Sexual HIV Risk Among Male Parolees and Their Female Partners: The Relate Project

PubMed Central

Comfort, Megan; Reznick, Olga Grinstead; Dilworth, Samantha E.; Binson, Diane; Darbes, Lynae A.; Neilands, Torsten B.

2014-01-01

Background The massively disproportionate impact of America’s prison boom on communities of color has raised questions about how incarceration may affect health disparities, including disparities in HIV. Primary partners are an important source of influence on sexual health. In this paper, we investigate sexual HIV risk among male-female couples following a man’s release from prison. Methods We draw upon data from the Relate Project, a novel cross-sectional survey of recently released men and their female partners in Oakland and San Francisco, California (N=344). Inferential analyses use the actor-partner model to explore actor and partner effects on sexual HIV risk outcomes. Results Dyadic analyses of sexual HIV risk among male parolees and their female partners paint a complex portrait of couples affected by incarceration and of partners’ influences on each other. Findings indicate that demographic factors such as education level and employment status, individual psycho-social factors such as perception of risk, and relationship factors such as commitment and power affect sexual HIV risk outcomes. Conclusion The Relate Project provides a novel dataset for the dyadic analysis of sexual risk among male parolees and their female partners, and results highlight the importance of focusing on the couple as a unit when assessing HIV risk and protective behaviors. Results also indicate potentially fruitful avenues for population-specific interventions that may help to reduce sexual health disparities among couples affected by incarceration. PMID:25642396

HIV Risk Perception, HIV Knowledge, and Sexual Risk Behaviors among Transgender Women in South Florida.

PubMed

De Santis, Joseph P; Hauglum, Shayne D; Deleon, Diego A; Provencio-Vasquez, Elias; Rodriguez, Allan E

2017-05-01

Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk. © 2016 Wiley Periodicals, Inc.

Neural correlates of perceived risk: the case of HIV

PubMed Central

Renner, Britta; Schupp, Harald T.

2012-01-01

Research indicates that many people do not use condoms consistently but rather rely on illusory control strategies for avoiding an infection with HIV. Preliminary evidence suggests that people form impressions of a partner’s HIV risk based on his or her physical appearance. To examine the neural correlates of such appearance-based HIV risk impressions, event-related potentials were recorded while participants viewed portraits of unacquainted persons. Participants’ explicit HIV risk ratings for each of the presented unacquainted persons were used to form categories of low and high HIV risk persons. Results showed that risky, compared to safe persons elicited distinct event-related potential (ERP) modulations. Viewing risky persons was associated with an increased positivity over right frontal regions between 180 and 240 ms. This suggests that impressions related to HIV risk occur rapidly, presumably reflecting automatic person evaluations eluding introspection. In a time window between 450 and 600 ms, risky persons elicited an increased late positive potential. Consistent with previous findings reporting augmented late positive potentials (LPP) amplitudes to affectively significant stimuli, the results support the assumption that risky faces draw more attention resources. These findings are in accordance with the ‘risk as feeling’ notion. PMID:21672948

Will HIV Vaccination Reshape HIV Risk Behavior Networks? A Social Network Analysis of Drug Users' Anticipated Risk Compensation

PubMed Central

Young, April M.; Halgin, Daniel S.; DiClemente, Ralph J.; Sterk, Claire E.; Havens, Jennifer R.

2014-01-01

Background An HIV vaccine could substantially impact the epidemic. However, risk compensation (RC), or post-vaccination increase in risk behavior, could present a major challenge. The methodology used in previous studies of risk compensation has been almost exclusively individual-level in focus, and has not explored how increased risk behavior could affect the connectivity of risk networks. This study examined the impact of anticipated HIV vaccine-related RC on the structure of high-risk drug users' sexual and injection risk network. Methods A sample of 433 rural drug users in the US provided data on their risk relationships (i.e., those involving recent unprotected sex and/or injection equipment sharing). Dyad-specific data were collected on likelihood of increasing/initiating risk behavior if they, their partner, or they and their partner received an HIV vaccine. Using these data and social network analysis, a "post-vaccination network" was constructed and compared to the current network on measures relevant to HIV transmission, including network size, cohesiveness (e.g., diameter, component structure, density), and centrality. Results Participants reported 488 risk relationships. Few reported an intention to decrease condom use or increase equipment sharing (4% and 1%, respectively). RC intent was reported in 30 existing risk relationships and vaccination was anticipated to elicit the formation of five new relationships. RC resulted in a 5% increase in risk network size (n = 142 to n = 149) and a significant increase in network density. The initiation of risk relationships resulted in the connection of otherwise disconnected network components, with the largest doubling in size from five to ten. Conclusions This study demonstrates a new methodological approach to studying RC and reveals that behavior change following HIV vaccination could potentially impact risk network connectivity. These data will be valuable in parameterizing future network models

HIV-negative Men-who-Have-Sex-with-Men who Bareback are Concerned about HIV Infection: Implications for HIV Risk Reduction Interventions

PubMed Central

Balán, Iván C.; Carballo-Diéguez, Alex; Ventuneac, Ana; Remien, Robert H.; Dolezal, Curtis; Ford, Jordan

2012-01-01

The emergence of barebacking (intentional unprotected anal intercourse in situations where there is risk of HIV infection) among men who have sex with men (MSM) has been partially attributed to a decrease in HIV-related concerns due to improved anti-retroviral treatment. It is important to understand the level of concern these men have regarding HIV infection because it can affect their interest in risk reduction behaviors as well as their possible engagement in risk reduction interventions. As part of a study on MSM who use the Internet to seek sexual partners, 89 ethnic and racially diverse men who reported never having an HIV-positive test result completed an in-depth qualitative interview and a computer-based quantitative assessment. Of the 82 men who were asked about concerns of HIV infection during the qualitative interviews, 30 expressed “significant concern” about acquiring HIV, while 42 expressed “moderate concern,” and 10 expressed “minimal concern. Themes that emerged across the different levels of concern were their perceptions of the severity of HIV infection, having friends who are HIV positive, and their own vulnerability to HIV infection. However, these themes differed depending on the level of concern. Among the most frequently mentioned approaches to decrease risk of HIV infection, participants mentioned avoiding HIV-positive sex partners, limiting the number of partners with whom they barebacked, and not allowing partners to ejaculate inside their rectum. Findings suggest that many MSM who bareback would be amenable to HIV prevention efforts that do not depend solely on condom use. PMID:22218787

A scoping review of the associations between mental health and factors related to HIV acquisition and disease progression in conflict-affected populations.

PubMed

Koegler, Erica; Kennedy, Caitlin E

2018-01-01

The association between poor mental health and factors related to HIV acquisition and disease progression (also referred to as HIV-related factors) may be stronger among conflict-affected populations given elevated rates of mental health disorders. We conducted a scoping review of the literature to identify evidence-based associations between mental health (depression, anxiety, and post-traumatic stress disorder [PTSD]) and factors related to HIV acquisition and progression in conflict-affected populations. Five electronic databases were searched on October 10, 2014 and updated on March 7, 2017 to identify peer-reviewed publications presenting primary data from January 1, 1994 to March 7, 2017. Articles were included if: 1) depression, anxiety, and/or PTSD was assessed using a validated scale, 2) HIV or HIV-related factors were a primary focus, 3) quantitative associations between depression/anxiety/PTSD and HIV or HIV-related factors were assessed, and 4) the study population was conflict-affected and from a conflict-affected setting. Of 714 citations identified, 33 articles covering 110,818 participants were included. Most were from sub-Saharan Africa ( n  = 25), five were from the USA, and one each was from the Middle East, Europe, and Latin America. There were 23 cross-sectional, 3 time-series, and 7 cohort studies. The search identified that mental health has been quantitatively associated with the following categories of HIV-related factors in conflict-affected populations: markers of HIV risk, HIV-related health status, sexual risk behaviors, and HIV risk exposures (i.e. sexual violence). Further, findings suggest that symptoms of poor mental health are associated with sexual risk behaviors and HIV markers, while HIV risk exposures and health status are associated with symptoms of poor mental health. Results suggest a role for greater integration and referrals across HIV and mental health programs for conflict-affected populations.

HIV risk and preventive interventions in transgender women sex workers

PubMed Central

Poteat, Tonia; Wirtz, Andrea L; Radix, Anita; Borquez, Annick; Silva-Santisteban, Alfonso; Deutsch, Madeline B; Khan, Sharful Islam; Winter, Sam; Operario, Don

2015-01-01

Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population. PMID:25059941

Household displacement and health risk behaviors among HIV/AIDS-affected children in rural China.

PubMed

Zhao, Qun; Zhao, Junfeng; Li, Xiaoming; Fang, Xiaoyi; Zhao, Guoxiang; Lin, Xiuyun; Zhang, Liying

2011-07-01

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangements and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of HIV/AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children), and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AIDS orphans and vulnerable children in communities with a high prevalence of HIV/AIDS. The government, community, and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents.

HIV risk and preventive interventions in transgender women sex workers.

PubMed

Poteat, Tonia; Wirtz, Andrea L; Radix, Anita; Borquez, Annick; Silva-Santisteban, Alfonso; Deutsch, Madeline B; Khan, Sharful Islam; Winter, Sam; Operario, Don

2015-01-17

Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population. Copyright © 2015 Elsevier Ltd. All rights reserved.

A systematic review of measures of HIV/AIDS stigma in paediatric HIV-infected and HIV-affected populations

PubMed Central

McAteer, Carole Ian; Truong, Nhan-Ai Thi; Aluoch, Josephine; Deathe, Andrew Roland; Nyandiko, Winstone M; Marete, Irene; Vreeman, Rachel Christine

2016-01-01

Introduction HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. Methods We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. Results and discussion Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. Conclusions Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity. PMID:27717409

A systematic review of measures of HIV/AIDS stigma in paediatric HIV-infected and HIV-affected populations.

PubMed

McAteer, Carole Ian; Truong, Nhan-Ai Thi; Aluoch, Josephine; Deathe, Andrew Roland; Nyandiko, Winstone M; Marete, Irene; Vreeman, Rachel Christine

2016-01-01

HIV-related stigma impacts the quality of life and care management of HIV-infected and HIV-affected individuals, but how we measure stigma and its impact on children and adolescents has less often been described. We conducted a systematic review of studies that measured HIV-related stigma with a quantitative tool in paediatric HIV-infected and HIV-affected populations. Varying measures have been used to assess stigma in paediatric populations, with most studies utilizing the full or variant form of the HIV Stigma Scale that has been validated in adult populations and utilized with paediatric populations in Africa, Asia and the United States. Other common measures included the Perceived Public Stigma Against Children Affected by HIV, primarily utilized and validated in China. Few studies implored item validation techniques with the population of interest, although scales were used in a different cultural context from the origin of the scale. Many stigma measures have been used to assess HIV stigma in paediatric populations, globally, but few have implored methods for cultural adaptation and content validity.

Sexual behavior and risk practices of HIV positive and HIV negative Rwandan women

PubMed Central

ADEDIMEJI, Adebola A.; HOOVER, Donald R.; SHI, Qiuhu; GARD, Tracy; MUTIMURA, Eugene; SINAYOBYE, Jean d’Amour; COHEN, Mardge H.; ANASTOS, Kathryn

2014-01-01

It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75% of participants were HIV positive and ~50% reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents’ age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors. PMID:25488169

Sexual Behavior and Risk Practices of HIV Positive and HIV Negative Rwandan Women.

PubMed

Adedimeji, Adebola A; Hoover, Donald R; Shi, Qiuhu; Gard, Tracy; Mutimura, Eugene; Sinayobye, Jean d'Amour; Cohen, Mardge H; Anastos, Kathryn

2015-07-01

It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75 % of participants were HIV positive and ~50 % reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents' age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors.

Alcohol misuse, depressive symptoms, and HIV/STI risks of US Hispanic women.

PubMed

McCabe, Brian E; Schaefer Solle, Natasha; Peragallo Montano, Nilda; Mitrani, Victoria B

2017-10-01

Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study's objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors. Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors. Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR = 2.15) and better HIV/STI knowledge (β = -.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR = 1.76) and worse HIV/STI knowledge (β = .37). Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women's health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.

Predictors of HIV, HIV Risk Perception, and HIV Worry Among Adolescent Girls and Young Women in Lilongwe, Malawi.

PubMed

Price, Joan T; Rosenberg, Nora E; Vansia, Dhrutika; Phanga, Twambilile; Bhushan, Nivedita L; Maseko, Bertha; Brar, Savvy K; Hosseinipour, Mina C; Tang, Jennifer H; Bekker, Linda-Gail; Pettifor, Audrey

2018-01-01

Adolescent girls and young women (AGYW) in sub-Saharan Africa have high HIV prevalence and incidence. We sought to understand which HIV risk factors individually and in combination contribute to risk, and whether these factors are associated with HIV worry and risk perception. This study is ongoing at 4 public health centers in Lilongwe, Malawi (2016-2017). AGYW of 15-24 years old were recruited to participate in a study assessing 4 models of service delivery. At each health center, participants completed a baseline survey assessing socioeconomic, behavioral, biomedical, and partnership characteristics; self-reported HIV status; and, if HIV-uninfected, HIV risk perception (high versus low or none) and HIV worry (any versus none). We analyzed associations between baseline characteristics and HIV prevalence, risk perception, and worry. Among 1000 AGYW, median age was 19 years (IQR: 17-21). Thirty-three participants reported being HIV-infected. Fifteen characteristics were associated with HIV infection. Having more risk factors was associated with higher HIV prevalence (≤4 factors, 0.5%; 5-8 factors, 6%; >8 factors, 21%). Having more risk factors was also associated with higher risk perception (P < 0.001) and higher worry (P < 0.001). However, among those with ≥8 risk factors, 52% did not consider themselves to be at high risk and 21% did not report any HIV worry. Most AGYW perceive little risk of HIV acquisition, even those at highest risk. As a critical gap in the HIV prevention cascade, accurate risk perception is needed to tailor effective and sustained combination prevention strategies for this vulnerable population.

Intergenerational Pathways Linking Childhood Sexual Abuse to HIV Risk Among Women

PubMed Central

Cavanaugh, Courtenay E.; Classen, Catherine C.

2009-01-01

Childhood sexual abuse is prevalent among women and it has been linked to a number of problems affecting women's health and functioning including women's parenting practices. Another body of literature has linked specific maternal parenting practices to daughters’ HIV risk, including mother-daughter sex communication, monitoring/knowledge about daughters’ activities, mother-daughter relationship quality, attitudes towards sex, and modeling of sexual values. This paper reviews and links these two bodies of literature to indicate how maternal histories of childhood sexual abuse may compromise mothers’ parenting practices, which may in turn impact daughters’ HIV risk. We also build upon Malow and colleagues’ model (2006) of the associations between childhood sexual abuse and HIV risk to present a model indicating potential intergenerational pathways between childhood sexual abuse and HIV risk among women. The literature supporting this model and gaps in the literature are described. PMID:19333846

HIV testing behaviour and use of risk reduction strategies by HIV risk category among MSM in Vancouver.

PubMed

Bogowicz, Paul; Moore, David; Kanters, Steve; Michelow, Warren; Robert, Wayne; Hogg, Robert; Gustafson, Réka; Gilbert, Mark

2016-03-01

We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis. © The Author(s) 2016.

Estimating the annual risk of HIV transmission within HIV sero-discordant couples in sub-Saharan Africa.

PubMed

Awad, Susanne F; Chemaitelly, Hiam; Abu-Raddad, Laith J

2018-01-01

To estimate the annual risk of HIV transmission (ϕ) within HIV sero-discordant couples in 23 countries in sub-Saharan Africa (SSA), by utilizing newly available national population-based data and accounting for factors known to potentially affect this estimation. We used a recently developed pair-based mathematical model that accommodates for HIV-dynamics temporal variation, sexual risk-behavior heterogeneity, and antiretroviral therapy (ART) scale-up. Estimated country-specific ϕ (in absence of ART) ranged between 4.2% (95% uncertainty interval (UI): 1.9%-6.3%) and 47.4% (95% UI: 37.2%-69.0%) per person-year (ppy), with a median of 12.4%. ϕ was strongly associated with HIV prevalence, with a Pearson correlation coefficient of 0.92, and was larger in high- versus low-HIV-prevalence countries. ϕ increased by 1.31% (95% confidence interval: 1.00%-1.55%) ppy for every 1% increase in HIV prevalence. ϕ estimates were similar to earlier estimates, and suggested considerable heterogeneity in HIV infectiousness across SSA. This heterogeneity may explain, partly, the differences in epidemic scales. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Recent trauma is associated with antiretroviral failure and HIV transmission risk behavior among HIV-positive women and female-identified transgenders.

PubMed

Machtinger, E L; Haberer, J E; Wilson, T C; Weiss, D S

2012-11-01

Trauma and posttraumatic stress disorder disproportionally affect HIV-positive women. Studies increasingly demonstrate that both conditions may predict poor HIV-related health outcomes and transmission-risk behaviors. This study analyzed data from a prevention-with-positives program to understand if socio-economic, behavioral, and health-related factors are associated with antiretroviral failure and HIV transmission-risk behaviors among 113 HIV-positive biological and transgender women. An affirmative answer to a simple screening question for recent trauma was significantly associated with both outcomes. Compared to participants without recent trauma, participants reporting recent trauma had over four-times the odds of antiretroviral failure (AOR 4.3; 95% CI 1.1-16.6; p = 0.04), and over three-times the odds of reporting sex with an HIV-negative or unknown serostatus partner (AOR 3.9; 95% CI 1.3-11.9; p = 0.02) and <100% condom use with these partners (AOR 4.5; 95% CI 1.5-13.3; p = 0.007). Screening for recent trauma in HIV-positive biological and transgender women identifies patients at high risk for poor health outcomes and HIV transmission-risk behavior.

Negotiating Risk: Knowledge and Use of HIV Prevention by Persons With Serious Mental Illness Living in Supportive Housing

PubMed Central

Kloos, Bret; Gross, Steven M.; Meese, Katharine J.; Meade, Christina S.; Doughty, Jhan D.; Hawkins, Dietra D.; Zimmerman, Susan O.; Snow, David L.; Sikkema, Kathleen J.

2008-01-01

As a population, persons with serious mental illness (SMI) have an elevated risk for HIV infection. However, relatively little is known about how the risk of HIV has affected their lives, how persons with SMI evaluate their HIV risk, and what preventive measures they undertake. Furthermore, relatively little is known about community-based HIV prevention for persons with SMI as most interventions have been restricted to clinical settings. This report presents findings on the HIV-related experiences of persons with SMI living in supportive housing programs, one possible setting for implementing community-based HIV prevention with this population. The qualitative investigation interviewed 41 men and women living in five supportive housing programs. In-depth, qualitative interviews elicited discussion of research participants’ (a) experiences with HIV, (b) knowledge about HIV and HIV prevention, (c) assessments of their own risk, (d) descriptions of how they apply their prevention knowledge, and (e) reports of barriers for HIV prevention. Research participants describe social networks that have substantial contact with persons affected by HIV. However, contrary to some expectations of persons with SMI, research participants report using HIV prevention knowledge in negotiating their risk of contracting HIV. The implications of these findings are discussed in terms of their relevance for implementing community-based HIV prevention for persons with SMI. PMID:16389505

Actual sexual risk and perceived risk of HIV acquisition among HIV-negative men who have sex with men in Toronto, Canada.

PubMed

Kesler, Maya A; Kaul, Rupert; Liu, Juan; Loutfy, Mona; Gesink, Dionne; Myers, Ted; Remis, Robert S

2016-03-11

Theory suggests that perceived human immunodeficiency virus (HIV) risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk. Sexually active men who have sex with men (MSM) were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI). Actual HIV risk (primary predictor) was constructed by applying principal component analysis (PCA) to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome) was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk. One hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37-50 years]). Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR) 18.33, 95% confidence interval (CI) 1.65-203.45). Older age was associated with lower perceived risk but only

At risk, infected, and invisible: older gay men and HIV/AIDS.

PubMed

Grossman, A H

1995-01-01

Older gay men over the age of 50 have been and continue to be an invisible part of the HIV/AIDS epidemic. The reasons for this phenomenon are many, but among them are societal beliefs, myths, and stereotypes emanating from ageism and homophobia. In addition, HIV/AIDS is sometimes misdiagnosed in older adults because many of its symptoms mimic other illness that affect older people. Among the HIV risk factors of older gay men are internalized homophobia, denial of risk, alcohol and other substance use, and anonymous sexual encounters. The challenge for nurses and other providers is to reach, educate, and assist older gay men effectively in changing and maintaining safe behaviors when they are engaging in sexual and drug-using behaviors that can transmit HIV.

Maternal HIV Serostatus, Mother–Daughter Sexual Risk Communication and Adolescent HIV Risk Beliefs and Intentions

PubMed Central

Hutchinson, M. Katherine; Duan, Lei; Jemmott, Loretta S.

2012-01-01

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters’ abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter’s HIV risk and provide them with relationship building and parent process skills to help reduce these risks. PMID:22677973

Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions.

PubMed

Cederbaum, Julie A; Hutchinson, M Katherine; Duan, Lei; Jemmott, Loretta S

2013-09-01

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.

Social Marginalization and Children's Rights: HIV-Affected Children in the Republic of Trinidad and Tobago

ERIC Educational Resources Information Center

Jones, Adele

2009-01-01

This article examines the social epidemiology of HIV/AIDS within a Caribbean context and the specific ways in which children are affected. In particular, the article explores the nature of risk and vulnerability among especially marginalized children: street children. Literature on HIV/AIDS was reviewed, and semistructured interviews with 44 key…

Shared Communities, Structural Contexts, and HIV Risk: Prioritizing the HIV Risk and Prevention Needs of Black Heterosexual Men

PubMed Central

Raj, Anita

2012-01-01

Black heterosexual men (BHM) are seldom mentioned in HIV prevention research, policy, and interventions, despite evidence that heterosexual contact is becoming the leading exposure category for BHM. The disparate effect of HIV/AIDS on BHM; the debunked “down low” myth; the contexts of BHM's lives in terms of disproportionate poverty, unemployment, and incarceration; and a growing empirical base linking these factors to increased HIV risk, underscore the need to prioritize HIV risk and prevention initiatives for BHM. We highlighted the structural contexts of HIV risk for BHM, and four community-based approaches to address HIV risk and prevention for BHM: (1) men's health programs; (2) workforce and postincarceration release programs; (3) linkages to women's prevention programs; and (4) faith-based initiatives. PMID:22401513

The relationship of reported HIV risk and history of HIV testing among emergency department patients.

PubMed

Merchant, Roland C; Freelove, Sarah M; Langan, Thomas J; Clark, Melissa A; Mayer, Kenneth H; Seage, George R; DeGruttola, Victor G

2010-01-01

Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, academic ED were surveyed about their history of ever having been tested for HIV and their reported HIV risk behaviors. A reported HIV risk score was calculated from the survey responses and divided into 4 levels, based on quartiles of the risk scores. Pearson's X(2) testing was used to compare HIV testing history and level of reported HIV risk. Logistic regression models were created to investigate the association between level of reported HIV risk and the outcome of ever having been tested for HIV. Of the 557 participants, 62.1% were female. A larger proportion of females than males (71.4% vs 60.6%; P < 0.01) reported they had been tested for HIV. Among the 211 males, 11.4% reported no HIV risk, and among the 346 females, 10.7% reported no HIV risk. The proportion of those who had been tested for HIV was greater among those reporting any risk compared with those reporting no risk for females (75.4% vs 37.8%; P < 0.001), but not for males (59.9% vs 66.7%; P < 0.52). However, certain high-risk behaviors, such as a history of injection-drug use, were associated with prior HIV testing for both genders. In the logistic regression analyses, there was no relationship between increasing level of reported HIV risk and a history of ever having been tested for HIV for males. For females, a history of ever having been tested was related to increasing level of reported risk, but not in a linear fashion. The relationship between reported HIV risk and history of testing among these ED patients was complex and differed by gender. Among these patients, having greater risk did not necessarily mean a higher likelihood of ever having been tested for HIV.

Migration and HIV risk: Life histories of Mexican-born men living with HIV in North Carolina

PubMed Central

Mann, Lilli; Valera, Erik; Hightow-Weidman, Lisa B.; Barrington, Clare

2015-01-01

Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina (NC), a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health. PMID:24866206

HIV Risk Behaviors among African American Women with at-Risk Male Partners

PubMed Central

Paxton, Keisha C.; Williams, John K.; Bolden, Sherica; Guzman, Yesenia; Harawa, Nina T.

2014-01-01

Background HIV continues to impact African American women at alarming rates. Yet, few researchers have examined the relationship factors promoting unprotected sex within African American communities, especially instances in which women are aware that their male partners are engaging in high risk behaviors. This qualitative study explored the sexual behaviors, relationship characteristics, and HIV prevention strategies utilized by African American women in relationships with African American men at-risk for HIV. Method To understand the issues that should be addressed in a sexual risk-reduction intervention, data were collected from three, two-hour focus group discussions (n=24) comprised primarily of low-income African American women with histories of at-risk male sex partners. At-risk partners included specifically men who had sex with other men or with transgender individuals, used crack cocaine or injection drugs, had lengthy incarceration periods, or an unknown sexual history. Discussion questions examined external factors affecting sexual risk behaviors such as societal pressures, peer norms, and financial vulnerability. Discussions were audiotaped, transcribed, and analyzed using a consensual qualitative research approach. Results Five themes, including self-esteem, social influences on behavior, relationship fidelity, sexual risk behavior, and partners' sexual behaviors, were identified as placing women at increased risk for HIV. Reasons for inconsistent condom use included concern for maintaining the relationship and substance use before and during sex. African American women also believed that men who have sex with men and women (MSMW) were dishonest about their sexuality due to stigma towards homosexuality/bisexuality. Despite these challenges, participants indicated that African American women have a strong sense of pride that can positively impact behaviors in relationships. Conclusion The findings of this study support that social and contextual factor

Attitudes and stereotypes regarding older women and HIV risk.

PubMed

Beaulaurier, Richard; Fortuna, Karen; Lind, Danielle; Emlet, Charles A

2014-01-01

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.

Cardiovascular risk-factor knowledge and risk perception among HIV-infected adults.

PubMed

Cioe, Patricia A; Crawford, Sybil L; Stein, Michael D

2014-01-01

Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk [F(1, 117) = 0.13, p > .05]. Estimated risk and perceived risk were weakly but significantly correlated; r (126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk-factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Patterns of HIV Prevalence and HIV Risk Behaviors among Injection Drug Users Prior to and 24 Months following Implementation of Cross-Border HIV Prevention Interventions in Northern Vietnam and Southern China

ERIC Educational Resources Information Center

Hammett, Theodore M.; Kling, Ryan; Johnston, Patrick; Liu, Wei; Ngu, Doan; Friedmann, Patricia; Binh, Kieu Thanh; Dong, Ha Viet; Van, Ly Kieu; Donghua, Meng; Chen, Yi; Des Jarlais, Don C.

2006-01-01

In 2002, we implemented a 4-year HIV prevention intervention for injection drug users (IDUs) in Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China, a cross-border region seriously affected by inter-twined epidemics of heroin injection and HIV infection. The interventions involve peer education on HIV risk reduction and…

Pre-exposure prophylaxis does not affect the fertility of HIV-1-uninfected men.

PubMed

Were, Edwin O; Heffron, Renee; Mugo, Nelly R; Celum, Connie; Mujugira, Andrew; Bukusi, Elizabeth A; Baeten, Jared M

2014-08-24

There is a paucity of data on the effect of antiretroviral medications on male fertility. Couples affected by HIV-1 often have fertility intentions, and antiretroviral medications, as both treatment of HIV-1-infected persons and pre-exposure prophylaxis (PrEP) for uninfected persons, are part of peri-conception risk reduction. Within a randomized, placebo-controlled trial of daily oral tenofovir disoproxil fumarate (TDF) and combination emtricitabine (FTC)/TDF PrEP for HIV-1 prevention conducted among heterosexual HIV-1-serodiscordant couples, we assessed the impact of TDF and FTC/TDF use on male fertility, measured as incident pregnancy in female partners of men assigned to PrEP vs. placebo. Of the 2962 HIV-1-uninfected men partners, 986 were randomized to TDF, 1013 to FTC/TDF, and 963 to placebo. The overall pregnancy incidence in their HIV-1-infected female partners was 12.9 per 100 person-years and did not differ significantly across the study arms (13.2 TDF, 12.4 FTC/TDF, 13.2 placebo). The frequency of live births, pregnancy losses, and gestational age at birth or loss was also statistically similar in the three randomization groups. TDF and FTC/TDF, when used as PrEP by HIV-1-uninfected men, did not adversely affect male fertility or pregnancy outcomes.

Latent Class Analysis of HIV Risk Behaviors Among Russian Women at Risk for Alcohol-Exposed Pregnancies.

PubMed

Bohora, Som; Chaffin, Mark; Shaboltas, Alla; Bonner, Barbara; Isurina, Galina; Batluk, Julia; Bard, David; Tsvetkova, Larissa; Skitnevskaya, Larissa; Volkova, Elena; Balachova, Tatiana

2017-11-01

The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner's risk associated with partner's drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner's risk that included partner's imprisonment and partner's sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners' risk, and these participants utilized protection (class III). The odds

Risk factors for incomplete immunization in children with HIV infection.

PubMed

Bhattacharya, Sangeeta Das; Bhattacharyya, Subhasish; Chatterjee, Devlina; Niyogi, Swapan Kumar; Chauhan, Nageshwar; Sudar, A

2014-09-01

To document the immunization rates, factors associated with incomplete immunization, and missed opportunities for immunizations in children affected by HIV presenting for routine outpatient follow-up. A cross-sectional study of immunization status of children affected by HIV presenting for routine outpatient care was conducted. Two hundred and six HIV affected children were enrolled. The median age of children in this cohort was 6 y. One hundred ninety seven of 206 children were HIV infected, nine were HIV exposed, but indeterminate. Fifty (25 %) children had incomplete immunizations per the Universal Immunization Program (UIP) of India. Hundred percent of children had received OPV. Ninety three percent of children got their UIP vaccines from a government clinic. Children with incomplete immunization were older, median age of 8 compared to 5 (p = 0.003). Each year of maternal education increased the odds of having a child with complete UIP immunizations by 1.18 (p = 0.008)-children of mothers with 6 y of education compared to those with no education were seven times more likely to have complete UIP vaccine status. The average number of visits to the clinic by an individual child in a year was 4. This represents 200 missed opportunities for immunizations. HIV infected children are at risk for incomplete immunization coverage though they regularly access medical care. Including routine immunizations, particularly catch-up immunizations in programs for HIV infected children maybe an effective way of protecting these children from vaccine preventable disease.

Relative importance of various measures of HIV-related stigma in predicting psychological outcomes among children affected by HIV

PubMed Central

Zhao, Guoxiang; Li, Xiaoming; Zhao, Junfeng; Zhang, Liying; Stanton, Bonita

2011-01-01

Objective To assess the relative importance of four different measures of HIV-related stigma in predicting psychological problems among children affected by HIV in rural China. Methods Cross-sectional data were collected from 755 orphans (i.e., children who lost one or both of their parents to HIV), 466 vulnerable children (children who were living with HIV-infected parents), and 404 comparison children who were from the same community and did not have HIV-related illness or death in their families. Four HIV-related stigma measures include perceived public stigma against people living with HIV/AIDS (PLWHA), perceived public stigma against children affected by HIV (orphans and vulnerable children), personal stigmatizing attitudes against PLWHA, and enacted stigma among children affected by HIV. Psychological problems included depression and adjustment problems. Results Various measures of HIV-related stigma independently and differentially contribute to children psychological problems. Enacted stigma and children's perceived public stigma against PLWHA or children affected by HIV are generally stronger predictors of psychological problems than their own feelings or attitudes towards PLWHA. Conclusion Various aspects of HIV-related stigma are important for us to understand the perception, attitudes, and experience of children affected by HIV, including both children experiencing HIV-related parental illness and death in their own family and children who were living in the communities hardly hit by HIV. Future health promotion and psychological care efforts for children affected by HIV need to consider the effect of various forms of HIV-related stigma on these children's psychosocial well-being and mobilize the community resources to mitigate the negative effect of HIV-related stigma on PLWHA and their children. PMID:21681458

Relative importance of various measures of HIV-related stigma in predicting psychological outcomes among children affected by HIV.

PubMed

Zhao, Guoxiang; Li, Xiaoming; Zhao, Junfeng; Zhang, Liying; Stanton, Bonita

2012-06-01

To assess the relative importance of four different measures of HIV-related stigma in predicting psychological problems among children affected by HIV in rural China. Cross-sectional data were collected from 755 orphans (i.e., children who lost one or both of their parents to HIV), 466 vulnerable children (children who were living with HIV-infected parents), and 404 comparison children who were from the same community and did not have HIV-related illness or death in their families. Four HIV-related stigma measures include perceived public stigma against people living with HIV/AIDS (PLWHA), perceived public stigma against children affected by HIV (orphans and vulnerable children), personal stigmatizing attitudes against PLWHA, and enacted stigma among children affected by HIV. Psychological problems included depression and adjustment problems. Various measures of HIV-related stigma independently and differentially contribute to children's psychological problems. Enacted stigma and children's perceived public stigma against PLWHA or children affected by HIV are generally stronger predictors of psychological problems than their own feelings or attitudes towards PLWHA. Various aspects of HIV-related stigma are important for us to understand the perception, attitudes, and experience of children affected by HIV, including both children experiencing HIV-related parental illness and death in their own family and children who were living in the communities hardly hit by HIV. Future health promotion and psychological care efforts for children affected by HIV need to consider the effect of various forms of HIV-related stigma on these children's psychosocial well-being and mobilize the community resources to mitigate the negative effect of HIV-related stigma on PLWHA and their children.

Orphan status, HIV risk behavior, and mental health among adolescents in rural Kenya.

PubMed

Puffer, Eve S; Drabkin, Anya S; Stashko, Allison L; Broverman, Sherryl A; Ogwang-Odhiambo, Rose A; Sikkema, Kathleen J

2012-09-01

To examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya. Randomly selected adolescents aged 10-18 years completed surveys assessing sexual activity, sex-related beliefs and self-efficacy, mental health, social support, caregiver-child communication, time since parental death, and economic resources. Analysis of covariance and regression analyses compared orphans and nonorphans; orphan status was tested as a moderator between well-being and HIV risk. Orphans reported poorer mental health, less social support, and fewer material resources. They did not differ from nonorphans on HIV risk indicators. Longer time since parental death was associated with poorer outcomes. In moderator analyses, emotional problems and poorer caregiver-youth communication were more strongly associated with lower sex-related self-efficacy for orphans. Orphans are at higher risk for psychosocial problems. These problems may affect orphans' self-efficacy for safer sex practices more than nonorphans. Decreased HIV risk could be one benefit of psychosocial interventions for orphans.

Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

ERIC Educational Resources Information Center

Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

2005-01-01

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti

PubMed Central

Surkan, Pamela J.; Mukherjee, Joia S.; Williams, David R.; Eustache, Eddy; Louis, Ermaze; Jean-Paul, Thierry; Lambert, Wesler; Scanlan, Fiona C.; Oswald, Catherine M.; Fawzi, Mary C. Smith

2010-01-01

In many settings worldwide, HIV-positive individuals have experienced a significant level of stigma and discrimination. This discrimination may also impact other family members affected by the disease, including children. The aim of our study was to identify factors associated with stigma and/or discrimination among HIV-affected youth and their HIV-positive caregivers in central Haiti. Recruitment of HIV-positive patients with children aged 10–17 years was conducted in 2006–2007. Data on HIV-related stigma and/or discrimination were based on interviews with 451 youth and 292 caregivers. Thirty-two percent of caregivers reported that children were discriminated against because of HIV/AIDS. Commune of residence was associated with discrimination against children affected by HIV/AIDS and HIV-related stigma among HIV-positive caregivers, suggesting variability across communities. Multivariable regression models showed that lacking social support, being an orphan, and caregiver HIV-related stigma were associated with discrimination in HIV-affected children. Caregiver HIV-related stigma demonstrated a strong association with depressive symptoms. The results could inform strategies for potential interventions to reduce HIV-related stigma and discrimination. These may include increasing social and caregiver support of children affected by HIV, enhancing support of caregivers to reduce burden of depressive symptoms, and promoting reduction of HIV-related stigma and discrimination at the community-level. PMID:20635244

Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada.

PubMed

Kesler, Maya A; Kaul, Rupert; Myers, Ted; Liu, Juan; Loutfy, Mona; Remis, Robert S; Gesink, Dionne

2016-11-01

Pre-exposure prophylaxis (PrEP) reduces HIV acquisition. Our goal was to determine the willingness of men who have sex with men (MSM) to take PrEP given perceived and actual HIV risk. HIV-negative MSM were recruited from September 2010 to June 2012 and asked about PrEP willingness and perceived HIV risk. Actual sexual HIV risk was measured by three condom-use components generated through principal components analysis. General HIV risk was measured using the HIV Incidence Risk Index for MSM (HIRI-MSM). Model 1 measured PrEP willingness given perceived and actual sexual HIV risk. Model 2 included actual HIV sexual risk, perceived HIV risk and general HIV risk. Model 3 removed actual sexual HIV risk. We recruited 150 HIV-negative MSM. About 55% were willing to take PrEP. Reasons for PrEP unwillingness were: low perceived risk (64%), side-effect concerns (44%), daily pill burden (16%) and efficacy concerns (4%). Model 1: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 27.11, 95% CI 1.33-554.43) after adjusting for perceived risk, which was not significantly associated with PrEP willingness (OR 4.79, 95% CI 0.72-31.96). Model 2: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 29.85, 95% CI 1.39-640.53) after adjusting for perceived and general HIV risk, neither of which was significantly associated with PrEP willingness (OR 5.07, 95% CI 0.73-35.09) and (OR 1.58, 95% CI 0.37-6.79), respectively. Model 3: After removing actual sexual HIV risk, MSM with high compared to low perceived risk were more willing to use PrEP (OR 6.85, 95% CI 1.23-38.05), and the HIRI-MSM general risk index was not associated with PrEP willingness (OR 1.87, 95% CI 0.54-6.54). Therefore, actual sexual HIV risk was the best predictor of PrEP willingness and general HIV risk did not inform PrEP willingness.

Social Support and HIV-related Risk Behaviors: A Systematic Review of the Global Literature

PubMed Central

Li, Xiaoming; Stanton, Bonita

2013-01-01

Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction. PMID:23921582

Fatherhood, marriage and HIV risk among young men in rural Uganda.

PubMed

Mathur, Sanyukta; Higgins, Jenny A; Thummalachetty, Nityanjali; Rasmussen, Mariko; Kelley, Laura; Nakyanjo, Neema; Nalugoda, Fred; Santelli, John S

2016-01-01

Compared to a large body of work on how gender may affect young women's vulnerability to HIV, we know little about how masculine ideals and practices relating to marriage and fertility desires shape young men's HIV risk. Using life-history interview data with 30 HIV-positive and HIV-negative young men aged 15-24 years, this analysis offers an in-depth perspective on young men's transition through adolescence, the desire for fatherhood and experience of sexual partnerships in rural Uganda. Young men consistently reported the desire for fatherhood as a cornerstone of masculinity and transition to adulthood. Ideally young men wanted children within socially sanctioned unions. Yet, most young men were unable to realise their marital intentions. Gendered expectations to be economic providers combined with structural constraints, such as limited access to educational and income-generating opportunities, led some young men to engage in a variety of HIV-risk behaviours. Multiple partnerships and limited condom use were at times an attempt by some young men to attain some part of their aspirations related to fatherhood and marriage. Our findings suggest that young men possess relationship and parenthood aspirations that - in an environment of economic scarcity - may influence HIV-related risk.

Fatherhood, marriage, and HIV risk among young men in rural Uganda

PubMed Central

Mathur, Sanyukta; Higgins, Jenny; Thummalachetty, Nityanjali; Rasmussen, Mariko; Kelley, Laura; Nakyanjo, Neema; Nalugoda, Fred; Santelli, John S.

2016-01-01

Compared to a large body of work on how gender may affect young women’s vulnerability to HIV, we know little about how masculine ideals and practices relating to marriage and fertility desires shape young men’s HIV risk. Using life-history interview data with 30 HIV-positive and HIV-negative young men ages 15-24 years, this analysis offers an in-depth perspective on young men’s transition through adolescence, desire for fatherhood, and experience of sexual partnerships in rural Uganda. Young men consistently reported the desire for fatherhood as a cornerstone of masculinity and transition to adulthood. Ideally young men wanted children within socially sanctioned unions. Yet, most young men were unable to realise their marital intentions. Gendered expectations to be economic providers combined with structural constraints, such as limited access to educational and income-generating opportunities, led some young men to engage in a variety of HIV risk behaviours. Multiple partnerships and limited condom use were at times an attempt by some young men to attain some part of their aspirations related to fatherhood and marriage. Our findings suggest that young men possess relationship and parenthood aspirations that – in an environment of economic scarcity – may influence HIV-related risk. PMID:26540470

The dynamics of injection drug users' personal networks and HIV risk behaviors.

PubMed

Costenbader, Elizabeth C; Astone, Nan M; Latkin, Carl A

2006-07-01

While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups. Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%. The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.

HIV-risk characteristics in community corrections.

PubMed

Clark, C Brendan; McCullumsmith, Cheryl B; Waesche, Matthew C; Islam, M Aminul; Francis, Reginald; Cropsey, Karen L

2013-01-01

Individuals in the criminal justice system engage in behaviors that put them at high risk for HIV. This study sought to identify characteristics of individuals who are under community corrections supervision (eg, probation) and at risk for HIV. Approximately 25,000 individuals under community corrections supervision were assessed for HIV risk, and 5059 participants were deemed high-risk or no-risk. Of those, 1519 exhibited high sexual-risk (SR) behaviors, 203 exhibited injection drug risk (IVR), 957 exhibited both types of risk (SIVR), and 2380 exhibited no risk. Sociodemographic characteristics and drug of choice were then examined using univariate and binary logistic regression. Having a history of sexual abuse, not having insurance, and selecting any drug of choice were associated with all forms of HIV risk. However, the effect sizes associated with the various drugs of choice varied significantly by group. Aside from those common risk factors, very different patterns emerged. Female gender was a risk factor for the SR group but was less likely to be associated with IVR. Younger age was associated with SR, whereas older age was associated with IVR. Black race was a risk factor for SR but had a negative association with IVR and SIVR. Living in a shelter, living with relatives/friends, and being unemployed were all risk factors for IVR but were protective factors for SR. Distinct sociodemographic and substance use characteristics were associated with sexual versus injection drug use risk for individuals under community corrections supervision who were at risk for HIV. Information from this study could help identify high-risk individuals and allow tailoring of interventions.

Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care

PubMed Central

Burns, Bridget F.; Bajunirwe, Francis; Kabakyenga, Jerome; Bwana, Mwebesa; Ng, Courtney; Kastner, Jasmine; Kembabazi, Annet; Sanyu, Naomi; Kusasira, Adrine; Haberer, Jessica E.; Bangsberg, David R.; Kaida, Angela

2017-01-01

Introduction We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. Methods We recruited HIV-positive men and women on antiretroviral therapy (ART) (‘index’) from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner (‘partner’), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. Results 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner’s HIV status. Similarly, the partner’s HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner’s desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment

Grappling with HIV Transmission Risks: Narratives of Rural Women in Eastern Kenya Living with HIV

PubMed Central

Kako, Peninnah M.; Stevens, Patricia E.; Karani, Anna K; Mkandawire-Valhmu, Lucy; Banda, Anne

2011-01-01

As people live longer and more productively with HIV infection, issues of agency in reducing HIV risk are particularly important for HIV-infected women living in high prevalence, under-resourced countries such as Kenya. Because of their gendered lives, in that being masculine is associated with dominance, while being feminine is associated with passiveness, women in rural Kenya must cope with continued HIV transmission risk even after knowing they are infected with HIV. In this narrative interview study, informed by theories of gender and post-colonial feminism, we examined personal accounts of HIV risk and risk reduction of 20 rural women in eastern Kenya who were living with HIV. From our analysis of the women's narratives, two major themes emerged: gender-based obstacles even in the context of a known HIV diagnosis, and struggles with economic pressures amid HIV risks. Implications for policy, programs, and research are discussed. PMID:22137546

Assessing Maladaptive Responses to the Stress of Being At-Risk of HIV Infection among HIV-Negative Gay Men in New York City

PubMed Central

Yi, Huso; Shidlo, Ariel; Sandfort, Theo

2009-01-01

The aim of this study was to examine the psychometric properties and preliminary validity of a newly developed 16-item measure to assess maladaptive responses to the stress of being at risk for HIV infection among HIV-negative gay men. The measure consisted of three factors: (1) fatalistic beliefs about maintaining an HIV-negative serostatus; (2) reduced perceived severity of HIV infection due to advances in medical treatment of HIV/AIDS; and (3) negative affective states associated with the risk of HIV infection. A total of 285 HIV-negative gay men at a counseling program in New York City participated in the study. Confirmatory factor analyses supported the three-factor model as an acceptable model fit: NNFI = .91, CFI = .92, GFI = .90, RMSEA = .07. The measure and its subscales obtained in this sample achieved adequate internal consistency coefficients. Construct validity was supported by significant positive associations with internalized homophobia, depression, self-justifications for the last unprotected anal intercourse (UAI), and actual UAI with casual sex partners. Understanding the dynamics of maladaptive responses to the epidemic and intense anxieties elicited by HIV risk among HIV-negative gay men living in a place of high seroprevalence provides useful information to guide psychosocial interventions in the population. PMID:20043254

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

PubMed Central

Kalichman, Moira O.; Cherry, Chauncey; Grebler, Tamar

2016-01-01

Abstract Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. Results showed that 166 (30%) men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. Men who engaged in nondisclosed condomless sex were less adherent to their HIV treatment, more likely to have unsuppressed HIV, demonstrated poorer disclosure self-efficacy, enacted fewer risk reduction communication skills, and held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness. PMID:27158850

The influence of religion on sexual HIV risk.

PubMed

Shaw, Stacey A; El-Bassel, Nabila

2014-08-01

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

News of Biomedical Advances in HIV: Relationship to Treatment Optimism and Expected Risk Behavior in US MSM.

PubMed

Zimmerman, Rick S; Kirschbaum, Allison L

2018-02-01

HIV treatment optimism and the ways in which news of HIV biomedical advances in HIV is presented to the most at-risk communities interact in ways that affect risk behavior and the incidence of HIV. The goal of the current study was to understand the relationships among HIV treatment optimism, knowledge of HIV biomedical advances, and current and expected increased risk behavior as a result of reading hypothetical news stories of further advances. Most of an online-recruited sample of MSM were quite knowledgeable about current biomedical advances. After reading three hypothetical news stories, 15-24% of those not living with HIV and 26-52% of those living with HIV reported their condom use would decrease if the story they read were true. Results suggest the importance of more cautious reporting on HIV biomedical advances, and for targeting individuals with greater treatment optimism and those living with HIV via organizations where they are most likely to receive their information about HIV.

Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa.

PubMed

Cluver, Lucie D; Orkin, F Mark; Boyes, Mark E; Sherr, Lorraine

2014-07-01

It is not known whether cumulative 'cash plus care' interventions can reduce adolescent HIV-infection risks in sub-Saharan Africa. This study investigated whether parental AIDS and other environmental adversities increase adolescent HIV-risk behaviour and whether social protection provision of 'cash' or integrated 'cash plus care' reduces HIV-risk behaviour. A prospective observational study with random sampling (<2.5% baseline refusal, 1-year follow-up, 96.8% retention). Three thousand five hundred and fifteen 10-18 year-olds (56.7% girls) were interviewed in South Africa between 2009-2010 and 2011-2012. All homes with a resident adolescent were sampled, within randomly selected census areas in two urban and two rural districts in two provinces. Measures included potential environmental risks (e.g. parental HIV/AIDS, poverty), social protection: receipt of cash/food support (e.g. child grants, school feeding), care (e.g. positive parenting) and HIV-risk behaviours (e.g. unprotected sex). Analyses used logistic regression. Cash alone was associated with reduced HIV risk for girls [odds ratio (OR) 0.63; 95% confidence interval (95% CI) 0.44-0.91, P = 0.02] but not for boys. Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes (girls OR 0.55; 95% CI 0.35-0.85, P = 0.007; boys OR 0.50; 95% CI 0.31-0.82, P = 0.005), compared with no support and controlling for confounders. Follow-up HIV-risk behaviour was reduced from 41 to 15% for girls and from 42 to 17% for boys. Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour, but were less likely to access integrated social protection. Integrated cash plus care reduces male and female adolescent HIV-risk behaviours. Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa.

HIV infection risk factors among male-to-female transgender persons: a review of the literature.

PubMed

De Santis, Joseph P

2009-01-01

Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identified.

Male circumcision and HIV infection risk.

PubMed

Krieger, John N

2012-02-01

Male circumcision is being promoted to reduce human immunodeficiency virus type 1 (HIV) infection rates. This review evaluates the scientific evidence suggesting that male circumcision reduces HIV infection risk in high-risk heterosexual populations. We followed the updated International Consultation on Urological Diseases evidence-based medicine recommendations to critically review the scientific evidence on male circumcision and HIV infection risk. Level 1 evidence supports the concept that male circumcision substantially reduces the risk of HIV infection. Three major lines of evidence support this conclusion: biological data suggesting that this concept is plausible, data from observational studies supported by high-quality meta-analyses, and three randomized clinical trials supported by high-quality meta-analyses. The evidence from these biological studies, observational studies, randomized controlled clinical trials, meta-analyses, and cost-effectiveness studies is conclusive. The challenges to implementation of male circumcision as a public health measure in high-risk populations must now be faced.

HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection.

PubMed

Eaton, Lisa A; West, Tessa V; Kenny, David A; Kalichman, Seth C

2009-04-01

Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual's beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.

HIV risk behavior before and after HIV counseling and testing in jail: a pilot study.

PubMed

Beckwith, Curt G; Liu, Tao; Bazerman, Lauri B; DeLong, Allison K; Desjardins, Simon F; Poshkus, Michael M; Flanigan, Timothy P

2010-04-01

Jail incarceration represents an opportunity to deliver HIV counseling and testing (C&T) services to persons at increased risk of infection. However, jails can be chaotic with rapid turnover of detainees. We conducted a pilot study to investigate the feasibility of comparing the effect of different approaches to HIV C&T in jail on subsequent HIV risk behaviors among persons testing HIV negative. Consecutive cohorts of newly incarcerated jail detainees were recruited with 132 subjects completing standard HIV C&T as per jail protocol and 132 subjects completing rapid testing with an individualized counseling session. Risk behavior was assessed and compared at baseline and 6 weeks after jail release. Among the 264 male participants, preincarceration substance use and sexual risk were common. The follow-up visit was completed by 59% of eligible participants. There were no differences in postrelease HIV risk behavior between the 2 arms but there was an overall decrease in risk behavior after jail release for the cohort. In addition, all participants in the rapid arm received rapid HIV test results compared with participants receiving 28% of conventional test results. Jail incarceration represents an important public health opportunity to deliver HIV C&T. This study demonstrated (1) feasibility in delivering rapid HIV testing combined with individualized counseling to jail detainees, (2) improved test result delivery rates, and (3) success with evaluating risk behaviors during the transition from jail to the community. Further research is needed to determine the optimal approach to HIV C&T in jail with the goal of increasing awareness of HIV serostatus and decreasing HIV risk behavior.

Orphan Status, HIV Risk Behavior, and Mental Health Among Adolescents in Rural Kenya

PubMed Central

Drabkin, Anya S.; Stashko, Allison L.; Broverman, Sherryl A.; Ogwang-Odhiambo, Rose A.; Sikkema, Kathleen J.

2012-01-01

Objective To examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya. Methods Randomly selected adolescents aged 10–18 years completed surveys assessing sexual activity, sex-related beliefs and self-efficacy, mental health, social support, caregiver–child communication, time since parental death, and economic resources. Analysis of covariance and regression analyses compared orphans and nonorphans; orphan status was tested as a moderator between well-being and HIV risk. Results Orphans reported poorer mental health, less social support, and fewer material resources. They did not differ from nonorphans on HIV risk indicators. Longer time since parental death was associated with poorer outcomes. In moderator analyses, emotional problems and poorer caregiver–youth communication were more strongly associated with lower sex-related self-efficacy for orphans. Conclusions Orphans are at higher risk for psychosocial problems. These problems may affect orphans’ self-efficacy for safer sex practices more than nonorphans. Decreased HIV risk could be one benefit of psychosocial interventions for orphans. PMID:22728899

Homophobia and communal coping for HIV risk management among gay men in relationships.

PubMed

Stachowski, Courtney; Stephenson, Rob

2015-02-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples' ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently understudied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples' coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples' coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples' relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia.

Gender identity and HIV risk among men who have sex with men in Cape Town, South Africa.

PubMed

Jobson, Geoffrey; Tucker, Andrew; de Swardt, Glenn; Rebe, Kevin; Struthers, Helen; McIntyre, James; Peters, Remco

2018-04-18

Gender identity plays a potentially important role contributing to HIV risk among MSM in South Africa. Where studies have included a focus on gender identity, MSM reporting gender non-conformity have been found to have a higher risk of being HIV positive than other MSM. This article examines HIV risk among gender non-conforming MSM in a sample of 316 MSM in Cape Town, South Africa. Reporting gender non-conformity was associated with higher HIV prevalence and increased HIV risk behaviour. Gender non-conformity was also associated with a higher likelihood of being unemployed and reporting low household incomes. These findings highlight the importance of gender-identity as a factor affecting access to HIV treatment, care, and prevention in South Africa and this is an issue that needs to be addressed in interventions targeting MSM populations.

Masculinity and HIV Risk among Homeless Men in Los Angeles

PubMed Central

Kennedy, David P.; Brown, Ryan A.; Golinelli, Daniela; Wenzel, Suzanne L.; Tucker, Joan S.; Wertheimer, Samuel R.

2012-01-01

HIV continues to be a serious public health problem for men who have sex with women (MSW), especially homeless MSW. Although consideration of gender has improved HIV prevention interventions, most of the research and intervention development has targeted how women’s HIV risk is affected by gender roles. The effect of gender roles on MSW has received relatively little attention. Previous studies have shown mixed results when investigating the association between internalization of masculine gender roles and HIV risk. These studies use a variety of scales that measure individual internalization of different aspects of masculinity. However, this ignores the dynamic and culturally constructed nature of gender roles. The current study uses cultural consensus analysis (CCA) to test for the existence of culturally agreed upon masculinity and gender role beliefs among homeless MSW in Los Angeles, as well as the relationship between these beliefs and HIV-related behaviors and attitudes. Interviews included 30 qualitative and 305 structured interviews with homeless MSW in Los Angeles’s Skid Row area. Analysis identified culturally relevant aspects of masculinity not represented by existing masculinity scales, primarily related to barriers to relationships with women. Behaviors, attitudes, and knowledge related to HIV were significantly associated with men’s level of agreement with the group about masculinity. The findings are discussed in light of implications for MSW HIV intervention development. PMID:23730216

Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients

PubMed Central

2013-01-01

Background Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. Methods A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. Results Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do

Use of a risk scoring tool to identify higher-risk HIV-1 serodiscordant couples for an antiretroviral-based HIV-1 prevention intervention.

PubMed

Irungu, Elizabeth M; Heffron, Renee; Mugo, Nelly; Ngure, Kenneth; Katabira, Elly; Bulya, Nulu; Bukusi, Elizabeth; Odoyo, Josephine; Asiimwe, Stephen; Tindimwebwa, Edna; Celum, Connie; Baeten, Jared M

2016-10-17

Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples. Prioritizing couples at highest HIV-1 transmission risk for ART and PrEP would maximize impact and minimize costs. The Partners Demonstration Project is an open-label, delivery study of integrated PrEP and ART for HIV-1 prevention among high risk HIV-1 serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of using a validated risk score that weighs a combination of easily measurable factors (age, children, marital status, male circumcision status, condom use, plasma HIV-1 levels) to identify couples at highest risk for HIV-1 transmission for enrollment. Couples scoring ≥5 met the risk score eligibility criteria. We screened 1694 HIV-1 serodiscordant couples and enrolled 1013. Of the screened couples, 1331 (78.6 %) scored ≥5 (with an expected incidence >3 % per year) and 76 % of these entered the study. The median age of the HIV-1 uninfected partner was 29 years [IQR 26, 36] and 20 % were <25 years of age. The HIV-1 uninfected partner was male in 67 % of partnerships, 33 % of whom were uncircumcised, 57 % of couples had no children, and 65 % reported unprotected sex in the month prior to enrollment. Among HIV-1 infected partners, 41 % had plasma viral load >50,000 copies/ml. A risk scoring tool identified HIV-1 serodiscordant couples for a demonstration project of PrEP and ART with high HIV-1 risk. The tool may be feasible for research and public health settings to maximize efficiency and minimize HIV-1 prevention costs.

Let us fight and support one another: adolescent girls and young women on contributors and solutions to HIV risk in Zambia

PubMed Central

Butts, Stefani A; Parmley, Lauren E; Alcaide, Maria L; Rodriguez, Violeta J; Kayukwa, Annette; Chitalu, Ndashi; Weiss, Stephen M; Jones, Deborah L

2017-01-01

In Zambia, adolescent girls and young women (AGYW) are disproportionately affected by human immunodeficiency virus (HIV), social, cultural and economic factors making them particularly vulnerable. This study was designed to understand the context in which AGYW are at risk and to identify perceived drivers of the epidemic and potential strategies to reduce HIV risk. Focus group discussions were conducted with AGYW in Zambian districts with the highest HIV prevalence from February through August 2016. The focus group guide addressed HIV risk factors and strategies for HIV prevention in AGYW. Focus group discussions were recorded, translated and transcribed, themes identified and responses coded. Results suggest that gender inequality undermined potentially protective factors against HIV among AGYW. Poverty and stigmatization were major barriers to accessing available HIV prevention services as well as primary risk factors for HIV infection. Sponsorship to support AGYW school attendance, programs for boys and girls to foster gender equality and financial assistance from the government of Zambia to support AGYW most in need were proposed as strategies to reduce HIV risk. Results highlight the utility of using community-based research to guide potential interventions for the affected population. Future research should explore the use of multilevel interventions to combat HIV among AGYW. PMID:29033613

Let us fight and support one another: adolescent girls and young women on contributors and solutions to HIV risk in Zambia.

PubMed

Butts, Stefani A; Parmley, Lauren E; Alcaide, Maria L; Rodriguez, Violeta J; Kayukwa, Annette; Chitalu, Ndashi; Weiss, Stephen M; Jones, Deborah L

2017-01-01

In Zambia, adolescent girls and young women (AGYW) are disproportionately affected by human immunodeficiency virus (HIV), social, cultural and economic factors making them particularly vulnerable. This study was designed to understand the context in which AGYW are at risk and to identify perceived drivers of the epidemic and potential strategies to reduce HIV risk. Focus group discussions were conducted with AGYW in Zambian districts with the highest HIV prevalence from February through August 2016. The focus group guide addressed HIV risk factors and strategies for HIV prevention in AGYW. Focus group discussions were recorded, translated and transcribed, themes identified and responses coded. Results suggest that gender inequality undermined potentially protective factors against HIV among AGYW. Poverty and stigmatization were major barriers to accessing available HIV prevention services as well as primary risk factors for HIV infection. Sponsorship to support AGYW school attendance, programs for boys and girls to foster gender equality and financial assistance from the government of Zambia to support AGYW most in need were proposed as strategies to reduce HIV risk. Results highlight the utility of using community-based research to guide potential interventions for the affected population. Future research should explore the use of multilevel interventions to combat HIV among AGYW.

Mental Health and Resilience in HIV/AIDS-Affected Children: A Review of the Literature and Recommendations for Future Research

PubMed Central

Betancourt, T.S.; Meyers-Ohki, S.E.; Charrow, A.; Hansen, N.

2012-01-01

Background To date, research on mental health in HIV-affected children (children who have an HIV-positive caregiver or live with the virus themselves) has focused on risk factors associated with the disease. However, simultaneous identification of factors that contribute to resilience in the face of risks is also needed. A greater understanding of modifiable protective processes that contribute to resilience in the mental health of children affected by HIV can inform the design of interventions that bolster naturally-occurring supports and contribute to early prevention or better management of risks. Methods We reviewed the recent literature on mental health and resilience in children and adolescents affected by HIV/AIDS. Literature searches of PsycInfo and PubMed were conducted during July-December 2011 consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Qualitative and quantitative studies were included for review if primary research questions pertained to mental health and coping or protective processes in children and families affected by HIV/AIDS. All studies subject to full review were evaluated for quality using a modified Systematic Assessment of Quality in Observational Research (SAQOR) rating system. Results 171 unique studies were returned from online searches of the literature and bibliography mining. Of these, 29 were evaluated as pertaining directly to mental health and resilience in families and children living with HIV/AIDS. Eight studies presented qualitative analyses. Ten quantitative studies examined individual resources contributing to child resilience and four quantitative studies looked at family-level resources. Ten studies also investigated community-level interactions. Four presented findings from resilience-focused interventions. Conclusions There is a clear need for rigorous research on mental health and resilience in HIV-affected children and adolescents. The evidence base would greatly

Smoking, HIV, and risk of pregnancy loss.

PubMed

Westreich, Daniel; Cates, Jordan; Cohen, Mardge; Weber, Kathleen M; Seidman, Dominika; Cropsey, Karen; Wright, Rodney; Milam, Joel; Young, Mary A; Mehta, C Christina; Gustafson, Deborah R; Golub, Elizabeth T; Fischl, Margaret A; Adimora, Adaora A

2017-02-20

Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014. We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach. Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0-19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.

Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents.

PubMed

Toska, Elona; Cluver, Lucie D; Hodes, Rebecca; Kidia, Khameer K

2015-01-01

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10-19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers. N = 128 (14.9%) of the total sample had ever had sex, while N = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085-17.474, p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to

Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV.

PubMed Central

Cohen, M; Deamant, C; Barkan, S; Richardson, J; Young, M; Holman, S; Anastos, K; Cohen, J; Melnick, S

2000-01-01

OBJECTIVES: The purpose of this study was to determine the prevalence and effect of domestic violence and childhood sexual abuse in women with HIV or at risk for HIV infection. METHODS: Participants with HIV or at risk for HIV infection enrolled in the Women's Interagency HIV Study. Childhood sexual abuse; all physical, sexual, and coercive violence by a partner; HIV serostatus; demographic data; and substance use and sexual habits were assessed. RESULTS: The lifetime prevalence of domestic violence was 66% and 67%, respectively, in 1288 women with HIV and 357 uninfected women. One quarter of the women reported recent abuse, and 31% of the HIV-seropositive women and 27% of the HIV-seronegative women reported childhood sexual abuse. Childhood sexual abuse was strongly associated with a lifetime history of domestic violence and high-risk behaviors, including using drugs, having more than 10 male sexual partners and having male partners at risk for HIV infection, and exchanging sex for drugs, money, or shelter. CONCLUSIONS: Our data support the hypothesis of a continuum of risk, with early childhood abuse leading to later domestic violence, which may increase the risk of behaviors leading to HIV infection. PMID:10754970

Risk Factors for Helminth, Malaria, and HIV Infection in Pregnancy in Entebbe, Uganda

PubMed Central

Woodburn, Patrick William; Muhangi, Lawrence; Hillier, Stephen; Ndibazza, Juliet; Namujju, Proscovia Bazanya; Kizza, Moses; Ameke, Christine; Omoding, Nicolas Emojong; Booth, Mark; Elliott, Alison Mary

2009-01-01

Background Infections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes. Objectives To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy. Methods The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression. Results There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus) showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities. Conclusions Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection. PMID:19564904

None of Us Will Get Out of Here Alive: The Intersection of Perceived Risk for HIV, Risk Behaviors and Survival Expectations among African American Emerging Adults.

PubMed

Edwards, Lorece V; Lindong, Ian; Brown, Lawrence; Hawkins, Anita S; Dennis, Sabriya; Fajobi, Olaoluwa; Rowel, Randolph; Braithwaite, Ronald; Sydnor, Kim D

2017-01-01

The Human Immunodeficiency Virus (HIV) significantly affects minority emerging adults, among whom the rate of new diagnoses is high and health disparities are more pronounced. Importantly, emerging adults today have limited knowledge of the earlier toll of the virus when it was identified as a killer. Among this population, perceptions of risk for HIV are low and sexual risk taking behaviors are high. The Get SMART Project is a behavioral intervention aimed to provide re-purposed HIV, alcohol, and substance abuse prevention education and HIV testing to African American emerging adults ages 18-24. The project was guided by the Health Belief Model, Community Promise, and Training for Institutional Procedures. Findings revealed that HIV testing is low. Marijuana and alcohol are drugs of choice. Emerging adults do not see themselves at risk for HIV, although they engaged in high-risk behaviors. Additionally, survival expectations influence behavior risk.

Childhood victimization and HIV risk behaviors among university students in Saint-Petersburg, Russia.

PubMed

Bogolyubova, Olga; Skochilov, Roman; Smykalo, Lyubov

2016-12-01

Exposure to childhood victimization and abuse has been shown to affect HIV risk in adult populations. In Russia, the existence of child abuse was largely unrecognized until 1990s and its behavioral consequences remain understudied. Our goal was to assess childhood victimization and HIV risk behavior among young adults in Saint-Petersburg, Russia: 743 students from 15 local universities were surveyed. Unprotected sexual intercourse was the most common type of HIV risk behavior: study participants reported no condom use at last intercourse (65.17%), inconsistent condom use (58.43%) and 30.81% never used condoms in the past 3 months. Childhood sexual victimization was significantly associated with unprotected sex at last intercourse and with inconsistent condom use in the past 3 months. Young adults in Russia are vulnerable to HIV epidemic due to the pervasiveness of unprotected sexual intercourse, and childhood sexual victimization is associated with risky sexual behavior in this population. Efforts to combat HIV epidemic in Russia must include programming for the prevention of childhood sexual abuse and the development of services for the survivors of childhood victimization.

Discordance of voluntary HIV testing with HIV sexual risk-taking and self-perceived HIV infection risk among social media-using black, Hispanic, and white young-men-who-have-sex-with-men (YMSM).

PubMed

Alexovitz, Kelsey A; Merchant, Roland C; Clark, Melissa A; Liu, Tao; Rosenberger, Joshua G; Bauermeister, Jose; Mayer, Kenneth H

2018-01-01

Discordance between self-perceived HIV risk and actual risk-taking may impede efforts to promote HIV testing among young adult men-who-have-sex-with-men (YMSM) in the United States (US). Understanding the extent of, and reasons for, the discordance of HIV risk self-perception, HIV risk-taking and voluntary HIV testing among black, Hispanic and white YMSM could aid in the development of interventions to increase HIV testing among this higher HIV risk population. HIV-uninfected 18-24-year-old black, Hispanic, and white YMSM were recruited from across the US through multiple social media websites. Participants were queried about their voluntary HIV testing history, perception of currently having an undiagnosed HIV infection, and condomless anal intercourse (CAI) history. We assessed the association between previous CAI and self-perceived possibility of currently having an HIV infection by HIV testing status using Cochran-Mantel-Haenszel testing. Of 2275 black, Hispanic and white social media-using 18-24 year-old YMSM, 21% had never been tested for HIV voluntarily, 87% ever had CAI with another man, 77% believed that it was perhaps possible (as opposed to not possible at all) they currently could have an undiagnosed HIV infection, and 3% who reported CAI with casual or exchange partners, but had not been tested for HIV, self-perceived having no possibility of being HIV infected. Of 471 YMSM who had not been HIV tested, 57% reported CAI with casual or exchange partners, yet self-perceived having no possibility of being HIV infected. Per the Cochran-Mantel-Haenszel test results, among those reporting HIV risk behaviors, the self-perception of possibly being HIV-infected was not greater among those who had never been tested for HIV, as compared to those who had been tested. Future interventions should emphasize promoting self-realization of HIV risk and translating that into seeking and accepting voluntary HIV testing among this higher HIV risk population.

Reward, Attention, and HIV-related Risk in HIV+ Individuals

PubMed Central

Anderson, Brian A.; Kronemer, Sharif I.; Rilee, Jessica J.; Sacktor, Ned; Marvel, Cherie L.

2015-01-01

Human immunodeficiency virus (HIV) is often contracted through engaging in risky reward-motivated behaviors such as needle sharing and unprotected sex. Understanding the factors that make an individual more vulnerable to succumbing to the temptation to engage in these risky behaviors is important to limiting the spread of HIV. One potential source of this vulnerability concerns the degree to which an individual is able to resist paying attention to irrelevant reward information. In the present study, we examine this possible link by characterizing individual differences in value-based attentional bias in a sample of HIV+ individuals with varying histories of risk-taking behavior. Participants learned associations between experimental stimuli and monetary reward outcome. The degree of attentional bias for these reward-associated stimuli, reflected in their ability to capture attention when presented as task-irrelevant distractors, was then assessed both immediately and six months following reward learning. Value-driven attentional capture was related to substance abuse history and non-planning impulsiveness during the time leading up to contraction of HIV as measured via self report. These findings suggest a link between the ability to ignore reward-associated information and prior HIV-related risk-taking behavior. Additionally, particular aspects of HIV-associated neurocognitive disorders were related to attentional bias, including motor deficits commonly associated with HIV-induced damage to the basal ganglia. PMID:26484383

Reward, attention, and HIV-related risk in HIV+ individuals.

PubMed

Anderson, Brian A; Kronemer, Sharif I; Rilee, Jessica J; Sacktor, Ned; Marvel, Cherie L

2016-08-01

Human immunodeficiency virus (HIV) is often contracted through engaging in risky reward-motivated behaviors such as needle sharing and unprotected sex. Understanding the factors that make an individual more vulnerable to succumbing to the temptation to engage in these risky behaviors is important to limiting the spread of HIV. One potential source of this vulnerability concerns the degree to which an individual is able to resist paying attention to irrelevant reward information. In the present study, we examine this possible link by characterizing individual differences in value-based attentional bias in a sample of HIV+ individuals with varying histories of risk-taking behavior. Participants learned associations between experimental stimuli and monetary reward outcome. The degree of attentional bias for these reward-associated stimuli, reflected in their ability to capture attention when presented as task-irrelevant distractors, was then assessed both immediately and six months following reward learning. Value-driven attentional capture was related to substance abuse history and non-planning impulsiveness during the time leading up to contraction of HIV as measured via self-report. These findings suggest a link between the ability to ignore reward-associated information and prior HIV-related risk-taking behavior. Additionally, particular aspects of HIV-associated neurocognitive disorders were related to attentional bias, including motor deficits commonly associated with HIV-induced damage to the basal ganglia. Copyright © 2015 Elsevier Inc. All rights reserved.

HIV DIAGNOSIS AND SEXUAL RISK BEHAVIOR INTENTIONS AMONG COUPLE VCT CLIENTS IN ETHIOPIA

PubMed Central

Bonnenfant, Yung-Ting; Hindin, Michelle J.; Gillespie, Duff

2014-01-01

This research examines whether members of HIV affected couples are more likely to change their abstinence and condom intentions than members of HIV− couples during couple voluntary counseling and testing (VCT). 1,260 couple VCT clients in Ethiopia were asked about their sexual risk behavior intentions for the next two months after pre-test and post-test counseling. Multinomial logistic regression was used to determine whether the couple’s HIV status was associated with changed intentions to abstain or use condoms between pre-test and post-test. Individuals belonging to male HIV+ serodiscordant couples (aRRR= 7.98, p<0.001), female HIV+ serodiscordant couples (aRRR=5.85, p<0.001), and HIV+ concordant couples (aRRR=3.12, p=0.05) were more likely to have increased their intentions to abstain or use condoms in the next two months than individuals in HIV− concordant relationships. The couple’s HIV status was not associated with decreased intentions to abstain or use condoms in the next two months. Counseling for all HIV affected couples should include practical information on obtaining and using condoms. This includes HIV affected couples who intend to abstain from sex, whether for a short or long period of time, so that they are prepared to have protected sex if their intentions change. PMID:22428865

Physical attractiveness and women's HIV risk in rural Malawi.

PubMed

Frye, Margaret; Chae, Sophia

2017-01-01

Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country's severe AIDS epidemic. We use interviewers' ratings of respondents' attractiveness, along with HIV test results and women's assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15-35. Results show that women who are rated by interviewers as 'much less' or 'less' attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women's own assessments of their HIV risk: Among women who tested negative, those perceived as 'much less' or 'less' attractive than average report themselves to be at greater risk of HIV infection. These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings.

Pre-migration trauma and HIV-risk behavior.

PubMed

Steel, Jennifer; Herlitz, Claes; Matthews, Jesse; Snyder, Wendy; Mazzaferro, Kathryn; Baum, Andy; Theorell, Töres

2003-03-01

This study examined the relationship between pre-migration trauma and HIV-risk behavior in refugees from sub-Saharan Africa. The sample comprised 122 persons who had emigrated from sub-Saharan Africa and were currently residing in Sweden. Qualitative methods including individual interviews, focus groups, and interviews with key informants addressed questions regarding trauma experience and HIV-risk behavior. A history of pre-migration trauma was found to be associated with HIV-risk behavior. According to the participants, symptoms associated with post-traumatic stress disorder, depression, adjustment disorder, and substance use mediated the relationship between pre-migration trauma and sexual risk behavior. In contrast, a minority of the participants who reported pre-migration trauma but not psychological sequelae, or experienced post-traumatic growth, reported safer sexual practices. It appears that for some individuals, pre-migration trauma resulted in psychiatric sequelae, which may increase an individual's risk to be infected with HIV. Interventions targeted at individuals at increased risk (i.e. pre-migration trauma with unresolved psychiatric symptomatology) may facilitate the prevention of HIV and other sexually transmitted diseases in this population. Integration of multiple psychosocial and health issues is recommended for comprehensive treatment and prevention programs.

Safer Conception for Couples Affected by HIV: Structural and Cultural Considerations in the Delivery of Safer Conception Care in Uganda.

PubMed

Mindry, Deborah; Wanyenze, Rhoda K; Beyeza-Kashesya, Jolly; Woldetsadik, Mahlet A; Finocchario-Kessler, Sarah; Goggin, Kathy; Wagner, Glenn

2017-08-01

In countries with high HIV prevalence and high fertility desires, the rights of HIV-affected couples to have children are a pressing issue. Conception among people living with HIV carries risks for both horizontal and vertical HIV transmission. In Uganda ~100,000 HIV-infected women become pregnant annually. Providers face a number of challenges to preventing HIV transmission, reducing unplanned pregnancies, and ensuring safer conception. We report findings from interviews with 27 HIV-affected couples (54 individuals) in Uganda. We explored key cultural and structural factors shaping couples' childbearing decisions. Our data reveal a complex intersection of gender norms, familial expectations, relationship dynamics, and HIV stigma influencing their decisions. Participants provided insights regarding provider bias, stigma, and the gendering of reproductive healthcare. To reduce horizontal transmission HIV and family planning clinics must address men's and women's concerns regarding childbearing with specific attention to cultural and structural challenges.

Assessing the Role of Masculinity in the Transmission of HIV: A Systematic Review to Inform HIV Risk Reduction Counseling Interventions for MSM

PubMed Central

Zeglin, Robert J.

2017-01-01

HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: 1) Number of partners, 2) Attitudes toward condoms, 3) Drug use, 4) Sexual positioning, 5) Condom decision-making, 6) Attitudes toward testing, and 7) Treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a Masculinity Model of Community HIV Transmission. Opportunities for counseling interventions include identifying how masculinity informs a client’s cognitions, emotions, and behaviors as well as adapting gender transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence. PMID:25917411

Family-based processes associated with adolescent distress, substance use and risky sexual behavior in families affected by maternal HIV.

PubMed

Lester, Patricia; Stein, Judith A; Bursch, Brenda; Rice, Eric; Green, Sara; Penniman, Typhanye; Rotheram-Borus, Mary Jane

2010-01-01

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother-adolescent (ages 12-21) dyads (N = 264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth aggressive conflict style, maternal bonding, maternal role reversal expectations, and overall family functioning. Results of structural equation modeling indicated that youth aggressive conflict resolution style was strongly associated with adolescent distress, substance use, and risky sexual behavior. In HIV-affected families, youth less frequently reported using an aggressive conflict resolution style and more frequently reported positive maternal bonds; their mothers reported less positive family functioning than control families. Finally, maternal distress indirectly affected adolescent distress and risk behavior via youth aggressive conflict resolution style.

Women at greater risk of HIV infection.

PubMed

Mahathir, M

1997-04-01

Although many people believe that mainly men get infected with HIV/AIDS, women are actually getting infected at a faster rate than men, especially in developing countries, and suffer more from the adverse impact of AIDS. As of mid-1996, the Joint UN Program on AIDS estimated that more than 10 million of the 25 million adults infected with HIV since the beginning of the epidemic are women. The proportion of HIV-positive women is growing, with almost half of the 7500 new infections daily occurring among women. 90% of HIV-positive women live in a developing country. In Asia-Pacific, 1.4 million women have been infected with HIV out of an estimated total 3.08 million adults from the late 1970s until late 1994. Biologically, women are more vulnerable than men to infection because of the greater mucus area exposed to HIV during penile penetration. Women under age 17 years are at even greater risk because they have an underdeveloped cervix and low vaginal mucus production. Concurrent sexually transmitted diseases increase the risk of HIV transmission. Women's risk is also related to their exposure to gender inequalities in society. The social and economic pressures of poverty exacerbate women's risk. Prevention programs are discussed.

Homophobia and Communal Coping for HIV risk management among Gay Men in Relationships

PubMed Central

Stachowski, Courtney; Stephenson, Rob

2015-01-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples’ ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently under-studied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples’ coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples’ coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples’ relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia. PMID:25614049

Personal Risk Perception, HIV Knowledge and Risk Avoidance Behavior, and Their Relationships to Actual HIV Serostatus in an Urban African Obstetric Population

PubMed Central

Stringer, Elizabeth M.; Sinkala, Moses; Kumwenda, Rosemary; Chapman, Victoria; Mwale, Alexandrina; Vermund, Sten H.; Goldenberg, Robert L.; Stringer, Jeffrey S.A.

2009-01-01

One quarter of pregnant women in Zambia are infected with HIV. Understanding how knowledge of HIV relates to personal risk perception and avoidance of risky behaviors is critical to devising effective HIV prevention strategies. In conjunction with a large clinical trial in Lusaka, Zambia, we surveyed postpartum women who had been tested for HIV but did not know their status before undergoing the questionnaire. Of 858 women for whom complete data were available, 248 (29%) were HIV infected. Women 22 years of age or older (adjusted odds ratio [AOR], 1.7; 95% confidence interval [CI], 1.1–2.5), women reporting ≥2 sexual partners in their lifetime (AOR, 1.8; 95% CI, 1.3–2.5), and women reporting a history of a sexually transmitted infection (AOR, 2.7; 95% CI, 1.7–4.3) were more likely to be HIV infected. Having had ≥2 lifetime sexual partners was a marker for perception of high personnel risk for HIV infection (AOR, 1.5; 95% CI, 1.1–2.1). However, there was no relationship between perceived risk of HIV infection and actual HIV status. In fact, 127 (52%) of 245 women who stated that they were at no or low risk for HIV infection were HIV infected. Living in an area of high HIV seroprevalence like Zambia seems to be the greatest risk factor for infection in unselected pregnant women. Before significant inroads can be made in decreasing the incidence of HIV infection among pregnant women, population-based strategies that involve men must be implemented. PMID:14707794

Annual Research Review: Mental Health and Resilience in HIV/AIDS-Affected Children--A Review of the Literature and Recommendations for Future Research

ERIC Educational Resources Information Center

Betancourt, Theresa S.; Meyers-Ohki, Sarah E.; Charrow, Alexandra; Hansen, Nathan

2013-01-01

Background: To date, research on mental health in HIV-affected children (children who have an HIV-positive caregiver or live with the virus themselves) has focused on risk factors associated with the disease. However, simultaneous identification of factors that contribute to resilience in the face of risks is also needed. A greater understanding…

HIV Risk Perceptions, the Transition to Marriage, and Divorce in Southern Malawi

PubMed Central

Grant, Monica J.; Soler-Hampejsek, Erica

2014-01-01

Little is known about whether young people in sub-Saharan Africa use the timing of marriage as a strategy to avoid HIV infection. Using five rounds of longitudinal data from the Malawi Schooling and Adolescent Survey, we do not find support for the hypothesis that young women’s perceived chances of future HIV infection are associated with the transition to marriage, but do find evidence that young married women who see themselves at risk of future infection have a higher hazard of divorce relative to women who perceive no chance of future infection. We also use individual level fixed effect regressions to examine how the transition to marriage affects respondents’ expectations of future HIV infection. Respondents are consistently more likely to perceive any chance of future HIV infection in the years following marriage. Our findings suggest that young women revise their risk perceptions based on their marital experiences, and that divorce may serve as a protective strategy for young married women concerned about their chance of future HIV infection. PMID:25207495

Affect management for HIV prevention with adolescents in therapeutic schools: the immediate impact of project balance.

PubMed

Brown, Larry K; Houck, Christopher; Donenberg, Geri; Emerson, Erin; Donahue, Kelly; Misbin, Jesse

2013-10-01

Adolescents in therapeutic schools are at greater risk for HIV and other STIs than their peers due to earlier higher rates of sexual risk and difficulty managing strong emotions. HIV prevention programs that incorporate techniques for affect management (AM) during sexual situations may be beneficial. This paper determined the immediate impact of such an intervention, AM, compared to a standard, skills-based HIV prevention intervention and a general health promotion intervention (HP) for 377 youth, ages 13-19, in therapeutic schools in two cities. 1 month after the intervention, analyses that adjusted for the baseline scores found adolescents in AM were more likely to report condom use at last sex than those in HP (0.89 vs. 0.67, p = 0.02) and that their HIV knowledge was significantly greater. These data suggest that AM techniques might improve the impact of standard skills-based prevention programs for adolescents in therapeutic schools.

Fracture risk by HIV infection status in perinatally HIV-exposed children.

PubMed

Siberry, George K; Li, Hong; Jacobson, Denise

2012-03-01

The objective of this study was to examine the incidence of fractures in HIV-infected children and comparable HIV-exposed, uninfected (HEU) children in a multicenter, prospective cohort study (PACTG 219/219C) in the United States. The main outcome was first fracture during the risk period. Nine fractures occurred in 7 of 1326 HIV-infected and 2 of 649 HEU children, corresponding to incidence rates of 1.2 per 1000 person-years and 1.1 per 1000 person-years, respectively. The incidence rate ratio was 1.1 (95% CI 0.2, 5.5). There was no evidence of a substantially increased risk of fracture in HIV-infected compared to HEU children.

Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People

PubMed Central

Scheim, Ayden; Xavier, Jessica; Reisner, Sari; Baral, Stefan

2016-01-01

Introduction: Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations. Methods: A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations. Results: Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations. Discussion: Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people. PMID:27429185

HIV Risk Perception among HIV Negative or Status-Unknown Men Who Have Sex with Men in China

PubMed Central

Fan, Wensheng; Yin, Lu; Li, Dongliang; Shao, Yiming; Vermund, Sten H.; Ruan, Yuhua; Zhang, Zheng

2014-01-01

Objective. To evaluate HIV risk perception and its associated factors among Chinese MSM. Methods. A cross-sectional study was conducted among MSM with an HIV negative or unknown status in Beijing, China, between 2011 and 2012. A questionnaire interview was conducted and a blood sample was collected for HIV and syphilis testing. Results. Of 887 MSM who reported they were HIV negative or did not know their HIV status before recruitment, only 7.3% reported a high risk of HIV infection, 28.0% medium risk, 52.2% low risk, and 12.5% no risk. In multivariate logistic regression models using those who reported a medium self-perceived risk as a reference group, self-reported high risk of HIV perception was associated with minority ethnicity (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.03–8.19), self-reported history of sexually transmitted diseases (OR: 2.27; 95% CI: 1.25–4.10), and HIV testing times since the last HIV testing (OR: 0.47; 95% CI: 0.26–0.84); low self-perceived risk of HIV infection was related to full-time employment (OR: 1.58; 95% CI: 1.15–2.18) and illicit drug use (OR: 0.28; 95% CI: 0.10–0.75). Conclusions. The HIV/AIDS epidemic is rapidly rising among Beijing MSM, but more than half MSM did not perceive this risk. PMID:24795880

HIV-Risk Index: Development and Validation of a Brief Risk Index for Hispanic Young People.

PubMed

Ballester-Arnal, Rafael; Gil-Llario, María Dolores; Castro-Calvo, Jesús; Giménez-García, Cristina

2016-08-01

The prevalence of HIV risk behaviors among young people facilitates the spread of HIV, in particular regarding unsafe sex behavior, although this trend is different within this population. For this reason, identifying the riskier young population is required to prevent HIV infection. The main purpose of this study was to develop and validate a risk index to assess the different sexual HIV risk exposure among Hispanic Young people. For this purpose, 9861 Spanish young people were randomly distributed into two groups (derivation and validation group). According to the results, the factor analyses grouped the nine items of the HIV- risk index into two factors (factor 1, direct sexual risk indicators and factor 2, indirect sexual risk indicators) with an equal structure for men and women by a multi-group confirmatory factor analysis. The variance explained was 54.26 %. Moreover, the Cronbach's alpha coefficient revealed high internal reliability (α = .79) and the convergent validity supported its evidence based on different HIV risk indexes. Therefore, the HIV-risk index seem to be a rigorous and valid measure to estimate HIV risk exposure among young people.

A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings.

PubMed

Heffron, Renee; Davies, Natasha; Cooke, Ian; Kaida, Angela; Mergler, Reid; van der Poel, Sheryl; Cohen, Craig R; Mmeje, Okeoma

2015-01-01

HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale "safer conception" programmes. Through our collective experience and discussions at a multi-disciplinary international World Health Organization-convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1) understanding fertility care and an ability to identify potential fertility problems; (2) providing equity of access to resources enabling informed decision-making about reproductive choices; (3) creating enabling environments that reduce stigma associated with HIV and infertility; and (4) creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with women's desires. Programmes, policies and guidelines

A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings

PubMed Central

Heffron, Renee; Davies, Natasha; Cooke, Ian; Kaida, Angela; Mergler, Reid; van der Poel, Sheryl; Cohen, Craig R; Mmeje, Okeoma

2015-01-01

Introduction HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale “safer conception” programmes. Discussion Through our collective experience and discussions at a multi-disciplinary international World Health Organization–convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1) understanding fertility care and an ability to identify potential fertility problems; (2) providing equity of access to resources enabling informed decision-making about reproductive choices; (3) creating enabling environments that reduce stigma associated with HIV and infertility; and (4) creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with women's desires

Family-Based Processes Associated with Adolescent Distress, Substance Use and Risky Sexual Behavior in Families Affected by Maternal HIV

PubMed Central

Lester, Patricia; Stein, Judith A.; Bursch, Brenda; Rice, Eric; Green, Sara; Penniman, Typhanye; Rotheram-Borus, Mary Jane

2014-01-01

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother–adolescent (ages 12–21) dyads (N=264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth aggressive conflict style, maternal bonding, maternal role reversal expectations, and overall family functioning. Results of structural equation modeling indicated that youth aggressive conflict resolution style was strongly associated with adolescent distress, substance use, and risky sexual behavior. In HIV-affected families, youth less frequently reported using an aggressive conflict resolution style and more frequently reported positive maternal bonds; their mothers reported less positive family functioning than control families. Finally, maternal distress indirectly affected adolescent distress and risk behavior via youth aggressive conflict resolution style. PMID:20419574

Drug use, travel and HIV risk.

PubMed

Lee, D; Bell, D C; Hinojosa, M

2002-08-01

A study was conducted to examine the travel experiences of a community sample of 160 drug users and 44 non-users recruited as part of a study of HIV risk. Of the sample, 47% (96/204) reported intercity travel in the previous ten years. Results showed that men were more likely to travel than women, Anglos more than minorities, and young persons more than old. When travellers testing HIV-seropositive (n = 13) were compared with seronegative travellers, HIV-positive travellers reported more sex while travelling than HIV-negative persons, but virtually all of the difference reported involved sex with condoms. There were no significant differences in sex risk behaviours while travelling between drug users and non-drug users, or in sex risk behaviors between drug injectors and non-injectors. Travellers had fewer injection partners while travelling than they had while at home. There was also a significant difference in number of sex partners with whom a condom was not used, with fewer sex partners while travelling.

Sexual Abuse and Adolescent HIV Risk: A Group Intervention Framework

ERIC Educational Resources Information Center

Lescano, Celia M.; Brown, Larry K.; Puster, Kristie L.; Miller, Paul M.

2004-01-01

Adolescents with a history of sexual abuse are at particular risk for HIV because of difficulties with affect regulation and dysfunctional thinking that are thought to be sequelae of the abuse. These difficulties can lead to impulsivity and failure to assertively set limits in sexual situations. Cognitive behavior therapy (CBT) has frequently been…

Male transvestite prostitutes and HIV risk.

PubMed Central

Elifson, K W; Boles, J; Posey, E; Sweat, M; Darrow, W; Elsea, W

1993-01-01

Human immunodeficiency virus (HIV)-1, syphilis, and hepatitis B prevalence and associated risk factors were assessed among male transvestite prostitutes. Structured street-level interviews were conducted with 53 respondents in Atlanta, Ga, from July 1990 through July 1991. Test results from serum samples revealed that 68% were seropositive for HIV-1, 81% had seromarkers for syphilis, and 80% had seromarkers for hepatitis B. Univariate logistic regression analysis indicated that seromarkers for syphilis and Black race were the primary factors associated with HIV-1 infection. The results show that transvestite prostitutes are a heterogenous population and distinct from nontransvestite prostitutes; specific outreach is thus needed. Targeted interventions should address the sexual and drug-use-related HIV risk behaviors of transvestite prostitutes. PMID:8427336

The attitudes of primary schoolchildren in Northern Thailand towards their peers who are affected by HIV and AIDS.

PubMed

Ishikawa, Naoko; Pridmore, Pat; Carr-Hill, Roy; Chaimuangdee, Kreangkrai

2011-02-01

After more than a decade of the AIDS epidemic in Thailand, the number of children whose parents are living with HIV or have died from AIDS is increasing significantly and it has been reported that these children are often discriminated against by their peers. In order to better understand the current situation and to explore possible strategies to support HIV-affected children, this study examined children's attitudes towards HIV and AIDS using questionnaires and focus group discussions with children in Grades three-six in five primary schools in a northern province in Thailand. A total of 513 children (274 boys and 239 girls) answered the questionnaire and five focus groups were organised. The findings showed a strong positive correlation between children's belief that HIV could be transmitted through casual contact and their negative attitudes towards their HIV-affected peers. Most children overestimated the risk of HIV transmission through casual contact and this made their attitudes less tolerant and less supportive. After HIV prevention education (which included information on HIV transmission routes) was given in three of the study schools, the same questionnaire and focus groups were repeated and the findings showed that children's attitudes had become more supportive. These findings suggest that HIV prevention education delivered through primary schools in Thailand can be an effective way to help foster a more supportive and inclusive environment and reduce the stigma and discrimination that decrease educational access and attainment for HIV-affected schoolchildren.

The attitudes of primary schoolchildren in Northern Thailand towards their peers who are affected by HIV and AIDS

PubMed Central

Ishikawa, Naoko; Pridmore, Pat; Carr-Hill, Roy; Chaimuangdee, Kreangkrai

2011-01-01

After more than a decade of the AIDS epidemic in Thailand, the number of children whose parents are living with HIV or have died from AIDS is increasing significantly and it has been reported that these children are often discriminated against by their peers. In order to better understand the current situation and to explore possible strategies to support HIV-affected children, this study examined children's attitudes towards HIV and AIDS using questionnaires and focus group discussions with children in Grades three-six in five primary schools in a northern province in Thailand. A total of 513 children (274 boys and 239 girls) answered the questionnaire and five focus groups were organised. The findings showed a strong positive correlation between children's belief that HIV could be transmitted through casual contact and their negative attitudes towards their HIV-affected peers. Most children overestimated the risk of HIV transmission through casual contact and this made their attitudes less tolerant and less supportive. After HIV prevention education (which included information on HIV transmission routes) was given in three of the study schools, the same questionnaire and focus groups were repeated and the findings showed that children's attitudes had become more supportive. These findings suggest that HIV prevention education delivered through primary schools in Thailand can be an effective way to help foster a more supportive and inclusive environment and reduce the stigma and discrimination that decrease educational access and attainment for HIV-affected schoolchildren. PMID:21259137

Risk of Anal Cancer in HIV-Infected and HIV-Uninfected Individuals in North America

PubMed Central

Lau, Bryan; Justice, Amy C.; Engels, Eric; Gill, M. John; Goedert, James J.; Kirk, Gregory D.; D’Souza, Gypsyamber; Bosch, Ronald J.; Brooks, John T.; Napravnik, Sonia; Hessol, Nancy A.; Jacobson, Lisa P.; Kitahata, Mari M.; Klein, Marina B.; Moore, Richard D.; Rodriguez, Benigno; Rourke, Sean B.; Saag, Michael S.; Sterling, Timothy R.; Gebo, Kelly A.; Press, Natasha; Martin, Jeffrey N.; Dubrow, Robert

2012-01-01

Background. Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends. Methods. In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34 189 HIV-infected (55% MSM, 19% other men, 26% women) and 114 260 HIV-uninfected individuals (90% men). Results. Among men, the unadjusted anal cancer incidence rates per 100 000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7–151.1) for HIV-infected MSM and 26.7 (95% CI, 11.5–61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100 000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8–6.0), but no difference was observed comparing women with other men (RR, 1.0; 95% CI, 0.5–2.2). In comparison with the period 2000–2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI, .3–.9) in 1996–1999 and 0.9 (95% CI, .6–1.2) in 2004–2007. Conclusions. Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued. PMID:22291097

HIV risk perception and preexposure prophylaxis interest among a heterosexual population visiting a sexually transmitted infection clinic.

PubMed

Khawcharoenporn, Thana; Kendrick, Sabrina; Smith, Kimberly

2012-04-01

Low perception of HIV risk despite behaviors associated with increased risk is thought to be a contributing factor for a higher prevalence of HIV in blacks than other groups in the United States. We sought to determine HIV risk perception and its impact on safer sex practices and interest in preexposure prophylaxis (PrEP). From August 1 to October 31, 2010, an anonymous survey was conducted at a sexually transmitted infection clinic asking questions about demographics, risk behaviors, and PrEP interest. Participants were categorized into high-risk, moderate-risk, and low-risk groups according to predefined HIV risk characteristics. Only heterosexual high-risk participants were further assessed for their risk perception, condom use and PrEP interest. There were 494 participants; 63% male, 70% blacks, 88% heterosexual; 83% were categorized into the high-risk group. Of the 359 heterosexual high-risk participants, 301 (84%) perceived themselves at no or low-risk. Rates of consistent condom use with vaginal, oral, and anal sex were low (<20%) in this group despite high levels of knowledge about HIV transmission risks. Rates of condom use were not affected by risk perception. No interest in PrEP was associated with low education level (adjusted odds ratio 4.97; p=0.02) and low risk perception. These findings suggest that despite having knowledge about HIV transmission risks, the majority of high-risk participants did not recognize their risks and used condoms with low frequency. Low risk perception and low education level may impact PrEP interest. Enhanced interventions are needed to improve HIV risk perception, safer sex practices, and knowledge about PrEP.

HIV/AIDS knowledge scores and perceptions of risk among African American students attending historically black colleges and universities.

PubMed

Sutton, Madeline Y; Hardnett, Felicia P; Wright, Pierre; Wahi, Sagina; Pathak, Sonal; Warren-Jeanpiere, Lari; Jones, Sandra

2011-01-01

African American young adults are disproportionately affected by the HIV/AIDS epidemic and often unaware of their personal risk for HIV. Historically black colleges and universities (HBCUs) enroll 25% of college-educated African American young adults and can play an important role in HIV prevention. We examined HIV/AIDS knowledge of students at HBCUs to inform and strengthen our HIV prevention efforts at HBCUs. African American undergraduate HBCU students completed online surveys assessing HIV/AIDS knowledge and behaviors, and we analyzed data to assess their knowledge and behaviors. A total of 1,051 of 1,230 surveys completed (85.4%) were analyzable. Eighty-two percent of students had average/high HIV knowledge scores. Seventy-nine percent of students surveyed perceived themselves to be at low risk for HIV infection; 64% of those who had at least two or more sex partners had not used a condom at last sex encounter. In the final model, significant independent effects were identified for average/high knowledge of HIV risk, including agreeing with assessing a potential partner's HIV risk by all of the five actions listed (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] 1.7, 4.3) and never using a needle to inject drugs (AOR=5.6, 95% CI 3.2, 9.7). Educating students about effectively assessing sex partner risk will improve HIV knowledge and prevention efforts at HBCUs.

Assessing HIV risk in workplaces for prioritizing HIV preventive interventions in Karnataka State, India.

PubMed

Halli, Shiva S; Buzdugan, Raluca; Ramesh, B M; Gurnani, Vandana; Sharma, Vivek; Moses, Stephen; Blanchard, James F

2009-09-01

To develop a model for prioritizing economic sectors for HIV preventive intervention programs in the workplace. This study was undertaken in Karnataka state, India. A 3-stage survey process was undertaken. In the first stage, we reviewed secondary data available from various government departments, identified industries in the private sector with large workforces, and mapped their geographical distribution. In the second stage, an initial rapid risk assessment of industrial sectors was undertaken, using key-informant interviews conducted in relation to a number of enterprises, and in consultation with stakeholders. In the third stage, we used both quantitative (polling booth survey) and qualitative methods (key informant interviews, in-depth interviews, focus group discussions) to study high-risk sectors in-depth, and assessed the need and feasibility of HIV workplace intervention programs. The highest risk sectors were found to be mining, garment/textile, sugar, construction/infrastructure, and fishing industries. Workers in all sectors had at best partial knowledge about HIV/AIDS, coupled with common misconceptions about HIV transmission. There were intersector and intrasector variations in risk and vulnerability across different geographical locations and across different categories of workers. This has implications for the design and implementation of workplace intervention programs. There is tremendous scope for HIV preventive interventions in workplaces in India. Given the variation in HIV risk across economic sectors and limited available resources, there will be increased pressure to prioritize intervention efforts towards high-risk sectors. This study offers a model for rapidly assessing the risk level of economic sectors for HIV intervention programs.

An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women.

PubMed

Balkus, Jennifer E; Brown, Elizabeth; Palanee, Thesla; Nair, Gonasagrie; Gafoor, Zakir; Zhang, Jingyang; Richardson, Barbra A; Chirenje, Zvavahera M; Marrazzo, Jeanne M; Baeten, Jared M

2016-07-01

To develop and validate an HIV risk assessment tool to predict HIV acquisition among African women. Data were analyzed from 3 randomized trials of biomedical HIV prevention interventions among African women (VOICE, HPTN 035, and FEM-PrEP). We implemented standard methods for the development of clinical prediction rules to generate a risk-scoring tool to predict HIV acquisition over the course of 1 year. Performance of the score was assessed through internal and external validations. The final risk score resulting from multivariable modeling included age, married/living with a partner, partner provides financial or material support, partner has other partners, alcohol use, detection of a curable sexually transmitted infection, and herpes simplex virus 2 serostatus. Point values for each factor ranged from 0 to 2, with a maximum possible total score of 11. Scores ≥5 were associated with HIV incidence >5 per 100 person-years and identified 91% of incident HIV infections from among only 64% of women. The area under the curve (AUC) for predictive ability of the score was 0.71 (95% confidence interval [CI]: 0.68 to 0.74), indicating good predictive ability. Risk score performance was generally similar with internal cross-validation (AUC = 0.69; 95% CI: 0.66 to 0.73) and external validation in HPTN 035 (AUC = 0.70; 95% CI: 0.65 to 0.75) and FEM-PrEP (AUC = 0.58; 95% CI: 0.51 to 0.65). A discrete set of characteristics that can be easily assessed in clinical and research settings was predictive of HIV acquisition over 1 year. The use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk.

Defining HIV risk and determining responsibility in postsocialist Poland.

PubMed

Owczarzak, Jill

2009-12-01

Drawing on 15 months of ethnographic research on HIV prevention programs in Poland, I explore the consequences of the shift from models of HIV prevention that emphasize "risk groups" and AIDS blame, to models that focus on "risky behaviors" and universal risk. The centrality of choice making and individual risk management in these models suggests objective risk assessment free from moralizing arguments. The Polish national prevention strategy shifted to focus on choice making, address all risk groups, and include concrete prevention strategies. This shift created a backlash that resulted in the reassertion of moral arguments about risk and risk groups that positioned those most vulnerable to HIV outside the purview of prevention efforts. AIDS organizations working with marginalized, "morally problematic" populations used the label "at risk" to legitimize claims to resources. They enacted a model of risk reduction in which the relevant actor is the individual buffeted by social forces; behavior change, and therefore HIV risk reduction, is a long process because of myriad forms of vulnerability clients face. Despite efforts to reconceptualize risk, organizations positioned the individual as the locus of HIV prevention interventions, rather than attempting to address the social context that shapes risk.

Stigmatization and discrimination towards people living with or affected by HIV/AIDS by the general public in Malaysia.

PubMed

Wong, L P; Syuhada, A R Nur

2011-09-01

Globally, HIV/AIDS-related stigma and discriminatory attitudes deter the effectiveness of HIV prevention and care programs. This study investigated the general public's perceptions about HIV/AIDS-related stigma and discrimination towards people living with or affected by HIV/AIDS in order to understand the root of HIV/AIDS-related stigma and discriminatory attitudes. Study was carried out using qualitative focus group discussions (FGD). An interview guide with semi-structured questions was used. Participants were members of the public in Malaysia. Purposive sampling was adopted for recruitment of participants. A total 14 focus group discussions (n = 74) was carried out between March and July 2008. HIV/AIDS-related stigma and discrimination towards people living with HIV/AIDS (PLWHA) was profound. Key factors affecting discriminatory attitudes included high-risk taking behavior, individuals related to stigmatized identities, sources of HIV infection, stage of the disease, and relationship with an infected person. Other factors that influence attitudes toward PLWHA include ethnicity and urban-rural locality. Malay participants were less likely than other ethnic groups to perceive no stigmatization if their spouses were HIV positive. HIV/AIDS-related stigma and discrimination were stronger among participants in rural settings. The differences indicate attitudes toward PLWHA are influenced by cultural differences.

When HIV-prevention messages and gender norms clash: the impact of domestic violence on women's HIV risk in slums of Chennai, India.

PubMed

Go, Vivian F; Sethulakshmi, C Johnson; Bentley, Margaret E; Sivaram, Sudha; Srikrishnan, A K; Solomon, Suniti; Celentano, David D

2003-09-01

This paper examines how marital violence affects women's ability to protect themselves from HIV/AIDS. In-depth interviews (n = 48) and focus groups (n = 84, 3-7 per group) were conducted among men and women in two randomly selected slums of Chennai, India. The study showed that community gender norms tacitly sanction domestic violence that interferes with adopting HIV-preventive behaviors. Given the choice between the immediate threat of violence and the relatively hypothetical specter of HIV, women often resign themselves to sexual demands and indiscretions that may increase their risk of HIV acquisition. In conclusion, AIDS-prevention interventions must incorporate gender-related social contexts in settings where husbands strictly enforce their locus of control. HIV-prevention messages targeting men may effectively reduce women's exposure to HIV/AIDS.

Europe's Shifting Response to HIV/AIDS: From Human Rights to Risk Management.

PubMed

Smith, Julia

2016-12-01

Despite a history of championing HIV/AIDS as a human rights issue, and a rhetorical commitment to health as a human right, European states and institutions have shifted from a rights-based response to a risk management approach to HIV/AIDS since the economic recession of 2008. An interdisciplinary perspective is applied to analyze health policy changes at the national, regional, and global levels by drawing on data from key informant interviews, and institutional and civil society documents. It is demonstrated that, in the context of austerity measures, member states such as the UK and Greece reduced commitments to rights associated with HIV/AIDS; at the regional level, the EU failed to develop rights-based approaches to address the vulnerabilities and health care needs of key populations affected by HIV/AIDS, particularly migrants and sex workers; and at the global level, the EU backtracked on commitments to global health and is prioritizing the intellectual property rights of pharmaceutical companies over the human rights of people living with HIV/AIDS. The focus within and from the EU is on containment, efficiency, and cost reduction. The rights of those most affected are no longer prioritized.

HIV transmission risk behavior among HIV-positive patients receiving antiretroviral therapy in KwaZulu-Natal, South Africa.

PubMed

Shuper, Paul A; Kiene, Susan M; Mahlase, Gethwana; MacDonald, Susan; Christie, Sarah; Cornman, Deborah H; Fisher, William A; Greener, Ross; Lalloo, Umesh G; Pillay, Sandy; van Loggerenberg, Francois; Fisher, Jeffrey D

2014-08-01

The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans.

Theorizing "Big Events" as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks.

PubMed

Friedman, Samuel R; Rossi, Diana; Braine, Naomi

2009-05-01

Political-economic transitions in the Soviet Union, Indonesia, and China, but not the Philippines, were followed by HIV epidemics among drug users. Wars also may sometimes increase HIV risk. Based on similarities in some of the causal pathways through which wars and transitions can affect HIV risk, we use the term "Big Events" to include both. We first critique several prior epidemiological models of Big Events as inadequately incorporating social agency and as somewhat imprecise and over-generalizing in their sociology. We then suggest a model using the following concepts: first, event-specific HIV transmission probabilities are functions of (a) the probability that partners are infection-discordant; (b) the infection-susceptibility of the uninfected partner; (c) the infectivity of the infected--as well as (d) the behaviours engaged in. These probabilities depend on the distributions of HIV and other variables in populations. Sexual or injection events incorporate risk behaviours and are embedded in sexual and injection partnership patterns and community networks, which in turn are shaped by the content of normative regulation in communities. Wars and transitions can change socio-economic variables that can sometimes precipitate increases in the numbers of people who engage in high-risk drug and sexual networks and behaviours and in the riskiness of what they do. These variables that Big Events affect may include population displacement; economic difficulties and policies; police corruption, repressiveness, and failure to preserve order; health services; migration; social movements; gender roles; and inter-communal violence--which, in turn, affect normative regulation, youth alienation, networks and behaviours. As part of these pathways, autonomous action by neighbourhood residents, teenagers, drug users and sex workers to maintain their economic welfare, health or happiness may affect many of these variables or otherwise mediate whether HIV epidemics follow

Sexual HIV risk among gay, bisexual and queer transgender men: findings from interviews in Vancouver, Canada.

PubMed

Rich, Ashleigh; Scott, Kai; Johnston, Caitlin; Blackwell, Everett; Lachowsky, Nathan; Cui, Zishan; Sereda, Paul; Moore, David; Hogg, Robert; Roth, Eric

2017-11-01

Gay, bisexual, queer and other men who have sex with men are disproportionately affected by HIV in Canada. While up to 63% of transgender men identify as gay, bisexual or queer and report a variety of HIV sexual risk behaviours, transgender men are often overlooked within epidemiological HIV surveillance and research. While a growing body of research has begun to examine sexual risk for transgender gay, bisexual and queer men, most studies have been conducted in the USA. This study explored sexual HIV risk for this population in the Canadian context, specifically in British Columbia, in an environment of publically funded universal access to healthcare, including HIV testing and treatment. We conducted interviews with 11 gay, bisexual and queer transgender men. Participants' narratives suggest that HIV risk for these transgender men is shaped by a diversity of sexual behaviours, including inconsistent condom use, seeking partners online for greater safety and accessing HIV/STI testing and other healthcare services despite facing transition-related barriers. Public health prevention and health education must recognise the presence of transgender men and ensure health services and broader population health promotion meet the unique sexual health needs of this sub-population of gay, bisexual and queer men.

Dynamic Indices of Methamphetamine Dependence and HIV Infection Predict Fluctuations in Affective Distress: A Five-year Longitudinal Analysis

PubMed Central

Montoya, Jessica L.; Umlauf, Anya; Abramson, Ian; Badiee, Jayraan; Woods, Steven Paul; Atkinson, J. Hampton; Grant, Igor; Moore, David J.

2013-01-01

Background Methamphetamine (METH) use and human immunodeficiency virus (HIV) infection are highly comorbid, and both are associated with increased prevalence of affective distress. Delineating the trajectory of affective distress in the context of METH dependence and HIV infection is important given the implications for everyday functional impairment, adverse health behaviors, and increased risk for adverse health outcomes. Methods We conducted a five-year longitudinal investigation involving 133 METH-dependent (74 HIV seropositive) and 163 non-METH-dependent (90 HIV seropositive) persons to examine both long-standing patterns and transient changes in affective distress. Mixed-effect regression models with random subject-specific slopes and intercepts evaluated the effect of METH dependence, HIV serostatus, and related variables on affective distress, as measured by the Profile of Mood States. Results Transient changes in affective distress were found to be greater among those with a diagnosis of current MDD, briefer durations of abstinence from METH, and higher quantity of METH consumed. Weak associations were observed among static (time-independent predictors) covariates and long-standing patterns in affective distress. Limitations Study lacked data pertaining to the participants’ involvement in METH treatment and relied on respondent-driven sampling. Conclusions Our longitudinal investigation of the trajectory of affective distress indicated that specific and dynamic indices of current METH use were associated with greater transient changes in mood. In the evaluation and treatment of affective distress, recency and quantity of current METH use are important to consider given their association with heightened affective distress and mood instability over time. PMID:24012068

Dynamic indices of methamphetamine dependence and HIV infection predict fluctuations in affective distress: a five-year longitudinal analysis.

PubMed

Montoya, Jessica L; Umlauf, Anya; Abramson, Ian; Badiee, Jayraan; Woods, Steven Paul; Atkinson, J Hampton; Grant, Igor; Moore, David J

2013-11-01

Methamphetamine (METH) use and human immunodeficiency virus (HIV) infection are highly comorbid, and both are associated with increased prevalence of affective distress. Delineating the trajectory of affective distress in the context of METH dependence and HIV infection is important given the implications for everyday functional impairment, adverse health behaviors, and increased risk for adverse health outcomes. We conducted a five-year longitudinal investigation involving 133 METH-dependent (74 HIV seropositive) and 163 non-METH-dependent (90 HIV seropositive) persons to examine both long-standing patterns and transient changes in affective distress. Mixed-effect regression models with random subject-specific slopes and intercepts evaluated the effect of METH dependence, HIV serostatus, and related variables on affective distress, as measured by the Profile of Mood States. Transient changes in affective distress were found to be greater among those with a diagnosis of current MDD, briefer durations of abstinence from METH, and higher quantity of METH consumed. Weak associations were observed among static (time-independent predictors) covariates and long-standing patterns in affective distress. Study lacked data pertaining to the participants' involvement in METH treatment and relied on respondent-driven sampling. Our longitudinal investigation of the trajectory of affective distress indicated that specific and dynamic indices of current METH use were associated with greater transient changes in mood. In the evaluation and treatment of affective distress, recency and quantity of current METH use are important to consider given their association with heightened affective distress and mood instability over time. © 2013 Elsevier B.V. All rights reserved.

Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas.

PubMed

Palazzolo, Sarah L; Yamanis, Thespina J; De Jesus, Maria; Maguire-Marshall, Molly; Barker, Suyanna L

2016-04-01

The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18- to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population.

Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas

PubMed Central

Palazzolo, Sarah L.; De Jesus, Maria; Maguire-Marshall, Molly; Barker, Suyanna L.

2016-01-01

Abstract Purpose: The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. Methods: We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18- to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Results: Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Conclusions: Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population. PMID:26669583

Perceptions of Community HIV/STI Risk Among U.S Women Living in Areas with High Poverty and HIV Prevalence Rates.

PubMed

Blackstock, Oni J; Frew, Paula; Bota, Dorothy; Vo-Green, Linda; Parker, Kim; Franks, Julie; Hodder, Sally L; Justman, Jessica; Golin, Carol E; Haley, Danielle F; Kuo, Irene; Adimora, Adaora A; Rompalo, Anne; Soto-Torres, Lydia; Wang, Jing; Mannheimer, Sharon B

2015-08-01

Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community's HIV/STI risk. We explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women's HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/STI risk driven by structural factors.

Perceptions of Community HIV/ STI Risk Among U.S Women Living in Areas with High Poverty and HIV Prevalence Rates

PubMed Central

Blackstock, Oni J.; Frew, Paula; Bota, Dorothy; Vo-Green, Linda; Parker, Kim; Franks, Julie; Hodder, Sally L.; Justman, Jessica; Golin, Carol E.; Haley, Danielle F.; Kuo, Irene; Adimora, Adaora A.; Rompalo, Anne; Soto-Torres, Lydia; Wang, Jing; Mannheimer, Sharon B.

2015-01-01

Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community’s HIV/STI risk. We explored perceptions of community HIV/ STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women’s HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/ STI risk driven by structural factors. PMID:26320916

The Prevalence of HIV Risk Behaviors among Felony Drug Court Participants

PubMed Central

Festinger, David S.; Dugosh, Karen L.; Metzger, David S.; Marlowe, Douglas B.

2013-01-01

[15] HIV Risk Behaviors in Drug Court A small percentage of participants in a large metropolitan felony Drug Court engaged in high-risk injection drug use, but a large percentage engaged in high-risk sexual behaviors. [16] HIV Risk Factors in Drug Court HIV risk behaviors were associated with being male, African–American, and younger. [17] Geographic Risk for HIV A large proportion of Drug Court participants resided in areas of the city with a high prevalence of persons living with HIV/AIDS, thus heightening the probability of exposure to the virus. PMID:25309974

HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

PubMed Central

Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska

2017-01-01

Abstract Introduction: Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. Methods: From 2013 to 2015, a survey using total population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Results: Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). Conclusions: These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities

HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV.

PubMed

Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska

2017-08-21

Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed ( n  = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV

Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners.

PubMed

Blackwell, Christopher W

2018-01-01

The incidence of new HIV infections in the United States continues to be greatest among men who have sex with men (MSM). MSM infected with HIV often seek seroconcordant sexual partners based on intent to limit psychosocial, legal, and health risks they perceive as higher with serodiscordant sexual partners. However, the rationales for limiting sexual relationships exclusively with other MSM infected with HIV may be rooted in misinformation or misperception. Thus, these clients may have a unique sexual health knowledge deficit that nurses, social workers, and other clinicians need to address to help them reduce risk. This article focuses on sexually related health risks that are distinct to MSM infected with HIV seroconcordant partners. Data on the most recent HIV-infection incidence rates in MSM in the United States is provided. Discussion concentrates on the risk these individuals may have in communicating and acquiring sexually transmitted diseases other than HIV, the risk of HIV superinfection, and how sexually transmitted diseases affect persons who are immunocompromised differently than those who are immunocompetent. Finally, recommendations for healthcare professionals who counsel MSM infected with HIV in sexual decision making is provided.

RCT of an integrated CBT-HIV intervention on depressive symptoms and HIV risk.

PubMed

Tobin, Karin; Davey-Rothwell, Melissa A; Nonyane, Bareng A S; Knowlton, Amy; Wissow, Lawrence; Latkin, Carl A

2017-01-01

Depression and depressive symptoms mediate the association between drug use and HIV risk. Yet, there are few interventions that target depressive symptoms and HIV risk for people who use drugs (PWUD). This study was a randomized controlled trial of an integrated cognitive behavioral therapy and HIV prevention intervention to reduce depressive symptoms, injection risk behaviors and increase condom use in a sample of urban people who used heroin or cocaine in the prior 6 months. A total of 315 individuals aged 18-55, who self-reported at least one HIV drug and sex risk behavior and scored ≥16 and <40 on the Centers for Epidemiologic Studies-Depression (CES-D) scale were randomized using a two-block design, stratified by sex to ensure equivalent numbers, to a 10 session intervention arm (n = 162) or a single session control arm (n = 153). The outcomes of interest were decreases in CES-D score and injection risk behaviors and increases in condom use. The sample was majority African American (85%) and unemployed (94%). Nearly half (47%) reported injection in the prior 6 months and only 19% were taking medication for depression. Follow-up assessments were conducted at 6 and 12 months. Retention at 12 months was 94%. Intervention arm was associated with statistically significantly lower CES-D score at 12 month compared to control. No differences were observed between arms in injection risk. At 6 month, intervention was associated with greater odds of condom use with non-main partner. These findings suggest the potential role of the integrated intervention in reducing depressive symptoms, but weak impact on HIV risk. This trial is registered with ClinicalTrials.gov under the title "Neighborhoods, Networks, Depression, and HIV Risk" number NCT01380613.

Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption among Latino MSM: Challenges and Opportunities to Intervene on HIV Risk

PubMed Central

Martinez, Omar; Muñoz-Laboy, Miguel; Levine, Ethan; Starks, Tyrel; Dolezal, Curtis; Dodge, Brian; Icard, Larry; Moya, Eva; Chavez-Baray, Silvia; Rhodes, Scott D.; Fernandez, M. Isabel

2016-01-01

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the United States, Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations among relationship factors and HIV risk among Latino MSM remain unknown. This mixed-methods study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past three months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n=175), approximately half reported multiple partners in the previous three months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older, and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants

Physical attractiveness and women’s HIV risk in rural Malawi

PubMed Central

Frye, Margaret; Chae, Sophia

2017-01-01

BACKGROUND Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. OBJECTIVE We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country’s severe AIDS epidemic. METHODS We use interviewers’ ratings of respondents’ attractiveness, along with HIV test results and women’s assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15–35. RESULTS Results show that women who are rated by interviewers as ‘much less’ or ‘less’ attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women’s own assessments of their HIV risk: Among women who tested negative, those perceived as ‘much less’ or ‘less’ attractive than average report themselves to be at greater risk of HIV infection. CONCLUSIONS These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. CONTRIBUTION This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings. PMID:29242708

Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1 Serodiscordant Couples

PubMed Central

MUGO, Nelly R.; HEFFRON, Renee; DONNELL, Deborah; WALD, Anna; WERE, Edwin O.; REES, Helen; CELUM, Connie; KIARIE, James N.; COHEN, Craig R.; KAYINTEKORE, Kayitesi; BAETEN, Jared M.

2011-01-01

Background Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. Methods In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. Results 3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and non-pregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33–4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93–3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22–4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26–4.85). Conclusions HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness. PMID:21785321

HIV risk practices by female sex workers according to workplace.

PubMed

Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann; Souza Júnior, Paulo Roberto Borges de

2014-06-01

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues.

HIV risk practices by female sex workers according to workplace

PubMed Central

Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann; de Souza, Paulo Roberto Borges

2014-01-01

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues. PMID:25119937

Ethnic Differences in HIV Risk Behaviors Among Methadone-Maintained Women Receiving Contingency Management for Cocaine Use Disorders

PubMed Central

Barry, Danielle; Weinstock, Jeremiah; Petry, Nancy M.

2008-01-01

Objective To identify ethnic differences in HIV risk behaviors among cocaine using women receiving methadone maintenance for opioid dependence, and to evaluate the efficacy of contingency management (CM) for cocaine use disorders in reducing HIV risk behaviors. Methods African American (N=47), Hispanic (N=47), and White women (N = 29) were randomized to standard methadone treatment or standard methadone treatment plus a CM intervention. They completed the HIV Risk Behavior Scale (HRBS) indicating frequency of drug use and sexual behaviors across the lifetime, in the month before baseline, and in the 3 months following clinical trial participation. Ethnic group differences and the effect of CM on change in HIV risk behaviors between baseline and follow-up were evaluated. Results White women reported significantly higher lifetime rates of risky drug use and sexual behaviors on the HRBS than African American women; neither group differed significantly from Hispanic women. No ethnic group differences in HIV risk behaviors were identified in the month prior to baseline. At follow-up, African American women reported fewer high-risk drug use behaviors than White or Hispanic women, and Hispanic women reported more high-risk sexual behaviors than White or African American women. CM was associated with reduction in high-risk drug use behaviors regardless of ethnicity, but did not affect high-risk sexual behaviors. Conclusions White women receiving methadone maintenance engage in more lifetime HIV risk behaviors than African American women. CM for cocaine use reduces risky drug use behaviors, but certain ethnic groups may benefit from additional targeted HIV prevention efforts. PMID:18684571

Stigma and HIV risk among Metis in Nepal

PubMed Central

Wilson, Erin; Pant, Sunil Babu; Comfort, Megan; Ekstrand, Maria

2011-01-01

Similar to other parts of Asia, the HIV epidemic in Nepal is concentrated among a small number of groups, including transgender people, or Metis. This study was conducted to explore the social context of stigma among Metis in Nepal to better understand their risk for HIV. Fourteen in-depth interviews were conducted with Metis in Kathmandu, Nepal. We found that stigma from families leading to rural-urban migration exposed Metis to discrimination from law enforcement, employers and sexual partners, which influenced their risk for HIV. Specific HIV-related risks identified were rape by law enforcement officers, inconsistent condom use and high reported numbers of sexual partners. These data point to an immediate need to work with law enforcement to reduce violence targeting Metis. HIV prevention, housing and employment outreach to Metis in rural areas and those who migrate to urban areas is also needed. Finally, there is a need for more research to determine the prevalence of HIV among Metis, to explore risk within sexual networks and to better understand of the relationship between Metis and their families in order to develop future programmes and interventions. PMID:21058085

HIV/AIDS Knowledge Scores and Perceptions of Risk Among African American Students Attending Historically Black Colleges and Universities

PubMed Central

Sutton, Madeline Y.; Hardnett, Felicia P.; Wright, Pierre; Wahi, Sagina; Pathak, Sonal; Warren-Jeanpiere, Lari; Jones, Sandra

2011-01-01

Objective African American young adults are disproportionately affected by the HIV/AIDS epidemic and often unaware of their personal risk for HIV. Historically black colleges and universities (HBCUs) enroll 25% of college-educated African American young adults and can play an important role in HIV prevention. We examined HIV/AIDS knowledge of students at HBCUs to inform and strengthen our HIV prevention efforts at HBCUs. Methods African American undergraduate HBCU students completed online surveys assessing HIV/AIDS knowledge and behaviors, and we analyzed data to assess their knowledge and behaviors. Results A total of 1,051 of 1,230 surveys completed (85.4%) were analyzable. Eighty-two percent of students had average/high HIV knowledge scores. Seventy-nine percent of students surveyed perceived themselves to be at low risk for HIV infection; 64% of those who had at least two or more sex partners had not used a condom at last sex encounter. In the final model, significant independent effects were identified for average/high knowledge of HIV risk, including agreeing with assessing a potential partner's HIV risk by all of the five actions listed (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] 1.7, 4.3) and never using a needle to inject drugs (AOR=5.6, 95% CI 3.2, 9.7). Conclusions Educating students about effectively assessing sex partner risk will improve HIV knowledge and prevention efforts at HBCUs. PMID:21886325

Defining HIV Risk and Determining Responsibility in Postsocialist Poland

PubMed Central

Owczarzak, Jill

2014-01-01

Drawing on 15 months of ethnographic research on HIV prevention programs in Poland, I explore the consequences of the shift from models of HIV prevention that emphasize “risk groups” and AIDS blame, to models that focus on “risky behaviors” and universal risk. The centrality of choice making and individual risk management in these models suggests objective risk assessment free from moralizing arguments. The Polish national prevention strategy shifted to focus on choice making, address all risk groups, and include concrete prevention strategies. This shift created a backlash that resulted in the reassertion of moral arguments about risk and risk groups that positioned those most vulnerable to HIV outside the purview of prevention efforts. AIDS organizations working with marginalized, “morally problematic” populations used the label “at risk” to legitimize claims to resources. They enacted a model of risk reduction in which the relevant actor is the individual buffeted by social forces, and behavior change, and therefore HIV risk reduction, is a long process because of myriad forms of vulnerability clients face. Despite efforts to reconceptualize risk, organizations positioned the individual as the locus of HIV prevention interventions, rather than attempting to address the social context that shapes risk. PMID:20092052

A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couples

PubMed Central

Crankshaw, Tamaryn L.; Matthews, Lynn T.; Giddy, Janet; Kaida, Angela; Ware, Norma C.; Smit, Jennifer A.; Bangsberg, David R.

2013-01-01

Integrated reproductive health services for people living with HIV must address their fertility intentions. For HIV-serodiscordant couples who want to conceive, attempted conception confers a substantial risk of HIV transmission to the uninfected partner. Behavioral and pharmacologic strategies may reduce HIV transmission risk among HIV-serodiscordant couples who seek to conceive. In order to develop effective pharmaco-behavioral programs, it is important to understand and address the contexts surrounding reproductive decision-making; perceived periconception HIV transmission risk; and periconception risk behaviors. We present a conceptual framework to describe the dynamics involved in periconception HIV risk behaviors in a South African setting. We adapt the Information-Motivation-Behavioral Skill Model of HIV Preventative Behavior to address the structural, individual and couple-level determinants of safer conception behavior. The framework is intended to identify factors that influence periconception HIV risk behavior among serodiscordant couples, and therefore to guide design and implementation of integrated and effective HIV, reproductive health and family planning services that support reproductive decision-making. PMID:23177680

The Effect of Marriage and HIV Risks on Condom Use Acceptability in Rural Malawi

PubMed Central

Anglewicz, Philip; Clark, Shelley

2013-01-01

A large and increasing proportion of HIV transmissions in sub-Saharan Africa occur within marriage. Condom use within marriage could, therefore, be an important prevention strategy, but there is considerable debate about whether married couples would be willing to use condoms. This paper contributes to this debate by identifying key factors that affect the acceptability of condom use within marriage and actual condom use among men and women in rural Malawi, using three waves of longitudinal data from 2004, 2006 and 2008. Specifically, we focused on the effect of (1) entry into first marriage, (2) respondent’s HIV status, HIV perceptions, and risk behaviors, and (3) spouse’s HIV characteristics on condom use acceptability within marriage and actual condom use with a spouse or steady partner. Using fixed-effects regression, we found that getting married coincides with a pronounced attitudinal shift regarding the acceptability of condom use within marriage that cannot be explained by differences in fertility status or selection into marriage. In addition, we found that, for women, perceived HIV status of the respondent and spouse generally had greater influence than actual HIV status on the acceptability of condom use within marriage and actual condom use with a spouse or steady partner, even after HIV status is known; while actual HIV status and HIV risk behaviors are generally more important among men. Although condom use within marriage remained low, these findings suggest that attitudes about and use of condoms are susceptible to change and that both marital status and perceptions of risk are important influences on condom use. PMID:24161086

Novel Neuroimaging Methods to Understand How HIV Affects the Brain

PubMed Central

Thompson, Paul

2015-01-01

In much of the developed world, the HIV epidemic has largely been controlled by anti-retroviral treatment. Even so, there is growing concern that HIV-infected individuals may be at risk for accelerated brain aging, and a range of cognitive impairments. What promotes or resists these changes is largely unknown. There is also interest in discovering factors that promote resilience to HIV, and combat its adverse effects in children. Here we review recent developments in brain imaging that reveal how the virus affects the brain. We relate these brain changes to changes in blood markers, cognitive function, and other patient outcomes or symptoms, such as apathy or neuropathic pain. We focus on new and emerging techniques, including new variants of brain MRI. Diffusion tensor imaging, for example, can map the brain’s structural connections while fMRI can uncover functional connections. Finally, we suggest how large-scale global research alliances, such as ENIGMA, may resolve controversies over effects where evidence is now lacking. These efforts pool scans from tens of thousands of individuals, and offer a source of power not previously imaginable for brain imaging studies. PMID:25902966

Transgender populations and HIV: unique risks, challenges and opportunities.

PubMed

Wansom, Tanyaporn; Guadamuz, Thomas E; Vasan, Sandhya

2016-04-01

Due to unique social, behavioural, structural and biological issues, transgender (TG) populations, especially TG women, are at high risk for HIV acquisition. This increased risk is multifactorial, due to differing psychosocial risk factors, poorer access to TG-specific healthcare, a higher likelihood of using exogenous hormones or fillers without direct medical supervision, interactions between hormonal therapy and antiretroviral therapy, and direct effects of hormonal therapy on HIV acquisition and immune control. Further research is needed to elucidate these mechanisms of risk and to help design interventions to reduce HIV risk among transgender populations.

Linearity and Nonlinearity in HIV/STI Transmission: Implications for the Evaluation of Sexual Risk Reduction Interventions

ERIC Educational Resources Information Center

Pinkerton, Steven D.; Chesson, Harrell W.; Crosby, Richard A.; Layde, Peter M.

2011-01-01

A mathematical model of HIV/sexually transmitted infections (STI) transmission was used to examine how linearity or nonlinearity in the relationship between the number of unprotected sex acts (or the number of sex partners) and the risk of acquiring HIV or a highly infectious STI (such as gonorrhea or chlamydia) affects the utility of sexual…

Condom Negotiation, HIV Testing, and HIV Risks among Women from Alcohol Serving Venues in Cape Town, South Africa

PubMed Central

Pitpitan, Eileen V.; Kalichman, Seth C.; Cain, Demetria; Eaton, Lisa A.; Carey, Kate B.; Carey, Michael P.; Harel, Ofer; Simbayi, Leickness C.; Mehlomakhulu, Vuyelwa; Mwaba, Kelvin

2012-01-01

Background Women in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection. Purpose To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women. Method Women (N = 1333) residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens) completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV. Results Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex. Conclusions For women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues. PMID:23056211

Assessing evidence for behaviour change affecting the course of HIV epidemics: a new mathematical modelling approach and application to data from Zimbabwe.

PubMed

Hallett, Timothy B; Gregson, Simon; Mugurungi, Owen; Gonese, Elizabeth; Garnett, Geoff P

2009-06-01

Determining whether interventions to reduce HIV transmission have worked is essential, but complicated by the potential for generalised epidemics to evolve over time without individuals changing risk behaviour. We aimed to develop a method to evaluate evidence for changes in risk behaviour altering the course of an HIV epidemic. We developed a mathematical model of HIV transmission, incorporating the potential for natural changes in the epidemic as it matures and the introduction of antiretroviral treatment, and applied a Bayesian Melding framework, in which the model and observed trends in prevalence can be compared. We applied the model to Zimbabwe, using HIV prevalence estimates from antenatal clinic surveillance and house-hold based surveys, and basing model parameters on data from sexual behaviour surveys. There was strong evidence for reductions in risk behaviour stemming HIV transmission. We estimate these changes occurred between 1999 and 2004 and averted 660,000 (95% credible interval: 460,000-860,000) infections by 2008. The model and associated analysis framework provide a robust way to evaluate the evidence for changes in risk behaviour affecting the course of HIV epidemics, avoiding confounding by the natural evolution of HIV epidemics.

Sexual compulsivity, state affect, and sexual risk behavior in a daily diary study of gay and bisexual men.

PubMed

Grov, Christian; Golub, Sarit A; Mustanski, Brian; Parsons, Jeffrey T

2010-09-01

Researchers have identified a strong link between sexual compulsivity (SC) and risky sexual behavior among men who have sex with men (MSM). Meanwhile, affect/mood has also been connected with negative sexual health outcomes (sexually transmitted infection/human immunodeficiency virus [HIV] transmission, sexual risk, sex under the influence of drugs/alcohol). Given that SC is characterized by marked distress around one's own sexual behavior, affect may play a central role in SC and HIV risk behavior. Data were taken from the Pillow Talk Project, a pilot study conducted in 2008-2009 with 50 highly sexually active MSM (9 or more male sex partners, ≤ 90 days), of which half displayed SC symptoms and half did not. Forty-seven men completed a daily diary online for 30 days (n = 1,060 diary days), reporting on their sexual behavior and concurrent affect: positive activation, negative activation, anxious arousal, and sexual activation. We conducted HLM analyses using daily affect (Level 1, within subjects) and SC and HIV status (Level 2, between subjects) to predict sexual behavior outcomes. Increased negative activation (characterized by fear, sadness, anger, and disgust) was associated with reduced sexual risk behavior, but less so among sexually compulsive MSM. Sexual activation was associated with increased sexual risk taking, but less so among sexually compulsive MSM. Anxious arousal was associated with increased sexual behavior, but not necessarily sexual risk taking. Findings indicate that affect plays key roles in sexual behavior and sexual risk taking; however, the association between affect and behavior may be different for sexually compulsive and non-sexually compulsive MSM.

Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents.

PubMed

Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine

2016-01-01

Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can "cash plus care" social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=-0.08, p<0.002 between structural deprivation and psychosocial problems, and B=-0.07, p<0.001 between psychosocial problems and HIV risk behaviour). Adolescents with the greatest structural deprivation are at higher risk of HIV, but social

Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents

PubMed Central

Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine

2016-01-01

Introduction Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. Methods This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Results Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=−0.08, p<0.002 between structural deprivation and psychosocial problems, and B=−0.07, p<0.001 between psychosocial problems and HIV risk behaviour). Conclusions Adolescents with the greatest structural

Estimating HIV incidence among key affected populations in China from serial cross-sectional surveys in 2010-2014.

PubMed

Cui, Yan; Guo, Wei; Li, Dongmin; Wang, Liyan; Shi, Cynthia X; Brookmeyer, Ron; Detels, Roger; Ge, Lin; Ding, Zhengwei; Wu, Zunyou

2016-01-01

HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China. Serial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality. The crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable. Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic.

Risk and protection for HIV/AIDS in African-American, Hispanic, and White adolescents.

PubMed

Bartlett, Robin; Buck, Raymond; Shattell, Mona M

2008-07-01

African-Americans and Hispanics are disproportionately affected by HIV/AIDS in the United States. HIV infection is often acquired during adolescence, a time when risky sexual behaviors are at their peak. This study explored relationships among selected risk factors, protective factors, and risky sexual behaviors among African-American, Hispanic, and White adolescents, from a sample of adolescents from the National Longitudinal Study of Adolescent Health. African-Americans and Hispanics were more likely to have sexual intercourse without the use of birth control than were Whites. African-Americans were more likely to have sexual behavior with multiple sexual partners than either Hispanics or Whites were, and African-Americans had higher self-esteem than did Hispanics and Whites. In order to develop culturally sensitive, effective interventions to prevent HIV/AIDS in adolescents, racial differences in risk and protective factors must be examined.

Risk of cancer among HIV-infected individuals compared to the background population: impact of smoking and HIV.

PubMed

Helleberg, Marie; Gerstoft, Jan; Afzal, Shoaib; Kronborg, Gitte; Larsen, Carsten S; Pedersen, Court; Bojesen, Stig E; Nordestgaard, Børge G; Obel, Niels

2014-06-19

The relative impact of immune deficiency and lifestyle-related factors on risk of cancer in the HIV-infected population is controversial. We aimed to estimate the population-attributable fractions (PAFs) associated with smoking, being HIV-infected and with immune deficiency. In a Danish, nationwide, population-based cohort study (1995-2011), incidences of cancer were compared between an HIV-infected cohort and a population-based matched cohort in analyses stratified on cancer category, smoking status and for HIV patients: low CD4 cell count. We included 3503 HIV patients [baseline CD4+ 450 cells/μl (inter-quartile range 310-630)] and 12,979 population controls. Smoking-related and virological cancers accounted for 23 and 43% of cancers in the HIV-infected population. The risk of these cancers were higher among HIV patients compared to controls [incidence rate ratio (IRR) 2.8, 95% confidence interval (CI) 1.6-4.9; and IRR 11.5, 95% CI 6.5-20.5], whereas the risk of other cancers did not differ (IRR 1.0, 95% CI 0.7-1.3). Non-smoking HIV patients did not have increased risk of non-virological cancers compared to non-smoking controls (IRR 1.2, 95% CI 0.7-2.1). The PAFs of cancer associated with smoking and with being HIV-infected were 27 and 49%, respectively. For cancers not strongly related to smoking or viral infections, the PAFs associated with being HIV-infected and with immune deficiency were 0%. The risk of cancer is increased in HIV patients compared to the background population. In absence of smoking, the increase in risk is confined to cancers related to viral infections, whereas the risk of other cancers is not elevated and does not seem to be associated with immune deficiency.

HIV infection and risk factors among the armed forces personnel stationed in Kinshasa, Democratic Republic of Congo.

PubMed

Rimoin, A W; Hoff, N A; Djoko, C F; Kisalu, N K; Kashamuka, M; Tamoufe, U; LeBreton, M; Kayembe, P K; Muyembe, J J; Kitchen, C R; Saylors, K; Fair, J; Doshi, R; Papworth, E; Mpoudi-Ngole, E; Grillo, M P; Tshala, F; Peeters, M; Wolfe, N D

2015-03-01

Despite recent declines in HIV incidence, sub-Saharan Africa remains the most heavily affected region in the global HIV/AIDS epidemic. Estimates of HIV prevalence in African military personnel are scarce and inconsistent. We conducted a serosurvey between June and September 2007 among 4043 Armed Forces personnel of the Democratic Republic of Congo (FARDC) stationed in Kinshasa, Democratic Republic of Congo (DRC) to determine the prevalence of HIV and syphilis infections and describe associated risk behaviours. Participants provided blood for HIV and syphilis testing and responded to a demographic and risk factor questionnaire. The prevalence of HIV was 3.8% and the prevalence of syphilis was 11.9%. Women were more likely than men to be HIV positive, (7.5% vs. 3.6% respectively, aOR: 1.66, 95% C.I: 1.21-2.28, p < 0.05). Factors significantly associated with HIV infection included gender and self-reported genital ulcers in the 12 months before date of enrollment. The prevalence of HIV in the military appears to be higher than the general population in DRC (3.8% vs. 1.3%, respectively), with women at increased risk of infection. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Neurocognitive Impairment and HIV Risk Factors: A Reciprocal Relationship

PubMed Central

Anand, Pria; Springer, Sandra A.; Copenhaver, Michael M.

2010-01-01

Cognitive impairment among populations at risk for HIV poses a significant barrier to managing risk behaviors. The impact of HIV and several cofactors, including substance abuse and mental illness, on cognitive function is discussed in the context of HIV risk behaviors, medication adherence, and risk-reduction interventions. Literature suggests that cognitive impairment is intertwined in a close, reciprocal relationship with both risk behaviors and medication adherence. Not only do increased risk behaviors and suboptimal adherence exacerbate cognitive impairment, but cognitive impairment also reduces the effectiveness of interventions aimed at optimizing medication adherence and reducing risk. In order to be effective, risk-reduction interventions must therefore take into account the impact of cognitive impairment on learning and behavior. PMID:20232242

Stimulant use patterns and HIV transmission risk among HIV-serodiscordant male couples.

PubMed

Gamarel, Kristi E; Woolf-King, Sarah E; Carrico, Adam W; Neilands, Torsten B; Johnson, Mallory O

2015-02-01

Substance use is strongly linked to HIV risk, and members of couples can have a powerful influence on each other's health behaviors. We examined whether couple-level patterns of stimulant use were differentially associated with engaging in condomless anal intercourse with primary partners and outside partners. Members of HIV serodiscordant male couples (N = 117 couples, 232 men) completed surveys, and HIV-positive men had blood drawn for viral load. Results revealed that stimulant use by only one partner in the couple was associated with a decrease in the odds of engaging in condomless anal sex with one's primary partner (AOR = 0.09, 95% CI: 0.01, 0.89). When both partners reported stimulant use, the HIV-negative partner had an increase in the odds of condomless sex with outside partners (AOR = 6.68, 95% CI: 1.09, 8.01). Understanding the role of couples' stimulant use patterns in HIV transmission risk is an important area for future research and intervention.

Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A "Seek, Test, Treat, and Retain" Harmonization Consortium.

PubMed

Loeliger, Kelsey B; Biggs, Mary L; Young, Rebekah; Seal, David W; Beckwith, Curt G; Kuo, Irene; Gordon, Michael S; Altice, Frederick L; Ouellet, Lawrence J; Cunningham, William E; Young, Jeremy D; Springer, Sandra A

2017-10-01

The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.

Venues for Meeting Sex Partners and Partner HIV Risk Characteristics: HIV Prevention Trials Network (HPTN064) Women's HIV Seroincidence Study (ISIS).

PubMed

Roman Isler, M; Golin, C; Wang, J; Hughes, J; Justman, J; Haley, D; Kuo, I; Adimora, A; Chege, W; Hodder, S

2016-06-01

Identifying venues where women meet sexual partners, particular partners who increase women's risk of acquiring HIV, could inform prevention efforts. We categorized venues where women enrolled in HPTN 064 reported meeting their last three sex partners as: (1) Formal, (2) Public, (3) Private, and (4) Virtual spaces. We used multinomial logistic regression to assess the association between these venues and women's individual characteristics and reports of their partners' HIV risk characteristics. The 2099 women reported meeting 3991 partners, 51 % at Public, 30 % Private, 17 % Formal and 3 % at Virtual venues. Women meeting partners at Formal venues reported more education and condom use than women meeting partners at other venues. Fewer partners met through Formal venues had "high" risk characteristics for HIV than through other venues and hence may pose less risk of HIV transmission. HIV prevention interventions can help women choose partners with fewer risk characteristics across all venue types.

Pre-risk HIV-prevention paradigm shift: the feasibility and acceptability of the parents matter! Program in HIV risk communities.

PubMed

Miller, Kim S; Maxwell, Karl D; Fasula, Amy M; Parker, J Terry; Zackery, Shannon; Wyckoff, Sarah C

2010-01-01

Many youth begin human immunodeficiency virus (HIV) sexual risk behaviors in preadolescence, yet risk-reduction programs are typically implemented in middle or late adolescence, missing an important window for prevention. Parent-based programming may play an important role in reaching youth early with prevention messages. One such program is the Parents Matter! Program (PMP), a five-session theory- and evidence-based intervention for parents of children aged 9 to 12 years. A randomized controlled trial showed PMP to be efficacious in promoting effective parent-child communication about sexuality and sexual risk reduction. We assessed the feasibility and acceptability of PMP when implemented under typical programmatic circumstances in communities at high risk for HIV infection. We selected 15 sites (including health departments, local education agencies, community-based organizations, and faith-based organizations) throughout the U.S. and Puerto Rico to participate in delivering PMP. Sites were provided training, program materials, and ongoing technical assistance. We collected multilevel data to assess the feasibility of program implementation and delivery, program relevance, and satisfaction with PMP activities and materials. PMP was successfully implemented and evaluated in 13 of 15 sites; 76% of parents attended at least four of five sessions. Organization-, facilitator-, and parent-level data indicated the feasibility and acceptability of PMP, and overall high satisfaction with PMP activities and materials. The results of this project demonstrate that HIV pre-risk prevention programs for parents can be implemented and embraced by a variety of community organizations in HIV at-risk communities. The time to embrace parents as partners in public health HIV-prevention efforts has come.

Behavioural risk factors for HIV/AIDS in a low-HIV prevalence Muslim nation: Bangladesh

PubMed Central

Gibney, L; Choudhury, P; Khawaja, Z; Sarker, M; Vermund, SH

2008-01-01

Summary A review of published and unpublished data indicates the prevalence of high-risk behaviours for HIV transmission in segments of the Bangladeshi population. These include casual unprotected sex, heterosexual as well as between males, prior to and after marriage. Intravenous drug use (IVDU) exists though illicit drugs are more commonly inhaled. There is a fear, however, that inhalers may turn to injecting drugs, as is common in neighbouring countries. The lack of public awareness of HIV/AIDS, and misconceptions about the disease, may contribute to continued high-risk behaviours by segments of the population and, thus, to the spread of HIV. Bangladesh’s proximity to India and Myanmar (countries with high HIV endemicity and a rapidly growing number of cases) increases fears of an epidemic in Bangladesh. This proximity will only be a risk factor, however, if high-risk contacts occur between nationals of these countries. PMID:10340200

The efficacy of serostatus disclosure for HIV Transmission risk reduction.

PubMed

O'Connell, Ann A; Reed, Sandra J; Serovich, Julianne A

2015-02-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698-705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed.

The Efficacy of Serostatus Disclosure for HIV Transmission Risk Reduction

PubMed Central

O’Connell, Ann A.; Serovich, Julianne A.

2015-01-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698–705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed. PMID:25164375

Gendered Differences in the Perceived Risks and Benefits of Oral PrEP Among HIV Serodiscordant Couples in Kenya

PubMed Central

Carroll, Jennifer J.; Ngure, Kenneth; Heffron, Renee; Curran, Kathryn; Mugo, Nelly R.

2016-01-01

Pre-exposure prophylaxis (PrEP) is effective for preventing HIV among HIV serodiscordant heterosexual couples. Gender roles may influence perceived personal and social risks related to HIV prevention behaviors and may affect use of PrEP. In this study, interviews and focus groups were conducted with 68 individuals from 34 mutually disclosed serodiscordant heterosexual partnerships in Thika, Kenya. Socio-cultural factors that affect adherence to PrEP were explored using grounded analysis. Three factors were identified, which shape perceptions of PrEP: gendered power dynamics and control over decision-making in the household; conflicts between risk reduction strategies and male sexual desire; culture bound definitions of women’s work. Adherence to PrEP in the Partners PrEP Study was high; however, participants articulated conflicting interests related to PrEP in connection with traditional gender roles. The successful delivery of PrEP will require understanding of key social factors, particularly related to gender and dyadic dynamics around HIV serostatus. PMID:26754017

Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics.

PubMed

Baral, Stefan; Logie, Carmen H; Grosso, Ashley; Wirtz, Andrea L; Beyrer, Chris

2013-05-17

Social and structural factors are now well accepted as determinants of HIV vulnerabilities. These factors are representative of social, economic, organizational and political inequities. Associated with an improved understanding of multiple levels of HIV risk has been the recognition of the need to implement multi-level HIV prevention strategies. Prevention sciences research and programming aiming to decrease HIV incidence requires epidemiologic studies to collect data on multiple levels of risk to inform combination HIV prevention packages. Proximal individual-level risks, such as sharing injection devices and unprotected penile-vaginal or penile-anal sex, are necessary in mediating HIV acquisition and transmission. However, higher order social and structural-level risks can facilitate or reduce HIV transmission on population levels. Data characterizing these risks is often far more actionable than characterizing individual-level risks. We propose a modified social ecological model (MSEM) to help visualize multi-level domains of HIV infection risks and guide the development of epidemiologic HIV studies. Such a model may inform research in epidemiology and prevention sciences, particularly for key populations including men who have sex with men (MSM), people who inject drugs (PID), and sex workers. The MSEM builds on existing frameworks by examining multi-level risk contexts for HIV infection and situating individual HIV infection risks within wider network, community, and public policy contexts as well as epidemic stage. The utility of the MSEM is demonstrated with case studies of HIV risk among PID and MSM. The MSEM is a flexible model for guiding epidemiologic studies among key populations at risk for HIV in diverse sociocultural contexts. Successful HIV prevention strategies for key populations require effective integration of evidence-based biomedical, behavioral, and structural interventions. While the focus of epidemiologic studies has traditionally been on

Knowledge of AIDS and HIV risk-related sexual behavior among Nigerian naval personnel

PubMed Central

Nwokoji, Ugboga Adaji; Ajuwon, Ademola J

2004-01-01

Background The epidemic of HIV continues to grow in Nigeria. Personnel in the military are at increased risk of HIV infection. Although HIV-risk related sexual behavior of Nigerian police officers has been studied, little is known about the sexual behavior of their counterparts in the Navy. This study describes knowledge of AIDS, and HIV-risk sexual behavior of naval personnel in Lagos Nigeria. Methods Four hundred and eighty personnel of the Nigerian Navy completed a 70-item questionnaire in 2002. Group discussion and in-depth interviews of four key informants were also conducted to gain insights into the context of risky sexual behaviors and suggestions for feasible HIV primary prevention interventions. Results The mean age of the respondents was 34 years. Although the overall mean AIDS knowledge score was 7.1 of 10 points, 52.1% of respondents believed that a cure for AIDS was available in Nigeria and that one can get HIV by sharing personal items with an infected person (25.3%). The majority (88.1%) had had lifetime multiple partners ranging from 1–40 with a mean of 5.1; 32.5% of male respondents had had sexual contact with a female sex worker, 19.9% did so during the six months preceding the survey. Forty-one percent of those with sexual contact with a female sex worker did not use a condom during the most recent sexual encounter with these women. Naval personnel who have been transferred abroad reported significantly more risky sexual behaviors than others. Group discussants and key informants believed that sex with multiple partners is a tradition that has persisted in the navy even in the era of AIDS because of the belief that AIDS affects only foreigners, that use of traditional medicine provides protection against HIV infection, and influence of alcohol. Conclusion Many naval personnel report participating in high-risk sexual behavior which may increase their risk of acquiring and spreading HIV. Naval personnel live and interact freely with civilian

The effect of marriage and HIV risks on condom use acceptability in rural Malawi.

PubMed

Anglewicz, Philip; Clark, Shelley

2013-11-01

A large and increasing proportion of HIV transmissions in sub-Saharan Africa occur within marriage. Condom use within marriage could, therefore, be an important prevention strategy, but there is considerable debate about whether married couples would be willing to use condoms. This paper contributes to this debate by identifying key factors that affect the acceptability of condom use within marriage and actual condom use among men and women in rural Malawi, using three waves of longitudinal data from 2004, 2006 and 2008. Specifically, we focused on the effect of (1) entry into first marriage, (2) respondent's HIV status, HIV perceptions, and risk behaviors, and (3) spouse's HIV characteristics on condom use acceptability within marriage and actual condom use with a spouse or steady partner. Using fixed-effects regression, we found that getting married coincides with a pronounced attitudinal shift regarding the acceptability of condom use within marriage that cannot be explained by differences in fertility status or selection into marriage. In addition, we found that, for women, perceived HIV status of the respondent and spouse generally had greater influence than actual HIV status on the acceptability of condom use within marriage and actual condom use with a spouse or steady partner, even after HIV status is known; while actual HIV status and HIV risk behaviors are generally more important among men. Although condom use within marriage remained low, these findings suggest that attitudes about and use of condoms are susceptible to change and that both marital status and perceptions of risk are important influences on condom use. Copyright © 2013 Elsevier Ltd. All rights reserved.

Men at risk; a qualitative study on HIV risk, gender identity and violence among men who have sex with men who report high risk behavior in Kampala, Uganda.

PubMed

King, Rachel; Barker, Joseph; Nakayiwa, Sylvia; Katuntu, David; Lubwama, George; Bagenda, Danstan; Lane, Tim; Opio, Alex; Hladik, Wolfgang

2013-01-01

In Uganda, men who have sex with men (MSM) are at high risk for HIV. Between May 2008 and February 2009 in Kampala, Uganda, we used respondent driven sampling (RDS) to recruit 295 MSM≥18 years who reported having had sex with another man in the preceding three months. The parent study conducted HIV and STI testing and collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. We conducted a nested qualitative sub-study with 16 men purposively sampled from among the survey participants based on responses to behavioral variables indicating higher risk for HIV infection. Sub-study participants were interviewed face-to-face. Domains of inquiry included sexual orientation, gender identity, condom use, stigma, discrimination, violence and health seeking behavior. Emergent themes included a description of sexual orientation/gender identity categories. All groups of men described conflicting feelings related to their sexual orientation and contextual issues that do not accept same-sex identities or behaviors and non-normative gender presentation. The emerging domains for facilitating condom use included: lack of trust in partner and fear of HIV infection. We discuss themes in the context of social and policy issues surrounding homosexuality and HIV prevention in Uganda that directly affect men's lives, risk and health-promoting behaviors.

Men at Risk; a Qualitative Study on HIV Risk, Gender Identity and Violence among Men Who Have Sex with Men Who Report High Risk Behavior in Kampala, Uganda

PubMed Central

King, Rachel; Barker, Joseph; Nakayiwa, Sylvia; Katuntu, David; Lubwama, George; Bagenda, Danstan; Lane, Tim; Opio, Alex; Hladik, Wolfgang

2013-01-01

In Uganda, men who have sex with men (MSM) are at high risk for HIV. Between May 2008 and February 2009 in Kampala, Uganda, we used respondent driven sampling (RDS) to recruit 295 MSM≥18 years who reported having had sex with another man in the preceding three months. The parent study conducted HIV and STI testing and collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. We conducted a nested qualitative sub-study with 16 men purposively sampled from among the survey participants based on responses to behavioral variables indicating higher risk for HIV infection. Sub-study participants were interviewed face-to-face. Domains of inquiry included sexual orientation, gender identity, condom use, stigma, discrimination, violence and health seeking behavior. Emergent themes included a description of sexual orientation/gender identity categories. All groups of men described conflicting feelings related to their sexual orientation and contextual issues that do not accept same-sex identities or behaviors and non-normative gender presentation. The emerging domains for facilitating condom use included: lack of trust in partner and fear of HIV infection. We discuss themes in the context of social and policy issues surrounding homosexuality and HIV prevention in Uganda that directly affect men's lives, risk and health-promoting behaviors. PMID:24358239

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria.

PubMed

Crowell, Trevor A; Keshinro, Babajide; Baral, Stefan D; Schwartz, Sheree R; Stahlman, Shauna; Nowak, Rebecca G; Adebajo, Sylvia; Blattner, William A; Charurat, Manhattan E; Ake, Julie A

2017-04-20

Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV. From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84-1.05]). These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

PubMed Central

Crowell, Trevor A; Keshinro, Babajide; Baral, Stefan D; Schwartz, Sheree R; Stahlman, Shauna; Nowak, Rebecca G; Adebajo, Sylvia; Blattner, William A; Charurat, Manhattan E; Ake, Julie A

2017-01-01

Abstract Introduction: Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. Methods: Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV. Results: From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84–1.05]). Conclusions: These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria. PMID:28453241

Hepatitis B and C Co-Infection in HIV Patients from the TREAT Asia HIV Observational Database: Analysis of Risk Factors and Survival

PubMed Central

Chen, Marcelo; Wong, Wing-Wai; Law, Matthew G.; Kiertiburanakul, Sasisopin; Yunihastuti, Evy; Merati, Tuti Parwati; Lim, Poh Lian; Chaiwarith, Romanee; Phanuphak, Praphan; Lee, Man Po; Kumarasamy, Nagalingeswaran; Saphonn, Vonthanak; Ditangco, Rossana; Sim, Benedict L. H.; Nguyen, Kinh Van; Pujari, Sanjay; Kamarulzaman, Adeeba; Zhang, Fujie; Pham, Thuy Thanh; Choi, Jun Yong; Oka, Shinichi; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Durier, Nicolas; Chen, Yi-Ming Arthur

2016-01-01

Background We assessed the effects of hepatitis B (HBV) or hepatitis C (HCV) co-infection on outcomes of antiretroviral therapy (ART) in HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of HIV-infected patients in the Asia-Pacific region. Methods Patients testing HBs antigen (Ag) or HCV antibody (Ab) positive within enrollment into TAHOD were considered HBV or HCV co-infected. Factors associated with HBV and/or HCV co-infection were assessed by logistic regression models. Factors associated with post-ART HIV immunological response (CD4 change after six months) and virological response (HIV RNA <400 copies/ml after 12 months) were also determined. Survival was assessed by the Kaplan-Meier method and log rank test. Results A total of 7,455 subjects were recruited by December 2012. Of patients tested, 591/5656 (10.4%) were HBsAg positive, 794/5215 (15.2%) were HCVAb positive, and 88/4966 (1.8%) were positive for both markers. In multivariate analysis, HCV co-infection, age, route of HIV infection, baseline CD4 count, baseline HIV RNA, and HIV-1 subtype were associated with immunological recovery. Age, route of HIV infection, baseline CD4 count, baseline HIV RNA, ART regimen, prior ART and HIV-1 subtype, but not HBV or HCV co-infection, affected HIV RNA suppression. Risk factors affecting mortality included HCV co-infection, age, CDC stage, baseline CD4 count, baseline HIV RNA and prior mono/dual ART. Shortest survival was seen in subjects who were both HBV- and HCV-positive. Conclusion In this Asian cohort of HIV-infected patients, HCV co-infection, but not HBV co-infection, was associated with lower CD4 cell recovery after ART and increased mortality. PMID:26933963

Penile Anaerobic Dysbiosis as a Risk Factor for HIV Infection

PubMed Central

Prodger, Jessica L.; Tobian, Aaron A. R.; Abraham, Alison G.; Kigozi, Godfrey; Aziz, Maliha; Nalugoda, Fred; Sariya, Sanjeev; Serwadda, David; Kaul, Rupert; Gray, Ronald H.; Price, Lance B.

2017-01-01

ABSTRACT Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4+ T cells or dendritic cells. The foreskin is a major site of viral entry in heterosexual transmission of HIV. Although the probability of acquiring HIV from a sexual encounter is low, the risk varies even after adjusting for known HIV risk factors. The genital microbiome may account for some of the variability in risk by interacting with the host immune system to trigger inflammatory responses that mediate the infection of mucosal immune cells. We conducted a case-control study of uncircumcised participants nested within a randomized-controlled trial of male circumcision in Rakai, Uganda. Using penile (coronal sulcus) swabs collected by study personnel at trial enrollment, we characterized the penile microbiome by sequencing and real-time PCR and cytokine levels by electrochemiluminescence assays. The absolute abundances of penile anaerobes at enrollment were associated with later risk of HIV seroconversion, with a 10-fold increase in Prevotella, Dialister, Finegoldia, and Peptoniphilus increasing the odds of HIV acquisition by 54 to 63%, after controlling for other known HIV risk factors. Increased abundances of anaerobic bacteria were also correlated with increased cytokines, including interleukin-8, which can trigger an inflammatory response that recruits susceptible immune cells, suggesting a mechanism underlying the increased risk. These same anaerobic genera can be shared between heterosexual partners and are associated with increased HIV acquisition in women, pointing to anaerobic dysbiosis in the genital microbiome and an accompanying inflammatory response as a novel, independent, and transmissible risk factor for HIV infection. PMID:28743816

Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

PubMed Central

Crooks, Denise; Tsui, Judith; Anderson, Bradley; Dossabhoy, Shernaz; Herman, Debra; Liebschutz, Jane M.; Stein, Michael D.

2016-01-01

Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets. PMID:25063229

Mitochondrial DNA Haplogroup A Decreases the Risk of Drug Addiction but Conversely Increases the Risk of HIV-1 Infection in Chinese Addicts.

PubMed

Zhang, A-Mei; Hu, Qiu-Xiang; Liu, Feng-Liang; Bi, Rui; Yang, Bi-Qing; Zhang, Wen; Guo, Hao; Logan, Ian; Zheng, Yong-Tang; Yao, Yong-Gang

2016-08-01

Drug addiction is one of the most serious social problems in the world today and addicts are always at a high risk of acquiring HIV infection. Mitochondrial impairment has been reported in both drug addicts and in HIV patients undergoing treatment. In this study, we aimed to investigate whether mitochondrial DNA (mtDNA) haplogroup could affect the risk of drug addiction and HIV-1 infection in Chinese. We analyzed mtDNA sequence variations of 577 Chinese intravenous drug addicts (289 with HIV-1 infection and 288 without) and compared with 2 control populations (n = 362 and n = 850). We quantified the viral load in HIV-1-infected patients with and without haplogroup A status and investigated the potential effect of haplogroup A defining variants m.4824A > G and m.8794C > T on the cellular reactive oxygen species (ROS) levels by using an allotopic expression assay. mtDNA haplogroup A had a protective effect against drug addiction but appeared to confer an increased risk of HIV infection in addicts. HIV-1-infected addicts with haplogroup A had a trend for a higher viral load, although the mean viral load was similar between carriers of haplogroup A and those with other haplogroup. Hela cells overexpressing allele m.8794 T showed significantly decreased ROS levels as compared to cells with the allele m.8794C (P = 0.03). Our results suggested that mtDNA haplogroup A might protect against drug addiction but increase the risk of HIV-1 infection. The contradictory role of haplogroup A might be caused by an alteration in mitochondrial function due to a particular mtDNA ancestral variant.

Risk behaviors and risk factors for HIV infection among participants in the Bangkok tenofovir study, an HIV pre-exposure prophylaxis trial among people who inject drugs.

PubMed

Martin, Michael; Vanichseni, Suphak; Suntharasamai, Pravan; Sangkum, Udomsak; Mock, Philip A; Leethochawalit, Manoj; Chiamwongpaet, Sithisat; Gvetadze, Roman J; Kittimunkong, Somyot; Curlin, Marcel E; Worrajittanon, Dararat; McNicholl, Janet M; Paxton, Lynn A; Choopanya, Kachit

2014-01-01

HIV spread rapidly among people who inject drugs in Bangkok in the late 1980s. In recent years, changes in drug use and HIV-associated risk behaviors have been reported. We examined data from the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial conducted among people who inject drugs, to assess participant risk behavior and drug use, and to identify risk factors for HIV infection. The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial. HIV status was assessed monthly and risk behavior every 3 months. We used generalized estimating equations logistic regression to model trends of injecting, needle sharing, drugs injected, incarceration, and sexual activity reported at follow-up visits; and proportional hazards models to evaluate demographic characteristics, sexual activities, incarceration, drug injection practices, and drugs injected during follow-up as predictors of HIV infection. The proportion of participants injecting drugs, sharing needles, and reporting sex with more than one partner declined during follow-up (p<0.001). Among participants who reported injecting at enrollment, 801 (53.2%) injected methamphetamine, 559 (37.1%) midazolam, and 527 (35.0%) heroin. In multivariable analysis, young age (i.e., 20-29 years) (p = 0.02), sharing needles (p<0.001), and incarceration in prison (p = 0.002) were associated with incident HIV infection. Participants reporting sex with an opposite sex partner, live-in partner, casual partner, or men reporting sex with male partners were not at a significantly higher risk of HIV infection compared to those who did not report these behaviors. Reports of HIV-associated risk behavior declined significantly during the trial. Young age, needle sharing, and incarceration were independently associated with HIV infection. Sexual activity was not associated with HIV infection, suggesting that the reduction in HIV incidence among participants taking daily oral tenofovir compared to those taking

Decision making under explicit risk is impaired in individuals with human immunodeficiency virus (HIV).

PubMed

Fujiwara, Esther; Tomlinson, Sara E; Purdon, Scot E; Gill, M John; Power, Christopher

2015-01-01

Human immunodeficiency virus (HIV) can affect the frontal-striatal brain regions, which are known to subserve decision-making functions. Previous studies have reported impaired decision making among HIV+ individuals using the Iowa Gambling Task, a task that assesses decision making under ambiguity. Previous study populations often had significant comorbidities such as past or present substance use disorders and/or hepatitis C virus coinfection, complicating conclusions about the unique contributions of HIV-infection to decision making. Decision making under explicit risk has very rarely been examined in HIV+ individuals and was tested here using the Game of Dice Task (GDT). We examined decision making under explicit risk in the GDT in 20 HIV+ individuals without substance use disorder or HCV coinfection, including a demographically matched healthy control group (n = 20). Groups were characterized on a standard neuropsychological test battery. For the HIV+ group, several disease-related parameters (viral load, current and nadir CD4 T-cell count) were included. Analyses focused on the GDT and spanned between-group (t-tests; analysis of covariance, ANCOVA) as well as within-group comparisons (Pearson/Spearman correlations). HIV+ individuals were impaired in the GDT, compared to healthy controls (p = .02). Their decision-making impairments were characterized by less advantageous choices and more random choice strategies, especially towards the end of the task. Deficits in the GDT in the HIV+ group were related to executive dysfunctions, slowed processing/motor speed, and current immune system status (CD4+ T-cell levels, ps < .05). Decision making under explicit risk in the GDT can occur in HIV-infected individuals without comorbidities. The correlational patterns may point to underlying fronto-subcortical dysfunctions in HIV+ individuals. The GDT provides a useful measure to assess risky decision making in this population and should be tested in larger studies.

Posttrial HIV vaccine adoption: concerns, motivators, and intentions among persons at risk for HIV.

PubMed

Newman, Peter A; Duan, Naihua; Rudy, Ellen T; Roberts, Kathleen J; Swendeman, Dallas

2004-11-01

Suboptimal uptake of existing vaccines, potential obstacles specific to HIV/AIDS stigma and mistrust, and marked health disparities suggest that it is vital to investigate consumer concerns, motivations, and adoption intentions regarding posttrial HIV vaccines before a vaccine is publicly available. Nine focus groups were conducted with participants (n = 99; median age, 33 years; 48% female; 22% African American, 44% Latino, and 28% white) recruited from 7 high-risk venues in Los Angeles using purposive venue-based sampling. A semistructured interview guide elicited concerns, motivators, and adoption intentions regarding hypothetical U.S. Food and Drug Administration-approved HIV vaccines. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. Concerns included vaccine efficacy, vaccine-induced infection, vaccine-induced HIV seropositivity, side effects, cost/access, trustworthiness, and relationship issues. Motivators included protection against HIV infection and the ability to safely engage in unprotected sex. Participants expressed reluctance to adopt partial efficacy vaccines and likelihood of increased sexual risk behaviors in response to vaccine availability. Tailored interventions to facilitate uptake of future U.S. Food and Drug Administration-approved HIV vaccines and to prevent risk behavior increases may be vital to the effectiveness of vaccines in controlling the AIDS pandemic.

A randomized trial of enhanced HIV risk-reduction and vaccine trial education interventions among HIV-negative, high-risk women who use noninjection drugs: the UNITY study.

PubMed

Koblin, Beryl A; Bonner, Sebastian; Hoover, Donald R; Xu, Guozhen; Lucy, Debbie; Fortin, Princess; Putnam, Sara; Latka, Mary H

2010-03-01

Limited data are available on interventions to reduce sexual risk behaviors and increase knowledge of HIV vaccine trial concepts in high-risk populations eligible to participate in HIV vaccine efficacy trials. The UNITY Study was a 2-arm randomized trial to determine the efficacy of enhanced HIV risk-reduction and vaccine trial education interventions to reduce the occurrence of unprotected vaginal sex acts and increase HIV vaccine trial knowledge among 311 HIV-negative noninjection drug using women. The enhanced vaccine education intervention using pictures along with application vignettes and enhanced risk-reduction counseling consisting of 3 one-on-one counseling sessions were compared with standard conditions. Follow-up visits at 1 week and 1, 6, and 12 months after randomization included HIV testing and assessment of outcomes. During follow-up, the percent of women reporting sexual risk behaviors declined significantly but did not differ significantly by study arm. Knowledge of HIV vaccine trial concepts significantly increased but did not significantly differ by study arm. Concepts about HIV vaccine trials not adequately addressed by either condition included those related to testing a vaccine for both efficacy and safety, guarantees about participation in future vaccine trials, assurances of safety, medical care, and assumptions about any protective effect of a test vaccine. Further research is needed to boost educational efforts and strengthen risk-reduction counseling among high-risk noninjection drug using women.

Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men.

PubMed

Zeglin, Robert J

2015-10-01

HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.

The Intersectionality of Stigmas among Key Populations of Older Adults Affected by HIV: a Thematic Analysis.

PubMed

Johnson Shen, Megan; Freeman, Ryann; Karpiak, Stephen; Brennan-Ing, Mark; Seidel, Liz; Siegler, Eugenia L

2018-03-26

The present study examined the intersectionality of stigma across varying groups of older persons living with HIV (PWH). Four focus groups of older PWH (gay/bisexual men, heterosexual men, heterosexual and bisexualwomen, and Spanish-speaking) were audio-recorded and transcribed. Inductive thematic text analysis was used to identify qualitative themes. Five major themes emerged from the data: 1) disclosure of HIV status; 2) types of stigma experienced; 3) discrimination experienced; 4) other outcomes associated with experiencing stigma; and 5) influence of aging on social isolation experienced due to stigma. Findings indicate women did not suffer from the intersection of stigmas. Other groups suffered from the intersection of stigma due to HIV status and age (gay/bisexual males); HIV status and perceived stigma of sexual orientation or drug use (heterosexual males); and HIV status and culture/ethnicity (Spanish-speaking). Results indicate that many at-risk groups, including heterosexual men, homosexual men, and Spanish-speaking individuals, experience an intersection of stigma between aging and their sexuality, HIV status, or real or perceived drug use. Results highlight the need for HIV support, especially social support, to address intersection of stigmas for unique groups of individuals disproportionately affected by HIV.

Cultural heuristics in risk assessment of HIV/AIDS.

PubMed

Bailey, Ajay; Hutter, Inge

2006-01-01

Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from broader cultural meaning systems to rationalize uncertainty. In this study, we identify some of the cultural heuristics used by migrant men in Goa, India to assess their risk of HIV infection from different sexual partners. Data derives from a series of in-depth interviews and a locally informed survey. Cultural heuristics identified include visual heuristics, heuristics of gender roles, vigilance and trust. The paper argues that, for more culturally informed HIV/AIDS behaviour change interventions, knowledge of cultural heuristics is essential.

We Are All Affected: Considering the Recovery of HIV/AIDS Infected and Affected Children

ERIC Educational Resources Information Center

Nelson, Carla

2008-01-01

This essay acknowledges that the HIV/AIDS pandemic has created entire communities for whom loss has become a common and a shared experience. As a result of this impact of HIV/AIDS, several questions surface. However, the one question upon which this essay focuses is, "What type of environment is required for children infected and affected by…

Children's representations of school support for HIV-affected peers in rural Zimbabwe.

PubMed

Campbell, Catherine; Andersen, Louise; Mutsikiwa, Alice; Madanhire, Claudius; Skovdal, Morten; Nyamukapa, Constance; Gregson, Simon

2014-04-26

HIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults. With reductions in development funding, public sector budgetary constraints, and a growing emphasis on the importance of indigenous resources in the HIV response, international policy allocates schools a key role in 'substituting for families' (Ansell, 2008) in supporting child health and well-being. We explore children's own accounts of the challenges facing their HIV-affected peers and the role of schools in providing such support. Contextualised within a multi-method study of school support for HIV-affected children in rural Zimbabwe, and regarding children's views as a key resource for child-relevant intervention and policy, 128 school children (10-14) wrote a story about an HIV-affected peer and how school assisted them in tackling their problems. Children presented harrowing accounts of negative impacts of HIV on the social, physical and mental well-being of peers, and how these manifested in the school setting. Whilst relationships with fellow learners and teachers were said to provide a degree of support, this was patchy and minimal, generally limited to small-scale and often one-off acts of material help or kindness (e.g. teachers giving children pens and exercise books or peers sharing school lunches), with little potential to impact significantly on the wider social drivers of children's daily challenges. Despite having respect for the enormity of the challenges many HIV-affected peers were coping with, children tended to keep a distance from them. School was depicted as a source of the very bullying, stigma and social exclusion that undermined children's opportunities for well-being in their lives more generally. Our findings challenge glib assumptions that schools can serve as a significant 'indigenous' supports of the health and well-being of HIV-affected children in the

Cancer risk among the HIV-infected elderly in the United States.

PubMed

Yanik, Elizabeth L; Katki, Hormuzd A; Engels, Eric A

2016-06-19

HIV-infected people and elderly people have higher cancer risk, but the combined effects of aging and HIV are not well described. We aimed to evaluate the magnitude of cancer risk in the HIV-infected elderly population. We conducted a case-cohort study including a 5% sample of U.S. Medicare enrollees and all cancer cases aged at least 65 in linked cancer registries. HIV was identified through Medicare claims. Among the HIV-infected, absolute cancer risk was calculated accounting for the competing risk of death. Associations between HIV and cancer were estimated with weighted Cox regression adjusting for demographic characteristics. Among 469 954 people in the 5% sample, 0.08% had an HIV diagnosis. Overall, 825 776 cancer cases were identified in cancer registries. Over 5 years, 10.1% of the HIV-infected elderly developed cancer, the most common diagnoses comprising lung (5-year cumulative incidence=2.2%), prostate (2.7%, among men), and colorectal cancer (0.9%), and non-Hodgkin lymphoma (0.8%). HIV was strongly associated with incidence of Kaposi sarcoma [adjusted hazard ratio (aHR)=94.4, 95% confidence interval (95%CI)=54.6-163], anal cancer (aHR=34.2, 95%CI=23.9-49.0) and Hodgkin lymphoma (aHR=6.3, 95%CI=2.8-14.3). HIV was also associated with incidence of liver cancer, non-Hodgkin lymphoma and lung cancer (aHR=3.4, 2.6, and 1.6, respectively). In the elderly, HIV infection is associated with higher risk for many cancers, although some associations were weaker than expected, perhaps reflecting effects of non-HIV pathways on cancer development. Due to the effects of HIV and aging, the HIV-infected elderly have a sizeable absolute risk, highlighting a need for cancer prevention.

Estimating HIV incidence among key affected populations in China from serial cross-sectional surveys in 2010–2014

PubMed Central

Cui, Yan; Guo, Wei; Li, Dongmin; Wang, Liyan; Shi, Cynthia X; Brookmeyer, Ron; Detels, Roger; Ge, Lin; Ding, Zhengwei; Wu, Zunyou

2016-01-01

Introduction HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China. Methods Serial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality. Results The crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable. Conclusions Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic. PMID:26989062

Domestic chores workload and depressive symptoms among children affected by HIV/AIDS in China.

PubMed

Yu, Yun; Li, Xiaoming; Zhang, Liying; Zhao, Junfeng; Zhao, Guoxiang; Zheng, Yu; Stanton, Bonita

2013-01-01

Limited data are available regarding the effects of domestic chores workload on psychological problems among children affected by HIV/AIDS in China. The current study aims to examine association between children's depressive symptoms and the domestic chores workload (i.e., the frequency and the amount of time doing domestic chores). Data were derived from the baseline survey of a longitudinal study which investigated the impact of parental HIV/AIDS on psychological problems of children. A total of 1449 children in family-based care were included in the analysis: 579 orphaned children who lost one or both parents due to AIDS, 466 vulnerable children living with one or both parents being infected with HIV, and 404 comparison children who did not have HIV/AIDS-infected family members in their families. Results showed differences on domestic chores workload between children affected by HIV/AIDS (orphans and vulnerable children) and the comparison children. Children affected by HIV/AIDS worked more frequently and worked longer time on domestic chores than the comparison children. Multivariate linear regression analysis showed that domestic chores workload was positively associated with depressive symptoms. The data suggest that children affected by HIV/AIDS may face increasing burden of domestic chores and it is necessary to reduce the excessive workload of domestic chores among children affected by HIV/AIDS through increasing community-based social support for children in the families affected by HIV/AIDS.

Domestic chores workload and depressive symptoms among children affected by HIV/AIDS in China

PubMed Central

Yu, Yun; Li, Xiaoming; Zhang, Liying; Zhao, Junfeng; Zhao, Guoxiang; Zheng, Yu; Stanton, Bonita

2012-01-01

Limited data are available regarding the effects of domestic chores workload on psychological problems among children affected by HIV/AIDS in China. The current study aims to examine association between children’s depressive symptoms and the domestic chores workload (i.e., the frequency and the amount of time doing domestic chores). Data were derived from the baseline survey of a longitudinal study which investigated the impact of parental HIV/AIDS on psychological problems of children. A total of 1,449 children in family-based care were included in the analysis: 579 orphaned children who lost one or both parents due to AIDS, 466 vulnerable children living with one or both parents being infected with HIV, and 404 comparison children who did not have HIV/AIDS infected family members in their families. Results showed differences on domestic chores workload between children affected by HIV/AIDS (orphans and vulnerable children) and the comparison children. Children affected by HIV/AIDS worked more frequently and worked longer time on domestic chores than the comparison children. Multivariate linear regression analysis showed that domestic chores workload was positively associated with depressive symptoms. The data suggest that children affected by HIV/AIDS may face increasing burden of domestic chores and it is necessary to reduce the excessive workload of domestic chores among children affected by HIV/AIDS through increasing community-based social support for children in the families affected by HIV/AIDS. PMID:22970996

The impact of stigma, experience, and group referent on HIV risk assessments and HIV testing intentions in Namibia.

PubMed

Smith, Rachel A; Morrison, Daniel

2006-11-01

People often perceive risks for others and themselves differently. This study examines whether personal beliefs about HIV and experience with those living with HIV influence personal risk assessments of contracting HIV in an interview sample of northern Namibians (N=400), but not others' assessments as explained by singular-distribution theory [Klar, Medding, & Sarel (1996). Nonunique invulnerability: Singular versus distributional probabilities and unrealistic optimism in comparative risk judgments. Organizational Behavior and Human Decision Processes, 67, 229-245]. Findings indicate that personal risk perceptions decrease with more HIV stigmatizing beliefs and increase with greater experience, but that those characteristics had no impact on assessments for others' risk. The study also examines whether the size and characteristics of the referent group, peers and the general Namibian population, influence others' risk assessments. Optimistic biases for personal risk versus others' risk appear with the highest discrepancy emerging between personal and general population risk assessments. Further, we found that personal risk perceptions did not mediate the relationship between personal characteristics, beliefs and experiences, and intentions to seek HIV testing.

Community narratives about women and HIV risk in 21 high-burden communities in Zambia and South Africa.

PubMed

Viljoen, Lario; Ndubani, Rhoda; Bond, Virginia; Seeley, Janet; Reynolds, Lindsey; Hoddinott, Graeme

2017-01-01

Public health researchers repeatedly represent women as a group vulnerable to ill health. This has been particularly true in the field of HIV research, where women are disproportionately affected by HIV in terms of disease burden and the social effects of the epidemic. Although women have been the focus of many prevention and treatment programs, structural barriers to implementation of these targeted programs persist. In this article we explore how high HIV-burden communities in South Africa and Zambia engage with the concepts of "woman" and "HIV risk". The data are drawn from participatory storytelling activities completed with 604 participants across 78 group discussions between December 2012 and May 2013. During discussions we found that participants made use of the core archetypal caricatures of "goodness," "badness," and "vulnerability" when describing women's HIV risk. Community members shifted between these categories in their characterizations of women, as they acknowledged the multiple roles women play, internalized different stories about women, and sometimes shifted register in the same stories. Findings suggest that health implementers, in consultation with community members, should consider the multiple positions women occupy and how this impacts the wider community's understandings of women and "risk". This approach of taking on board community understandings of the complexity of HIV risk can inform the design and implementation of HIV prevention and care programs by rendering programs more focused and in-line with community needs.

Self-Efficacy for Sexual Risk Reduction and Partner HIV Status as Correlates of Sexual Risk Behavior Among HIV-Positive Adolescent Girls and Women

PubMed Central

Boone, Melissa R.; Cherenack, Emily M.

2015-01-01

Abstract Little is known about the correlates of sexual risk behavior among HIV-positive adolescent girls and women in the United States. This study investigates two potential factors related to unprotected vaginal and anal intercourse (UVAI) that have yet to be thoroughly studied in this group: self-efficacy for sexual risk reduction and partner HIV status. Data was analyzed from 331 HIV-positive adolescent girls and women between 12 and 24 years old who reported vaginal and/or anal intercourse with a male partner in the past 3 months at fifteen sites across the United States. Results show that overall self-efficacy (B = −0.15, p=0.01), self-efficacy to discuss safe sex with one's partner (B = −0.14, p=0.01), and self-efficacy to refuse unsafe sex (B = −0.21, p=0.01) are related to UVAI episodes. Participants with only HIV-positive partners or with both HIV-positive and HIV-negative partners showed a trend towards higher percentages of UVAI episodes compared to participants with only HIV-negative partners (F(2, 319)=2.80, p=0.06). These findings point to the importance of including self-efficacy and partner HIV status in risk-reduction research and interventions developed for HIV-positive adolescent girls and young women. PMID:25856632

Self-Efficacy for Sexual Risk Reduction and Partner HIV Status as Correlates of Sexual Risk Behavior Among HIV-Positive Adolescent Girls and Women.

PubMed

Boone, Melissa R; Cherenack, Emily M; Wilson, Patrick A

2015-06-01

Little is known about the correlates of sexual risk behavior among HIV-positive adolescent girls and women in the United States. This study investigates two potential factors related to unprotected vaginal and anal intercourse (UVAI) that have yet to be thoroughly studied in this group: self-efficacy for sexual risk reduction and partner HIV status. Data was analyzed from 331 HIV-positive adolescent girls and women between 12 and 24 years old who reported vaginal and/or anal intercourse with a male partner in the past 3 months at fifteen sites across the United States. Results show that overall self-efficacy (B=-0.15, p=0.01), self-efficacy to discuss safe sex with one's partner (B=-0.14, p=0.01), and self-efficacy to refuse unsafe sex (B=-0.21, p=0.01) are related to UVAI episodes. Participants with only HIV-positive partners or with both HIV-positive and HIV-negative partners showed a trend towards higher percentages of UVAI episodes compared to participants with only HIV-negative partners (F(2, 319)=2.80, p=0.06). These findings point to the importance of including self-efficacy and partner HIV status in risk-reduction research and interventions developed for HIV-positive adolescent girls and young women.

Integrating Professional and Folk Models of HIV Risk: YMSM's Perceptions of High-Risk Sex

ERIC Educational Resources Information Center

Kubicek, Katrina; Carpineto, Julie; McDavitt, Bryce; Weiss, George; Iverson, Ellen F.; Au, Chi-Wai; Kerrone, Dustin; Martinez, Miguel; Kipke, Michele D.

2008-01-01

Risks associated with HIV are well documented in research literature. Although a great deal has been written about high-risk sex, little research has been conducted to examine how young men who have sex with men (YMSM) perceive and define high-risk sexual behavior. In this study, we compare the "professional" and "folk" models of HIV risk based on…

Health Costs of Wealth Gains: Labor Migration and Perceptions of HIV/AIDS Risks in Mozambique

ERIC Educational Resources Information Center

Agadjanian, Victor; Arnaldo, Carlos; Cau, Boaventura

2011-01-01

The study employs survey data from rural Mozambique to examine how men's labor migration affects their non-migrating wives' perceptions of HIV/AIDS risks. Using a conceptual framework centered on tradeoffs between economic security and health risks that men's migration entails for their left-behind wives, it compares women married to migrants and…

Labor Migration and HIV Risk: A Systematic Review of the Literature

PubMed Central

Weine, Stevan M.; Kashuba, Adrianna B.

2013-01-01

To inform the development of multilevel strategies for addressing HIV risk among labor migrants, 97 articles from the health and social science literatures were systematically reviewed. The study locations were Africa (23 %), the Americas (26 %), Europe (7 %), South East Asia (21 %), and Western Pacific (24 %). Among the studies meeting inclusion criteria, HIV risk was associated with multilevel determinants at the levels of policy, sociocultural context, health and mental health, and sexual practices. The policy determinants most often associated with HIV risk were: prolonged and/or frequent absence, financial status, and difficult working and housing conditions. The sociocultural context determinants most often associated with HIV risk were: cultural norms, family separation, and low social support. The health and mental health factors most often associated with HIV risk were: substance use, other STIs, mental health problems, no HIV testing, and needle use. The sexual practices most often associated with increased HIV risk were: limited condom use, multiple partnering, clients of sex workers, low HIV knowledge, and low perceived HIV risk. Magnitude of effects through multivariate statistics were demonstrated more for health and mental health and sexual practices, than for policy or sociocultural context. The consistency of these findings across multiple diverse global labor migration sites underlines the need for multilevel intervention strategies. However, to better inform the development, implementation, and evaluation of multilevel interventions, additional research is needed that overcomes prior methodological limitations and focuses on building new contextually tailored interventions and policies. PMID:22481273

The Adolescent HIV Disclosure Cognition and Affect Scale: Preliminary Reliability and Validity.

PubMed

Evangeli, Michael

2017-07-01

Globally, there are 2 million HIV-positive 10-19-year-olds. One challenge for this population is sharing their HIV status with others (onward HIV disclosure). There are no multi-item, multidimensional scales of HIV disclosure cognitions and affect for young people living with HIV. An 18-item measure of HIV disclosure cognition and affect was developed, administered to 65 adolescents living with HIV (aged 12-16 years). Data were explored using principal component analysis and preliminary construct and criterion validity assessed. Three factors were revealed: negative disclosure attitudes and feelings, self-efficacy, and positive disclosure attitudes and feelings. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV disclosure in the past 6 months, HIV disclosure intention and self-perception. Preliminary evidence of the measure's good psychometric properties suggests it may be helpful in future clinical and research work. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Parental HIV disclosure: from perspectives of children affected by HIV in Henan, China.

PubMed

Zhao, Junfeng; Li, Xiaoming; Qiao, Shan; Zhao, Guoxiang; Zhang, Liying; Stanton, Bonita

2015-01-01

Culturally and developmentally appropriate parental HIV disclosure (i.e., parents disclose their HIV infection to children) has been shown to be closely related with the well-being of both HIV-infected parents and their children. However, current practices and effects of parental HIV disclosure remain poorly understood in low- and middle-income countries including China. Quantitative data from 626 children affected by parental HIV (orphans and vulnerable children) in Henan, China, were collected in 2011 to examine children's perceptions and knowledge regarding their parents' HIV disclosure practices and to assess the associations of these practices with children's demographic and psychosocial factors. The data in the current study revealed that only a small proportion of children learned parental HIV infection from their parents (direct disclosure), and many of these disclosure seemed being unplanned. Among the children who were not told by their parents, at least 95% of them either knew parental illness from others (indirect disclosure) or from their own observations or suspicions. The children reported similar disclosure practices by fathers and mothers. There were minimum differences between disclosed and nondisclosed children on a number of psychosocial measures. The findings support the notion that parental HIV disclosure is a complex process and can only be beneficial if it is carefully planned. The data in the current study suggest the needs for the culturally and developmentally appropriate approach in parental HIV disclosure in order to maximize both short- and long-term benefits to children, parents, and family functioning.

HIV risk perception and distribution of HIV risk among African, Caribbean and other Black people in a Canadian city: mixed methods results from the BLACCH study

PubMed Central

2013-01-01

Background African, Caribbean and other Black (ACB) people are a priority group for HIV prevention in Canada, but little is known about the epidemiology of HIV risk in this population. This paper helps fill the knowledge gap by: presenting service providers’ and ACB people’s perceptions about HIV risk in ACB populations; describing the distribution of HIV risk behaviours among ACB people according to markers of social status and position; and comparing results from these two analyses. Methods The Black, African and Caribbean Canadian Health (BLACCH) Study is a mixed methods study that used semi-structured interviews and a cross-sectional quantitative questionnaire to collect information about HIV and health from 188 ACB people in London, Ontario, Canada. Qualitative content analysis was used to identify interview themes, and weighted bivariate statistical analyses were performed on the quantitative data. Behaviours related to HIV risk were stratified by sex, poverty status, immigration experience and employment status. Results Community members perceived that they were at low risk for HIV and mainly focused on sexual risks. They called for more information about HIV in Canada and culturally appropriate HIV services. Service providers cited marital infidelity and cultural and religious attitudes about condoms as barriers to women protecting themselves. They mentioned cultural norms, beliefs about masculinity and underrepresentation of heterosexual ACB men at AIDS service organizations as barriers to men protecting themselves. There were few statistically significant differences in risk behaviours reported by men and women. Those living in poverty were more likely to abstain from sex (p = 0.006) and use condoms (p = 0.027) in the past year. Those living in Canada longer reported higher prevalences of forced sex (p < 0.001), mixing alcohol or drugs with sex (p = 0.001) and past STI diagnoses (p = 0.032). Stable employment was associated with

Impulsivity, Sensation Seeking, and Risk-Taking Behaviors among HIV-Positive and HIV-Negative Heroin Dependent Persons

PubMed Central

Paydary, Koosha; Mahin Torabi, Somayeh; SeyedAlinaghi, SeyedAhmad; Noori, Mehri; Noroozi, Alireza; Ameri, Sara; Ekhtiari, Hamed

2016-01-01

Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS). Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people. PMID:27051528

Integrating Professional and Folk Models of HIV Risk: YMSM’s Perceptions of High-Risk Sex

PubMed Central

Kubicek, Katrina; Carpineto, Julie; McDavitt, Bryce; Weiss, George; Iverson, Ellen F.; Au, Chi-Wai; Kerrone, Dustin; Martinez, Miguel; Kipke, Michele D.

2009-01-01

Risks associated with HIV are well documented in research literature. While a great deal has been written about high-risk sex, little research has been conducted to examine how young men who have sex with men (YMSM) perceive and define high-risk sexual behavior. In this study, we compare the “professional’ and “folk” models of HIV-risk based on YMSM’s understanding of high-risk sex and where and how they gathered their understanding of HIV-risk behaviors. The findings reported here emerged from the quantitative and qualitative interviews from the Healthy Young Men’s Study (HYM), a longitudinal study examining risk and protective factors for substance use and sexual risk among an ethnically diverse sample of YMSM. Findings are discussed in relation to framing how service providers and others can increase YMSM’s knowledge of sexual behavior and help them build solid foundations of sexual health education to protect them from STI and HIV infection. PMID:18558819

Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia.

PubMed

Mazeingia, Yohannes Teka; Olijjira, Lemessa; Dessie, Yadeta

2017-01-01

Female sex workers have been disproportionately affected with HIV and anal sexual experience elevate their vulnerability. Anal intercourse has more risk of HIV transmission than vaginal intercourse for receptors that coupled with low condom and proper lubricant use behavior during anal sex. Besides majority of them did not understand HIV transmission risk of anal intercourse. In Ethiopia, studies on anal sexual experience is almost none existent, so the purpose of this study is to explored anal sexual experience and HIV transmission risk awareness among female sex worker in Dire Dawa, Eastern Ethiopia. Qualitative study with thematic analysis approach was conducted among 18 female sex workers and recruitment of study participants performed until saturation of information. The principal investigator conducted in-depth interviews using local language (Amharic) and it was recorded on audio recorder. Tape recorded data was transcribed and translated to English and entered into open code version 3.4 for coding and theme identification. Data collection conducted simultaneously with data analysis. Female sex workers practiced anal sex for different themes like financial influence, coercion, intentionally, peer pressure and as a sign of intimacy and love. Coercion, negative attitudes, poor awareness about HIV transmission risks of anal sex and protection capacity of condom and proper lubricants are the identified themes for not using condom and proper lubricants during anal sex by female sex workers. Inaccessibility and unavailability of health services for issues related to anal sex was the core reason for female sex workers' misperception and risk anal sexual experience. Female sex workers practiced anal sex without risk reduction approaches and they did not understand exacerbated risk of anal sex to HIV transmission. Stakeholders including ministry of health need to incorporate potential awareness raising tasks and programs about risk of anal sex and methods of risk

Online Sex Partner Meeting Venues as a Risk Factor for Testing HIV Positive Among a Community-Based Sample of Black Men Who Have Sex With Men.

PubMed

Eaton, Lisa A; Maksut, Jessica L; Gamarel, Kristi E; Siembida, Elizabeth J; Driffin, Daniel D; Baldwin, Robert

2016-06-01

In the United States, black men who have sex with men (BMSM) are disproportionately affected by the HIV epidemic. The elevated estimates of HIV among BMSM suggest that to slow rates of HIV infections, a range of factors that may contribute to transmission must be researched. Use of online venues for seeking out sex partners is one such area that may further advance our understanding of risks for HIV among BMSM. Black men who have sex with men residing in Atlanta, GA, reporting HIV-negative/unknown status completed survey assessments and HIV antibody testing. Logistic regression using generalized linear modeling was used to conduct both bivariate and multivariable analyses of psychosocial variables-that is, substance use, sexually transmitted infection symptoms/diagnoses, sexual risk behavior, online sex partner meeting, and HIV test results. Two hundred thirty-two BMSM tested HIV negative and 39 BMSM tested HIV positive (14% new diagnoses). Reporting symptoms of a rectal sexually transmitted infection (odds ratio, 4.28; 95% confidence interval, 1.06-15.41) and use of sexual networking apps (odds ratio, 2.15; 95% confidence interval, 1.06-4.36) were both associated with testing HIV positive in a multivariable analysis. The use of sexual networking apps is associated with risks for HIV infection above and beyond what is captured by sexual risk behavior alone. Evaluating how sexual networking apps affect sexual networks and social norms regarding sexual risk taking and HIV transmission is an important and novel area for HIV prevention and intervention development.

A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission.

PubMed

Eaton, Lisa A; Kalichman, Seth C; O'Connell, Daniel A; Karchner, William D

2009-10-01

A common HIV/AIDS risk reduction strategy among men who have sex with men (MSM) is to limit their unprotected sex partners to those who are of the same HIV status, a practice referred to as serosorting. Decisions to serosort for HIV risk reduction are based on personal impressions and beliefs, and there is limited guidance offered on this community derived strategy from public health services. This paper reviews research on serosorting for HIV risk reduction and offers an evidence-based approach to serosorting guidance. Following a comprehensive electronic and manual literature search, we reviewed 51 studies relating to the implications of serosorting. Studies showed that HIV negative MSM who select partners based on HIV status are inadvertently placing themselves at risk for HIV. Infrequent HIV testing, lack of HIV status disclosure, co-occurring sexually transmitted infections, and acute HIV infection impede the potential protective benefits of serosorting. Public health messages should continue to encourage reductions in numbers of sexual partners and increases in condom use. Risk reduction messages should also highlight the limitations of relying on one's own and partner's HIV status in making sexual risk decisions.

Eban HIV/STD risk reduction intervention: conceptual basis and procedures.

PubMed

2008-09-01

To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention, and how the content was shaped by culturally congruent concepts to address the needs of the study target population. The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual-, interpersonal-, and community-level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couple-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afrocentric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from 4 urban sites (Atlanta, Los Angeles, New York, and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements, and content of each session are described and lessons learned from this intervention trial are discussed. An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV-serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the participants responded very well

Psychological Resilience among Children Affected by Parental HIV/AIDS: A Conceptual Framework

PubMed Central

Li, Xiaoming; Chi, Peilian; Sherr, Lorraine; Cluver, Lucie; Stanton, Bonita

2015-01-01

HIV-related parental illness and death have a profound and lasting impact on a child's psychosocial wellbeing, potentially compromising the child's future. In response to a paucity of theoretical and conceptual discussions regarding the development of resilience among children affected by parental HIV, we proposed a conceptual framework of psychological resilience among children affected by HIV based on critical reviews of the existing theoretical and empirical literature. Three interactive social ecological factors were proposed to promote the resilience processes and attenuate the negative impact of parental HIV on children's psychological development. Internal assets, such as cognitive capacity, motivation to adapt, coping skills, religion/spirituality, and personality, promote resilience processes. Family resources and community resources are two critical contextual factors that facilitate resilience process. Family resources contain smooth transition, functional caregivers, attachment relationship, parenting discipline. Community resources contain teacher support, peer support, adult mentors, and effective school. The implications of the conceptual framework for future research and interventions among children affected by parental HIV were discussed. PMID:26716068

Psychological Resilience among Children Affected by Parental HIV/AIDS: A Conceptual Framework.

PubMed

Li, Xiaoming; Chi, Peilian; Sherr, Lorraine; Cluver, Lucie; Stanton, Bonita

2015-01-01

HIV-related parental illness and death have a profound and lasting impact on a child's psychosocial wellbeing, potentially compromising the child's future. In response to a paucity of theoretical and conceptual discussions regarding the development of resilience among children affected by parental HIV, we proposed a conceptual framework of psychological resilience among children affected by HIV based on critical reviews of the existing theoretical and empirical literature. Three interactive social ecological factors were proposed to promote the resilience processes and attenuate the negative impact of parental HIV on children's psychological development. Internal assets, such as cognitive capacity, motivation to adapt, coping skills, religion/spirituality, and personality, promote resilience processes. Family resources and community resources are two critical contextual factors that facilitate resilience process. Family resources contain smooth transition, functional caregivers, attachment relationship, parenting discipline. Community resources contain teacher support, peer support, adult mentors, and effective school. The implications of the conceptual framework for future research and interventions among children affected by parental HIV were discussed.

HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?

PubMed

Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill

2016-08-01

Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.

Risk factors for HIV-AIDS among youth in Cape Town, South Africa.

PubMed

Simbayi, Leickness C; Kalichman, Seth C; Jooste, Sean; Cherry, Charsey; Mfecane, Sakhumzi; Cain, Demetria

2005-03-01

South Africa is in the midst of a devastating HIV-AIDS epidemic and most new HIV infections occur among young adults and adolescents. The current study examined risk behaviors and HIV risk factors among young people living in a Black South African township. Using community-based outreach methods of street intercept and facility-based surveying, 113 men and 115 women age 25 and younger responded to an anonymous survey. Results showed that men (68%) and women (56%) reported HIV-related high risk sexual behaviors. Although knowledge about HIV transmission was generally high, there was evidence that misconceptions about AIDS persist, particularly myths related to HIV transmission. For young men, HIV risk factors were associated with fewer years of education, lower levels of AIDS-related knowledge, condom attitudes, and Dagga (marijuana) use. Among young women, HIV risk factors were associated with beliefs that condoms get in the way of sex and rates of unprotected vaginal intercourse. Despite adequate general AIDS knowledge and risk sensitization, South African youth demonstrated high rates of sexual practices that place them at risk for HIV infection. There is an urgent need for behavioral interventions targeted to young South Africans living in the most economically disadvantaged areas.

Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection in New York City.

PubMed

Gwadz, Marya; Cleland, Charles M; Kutnick, Alexandra; Leonard, Noelle R; Ritchie, Amanda S; Lynch, Laura; Banfield, Angela; McCright-Gill, Talaya; Del Olmo, Montserrat; Martinez, Belkis

2016-01-01

The Centers for Disease Control and Prevention recommends persons at high risk for HIV infection in the United States receive annual HIV testing to foster early HIV diagnosis and timely linkage to health care. Heterosexuals make up a significant proportion of incident HIV infections (>25%) but test for HIV less frequently than those in other risk categories. Yet factors that promote or impede annual HIV testing among heterosexuals are poorly understood. The present study examines individual/attitudinal-, social-, and structural-level factors associated with past-year HIV testing among heterosexuals at high risk for HIV. Participants were African-American/Black and Hispanic heterosexual adults (N = 2307) residing in an urban area with both high poverty and HIV prevalence rates. Participants were recruited by respondent-driven sampling in 2012-2015 and completed a computerized structured assessment battery covering background factors, multi-level putative facilitators of HIV testing, and HIV testing history. Separate logistic regression analysis for males and females identified factors associated with past-year HIV testing. Participants were mostly male (58%), African-American/Black (75%), and 39 years old on average (SD = 12.06 years). Lifetime homelessness (54%) and incarceration (62%) were common. Half reported past-year HIV testing (50%) and 37% engaged in regular, annual HIV testing. Facilitators of HIV testing common to both genders included sexually transmitted infection (STI) testing or STI diagnosis, peer norms supporting HIV testing, and HIV testing access. Among women, access to general medical care and extreme poverty further predicted HIV testing, while recent drug use reduced the odds of past-year HIV testing. Among men, past-year HIV testing was also associated with lifetime incarceration and substance use treatment. The present study identified gaps in rates of HIV testing among heterosexuals at high risk for HIV, and both common and

HIV Risk, Substance Use, and Personality Characteristics among Adults with History of Serious Mental Illness.

PubMed

Mainville, Cathryn H; Richardson, Mark A; Brady, Stephen M; Berger-Greenstein, Jori; Bacic, Janine

2017-01-01

The present study examined the relationship between characteristics associated with personality disorders, substance use, and HIV risk among adults with a history of serious mental illness. Participants included 103 adults with antisocial or borderline personality disorder, serious mental illness, and recent HIV risk behavior. The sample was predominately male (64%), diverse (42% African American and 13% Hispanic), and homeless/marginally housed (76%). In order to examine the relationship between personality characteristics and risk we constructed a risk index comprising key symptoms of antisocial and borderline personality disorders, namely; impulsivity, affective instability, and disregard for safety of self/others. Contrary to our primary hypotheses, risk index scores did not predict HIV risk behavior and substance abuse did not mediate this risk. Exploratory analyses did reveal that women engaged in significantly more risk behaviors than their male counterparts and that risk scores were a significant predictor of total sex acts for women but not men. In addition, increased emotional dysregulation was a significant predictor of condomless sex acts for women but not men. Finally, recent alcohol use and increased impulsivity was associated with more condomless oral sex for men and women. These results suggest the relationship among serious mental illness, personality disorder, substance abuse, and gender is complex and merits further study.

Social Support and Its Impact on Ethnic Identity and HIV Risk among Migrant Workers.

PubMed

Shehadeh, Nancy; Rubens, Muni; Attonito, Jennifer; Jennings, Terri

2018-02-01

Migrant workers are disproportionately affected by HIV due to poverty, social isolation, lack of access to and availability of health care services, acculturation, language barriers, constant mobility, and lack of knowledge. This study examined the impact of changes in social support on ethnic identity and HIV risk behaviors among migrant workers in South Florida. For this study, baseline and 6-month follow-up data were collected from an HIV intervention study among migrant workers in South Florida (n = 270) who reported unprotected sex in the past 30 days. The Multigroup Identity Measure was used to assess ethnic identity and the Social Provisions Scale examined the degree to which respondents' social relationships provide various dimensions of social support. Social support was a significant predictor of ethnic identity and of ethnic identity subscales, ethnic identity belonging and ethnic identity explore. There were small but statistically significant short-term changes in ethnic identity and ethnic identity subscales among the migrant workers over the 6-month time period assessed after controlling for the intervention. Future studies should be conducted over a longer period of time to better assess this relationship and possible factors to reduce HIV risk behaviors. There is a need to focus on improving the quality of health and reduce HIV and other risks experienced by this marginalized community.

Longitudinal Association of HIV Conspiracy Beliefs with Sexual Risk Among Black Males Living with HIV

PubMed Central

Galvan, Frank H.; Wagner, Glenn J.; Klein, David J.

2010-01-01

Research is needed to identify culturally relevant factors that may contribute to sexual risk among African Americans. We investigated HIV-specific medical mistrust as one such cultural factor, often exhibited as conspiracy beliefs about HIV (e.g., “AIDS was produced in a government laboratory”), which may be indicative of general suspicion of HIV treatment and prevention messages. Over a 6-month time-period, we measured endorsement of HIV conspiracy beliefs three times and frequency of condom use monthly among 181 HIV-positive African American males. A hierarchical multivariate repeated-measures logistic random effects model indicated that greater belief in HIV conspiracies was associated with a higher likelihood of reporting unprotected intercourse across all time-points. An average of 54% of participants who endorsed conspiracies reported unprotected intercourse, versus 39% who did not endorse conspiracies. Secondary prevention interventions may need to address medical mistrust as a contributor to sexual risk among African Americans living with HIV. PMID:20734227

Perception of risk of HIV and sexual risk behaviors among University students: implication for planning interventions.

PubMed

Shiferaw, Yitayal; Alemu, Abebe; Assefa, Abate; Tesfaye, Berihun; Gibermedhin, Etsegenet; Amare, Misiker

2014-03-19

The university environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. Despite recently gained decline of the overall incidence of HIV infection, still significant proportion of youth population are at high risk of HIV infection. The aims of this study were to assess the perception of HIV risk and factors associated with risk perception among students at University of Gondar, Northwest Ethiopia. A cross sectional study was conducted between February and April, 2012 among health science students. A total of 384 students were involved in the study using stratified sampling technique. Chi-square test and logistic regression analysis were employed. P-value < 0.05 was considered statistically significant for all cases. Of the total 384 participated students, 200(52.1%) were females. Out of the total study respondents, 202(52.6%) were sexually experienced. One hundred and nine (59.2%) out of 184 males and 93(46.5%) out of 200 females had had sexual experience. About 23(57.5%) of those age below 20 years, 70(52.2%) of 20-24 years old, and 13(61.9%) of those ages of 25 years or older were perceived themselves as if they have no chance of acquiring HIV infection. Students initiated sexual intercourse at early age (≤8 years) were significantly associated with having multiple partnerships (crude OR =3.6, p = 0.002 for male and crude OR = 1.7, p = 0.04 for female). Statistically significant difference was observed in the distribution of condom use during sexual intercourse among various age groups (p-value = 0.001). Sexual initiation at younger age, having multiple partnerships, inconsistent condom use and alcohol and/or drug abuse were significantly perceived as predictor for an increased risks for HIV infection. Students were engaged in various HIV risk behaviors. Early sexual initiation and alcohol and/or drug abuse were important factors for having multiple partnerships. Poor agreement

Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi.

PubMed

Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer

2013-01-01

The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

Hispanic women's experiences with substance abuse, intimate partner violence, and risk for HIV.

PubMed

Gonzalez-Guarda, Rosa Maria; Vasquez, Elias P; Urrutia, Maria T; Villarruel, Antonia M; Peragallo, Nilda

2011-01-01

Hispanic females are disproportionately affected by substance abuse, intimate partner violence, and HIV. Despite these disparities, research describing the cultural and gender-specific experiences of Hispanic women with regard to these conditions is lacking. Transplantadas en otro mundo (Uprooted in another world), El criador de abuso (The breeding ground of abuse), and Rompiendo el silencio (Breaking the silence). This study supports the importance of addressing substance abuse, violence, and risk for HIV in an integrated manner and stresses the importance of addressing associated cultural factors (e.g., acculturation, machismo ) in interventions targeting Hispanics.

Prevalence of and risk factors for anal high-risk HPV among HIV-negative and HIV-positive MSM and transgender women in three countries at South-East Asia

PubMed Central

Somia, I Ketut Agus; Teeratakulpisarn, Nipat; Jeo, Wifanto S.; Yee, Ilias A.; Pankam, Tippawan; Nonenoy, Siriporn; Trachuntong, Deondara; Mingkwanrungrueng, Pravit; Sukmawati, Made Dewi D.; Ramautarsing, Reshmie; Nilasari, Hanny; Hairunisa, Nany; Azwa, Iskandar; Yunihastuti, Evy; Merati, Tuti P.; Phanuphak, Praphan; Palefsky, Joel; Phanuphak, Nittaya

2018-01-01

Abstract This study aimed to assess the prevalence of and associated risk factors for anal high-risk human papillomavirus (hr-HPV) infection among men who have sex with men (MSM) and transgender women (TGW) in Indonesia, Thailand, and Malaysia. This was baseline data from a prospective cohort study with clinic sites in Jakarta and Bali (Indonesia), Bangkok (Thailand), and Kuala Lumpur (Malaysia). MSM and TGW aged 18 years and older from Indonesia, Thailand, and Malaysia were enrolled. Demographic and behavioral characteristics were assessed, and anal samples were collected for HPV genotyping. Multivariate logistic regression models were used to assess risk factors for anal hr-HPV overall and among HIV-positive participants. A total of 392 participants were enrolled, and 48 were TGW. As many as 245 were HIV-positive, and 78.0% of the participants were on combination antiretroviral therapy (cART). Median CD4 count was 439 cells/mm3 and 68.2% had undetectable HIV-RNA. HIV-positive participants had significantly more hr-HPV compared to HIV-negative participants (76.6% vs 53.5%, P < .001). HPV-16 was the most common high-risk type (20%), whereas HPV-33, -39, and -58 were significantly more common among HIV-positive participants. HIV-positive participant significantly associated with anal hr-HPV infection compared with HIV-negative (OR: 2.87, 95% CI: 1.76–4.70, P ≤ .001), whereas among HIV-positive participants transgender identity had lower prevalence of hr-HPV infection (OR: 0.42, 95% CI: 0.19–0.91, P = .03). High-risk HPV infection was very common among MSM and TGW in South-East Asia. Overall, HIV-infection, regardless of cART use and immune status, significantly increased the risk, while among HIV-positive participants transgender identity seemed to decrease the risk of anal hr-HPV. PMID:29517698

A Randomized Controlled Trial of a Resilience-Based Intervention for Children Affected by Parental HIV: Educational Outcomes at 24-, 30-, and 36-Months

ERIC Educational Resources Information Center

Harrison, Sayward E.; Li, Xiaoming; Zhang, JiaJia; Zhao, Junfeng; Zhao, Guoxiang

2018-01-01

Children of parents with human immunodeficiency virus (HIV) are at-risk for a variety of negative outcomes, including poor educational achievement. The multi-level, resilience-based "ChildCARE" intervention has been found to yield short-term improvement in a number of school-related variables for children affected by parental HIV.…

Group Intervention to Reduce HIV Transmission Risk Behavior Among Persons Living With HIV/AIDS

ERIC Educational Resources Information Center

Kalichman, Seth C.; Rompa, David; Cage, Marjorie

2005-01-01

Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the…

Comprehensive HIV Prevention for Transgender Persons.

PubMed

Neumann, Mary Spink; Finlayson, Teresa J; Pitts, Nicole L; Keatley, JoAnne

2017-02-01

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels-socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration.

Comprehensive HIV Prevention for Transgender Persons

PubMed Central

Neumann, Mary Spink; Finlayson, Teresa J.; Pitts, Nicole L.; Keatley, JoAnne

2017-01-01

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons’ HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels—socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration. PMID:27997228

Exposure to violence and psychological well-being over time in children affected by HIV/AIDS in South Africa and Malawi

PubMed Central

Skeen, S.; Macedo, A.; Tomlinson, M.; Hensels, I. S.; Sherr, L.

2016-01-01

ABSTRACT Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12–15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). Interpersonal violence in the home predicted child depression (β = 0.17, p < .001), trauma symptoms (β = 0.17, p < .001), lower self-esteem (β = −0.17, p < .001), and internalising and externalising behavioural problems (β = 0.07, p < .05), while exposure to community violence predicted trauma symptoms (β = 0.16, p < .001) and behavioural problems (β = 0.07, p < .05). Harsh physical discipline predicted lower self-esteem (β = −0.18, p < .001) and behavioural problems for children (β = 0.24, p < .001). Exposure to home (OR: 1.89, 95% CI: 1.23–2.85) and community violence predicted risk behaviour (OR: 2.39, 95% CI: 1.57–3.62). Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children. PMID:27002770

Parenting Styles and Emotional Intelligence of HIV-affected Children in Thailand

PubMed Central

Lee, Sung-Jae; Li, Li; Thammawijaya, Panithee

2013-01-01

The purpose of this study was to examine the impact of parenting styles on emotional intelligence of HIV-affected children in Thailand. This study uses data from 205 HIV-affected children in northern and northeastern Thailand. Correlation and regression analyses were used to examine the predictors of emotional intelligence. Children reporting higher levels of stress reported less caring parenting style (Standardized beta [B] = −0.18, p=0.050). Children with higher self-esteem were also more likely to perceive their parents as caring (B = 0.48, p = 0.002). Children who scored lower on their self-esteem reported their parents to be more overprotective (B = −0.30, p = 0.030), and children reporting higher levels of stress reported their parents to be more overprotective (B = 0.12, p = 0.010). Children reporting caring parenting style were significantly more likely to report higher emotional intelligence (B = 0.66, p = 0.001). Parenting styles play an important role in the emotional intelligence. Identifying and testing interventions to help parents improve their parenting styles, while helping their HIV-affected children cope with stress and self-esteem, are essential in promoting mental health of HIV-affected children in Thailand. PMID:23651471

Parenting styles and emotional intelligence of HIV-affected children in Thailand.

PubMed

Lee, Sung-Jae; Li, Li; Thammawijaya, Panithee

2013-01-01

The purpose of this study was to examine the impact of parenting styles on emotional intelligence of HIV-affected children in Thailand. This study uses data from 205 HIV-affected children in northern and northeastern Thailand. Correlation and regression analyses were used to examine the predictors of emotional intelligence. Children reporting higher levels of stress reported less caring parenting style (standardized beta [B]=-0.18, p=0.050). Children with higher self-esteem were also more likely to perceive their parents as caring (B=0.48, p=0.002). Children who scored lower on their self-esteem reported their parents to be more overprotective (B=-0.30, p=0.030), and children reporting higher levels of stress reported their parents to be more overprotective (B=0.12, p=0.010). Children reporting caring parenting style were significantly more likely to report higher emotional intelligence (B=0.66, p=0.001). Parenting styles play an important role in the emotional intelligence. Identifying and testing interventions to help parents improve their parenting styles, while helping their HIV-affected children cope with stress and self-esteem, are essential in promoting mental health of HIV-affected children in Thailand.

A randomized trial of enhanced HIV risk reduction and vaccine trial education interventions among HIV-negative, high-risk women who use non-injection drugs: The UNITY Study

PubMed Central

Koblin, Beryl A.; Bonner, Sebastian; Hoover, Donald R.; Xu, Guozhen; Lucy, Debbie; Fortin, Princess; Putnam, Sara; Latka, Mary H.

2014-01-01

Background Limited data are available on interventions to reduce sexual risk behaviors and increase knowledge of HIV vaccine trial concepts in high risk populations eligible to participate in HIV vaccine efficacy trials. Methods The UNITY Study was a two-arm randomized trial to determine the efficacy of enhanced HIV risk reduction and vaccine trial education interventions to reduce the occurrence of unprotected vaginal sex acts and increase HIV vaccine trial knowledge among 311 HIV-negative non-injection drug using women. The enhanced vaccine education intervention using pictures along with application vignettes and enhanced risk reduction counseling consisting of three one-on-one counseling sessions were compared to standard conditions. Follow-up visits at one week and one, six and twelve months after randomization included HIV testing and assessment of outcomes. Results During follow up, the percent of women reporting sexual risk behaviors declined significantly, but did not differ significantly by study arm. Knowledge of HIV vaccine trial concepts significantly increased but did not significantly differ by study arm. Concepts about HIV vaccine trials not adequately addressed by either condition included those related to testing a vaccine for both efficacy and safety, guarantees about participation in future vaccine trials, assurances of safety, medical care, and assumptions about any protective effect of a test vaccine. Conclusions Further research is needed to boost educational efforts and strengthen risk reduction counseling among high-risk non-injection drug using women. PMID:20190585

HIV-negative and HIV-discordant Gay Male Couples’ Use of HIV Risk-Reduction Strategies: Differences by Partner Type and Couples’ HIV-status

PubMed Central

Mitchell, Jason W.

2014-01-01

Previous research has found that gay men and other men who have sex with men (MSM) have adopted a variety of HIV risk-reduction strategies to engage in unprotected anal intercourse (UAI). However, whether gay male couples’ use these strategies within and out of their relationships remains unknown. The present national cross-sectional study collected dyadic data from an online sample of 275 HIV-negative and 58 discordant gay male couples to assess their use of these strategies, and whether their use of these strategies had differed by partner type and couples’ HIV-status. The sample used a variety of risk-reduction strategies for UAI. Some differences and patterns by partner type and couples’ HIV status were detected about men’s use of these strategies. Findings indicate the need to bolster HIV prevention and education with gay male couples about their use of these strategies within and outside of their relationships. PMID:23247364

Immunodeficiency, AIDS-related pneumonia, and risk of lung cancer among HIV-infected individuals.

PubMed

Marcus, Julia L; Leyden, Wendy A; Chao, Chun R; Horberg, Michael A; Klein, Daniel B; Quesenberry, Charles P; Towner, William J; Silverberg, Michael J

2017-04-24

The objective is to clarify the role of immunodeficiency and pneumonia in elevated lung cancer risk among HIV-infected individuals. Cohort study of HIV-infected and HIV-uninfected adults in a large integrated healthcare system in California during 1996-2011. We used Poisson models to obtain rate ratios for lung cancer associated with HIV infection, overall and stratified by recent CD4 cells/μl (HIV-uninfected as reference group), with χ tests for trends across CD4 strata. Fully adjusted models included demographics, cancer risk factors (smoking, drug/alcohol abuse, overweight/obesity), and prior pneumonia. Among 24 768 HIV-infected and 257 600 HIV-uninfected individuals, the lung cancer rate per 100 000 person-years was 66 (n = 80 events) for HIV-infected and 33 (n = 506 events) for HIV-uninfected individuals [rate ratio 2.0, 95% confidence interval (CI): 1.7-2.2]. Overall, HIV-infected individuals were at increased risk of lung cancer after adjustment for demographics and cancer risk factors (rate ratio 1.4, 95% CI: 1.1-1.7), but not after additional adjustment for pneumonia (rate ratio 1.2, 95% CI: 0.9-1.6). Lower CD4 cell counts were associated with higher risk of lung cancer in unadjusted and demographics-adjusted models (P < 0.001 for all), but this trend did not remain after adjustment for cancer risk factors and pneumonia. Compared with HIV-uninfected individuals, HIV-infected individuals with CD4 less than 200 cells/μl were not at increased risk of lung cancer in fully adjusted models. The increased lung cancer risk among HIV patients is attributable to differences in demographics, risk factors such as smoking, and history of pneumonia. Immunodeficiency does not appear to have an independent effect on lung cancer risk.

Pro-social and problematic social network influences on HIV/AIDS risk behaviours among newly homeless youth in Los Angeles.

PubMed

Rice, E; Milburn, N G; Rotheram-Borus, M J

2007-05-01

We examined the social network composition among newly homeless youth over time and assessed how pro-social and problematic peers affected sexual and drug-using HIV/AIDS risk-behaviours among 183 youth in Los Angeles County, California. The percentage of newly homeless youth who reported that 'most' or 'all' of their friends were attending school, had jobs, and got along with their families was 73%, 24%, and 50% respectively. Logistic regression models indicated that presence of these pro-social peers reduced HIV risk behaviours at two years; odds of HIV-risk were lower with a greater number of peers who attend school, have a job, or have positive family relationships or if networks change over time to include more of these peers. Presence of problematic peers increased the likelihood of HIV risk-taking; odds of HIV risk behaviours increased with a greater number of peers at baseline who steal, have overdosed, have been arrested, or are in a gang, or if networks change to include more of these peers. Interventions should target newly homeless youth in networks that contain problematic peers, but should strive to harness the naturally occurring pro-social peer influences present in these networks.

Characteristics of high risk HIV-positive IDUs in Vietnam: implications for future interventions

PubMed Central

Go, Vivian F.; Frangakis, Constantine; Van Nam, Le; Sripaipan, Teerada; Bergenstrom, Anna; Latkin, Carl; Celentano, David D.; Quan, Vu Minh

2010-01-01

The HIV epidemic in Vietnam is concentrated primarily in injecting drug users (IDUs). To prevent HIV-1 super-infection and to develop effective HIV prevention programs, data are needed to understand the characteristics of high risk HIV-positive IDUs. In 2003, we conducted a community-based cross-sectional study among predominately male, out-of-treatment IDUs, aged 18–45, in Bac Ninh Province, Vietnam. Among 299 male participants, 42.8% were HIV-positive and among those, 96.9% did not know their status prior to the study. Thirty-two percent were HIV-positive and had high HIV behavioral risk (having unprotected sex or having shared injecting equipment in the past 6 months). Injecting for ≥ 3 years, younger age, and pooling money to buy drugs were independently associated with being at high risk for transmitting HIV. IDUs who purchased >1 syringe at a time were less likely to have high HIV behavioral risk. Structural interventions that increase syringe accessibility may be effective in reducing HIV risk behavior among HIV-positive IDUs. Study limitations are noted in the text. PMID:20735189

HIV in Indian prisons: risk behaviour, prevalence, prevention & treatment.

PubMed

Dolan, Kate; Larney, Sarah

2010-12-01

HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered prison management and population statistics, general conditions in prisons, provision of general medical care and the HIV situation in prison. No data on drug injection in prison were identified. Sex between men was reported to be common in some Indian prisons. A national study found that 1.7 per cent of inmates were HIV positive. Some prisons provided HIV education. Condom provision was considered illegal. A few prisoners received drug treatment for drug use, HIV infection or co-infection with sexually transmitted infections (STIs). HIV prevalence in prisons in India was higher than that in the general community. Regular monitoring of information on HIV risk behaviours and prevalence in Indian prisons is strongly recommended. Evidence based treatment for drug injectors and nation-wide provision of HIV prevention strategies are urgently required. Voluntary counselling, testing and treatment for HIV and STIs should be provided.

Vulnerability and risk factors for sexually transmitted infections and HIV among adolescents in Kampala, Uganda.

PubMed

Råssjö, E-B; Mirembe, F M; Darj, E

2006-10-01

Three hundred and six sexually experienced adolescents participated in a study on sexually transmitted infection (STI) prevalence and associated risk factors. The prevalence of Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and syphilis was 4.5%, 9%, 8% and 4% for females and 4.7%, 5.7%, 0% and 2.8% for males. HIV-seropositivity was found in 15.2% of females and 5.8% of males. Structured face-to-face interviews were used to obtain information about social background, sexual experience and genital symptoms. Four focus-group discussions were used in order to validate the interview data. Females were more likely to be infected by the four treatable STIs and HIV, despite risky behavior being more common among males. Unemployment, little formal education, the presence of bacterial STIs and post-coital bleeding or a bad smell from the vagina was highly associated with the risk for HIV in females. The higher prevalence of STIs, including HIV, among adolescent girls cannot be explained by sexual behavior only, as boys reported more risk behavior and were still less affected by STIs. Biological and social factors are definitely of importance.

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

PubMed Central

Golin, Carol; El-Sadr, Wafaa; Hughes, James P.; Wang, Jing; Roman Isler, Malika; Mannheimer, Sharon; Kuo, Irene; Lucas, Jonathan; DiNenno, Elizabeth; Justman, Jessica; Frew, Paula M.; Emel, Lynda; Rompalo, Anne; Polk, Sarah; Adimora, Adaora A.; Rodriquez, Lorenna; Soto-Torres, Lydia; Hodder, Sally

2014-01-01

Abstract Background: The challenge of identifying and recruiting U.S. women at elevated risk for HIV acquisition impedes prevention studies and services. HIV Prevention Trials Network (HPTN) 064 was a U.S. multisite, longitudinal cohort study designed to estimate HIV incidence among women living in communities with prevalent HIV and poverty. Venue-based sampling (VBS) methodologies and participant and venue characteristics are described. Methods: Eligible women were recruited from 10 U.S. communities with prevalent HIV and poverty using VBS. Participant eligibility criteria included age 18–44 years, residing in a designated census tract/zip code, and self-report of at least one high-risk personal and/or male sexual partner characteristic associated with HIV acquisition (e.g., incarceration history). Ethnography was conducted to finalize recruitment areas and venues. Results: Eight thousand twenty-nine women were screened and 2,099 women were enrolled (88% black, median age 29 years) over 14 months. The majority of participants were recruited from outdoor venues (58%), retail spaces (18%), and social service organizations (13%). The proportion of women recruited per venue category varied by site. Most participants (73%) had both individual and partner characteristics that qualified them for the study; 14% were eligible based on partner risk only. Conclusion: VBS is a feasible and effective approach to rapidly recruit a population of women at enhanced risk for HIV in the United States. Such a recruitment approach is needed in order to engage women most at risk and requires strong community engagement. PMID:24742266

HIV/STI Risk Behavior of Drug Court Participants

ERIC Educational Resources Information Center

Robertson, Angela A.; St. Lawrence, Janet S.; McCluskey, D. Lee

2012-01-01

Drug abusing offenders have high rates of HIV and other sexually transmitted infections (STI). To date, the HIV/STI prevention needs of offenders in drug court programs have been ignored. This multi-method study employed interviews to assess drug court professionals' perceptions of the need for an HIV risk reduction intervention to be integrated…

Evaluating Safer Conception Options for HIV-Serodiscordant Couples (HIV-Infected Female/HIV-Uninfected Male): A Closer Look at Vaginal Insemination

PubMed Central

Mmeje, Okeoma; Cohen, Craig R.; Cohan, Deborah

2012-01-01

HIV serodiscordant couples represent at least half of all HIV-affected couples worldwide. Many of these couples have childbearing desires. Safer methods of conception may allow for pregnancy while minimizing the risk of sexual transmission of HIV. In serodiscordant partnerships with an HIV-infected female and HIV-uninfected male, vaginal insemination of a partner's semen during the fertile period coupled with 100% condom use may be the safest method of conception. PMID:22927714

First Impressions of HIV Risk: It Takes Only Milliseconds to Scan a Stranger

PubMed Central

Renner, Britta; Schmälzle, Ralf; Schupp, Harald T.

2012-01-01

Research indicates that many people do not use condoms consistently but instead rely on intuition to identify sexual partners high at risk for HIV infection. The present studies examined neural correlates for first impressions of HIV risk and determined the association of perceived HIV risk with other trait characteristics. Participants were presented with 120 self-portraits retrieved from a popular online photo-sharing community (www.flickr.com). Factor analysis of various explicit ratings of trait characteristics yielded two orthogonal factors: (1) a ‘valence-approach’ factor encompassing perceived attractiveness, healthiness, valence, and approach tendencies, and (2) a ‘safeness’ factor, entailing judgments of HIV risk, trustworthiness, and responsibility. These findings suggest that HIV risk ratings systematically relate to cardinal features of a high-risk HIV stereotype. Furthermore, event-related brain potential recordings revealed neural correlates of first impressions about HIV risk. Target persons perceived as risky elicited a differential brain response in a time window from 220–340 ms and an increased late positive potential in a time window from 350–700 ms compared to those perceived as safe. These data suggest that impressions about HIV risk can be formed in a split second and despite a lack of information about the actual risk profile. Findings of neural correlates of risk impressions and their relationship to key features of the HIV risk stereotype are discussed in the context of the ‘risk as feelings’ theory. PMID:22291959

First impressions of HIV risk: it takes only milliseconds to scan a stranger.

PubMed

Renner, Britta; Schmälzle, Ralf; Schupp, Harald T

2012-01-01

Research indicates that many people do not use condoms consistently but instead rely on intuition to identify sexual partners high at risk for HIV infection. The present studies examined neural correlates for first impressions of HIV risk and determined the association of perceived HIV risk with other trait characteristics. Participants were presented with 120 self-portraits retrieved from a popular online photo-sharing community (www.flickr.com). Factor analysis of various explicit ratings of trait characteristics yielded two orthogonal factors: (1) a 'valence-approach' factor encompassing perceived attractiveness, healthiness, valence, and approach tendencies, and (2) a 'safeness' factor, entailing judgments of HIV risk, trustworthiness, and responsibility. These findings suggest that HIV risk ratings systematically relate to cardinal features of a high-risk HIV stereotype. Furthermore, event-related brain potential recordings revealed neural correlates of first impressions about HIV risk. Target persons perceived as risky elicited a differential brain response in a time window from 220-340 ms and an increased late positive potential in a time window from 350-700 ms compared to those perceived as safe. These data suggest that impressions about HIV risk can be formed in a split second and despite a lack of information about the actual risk profile. Findings of neural correlates of risk impressions and their relationship to key features of the HIV risk stereotype are discussed in the context of the 'risk as feelings' theory.

HIV Infection Affects Streptococcus mutans Levels, but Not Genotypes

PubMed Central

Liu, G.; Saxena, D.; Chen, Z.; Norman, R.G.; Phelan, J.A.; Laverty, M.; Fisch, G.S.; Corby, P.M.; Abrams, W.; Malamud, D.; Li, Y.

2012-01-01

We report a clinical study that examines whether HIV infection affects Streptococcus mutans colonization in the oral cavity. Whole stimulated saliva samples were collected from 46 HIV-seropositive individuals and 69 HIV-seronegative control individuals. The level of S. mutans colonization was determined by conventional culture methods. The genotype of S. mutans was compared between 10 HIV-positive individuals before and after highly active antiretroviral therapy (HAART) and 10 non-HIV-infected control individuals. The results were analyzed against viral load, CD4+ and CD8+ T-cell counts, salivary flow rate, and caries status. We observed that S. mutans levels were higher in HIV-infected individuals than in the non-HIV-infected control individuals (p = 0.013). No significant differences in S. mutans genotypes were found between the two groups over the six-month study period, even after HAART. There was a bivariate linear relationship between S. mutans levels and CD8+ counts (r = 0.412; p = 0.007), but not between S. mutans levels and either CD4+ counts or viral load. Furthermore, compared with non-HIV-infected control individuals, HIV-infected individuals experienced lower salivary secretion (p = 0.009) and a positive trend toward more decayed tooth surfaces (p = 0.027). These findings suggest that HIV infection can have a significant effect on the level of S. mutans, but not genotypes. PMID:22821240

A time-motion study of cardiovascular disease risk factor screening integrated into HIV clinic visits in Swaziland.

PubMed

Palma, Anton M; Rabkin, Miriam; Simelane, Samkelo; Gachuhi, Averie B; McNairy, Margaret L; Nuwagaba-Biribonwoha, Harriet; Bongomin, Pido; Okello, Velephi N; Bitchong, Raymond A; El-Sadr, Wafaa M

2018-03-01

Screening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urban HIV clinic in Swaziland, we conducted a time-motion study to assess the impact of screening on patient flow and HIV service delivery and exit interviews to assess patient acceptability. A convenience sample of patients ≥40 years of age attending routine HIV clinic visits was screened for hypertension, diabetes, hyperlipidemia and tobacco smoking. We observed HIV visits with and without screening and measured time spent on HIV and CVD risk factor screening activities. We compared screened and unscreened patients on total visit time and time spent receiving HIV services using Wilcoxon rank-sum tests. A separate convenience sample of screened patients participated in exit interviews to assess their satisfaction with screening. We observed 172 patient visits (122 with CVD risk factor screening and 50 without). Screening increased total visit time from a median (range) of 4 minutes (2 to 11) to 15 minutes (9 to 30) (p < 0.01). Time spent on HIV care was not affected: 4 (2 to 10) versus 4 (2 to 11) (p = 0.57). We recruited 126 patients for exit interviews, all of whom indicated that they would recommend screening to others. Provision of CVD risk factor screening more than tripled the length of routine HIV clinic visits but did not reduce the time spent on HIV services. Programme managers need to take longer visit duration into account in order to effectively integrate CVD risk factor screening and counselling into HIV programmes. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Experiences of Black MSM at an HBCU Regarding Stigma and HIV Risk Behavior

ERIC Educational Resources Information Center

Jeter, Natasha Harden

2016-01-01

Black men who have sex with men (MSM) on Historically Black College/University (HBCU) campuses face a unique set of challenges. In addition to being disproportionately affected by HIV, Black MSM are impacted by risk behavior, stigma, and environmental policies and practices that adversely influence their experiences. The purpose of this study was…

Comparison of sexual behavior and HIV risk between two HIV-1 serodiscordant couple cohorts: the CHAVI 002 study.

PubMed

Ritchie, Adam J; Kuldanek, Kristin; Moodie, Zoe; Wang, Z Maggie; Fox, Julie; Nsubuga, Rebecca N; Legg, Kenneth; Birabwa, Esther F; Kaleebu, Pontiano; McMichael, Andrew J; Watera, Christine; Goonetilleke, Nilu; Fidler, Sarah

2012-01-01

The CHAVI002 study was designed to characterize immune responses, particularly HIV-specific T-cell responses, amongst 2 cohorts of HIV-exposed seronegative (HESN) individuals. The absence of a clear definition of HESNs has impaired comparison of research within and between such cohorts. This report describes two distinct HESN cohorts and attempts to quantify HIV exposure using a 'HIV risk index' (RI) model. HIV serodiscordant couples (UK; 24, Uganda; 72) and HIV unexposed seronegative (HUSN) controls (UK; 14, Uganda; 26 couples, 3 individuals) completed sexual behavior questionnaires every 3 months over a 9 month period. The two cohorts were heterogeneous, with most HESNs in the UK men who have sex with men (MSM), while all HESNs in Uganda were in heterosexual relationships. Concordance of responses between partners was determined. Each participant's sexual behavior score (SBS) was estimated based on the number and type of unprotected sex acts carried out in defined time periods. Independent HIV acquisition risk factors (partner plasma viral load, STIs, male circumcision, pregnancy) were integrated with the SBS, generating a RI for each HESN. 96 HIV serodiscordant couples completed 929 SBQs. SBSs remained relatively stable amongst the UK cohort, whilst decreasing from Visit 1 to 2 in the Ugandan cohort. Compared to the Ugandan cohort, SBSs and RIs in the UK cohort were lower at visit 1, and generally higher at later visits. Differences between the cohorts, with lower rates of ART use in Uganda and higher risk per-act sex in the UK, had major impacts on the SBSs and RIs of each cohort. There was one HIV transmission event in the UK cohort. Employment of a risk quantification model facilitated quantification and comparison of HIV acquisition risk across two disparate HIV serodiscordant couple cohorts.

Human cytomegalovirus infant infection adversely affects growth and development in maternally HIV-exposed and unexposed infants in Zambia.

PubMed

Gompels, U A; Larke, N; Sanz-Ramos, M; Bates, M; Musonda, K; Manno, D; Siame, J; Monze, M; Filteau, S

2012-02-01

Human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) coinfections have been shown to increase infant morbidity, mortality, and AIDS progression. In HIV-endemic regions, maternal HIV-exposed but HIV-uninfected infants, which is the majority of children affected by HIV, also show poor growth and increased morbidity. Although nutrition has been examined, the effects of HCMV infection have not been evaluated. We studied the effects of HCMV infection on the growth, development, and health of maternally HIV-exposed and unexposed infants in Zambia. Infants were examined in a cohort recruited to a trial of micronutrient-fortified complementary foods. HIV-infected mothers and infants had received perinatal antiretroviral therapy to prevent mother-to-child HIV transmission. Growth, development, and morbidity were analyzed by linear regression analyses in relation to maternal HIV exposure and HCMV infection, as screened by sera DNA for viremia at 6 months of age and by antibody for infection at 18 months. All HCMV-seropositive infants had decreased length-for-age by 18 months compared with seronegative infants (standard deviation [z]-score difference: -0.44 [95% confidence interval {CI}, -.72 to -.17]; P = .002). In HIV-exposed infants, those who were HCMV positive compared with those who were negative, also had reduced head size (mean z-score difference: -0.72 [95% CI, -1.23 to -.22]; P = .01) and lower psychomotor development (Bayley test score difference: -4.1 [95% CI, -7.8 to -.5]; P = .03). HIV-exposed, HCMV-viremic infants were more commonly referred for hospital treatment than HCMV-negative infants. The effects of HCMV were unaffected by micronutrient fortification. HCMV affects child growth, development, and morbidity of African infants, particularly in those maternally exposed to HIV. HCMV is therefore a risk factor for child health in this region.

Attitudes and beliefs regarding depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

PubMed Central

Brawner, Bridgette M.

2012-01-01

Individuals’ attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purpose of this study was to elucidate attitudes and beliefs about depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semi-structured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e. loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females. PMID:23164403

UNDERSTANDING THE CONTEXT OF HIV RISK BEHAVIOR AMONG HIV-POSITIVE AND HIV-NEGATIVE FEMALE SEX WORKERS AND MALE BAR CLIENTS FOLLOWING ANTIRETROVIRAL THERAPY ROLLOUT IN MOMBASA, KENYA

PubMed Central

McClelland, Lauren; Wanje, George; Kashonga, Frances; Kibe, Lydiah; McClelland, R. Scott; Kiarie, James; Mandaliya, Kishorchandra; Peshu, Norbert; Kurth, Ann

2011-01-01

This study explored perceptions of HIV following local introduction of antiretroviral therapy (ART), among 30 HIV-positive and -negative female sex workers (FSWs) and 10 male bar patrons in Mombasa, Kenya. Semi-structured interviews were analyzed qualitatively to identify determinants of sexual risk behaviors. ART was not perceived as a barrier to safer sex and in some cases led to decreased high-risk behaviors. Barriers to safer sex included economic pressure and sexual partnership types. Many women reported that negotiating condom use is more difficult in long-term partnerships. These women favored short-term partnerships to minimize risk through consistent condom use. For women living with HIV, concern about maintaining health and avoiding HIV superinfection was a strong motivator of protective behaviors. For HIV-negative women, a negative HIV test was a powerful motivator. Incorporation of context- and serostatus-specific factors (e.g., self-protection for HIV-positive women) into tailored prevention counseling may support high-risk women to reduce risk behaviors. PMID:21861605

Sex, touch, and HIV risk among ecstasy users.

PubMed

Theall, Katherine P; Elifson, Kirk W; Sterk, Claire E

2006-03-01

We examined HIV risk among heavy and nonheavy ecstasy users, focusing specifically on touch and sexual behavior as part of the ecstasy experience. Structured interviews were conducted with 268 young adult (age 18-25) ecstasy users in Atlanta, Georgia. Heavy ecstasy users were more likely to have been tested for HIV than nonheavy users (79 vs. 68%). However, they also were more likely to perceive no chance of contracting HIV (36 vs. 26%). Touch, both sensual and sexual, was a significant part of the ecstasy experience. In addition, ecstasy use seemed to increase the sexual desire, however, not the ability to achieve an orgasm. Heavy users reported more sexual risk-taking than their nonheavy using counterparts. Results suggest that the setting of ecstasy use also may influence involvement in risk behaviors. Future longitudinal studies are needed on the relationship between ecstasy use, touch, sexual arousal and ability, and risk behavior.

Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption Among Latino Men Who Have Sex with Men: Challenges and Opportunities to Intervene on HIV Risk.

PubMed

Martinez, Omar; Muñoz-Laboy, Miguel; Levine, Ethan C; Starks, Tyrel; Dolezal, Curtis; Dodge, Brian; Icard, Larry; Moya, Eva; Chavez-Baray, Silvia; Rhodes, Scott D; Fernandez, M Isabel

2017-05-01

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed

HIV Risk Behavior and Access to Services: What Predicts HIV Testing among Heterosexually Active Homeless Men?

ERIC Educational Resources Information Center

Wenzel, Suzanne L.; Rhoades, Harmony; Tucker, Joan S.; Golinelli, Daniela; Kennedy, David P.; Zhou, Annie; Ewing, Brett

2012-01-01

HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV…

An ethnographic study of HIV/AIDS among Ayoreo sex workers: cultural factors and risk perception.

PubMed

López-Entrambasaguas, Olga M; Granero-Molina, José; Fernández-Sola, Cayetano

2013-12-01

To describe and understand Ayoreo sex workers' perceptions of HIV/AIDS and to identify factors that may affect the prevention of risk behaviours. According to recent HIV/AIDS incidence reports, being female, indigenous and a sex worker means belonging to a maximum-risk group, left in the background in terms of strategies for the fight against HIV. Although there has been research into intervention models in these populations, it is important to detail the perceptions of the problem from the perspective of sex workers from the affected ethnic groups. This study used an ethnographic methodology that included participant observation and semi-structured interviews. The research was conducted in two phases. First, participant observation was chosen to access and observe the behaviour of Ayoreo sex workers. The second phase was a semi-structured interview with sex workers and key informants. The interviews, together with the field notes, were transcribed and analysed, following inductive strategies to find emerging themes. Here, we present the results related to four emerging themes: the cultural acceptance of sex work as a useful economic activity; the lack of concern for sexually transmitted illnesses and the stigmatisation of people who are HIV seropositive; external factors that increase vulnerability such as difficulties in using a condom; and conflictive and unbalanced relationships between the Ayoreo people and the health system and health professionals. The health- and sexual reproduction-related culture, the knowledge and attitudes of sex workers, external factors, and relationships with the health system and health professionals continue to place Ayoreo sex workers in high-risk conditions in relation to sexually transmitted diseases and HIV/AIDS. Employing cultural care as its base, nursing could develop programmes and interventions culturally adapted for the prevention of disease and the promotion of health in these populations. © 2013 John Wiley & Sons Ltd.

Depression and HIV risk behavior practices among at risk women.

PubMed

Klein, Hugh; Elifson, Kirk W; Sterk, Claire E

2008-01-01

In this study, we examined the relationship between depression and HIV-related risk behavior practices in a sample of 250 at risk, predominantly African American women living in the Atlanta, Georgia metropolitan area. Interviews were conducted between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample via targeted sampling and ethnographic mapping procedures. Our conceptual model hypothesized a relationship between depression and HIV risk in which depression and condom-related attitudes were construed as intervening (or mediating) variables. A multivariate analysis was used to determine the relationship between depression and women's risk behaviors. The results showed that depression was a key-mediating variable, having its primary influence on women's risky practices through its impact upon their attitudes toward using condoms. Factors associated with depression, included religiosity, closeness of family relationships, financial problems, childhood maltreatment experiences, and drug-related problems. The implications of these findings for prevention and intervention efforts are: (1) heightening faith community involvement and religious participation to decrease depression; (2) working with women whose familial bonds are in need of strengthening to combat depression; (3) providing mental health and counseling services to women who were emotionally and/or sexually abused during their formative years seems to help these women to recover from unresolved issues that may be fueling depression; (4) assisting at risk women who need training in money management issues to minimize their risk for depression; and (5) helping women drug abusers to receive treatment for their drug problems to combat their depression and lower their HIV risk.

Accuracy and determinants of perceived HIV risk among young women in South Africa.

PubMed

Maughan-Brown, Brendan; Venkataramani, Atheendar S

2017-07-21

HIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDS-free generation - including reaching the UNAIDS 90-90-90 target - thus depends critically on the content of these perceptions. We examined the accuracy of HIV-risk perceptions and their correlates among young black women in South Africa, a group with one of the highest HIV incidence rates worldwide. We used individual-level longitudinal data from the Cape Area Panel Study (CAPS) from 2005 to 2009 on black African women (20-30 years old in 2009) to assess the association between perceived HIV-risk in 2005 and the probability of testing HIV-positive four years later. We then estimated multivariable logistic regressions using cross-sectional data from the 2009 CAPS wave to assess the relationship between risk perceptions and a wide range of demographic, sexual behaviour and psychosocial covariates of perceived HIV-risk. We found that the proportion testing HIV-positive in 2009 was almost identical across perceived risk categories in 2005 (no, small, moderate, great) (χ 2  = 1.43, p = 0.85). Consistent with epidemiologic risk factors, the likelihood of reporting moderate or great HIV-risk perceptions was associated with condom-use (aOR: 0.57; 95% CI: 0.36, 0.89; p < 0.01); having ≥3 lifetime partners (aOR: 2.38, 95% CI: 1.53, 3.73; p < 0.01); knowledge of one's partner's HIV status (aOR: 0.67; 95% CI: 0.43, 1.07; p = 0.09); and being in an age-disparate partnerships (aOR: 1.73; 95% CI: 1.09, 2.76; p = 0.02). However, the likelihood of reporting moderate or great self-perceived risk did not vary with sexually transmitted disease history and respondent age, both strong predictors of HIV risk in the study setting. Risk perceptions were associated with stigmatising attitudes (aOR: 0.53; 95% CI: 0.26, 1.09; p = 0.09); prior HIV testing (aOR: 0.21; 95% CI: 0.13, 0.35; p < 0.01); and having heard that male circumcision is protective (aOR: 0.38; 95% CI: 0

Sexual orientation- and race-based discrimination and sexual HIV risk behavior among urban MSM.

PubMed

Frye, Victoria; Nandi, Vijay; Egan, James; Cerda, Magdalena; Greene, Emily; Van Tieu, Hong; Ompad, Danielle C; Hoover, Donald R; Lucy, Debbie; Baez, Eduardo; Koblin, Beryl A

2015-02-01

Understanding what social factors are associated with risk of HIV acquisition and transmission among gay, bisexual and other men who have sex with men (MSM) is a critical public health goal. Experiencing discrimination may increase risk of HIV infection among MSM. This analysis assessed relations between experiences of sexual orientation- and race-based discrimination and sexual HIV risk behavior among MSM in New York City. 1,369 MSM completed a self-administered computerized assessment of past 3-month sexual behavior, experience of social discrimination and other covariates. Regression models assessed relations between recent experience of discrimination and sexual HIV risk behavior. Mean age was 32 years; 32 % were white; 32 % Latino/Hispanic; 25 % African American/Black. Of MSM who self-reported HIV-positive or unknown status (377), 7 % (N = 27) reported having unprotected insertive anal intercourse with an HIV-negative or unknown status partner ("HIV transmission risk"). Of MSM who self-reported HIV-negative status (992), 11 % (110) reported unprotected receptive anal intercourse with an HIV-positive or unknown status partner ("HIV acquisition risk"). HIV acquisition risk was positively associated with sexual orientation-based discrimination in home or social neighborhoods, but not race-based discrimination. We observed that sexual orientation-based discrimination was associated with sexual HIV risk behavior among urban-dwelling MSM. Addressing environmental sources of this form of discrimination, as well as the psychological distress that may result, should be prioritized in HIV prevention efforts.

It's harder for boys? Children's representations of their HIV/AIDS-affected peers in Zimbabwe

PubMed Central

LeRoux-Rutledge, Emily; Guerlain, Madeleine A.; Andersen, Louise B.; Madanhire, Claudius; Mutsikiwa, Alice; Nyamukapa, Constance; Skovdal, Morten; Gregson, Simon; Campbell, Catherine

2015-01-01

ABSTRACT This study examines whether children in rural Zimbabwe have differing representations of their HIV/AIDS-affected peers based on the gender of those peers. A group of 128 children (58 boys, 70 girls) aged 10–14 participated in a draw-and-write exercise, in which they were asked to tell the story of either an HIV/AIDS-affected girl child, or an HIV/AIDS-affected boy child. Stories were inductively thematically coded, and then a post hoc statistical analysis was conducted to see if there were differences in the themes that emerged in stories about girls versus stories about boys. The results showed that boys were more often depicted as materially deprived, without adult and teacher support, and heavily burdened with household duties. Further research is needed to determine whether the perceptions of the children in this study point to a series of overlooked challenges facing HIV/AIDS-affected boys, or to a culture of gender inequality facing HIV/AIDS-affected girls – which pays more attention to male suffering than to female suffering. PMID:26615976

HIV-1 subtype C is not associated with higher risk of heterosexual HIV-1 transmission: a multinational study among HIV-1 serodiscordant couples.

PubMed

Kahle, Erin; Campbell, Mary; Lingappa, Jairam; Donnell, Deborah; Celum, Connie; Ondondo, Raphael; Mujugira, Andrew; Fife, Kenneth; Mugo, Nelly; Kapiga, Saidi; Mullins, James I; Baeten, Jared M

2014-01-14

HIV-1 subtype C has emerged as the most prevalent strain of HIV-1 worldwide, leading to speculation that subtype C may be more transmissible than other subtypes. We compared the risk of HIV-1 transmission for subtype C versus non-C subtypes (A, D, G and recombinant forms) among heterosexual African HIV-1 serodiscordant couples. We conducted a nested case-control analysis using data from two prospective cohort studies of heterosexual HIV-1 serodiscordant couples from six countries in eastern and southern Africa. Cases (N = 121) included incident HIV-1 transmissions that were established as linked within the serodiscordant partnership by viral sequencing; controls (N = 501) were nontransmitting HIV-1-infected partners. Subtype was determined for partial env and gag genes. Multiple logistic regression controlled for age and gender of the HIV-1-nfected partner and self-reported unprotected sex. Plasma and genital HIV-1 RNA concentrations were compared between subtype C and non-C subtypes using generalized estimating equations. HIV-1 subtype C was not associated with increased risk of HIV-1 transmission compared with non-C subtypes: env adjusted odds ratio (adjOR) 1.14 [95% confidence interval (CI) 0.74-1.75, P = 0.6] and gag adjOR 0.98 (95% CI 0.63-1.52, P = 0.9). Plasma and genital HIV-1 RNA levels did not differ significantly for subtype C versus non-C. In a geographically diverse population of heterosexual African HIV-1 serodiscordant couples, subtype C was not associated with greater risk of HIV-1 transmission compared with non-C subtypes, arguing against the hypothesis that subtype C is more transmissible compared with other common subtypes.

Feasibility and acceptability of cell phone diaries to measure HIV risk behavior among female sex workers.

PubMed

Roth, Alexis M; Hensel, Devon J; Fortenberry, J Dennis; Garfein, Richard S; Gunn, Jayleen K L; Wiehe, Sarah E

2014-12-01

Individual, social, and structural factors affecting HIV risk behaviors among female sex workers (FSWs) are difficult to assess using retrospective surveys methods. To test the feasibility and acceptability of cell phone diaries to collect information about sexual events, we recruited 26 FSWs in Indianapolis, Indiana (US). Over 4 weeks, FSWs completed twice daily digital diaries about their mood, drug use, sexual interactions, and daily activities. Feasibility was assessed using repeated measures general linear modeling and descriptive statistics examined event-level contextual information and acceptability. Of 1,420 diaries expected, 90.3 % were completed by participants and compliance was stable over time (p > .05 for linear trend). Sexual behavior was captured in 22 % of diaries and participant satisfaction with diary data collection was high. These data provide insight into event-level factors impacting HIV risk among FSWs. We discuss implications for models of sexual behavior and individually tailored interventions to prevent HIV in this high-risk group.

Telling stories and adding scores: Measuring resilience in young children affected by maternal HIV and AIDS.

PubMed

Ebersöhn, Liesel; Eloff, Irma; Finestone, Michelle; Grobler, Adri; Moen, Melanie

2015-01-01

"Telling stories and adding scores: Measuring resilience in young children affected by maternal HIV and AIDS", demonstrates how a concurrent mixed method design assisted cross-cultural comparison and ecological descriptions of resilience in young South African children, as well as validated alternative ways to measure resilience in young children. In a longitudinal randomised control trial, which investigated psychological resilience in mothers and children affected by HIV/AIDS, we combined a qualitative projective story-telling technique (Düss Fable) with quantitative data (Child Behaviour Checklist). The children mostly displayed adaptive resilience-related behaviours, although maladaptive behaviours were present. Participating children use internal (resolve/agency, positive future expectations, emotional intelligence) and external protective resources (material resources, positive institutions) to mediate adaptation. Children's maladaptive behaviours were exacerbated by internal (limited problem-solving skills, negative emotions) and external risk factors (chronic and cumulative adversity).

Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

PubMed Central

Drake, Alison L.; Wagner, Anjuli; Richardson, Barbra; John-Stewart, Grace

2014-01-01

Background Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection. Methods and Findings We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0–4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p<0.001). Risk of HIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5–2.1) or postpartum women (HR 1.1, 95% CI 0.6–1.6) than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2–3.9) or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2–4.4). However, the small number of studies limited power to detect associations

Are Rural Women Powerless When it Comes to HIV & AIDS Risk? Implications for Adult Education Programmes in South Africa

ERIC Educational Resources Information Center

Kiggundu, Edith; Castle, Jane

2007-01-01

There is an urgent need for fresh approaches to HIV & AIDS education for adults and youth in South Africa, particularly for those marginalised by society, such as rural black women. In this article we explore the factors which affect awareness, condom use and HIV & AIDS risk among a group of women who attend classes in a rural Adult…

HIV Risk Behavior among Youth in the Dominican Republic: The Role of Alcohol and Other Drugs.

PubMed

Guilamo-Ramos, Vincent; Jaccard, James; Lushin, Viktor; Martinez, Roberto; Gonzalez, Bernardo; McCarthy, Katharine

2011-01-01

Existing literature related to HIV in the Dominican Republic has tended to neglect the unique role of tourism areas as distinct ecologies facilitative of sexual risk behavior, particularly HIV vulnerability and transmission. Furthermore, limited attention has focused on Dominican adolescents living in close proximity to tourism areas who have become increasingly exposed to alcohol due to the expanding tourism industry in the Dominican Republic. While most previous analyses of the effects of alcohol on adolescent sexual risk behavior have focused on the transient effects of alcohol on judgment and decision making, the effects of chronic alcohol use on sexual behavior has been a neglected area of research. Our study explores the relationship between chronic alcohol use, the parent-adolescent relationship, affective factors such as self-esteem, and intentions to engage in sex. We examine the above factors within the context of tourism areas which represent a unique ecology of alcohol availability and consumption and HIV risk. We discuss implications for developing applied family-based programs to target Dominican adolescent alcohol use and sexual risk behavior in tourism areas of high alcohol exposure.

The role of HIV-related knowledge and ethnicity in determining HIV risk perception and willingness to undergo HIV testing among rural women in Burkina Faso.

PubMed

Sarker, Malabika; Milkowski, Andrea; Slanger, Tracy; Gondos, Adam; Sanou, Aboubakary; Kouyate, Bocar; Snow, Rachel

2005-06-01

We conducted a random community based survey of 300 young (15-29 years) rural women in Nouna, Burkina Faso. Only one-third of women were aware that a person could have HIV without having symptoms and these women were significantly more likely to classify themselves to be at high risk for getting HIV. Furthermore, multiple partners, Bwaba ethnicity and having mentioned a health worker as a source of HIV information were significantly associated with perceived high personal risk. Perceived willingness to participate in VCT was high (69%). The dissemination of information on the asymptomatic nature of HIV infection could potentially be very important in forming risk perception, awareness, and their willingness to participate in HIV interventions.

Intervention outcomes among HIV-affected families over 18 months.

PubMed

Rotheram-Borus, Mary Jane; Rice, Eric; Comulada, W Scott; Best, Karin; Elia, Carla; Peters, Katherine; Li, Li; Green, Sara; Valladares, Ena

2012-07-01

We evaluate the efficacy of a family-based intervention over time among HIV-affected families. Mothers living with HIV (MLH; n = 339) in Los Angeles and their school-aged children were randomized to either an intervention or control condition and followed for 18 months. MLH and their children in the intervention received 16 cognitive-behavioral, small-group sessions designed to help them maintain physical and mental health, parent while ill, address HIV-related stressors, and reduce HIV-transmission behaviors. At recruitment, MLH reported few problem behaviors related to physical health, mental health, or sexual or drug transmission acts. Compared to MLH in the control condition, intervention MLH were significantly more likely to monitor their own CD4 cell counts and their children were more likely to decrease alcohol and drug use. Most MLH and their children had relatively healthy family relationships. Family-based HIV interventions should be limited to MLH who are experiencing substantial problems.

HIV Education and Sexual Risk Behaviors Among Young Men Who Have Sex with Men

PubMed Central

Beyrer, Chris; Arrington-Sanders, Renata

2018-01-01

Abstract Purpose: Men who have sex with men (MSM) have nearly 80 times the lifetime risk of human immunodeficiency virus (HIV) relative to men who have sex with women only (MSW), and young MSM (YMSM) accounted for 95% of estimated HIV diagnoses among adolescents between 13 and 24 years in 2015. We aimed to evaluate HIV education and sexual risk behaviors among YMSM relative to young MSW (YMSW) and to evaluate the relationship between HIV education and YMSM sexual risk behaviors. Methods: We used Youth Risk Behavior Surveillance System data from 13 states that collected information on sex of sexual contacts and on HIV education in 2011 and/or 2013. We assessed HIV education, number of sexual partners ever and in the past three months, and condom use at last sex in logistic regression analyses controlling for age, race/ethnicity, state, and year. Results: YMSM were less likely to report school-based HIV education and more likely to report sexual risk behaviors relative to YMSW. HIV education was associated with reduced sexual risk behaviors among all students and with significant additional reductions in sexual risk behaviors among YMSM. Conclusion: There is a need for HIV education programs to reach YMSM, who are at increased risk of HIV. PMID:29297755

HIV Education and Sexual Risk Behaviors Among Young Men Who Have Sex with Men.

PubMed

Raifman, Julia; Beyrer, Chris; Arrington-Sanders, Renata

Men who have sex with men (MSM) have nearly 80 times the lifetime risk of human immunodeficiency virus (HIV) relative to men who have sex with women only (MSW), and young MSM (YMSM) accounted for 95% of estimated HIV diagnoses among adolescents between 13 and 24 years in 2015. We aimed to evaluate HIV education and sexual risk behaviors among YMSM relative to young MSW (YMSW) and to evaluate the relationship between HIV education and YMSM sexual risk behaviors. We used Youth Risk Behavior Surveillance System data from 13 states that collected information on sex of sexual contacts and on HIV education in 2011 and/or 2013. We assessed HIV education, number of sexual partners ever and in the past three months, and condom use at last sex in logistic regression analyses controlling for age, race/ethnicity, state, and year. YMSM were less likely to report school-based HIV education and more likely to report sexual risk behaviors relative to YMSW. HIV education was associated with reduced sexual risk behaviors among all students and with significant additional reductions in sexual risk behaviors among YMSM. There is a need for HIV education programs to reach YMSM, who are at increased risk of HIV.

Correlates of HIV knowledge and Sexual risk behaviors among Female Military Personnel

PubMed Central

Essien, E. James; Monjok, Emmanuel; Chen, Hua; Abughosh, Susan; Ekong, Ernest; Peters, Ronald J.; Holmes, Laurens; Holstad, Marcia M.; Mgbere, Osaro

2010-01-01

Objective Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. Method The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Results Multivariate logistic regression analysis revealed that level of education and knowing someone with HIV/AIDS were significant (p<0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P<0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P<0.05) associated with number of children, annual income, and number of sexual partners. Conclusion Data indicates the importance of incorporating these predictor variables into intervention designs. PMID:20387111

Audience segmentation as a social-marketing tool in health promotion: use of the risk perception attitude framework in HIV prevention in Malawi.

PubMed

Rimal, Rajiv N; Brown, Jane; Mkandawire, Glory; Folda, Lisa; Böse, Kirsten; Creel, Alisha H

2009-12-01

We sought to determine whether individuals' risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviors. A household-level survey of individuals (N=968) was conducted in 4 districts in Malawi. On the basis of responses about perceptions of risk and beliefs about personal efficacy, we used cluster analysis to create 4 groups within the risk perception attitude framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). We ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect knowledge about HIV, HIV-testing uptake, and condom use. A significant association was found between membership in 1 or more of the 4 risk perception attitude framework groups and the 3 study variables of interest: knowledge about HIV (F8, 956=20.77; P<.001), HIV testing uptake (F8, 952=10.91; P<.001), and condom use (F8, 885=29.59; P<.001). The risk perception attitude framework can serve as a theoretically sound audience segmentation technique that can be used to determine whether messages should augment perceptions of risk, beliefs about personal efficacy, or both.

Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.

PubMed

Drain, Paul K; Losina, Elena; Parker, Gary; Giddy, Janet; Ross, Douglas; Katz, Jeffrey N; Coleman, Sharon M; Bogart, Laura M; Freedberg, Kenneth A; Walensky, Rochelle P; Bassett, Ingrid V

2013-01-01

After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults. We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm(3). We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing ("competing needs to healthcare") on presentation with late-stage HIV disease. Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2-2.4), were male (AOR 1.7, 95% CI 1.2-2.3), worked outside the home (AOR 1.5, 95% CI 1.1-2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1-2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0-1.9) had higher odds of late-stage HIV disease presentation. Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.

HIV Risk Perception and Risky Behavior Among People Who Inject Drugs in Kermanshah, Western Iran.

PubMed

Noroozi, Mehdi; Ahounbar, Elahe; Karimi, Salah Eddin; Ahmadi, Sina; Najafi, Mohammad; Bazrafshan, Ali; Shushtari, Zahra Jorjoran; Farhadi, Mohammad Hassan; Higgs, Peter; Rezaei, Fatemeh; Ghiasvand, Hesam; Sharhani, Asaad; Armoon, Bahram; Waye, Katherine

2017-08-01

Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception's effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. Study participants were categorized as follows: "low" (n = 100, 22%), "moderate" (n = 150, 32%), and "high" (n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as "high" risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of "high" risk perception when compared to PWID with "low" risk perception. Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use.

Bleeding injuries in professional football: estimating the risk for HIV transmission.

PubMed

Brown, L S; Drotman, D P; Chu, A; Brown, C L; Knowlan, D

1995-02-15

To determine the risk for bleeding injuries in professional football and to estimate the risk for transmission of the human immunodeficiency virus (HIV) through such injuries. A prospective, observational study. Professional football players from 11 teams of the National Football League were observed during 155 regular season games from September through December 1992. The frequencies of bleeding injuries were calculated in association with environmental and athletic factors. Using this information, HIV prevalence, and data on transmission of HIV in other circumstances, the risk for transmission of HIV during football games was estimated. 575 bleeding injuries (average, 3.7 per game for each team) involving 538 players (average, 3.5 players on each team per game) were observed. Approximately 88% of the bleeding injuries were abrasions; the remainder were lacerations. Bleeding injuries were markedly more frequent during games played on artificial surfaces, during games played in domed stadiums, and on teams with a final win/loss percentage of 0.500 or lower. Using data on the prevalence of HIV among college men and rates of HIV transmission in the health care setting, the risk for HIV transmission to each player was estimated to be less than 1 per 85 million game contacts. Although injuries occur in professional football competitions, bleeding injuries, especially lacerations, occur infrequently. We estimate that the risk for HIV transmission during such competition is extremely remote. The role of artificial playing surfaces on the incidence or severity of bleeding injuries should be investigated.

Risk-taking behavior for HIV acquisition during pregnancy in Porto Alegre, Brazil.

PubMed

Yeganeh, Nava; Varella, Ivana; Santos, Breno Riegel; Gonçalves de Melo, Marineide; Simon, Mariana; Melo, Taui; Nielsen-Saines, Karin

2012-01-01

Recent studies suggest that acquisition of HIV-1 infection during pregnancy and breastfeeding is associated with a high risk of HIV mother-to-child transmission. This study evaluates risk factors associated with HIV acquisition during pregnancy in women delivering at a large metropolitan medical facility located in the south of Brazil. From February to August 2009, our group conducted a cross-sectional study assessing women's risk for HIV acquisition by administering an oral survey to peripartum women. Of 2465 participants, 42% (n = 1046) knew that partner had been tested for HIV. During pregnancy, 82% (n = 2022) of participants never used condoms; yet 97% (n = 2399) practiced vaginal sex. Multivariate logistic regression analysis showed that patients with more years of education, in a relationship for more than 1 year, and who knew their own HIV status were more likely to know their partners' HIV status (P < 0.05). Those who were in relationship for more than 1 year and were married/living together were more likely to be comfortable discussing HIV testing with partners (P < 0.05). In conclusion, women in Brazil are at risk of HIV-infection during pregnancy as they remain sexually active, often do not know their sexual partner's HIV status, and have minimal condom use.

Children’s representations of school support for HIV-affected peers in rural Zimbabwe

PubMed Central

2014-01-01

Background HIV has left many African children caring for sick relatives, orphaned or themselves HIV-positive, often facing immense challenges in the absence of significant support from adults. With reductions in development funding, public sector budgetary constraints, and a growing emphasis on the importance of indigenous resources in the HIV response, international policy allocates schools a key role in ‘substituting for families’ (Ansell, 2008) in supporting child health and well-being. We explore children’s own accounts of the challenges facing their HIV-affected peers and the role of schools in providing such support. Methods Contextualised within a multi-method study of school support for HIV-affected children in rural Zimbabwe, and regarding children’s views as a key resource for child-relevant intervention and policy, 128 school children (10–14) wrote a story about an HIV-affected peer and how school assisted them in tackling their problems. Results Children presented harrowing accounts of negative impacts of HIV on the social, physical and mental well-being of peers, and how these manifested in the school setting. Whilst relationships with fellow learners and teachers were said to provide a degree of support, this was patchy and minimal, generally limited to small-scale and often one-off acts of material help or kindness (e.g. teachers giving children pens and exercise books or peers sharing school lunches), with little potential to impact significantly on the wider social drivers of children’s daily challenges. Despite having respect for the enormity of the challenges many HIV-affected peers were coping with, children tended to keep a distance from them. School was depicted as a source of the very bullying, stigma and social exclusion that undermined children’s opportunities for well-being in their lives more generally. Conclusions Our findings challenge glib assumptions that schools can serve as a significant ‘indigenous’ supports of

Perceived stigma and social risk of HIV testing and disclosure among Iranian-Australians living in the Sydney metropolitan area.

PubMed

Hosseinzadeh, Hassan; Hossain, Syeda Zakia; Bazargan-Hejazi, Shahrzad

2012-05-01

Fear of being stigmatised is a major social risk for seeking help in the HIV/AIDS arena. However, little is known about the social perceptions that people hold about the disease. This study explores the level of perceived stigma and its effect on the social risk of HIV testing and disclosure among Iranian-Australians immigrants living in the Sydney metropolitan area. A total of 236 Iranian-Australians immigrants aged 20-65 years participated in this cross-sectional study. The majority of respondents (73.3%) perceived that HIV-infected people face a great deal of or some stigma. Participants were concerned about being stigmatised if they tested positive or were known to be HIV-positive in the future. A significant majority expressed that such concerns would affect their decision-making related to HIV testing and disclosure. Females were more likely to perceive HIV/AIDS stigma. Multiple regression analyses showed that perceived HIV/AIDS stigma could explain 28.6% of the variance in social risk of HIV testing and disclosure (B=0.89, β=0.53, P<0.0001) and 24.6% of the variance in decision-making related to HIV testing and disclosure (B=0.62, β=0.49, P<0.0001) after controlling for sociodemographic factors. Time since migration (predictive power of 4.8-6.78%) strongly influenced the associations. If social stigma is left unaddressed, individuals would be reluctant to undertake HIV testing or disclose their HIV status if tested positive. Further attempts are needed to change the current social construction of HIV/AIDS among Iranians-Australians living in Sydney.

Male circumcision and risk of HIV acquisition among MSM.

PubMed

Sánchez, Jorge; Sal Y Rosas, Victor G; Hughes, James P; Baeten, Jared M; Fuchs, Jonathan; Buchbinder, Susan P; Koblin, Beryl A; Casapia, Martín; Ortiz, Abner; Celum, Connie

2011-02-20

To assess the association between male circumcision, insertive anal sex practices, and HIV acquisition in a cohort of MSM. Data were from 1824 HSV-2-seropositive, HIV-seronegative MSM, 1362 (75%) from Peru and 462 (25%) from the US, who participated in a randomized placebo-controlled trial of HSV-2 suppression for HIV prevention (HPTN 039). Circumcision status was determined by examination at enrollment. HIV testing was done every 3 months for up to 18 months. Partner-specific sexual behavior for up to the last three partners during the previous 3 months was analyzed. There was no significant association between male circumcision and HIV acquisition in univariate analysis [relative risk (RR) = 0.84, 95% confidence interval (CI) 0.50-1.42]. In a prespecified multivariate analysis that assumed a linear relationship between the proportion of insertive acts and effect of circumcision on HIV acquisition, the interaction between circumcision and proportion of insertive acts was not significant (P = 0.11). In an exploratory analysis that categorized behavior with recent partners by proportion of insertive acts (<60 or ≥60% insertive acts), circumcision was associated with a nonstatistically significant 69% reduction in the risk of HIV acquisition (RR = 0.31, 95% CI 0.06-1.51) among men who reported at least 60% of insertive acts with recent male partners. Circumcision does not have a significant protective effect against HIV acquisition among MSM from Peru and US, although there may be reduced risk for men who are primarily insertive with their male partners. This association needs to be investigated across diverse cohorts of MSM.

Ethnicity and HIV risk behaviour, testing and knowledge in Guatemala

PubMed Central

Taylor, Tory M.; Hembling, John; Bertrand, Jane T.

2015-01-01

Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes. PMID:24834462

Ethnicity and HIV risk behaviour, testing and knowledge in Guatemala.

PubMed

Taylor, Tory M; Hembling, John; Bertrand, Jane T

2015-01-01

To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

Ricky and Lucy: gender stereotyping among young Black men who have sex with men in the US Deep South and the implications for HIV risk in a severely affected population.

PubMed

Lichtenstein, Bronwen; Kay, Emma Sophia; Klinger, Ian; Mutchler, Matt G

2018-03-01

HIV disproportionately affects young Black men who have sex with men in the USA, with especially high rates in the Deep South. In this Alabama study, we interviewed 24 pairs of young Black men who have sex with men aged 19-24 and their close friends (n = 48) about sexual scripts, dating men and condom use. Three main themes emerged from the study: the power dynamics of 'top' and 'bottom' sexual positions for condom use; gender stereotyping in the iconic style of the 'I Love Lucy' show of the 1950s; and the sexual dominance of 'trade' men. Gender stereotyping was attributed to the cultural mores of Black families in the South, to the preferences of 'trade' men who exerted sexual and financial control and to internalised stigma relating to being Black, gay and marginalised. The findings suggest that HIV prevention education for young Black men who have sex with men is misguided if gendered power dynamics are ignored, and that funded access to self-protective strategies such as pre-exposure prophylaxis and post-exposure prophylaxis could reduce HIV risk for this severely affected population.

Gender relations and risks of HIV transmission in South India: the discourse of female sex workers' clients.

PubMed

Aubé-Maurice, Joanne; Clément, Michèle; Bradley, Janet; Lowndes, Catherine M; Gurav, Kaveri; Alary, Michel

2012-01-01

In South India, where the majority of the country's cases of HIV are concentrated, transmission of infection occurs mainly within networks composed of female sex workers, their clients and the other sexual partners of the latter. This study aims to determine how gender relations affect the risks of HIV transmission in this region. Semi-structured interviews were carried out with 30 clients and analysed qualitatively. Results show that clients perceive sexual relations with female sex workers as a vice involving loss of control and contact with women at the bottom of the social ladder. Paradoxically, this sometimes allows them to conform to the masculine ideal, in giving sexual satisfaction to a woman, in a context of incompatibility between the idealised and actual masculine and feminine archetypes. Attitudes to condoms, affected by various facets of the client-female sex worker relationship, are indicators of the link between this relationship and the risks of contracting HIV. The results suggest that there is a need for expanding targeted HIV prevention towards clients and female sex workers alongside more general interventions on gender issues, particularly among young people, focusing on the structural elements moulding current relations between men and women, with particular consideration of local cultural characteristics.

Network-based analysis of comorbidities risk during an infection: SARS and HIV case studies.

PubMed

Moni, Mohammad Ali; Liò, Pietro

2014-10-24

Infections are often associated to comorbidity that increases the risk of medical conditions which can lead to further morbidity and mortality. SARS is a threat which is similar to MERS virus, but the comorbidity is the key aspect to underline their different impacts. One UK doctor says "I'd rather have HIV than diabetes" as life expectancy among diabetes patients is lower than that of HIV. However, HIV has a comorbidity impact on the diabetes. We present a quantitative framework to compare and explore comorbidity between diseases. By using neighbourhood based benchmark and topological methods, we have built comorbidity relationships network based on the OMIM and our identified significant genes. Then based on the gene expression, PPI and signalling pathways data, we investigate the comorbidity association of these 2 infective pathologies with other 7 diseases (heart failure, kidney disorder, breast cancer, neurodegenerative disorders, bone diseases, Type 1 and Type 2 diabetes). Phenotypic association is measured by calculating both the Relative Risk as the quantified measures of comorbidity tendency of two disease pairs and the ϕ-correlation to measure the robustness of the comorbidity associations. The differential gene expression profiling strongly suggests that the response of SARS affected patients seems to be mainly an innate inflammatory response and statistically dysregulates a large number of genes, pathways and PPIs subnetworks in different pathologies such as chronic heart failure (21 genes), breast cancer (16 genes) and bone diseases (11 genes). HIV-1 induces comorbidities relationship with many other diseases, particularly strong correlation with the neurological, cancer, metabolic and immunological diseases. Similar comorbidities risk is observed from the clinical information. Moreover, SARS and HIV infections dysregulate 4 genes (ANXA3, GNS, HIST1H1C, RASA3) and 3 genes (HBA1, TFRC, GHITM) respectively that affect the ageing process. It is notable

Projecting Sexual and Injecting HIV Risks into Future Outcomes with Agent-Based Modeling

NASA Astrophysics Data System (ADS)

Bobashev, Georgiy V.; Morris, Robert J.; Zule, William A.

Longitudinal studies of health outcomes for HIV could be very costly cumbersome and not representative of the risk population. Conversely, cross-sectional approaches could be representative but rely on the retrospective information to estimate prevalence and incidence. We present an Agent-based Modeling (ABM) approach where we use behavioral data from a cross-sectional representative study and project the behavior into the future so that the risks of acquiring HIV could be studied in a dynamical/temporal sense. We show how the blend of behavior and contact network factors (sexual, injecting) play the role in the risk of future HIV acquisition and time till obtaining HIV. We show which subjects are the most likely persons to get HIV in the next year, and whom they are likely to infect. We examine how different behaviors are related to the increase or decrease of HIV risks and how to estimate the quantifiable risk measures such as survival HIV free.

Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples.

PubMed

Saleem, Haneefa T; Surkan, Pamela J; Kerrigan, Deanna; Kennedy, Caitlin E

2016-01-01

Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure

'Love and trust, you can be blinded': HIV risk within relationships among Latina women in Miami, Florida.

PubMed

Ibañez, Gladys E; Whitt, Elaine; Avent, Tenesha; Martin, Steve S; Varga, Leah M; Cano, Miguel A; O'Connell, Daniel J

2017-10-01

Latina women are disproportionately affected by HIV in the US, and account for 30% of all HIV infections in Miami-Dade County, Florida. The main risk for Latina women is heterosexual contact. Little is known about the relational and cultural factors that may impact women's HIV risk perception. This study aims to describe Latina women's perception of their HIV risk within a relational, cultural, and linguistic context. Eight focus groups of Latina women (n = 28), four English speaking groups and four Spanish speaking groups, were conducted between December 2013 and May 2014. Women were recruited from a diversion program for criminal justice clients and by word of mouth. Eligibility criteria included the following: self-identify as Hispanic/Latino, 18-49 years of age, and self-identify as heterosexual. A two-level open coding analytic approach was conducted to identify themes across groups. Most participants were foreign-born (61%) and represented the following countries: Cuba (47%), Honduras (17.5%), Mexico (12%), as well as Nicaragua, Puerto Rico, Colombia, and Venezuela (15%). Participant ages ranged between 18 and 49, with a mean age of 32 years. Relationship factors were important in perceiving HIV risk including male infidelity, women's trust in their male partners, relationship type, and getting caught up in the heat of the moment. For women in the English speaking groups, drug use and trading sex for drugs were also reasons cited for putting them at risk for HIV. English speaking women also reported that women should take more responsibility regarding condom use. Findings emphasize the importance of taking relational and cultural context into account when developing HIV prevention programs for Latina women. Interventions targeting English speaking Latina women should focus on women being more proactive in their sexual health; interventions focused on Spanish speaking women might target their prevention messages to either men or couples.

The Sexual Discounting Task: HIV Risk Behavior and the Discounting of Delayed Sexual Rewards in Cocaine Dependence

PubMed Central

Johnson, Matthew W.; Bruner, Natalie R.

2011-01-01

Background Cocaine dependence is associated with high rates of sexual risk behavior and HIV infection. However, little is known about the responsible mechanism(s). Methods Cocaine-dependent individuals (N=62) completed a novel Sexual Discounting Task assessing decisions between immediate unprotected sex and delayed sex with a condom across four hypothetical partners: most (and least) likely to have a sexually transmitted infection (STI), and most (and least) sexually desirable; a real rewards money delay-discounting task, and self-reported sexual risk behavior using the HIV Risk-Taking Behavior Scale (HRBS). Results Sexual Discounting Task results were largely systematic and showed a strong effect of delay in decreasing condom use. Sexual discounting (preference for immediate unprotected sex) was significantly greater when making responses for partners judged least (compared to most) likely to have an STI, and for partners judged most (compared to least) desirable. Differences in sexual discounting were significant after controlling for differences in condom use (with no delay) between conditions. Greater discounting in 3 or the 4 Sexual Discounting Task conditions, but not in the money discounting task, was associated with greater self-reported sexual risk behavior as measured by the HRBS Conclusions Results suggest that delay is a critical variable strongly affecting HIV sexual risk behavior, and that the Sexual Discounting Task provides a clinically sensitive measure of this phenomenon that may address a variety of questions about HIV risk in future research. The wealth of behavioral and neurobiological data on delay discounting should be brought to bear on HIV education and prevention. PMID:22055012

Exploring Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection Recruited with Venue-based Sampling.

PubMed

Gwadz, Marya; Cleland, Charles M; Jenness, Samuel M; Silverman, Elizabeth; Hagan, Holly; Ritchie, Amanda S; Leonard, Noelle R; McCright-Gill, Talaya; Martinez, Belkis; Swain, Quentin; Kutnick, Alexandra; Sherpa, Dawa

2016-02-01

Annual HIV testing is recommended for high-risk populations in the United States, to identify HIV infections early and provide timely linkage to treatment. However, heterosexuals at high risk for HIV, due to their residence in urban areas of high poverty and elevated HIV prevalence, test for HIV less frequently than other risk groups, and late diagnosis of HIV is common. Yet the factors impeding HIV testing in this group, which is predominantly African American/Black and Latino/Hispanic, are poorly understood. The present study addresses this gap. Using a systematic community-based sampling method, venue-based sampling (VBS), we estimate rates of lifetime and recent (past year) HIV testing among high-risk heterosexuals (HRH), and explore a set of putative multi-level barriers to and facilitators of recent testing, by gender. Participants were 338 HRH African American/Black and Latino/Hispanic adults recruited using VBS, who completed a computerized structured assessment battery guided by the Theory of Triadic Influence, comprised of reliable/valid measures on socio-demographic characteristics, HIV testing history, and multi-level barriers to HIV testing. Logistic regression analysis was used to identify factors associated with HIV testing within the past year. Most HRH had tested at least once (94%), and more than half had tested within the past year (58%), but only 37% tested annually. In both men and women, the odds of recent testing were similar and associated with structural factors (better access to testing) and sexually transmitted infection (STI) testing and diagnosis. Thus VBS identified serious gaps in rates of annual HIV testing among HRH. Improvements in access to high-quality HIV testing and leveraging of STI testing are needed to increase the proportion of HRH testing annually for HIV. Such improvements could increase early detection of HIV, improve the long-term health of individuals, and reduce HIV transmission by increasing rates of viral

Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples.

PubMed

Baeten, Jared M; Donnell, Deborah; Kapiga, Saidi H; Ronald, Allan; John-Stewart, Grace; Inambao, Mubiana; Manongi, Rachel; Vwalika, Bellington; Celum, Connie

2010-03-13

Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision. Data collected as part of a prospective study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners. Circumcision status was determined by physical examination. Cox proportional hazards analysis was used. A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months; 374 (34%) male partners were circumcised. Sixty-four female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the male partner was associated with a nonstatistically significant approximately 40% lower risk of HIV-1 acquisition by the female partner (hazard ratio 0.62, 95% confidence interval 0.35-1.10, P = 0.10). The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership (n = 50, hazard ratio 0.57, P = 0.11), after adjustment for male partner plasma HIV-1 concentrations (hazard ratio 0.60, P = 0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (hazard ratio 0.53, P = 0.07). Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male, we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1.

Did the 2014 Ebola outbreak in Liberia affect HIV testing, linkage to care and ART initiation?

PubMed Central

Bhat, P.; Owiti, P.; Edwards, J. K.; Tweya, H.; Najjemba, R.

2017-01-01

Setting: Health facilities providing human immunodeficiency virus (HIV) testing, care and treatment in Liberia. Objective: To evaluate individuals aged ⩾15 years who were tested, diagnosed and enrolled into HIV care before (2013), during (2014) and after the Ebola outbreak (2015). Design: A cross-sectional descriptive study. Results: A median of 6930 individuals aged ⩾15 years per county were tested for HIV before the Ebola outbreak; this number declined by 35% (2444/6930) during the outbreak. HIV positivity remained similar before (7028/207 314, 3.4%) and during the outbreak (4146/121 592, 3.5%). During Ebola, HIV testing declined more in highly affected counties (68 035/127 468, 47%) than in counties that were less affected (16 444/23 955, 31%, P < 0.001). Compared to the pre-Ebola period, HIV testing in less-affected counties recovered more quickly during the post-outbreak period, with a 19% increase in testing, while medium and highly affected counties remained at respectively 38% and 48% below pre-outbreak levels. Enrolment for HIV care increased during and after the outbreak compared to the pre-Ebola period. Conclusion: HIV testing and diagnosis were significantly limited during the Ebola outbreak, with the most severe effects occurring in highly affected counties. However, enrolment for HIV care and treatment were resilient throughout the outbreak. Pro-active measures are needed to sustain HIV testing rates in future epidemics. PMID:28744442

Extracurricular interest as a resilience building block for children affected by parental HIV/AIDS.

PubMed

Zhao, Junfeng; Chi, Peilian; Li, Xiaoming; Tam, Cheuk Chi; Zhao, Guoxiang

2014-01-01

Parental illness and death due to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) impose challenges to children's psychological adjustment. Positive psychology emphasizes individual's resilience in the face of adversity, trauma, and tragedy. Limited data are available regarding the factors that can cultivate resilience of children affected by HIV/AIDS. This study aims to examine the role of extracurricular interest in strengthening resilience among children affected by HIV/AIDS. Participants included 755 children orphaned by parental HIV/AIDS, 466 vulnerable children living with HIV-positive parent(s), and 404 comparison children from HIV-free families in the same community in rural China. The measures include extracurricular interest (i.e., reading, sports, music, painting, science, and playing chess) and indicators of psychological adjustment (i.e., depression, loneliness, and self-esteem). Having extracurricular interest was positively associated with self-esteem and negatively associated with depression and loneliness. Having extracurricular interest attenuated the negative effect of parental HIV/AIDS on children's self-esteem and loneliness, after controlling for children's age, gender, and family socioeconomic status. The findings underscore the importance of nurturing extracurricular interest and make available of such activities to promote resilience for children affected by HIV/AIDS in resource-limited settings.

A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women.

PubMed

Stewart, Jennifer M; Rogers, Christopher K; Bellinger, Dawn; Thompson, Keitra

2016-07-01

HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups (n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context-related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings. © The Author(s) 2016.

HIV sexual risk behavior in older black women: a systematic review.

PubMed

Smith, Tanyka K; Larson, Elaine L

2015-01-01

Human immunodeficiency virus (HIV) is a major public health concern in the United States, particularly among older Black women who comprise approximately 40% of the newly diagnosed cases among women. This systematic review sought to answer the research question: What are the sexual practices in older Black women associated with HIV risk? CINAHL, PubMed, MEDLINE, and Web of Knowledge electronic databases were searched for English-language research studies published between 2003 and 2013 that focused on the HIV sexual risk practices of Black women over the age of 50. Using PRISMA guidelines, two reviewers independently reviewed and appraised the quality of relevant articles; agreement of select studies was achieved by consensus. Among the 3,167 articles surveyed, 9 met inclusion criteria. The majority (88%) were quantitative, observational studies. All nine articles addressed at least one of three factors that contribute to HIV sexual risk: Behavioral (inconsistent condom use and multiple sexual partners), psychological (risk perception, depression/stress, trauma, and self-esteem issues), and social factors (economics, education, and drugs/alcohol use). Outcome measures varied across studies. Although this systematic review appraised few studies, findings suggest that many older Black women are engaged in HIV risk-taking practices. Clinicians and researchers need to be aware of the HIV risk practices of older Black women to improve health outcomes through education, effective communication and risk appraisal. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Changing risk factors for HIV infection.

PubMed

Volkow, Patricia; Mohar, Alejandro; Terrazas, José-Juan; Pérez-Padilla, José-Rogelio; Vilar-Compte, Diana; Carranza, Dora; Sierra-Madero, Juan

2002-01-01

HIV infection in women is a growing problem in developing countries. Risk factors for HIV infection vary from country to country and may change with time. We describe a retrospective review of the epidemiologic characteristics and associated gynecologic diseases of all HIV-infected women seen at two tertiary-care hospitals in Mexico City. One hundred thirty consecutive patients were included in the study from March 1985 to January 1996. Mean age at HIV diagnosis was 36.2 years (range: 16-76). Of the 75 women diagnosed with AIDS prior to 1992, 58 (69%) were infected through blood transfusion and 17 (20%) through sexual contact. After January 1992, 11 (23%) acquired infection through blood transfusion and 28 (60%) through sexual contact; these differences were statistically significant (p <0.0001). Prior to 1992, 66 (90%) women presented in stage IV, whereas after that year only 29 (51%) (p <0.001) presented in stage IV. Of 92 patients on whom a cervico-vaginal smear was carried out, human papillomavirus infection was identified in 22 (24%) women, nine (9.8%) had morphologic evidence of a cervical intraepithelial neoplasia (four with mild or moderate dysplasia and five with in situ cervical carcinoma). Four patients had invasive cervical carcinoma. The main risk factor for HIV infection in Mexican women with AIDS changed from transfusion acquired to sexually acquired in 1992. As a country, we were successful in providing safe blood but failed to prevent sexual transmission. Our patients had a high frequency of cervical carcinoma and precursor lesions associated with human papilloma virus.

What leads some people to think they are HIV-positive before knowing their diagnosis? A systematic review of psychological and behavioural correlates of HIV-risk perception.

PubMed

Evangeli, Michael; Baker, Laura L E; Pady, Kirsten; Jones, Bethanie; Wroe, Abigail L

2016-08-01

Current HIV-risk perception refers to the extent to which individuals think they might be HIV-positive. This belief, distinct from the perceived risk about being infected with HIV in the future, is likely to have a range of important consequences. These consequences may include both psychological effects (e.g., impacts on well-being) and behavioural effects (e.g., HIV testing uptake). Given these possible outcomes, and the suggested importance of risk perception in health behaviour models, understanding the behavioural and psychological antecedents of current HIV-risk perception is crucial. This systematic review investigates the relationship between behavioural and psychological factors and current HIV-risk perception (in individuals who are unaware of their actual HIV status). Eight studies were eligible for inclusion in the review (five quantitative and three qualitative studies). Drug risk behaviour and sexual risk behaviour (both self and partner) were often associated with current HIV-risk perception, although other studies failed to show a relationship between one's own sexual risk behaviour and risk perception. Psychological factors were only rarely assessed in relation to current HIV-risk perception. Where these variables were included, there was evidence that experiencing symptoms perceived to be consistent with HIV and prompts to test were associated with increased current HIV-risk perception. These findings are consistent with the Common-Sense Model (CSM) of illness representation and self-regulation. Methodological quality criteria were rarely met for the included studies. In addition, it was often difficult to ascertain whether potentially includable studies were eligible due to imprecise definitions of HIV-risk perception. Research and practice implications are discussed, with particular emphasis on the role of risk appraisals as a potential mediator of the relationship between HIV-risk behaviour, symptoms and current HIV-risk perception.

Risk perceptions of STIs/HIV and sexual risk behaviours among sexually experienced adolescents in the Northern part of Lao PDR

PubMed Central

2013-01-01

Background Young people in Laos are more vulnerable to STIs/HIV due to their sexual risk behaviours, low perceptions of risk and their socio-cultural environments. Perceived risk of contracting STIs/HIV is crucial for the assessment of their risk regarding their actual sexual risk behaviors. Thus, the objective of this paper is to explore perceptions of risk related to STIs/HIV and identify factors associated with this perceived risk among adolescents. Methods This was a cross sectional study of sexually experienced adolescents aged 14 to 19 years old in the Luangnamtha province. The multistage sampling techniques were used for selecting 1008 adolescents aged 14-19 years old. Of these, 483 respondents reported having had sexual experience was selected for analysis. Univariate and Logistic regression were performed. Result Six per cent of respondents reported ever having had anal sex. Slightly less than two thirds initiated their first sexual intercourse before age 15. Two thirds of the sexually experienced males reported two or more sexual partners during their lifetime with the mean 3.1 + 3.65 while only twelve per cent of girls reported this cumulative number of partners. Slightly more than half (57.6%) regarded themselves to have no risk at all with 17.2 per cent considered themselves to have low risk. Respondents had poor knowledge on STIs/HIV. Factors associated with risk perception of getting STIs were: being male, high level of knowledge about STIs and having had symptoms of STIs in last six months. Perceived risk of getting HIV was significantly associated with being male, having more knowledge about STIs and HIV. Conclusion Adolescents in this study engaged in sexual risk behaviours, but they have low perception of risk getting STI/HIV. Socio-demographic factors, knowledge of STIs/HIV, and the level of exposure to STIs were the main determinants of the risk perception of STIs/HIV. Our finding supports the need to target adolescents in Luangnamtha

A Novel Approach to Prevention for At-Risk HIV-Negative Men Who Have Sex With Men: Creating a Teachable Moment to Promote Informed Sexual Decision-Making

PubMed Central

Cherry, Chauncey; Cain, Demetria; Pope, Howard

2011-01-01

Objectives. As a result of the impact of HIV among men who have sex with men (MSM), multiple strategies for reducing HIV risks have emerged from within the gay community. One common HIV risk reduction strategy limits unprotected sex partners to those who are of the same HIV status (serosorting). We tested a novel, brief, one-on-one intervention, based on informed decision-making and delivered by peer counselors, designed to address the limitations of serosorting (e.g., risk for HIV transmission). Methods. In 2009, we recruited a group of 149 at-risk men living in Atlanta, Georgia, and randomly assigned them to an intervention condition addressing serosorting or a standard-of-care control condition. Results. Men in the serosorting intervention reported fewer sexual partners (Wald χ2 = 8.79, P < .01) at the study follow-ups. Behavioral results were also consistent with changes in psychosocial variables, including condom use self-efficacy and perceptions of risk for HIV transmission. Conclusions. With the current intervention, service providers can offer risk reduction for men arguably at the highest risk for HIV infection in the United States. Addressing risks associated with serosorting in a feasible, low-cost intervention has the potential to significantly affect the HIV epidemic. PMID:21233441

SOCIAL PSYCHOLOGICAL DYNAMICS OF ENHANCED HIV RISK REDUCTION AMONG PEER INTERVENTIONISTS

PubMed Central

Dickson-Gomez, Julia; Weeks, Margaret R.; Convey, Mark; Li, Jianghong

2014-01-01

The authors present a model of interactive social psychological and relational feedback processes leading to human immunodeficiency virus (HIV) risk reduction behavior change among active drug users trained as Peer Health Advocates (PHAs). The model is supported by data from qualitative interviews with PHAs and members of their drug-using networks in the Risk Avoidance Partnership (RAP) project. Results suggest three mutually reinforcing social psychological processes that motivate PHAs to provide HIV prevention intervention to their peers and to reduce their own risk behaviors: development of a prosocial identity, positive social reinforcement from drug users and community members, and cognitive dissonance associated with continued risk behavior while engaging in health advocacy. These processes directly influence peer interventionists’ motivation and efficacy to continue giving intervention to their peers, and to reduce their HIV risk behaviors. The authors discuss implications of the model for continued research on effective HIV prevention in high-risk groups. PMID:25414528

A cross-sectional survey of attitudes to HIV risk and rapid HIV testing among clients of sex workers in Switzerland.

PubMed

Darling, Katharine E A; Diserens, Esther-Amélie; N'garambe, Chantal; Ansermet-Pagot, Anne; Masserey, Eric; Cavassini, Matthias; Bodenmann, Patrick

2012-10-01

To assess attitudes to HIV risk and acceptability of rapid HIV testing among clients of street-based female sex workers (FSW) in Lausanne, Switzerland, where HIV prevalence in the general population is 0.4%. The authors conducted a cross-sectional study in the red light district of Lausanne for five nights in September of 2008, 2009 and 2010. Clients of FSW were invited to complete a questionnaire in the street assessing demographic characteristics, attitudes to HIV risk and HIV testing history. All clients interviewed were then offered anonymous finger stick rapid HIV testing in a van parked on-site. The authors interviewed 112, 127 and 79 clients in 2008, 2009 and 2010, respectively. All were men, average age 32-37 years old; 40-60% were in a stable relationship. History of unprotected sex was higher with non-commercial partners (33-50%) than with FSW (6-11%); 29-46% of clients had never undergone an HIV test. Anonymous rapid HIV testing was accepted by 45-50% of clients. Out of 109 HIV tests conducted during the three study periods, none was reactive. On-site HIV counselling and testing is acceptable among clients of FSW in this urban setting. These individuals represent an unquantified population, a proportion of which has an incomplete understanding of HIV risk in the face of high-risk behaviour, with implications for potential onward transmission to non-commercial sexual partners.