mortality rate are pregnancy-induced hypertension disorders and hemorrhage In , it was estimated that the unmet need for family planning was Both under-5 and infant mortality rates show a declining trend.

The infant mortality rate was The most common reported causes for infant mortality were: respiratory problems, fetal growth retardation, congenital diseases, neonatal sepsis, and external causes. According to the MICS , malnutrition rates among children under 5 years old were low 5. The most common cause of death in this age group was external causes.

Mortality due to malignant neoplasms is increasing, and was the second cause of death in this age group in The last MICS survey indicated that sex before the age of 15 occurs almost five times more frequently in the rural interior compared to urban and other rural areas Youth from the interior reported having less knowledge than those in the urban and rural areas regarding HIV and the use of condoms Another study showed that Among the registered suicides in the — period, most were in the 20—year age group, but among females, most were 15—19 years old There is reason for growing concern regarding mental health issues, as youth between 10 and 14 years old make up an increasing proportion of registered suicide attempts The Suriname Health Study was the first nationwide study of 15—year-olds regarding the prevalence of risk factors related to lifestyle and NCDs 23, More than half of adult women and a quarter of adult men were obese and had increased waist circumference central obesity.

Compared to surveys conducted in the s, prevalence of overweight and obesity has tripled or even quadrupled in the adult population Half of the senior citizens live in the urban capital district of Paramaribo, where most of the specialized geriatric and specialized health services are concentrated.

Access to health care by the elderly living in rural areas and the interior is more difficult. There have been no significant changes in causes of mortality in the 60 years and older age group; cardiovascular diseases account for one-third of the deaths followed by neoplasms and diabetes. From to , a declining trend in cardiovascular deaths has been observed probably due to the increased availability of specialized health services , but they account for more than a quarter of all deaths HIV-related deaths have shown a consistent decline, from the sixth leading cause in to the eighth leading cause of death in The median age at death in was 67 years.

The incidence of malaria has declined to below elimination levels 4 in all but one subdistrict in the interior. Plasmodium vivax is the predominant type of malaria infection. Malaria has become an occupational disease primarily linked to gold mining, with males being most affected Between and , two major epidemics for which the population had no immunity occurred, namely, chikungunya in and Zika in late The first case of Zika virus infection was confirmed in November and since then the disease has spread to all 10 districts including rural areas and the interior.

Of eight newborns with suspected Zika-related microcephaly, one case was confirmed. The annual number of newly diagnosed cases stabilized to about from to The majority of new cases were persons of Creole or Maroon descent.

Addressing this treatment gap remains a major challenge for the health services. Moreover, a significant difference exists between men and women in treatment retention rates, but not between different ethnic groups.

On average, 1. The burden of cardiovascular disease and diabetes is reflected by the fact that stroke, ischemic heart disease, and diabetes are among the top 15 diseases and conditions with the highest disability-adjusted life years Diabetes prevalence in Suriname is the highest in persons of Hindustani and Javanese descent Moreover, one-quarter of the survey population had hypercholesterolemia These findings indicate the need to scale up proactive screening for cardiovascular disease risk factors and lifestyle modification, specifically for high-risk ethnic groups.

Suicide rates have increased steadily and in the rate was The male-to-female ratio for suicides averages between 2 to 3 males to 1 female, while for suicide attempts the ratio is higher for women 0. In the past decade great progress has been made in the control of malaria; the corresponding MDG has been reached and efforts are focused on the elimination of this disease.

Universal access to good-quality care, in particular maternal and neonatal care, will remain a priority in the coming years, as maternal and infant mortality rates still are above the MDG targets. The efforts to stop mother-to-child transmission of HIV have been successful, and the elimination target is within reach, but mother and child health services need to be strengthened to ensure sustainability of this program.

Other priority areas of HIV control need to be addressed, such as attending to at-risk populations youth, men who have sex with men, and sex workers , adopting novel treatment adherence strategies, and integrating TB and HIV screening and care services.

Significant legislation was enacted to provide universal health insurance coverage, establish a minimum wage, and expand pension benefits. Tobacco control legislation came into force, but more needs to be done legislatively to facilitate healthy lifestyle choices and curtail the high incidence of NCDs. This requires programs in schools and workplaces, increased availability of healthy food in urban and rural areas, and construction of recreational and sports facilities.

Environmental health hazards, such as the use of mercury in mining and handling of pesticides, also require regulatory action. These interventions demand strong collaboration in a setting where policy-making is fragmented across different sectors. In , the first steps were taken to promote a Health in All Policies vision across sectors These important initiatives needs to be fostered, expanded, and put into concrete action in the coming years.

In Suriname the economic crisis threatens the gains achieved, as well as the possibility of efficiently addressing ongoing and new health challenges. Safeguarding the health agenda in these times of crisis must remain a priority and continued advocacy and support by the international community is crucial in this regard.

In addition, some ethnic minority groups are affected disproportionally by C. Migrants from Suriname constitute one of the largest ethnic minority groups in the Netherlands, and the highest prevalence of C.

In , the C. Suriname is a former colony of the Netherlands in the Caribbean region. It is a multi-ethnic society consisting of Creoles, Maroons, Hindustani, Javanese, Chinese, Caucasians, and indigenous Amerindians, as well as a mixed race population.

Although considered an upper middle-income country by World Bank standards, Suriname is an emerging economy in which reliable diagnostics to detect C. The prevalence of C. Since the independence of Suriname in , a large proportion of the Surinamese population migrated to the Netherlands and today almost as many people of Surinamese origin live in the Netherlands as in Suriname itself.

Amsterdam has the largest number of Surinamese inhabitants outside of Suriname. As a result, traveling between the two countries is common.

A study in found that more than half of the population of Surinamese descent living in the Netherlands had visited friends and relatives in Suriname during the preceding five years [6].

Discordant sexual mixing is defined as sex between partners from two different groups e. A group characterized by a high degree of sexual mixing can act as a bridge population for STI transmission between seemingly unrelated groups. Surinamese migrants living in the Netherlands may thus be a bridge population for STI transmission between the native populations in Suriname and the Netherlands [6].

If this is the case, it has implications for the design of effective preventive measures to reduce STI transmission. Joint campaigns involving both countries and a focus on travelers might be needed to reduce overall STI prevalence and to increase the impact of prevention. We hypothesized that Surinamese migrants constitute a bridge population for the transmission of C. If this were the case, this would be reflected by:.

We collected C. This method was specifically designed to have a discriminatory power as required for molecular epidemiological analyses. It was epidemiologically validated on clinical samples to differentiate C.

In a previous study, this approach successfully demonstrated the distinct transmission of C. In this study, the distribution of clusters was related to predefined risk characteristics like sexual mixing between native and migrant populations in the two countries. Participants were recruited at two sites in Paramaribo, Suriname and at one site in Amsterdam, the Netherlands:. Exclusion criteria were: age younger than 18 years, antibiotic use in the previous 7 days, men having sex with men in the past 6 months, and previous participation in this study.

After written informed consent, participants were given a unique code to participate anonymously. Participants were interviewed about demographic characteristics, including place of birth, place of birth of both parents, ethnicity of sexual partners, number of sexual partners, and place of residence of their sexual partners. Part of the data collected in the Netherlands has been described previously by Bom et al.

Part of the data collected in Suriname has been described previously by Van der Helm et al. In Paramaribo, urine samples from men and nurse-collected vaginal swabs were obtained, shipped and tested with the Aptima Chlamydia assay for the detection of C. The urine samples were tested within 40 days, and the vaginal swabs within 50 days after collection. A more detailed description has been reported in a previous study [5].

In Amsterdam, urine samples from men and nurse-collected vaginal or cervical swabs were tested with the Aptima assay at the Public Health Laboratory in Amsterdam. For each individual, only one C. For female participants, vaginal samples were preferred; if vaginal samples were not available, cervical samples were selected.

A more detailed description has been reported in a previous study [9]. Nucleic acids from C. Only samples of which all 6 loci were successfully amplified, sequenced, and identified, and therefore had obtained a full sequence type ST or MLST profile, were included in the analyses. A minimum spanning tree was generated using MLST profiles. As the number of STs was too large to be used in statistical analyses, cluster analysis was performed, allowing single locus variance using BioNumerics 7.

A cluster was defined as a group of STs differing by not more than 1 locus from another ST within that group. Only clusters of at least 25 samples were included in the cluster analysis as these clusters were large enough for statistical analyses.

The remaining samples were compiled in a residual group, which was used in the analyses as an additional cluster. Participants were classified into 5 groups based on country of residence of the participant, and country of birth of the participant, and of his or her parents Figure 1 :.

Data were missing for 6 of the participants, therefore they were not included in the analyses. Sexual partners in the past 12 months were classified into three groups based on country of residence of the sexual partner, and the ethnicity of the sexual partner, as perceived by the participant:.

A partner of perceived Surinamese ethnicity was defined as a partner with a Creole, Hindustani, Javanese, Chinese, Maroon, Amerindian, or mixed race ethnicity. A partner of perceived Dutch ethnicity was defined as a partner with a Caucasian ethnicity. Fisher's exact tests were used when the expected cell count was less than one. Analyses were performed with SPSS package version To test whether the distribution of C. A total of men and women participated in Paramaribo and men and women participated in Amsterdam.

Table 1 shows general characteristics of the C. In both cities we found 9 different genovars, being B, and D through K. Within this minimum spanning tree, identical samples or samples differing by one locus were grouped together. If these groups contained 25 or more samples, they were considered a cluster and this is indicated in the minimum spanning tree with a halo. A cluster supposedly represents one C. Each circle represents one MLST type. Size of the circles is proportional to the number of identical MLST profiles.

Bold lines connect types that differ by one single locus. Halos indicate clusters. Demographic characteristics were compared for the four large clusters and the residual group. Gender, age, and number of sexual partners in the past 12 months did not differ significantly between the clusters.

The participants in cluster 2 had received more education, whereas participants in clusters 3 and 4 had received less education; these differences are largely due to the city of origin of the participants. Clusters 3 and 4 had more native Surinamese participants than the other clusters and cluster 2 had more native Dutch participants. Cluster 4 had more Surinamese migrant participants compared with the other clusters. Guiana, and the Netherlands to look for safety, employment, and.

This urbanization fuelled a lively. Klooster, At the same time, the rapid spread of STDs. Although genital baths must have been a common practice in the. Aluku Maroons in French Guiana Fleury, v ery little has. Giv en the lack of informa-. W e did so by quantifying. With this paper , we. Fieldwork was conducted from January to July and. Klaaskreek Brokopondo. After explaining to our informants. W e recorded the vernacular names, the methods of preparation,. In addition, we conducted a systematic survey of.

W oman taking a genital steam bath. Laurent du Maroni, the main border town in French Guiana. Duplicates of botanical. Finally, we. Behari-Ramdas, , and a hectare plot study combined with. W e merged the data concerning geni-. T o prepare a steam bath, the woman boils plant material,. W e recorded plant steam-bath species see Appendix ,. W e were unable. Although most of the plants.

At the medicinal. More than kg of steam-bath ingredients were offered for. The plants cited. Piperaceae, , and Xylopia frutescens. Annonaceae, Many plants were cited for more than. Siparunaceae , Campomanesia. Genital steam baths are regarded as aphrodisiacs for both. T riana Melastomataceae ,. Don ex DC. Melastomataceae , or a pleased husband. Not all intimate baths, however , are meant. W omen of different ethnic-. Most popular vaginal steam-bath herbs sold in Paramaribo, Suriname.

Campomanesia aromatica a 22 1, Scoparia dulcis 23 1, Costus scaber 9 Siparuna guianensis 20 1, Vismia guianensis a 99 15 Parkia pendula 93 18 3, Piper marginatum 60 14 Bellucia grossularioides a 48 12 Maprounea guianensis 45 9 Ludwigia nervosa a 45 11 Miconia prasina a 42 12 Miscellaneous 65 spp.

Total — 42, Remaining species are also sold. These baths also caused the uterus to return to its. If a woman refrained from cleansing her uterus after childbirth,. According to. This description suggests. None of our respondents were aware that a dry , tight vagina. On the contrary, the y were convinced. Reason for taking a genital steam bath No. Cleanse vagina general Cleanse uterus after birth Disguise bad smell Enhance sexual pleasure Prevent and treat fever after birth Strengthening woman after birth Contract uterus after delivery Slimming after birth Cleanse uterus after menstruation Keep partner pleased Feel good, feel free Reduce uterus pain after delivery Magic luck charms, love charms The Maroon males we spoke to were all positive about genital.

Their only concern was that some women used not only. Why are so many different species used for intimate hygiene? Our informants explained that every woman must try out a num-. Most Surinamese medical practitioners we. Plants for genital steam baths are also exported to the. Netherlands, where they are popular among Surinamese migrant. Several Surinamese enterprises started with an on-line. Some of them receive orders. Remarkably, none of the Dutch medical.

In general,. Dutch doctors discourage the use of vaginal douches and other. Being clean is essential in the Afro-Surinamese culture and. Menstruating women and moth-. V aginal baths are seen as a way to purify the female. Moreover, by pleasing their partner and disinfecting. The type of application and the herbal ingredients used in. Suriname are different from those used in Africa. Runganga and Kasule, The perceived effects and the. Maroons of both sex es, who were interviewed by T erborg.

When asked if dry sex caused contact bleeding. The vast majority of the HIV -positives. Several initiativ es on the national level are being under-. Studies on HIV prevalence among ethnic minorities in the.

Netherlands report considerable sexual risk behaviour among. None of these reports, however , men-. HIV prevalence among. Kramer et al. W e have reasons to believ e that dry-sex practices are also. W e noticed steam-bath herbs. On the contrary,. Fleury emphasised the promising potential of genital. Remarkably , Tortevoye. In Guyana, traditional midwifes prepare steam baths to con-. Dry-se x practices are also. These observations strengthen our idea that the use of herbs for.

Given the popularity of dry sex, its important role in Afro-. Surinamese culture, and the limited understanding of infective. Moreover, prohibiting. Dalle, The maternal mortality ratio in Suriname was Our results show that genital steam baths are frequently used. In the major Maroon settlements, where.

Cleaning out the uterus after a. W e hope that our results can help to. More research is. Given the astonishing number of steam-bath herbs used and. The main purposes of these baths. In particular those herbs. Medical personnel in the Nether-. W e thank all Surinamese women who shared their knowledge.

Groenendijk, R. Havinga, K. W e are grateful. W e thank L. Cobb, P. Maas, E. W erger for their comments on our manuscript. This research was.