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Sample records for address hiv prevention

  1. Harnessing the Prevention Benefits of Antiretroviral Therapy to Address HIV and Tuberculosis

    PubMed Central

    Granich, Reuben; Lo, Ying-Ru; Suthar, Amitabh B; Vitoria, Marco; Baggaley, Rachel; Obermeyer, Carla Makhlouf; McClure, Craig; Souteyrand, Yves; Perriens, Jos; Kahn, James G; Bennett, Rod; Smyth, Caoimhe; Williams, Brian; Montaner, Julio; Hirnschall, Gottfried

    2011-01-01

    After 30 years we are still struggling to address a devastating HIV pandemic in which over 25 million people have died. In 2010, an estimated 34 million people were living with HIV, around 70% of whom live in sub-Saharan Africa. Furthermore, in 2009 there were an estimated 1.2 million new HIV-associated TB cases, and tuberculosis (TB) accounted for 24% of HIV-related deaths. By the end of 2010, 6.6 million people were taking antiretroviral therapy (ART), around 42% of those in need as defined by the 2010 World Health Organization (WHO) guidelines. Despite this achievement, around 9 million people were eligible and still in need of treatment, and new infections (approximately 2.6 million in 2010 alone) continue to add to the future caseload. This combined with the international fiscal crisis has led to a growing concern regarding weakening of the international commitment to universal access and delivery of the Millennium Development Goals by 2015. The recently launched UNAIDS/WHO Treatment 2.0 platform calls for accelerated simplification of ART, in line with a public health approach, to achieve and sustain universal access to ART, including maximizing the HIV and TB preventive benefit of ART by treating people earlier, in line with WHO 2010 normative guidance. The potential individual and public health prevention benefits of using treatment in the prevention of HIV and TB enhance the value of the universal access pledge from a life-saving initiative, to a strategic investment aimed at ending the HIV epidemic. This review analyzes the gaps and summarizes the evidence regarding ART in the prevention of HIV and TB. PMID:21999771

  2. Addressing the need for access to culturally and linguistically appropriate HIV/AIDS prevention for Latinos.

    PubMed

    Rios-Ellis, Britt; Frates, Janice; D'Anna, Laura Hoyt; Dwyer, Maura; Lopez-Zetina, Javier; Ugarte, Carlos

    2008-10-01

    This article reports a comprehensive national needs assessment of Latinos' access to HIV/AIDS prevention and education services in 14 cities throughout the United States and Puerto Rico. Interviews and focus groups were conducted with Latinos who were HIV-positive and at risk for HIV infection. The study explored risk behaviors, access to health care services, and exposure to HIV prevention messages. Differences in predictors of risk behaviors were noted by sex. For women, increased age, being married, foreign-born, and a U.S. resident, and having tested for HIV previously, were associated with reduced HIV/AIDS risk. Thematic analysis of qualitative findings revealed limited awareness of risk factors, and a need for culturally and linguistically appropriate, family-centered HIV/AIDS education incorporating Latino values. Findings were incorporated into culturally relevant brochures featuring vignettes and quotes. Brochures were distributed and evaluated by 71 community-based organizations (CBOs) in the U.S. and Latin America. Evaluators responded positively to the brochures, and Latino-serving organizations in 48 states now use them for HIV/AIDS prevention outreach and education. PMID:18157640

  3. Adapting a Family-Based HIV Prevention Program for HIV-Infected Preadolescents and Their Families: Youth, Families and Health Care Providers Coming Together to Address Complex Needs

    PubMed Central

    McKay, Mary; Block, Megan; Mellins, Claude; Traube, Dorian E.; Brackis-Cott, Elizabeth; Minott, Desiree; Miranda, Claudia; Petterson, Jennifer; Abrams, Elaine J.

    2010-01-01

    SUMMARY This article describes a family-based HIV prevention and mental health promotion program specifically designed to meet the needs of perinatally-infected preadolescents and their families. This project represents one of the first attempts to involve perinatally HIV-infected youth in HIV prevention efforts while simultaneously addressing their mental health and health care needs. The program, entitled CHAMP+ (Collaborative HIV Prevention and Adolescent Mental Health Project-Plus), focuses on: (1) the impact of HIV on the family; (2) loss and stigma associated with HIV disease; (3) HIV knowledge and understanding of health and medication protocols; (4) family communication about puberty, sexuality and HIV; (5) social support and decision making related to disclosure; and (6) parental supervision and monitoring related to sexual possibility situations, sexual risk taking behavior and management of youth health and medication. Findings from a preliminary evaluation of CHAMP+ with six families are presented along with a discussion of challenges related to feasibility and implementation within a primary health care setting for perinatally infected youth. PMID:20852676

  4. Preparing Social Workers To Address HIV/AIDS Prevention and Detection: Implications for Professional Training and Education.

    ERIC Educational Resources Information Center

    Wolf, Michael S.; Mitchell, Christopher G.

    2002-01-01

    Investigated social workers' knowledge and practices regarding HIV prevention education, risk assessment, and case finding. HIV/AIDS knowledge and behaviors significantly related to age, geographic location, and practice setting. Most respondents provided little to no HIV-related services in clinical practice. Prior HIV-related training and…

  5. HIV Prevention

    MedlinePlus

    ... to treat HIV infection (called antiretroviral therapy, or ART) the right way, every day and his or ... way, every day, the medicine to treat HIV (ART) reduces the amount of HIV (called “viral ...

  6. Preventing HIV with Medicine

    MedlinePlus

    ... information in Spanish ( en español ) Preventing HIV with medicine Get medicine right after you are exposed to ... to top More information on Preventing HIV with medicine Explore other publications and websites National HIV and ...

  7. The Sex Check: The Development of an HIV-Prevention Service to Address the Needs of Latino MSM

    PubMed Central

    Katz, Jennifer L.; Orellana, E. Roberto; Walker, Denise D.; Viquez, Luis; Picciano, Joseph F.; Roffman, Roger A.

    2012-01-01

    The Sex Check is a brief, telephone-delivered, HIV-prevention intervention tailored for individuals who are at high risk of HIV infection or transmission but who are neither reducing their risk on their own nor seeking support for this purpose. Because the intervention is delivered on a one-to-one basis, permits anonymity, is marketed to “men who have sex with men,” and is brief, it may be particularly responsive to cultural, structural, and attitudinal barriers to serving Latino MSM. Because many Latino MSM continue to engage in high risk sexual behaviors, developing and testing prevention interventions with this population is a public health priority. PMID:22605913

  8. Preventing HIV Infection in Women

    PubMed Central

    Adimora, Adaora A.; Ramirez, Catalina; Auerbach, Judith D.; Aral, Sevgi O.; Hodder, Sally; Wingood, Gina; El-Sadr, Wafaa; Bukusi, Elizabeth Anne

    2014-01-01

    Although the number of new infections has declined recently, women still constitute almost half of the world's 34 million people with HIV infection, and HIV remains the leading cause of death among women of reproductive age. Prevention research has made considerable progress during the past few years in addressing the biological, behavioral and social factors that influence women's vulnerability to HIV infection. Nevertheless, substantial work still must be done in order to implement scientific advancements and to resolve the many questions that remain. This article highlights some of the recent advances and persistent gaps in HIV prevention research for women and outlines key research and policy priorities. PMID:23764631

  9. Moving beyond the "male perpetrator, female victim" discourse in addressing sex and relationships for HIV prevention: peer research in Eastern Zambia.

    PubMed

    Heslop, Jo; Banda, Rabecca

    2013-05-01

    Despite the resources put into HIV education programmes with young people in sub-Saharan Africa in the past two decades, there is little clear evidence of impact. Many programmes continue to be oriented towards individual behaviour change (and in reality, often sexual abstinence) with insufficient focus on understanding how societies constrain or enable individual agency in sexual decision-making and how this is affected by social norms. If education programmes do address gender they often reinforce a "male perpetrator, female victim" discourse, where girls and women are held responsible for boys' and men's sexuality as well as their own. This paper discusses the discourses around gender, sexuality and HIV constructed by young women and men (aged 16-29) in a rural Eastern Zambia village. Data on young women's and men's narratives were gathered using a participatory peer approach. Research uncovered numerous and sometimes conflicting discourses (cultural, moral, economic, and sexual) influencing young women's and men's thinking about sexuality and sexual behaviour, in particular the limited possibilities for safe consensual sex, and thus their vulnerability to HIV. The research suggests that the realities young people face are much more complex than HIV prevention strategies address. We recommend a more nuanced approach, tailored to the community contexts involved. PMID:23684205

  10. The development and implementation of theory-driven programs capable of addressing poverty-impacted children’s health, mental health and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care

    PubMed Central

    McKay, Mary McKernan; Alicea, Stacey; Elwyn, Laura; McClain, Zachary R.B.; Parker, Gary; Small, Latoya A; Ann Mellins, Claude

    2014-01-01

    This article describes a program of prevention and intervention research conducted by the CHAMP (CHAMP – Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively-designed, family-based approaches meant to address the prevention, health and mental health needs of poverty-impacted, African American and Latino urban youth who are either at risk for HIV exposure or who are perinatally-infected and at high risk for re-infection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multi-level contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include: the Triadic Theory of Influence (TTI) (Bell, Flay, & Paikoff, 2002), Social Action Theory (SAT) (Ewart, 1991) and Ecological Developmental Perspectives (Paikoff, Traube, & McKay, 2006). CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence and intensive input from consumers and healthcare providers. PMID:24787707

  11. HIV Prevention Readiness in Undergraduates and Inmates.

    ERIC Educational Resources Information Center

    Antonio, Michael E.; And Others

    Prevention of Human Immunodeficiency Virus (HIV) transmission is increasingly an international priority. Education of high-risk populations, such as incarcerated individuals, is particularly important in thwarting the spread of HIV. To address this concern, the attitudes, beliefs, and knowledge of inmates concerning HIV and AIDS related issues are…

  12. HIV/AIDS Prevention Program Evaluation Report.

    ERIC Educational Resources Information Center

    Amaro, Hortensia; Barker, Marybeth; Cassisy, Theresa; Hardy-Fanta, Carol; Hereen, Tim; Levenson, Suzette; McCloskey, Lois; Melendez, Michael

    This report addresses the four research objectives that were established by the Massachusetts Primary Prevention Group (MPPG) and the Massachusetts Department of Public Health's HIV/AIDS Bureau. The objectives were to: (1) review and summarize literature that formally evaluated HIV prevention interventions; (2) describe how currently funded…

  13. Addressing Poverty, Unemployment and Gender Inequality in Southern Africa: An Alternative Strategy for HIV/AIDS Prevention with Sex Workers in Botswana

    ERIC Educational Resources Information Center

    Ntseane, Peggy Gabo

    2004-01-01

    This article presents the results of a study that was conducted as an effort to identify the needs of sex workers as potential beneficiaries of future HIV prevention and empowerment activities. The purpose of this study was to assess the situation and needs of sex workers in the context of HIV/AIDS. Data were collected from one of the small…

  14. Sex worker-led structural interventions in India: a case study on addressing violence in HIV prevention through the Ashodaya Samithi collective in Mysore

    PubMed Central

    Reza-Paul, Sushena; Lorway, Rob; O’Brien, Nadia; Lazarus, Lisa; Jain, Jinendra; Bhagya, M.; Fathima, Mary P; Venukumar, KT; Raviprakash, K.N.; Baer, James; Steen, Richard

    2012-01-01

    Background & objectives: Structural interventions have the capacity to improve the outcomes of HIV/AIDS interventions by changing the social, economic, political or environmental factors that determine risk and vulnerability. Marginalized groups face disproportionate barriers to health, and sex workers are among those at highest risk of HIV in India. Evidence in India and globally has shown that sex workers face violence in many forms ranging from verbal, psychological and emotional abuse to economic extortion, physical and sexual violence and this is directly linked to lower levels of condom use and higher levels of sexually transmitted infections (STIs), the most critical determinants of HIV risk. We present here a case study of an intervention that mobilized sex workers to lead an HIV prevention response that addresses violence in their daily lives. Methods: This study draws on ethnographic research and project monitoring data from a community-led structural intervention in Mysore, India, implemented by Ashodaya Samithi. Qualitative and quantitative data were used to characterize baseline conditions, community responses and subsequent outcomes related to violence. Results: In 2004, the incidence of reported violence by sex workers was extremely high (> 8 incidents per sex worker, per year) but decreased by 84 per cent over 5 years. Violence by police and anti-social elements, initially most common, decreased substantially after a safe space was established for sex workers to meet and crisis management and advocacy were initiated with different stakeholders. Violence by clients, decreased after working with lodge owners to improve safety. However, initial increases in intimate partner violence were reported, and may be explained by two factors: (i) increased willingness to report such incidents; and (ii) increased violence as a reaction to sex workers’ growing empowerment. Trafficking was addressed through the establishment of a self-regulatory board (SRB). The

  15. HIV treatment for prevention.

    PubMed

    Ambrosioni, Juan; Calmy, Alexandra; Hirschel, Bernard

    2011-01-01

    "No virus, no transmission." Studies have repeatedly shown that viral load (the quantity of virus present in blood and sexual secretions) is the strongest predictor of HIV transmission during unprotected sex or transmission from infected mother to child. Effective treatment lowers viral load to undetectable levels. If one could identify and treat all HIV-infected people immediately after infection, the HIV/AIDS epidemic would eventually disappear.Such a radical solution is currently unrealistic. In reality, not all people get tested, especially when they fear stigma and discrimination. Thus, not all HIV-infected individuals are known. Of those HIV-positive individuals for whom the diagnosis is known, not all of them have access to therapy, agree to be treated, or are taking therapy effectively. Some on effective treatment will stop, and in others, the development of resistance will lead to treatment failure. Furthermore, resources are limited: should we provide drugs to asymptomatic HIV-infected individuals without indication for treatment according to guidelines in order to prevent HIV transmission at the risk of diverting funding from sick patients in urgent need? In fact, the preventive potential of anti-HIV drugs is unknown. Modellers have tried to fill the gap, but models differ depending on assumptions that are strongly debated. Further, indications for antiretroviral treatments expand; in places like Vancouver and San Francisco, the majority of HIV-positive individuals are now under treatment, and the incidence of new HIV infections has recently fallen. However, correlation does not necessarily imply causation. Finally, studies in couples where one partner is HIV-infected also appear to show that treatment reduces the risk of transmission.More definite studies, where a number of communities are randomized to either receive the "test-and-treat" approach or continue as before, are now in evaluation by funding agencies. Repeated waves of testing would precisely

  16. Factors Influencing Black Churches' Readiness to Address HIV.

    PubMed

    Pichon, Latrice C; Powell, Terrinieka Williams; Ogg, Siri A; Williams, Andrea L; Becton-Odum, Nicole

    2016-06-01

    This study employed a community-based participatory research approach to understand factors that influence church readiness to engage in HIV prevention and treatment activities. A convenience sample of twenty-six Black faith leaders participated in four focus groups. Data analysis was done through qualitative content analysis. Three themes emerged. First, the pastor's blessing and authority as the church's decision-maker determines readiness to engage in HIV prevention. Second, the church's purview of sexual health as part of a holistic ministry facilitates faith leader's readiness. Lastly, securing financial and human resources makes it feasible for faith leaders to implement activities. Findings suggest HIV-related stigma alone does not explain readiness to address HIV. Participants also discussed activities their churches are equipped to handle, including HIV testing events and health fairs. PMID:26345680

  17. Microbicides for HIV prevention

    PubMed Central

    Ramjee, Gita

    2011-01-01

    Although the HIV incidence rate has slowed in some countries, HIV remains a serious health challenge, particularly in the developing world. The epidemic is increasingly feminised, with young women at high risk of acquiring the virus. There is thus a clear requirement for acceptable woman-initiated methods of HIV prevention. Foremost among these are vaginally-applied substances known as microbicides; early research into potential microbicides focussed on non-HIV-specific compounds such as surfactants and polyanionic entry inhibitors. However, proof of the microbicide concept as a viable prevention strategy was not provided until the CAPRISA 004 trial of a microbicide containing the HIV-specific antiretroviral tenofovir was completed in mid-2010. Confirmation of the proof of concept provided by CAPRISA 004 by at least two major trials will hopefully lead to licensure of the product by 2018. Parallel studies are planned to ascertain the feasibility of implementation of these products in the public sector with subsequent research focussed on appropriate and acceptable methods of delivery of the active ingredient, and to increase adherence through other delivery systems such as vaginal rings. PMID:22310825

  18. Students for Safer Sexuality: A Peer Education Program Addressing the Postponement of Sexual Involvement and the Prevention of Unwanted Pregnancy, HIV and Other Sexually Transmitted Diseases.

    ERIC Educational Resources Information Center

    Wright, Pam; Vaughan, David

    Students for Safer Sexuality is a peer education program designed to train 11th and 12th graders to be key agents in the delivery of sexuality education, HIV prevention, and communication skills programs. There were 15 students involved in the first year and 20 students currently involved. Participants are trained to lead discussion groups,…

  19. Preexposure Prophylaxis for HIV Prevention

    PubMed Central

    Kelesidis, Theodoros; Landovitz, Raphael J.

    2012-01-01

    Reducing the incidence of HIV remains one of our greatest public health challenges. However, there is growing optimism that preexposure prophylaxis (PrEP) could have a major impact on preventing incident HIV infection. Recently presented data on the use of oral PrEP in men who have sex with men (MSM) have provided proof-of-principle for this strategy. Additional clinical trials are evaluating whether PrEP provides similar protection to risk groups other than MSM, such as heterosexual persons and injection drug users. Still unanswered questions include optimal dosing strategies, long-term safety, maximizing adherence and minimizing costs, addressing drug resistance in the face of PrEP failure, optimizing access, and assessing effects on risk behavior. Future implementation will be guided by the results of clinical trials in progress. This article provides a review of the data on the potential strengths and limitations of PrEP as an HIV prevention strategy, identifies challenges to implementation of this approach, and outlines knowledge gaps. PMID:21465112

  20. A "big data" approach to HIV epidemiology and prevention.

    PubMed

    Young, Sean D

    2015-01-01

    The recent availability of "big data" from social media and mobile technologies provides promise for development of new tools and methods to address the HIV epidemic. This manuscript presents recent work in this growing area of bioinformatics, digital epidemiology, and disease modeling, describes how it can be applied to address HIV prevention, and presents issues that need to be addressed prior to implementing a mobile technology big-data approach to HIV prevention. PMID:25449693

  1. Summary of CDC consultation to address social determinants of health for prevention of disparities in HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis. December 9-10, 2008.

    PubMed

    Sharpe, Tanya Telfair; Harrison, Kathleen McDavid; Dean, Hazel D

    2010-01-01

    In December 2008, the Centers for Disease Control and Prevention (CDC) convened a meeting of national public health partners to identify priorities for addressing social determinants of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB). The consultants were divided into four working groups: (1) public health policy, (2) data systems, (3) agency partnerships and prevention capacity building, and (4) prevention research and evaluation. Groups focused on identifying top priorities; describing activities, methods, and metrics to implement priorities; and identifying partnerships and resources required to implement priorities. The meeting resulted in priorities for public health policy, improving data collection methods, enhancing existing and expanding future partnerships, and improving selection criteria and evaluation of evidence-based interventions. CDC is developing a national communications plan to guide and inspire action for keeping social determinants of HIV/AIDS, viral hepatitis, STDs, and TB in the forefront of public health activities. PMID:20626189

  2. Addressing HIV stigma in protected medical settings

    PubMed Central

    Li, Li; Liang, Li-Jung; Lin, Chunqing; Wu, Zunyou

    2015-01-01

    Previous studies suggest that the implementation of universal precaution (UP) plays a role in reducing HIV stigma. In this study we investigate the efficacy of a stigma reduction intervention on UP compliance and explore whether UP compliance could potentially influence HIV stigma reduction in medical settings. A randomized controlled intervention trial was conducted in two provinces of China with 1760 healthcare service providers recruited from 40 county-level hospitals. Longitudinal analyses included data collection at baseline, 6-, and 12-month follow-up assessments. Using a hierarchical modeling approach, we estimated the intervention effect for each provider’s UP compliance and its potential mediating role on HIV stigma with the bootstrapping method. A significant intervention effect on UP compliance was observed at both the 6- and 12-month follow-up assessments. The intervention effect on provider avoidance intent was partially mediated by the provider’s own UP compliance at the two follow-up points. This study provides evidence that UP compliance should be part of HIV stigma reduction programs, especially in resource-restrained countries. Findings suggest that a protected work environment may be necessary but not sufficient to address HIV stigma in medical settings. PMID:26608559

  3. Addressing HIV stigma in protected medical settings.

    PubMed

    Li, Li; Liang, Li-Jung; Lin, Chunqing; Wu, Zunyou

    2015-01-01

    Previous studies suggest that the implementation of universal precaution (UP) plays a role in reducing HIV stigma. In this study we investigate the efficacy of a stigma reduction intervention on UP compliance and explore whether UP compliance could potentially influence HIV stigma reduction in medical settings. A randomized controlled intervention trial was conducted in two provinces of China with 1760 healthcare service providers recruited from 40 county-level hospitals. Longitudinal analyses included data collection at baseline, 6-, and 12-month follow-up assessments. Using a hierarchical modeling approach, we estimated the intervention effect for each provider's UP compliance and its potential mediating role on HIV stigma with the bootstrapping method. A significant intervention effect on UP compliance was observed at both the 6- and 12-month follow-up assessments. The intervention effect on provider avoidance intent was partially mediated by the provider's own UP compliance at the two follow-up points. This study provides evidence that UP compliance should be part of HIV stigma reduction programs, especially in resource-restrained countries. Findings suggest that a protected work environment may be necessary but not sufficient to address HIV stigma in medical settings. PMID:26608559

  4. The future of HIV prevention.

    PubMed

    Padian, Nancy S; Isbell, Michael T; Russell, Elizabeth S; Essex, M

    2012-08-01

    In the decades since the emergence of HIV, numerous approaches to prevent transmission have been tested with varying degrees of success. Because a highly effective vaccine will not be available within the next decade, it is increasingly clear that preventing new HIV infections will require successful implementation of promising behavioral and biomedical interventions in combination. These prevention packages must be sufficiently flexible to include a variety of evidence-based interventions that serve each dynamic population they target, particularly those who are most vulnerable. To optimize the impact of combination intervention packages, well-designed implementation science studies are vital. Efficacy in a clinical trial does not necessarily translate to effectiveness at the population-level, and prioritized research studies should investigate programmatic implementation and operations scale-up and new methods to monitor and evaluate these processes both for organization and cost-effectiveness. With an estimated 2.7 million people becoming newly infected with HIV in 2010, the prevention of HIV remains an urgent global health priority. Since the emergence of HIV/AIDS more than 30 years ago, the evidence base for HIV prevention has expanded and evolved. Here we explore the status of evidence-based HIV prevention, describing both the continuing challenges and the emerging opportunities to reduce HIV incidence. PMID:22772385

  5. Chopsticks Don't Make It Culturally Competent: Addressing Larger Issues for HIV Prevention among Gay, Bisexual, and Queer Asian Pacific Islander Men

    ERIC Educational Resources Information Center

    Han, Chong-suk

    2009-01-01

    According to the Centers for Disease Control and Prevention, men who have sex with men account for the largest proportion of cumulative AIDS cases among Asian Pacific Islanders. Yet little is known about the factors that need to be addressed in developing culturally competent intervention strategies for members of this group. This article explores…

  6. Family Wellness, Not HIV Prevention

    PubMed Central

    Swendeman, Dallas; Flannery, Diane

    2010-01-01

    HIV exceptionalism (and disease-specific programs generally) garner both unbalanced funding and the most talented personnel, distorting local health priorities. In support of HIV exceptionalism, the successful mobilization of significant global health sector resources was not possible prior to HIV. Both sides of the debate have merits; rather than perpetuating polarization, we suggest that sustained improvements in global health require creating a prevention infrastructure to meet multiple health challenges experienced by local communities. We propose four fundamental shifts in HIV and disease prevention: (1) horizontally integrating prevention at one site locally, with priorities tailored to local health challenges and managed by local community leaders; (2) using a family wellness metaphor for services, not disease prevention; (3) implementing evidence-based prevention programs (EBPP) based on common principles, factors, and processes, rather than replication of specific programs; and (4) utilizing the expertise of private enterprise to re-design EBPP into highly attractive, engaging, and accessible experiences. PMID:19148744

  7. Can money prevent the spread of HIV? A review of cash payments for HIV prevention

    PubMed Central

    Pettifor, Audrey; MacPhail, Catherine; Nguyen, Nadia; Rosenberg, Molly

    2013-01-01

    Cash payments to improve health outcomes have been used for many years, however, their use for HIV prevention is new and the impact not yet well understood. We provide a brief background on the rationale behind using cash to improve health outcomes, review current studies completed or underway using cash for prevention of sexual transmission of HIV, and outline some key considerations on the use of cash payments to prevent HIV infections. We searched the literature for studies that implemented cash transfer programs and measured HIV or HIV-related outcomes. We identified 16 studies meeting our criteria; 10 are completed. The majority of studies have been conducted with adolescents in developing countries and payments are focused on addressing structural risk factors such as poverty. Most have seen reductions in sexual behavior and one large trial has documented a difference in HIV prevalence between young women getting cash transfers and those not. Cash transfer programs focused on changing risky sexual behaviors to reduce HIV risk suggest promise. The context in which programs are situated, the purpose of the cash transfer, and the population will all affect the impact of such programs; ongoing RCTs with HIV incidence endpoints will shed more light on the efficacy of cash payments as strategy for HIV prevention. PMID:22760738

  8. Preventing HIV Infection among Youth.

    ERIC Educational Resources Information Center

    Alcohol, Drug Abuse, and Mental Health Administration (DHHS/PHS), Rockville, MD. Office for Substance Abuse Prevention.

    This document notes that a recent threat to American's youth is the risk of infection from the human immunodeficiency virus (HIV). It views youth at high risk for alcohol or other drug use as also being, in all probability, at highest risk for exposure to HIV, and suggests that programs set up to prevent adolescents from becoming involved with…

  9. Substance misuse prevention: addressing anhedonia.

    PubMed

    Sussman, Steve; Leventhal, Adam

    2014-01-01

    Anhedonia refers to the inability of experiencing pleasure in positive life events. It has been conceptualized as a stable yet malleable characteristic and is associated with hypoactivity in the mesolimbic and mesocortical dopaminergic systems. Very recently, it has been posited as an etiologic factor associated with drug addiction onset, escalation, and relapse. Prevention programming could be developed to counteract the harmful impact of anhedonia, so as to minimize its impact on drug misuse. Remedial efforts are those that either (1) permit the individual to tolerate low levels of pleasure without resorting to drug misuse or other maladaptive behaviors that may unhealthily besot pleasure (for example, through normalization, structuring time, or meditation) or (2) counteract anhedonia by enhancing ones capability to experience pleasure (for example, behavioral activation, positive psychology, pharmacotherapy, or pursuit of positive addictions). School-based activities could be developed that can be completed by individuals, small workgroups, or the whole classroom. The concept of anhedonia is described in this chapter, and possible prevention strategies that might be utilized in schools as well as other contexts are discussed. PMID:24753277

  10. HIV transmission biology: translation for HIV prevention.

    PubMed

    Ronen, Keshet; Sharma, Amit; Overbaugh, Julie

    2015-11-01

    Rigorous testing of new HIV-prevention strategies is a time-consuming and expensive undertaking. Thus, making well informed decisions on which candidate-prevention approaches are most likely to provide the most benefit is critical to appropriately prioritizing clinical testing. In the case of biological interventions, the decision to test a given prevention approach in human trials rests largely on evidence of protection in preclinical studies. The ability of preclinical studies to predict efficacy in humans may depend on how well the model recapitulates key biological features of HIV transmission relevant to the question at hand. Here, we review our current understanding of the biology of HIV transmission based on data from animal models, cell culture, and viral sequence analysis from human infection. We summarize studies of the bottleneck in viral transmission; the characteristics of transmitted viruses; the establishment of infection; and the contribution of cell-free and cell-associated virus. We seek to highlight the implications of HIV-transmission biology for development of prevention interventions, and to discuss the limitations of existing preclinical models. PMID:26418086

  11. Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): the case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions.

    PubMed

    Mbizvo, Michael Takura; Zaidi, Shahida

    2010-07-01

    The new target for achieving universal access to reproductive health was integrated within the revised Millennium Development Goal framework in October 2008, following reaffirmation of this ICPD goal at the 2005 World Summit. To achieve this goal, the Alliance for Women's Health identified 3 issues needing urgent attention: (1) adolescent sexual and reproductive health; (2) unsafe abortions and related mortality and morbidity; and (3) HIV prevention and care. These themes were discussed in Cape Town at the FIGO 2009 Precongress Workshop convened by the Alliance. The critical gaps identified by the Workshop included: the lack of information on sexual and reproductive health (SRH) issues for adolescents, such as safe sexual practices, contraception, risks related to early childbearing; unsafe abortion and its adverse consequences; and inadequate linkages between sexual and reproductive health and HIV interventions that result in missed opportunities for addressing both. Recommendations included the use of innovative information dissemination techniques, ensuring access to family planning and comprehensive abortion care to the full extent allowed by national laws, in accordance with FIGO and WHO guidelines, and promotion of universal HIV counseling and testing with opt-out strategies within SRH services and information on SRH in all HIV services. PMID:20451907

  12. Combination prevention: a deeper understanding of effective HIV prevention.

    PubMed

    Hankins, Catherine A; de Zalduondo, Barbara O

    2010-10-01

    Evidence-informed and human rights-based combination prevention combines behavioural, biomedical, and structural interventions to address both the immediate risks and underlying causes of vulnerability to HIV infection, and the pathways that link them. Because these are context-specific, no single prescription or standard package will apply universally. Anchored in 'know your epidemic' estimates of where the next 1000 infections will occur and 'know your response' analyses of resource allocation and programming gaps, combination prevention strategies seek to realign programme priorities for maximum effect to reduce epidemic reproductive rates at local, regional, and national levels. Effective prevention means tailoring programmes to local epidemics and ensuring that components are delivered with the intensity, quality, and scale necessary to achieve intended effects. Structural interventions, addressing the social, economic, cultural, and legal constraints that create HIV risk environments and undermine the agency of individuals to protect themselves and others, are also public goods in their own right. Applying the principles of combination prevention systematically and consistently in HIV programme planning, with due attention to context, can increase HIV programme effectiveness. Better outcome and impact measurement using multiple methods and data triangulation can build the evidence base on synergies between the components of combination prevention at individual, group, and societal levels, facilitating iterative knowledge translation within and among programmes. PMID:21042055

  13. HIV prevention transformed: the new prevention research agenda.

    PubMed

    Padian, Nancy S; McCoy, Sandra I; Karim, Salim S Abdool; Hasen, Nina; Kim, Julia; Bartos, Michael; Katabira, Elly; Bertozzi, Stefano M; Schwartländer, Bernhard; Cohen, Myron S

    2011-07-16

    We have entered a new era in HIV prevention whereby priorities have expanded from biomedical discovery to include implementation, effectiveness, and the effect of combination prevention at the population level. However, gaps in knowledge and implementation challenges remain. In this Review we analyse trends in the rapidly changing landscape of HIV prevention, and chart a new path for HIV prevention research that focuses on the implementation of effective and efficient combination prevention strategies to turn the tide on the HIV pandemic. PMID:21763938

  14. Microbicides: Topical Prevention against HIV

    PubMed Central

    Shattock, Robin J.; Rosenberg, Zeda

    2012-01-01

    Microbicides represent a potential intervention strategy for preventing HIV transmission. Vaginal microbicides would meet the need for a discreet method that women could use to protect themselves against HIV. Although early-generation microbicides failed to demonstrate efficacy, newer candidates are based on more potent antiretroviral (ARV) products. Positive data from the CAPRISA 004 trial of tenofovir gel support use in women and represent a turning point for the field. This article reviews current progress in development of ARV-based microbicides. We discuss the consensus on selection criteria, the potential for drug resistance, rationale for drug combinations, and the use of pharmacokinetic (PK)/pharmacodynamic (PD) assessment in product development. The urgent need for continued progress in development of formulations for sustained delivery is emphasized. Finally, as the boundaries between different prevention technologies become increasingly blurred, consideration is given to the potential synergy of diverse approaches across the prevention landscape. PMID:22355798

  15. Personalized Biobehavioral HIV Prevention for Women and Adolescent Girls

    PubMed Central

    Teitelman, Anne M.; Bevilacqua, Amanda W.; Jemmott, Loretta Sweet

    2013-01-01

    Background: Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. Primary Study Objective: The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. Methods: We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. Results: The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk—reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk—reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Conclusions: Generalized programs and

  16. An STD/HIV prevention intervention framework.

    PubMed

    Cohen, D A; Scribner, R

    2000-01-01

    Historically, interventions to prevent STD/HIV transmission have been categorized by program methodology rather than defining the content and nature of the intervention. A new taxonomy is needed to help expand the scope of interventions that can be used to prevent STD and HIV transmission. The taxonomy defines two major types of interventions, individual-level and structural level. The former targets risk factors attributable to individuals. Structural interventions target conditions outside the control of the individual. Individual-level interventions focus on counseling, screening, and treatment. They include psychological and biological interventions. Structural-level interventions address accessibility of relevant consumer products (condoms, needles), physical structures (e.g. blighted and abandoned housing, lighting, design of social facilities), social structures (policies that facilitate or constrain behaviors such as supervision of youth, and enforcement of alcohol beverage laws); and media messages (messages and images in the broadcast and print media that portray high-risk behaviors as positive and without serious consequences). A new taxonomy not only clarifies the content of preventive interventions but highlights neglected strategies involving individual biological interventions and structural interventions to prevent STD/HIV transmission. PMID:12240881

  17. Highly active antiretroviral treatment for the prevention of HIV transmission

    PubMed Central

    2010-01-01

    In 2007 an estimated 33 million people were living with HIV; 67% resided in sub-Saharan Africa, with 35% in eight countries alone. In 2007, there were about 1.4 million HIV-positive tuberculosis cases. Globally, approximately 4 million people had been given highly active antiretroviral therapy (HAART) by the end of 2008, but in 2007, an estimated 6.7 million were still in need of HAART and 2.7 million more became infected with HIV. Although there has been unprecedented investment in confronting HIV/AIDS - the Joint United Nations Programme on HIV/AIDS estimates $13.8 billion was spent in 2008 - a key challenge is how to address the HIV/AIDS epidemic given limited and potentially shrinking resources. Economic disparities may further exacerbate human rights issues and widen the increasingly divergent approaches to HIV prevention, care and treatment. HIV transmission only occurs from people with HIV, and viral load is the single greatest risk factor for all modes of transmission. HAART can lower viral load to nearly undetectable levels. Prevention of mother to child transmission offers proof of the concept of HAART interrupting transmission, and observational studies and previous modelling work support using HAART for prevention. Although knowing one's HIV status is key for prevention efforts, it is not known with certainty when to start HAART. Building on previous modelling work, we used an HIV/AIDS epidemic of South African intensity to explore the impact of testing all adults annually and starting persons on HAART immediately after they are diagnosed as HIV positive. This theoretical strategy would reduce annual HIV incidence and mortality to less than one case per 1000 people within 10 years and it would reduce the prevalence of HIV to less than 1% within 50 years. To explore HAART as a prevention strategy, we recommend further discussions to explore human rights and ethical considerations, clarify research priorities and review feasibility and acceptability

  18. No One Is Immune: A Community Education Partnership Addressing HIV/AIDS and Older Adults.

    PubMed

    Orel, Nancy A; Stelle, Charlie; Watson, Wendy K; Bunner, Betsy L

    2010-06-01

    There has been a dramatic increase in the number of new HIV diagnoses among people aged 50 to 64 in the United States, and according to the Centers for Disease Control and Prevention (CDC), in just 7 years (by 2015) 50% of those living with AIDS will be aged 50 or older. To address this public health concern, viable HIV/AIDS prevention and treatment options for individuals over the age of 50 are necessary. This article discusses the No One Is Immune initiative that planned, implemented, and coordinated evidence- based HIV/AIDS prevention and education programs specifically tailored for middle-aged and older adults. Guided by the health belief model, an educational conference entitled "Sexuality, Medication, and HIV/AIDS in Middle and Later Adulthood" was conducted along with research activities that assessed HIV/AIDS knowledge gained using both qualitative and quantitative measures. This project can be replicated by other providers within the aging network. PMID:22745521

  19. Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA.

    PubMed

    Khosla, Nidhi; Zachary, Iris

    2016-10-01

    HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust. PMID:26875546

  20. Factors That Influence HIV Risk among Hispanic Female Immigrants and Their Implications for HIV Prevention Interventions

    PubMed Central

    Hernandez, Amy M.; Zule, William A.; Karg, Rhonda S.; Browne, Felicia A.; Wechsberg, Wendee M.

    2012-01-01

    Hispanics are the fastest growing minority group in North Carolina with increasing incidence of HIV infection. Gender roles, cultural expectations, and acculturation of women may explain some of Hispanic women's risks. The perspectives of Hispanic female immigrants and community-based providers were sought to identify services they offer, understand HIV risk factors, and support the adaptation of a best-evidence HIV behavioural intervention for Hispanic women. Two sets of focus groups were conducted to explicate risks and the opportunities to reach women or couples and the feasibility to conduct HIV prevention in an acceptable manner. Salient findings were that Hispanic female immigrants lacked accurate HIV/AIDS and STI knowledge and that traditional gender roles shaped issues surrounding sexual behaviour and HIV risks, as well as condom use, partner communication, and multiple sexual partnerships. Intervention implications are discussed such as developing and adapting culturally appropriate HIV prevention interventions for Hispanics that address gender roles and partner communication. PMID:22518308

  1. HIV / AIDS: Symptoms, Diagnosis, Prevention and Treatment

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / Summer ... and have resulted in a dramatic decrease in AIDS deaths in the U.S. NIH Research to Results ...

  2. Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era.

    PubMed

    Mutchler, Matt G; McDavitt, Bryce; Ghani, Mansur A; Nogg, Kelsey; Winder, Terrell J A; Soto, Juliana K

    2015-09-01

    Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded "tool kit" of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and "spreading the word" about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such "prevention navigation" could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options. PMID:26121564

  3. Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era

    PubMed Central

    McDavitt, Bryce; Ghani, Mansur A.; Nogg, Kelsey; Winder, Terrell J.A.; Soto, Juliana K.

    2015-01-01

    Abstract Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded “tool kit” of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and “spreading the word” about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such “prevention navigation” could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options. PMID:26121564

  4. Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting.

    PubMed

    Walker, Crystal Martin; Likes, Wendy; Bernard, Marye; Kedia, Satish; Tolley, Elizabeth

    2016-01-01

    Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities. PMID:27080925

  5. HIV prevention transformed: the new prevention research agenda

    PubMed Central

    Padian, Nancy S.; McCoy, Sandra I.; Karim, Salim Abdool; Hasen, Nina; Kim, Julia; Bartos, Michael; Katabira, Elly; Bertozzi, Stefano; Schwartländer, Bernhard; Cohen, Myron S.

    2013-01-01

    SUMMARY We have entered a new era in HIV prevention whereby priorities have expanded from biomedical discovery to include implementation, effectiveness, and the effect of combination prevention at the population level. However, gaps in knowledge and implementation challenges remain. In this Review we analyse trends in the rapidly changing landscape of HIV prevention, and chart a new path for HIV prevention research that focuses on the implementation of effective and efficient combination prevention strategies to turn the tide on the HIV pandemic. PMID:21763938

  6. Informing Comprehensive HIV Prevention: A Situational Analysis of the HIV Prevention and Care Context, North West Province South Africa

    PubMed Central

    Lippman, Sheri A.; Treves-Kagan, Sarah; Gilvydis, Jennifer M.; Naidoo, Evasen; Khumalo-Sakutukwa, Gertrude; Darbes, Lynae; Raphela, Elsie; Ntswane, Lebogang; Barnhart, Scott

    2014-01-01

    Objective Building a successful combination prevention program requires understanding the community’s local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. Method The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO’s Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. Results We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. Conclusions Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four ‘themes’ identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills

  7. eHealth interventions for HIV prevention.

    PubMed

    Noar, Seth M; Willoughby, Jessica Fitts

    2012-01-01

    The rapidly changing media landscape and proliferation of new technologies creates vast new opportunities for HIV prevention. The fast growth of the relatively new eHealth field is a testament to the excitement and promise of these new technologies. eHealth interventions in HIV prevention tested to date include computer- and Internet-based interventions; chat room interventions; text messaging interventions; and social media. The current article provides a brief review of these types of interventions in HIV prevention, including their unique advantages and evidence of efficacy. Implications for future research in the eHealth HIV prevention field are discussed. PMID:22519523

  8. Developing family interventions for adolescent HIV prevention in South Africa.

    PubMed

    Kuo, Caroline; Atujuna, Millicent; Mathews, Catherine; Stein, Dan J; Hoare, Jacqueline; Beardslee, William; Operario, Don; Cluver, Lucie; K Brown, Larry

    2016-01-01

    Adolescents and young people account for 40% of all new HIV infections each year, with South Africa one of the hardest hit countries, and having the largest population of people living with HIV. Although adolescent HIV prevention has been delivered through diverse modalities in South Africa, and although family-based approaches for adolescent HIV prevention have great potential for highly affected settings such as South Africa, there is a scarcity of empirically tested family-based adolescent HIV preventive interventions in this setting. We therefore conducted focus groups and in-depth interviews with key informants including clinicians, researchers, and other individuals representing organizations providing HIV and related health services to adolescents and parents (N = 82). We explored family perspectives and interactions around topics such as communication about sex, HIV, and relationships. Participants described aspects of family interactions that presented both challenges and opportunities for family-based adolescent HIV prevention. Parent-child communication on sexual topics were taboo, with these conversations perceived by some adults as an invitation for children to engage in HIV risk behavior. Parents experienced social sanctions for discussing sex and adolescents who asked about sex were often viewed as disrespectful and needing discipline. However, participants also identified context-appropriate strategies for addressing family challenges around HIV prevention including family meetings, communal parenting, building efficacy around parent-adolescent communication around sexual topics, and the need to strengthen family bonding and positive parenting. Findings indicate the need for a family intervention and identify strategies for development of family-based interventions for adolescent HIV prevention. These findings will inform design of a family intervention to be tested in a randomized pilot trial (ClinicalTrials.gov #NCT02432352). PMID:26916841

  9. Developing family interventions for adolescent HIV prevention in South Africa

    PubMed Central

    Kuo, Caroline; Atujuna, Millicent; Mathews, Catherine; Stein, Dan J.; Hoare, Jacqueline; Beardslee, William; Operario, Don; Cluver, Lucie; K. Brown, Larry

    2016-01-01

    ABSTRACT Adolescents and young people account for 40% of all new HIV infections each year, with South Africa one of the hardest hit countries, and having the largest population of people living with HIV. Although adolescent HIV prevention has been delivered through diverse modalities in South Africa, and although family-based approaches for adolescent HIV prevention have great potential for highly affected settings such as South Africa, there is a scarcity of empirically tested family-based adolescent HIV preventive interventions in this setting. We therefore conducted focus groups and in-depth interviews with key informants including clinicians, researchers, and other individuals representing organizations providing HIV and related health services to adolescents and parents (N = 82). We explored family perspectives and interactions around topics such as communication about sex, HIV, and relationships. Participants described aspects of family interactions that presented both challenges and opportunities for family-based adolescent HIV prevention. Parent–child communication on sexual topics were taboo, with these conversations perceived by some adults as an invitation for children to engage in HIV risk behavior. Parents experienced social sanctions for discussing sex and adolescents who asked about sex were often viewed as disrespectful and needing discipline. However, participants also identified context-appropriate strategies for addressing family challenges around HIV prevention including family meetings, communal parenting, building efficacy around parent–adolescent communication around sexual topics, and the need to strengthen family bonding and positive parenting. Findings indicate the need for a family intervention and identify strategies for development of family-based interventions for adolescent HIV prevention. These findings will inform design of a family intervention to be tested in a randomized pilot trial (ClinicalTrials.gov #NCT02432352). PMID

  10. Opportunity Knocks: HIV Prevention in Primary Care.

    PubMed

    Thrun, Mark W

    2014-06-01

    Expansions in health care coverage, a comprehensive framework for HIV prevention and care, electronic medical records, and novel HIV prevention modalities create a current opportunity to change the trajectory of the HIV epidemic in the United States. HIV is increasingly disproportionately found in populations historically at higher risk, including gay men and other men who have sex with men, transgender women, injection drug users, and persons of color. This underscores the need for providers to identify persons at higher risk for HIV and assure the provision of screening and prevention services. In turn, universal screening for HIV-testing every adolescent and adult at least once in their lifetime-will increasingly be necessary to find the infrequent cases of HIV in lower risk populations. In both these domains, primary care providers will play a unique role in complementing traditional providers of HIV prevention and care services by increasing the proportion of their patients who have been screened for HIV, opening dialogues around sexual health, including asking about sexual orientation and gender identity, and prescribing antivirals as pre- and postexposure prophylaxis for their non-HIV-infected patients. Primary care providers must understand and embrace their importance along the HIV prevention and care continuum. PMID:26789615

  11. Advances in HIV Prevention for Serodiscordant Couples

    PubMed Central

    Muessig, Kathryn E.; Cohen, Myron S.

    2014-01-01

    Serodiscordant couples play an important role in maintaining the global HIV epidemic. This review summarizes biobehavioral and biomedical HIV prevention options for serodiscordant couples focusing on advances in 2013 and 2014, including World Health Organization guidelines and best-evidence for couples counseling, couples-based interventions, and the use of antiviral agents for prevention. In the past few years marked advances have been made in HIV prevention for serodiscordant couples and numerous ongoing studies are continuously expanding HIV prevention tools, especially in the area of pre-exposure prophylaxis. Uptake and adherence to antiviral therapy remains a key challenge. Additional research is needed to develop evidence-based interventions for couples, and especially for male-male couples. Randomized trials have demonstrated the prevention benefits of antiretroviral-based approaches among serodiscordant couples; however, residual transmission observed in recognized serodiscordant couples represents an important and resolvable challenge in HIV prevention. PMID:25145645

  12. Antibodies for HIV Prevention in young women

    PubMed Central

    Abdool Karim, Salim S.; Karim, Quarraisha Abdool; Baxter, Cheryl

    2016-01-01

    Purpose of review Young women in sub-Saharan Africa bear a disproportionate HIV burden. They urgently require new HIV prevention approaches that women can use. This review provides an overview of the use of antiretrovirals for HIV pre-exposure prophylaxis (PrEP), highlighting some of the challenges with this technology and explores the potential role of monoclonal antibodies (mAbs) for HIV prevention in women. Recent findings Recent findings on the initial steps in viral entry and establishment of a productive local infectious nidus in the vaginal epithelium has provided important clues for HIV prevention in the female genital tract. Topical and oral formulations of antiretroviral drugs have been shown to prevent HIV infection in women with varying levels of success, depending principally on adherence. Further, a number of new broad and potent mAbs have been isolated over the last 5 years. Non-human primate studies demonstrate that broadly neutralizing HIV mAbs can protect rhesus macaques from SHIV infection. These findings have created newfound enthusiasm for passive immunization as a potential prevention strategy for women. Summary If potent broadly neutralising mAbs are effective in preventing HIV infection in women, it could fill an important gap in HIV prevention technologies for young women, especially in Africa. PMID:25700207

  13. The importance of addressing gender inequality in efforts to end vertical transmission of HIV

    PubMed Central

    Ghanotakis, Elena; Peacock, Dean; Wilcher, Rose

    2012-01-01

    Issues The recently launched “Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive” sets forth ambitious targets that will require more widespread implementation of comprehensive prevention of vertical HIV transmission (PMTCT) programmes. As PMTCT policymakers and implementers work toward these new goals, increased attention must be paid to the role that gender inequality plays in limiting PMTCT programmatic progress. Description A growing body of evidence suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services. Lessons Learned In light of this evidence, global health donors and international bodies increasingly recognize that it is critical to address the gender disparities that put women and children at increased risk of HIV and impede their access to care. The current policy environment provides unprecedented opportunities for PMTCT implementers to integrate efforts to address gender inequality with efforts to expand access to clinical interventions for preventing vertical HIV transmission. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. PMTCT programmes must embrace these strategies and expand beyond the traditional focus of delivering ARV prophylaxis to pregnant women living with HIV. Without greater implementation of comprehensive, gender transformative PMTCT programmes, elimination of vertical transmission of HIV will remain elusive. PMID:22789642

  14. HIV/AIDS/STD. Education for Prevention.

    ERIC Educational Resources Information Center

    Mayes, Jane Ruthven, Ed.

    The contents of this booklet come from contributions to the 1995 Global Conference on School Health and HIV/AIDS Prevention. The objectives of the booklet are: (1) to strengthen the awareness of teachers and education personnel regarding the importance of developing school health and HIV/AIDS prevention curricula; (2) to show the specific roles of…

  15. Strategies for universalistic and targeted HIV prevention.

    PubMed

    Des Jarlais, D C; Padian, N

    1997-10-01

    The controversy over "targeted" versus "universalistic" programs for HIV prevention has persisted throughout the history of the HIV/AIDS epidemic in the United States and in some European countries. Building on previous analyses, we outline methods for integrating universalistic and targeted HIV prevention programming. The outline considers possible synergy between targeted and universalistic programs, rather than a forced choice between the two. Components within this framework include a continuum of the intensity of targeted programs, specification of local risk behavior populations, categories of risk behavior, and HIV seroprevalence within local risk-behavior populations. Given the scarce resources currently available, preventing all new HIV infections is not a realistic public health goal, but with better use of current scientific knowledge, it should be possible to greatly reduce the rate of new HIV infections. PMID:9358108

  16. HIV prevention: integrating biomedical and behevioral interventions.

    PubMed

    Del Rio, Carlos

    Recommendations for HIV prevention in clinical care settings by an IAS-USA panel were recently published. They include recommendations on HIV testing, antiretroviral therapy initiation, risk-reduction counseling, and antiretroviral therapy adherence counseling for HIV-infected individuals. For individuals at risk for HIV infection, recommendations for preexposure prophylaxis, other risk-reduction strategies, adherence counseling, and postexposure prophylaxis are included. Many HIV-infected individuals in the United States are not fully engaged in HIV care and are not virologically suppressed, thus a crucial component of efforts to reduce HIV transmission is moving patients through the HIV care continuum. This article summarizes an IAS-USA continuing education webinar presented by Carlos del Rio, MD, in September 2014. PMID:25612180

  17. HIV infection among persons who inject drugs: ending old epidemics and addressing new outbreaks.

    PubMed

    Des Jarlais, Don C; Kerr, Thomas; Carrieri, Patrizia; Feelemyer, Jonathan; Arasteh, Kamyar

    2016-03-27

    AIDS among persons who inject drugs, first identified in December 1981, has become a global epidemic. Injecting drug use has been reported in 148 countries and HIV infection has been seen among persons who inject drugs in 61 countries. Many locations have experienced outbreaks of HIV infection among persons who inject drugs, under specific conditions that promote very rapid spread of the virus. In response to these HIV outbreaks, specific interventions for persons who inject drugs include needle/syringe exchange programs, medicated-assisted treatment (with methadone or buprenorphine) and antiretroviral therapy. Through a 'combined prevention' approach, these interventions significantly reduced new HIV infections among persons who inject drugs in several locations including New York City, Vancouver and France. The efforts effectively ended the HIV epidemic among persons who inject drugs in those locations. This review examines possible processes through which combined prevention programs may lead to ending HIV epidemics. However, notable outbreaks of HIV among persons who inject drugs have recently occurred in several countries, including in Athens, Greece; Tel-Aviv, Israel; Dublin, Ireland; as well as in Scott County, Indiana, USA. This review also considers different factors that may have led to these outbreaks. We conclude with addressing the remaining challenges for reducing HIV infection among persons who inject drugs. PMID:26836787

  18. AIDS Exceptionalism: On the Social Psychology of HIV Prevention Research.

    PubMed

    Fisher, William A; Kohut, Taylor; Fisher, Jeffrey D

    2009-12-01

    The current analysis considers the HIV prevention research record in the social sciences. We do so with special reference to what has been termed "AIDS Exceptionalism"- departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at the expense of public health protection. In considering this issue, we review the historical context of the HIV epidemic; empirically demonstrate a pattern of prevention research characterized by systematic neglect of prevention interventions for HIV-infected persons; and articulate a rationale for "Prevention for Positives," supportive prevention efforts tailored to the needs of HIV+ individuals. We then propose a social psychological conceptualization of processes that appear to have influenced developments in HIV prevention research and directed its focus to particular target populations. Our concluding section considers whether there are social and research policy lessons to be learned from the record of HIV prevention research that might improve our ability to addresses effectively, equitably, and in timely fashion future epidemics that play out, as HIV does, at the junction of biology and behavior. At the first quarter century of the AIDS epidemic, it is important to weigh our accomplishments against our failures in the fight against AIDS…Future historians will conclude that we cannot escape responsibility for our failure to use effective, scientifically proven strategies to control the AIDS epidemic…They will also likely regard as tragic those instances when we allowed scarce resources to be used to support ideologically driven "prevention" that only served a particular political agenda.Editorial: A Quarter Century of AIDS. American Journal of Public Health. (Stall & Mills, 2006, p. 961). PMID:23667386

  19. Preventing Mother-to-Child Transmission of HIV during Childbirth

    MedlinePlus

    HIV and Pregnancy Preventing Mother-to-Child Transmission of HIV During Childbirth (Last updated 8/17/2015; last ... the risk of mother-to-child transmission of HIV reduced during childbirth? During childbirth, women with HIV ...

  20. An HIV-Preventive Intervention for Youth Living with HIV

    ERIC Educational Resources Information Center

    Lightfoot, Marguerita; Rotheram-Borus, Mary Jane; Tevendale, Heather

    2007-01-01

    As the number of youth infected with HIV rises, secondary prevention programs are needed to help youth living with HIV meet three goals: (1) increase self-care behaviors, medical adherence, and health-related interactions; (2) reduce transmission acts; and (3) enhance their quality of life. This article describes an intervention program for youth…

  1. HIV prevention among female sex workers in Africa.

    PubMed

    Scheibe, A; Drame, F M; Shannon, K

    2012-01-01

    Sex work occurs to meet the demand for sexual services and is a universal phenomenon. In Africa sex work takes many forms and is an important source of income for many women. Yet sex worker reproductive health needs remain largely unmet. The criminalisation of sex work; community and service provider stigma; violence; substance use and limited access to health services and prevention commodities contribute to the high HIV burden evident among female sex workers in Africa. Following UNAIDS' three pillar approach to HIV prevention and sex work we present an overview of current opportunities, barriers and suggestions to improve HIV prevention policy and programming for sex work in Africa. Universal access to a comprehensive package of HIV services is the first pillar. Reproductive health commodities; voluntary and anonymous HIV counselling and testing; treatment of sexually transmitted infections, HIV and opportunistic infections; harm reduction for substance use and psychosocial support services make up the recommended package of services. The second pillar is a sex worker-supportive environment. The inclusion of sex worker programmes within national HIV strategic planning; sex worker-led community mobilisation and the establishment of sex work community networks (comprised of sex workers, health service providers, law enforcers and other stakeholders) enable effective programme implementation and are recommended. The reduction of sex worker vulnerability and addressing structural issues form the final pillar. The decriminalisation of sex work; development of supportive policy; gender equality and economic development are key factors that need to be addressed to increase sex worker resilience. Evidence supports the public health benefit of human rights based approaches to HIV prevention; moralistic and restrictive policy and laws towards sex work are harmful and should be removed. The establishment of these pillars will increase sex worker safety and enhance the

  2. Addressing Sexual Problems in HIV Primary Care: Experiences from Patients

    PubMed Central

    Sandfort, Theo G. M.; Collier, Kate L.; Grossberg, Robert

    2012-01-01

    Evidence suggests that sexual problems are common among people living with HIV and may be related to sexual risk taking and treatment adherence. This study explored the extent to which sexual problems experienced by people with HIV are addressed in primary care as well as how primary care responses to sexual problems are experienced by patients. Structured interviews were conducted with 60 patients at an urban HIV clinic. The average age of the participants (37 male, 23 female) was 45.8 years (SD = 7.9). Sexual problems were common. The most common sexual problem experienced in the past year was a lack of interest in sex (53.3 % reported) and the least common problem was painful intercourse (reported by 20 %). There were no gender differences in reports of sexual problems, except that painful intercourse was more frequently reported by women than men. Relatively few individuals who experienced sexual problems had discussed them with their provider, but these individuals were generally pleased with the counseling they had received and could identify several factors that facilitated a positive patient-provider interaction. Those who offer primary care services to people with HIV should be aware of sexual problems their patients may be experiencing and should feel confident in their ability to successfully address these problems. Providers may need additional training in order to adequately address sexual problems among people with HIV in primary care settings. PMID:22965768

  3. AIDS Exceptionalism: On the Social Psychology of HIV Prevention Research

    PubMed Central

    Fisher, William A.; Kohut, Taylor; Fisher, Jeffrey D.

    2013-01-01

    The current analysis considers the HIV prevention research record in the social sciences. We do so with special reference to what has been termed “AIDS Exceptionalism”— departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at the expense of public health protection. In considering this issue, we review the historical context of the HIV epidemic; empirically demonstrate a pattern of prevention research characterized by systematic neglect of prevention interventions for HIV-infected persons; and articulate a rationale for “Prevention for Positives,” supportive prevention efforts tailored to the needs of HIV+ individuals. We then propose a social psychological conceptualization of processes that appear to have influenced developments in HIV prevention research and directed its focus to particular target populations. Our concluding section considers whether there are social and research policy lessons to be learned from the record of HIV prevention research that might improve our ability to addresses effectively, equitably, and in timely fashion future epidemics that play out, as HIV does, at the junction of biology and behavior. At the first quarter century of the AIDS epidemic, it is important to weigh our accomplishments against our failures in the fight against AIDS…Future historians will conclude that we cannot escape responsibility for our failure to use effective, scientifically proven strategies to control the AIDS epidemic…They will also likely regard as tragic those instances when we allowed scarce resources to be used to support ideologically driven “prevention” that only served a particular political agenda. Editorial: A Quarter Century of AIDS. American Journal of Public Health. (Stall & Mills, 2006, p. 961) PMID:23667386

  4. HIV treatment as prevention and HPTN 052

    PubMed Central

    Cohen, Myron S.; McCauley, Marybeth; Gamble, Theresa R.

    2012-01-01

    Purpose of review This review summarizes the development and implementation of a large clinical trial, HIV Prevention Trials Network (HPTN) 052, whose initial results were recently presented and published. Recent findings A randomized, clinical trial demonstrated that antiretroviral therapy reduces the sexual transmission of HIV in HIV-serodiscordant couples by more than 96%. The logistical challenges in preparing for and conducting such a trial were considerable. Summary HPTN 052 required many years of preparation, considerable collaboration between National Institute of Health and six pharmaceutical companies, and careful ongoing consideration of a large number of ethical issues. HPTN 052 revealed the magnitude of benefit when using antiretroviral therapy to prevent the transmission of HIV, and served as proof of a concept. The results have proven central to the development of new global HIV-prevention efforts. PMID:22227585

  5. Addressing Educational Needs of Children with HIV/AIDS.

    ERIC Educational Resources Information Center

    Naude, Hendrina; Pretorius, Etheresia

    2002-01-01

    This paper reviews medical and neuropsychological effects of HIV/AIDS in children and relates these findings specifically to educational difficulties. It then proposes an instructional delivery framework for these children that stresses the importance of addressing their educational needs and includes specific suggestions for reading instruction,…

  6. HIV Prevention by Oral Preexposure Prophylaxis

    PubMed Central

    Heneine, Walid; Kashuba, Angela

    2012-01-01

    The impressive advances in antiretroviral (ARV) therapy of chronic human immunodeficiency virus (HIV) infections during the last decade and the availability of potent ARV drugs have fueled interest in using chemoprophylaxis as a novel HIV prevention strategy. Preexposure prophylaxis (PrEP) refers to the use of ARV drugs in HIV-negative persons to prevent HIV infection. The rationale for PrEP builds on the success of ARV prophylaxis in preventing mother-to-child transmission of HIV and on a large body of animal studies that show the efficacy of PrEP against mucosal and parenteral infection. We focus on oral administration of ARV drugs for prevention of HIV infection. Identifying an effective prophylactic pill that individuals can take outside the setting of sexual intercourse precludes the necessity to disclose such use to their partners, thereby empowering those who might not be in a position to negotiate with their partners. Several human clinical trials evaluating the efficacy of daily regimens of the HIV reverse-transcriptase (RT) inhibitors tenofovir disoproxil fumarate (TDF) or Truvada (TDF and emtricitabine [FTC]) are under way among high-risk populations. The results of one trial among men who have sex with men showed that daily Truvada was safe and effective, providing the first support for oral PrEP as a prevention strategy. Here we outline the preclinical and clinical research on oral PrEP, pharmacologic considerations, and future directions and challenges. PMID:22393535

  7. HIV/STD/TB PREVENTION NEWS DATABASE

    EPA Science Inventory

    The CDC National Prevention Information Network (NPIN) is the U.S. reference, referral, and distribution service for information on HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis (TB). NPIN produces, collects, catalogs, processes, stocks, and disseminates materi...

  8. Shared communities, structural contexts, and HIV risk: prioritizing the HIV risk and prevention needs of Black heterosexual men.

    PubMed

    Bowleg, Lisa; Raj, Anita

    2012-05-01

    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

  9. Topical microbicides: missing link for HIV prevention.

    PubMed

    Heise, L

    1999-01-01

    This article features intravaginal microbicides available in various forms, such as gel, suppository, cream, film or sponge, preventing HIV infections and other sexually transmitted disease (STD) pathogens. Microbicides also vary in their action by boosting the body's natural defense, by killing or inactivating STD pathogens, or by creating a protective barrier between the virus and the vaginal wall. Despite the potential of these products to prevent HIV and other STDs, large pharmaceutical companies are hesitant to invest in them because they assume that the only market would be in the developing world. The Global Campaign for Microbicides and HIV/STD Prevention Alternatives for Women was launched having the priority goal of educating individuals about female condoms and microbicides as promising technologies that deserve more attention and investment. While microbicides are not available yet, the use of condom still provides the best protection against HIV/STDs. PMID:12295464

  10. Adapting a Multifaceted U.S. HIV Prevention Education Program for Girls in Ghana

    ERIC Educational Resources Information Center

    Fiscian, Vivian Sarpomaa; Obeng, E. Kwame; Goldstein, Karen; Shea, Judy A.; Turner, Barbara J.

    2009-01-01

    We adapted a U.S. HIV prevention program to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic…

  11. Interventions to Address HIV and Intimate Partner Violence in Sub-Saharan Africa: A Review of the Literature

    PubMed Central

    Anderson, Jocelyn C.; Campbell, Jacquelyn C.; Farley, Jason E.

    2013-01-01

    HIV and intimate partner violence (IPV) are commonly co-occurring epidemics affecting the health of women globally and especially in sub-Saharan Africa. There is a need for interventions that address both HIV and IPV in health care settings. Our review examined recent literature for intervention studies that explored both HIV and IPV. Of the 9 interventions identified, only 2 were set in health care settings; the remainder were community based. Large multifaceted community-based interventions showed promise in the areas of addressing social norms in order to empower women. Educational interventions have shown short-term improvements in HIV-related knowledge and behavioral intention. Further research is needed to examine brief screening, intervention, and referral for HIV and IPV services within health care settings. Health care-specific interventions such as use of pre-exposure and post-exposure prophylaxis to prevent HIV transmission must also be studied in the context of IPV. PMID:23790280

  12. Microbicides: a new hope for HIV prevention

    PubMed Central

    Nutan; Gupta, Satish K.

    2011-01-01

    Human immunodeficiency virus (HIV), causative agent of acquired immunodeficiency syndrome (AIDS), is a global health concern. To control its transmission, safe sex has been proposed as one of the strategies. Microbicides- intravaginal/intrarectal topical formulations of anti-HIV agents have also been proposed to prevent HIV transmission. Microbicides would provide protection by directly inactivating HIV or preventing the attachment, entry or replication of HIV in susceptible target cells as well as their dissemination from target cells present in semen or the host cells lining the vaginal/rectal wall to other migratory cells. Microbicides must be safe, effective following vaginal or rectal administration, and should cause minimal or no genital symptoms or inflammations following long-term repeated usage. However, a safe and efficacious anti-HIV microbicide is not yet available despite the fact that more than 60 candidate agents have been identified to have in vitro activity against HIV, several of which have advanced to clinical testing. Nonetheless, proof-of-concept of microbicides has been established based on the results of recent CAPRISA 004 clinical trials. In this article, the trends and challenges in the development of effective and safe microbicides to combat HIV transmission are reviewed. PMID:22310826

  13. Transgender HIV prevention: a qualitative needs assessment.

    PubMed

    Bockting, W O; Robinson, B E; Rosser, B R

    1998-08-01

    Although clinical experience and preliminary research suggest that some transgender people are at significant risk for HIV, this stigmatized group has so far been largely ignored in HIV prevention. As part of the development of HIV prevention education targeting the transgender population, focus groups of selected transgender individuals assessed their HIV risks and prevention needs. Data were gathered in the following four areas: (1) the impact of HIV/AIDS on transgender persons; (2) risk factors; (3) information and services needed; and (4) recruitment strategies. Findings indicated that HIV/AIDS compounds stigmatization related to transgender identity, interferes with sexual experimentation during the transgender 'coming out' process, and may interfere with obtaining sex reassignment. Identified transgender-specific risk factors include: sexual identity conflict, shame and isolation, secrecy, search for affirmation, compulsive sexual behaviour, prostitution, and sharing needles while injecting hormones. Community involvement, peer education and affirmation of transgender identity were stressed as integral components of a successful intervention. Education of health professionals about transgender identity and sexuality and support groups for transgender people with HIV/AIDS are urgently needed. PMID:9828969

  14. Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.

    PubMed

    Deren, Sherry; Gelpí-Acosta, Camila; Albizu-García, Carmen E; González, Ángel; Des Jarlais, Don C; Santiago-Negrón, Salvador

    2014-11-01

    High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions. PMID:25211722

  15. Addressing the HIV/AIDS Epidemic Among Puerto Rican People Who Inject Drugs: The Need for a Multiregion Approach

    PubMed Central

    Deren, Sherry; Gelpí-Acosta, Camila; Albizu-García, Carmen E.; González, Ángel; Des Jarlais, Don C.; Santiago-Negrón, Salvador

    2014-01-01

    High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast–Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions. PMID:25211722

  16. Interventions to Prevent Sexually Transmitted Infections, Including HIV Infection

    PubMed Central

    Cates, Willard

    2011-01-01

    The Centers for Disease Control and Prevention (CDC) Sexually Transmitted Disease (STD) Treatment Guidelines were last updated in 2006. To update the “Clinical Guide to Prevention Services” section of the 2010 CDC STD Treatment Guidelines, we reviewed the recent science with reference to interventions designed to prevent acquisition of STDs, including human immunodeficiency virus (HIV) infection. Major interval developments include (1) licensure and uptake of immunization against genital human papillomavirus, (2) validation of male circumcision as a potent prevention tool against acquisition of HIV and some other sexually transmitted infections (STIs), (3) failure of a promising HIV vaccine candidate to afford protection against HIV acquisition, (4) encouragement about the use of antiretroviral agents as preexposure prophylaxis to reduce risk of HIV and herpes simplex virus acquisition, (5) enhanced emphasis on expedited partner management and rescreening for persons infected with Chlamydia trachomatis and Neisseria gonorrhoeae, (6) recognition that behavioral interventions will be needed to address a new trend of sexually transmitted hepatitis C among men who have sex with men, and (7) the availability of a modified female condom. A range of preventive interventions is needed to reduce the risks of acquiring STI, including HIV infection, among sexually active people, and a flexible approach targeted to specific populations should integrate combinations of biomedical, behavioral, and structural interventions. These would ideally involve an array of prevention contexts, including (1) communications and practices among sexual partners, (2) transactions between individual clients and their healthcare providers, and (3) comprehensive population-level strategies for prioritizing prevention research, ensuring accurate outcome assessment, and formulating health policy. PMID:22080271

  17. A Review of HIV Prevention Interventions for Juvenile Offenders

    PubMed Central

    Stewart, Angela; Fasciano, John; Brown, Larry K.

    2010-01-01

    Objective To conduct a critical review of all HIV prevention intervention studies conducted with adolescents in juvenile justice settings to inform future intervention development. Method PubMed and PsycInfo database searches were conducted for peer-reviewed, published HIV prevention intervention studies with juvenile offenders. Results Sixteen studies were identified (N = 3,700 adolescents). Half of the projects utilized rigorous methodologies to determine intervention effect on behavior change, such as conducting a randomized controlled trial (n = 8). Nine studies reported behaviors at least 3 months post-intervention and five out of nine showed decreases in sexual risk behavior. Conclusions Several HIV prevention programs with juvenile offenders have led to sexual risk reduction, although effect sizes are modest. Most existing programs have neglected to address the impact of family, mental health, and substance use on HIV risk. More work is needed to develop evidence-based interventions that include HIV prevention strategies relevant and appropriate for the juvenile justice setting. PMID:19741021

  18. Socially-integrated transdisciplinary HIV prevention.

    PubMed

    Friedman, Samuel R; Downing, Martin J; Smyrnov, Pavlo; Nikolopoulos, Georgios; Schneider, John A; Livak, Britt; Magiorkinis, Gkikas; Slobodianyk, Liudmyla; Vasylyeva, Tetyana I; Paraskevis, Dimitrios; Psichogiou, Mina; Sypsa, Vana; Malliori, Melpomeni M; Hatzakis, Angelos

    2014-10-01

    Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases. PMID:24165983

  19. Faith and HIV prevention: the conceptual framing of HIV prevention among Pentecostal Batswana teenagers

    PubMed Central

    2014-01-01

    Background There is a huge interest by faith-based organizations (FBOs) in sub-Saharan Africa and elsewhere in HIV prevention interventions that build on the religious aspects of being. Successful partnerships between the public health services and FBOs will require a better understanding of the conceptual framing of HIV prevention by FBOS to access for prevention intervention, those concepts the churches of various denominations and their members would support or endorse. This study investigated the conceptual framing of HIV prevention among church youths in Botswana; - a country with one of the highest HIV prevalence in the world. Method Participants were 213 Pentecostal church members (67% female; age range 12 to 23 years; median age = 19 years). We engaged the participants in a mixed-method inductive process to collect data on their implicit framing of HIV prevention concepts, taking into account the centrality of religion concepts to them and the moderating influences of age, gender and sexual experience. After, we analysed the data using multi-dimensional scaling (MDS) and hierarchical cluster analysis (HCA) to map the ways the church youths framed HIV prevention. Results The findings suggest the church youth to conceptually frame their HIV prevention from both faith-oriented and secular-oriented perspectives, while prioritizing the faith-oriented concepts based on biblical teachings and future focus. In their secular-oriented framing of HIV prevention, the church youths endorsed the importance to learn the facts about HIV and AIDS, understanding of community norms that increased risk for HIV and prevention education. However, components of secular-oriented framing of HIV prevention concepts were comparatively less was well differentiated among the youths than with faith-oriented framing, suggesting latent influences of the church knowledge environment to undervalue secular oriented concepts. Older and sexually experienced church youths in their framing

  20. HIV-negative and HIV-positive gay men's attitudes to medicines, HIV treatments and antiretroviral-based prevention.

    PubMed

    Holt, Martin; Murphy, Dean; Callander, Denton; Ellard, Jeanne; Rosengarten, Marsha; Kippax, Susan; de Wit, John

    2013-07-01

    We assessed attitudes to medicines, HIV treatments and antiretroviral-based prevention in a national, online survey of 1,041 Australian gay men (88.3% HIV-negative and 11.7% HIV-positive). Multivariate analysis of variance was used to identify the effect of HIV status on attitudes. HIV-negative men disagreed with the idea that HIV drugs should be restricted to HIV-positive people. HIV-positive men agreed and HIV-negative men disagreed that taking HIV treatments was straightforward and HIV-negative men were more sceptical about whether HIV treatment or an undetectable viral load prevented HIV transmission. HIV-negative and HIV-positive men had similar attitudes to pre-exposure prophylaxis but divergent views about 'treatment as prevention'. PMID:23001412

  1. Australia's role in HIV prevention in the developing world.

    PubMed

    Cooper, D A

    1995-12-01

    A scientist with the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales in Sydney, Australia, addresses the fact that Australians working in the area of HIV infection have been very successful in prevention, treatment, and care. In the early 1980s, a bipartisan political decision was made to foster an effective partnership between HIV-infected communities, health care providers, and governments. HIV-infected communities included sex workers, prisoners, Aboriginal people, and high profile gay community activists. These three different groups succeeded in forming such a partnership, as reflected in the fact that the annual number of new HIV cases is down to 500 from a peak of 3000 in 1984. A key method used to contain HIV infection was needle-and-syringe exchange programs and continuing access to needles to prevent HIV transmission in the injecting drug community. Even though Australia has all this experience and success, it had a backseat role in ushering in the UNAIDS program because Australia did not contribute a significant share of the agency's relatively small budget (US$100 million/year). If Australia were to give just 10%, it would acquire a front row seat along with the Netherlands, Sweden, Belgium, France, and the UK. These nations have the greatest say as to where UNAIDS funds go. The Australian international aid organization has recently received an increase in funds, $110 million for 4 years to spend on four areas, one of which is HIV/AIDS. Australia has just allocated $25 million for a 5-year program for HIV/STD (sexually transmitted disease) prevention in Indonesia. This money would have been able to buy Australia a leading role in UNAIDS. Australians need to reassess their priorities. Australians can help their neighbors in the Asia-Pacific region move away from their denial of HIV to HIV prevention and care. They can conduct clinical trials of shorter and more user-friendly regimens of antiviral drugs that

  2. Time to Address a Preventable Tragedy.

    ERIC Educational Resources Information Center

    Wescott, Siobhan M.

    1990-01-01

    Discusses the epidemic of fetal alcohol syndrome (FAS) affecting Native American communities, the lifetime costs associated with an FAS birth, behavioral aberrations of FAS children that affect classroom performance, and federal and state legislation and funding aimed at FAS prevention through treatment of pregnant alcoholics. (SV)

  3. Native Women at Risk: Addressing Cancer Prevention.

    ERIC Educational Resources Information Center

    Thiemann, Kay M. B.

    1994-01-01

    Discusses outcomes of a conference that brought together representatives from Indian tribes, state health departments, the Indian Health Service, the Mayo Clinic, and the American Cancer Society, to address the high rate of cervical cancer among American Indian women. Describes barriers to health care and plans to promote cancer screening among…

  4. Addressing Childhood Obesity: Opportunities for Prevention.

    PubMed

    Brown, Callie L; Halvorson, Elizabeth E; Cohen, Gail M; Lazorick, Suzanne; Skelton, Joseph A

    2015-10-01

    The overweight and obesity epidemic among children and adolescents in the United States continues to worsen, with notable racial, ethnic, and socioeconomic disparities. Risk factors for pediatric obesity include genetics; environmental and neighborhood factors; increased intake of sugar-sweetened beverages (SSBs), fast-food, and processed snacks; decreased physical activity; shorter sleep duration; and increased personal, prenatal, or family stress. Pediatricians can help prevent obesity by measuring body mass index at least yearly and providing age- and development-appropriate anticipatory guidance to families. Public policies and environmental interventions aim to make it easier for children to make healthy nutrition and physical activity choices. Interventions focused on family habits and parenting strategies have also been successful at preventing or treating childhood obesity. PMID:26318950

  5. Socially-Integrated Transdisciplinary HIV Prevention

    PubMed Central

    Downing, Martin J.; Smyrnov, Pavlo; Nikolopoulos, Georgios; Schneider, John A.; Livak, Britt; Magiorkinis, Gkikas; Slobodianyk, Liudmyla; Vasylyeva, Tetyana I.; Paraskevis, Dimitrios; Psichogiou, Mina; Sypsa, Vana; Malliori, Melpomeni M.; Hatzakis, Angelos

    2013-01-01

    Current ideas about HIV prevention include a mixture of primarily biomedical interventions, sociomechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make “treatment as prevention” more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases. PMID:24165983

  6. Preventing HIV among Latino and African American Gay and Bisexual Men in a Context of HIV-Related Stigma, Discrimination, and Homophobia: Perspectives of Providers

    PubMed Central

    Brooks, Ronald A.; Etzel, Mark A.; Hinojos, Ernesto; Henry, Charles L.; Perez, Mario

    2005-01-01

    HIV-related stigma, discrimination, and homophobia impede community based efforts to combat HIV disease among Latino and African American gay and bisexual men. This commentary highlights ways to address these social biases in communities of color in Los Angeles from the perspectives of staff from HIV prevention programs. Information was collected from HIV prevention program staff participating in a two-day symposium. The outcomes from the symposium offer strategies for developing and implementing HIV prevention services for Latino and African American gay and bisexual men, which include: 1) addressing social biases present in a community that can hinder, and even prohibit, utilization of effective HIV prevention programs; 2) recasting HIV prevention messages in a broader social or health context; 3) developing culturally appropriate HIV prevention messages; 4) exploring new modalities and venues for delivering HIV prevention messages that are appropriate for gay and bisexual men of color and the communities in which they live; and 5) broadening the target of HIV prevention services to include service providers, local institutions and agencies, and the community at-large. These strategies underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention programs. PMID:16283834

  7. Views of Young, Rural African Americans of the Role of Community Social Institutions' in HIV Prevention

    PubMed Central

    Youmans, Selena; Lloyd, Stacy W.; Coker-Appiah, Dionne S.; Banks, Bahby; Blumenthal, Connie; Albritton, Tashuna; Ellison, Arlinda; Smith, Giselle Corbie; Adimora, Adaora A.

    2010-01-01

    Background We explored rural African American youths' perceptions about the role of community social institutions in addressing HIV. Methods We conducted four focus groups with African Americans aged 16 to 24 years in two rural counties in North Carolina. Groups were stratified by gender and risk status. We used a grounded theory approach to content analysis. Results Participants identified four social institutions as primary providers of HIV-related health promotion efforts: faith organizations, schools, politicians, and health agencies. They reported perceiving a lack of involvement in HIV prevention by faith-based organizations, constraints of abstinence-based sex education policies, politicians' lack of interest in addressing broader HIV determinants, and inadequacies in health agency services, and viewed all of these as being counter-productive to HIV prevention efforts. Conclusions youth have important insights about local social institutions that should be considered when designing HIV prevention interventions that partner with local organizations. PMID:20453373

  8. Faith-Based HIV Care and Prevention in Chinese Immigrant Communities: Rhetoric or Reality?

    PubMed Central

    Kang, Ezer; Chin, John J.; Behar, Elana

    2012-01-01

    Ethnic churches attended by first generation Chinese immigrants are uniquely positioned to address emerging HIV prevention and care needs within the Chinese community at-large. Efforts to develop faith-based HIV programs necessitate identifying how HIV intersects with the sinicization of Christianity within Chinese churches. This paper will review the process of contextualizing HIV within theological and cultural frameworks that are meaningful for ethnic Chinese church leaders and members. The authors specifically propose two points of integration between public health and ecclesial functions: (1) HIV stigma-mitigation initiatives as informed by Christo-centric teachings of compassion and justice, and (2) HIV prevention and care reframed as social responsibility and informed by the Christian tradition of evangelism. Systems and practices that hinder and promote the involvement of Chinese churches in HIV prevention, care, and stigma-reduction will be discussed. PMID:23483037

  9. Internalized heterosexism among HIV-positive, gay-identified men: implications for HIV prevention and care.

    PubMed

    Johnson, Mallory O; Carrico, Adam W; Chesney, Margaret A; Morin, Stephen F

    2008-10-01

    Internalized heterosexism (IH), or the internalization of societal antihomosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and it has been inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, the authors tested a model framed in social action theory (C. K. Ewart, 1991, 2004) in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results support the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART nonadherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse and 17% of the variance in ART nonadherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men. PMID:18837600

  10. SOMOS: Evaluation of an HIV Prevention Intervention for Latino Gay Men

    ERIC Educational Resources Information Center

    Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.

    2011-01-01

    Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…

  11. A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care

    PubMed Central

    Muessig, Kathryn E.; Nekkanti, Manali; Bauermeister, Jose; Bull, Sheana

    2015-01-01

    eHealth, mHealth and “Web 2.0” social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013–2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy. PMID:25626718

  12. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care.

    PubMed

    Muessig, Kathryn E; Nekkanti, Manali; Bauermeister, Jose; Bull, Sheana; Hightow-Weidman, Lisa B

    2015-03-01

    eHealth, mHealth and "Web 2.0" social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013-2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy. PMID:25626718

  13. Combination HIV prevention options for young women in Africa.

    PubMed

    Baxter, Cheryl; Abdool Karim, Salim

    2016-07-01

    Although the number of new HIV infections has declined by over 30% in the past decade, the number of people who acquire HIV each year remains unacceptably high. In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that there were about 2 million new HIV infections. The virus continues to spread, particularly in key populations, such as men who have sex with men (MSM), transgender individuals, sex workers and people who inject drugs. In Africa, young women have the highest HIV incidence rates. Scaling up known efficacious HIV prevention strategies for these groups at high risk is therefore a high priority. HIV prevention has generally been targeted at HIV-negative individuals or in some instances, entire communities. Prevention efforts are, however, shifting from a narrow focus on HIV-uninfected persons to a continuum of prevention that includes both HIV-negative and HIV-positive individuals. Given that a single HIV prevention intervention is unlikely to be able to alter the epidemic trajectory as HIV epidemics in communities are complex and comprise a mosaic of different risk factors and different routes of transmission, there is need to provide combination prevention. Hence, a mix of behavioural, biomedical and structural HIV prevention options is likely to be needed to alter the course of the HIV epidemic. The combination of HIV prevention interventions needed will vary depending on cultural context, the population targeted and the stage of the epidemic. This paper reviews the available HIV prevention strategies for young women and discusses new HIV prevention approaches in development. PMID:27399041

  14. Can a pill prevent HIV? Negotiating the biomedicalisation of HIV prevention.

    PubMed

    Young, Ingrid; Flowers, Paul; McDaid, Lisa

    2016-03-01

    This article examines how biomedicalisation is encountered, responded to and negotiated within and in relation to new biomedical forms of HIV prevention. We draw on exploratory focus group discussions on pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) to examine how the processes of biomedicalisation are affected by and affect the diverse experiences of communities who have been epidemiologically framed as 'vulnerable' to HIV and towards whom PrEP and TasP will most likely be targeted. We found that participants were largely critical of the perceived commodification of HIV prevention as seen through PrEP, although this was in tension with the construction of being medical consumers by potential PrEP candidates. We also found how deeply entrenched forms of HIV stigma and homophobia can shape and obfuscate the consumption and management of HIV-related knowledge. Finally, we found that rather than seeing TasP or PrEP as 'liberating' through reduced levels of infectiousness or risk of transmission, social and legal requirements of responsibility in relation to HIV risk reinforced unequal forms of biomedical self-governance. Overall, we found that the stratifying processes of biomedicalisation will have significant implications in how TasP, PrEP and HIV prevention more generally are negotiated. PMID:26498141

  15. Not Just the Needle: The State of HIV Prevention Science among Substance Users and Future Directions

    PubMed Central

    Shoptaw, Steve; Montgomery, Brooke; Williams, Chyvette T.; El-Bassel, Nabila; Aramrattana, Apinun; Metzger, David S.; Kuo, Irene; Bastos, Francisco I.; Strathdee, Steffanie A.

    2013-01-01

    Successes in preventing HIV transmission among substance using populations have focused primarily among injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by non-injectable means, and there is a dearth of HIV prevention interventions that target non-injecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine in addition to new and emerging substances (e.g., synthetic cannabinoids, cathinones and other amphetamine analogs) are needed to develop and scale-up effective and robust interventions for populations at risk for HIV-transmission via sexual behaviors related to non-injection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV-infected and those who are HIV- uninfected and at high risk. We propose a research agenda that prioritizes: (1) ) combination HIV prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in non-treatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance-related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence. PMID:23764632

  16. [Prevention and screening of HIV infection ].

    PubMed

    Bourdillon, François

    2014-10-01

    The prevention of the HIV infection remains relevant considering the dynamics of the epidemic and the slackening of the preventive behavior of certain populations. The strategies associate initiatives of universal prevention: information, education, communication, screening; and specific actions in the direction of the most exposed populations. The paradigms of prevention evolved a lot these last years to take into account the preventive efficiency of antiretrovirals. If the condom remains the reference method, it is advisable for the populations the most exposed today to associate all the tools of prevention: behavioral methods, screening and antiretroviral. The possibility given to non-governmental organizations to realize test of fast screening allowed to go to closer of the most exposed populations.The arrival on the market of the autotests must be supervised to touch the people who do not turn to the screening. PMID:25510127

  17. Intervention Mapping as a Participatory Approach to Developing an HIV Prevention Intervention in Rural African American Communities

    ERIC Educational Resources Information Center

    Corbie-Smith, Giselle; Akers, Aletha; Blumenthal, Connie; Council, Barbara; Wynn, Mysha; Muhammad, Melvin; Stith, Doris

    2010-01-01

    Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few…

  18. HIV and family living. Preventing the spread of HIV and other diseases.

    PubMed

    Sax, P; Weinberger, H

    1995-10-01

    HIV is spread through direct contact with body fluids, such as blood, semen, vaginal fluids, and breast milk. HIV is not spread through everyday contact. People with HIV are not dangerous to the people they live with at home or in the community and with whom they have ordinary, non-sexual contact. Certain precautions should be taken, however, to minimize risk. First, personal items such as razors, toothbrushes or earrings, should not be shared. Latex gloves should be worn by uninfected family members when they may come into contact with bodily fluids, and the family members should always wash their hands with soap and water after touching blood and other fluids, even if gloves have been worn. The person with HIV can be protected by minimizing exposure to food-borne illnesses carried by raw or undercooked meat, eggs or unpasteurized milk; limiting contact with people who have colds, the flu or diarrhea; and avoiding contact with cages or litter boxes of pets. To help clarify sanitary measures, some frequently asked questions are answered. These questions address the safety of sharing food with HIV-infected people; chickenpox infection and emergence of shingles; prevention of CMV infection; toxoplasmosis and cats; spread of M. avium complex (MAC); and the safety of contact between HIV-infected people and infants. PMID:11362833

  19. Prevention of HIV/AIDS Education in Rural Communities II.

    ERIC Educational Resources Information Center

    Torabi, Mohammad R., Ed.

    1997-01-01

    This second special issue of the Health Education Monograph Series on HIV/AIDS Prevention in Rural Communities presents seven articles: (1) "Preventing Maternal-Infant Transmission of HIV: Social and Ethical Issues" (James G. Anderson, Marilyn M. Anderson, and Tara Booth); (2) "HIV Infection in Diverse Rural Population: Migrant Farm Workers in…

  20. Prevention of HIV/AIDS Education in Rural Communities III.

    ERIC Educational Resources Information Center

    Torabi, Mohammad R., Ed.

    1998-01-01

    This third special issue of the Health Education Monograph Series on HIV/AIDS Prevention in Rural Communities presents 9 articles on: "Rural Adolescent Views of HIV Prevention: Focus Groups at Two Indiana Rural 4-H Clubs" (William L. Yarber and Stephanie A. Sanders); "Implementing HIV Education: Beyond Curriculum" (Susan Frelick Wooley);…

  1. Ethical issues for late-stage trials of multipurpose prevention technologies for HIV and pregnancy.

    PubMed

    Cohen, Jessica A; Mastroianni, Anna C; Macklin, Ruth

    2014-11-01

    Multipurpose prevention technologies (MPTs) designed to simultaneously prevent pregnancy and HIV could provide urgently needed tools to address unmet sexual and reproductive health needs of women worldwide. Late-stage clinical trials will be complex given the need to demonstrate efficacy for HIV and contraceptive indications simultaneously from a single product. Currently, HIV and pregnancy prevention trials have distinctive design features that will need to be reconciled in MPT trials. This article identifies several ethical issues uniquely associated with this research that will benefit from future deliberation and guidance to ensure that this globally important research can proceed efficiently and expeditiously. PMID:25113651

  2. Ethical issues for late-stage trials of multipurpose prevention technologies for HIV and pregnancy

    PubMed Central

    Cohen, Jessica A.; Mastroianni, Anna C.; Macklin, Ruth

    2014-01-01

    Multipurpose prevention technologies (MPTs) designed to simultaneously prevent pregnancy and HIV could provide urgently needed tools to address unmet sexual and reproductive health needs of women worldwide. Late-stage clinical trials will be complex given the need to demonstrate efficacy for HIV and contraceptive indications simultaneously from a single product. Currently, HIV and pregnancy prevention trials have distinctive design features that will need to be reconciled in MPT trials. This article identifies several ethical issues uniquely associated with this research that will benefit from future deliberation and guidance to ensure that this globally important research can proceed efficiently and expeditiously. PMID:25113651

  3. The use of cash transfers for HIV prevention--are we there yet?

    PubMed

    Taaffe, Jessica; Cheikh, Nejma; Wilson, David

    2016-01-01

    Poverty and social inequality are significant drivers of the HIV epidemic and are risk factors for acquiring HIV. As such, many individuals worldwide are at risk for new HIV infection, especially young women in East and Southern Africa. By addressing these drivers, social protection programmes may mitigate the impact of poverty and social inequality on HIV risk. There is reason to believe that social protection can be used successfully for HIV prevention; social protection programmes, including cash transfers, have led to positive health outcomes and behaviour in other contexts, and they have been used successfully to promote education and increased income and employment opportunities. Furthermore, cash transfers have influenced sexual behaviour of young women and girls, thereby decreasing sexual risk factors for HIV infection. When HIV outcomes have been measured, several randomised controlled trials have shown that indirectly, cash transfers have led to reduced HIV prevalence and incidence. In these studies, school attendance and safer sexual health were directly incentivised through the cash transfer, yet there was a positive effect on HIV outcomes. In this review, we discuss the growth of social protection programmes, their benefits and impact on health, education and economic potential, and how these outcomes may affect HIV risk. We also review the studies that have shown that cash transfers can lead to reduced HIV infection, including study limitations and what questions still remain with regard to using cash transfers for HIV prevention. PMID:27002355

  4. Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV

    PubMed Central

    Amin, Avni

    2015-01-01

    Introduction Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. Discussion There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. Conclusions Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support. PMID:26643464

  5. HIV/AIDS: Symptoms, Diagnosis, Prevention and Treatment

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / Summer ... and have resulted in a dramatic decrease in AIDS deaths in the U.S. NIH Research to Results ...

  6. Persisting with prevention: The importance of adherence for HIV prevention

    PubMed Central

    Weiss, Helen A; Wasserheit, Judith N; Barnabas, Ruanne V; Hayes, Richard J; Abu-Raddad, Laith J

    2008-01-01

    Background Only four out of 31 completed randomized controlled trials (RCTs) of HIV prevention strategies against sexual transmission have shown significant efficacy. Poor adherence may have contributed to the lack of effect in some of these trials. In this paper we explore the impact of various levels of adherence on measured efficacy within an RCT. Analysis We used simple quantitative methods to illustrate the impact of various levels of adherence on measured efficacy by assuming a uniform population in terms of sexual behavior and the binomial model for the transmission probability per partnership. At 100% adherence the measured efficacy within an RCT is a reasonable approximation of the true biological efficacy. However, as adherence levels fall, the efficacy measured within a trial substantially under-estimates the true biological efficacy. For example, at 60% adherence, the measured efficacy can be less than half of the true biological efficacy. Conclusion Poor adherence during a trial can substantially reduce the power to detect an effect, and improved methods of achieving and maintaining high adherence within trials are needed. There are currently 12 ongoing HIV prevention trials, all but one of which require ongoing user-adherence. Attention must be given to methods of maximizing adherence when piloting and designing RCTs and HIV prevention programmes. PMID:18620578

  7. Physician barriers to successful implementation of US Preventive Services Task Force routine HIV testing recommendations.

    PubMed

    Zheng, Micha Yin; Suneja, Amit; Chou, Ann Love; Arya, Monisha

    2014-01-01

    In 2006, the US Centers for Disease Control and Prevention issued recommendations supporting routine HIV testing in health care settings for all persons aged 13 to 64 years. Despite these recommendations, physicians are not offering HIV testing routinely. We apply a model that has previously identified 3 central, inter-related factors (knowledge-, attitude-, and behavior-related barriers) for why physicians do not follow practice guidelines in order to better understand why physicians are not offering HIV testing routinely. This model frames our review of the existing literature on physician barriers to routine HIV testing. Within the model, knowledge barriers include lack of familiarity or awareness of clinical recommendations, attitude barriers include lack of agreement with guidelines, while behavioral barriers include external barriers related to the guidelines themselves, to patients, or to environmental factors. Our review reveals that many physicians face these barriers with regards to implementing routine HIV testing. Several factors underscore the importance of determining how to best address physician barriers to HIV testing, including: provisions of the Affordable Care Act that are likely to require or incentivize major payers to cover HIV testing, evidence which suggests that a physician's recommendation to test for HIV is a strong predictor of patient testing behavior, and data which reveals that nearly 20% of HIV-positive individuals may be unaware of their status. In April 2013, the US Preventive Services Task Force released a recommendation supporting routine HIV testing; strategies are needed to help address ongoing physician barriers to testing. PMID:24442739

  8. Addressing gender dynamics and engaging men in HIV programs: lessons learned from Horizons research.

    PubMed

    Pulerwitz, Julie; Michaelis, Annie; Verma, Ravi; Weiss, Ellen

    2010-01-01

    In the field of human immunodeficiency virus (HIV) prevention, there has been increasing interest in the role that gender plays in HIV and violence risk, and in successfully engaging men in the response. This article highlights findings from more than 10 studies in Asia, Africa, and Latin America--conducted from 1997 through 2007 as part of the Horizons program--that have contributed to understanding the relationship between gender and men's behaviors, developing useful measurement tools for gender norms, and designing and evaluating the impact of gender-focused program strategies. Studies showed significant associations between support for inequitable norms and risk, such as more partner violence and less condom use. Programmatic lessons learned ranged from insights into appropriate media messages, to strategies to engage men in critically reflecting upon gender inequality, to the qualities of successful program facilitators. The portfolio of work reveals the potential and importance of directly addressing gender dynamics in HIV- and violence-prevention programs for both men and women. PMID:20297757

  9. HIV-1 Treatment-as-Prevention

    PubMed Central

    Tang, Zhenzhu; Lan, Guanghua; Chen, Ying Qing; Zhu, Qiuying; Yang, Xiaoyi; Shen, Zhiyong; Chen, Yi; Zhang, Heng; Kan, Wei; Xing, Hui; Ruan, Yuhua; Shao, Yiming

    2015-01-01

    Abstract The Chinese national observational cohort study suggests that the treatment-as-prevention (TasP) approach can be an effective public health HIV-1 prevention strategy. However, results from that study may have been biased because the follow-up time of index patients prior to their initiation of antiretroviral therapy (ART) was excluded. In this study, we correct for such bias by using an extended time-dependent Cox regression model to conduct a cohort study analysis of serodiscordant couples in Guangxi of China, inclusive of all follow-up time. During the follow-up of this observational cohort study of HIV-1 sero-discordant couples, the positive index partners may have never be treated with ART, or enter untreated but subsequently began treatment, or may have been treated immediately upon entry into the public health system. The treatment effectiveness of ART in HIV-1 acquisition among HIV-negative partners is assessed by the extended Cox regression model with treatment status as a time-varying covariate. A total of 6548 sero-discordant couples were included in the cohort study analysis. Among them, 348 negative partners sero-converted. HIV seroincidence was significantly higher among the nontreated (4.3 per 100 person-years, 3.7–4.9) compared with those receiving ART (1.8 per 100 person-years, 1.5–2.0). An overall 35% reduction in risk of HIV transmission was associated with receiving ART (adjusted hazard ratio [AHR] 0.65, 95% confidence interval [CI] 0.51–0.83), and the yearly risk reduction was also significant in the first 3 consecutive years of follow-up. Moreover, ART was found to be significantly inversely associated with multiple baseline characteristics of index partners. TasP may be feasible on a national or regional scale. In addition to other proven preventive strategies such as the use of condoms, ART adherence to maintain viral suppression would then be the key challenge for successful TasP implementation.

  10. Perspectives on Efforts to Address HIV/AIDS of Religious Clergy Serving African American and Hispanic Communities in Utah

    PubMed Central

    Alder, Stephen C; Simonsen, Sara Ellis; Duncan, Megan; Shaver, John; DeWitt, Jan; Crookston, Benjamin

    2007-01-01

    Introduction The HIV/AIDS epidemic in America is rapidly progressing in certain subpopulations, including African-American and Hispanic communities. Churches may provide a means for reaching high-risk minority populations with effective HIV/AIDS prevention. We report on a series of focus group interviews conducted with Utah clergy who primarily serve African American and Hispanic congregations. Methods A total of three focus groups (two with Catholic clergy serving Hispanic congregations and one with protestant clergy serving African American congregations) were conducted with eleven participants, lasting approximately two hours each. Each focus group was audio-recorded and transcribed for analysis. Analysis of the data was conducted using a modified grounded theory approach. Results There were remarkable similarities in the attitudes and beliefs among all clergy participating in this study regarding HIV/AIDS and church-based prevention programs. All groups expressed concern about the diseases as a global epidemic and reported that the disease is highly preventable. Also, participants indicated a sense of responsibility to address the issues surrounding HIV/AIDS-related prevention, testing and care within their theological framework. Conclusion HIV/AIDS prevention and care for the infected are seen as falling within the scope of religious organizations. Openness to expanding efforts in this regard was shared by clergy participating in this study. Approaching religious leaders with tailored approaches that respect the values and practices of their particular religions will be more effective than attempting to impose approaches that do not achieve this standard. PMID:18923690

  11. HIV testing and preventive services accessibility among men who have sex with men at high risk of HIV infection in Beijing, China.

    PubMed

    Zhao, Yuejuan; Zhang, Li; Zhang, Heng; Xia, Dongyan; Pan, Stephen W; Yue, Hai; Lu, Hongyan; Xing, Hui; He, Xiong; Shao, Yiming; Ruan, Yuhua

    2015-02-01

    behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services. PMID:25674755

  12. HIV Testing and Preventive Services Accessibility Among Men Who Have Sex With Men at High Risk of HIV Infection in Beijing, China

    PubMed Central

    Zhao, Yuejuan; Zhang, Li; Zhang, Heng; Xia, Dongyan; Pan, Stephen W.; Yue, Hai; Lu, Hongyan; Xing, Hui; He, Xiong; Shao, Yiming; Ruan, Yuhua

    2015-01-01

    , and risky behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services. PMID:25674755

  13. Placing contraception at the centre of the HIV prevention agenda.

    PubMed

    Crankshaw, Tamaryn L; Smit, Jennifer A; Beksinska, Mags E

    2016-07-01

    Over the past decade, the global response to the HIV epidemic has been unprecedented, and enormous progress has been made. Significant investment in the roll out of antiretroviral treatment (ART) and efforts to increase treatment coverage have greatly reduced the number of AIDS-related deaths worldwide. There are a growing number of promising innovations to expand the HIV prevention mix. However, the reach of these interventions is still very limited in adolescent girls and young women (15-24 years) and the full realisation of the intervention mandates has not yet been achieved. The HIV prevention field has been criticised for the tendency to adopt a narrow focus. The Fast-Track Strategy offers a unique opportunity for the HIV prevention field to broaden its gaze and to begin to identify synergies (and efficiencies) with prevention approaches from other global development priorities, namely sexual and reproductive health and rights (SRHR). This paper applies a SRHR lens to HIV prevention by highlighting the critical relationship between unintended pregnancy and HIV, and seeks to expand on earlier debates that prevention of HIV and prevention of unintended pregnancy are inextricably linked, complementary activities with interrelated and common goals. We call for the prioritisation of prevention of unintended pregnancy amongst two overlapping population groups - girls and young women (15-24 years old) and women living with HIV - as a key tactic to accomplish the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track Strategy and as a way to fully realise existing HIV prevention efforts. We discuss the intersecting pathways between HIV prevention and unintended pregnancy prevention and build a case for contraception to be placed at the centre of the HIV prevention agenda. PMID:27399045

  14. Coming to terms with complexity: a call to action for HIV prevention.

    PubMed

    Piot, Peter; Bartos, Michael; Larson, Heidi; Zewdie, Debrework; Mane, Purnima

    2008-09-01

    A quarter of a century of AIDS responses has created a huge body of knowledge about HIV transmission and how to prevent it, yet every day, around the world, nearly 7000 people become infected with the virus. Although HIV prevention is complex, it ought not to be mystifying. Local and national achievements in curbing the epidemic have been myriad, and have created a body of evidence about what works, but these successful approaches have not yet been fully applied. Essential programmes and services have not had sufficient coverage; they have often lacked the funding to be applied with sufficient quality and intensity. Action and funding have not necessarily been directed to where the epidemic is or to what drives it. Few programmes address vulnerability to HIV and structural determinants of the epidemic. A prevention constituency has not been adequately mobilised to stimulate the demand for HIV prevention. Confident and unified leadership has not emerged to assert what is needed in HIV prevention and how to overcome the political, sociocultural, and logistic barriers in getting there. We discuss the combination of solutions which are needed to intensify HIV prevention, using the existing body of evidence and the lessons from our successes and failures in HIV prevention. PMID:18687458

  15. Antiretroviral Therapy as HIV Prevention: Status and Prospects

    PubMed Central

    Venkatesh, Kartik K.

    2010-01-01

    As antiretroviral treatment of HIV infection has become increasingly accessible, attention has focused on whether these drugs can used for prevention because of increased tolerability of newer medications, decreased cost, and the limitations of other approaches. We review the status of antiretroviral HIV prevention, including chemoprophylaxis, as well as the effects of treatment of infected individuals on prevention. It is possible that the life-saving agents that have transformed the natural history of AIDS can be a critical component of HIV prevention efforts, but their ultimate role in affecting HIV transmission dynamics remains to be defined. PMID:20724682

  16. Efficacy of a Preventive Intervention for Youths Living with HIV.

    ERIC Educational Resources Information Center

    Rotheram-Borus, Mary Jane; Lee, Martha B.; Murphy, Debra A.; Futterman, Donna; Duan, Naihua; Birnbaum, Jeffrey M.; Lightfoot, Marguerita

    2001-01-01

    Examined HIV transmission behaviors and health practices among HIV-infected youths over 15 months following participation in a preventive intervention that emphasized coping with HIV and reducing risky behaviors. The intervention resulted in increases in social support coping and reductions in risky sexual and lifestyle behaviors specifically…

  17. Adolescent Self-Consent for Biomedical HIV Prevention Research

    PubMed Central

    Gilbert, Amy Lewis; Knopf, Amelia S.; Fortenberry, J. Dennis; Hosek, Sybil G.; Kapogiannis, Bill G.; Zimet, Gregory D.

    2015-01-01

    Purpose The Adolescent Medicine Trials Network Protocol 113 (ATN113) is an open-label, multi-site demonstration project and phase II safety study of HIV pre-exposure prophylaxis with 15-17 year old young men who have sex with men that requires adolescent consent for participation. The purpose of this study was to examine factors related to the process by which Institutional Review Boards (IRBs) and researchers made decisions regarding whether to approve and implement ATN113, so as to inform future biomedical HIV prevention research with high-risk adolescent populations. Methods Participants included seventeen researchers at thirteen sites in twelve states considering ATN113 implementation. Qualitative descriptive methods were used. Data sources included interviews and documents generated during the initiation process. Results A common process for initiating ATN113 emerged, and informants described how they identified and addressed practical, ethical and legal challenges that arose. Informants described the process as responding to the protocol, preparing for IRB submission, abstaining from or proceeding with submission, responding to IRB concerns and reacting to the outcomes. A complex array of factors impacting approval and implementation were identified; and ATN113 was ultimately implemented in 7 of 13 sites. Informants also reflected on lessons learned that may help inform future biomedical HIV prevention research with high-risk adolescent populations. Conclusions The results illustrate factors for consideration in determining whether to implement such trials, demonstrate that such protocols have the potential to be approved, and highlight a need for clearer standards regarding biomedical HIV prevention research with high-risk adolescent populations. PMID:26095412

  18. Gender Differences in HIV/AIDS Preventive Self-Efficacy Among Taiwanese Adolescents.

    PubMed

    Lee, Yi-Hui; Salman, Ali; Cooksey-James, Tawna

    2016-02-01

    The aim of the cross-sectional study was to understand gender differences in HIV/AIDS preventive self-efficacy among Taiwanese adolescents. Self-administered questionnaires were used to measure HIV/AIDS preventive self-efficacy and covariates (age, substance use, and sexual experiences). Data were collected from 734 Taiwanese high school adolescents aged 16 to 18 years. Descriptive statistic analyses, t-test, and ANCOVA were utilized to analyze data. The results indicate significant differences exist between genders in HIV/AIDS preventive self-efficacy among Taiwanese adolescents. Compared to the males, female adolescents were found having significantly higher HIV/AIDS preventive self-efficacy related to refusing sexual intercourse, condom use, and questioning potential sexual partners than those who are males. While controlling age, sexual experience, and substance use, female Taiwanese adolescents also had higher HIV/AIDS preventive self-efficacy than those who are males. The findings suggest the importance of addressing gender differences in HIV/AIDS preventive self-efficacy when developing HIV reduction programs for Taiwanese adolescents. PMID:26829258

  19. Weighing the Gold in the Gold Standard: Challenges in HIV Prevention Research

    PubMed Central

    PADIAN, Nancy S.; McLOY, Sandra I.; BALKUS, Jennifer E.; WASSERHEIT, Judith N.

    2013-01-01

    Objective(s) Few HIV prevention interventions have been evaluated in randomized controlled trials (RCTs). We examined design, implementation, and contextual considerations that may limit detection of a positive or adverse effect in HIV prevention trials. Design A systematic review of late phase RCTs for prevention of sexual transmission of HIV that 1) randomly allocated intervention and comparison groups; 2) evaluated interventions to prevent sexual transmission in non-pregnant populations; and 3) reported HIV incidence as the primary or secondary outcome. Methods PubMed/MEDLINE, other electronic databases, and electronic conference proceedings of recent HIV/AIDS-related conferences were searched to identify published or unpublished trials meeting the inclusion criteria. Descriptive, methodological, and contextual factors were abstracted from each trial. Results The review included 36 HIV prevention RCTs reporting on 38 unique interventions. Only six RCTs, all evaluating biomedical interventions, demonstrated definitive effects on HIV incidence. Five of the six RCTs significantly reduced HIV infection: all three male circumcision trials, one trial of STI treatment and care, and one vaccine trial. One microbicide trial of nonoxynol-9 gel produced adverse results. Lack of statistical power, poor adherence, and diluted versions of the intervention in comparison groups may have been important issues for the other trials that demonstrated “flat” results. Conclusions Almost 90% of HIV prevention trials had “flat” results, which may be attributable to trial design and/or implementation. The HIV prevention community must not only examine evidence from significant RCTs, but must also examine flat trials, and address design and implementation issues that limit detection of an effect. PMID:20179575

  20. HIV among men who have sex with men in Malawi: elucidating HIV prevalence and correlates of infection to inform HIV prevention

    PubMed Central

    Wirtz, Andrea L; Jumbe, Vincent; Trapence, Gift; Kamba, Dunker; Umar, Eric; Ketende, Sosthenes; Berry, Mark; Strömdahl, Susanne; Beyrer, Chris; Baral, Stefan D

    2013-01-01

    services. Results provide a number of priorities for research and prevention programmes for MSM, including providing access to and encouraging regular confidential HIV testing and counselling, and risk reduction counselling related to anal intercourse. Other targets include the provision of condoms and compatible lubricants, HIV prevention information, and HIV and sexually transmitted infection treatment and adherence support. Addressing multiple levels of HIV risk, including structural factors, may help to ensure that programmes have sufficient coverage to impact this HIV epidemic among MSM. PMID:24321110

  1. Preventing HIV infection: educating the general public.

    PubMed

    Kroger, F

    1991-01-01

    This essay discusses the rationale for targeting HIV prevention programs to the general public, as opposed to focusing strictly on high-risk populations. The author first considers varying definitions of the term "general public," then explains the goal of general public education programs. Additionally, the author lays down the theoretical foundations of general audience education programs and weights related research findings. Finally, he offers recommendations for future practice. Noting the complex socioecological elements involved in health behavior, the author argues in favor of a broad definition for the general public. This broad outlook allows programs to still target high-risk population while not bypassing low-risk persons, who are sometimes treated as irrelevant because they do not contribute to excess morbidity or mortality. When it comes to HIV educational programs for the general public, their goals should be to instruct the public on how the virus is transmitted, to allay unfounded fears, and to increase the level of support for AIDS prevention and control. Such a program would require a theoretical basis drawn from multiple sources: health education, health communication, clinical and social psychology, and social marketing. The author concludes by proving recommendations designed to reinforce existing programs: 1) strengthen efforts to ensure that all people are educated about HIV and to encourage people to treat AIDS patients with compassion; 2) continue to explore for the most effective communication channels; 3) strengthen the communication infrastructure for those who are disenfranchised from health education; and 4) strengthen evaluation efforts of health communication programs. PMID:12317020

  2. Sustaining youth peer HIV / STD prevention education.

    PubMed

    Kauffman, C; Hue, L

    1997-01-01

    This article describes an adolescent, peer-education training program in Jamaica that was developed and operated by the Red Cross Societies of Jamaica and the US and was funded by AIDSCAP. The program aimed to develop a training system to prepare youth peer educators in preventing the spread of HIV infections and sexually transmitted diseases. The goal was to increase knowledge about, change attitudes toward, and develop prevention skills for HIV/AIDS. The initial program was to be replicated on a large scale and be sustainable over time. The program was developed in response to the 1500+ Jamaicans diagnosed with AIDS and the 20,000 or so with HIV infections. Transmission is mostly heterosexual. 15% of girls and 47% of boys are sexually active by 14 years of age, and almost 50% of syphilis and gonorrhea cases are among adolescents. The national training program relies on peer educators, aged 14-19 years, who are literate to the 6th-grade level. Training sessions are conducted for 10-21 persons/session for 27 hours over 3 weekends. Training relies on engaging games and activities. Trainees are taught how to facilitate 14 specific activities, including the correct way to use a condom. Peer educators work together in groups of twos or threes among groups of 10-15 adolescents, aged 10-15 years. By the third year of operation, most of the systems and materials were in place and the program expanded; cost-benefit analysis revealed that costs were returned. The program has continued with a variety of funds and delivery systems and new funding will likely shift the program emphasis. The program has survived with the enthusiasm and support of the trainers. Other start-up programs should ensure the involvement of youth at all stages of development. PMID:12293325

  3. Targeting Structural Change for HIV Prevention: A Process and Tool for Community Application.

    PubMed

    Willard, Nancy; Chutuape, Kate; Stewart-Campbell, Rachel; Boyer, Cherrie B; Ellen, Jonathan

    2015-11-01

    To address the persistent HIV epidemic in the United States, prevention efforts are focusing on social determinants related to HIV risk by targeting systems and structures, such as organizational and institutional policies, practices and programs, and legislative and regulatory approaches to modify features of the environment that influence HIV risk. With limited evidenced-based examples, communities can benefit from strategic planning resources that help them consider developing structural-level changes that target root causes of HIV risk. In this article, we present the Connect to Protect® project that outlines a process and a tool to move from general ideas to specific structural changes. Examples from 14 coalitions are also provided. Using the process and tools presented here can provide a launching pad for other coalitions seeking to build an HIV prevention agenda and for practitioners seeking to incorporate structural changes for community health promotion. PMID:25776019

  4. Targeting Structural Change for HIV Prevention: A Process and Tool for Community Application

    PubMed Central

    Willard, Nancy; Chutuape, Kate; Stewart-Campbell, Rachel; Boyer, Cherrie B.; Ellen, Jonathan

    2015-01-01

    To address the persistent HIV epidemic in the United States, prevention efforts are focusing on social determinants related to HIV risk by targeting systems and structures, such as organizational and institutional policies, practices and programs, and legislative and regulatory approaches to modify features of the environment that influence HIV risk. With limited evidenced-based examples, communities can benefit from strategic planning resources that help them consider developing structural-level changes that target root causes of HIV risk. In this article, we present the Connect to Protect® project that outlines a process and a tool to move from general ideas to specific structural changes. Examples from 14 coalitions are also provided. Using the process and tools presented here can provide a launching pad for other coalitions seeking to build an HIV prevention agenda and for practitioners seeking to incorporate structural changes for community health promotion. PMID:25776019

  5. The future of HIV prevention: prospects for an effective anti-HIV microbicide.

    PubMed

    Nuttall, Jeremy; Romano, Joseph; Douville, Karen; Galbreath, Caroline; Nel, Annaléne; Heyward, William; Mitchnick, Mark; Walker, Saul; Rosenberg, Zeda

    2007-03-01

    Topical microbicides are self-administered products for prevention of HIV transmission, and they present one of the most promising strategies for combating the HIV-AIDS epidemic. The development of microbicides is a long and complicated process, with many hurdles that are unique to this class of product, including challenges in product design, in the conduct and design of clinical trials, and in obtaining licensure of a new class of products intended for use almost exclusively in developing countries. Once they have been registered, there are additional challenges to the marketing and distribution of microbicides. An overview of the types of microbicide currently in development, and a summary of the issues and the approaches being taken to address them, are provided. PMID:17502237

  6. Breaking the Silence: The Black Church Addresses HIV.

    ERIC Educational Resources Information Center

    Swartz, Aimee

    2002-01-01

    AIDS is the leading cause of death among African Americans age 25-44 years. About half of all new U.S. HIV cases are African Americans, though African Americans make up only 13 percent of the population. Most U.S. children living with HIV are African American. There exists a strong pattern of resistance and denial of the disease in the African…

  7. EFFECT OF HIV PREVENTION AND TREATMENT PROGRAM ON HIV AND HCV TRANSMISSION AND HIV MORTALITY AT AN INDONESIAN NARCOTIC PRISON.

    PubMed

    Nelwan, Erni J; Indrati, Agnes K; Isa, Ahmad; Triani, Nurlita; Alam, Nisaa Nur; Herlan, Maria S; Husen, Wahid; Pohan, Herdiman T; Alisjahbana, Bachti; Meheus, Andre; Van Crevel, Reinout; van der Ven, Andre Jam

    2015-09-01

    Validated data regarding HIV-transmission in prisons in developing countries is scarce. We examined sexual and injecting drug use behavior and HIV and HCV transmission in an Indonesian narcotic prison during the implementation of an HIV prevention and treatment program during 2004-2007 when the Banceuy Narcotic Prison in Indonesia conducted an HIV transmission prevention program to provide 1) HIV education, 2) voluntary HIV testing and counseling, 3) condom supply, 4) prevention of rape and sexual violence, 5) antiretroviral treatment for HIV-positive prisoners and 6) methadone maintenance treatment. During a first survey that was conducted between 2007 and 2009, new prisoners entered Banceuy Narcotics Prison were voluntary tested for HIV and HCV-infection after written informed consent was obtained. Information regarding sexual and injecting risk behavior and physical status were also recorded at admission to the prison. Participants who tested negative for both HIV and HCV during the first survey were included in a second survey conducted during 2008-2011. During both surveys, data on mortality among HIV-seropositive patients were also recorded. All HIV-seropositive participants receive treatment for HIV. HIV/ AIDS-related deaths decreased: 43% in 2006, 18% in 2007, 9% in 2008 and 0% in 2009. No HIV and HCV seroconversion inside Banceuy Narcotic Prison were found after a median of 23 months imprisonment (maximum follow-up: 38 months). Total of 484.8 person-years observation was done. Participants reported HIV transmission risk-behavior in Banceuy Prison during the second survey was low. After implementation of HIV prevention and treatment program, no new HIV or HCV cases were detected and HIV-related mortality decreased. PMID:26863859

  8. Evaluation of the Positive Prevention HIV/STD Curriculum

    ERIC Educational Resources Information Center

    LaChausse, Robert G.

    2006-01-01

    This study evaluated the effectiveness of Positive Prevention, a theory-based, HIV/STD prevention education curriculum for high school youth. Three hundred fifty-three students participated in a longitudinal experimental design to determine the impact of the curriculum on HIV/AIDS knowledge, self-efficacy to abstain from sex, self-efficacy of…

  9. Getting Personal: Progress and Pitfalls in HIV Prevention among Latinas

    ERIC Educational Resources Information Center

    Amaro, Hortensia; Raj, Anita; Reed, Elizabeth; Ulibarri, Monica

    2011-01-01

    This article first presents the political, personal, and epidemiological context of Hortensia Amaro's 1988 publication in "Psychology of Women Quarterly" ("PWQ"), "Considerations for Prevention of HIV Infection Among Hispanic Women" (Amaro, 1988). Second, it provides a brief summary of progress in HIV prevention with Latinas. The third section…

  10. Advances in HIV/AIDS Education and Prevention.

    ERIC Educational Resources Information Center

    Kelly, Jeffrey A.

    1995-01-01

    Reviews human immunodeficiency virus (HIV) behavioral epidemiology pertinent to planning risk reduction interventions and HIV prevention outcome projects that have resulted in objective evidence of risk behavior change. Key prevention issues of which we still have limited knowledge are considered, and potential ways to incorporate improved HIV…

  11. Substance Use and HIV Prevention for Youth in Correctional Facilities

    ERIC Educational Resources Information Center

    Mouttapa, Michele; Watson, Donnie W.; McCuller, William J.; Reiber, Chris; Tsai, Winnie

    2009-01-01

    Evidence-based programs for substance use and HIV prevention (SUHIP) were adapted for high-risk juveniles detained at 24-hour secure correctional facilities. In this pilot study, comparisons were made between adolescents who received the SUHIP intervention and a control group on changes in: (1) knowledge of HIV prevention behaviors, (2) attitudes…

  12. Antiviral agents and HIV prevention: controversies, conflicts, and consensus

    PubMed Central

    Cohen, Myron S.; Muessig, Kathryn E.; Smith, M. Kumi; Powers, Kimberly A.; Kashuba, Angela D.M.

    2013-01-01

    Antiviral agents can be used to prevent HIV transmission before exposure as preexpo-sure prophylaxis (PrEP), after exposure as postexposure prophylaxis, and as treatment of infected people for secondary prevention. Considerable research has shed new light on antiviral agents for PrEP and for prevention of secondary HIV transmission. While promising results have emerged from several PrEP trials, the challenges of poor adherence among HIV-negative clients and possible increase in sexual risk behaviors remain a concern. In addition, a broader pipeline of antiviral agents for PrEP that focuses on genital tract pharmacology and safety and resistance issues must be developed. Antiretroviral drugs have also been used to prevent HIV transmission from HIV-infected patients to their HIV-discordant sexual partners. The HIV Prevention Trials Network 052 trial demonstrated nearly complete prevention of HIV transmission by early treatment of infection, but the generalizability of the results to other risk groups – including intravenous drug users and MSM – has not been determined. Most importantly, the best strategy for use of antiretroviral agents to reduce the spread of HIV at either the individual level or the population level has not been developed, and remains the ultimate goal of this area of investigation. PMID:22507927

  13. HIV-Related Stigma and HIV Prevention Uptake Among Young Men Who Have Sex with Men and Transgender Women in Thailand.

    PubMed

    Logie, Carmen H; Newman, Peter A; Weaver, James; Roungkraphon, Surachet; Tepjan, Suchon

    2016-02-01

    HIV-related stigma is a pervasive structural driver of HIV. With an HIV epidemic among young men who have sex with men (MSM) and transgender women (TG) in Thailand characterized as explosive, we conducted a cross-sectional survey among MSM and TG aged 18-30 years. From April-August 2013, participants recruited using venue-based sampling from gay entertainment sites and community-based organizations completed a tablet-assisted survey interview in Thai language. We conducted multiple logistic regression to assess correlations between HIV-related stigma (felt-normative, vicarious domains) and socio-demographic variables, HIV vulnerabilities (gay entertainment employment, sex work, forced sex history), and HIV prevention uptake (condom use, HIV testing, rectal microbicide acceptability). Among participants (n = 408), 54% identified as gay, 25% transgender, and 21% heterosexual. Two-thirds (65.7%) were employed at gay entertainment venues, 67.0% had more than three male partners (past month), 55.6% had been paid for sex, and 4.5% were HIV-positive. One-fifth (21.3%) reported forced sex. Most participants reported experiencing felt-normative and vicarious HIV-related stigma. Adjusting for socio-demographics, participants with higher total HIV-related stigma scores had significantly lower odds of HIV testing and rectal microbicide acceptability, and higher odds of having experienced forced sex. Both vicarious and felt-normative dimensions of HIV-related stigma were inversely associated with HIV testing and rectal microbicide acceptability. Our findings suggest that HIV-related stigma harms the health of HIV-negative MSM and TG at high risk for HIV infection. HIV-related interventions and research among young MSM and TG in Thailand should address multiple dimensions of HIV-related stigma as a correlate of risk and a barrier to accessing prevention. PMID:26788978

  14. What Parents and Their Gay and Bisexual Sons Say About HIV Prevention.

    PubMed

    LaSala, Michael C; Fedor, James P; Revere, Elyse J; Carney, Robert

    2016-09-01

    Despite ongoing prevention efforts, young gay and bisexual men (YGBM) accounted for more than three fourths of all recent HIV infections. Furthermore, they continue to engage in high-risk sexual behaviors at alarming rates. Nowadays, families are beginning to emerge as important resources for these youth. However, the viewpoints of YGBM and their families are largely missing from HIV prevention research and intervention development. To address this gap, we solicited the opinions of YGBM and their parents as to why YGBM engage in unsafe sex and what might be done to help them avoid HIV. Participants discussed youth's sense of invulnerability, sexual arousal, parental disapproval, and lack of societal acceptance as contributors to unsafe sex. Participants called for gay-sensitive sex education and community programming as well as increased societal acceptance. Overall, respondents recommended interpersonal and structural-level interventions that emphasized the importance of reducing stigma as a key component of HIV prevention. PMID:26443796

  15. Considerations in HIV Prevention for Women Affected by the Criminal Justice System

    PubMed Central

    Comfort, Megan

    2011-01-01

    Within the national dialogue of HIV prevention strategies, relatively little consideration is given to the millions of women and girls affected by the criminal justice system either through their own incarceration or that of their partners. Yet statistics indicate that these women and girls are disproportionately infected or at risk for HIV and other sexually transmitted infections and much of this risk is directly related to the dynamics and circumstances that led to their incarceration or relationships with incarcerated men. As we look for the link between public health and correctional health within our National HIV/AIDS Strategy, it is imperative that the risks, obstacles, and opportunities facing women and girls affected by incarceration are brought into the discussion. Gender responsive HIV prevention policies and practices must be developed to address the unique risks and opportunities for these women and girls. This paper presents data on HIV risk and other health issues specific to this community of women and girls, discusses key factors for consideration when developing gender-responsive HIV strategies for these communities, and makes recommendations for inclusion in the National HIV/AIDS Strategy and other state and local HIV prevention efforts. PMID:21782463

  16. Addressing the fears of HIV transmission in dental practice.

    PubMed

    Hardie, J

    1992-03-01

    Recent surveys indicate that dental personnel are prepared to provide care for HIV+/AIDS patients, but do so with some reluctance. Their specific concerns have been identified and an attempt has been made to allay these fears by examining them from scientific, clinical, epidemiologic and historical perspectives. These somewhat pragmatic criteria suggest that HIV transmission in dental practice is extremely unlikely-if not impossible. However, the explanations offered to arrive at these conclusions may fail to resolve the suspicions that some dentists and their auxiliaries harbor toward individuals demonstrating lifestyles foreign to their own. If this is so, the advice of counsellors, social scientists and behavioral modification experts must be sought if dental personnel wish to provide care to HIV+/AIDS patients in an atmosphere of mutual trust, confidence and respect. PMID:1555122

  17. HIV prevention for South African youth: which interventions work? A systematic review of current evidence

    PubMed Central

    2010-01-01

    Background In South Africa, HIV prevalence among youth aged 15-24 is among the world's highest. Given the urgent need to identify effective HIV prevention approaches, this review assesses the evidence base for youth HIV prevention in South Africa. Methods Systematic, analytical review of HIV prevention interventions targeting youth in South Africa since 2000. Critical assessment of interventions in 4 domains: 1) study design and outcomes, 2) intervention design (content, curriculum, theory, adaptation process), 3) thematic focus and HIV causal pathways, 4) intervention delivery (duration, intensity, who, how, where). Results Eight youth HIV prevention interventions were included; all were similar in HIV prevention content and objectives, but varied in thematic focus, hypothesised causal pathways, theoretical basis, delivery method, intensity and duration. Interventions were school- (5) or group-based (3), involving in- and out-of-school youth. Primary outcomes included HIV incidence (2), reported sexual risk behavior alone (4), or with alcohol use (2). Interventions led to reductions in STI incidence (1), and reported sexual or alcohol risk behaviours (5), although effect size varied. All but one targeted at least one structural factor associated with HIV infection: gender and sexual coercion (3), alcohol/substance use (2), or economic factors (2). Delivery methods and formats varied, and included teachers (5), peer educators (5), and older mentors (1). School-based interventions experienced frequent implementation challenges. Conclusions Key recommendations include: address HIV social risk factors, such as gender, poverty and alcohol; target the structural and institutional context; work to change social norms; and engage schools in new ways, including participatory learning. PMID:20187957

  18. How Peru introduced a plan for comprehensive HIV prevention and care for transwomen

    PubMed Central

    Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

    2016-01-01

    Introduction As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a “Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen.” Discussion A policy dialogue between key stakeholders – Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies – created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. Conclusions The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change. PMID:27431469

  19. Feasibility of a Computer-Based Intervention Addressing Barriers to HIV Testing Among Young Patients Who Decline Tests at Triage.

    PubMed

    Aronson, Ian David; Cleland, Charles M; Perlman, David C; Rajan, Sonali; Sun, Wendy; Bania, Theodore C

    2016-09-01

    Young people face greatly increased human immunodeficiency virus (HIV) risk and high rates of undiagnosed HIV, yet are unlikely to test. Many also have limited or inconsistent access to health care, including HIV testing and prevention education, and prior research has documented that youth lack knowledge necessary to understand the HIV test process and to interpret test results. Computer-based interventions have been used to increase HIV test rates and knowledge among emergency department (ED) patients, including those who decline tests offered at triage. However, patients aged 18-24 years have been less likely to test, even after completing an intervention, compared to older patients in the same ED setting. The current pilot study sought to examine the feasibility and acceptability of a new tablet-based video intervention designed to address established barriers to testing among ED patients aged 18-24 years. In particular, we examined whether young ED patients would: agree to receive the intervention; complete it quickly enough to avoid disrupting clinical workflows; accept HIV tests offered by the intervention; demonstrate increased postintervention knowledge; and report they found the intervention acceptable. Over 4 weeks, we recruited 100 patients aged 18-24 in a high-volume urban ED; all of them declined HIV tests offered at triage. Almost all (98%) completed the intervention (mean time <9 mins), 30% accepted HIV tests offered by the tablets. Knowledge was significantly higher after than before the intervention (t = -6.67, p < .001) and patients reported generally high acceptability. Additional research appears warranted to increase postintervention HIV testing. PMID:27565191

  20. Strategies for addressing restorative challenges in HIV-infected children.

    PubMed

    Abdelnur, Juliana Pires; Cerqueira, Daniella Ferraz; Castro, Gloria Fernanda; Maia, Lucianne Cople; de Souza, Ivete Pomarico Ribeiro

    2008-01-01

    The complete caries removal of deep/extensive dentin carious lesions with conventional procedures (high- and low-speed bur) may increase the risk of pulp exposure. In children with systemic diseases, such as HIV-infected children, the dental treatment proposed for the primary dentition with pulp involvement is tooth extraction once endodontic therapies cannot be guaranteed successfully. Therefore, the objective of this study was to describe 3 cases of alternative techniques for caries removal in extensive and/or deep dentin carious lesions in the primary dentition of HIV-infected children: (1) atraumatic restorative treatment (ART); (2) Carisolv; and (3) Papacarie. PMID:18505652

  1. E-dating, identity and HIV prevention: theorising sexualities, risk and network society.

    PubMed

    Davis, Mark; Hart, Graham; Bolding, Graham; Sherr, Lorraine; Elford, Jonathan

    2006-05-01

    This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society. PMID:16669808

  2. Sexual Behaviors and Transmission Risks Among People Living with HIV: Beliefs, Perceptions, and Challenges to Using Treatments as Prevention.

    PubMed

    Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar; Hoyt, Ginger; Merely, Cindy; Welles, Brandi

    2016-08-01

    Antiretroviral therapy (ART) improves the health of people living with HIV and can reduce infectiousness, preventing HIV transmission. The potential preventive benefits of ART are undermined by beliefs that it is safe to have condomless sex when viral load is below levels of detection (infectiousness beliefs and risk perceptions). In this study, we hypothesized that infectiousness beliefs and HIV transmission risk perceptions would prospectively predict people living with HIV engaging in more condomless sex with HIV-negative and unknown HIV status sex partners. Sexually active HIV-positive men (n = 538, 76 %) and women (n = 166, 24 %) completed computerized interviews of sexually transmitted infection (STI) symptoms and diagnoses, unannounced pill counts for medication adherence, medical chart-abstracted HIV viral load, and 28 daily cell-phone-delivered prospective sexual behavior assessments. Results showed that a total of 313 (44 %) participants had engaged in condomless sex with HIV-negative/unknown status sex partners, and these individuals demonstrated higher rates of STI symptoms and diagnoses. Two-thirds of participants who had condomless sex with HIV-negative/unknown status partners had not disclosed their HIV status. Multivariable logistic regression models showed that beliefs regarding viral load and HIV infectiousness and perceptions of lower risk of HIV transmission resulting from HIV viral suppression predicted condomless sex with potentially uninfected partners over and above sex behaviors with HIV-positive partners and STI symptoms/diagnoses. Interventions that address HIV status disclosure and aggressively treat STI in sexually active people living with HIV should routinely accompany the use of HIV treatments as prevention. PMID:26292837

  3. Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa.

    PubMed

    Andersson, Neil; Cockcroft, Anne; Shea, Bev

    2008-12-01

    Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component. PMID:19033757

  4. Recommendations for the School Health Nurse in Addressing HIV/AIDS with Adolescents.

    ERIC Educational Resources Information Center

    Uris, Patricia

    The school is a defined setting where health issues can be addressed. School nurses providing health care to adolescents who are infected or affected by HIV/AIDS need strong policies and good training to make their efforts effective. the goal of these recommendations is to strengthen adolescent HIV programs in schools and to improve standards of…

  5. Men and women have specific needs that facilitate enrollment in HIV-prevention counseling

    PubMed Central

    Durantini, Marta R.; Albarracin, Dolores

    2013-01-01

    Although reducing HIV risk is a primary motive for the design of HIV prevention interventions, the goals of the clients may be very different. Social theories of gender suggest that women, who often seek to resolve social and relational problems, may see HIV-prevention counseling as a mean of resolving partner violence. In contrast, men, who often worry about their physical strength, may seek to enroll in HIV-prevention programs when they experience physical symptoms unrelated to HIV. An unobtrusive study was conducted to observe enrollment in HIV risk-reduction counseling after measuring partner-violence complaints (e.g., feeling threatened or being hit), emotional complaints (e.g., fatigue or anxiety), and physical complaints (e.g., cardiovascular or digestive symptoms). The sample was a group of 350 participants, 70% clients from a state-health department in North Central Florida and 30% community members. Consistent with predictions, complaints of partner violence had a positive association with enrollment in women but not in men, whereas complaints about physical health had a positive association with enrollment in men, but not in women. Emotional complaints did not predict enrollment in either gender group. This study suggests that broad, gender-specific population needs must be competently addressed within HIV-prevention programs and may be strategically used to increase program enrollment. PMID:22390217

  6. HIV prevention and low-income Chilean women: machismo, marianismo and HIV misconceptions.

    PubMed

    Cianelli, Rosina; Ferrer, Lilian; McElmurry, Beverly J

    2008-04-01

    Socio-cultural factors and HIV-related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low-income Chilean women regarding HIV and relevant socio-cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed-methods study, fifty low-income Chilean women participated in a survey and twenty were selected to participate in prevention, in-depth interviews. Results show evidence of widespread misinformation and misconceptions related to HIV/AIDS. Machismo and marianismo offer major barriers to prevention programme development. Future HIV prevention should stress partner communication, empowerment and improving the education of women vulnerable to HIV. PMID:18432428

  7. Evidence-based HIV/STD prevention intervention for black men who have sex with men.

    PubMed

    Herbst, Jeffrey H; Painter, Thomas M; Tomlinson, Hank L; Alvarez, Maria E

    2014-04-18

    This report summarizes published findings of a community-based organization in New York City that evaluated and demonstrated the efficacy of the Many Men, Many Voices (3MV) human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevention intervention in reducing sexual risk behaviors and increasing protective behaviors among black men who have sex with men (MSM). The intervention addressed social determinants of health (e.g., stigma, discrimination, and homophobia) that can influence the health and well-being of black MSM at high risk for HIV infection. This report also highlights efforts by CDC to disseminate this evidence-based behavioral intervention throughout the United States. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion to provide an example of a program that might be effective for reducing HIV infection- and STD-related disparities in the United States. 3MV uses small group education and interaction to increase knowledge and change attitudes and behaviors related to HIV/STD risk among black MSM. Since its dissemination by CDC in 2004, 3MV has been used in many settings, including health department- and community-based organization programs. The 3MV intervention is an important component of a comprehensive HIV and STD prevention portfolio for at-risk black MSM. As CDC continues to support HIV prevention programming consistent with the National HIV/AIDS Strategy and its high-impact HIV prevention approach, 3MV will remain an important tool for addressing the needs of black MSM at high risk for HIV infection and other STDs. PMID:24743663

  8. Sexual behavior patterns of gay university men: implications for preventing HIV infection.

    PubMed

    D'Augelli, A R

    1992-07-01

    Gay male university students less than 25 years old were studied to determine whether they had changed their sexual activity patterns to reduce the risk of HIV infection. Most had not established sexual behavior patterns typical of the older gay men who had been studied in earlier research. Although most of the participants surveyed were concerned about HIV infection, some did engage in risky sexual behavior. The risk-reduction strategies most often used were having fewer sexual partners and being more selective in choosing partners. Future HIV-prevention interventions must be designed to address the needs of this generation of gay men. PMID:1506566

  9. The Use of Technology to Advance HIV Prevention for Couples.

    PubMed

    Mitchell, Jason W

    2015-12-01

    The majority of HIV prevention studies and programs have targeted individuals or operated at the community level. This has also been the standard approach when incorporating technology (e.g., web-based, smartphones) to help improve HIV prevention efforts. The tides have turned for both approaches: greater attention is now focusing on couple-based HIV prevention and using technology to help improve these efforts for maximizing reach and potential impact. To assess the extent that technology has been used to help advance HIV prevention with couples, a literature review was conducted using four databases and included studies that collected data from 2000 to early 2015. Results from this review suggest that technology has primarily been used to help advance HIV prevention with couples as a tool for (1) recruitment and data collection and (2) intervention development. Challenges and limitations of conducting research (e.g., validity of dyadic data) along with future directions for how technology (e.g., mHealth, wearable sensors) can be used to advance HIV prevention with couples are then discussed. Given the growing and near ubiquitous use of the Internet and smartphones, further efforts in the realm of mHealth (e.g., applications or "apps") and eHealth are needed to develop novel couple-focused HIV-preventive interventions. PMID:26412083

  10. MSM in HIV-prevention trials are sexual partners with each other: An ancillary study to the EXPLORE intervention.

    PubMed

    Mimiaga, Matthew J; Safren, Steven A; Benet, Dana Jones; Manseau, Marc W; DeSousa, Nancy; Mayer, Kenneth H

    2006-01-01

    The EXPLORE study evaluated a behavioral intervention to prevent HIV seroconversion among men who have sex with men (MSM). The present ancillary study enrolled 345 EXPLORE participants at one study site (Boston) and assessed high-risk sexual behavior with other EXPLORE participants. It also assessed sexual intentions across other EXPLORE participants, HIV-negative individuals, and unknown HIV serostatus partners. Thirty-one percent reported having sex with another EXPLORE participant: 27% unprotected receptive oral sex with ejaculation (UO), 30% unprotected insertive anal sex (UIA), and 34% reported unprotected receptive anal sex (URA). Significant relationships between intentions to engage in UO, UIA, and URA, and type of partner emerged with intentions to engage in UO, UIA, and URA higher in HIV-negative partners, other EXPLORE participants, and unknown-HIV serostatus partners. Future HIV-prevention studies recruiting MSM at increased sexual risk of HIV infection should address participants potentially becoming sexual partners with each other. PMID:16331532

  11. The 'third wave' of HIV prevention: filling gaps in integrated interventions, knowledge, and funding.

    PubMed

    Sepúlveda, Jaime

    2012-07-01

    There is growing optimism in the global health community that the HIV epidemic can be halted. After decades of relying primarily on behavior change to prevent HIV transmission, a second generation of prevention efforts based on medical or biological interventions such as male circumcision and preexposure prophylaxis--the use of antiretroviral drugs to protect uninfected, at-risk individuals--has shown promising results. This article calls for a third generation of HIV prevention efforts that would integrate behavioral, biological, and structural interventions focused on the social, political, and environmental underpinnings of the epidemic, making use of local epidemiological evidence to target affected populations. In this third wave, global programs should deliver HIV prevention services together with cost-effective interventions for reproductive health and for tuberculosis, malaria, and other diseases. Additionally, new efforts are needed to address gaps in HIV prevention research, evaluation, and implementation. Increased and sustained funding, along with evidence-based allocation of funds, will be necessary to accelerate the decline in new HIV infections. PMID:22778344

  12. Articulating A Rights-Based Approach to HIV Treatment and Prevention Interventions

    PubMed Central

    Barr, David; Amon, Joseph J; Clayton, Michaela

    2011-01-01

    Since the beginning of the epidemic, the protection of human rights has been an integral component in the response to Human Immunodeficiency Virus (HIV). The high degree of stigma and discrimination associated with acquired immune deficiency syndrome (AIDS) has made human rights protection not only a priority to ensure the rights of people living with and at-risk for HIV, but to address public health goals as well. Advances in understanding the impact of antiretroviral treatment on HIV prevention provide exciting opportunities and even a paradigm shift in terms of AIDS prevention. However, this potential cannot be reached unless the advancement of human rights is a primary component of treatment and prevention programme and policy development. The use of antiretroviral treatment as prevention reinforces the value of basic principles related to the dignity and agency of people living with HIV to participate in the design and implementation of programmes, to be informed and to make informed decisions about their health and lives, to be protected from harm, and to have opportunities to seek redress and accountability for abuses. The possibility of using HIV treatment as a prevention tool means that now, more than ever, legal reform and community empowerment and mobilisation are necessary to realize the rights and health of people affected by HIV. PMID:21999775

  13. Conceptualizing a Human Right to Prevention in Global HIV/AIDS Policy

    PubMed Central

    Meier, Benjamin Mason; Brugh, Kristen Nichole; Halima, Yasmin

    2012-01-01

    Given current constraints on universal treatment campaigns, recent advances in public health prevention initiatives have revitalized efforts to stem the tide of HIV transmission. Yet, despite a growing imperative for prevention—supported by the promise of behavioral, structural and biomedical approaches to lower the incidence of HIV—human rights frameworks remain limited in addressing collective prevention policy through global health governance. Assessing the evolution of rights-based approaches to global HIV/AIDS policy, this review finds that human rights have shifted from collective public health to individual treatment access. While the advent of the HIV/AIDS pandemic gave meaning to rights in framing global health policy, the application of rights in treatment access litigation came at the expense of public health prevention efforts. Where the human rights framework remains limited to individual rights enforced against a state duty bearer, such rights have faced constrained application in framing population-level policy to realize the public good of HIV prevention. Concluding that human rights frameworks must be developed to reflect the complementarity of individual treatment and collective prevention, this article conceptualizes collective rights to public health, structuring collective combination prevention to alleviate limitations on individual rights frameworks and frame rights-based global HIV/AIDS policy to assure research expansion, prevention access and health system integration. PMID:23226723

  14. Conceptualizing Community Mobilization for HIV Prevention: Implications for HIV Prevention Programming in the African Context

    PubMed Central

    Lippman, Sheri A.; Maman, Suzanne; MacPhail, Catherine; Twine, Rhian; Peacock, Dean; Kahn, Kathleen; Pettifor, Audrey

    2013-01-01

    Introduction Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation. Objectives We aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting. Method We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge. Results CM domains include: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks. Conclusions To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural

  15. Is Sex Like Driving? HIV Prevention and Risk Compensation*

    PubMed Central

    Wilson, Nicholas L.; Xiong, Wentao; Mattson, Christine L.

    2015-01-01

    Risk compensation has been called the “Achilles’ heel” of HIV prevention policies (Cassell et al 2006). This paper examines the behavioral response to male circumcision, a major HIV prevention policy currently being implemented throughout much of Sub-Saharan Africa. Contrary to the presumption of risk compensation, we find that the response due to the perceived reduction in HIV transmission appears to have been a reduction in risky sexual behavior. We suggest a mechanism for this finding: circumcision may reduce fatalism about acquiring HIV/AIDS and increase the salience of the tradeoff between engaging in additional risky behavior and avoiding acquiring HIV. We also find what appears to be a competing effect that does not operate through the circumcision recipient’s belief about the reduction in the risk of acquiring HIV. PMID:26997745

  16. Masculine ideology, norms, and HIV prevention among young Black men

    PubMed Central

    Hall, Naomi M.; Applewhite, Sheldon

    2014-01-01

    This study examines the relationship between masculine ideology, adherence to norms, and HIV prevention among young Black heterosexual and gay men on the campus of a historically Black college/university. The data from four focus groups and nine individual interviews (N = 35) were aggregated and two recurring themes emerged: sexual communication, and mate availability. Additional themes related to HIV prevention were stigma, protection, and testing. The importance of investigating masculinity with young men is highlighted and implications for professionals working with college students to prevent the transmission of HIV are included. PMID:25525415

  17. Recent HIV Testing Among Young Men Who Have Sex with Men in Bangkok and Chiang Mai: HIV Testing and Prevention Strategies Must Be Enhanced in Thailand.

    PubMed

    Johnston, Lisa G; Steinhaus, Mara C; Sass, Justine; Sirinirund, Petchsri; Lee, Catherine; Benjarattanaporn, Patchara; Gass, Robert

    2016-09-01

    HIV infection among men who have sex with men, particularly in Thai urban settings and among younger cohorts, is escalating. HIV testing and counseling (HTC) are important for prevention and obtaining treatment and care. We examine data from a 2013 survey of males, 15-24 years, reporting past-year sex with a male and living in Bangkok or Chiang Mai. Almost three quarters of young MSM (YMSM) in Bangkok and only 27 % in Chiang Mai had an HIV test in the previous year. Associations for HIV testing varied between cities, although having employment increased the odds of HIV testing for both cities. In Bangkok, family knowledge of same sex attraction and talking to parents/guardians about HIV/AIDS had higher odds of HIV testing. Expanded HTC coverage is needed for YMSM in Chiang Mai. All health centers providing HTC, including those targeting MSM, need to address the specific needs of younger cohorts. PMID:26884309

  18. HIV Prevention Messages Targeting Young Latino Immigrant MSM.

    PubMed

    Solorio, Rosa; Norton-Shelpuk, Pamela; Forehand, Mark; Martinez, Marcos; Aguirre, Joel

    2014-01-01

    Young Latino immigrant men who have sex with men (MSM) are at risk for HIV and for delayed diagnosis. A need exists to raise awareness about HIV prevention in this population, including the benefits of timely HIV testing. This project was developed through collaboration between University of WA researchers and Entre Hermanos, a community-based organization serving Latinos. Building from a community-based participatory research approach, the researchers developed a campaign that was executed by Activate Brands, based in Denver, Colorado. The authors (a) describe the development of HIV prevention messages through the integration of previously collected formative data; (b) describe the process of translating these messages into PSAs, including the application of a marketing strategy; (c) describe testing the PSAs within the Latino MSM community; and (c) determine a set of important factors to consider when developing HIV prevention messages for young Latino MSM who do not identify as gay. PMID:24864201

  19. HIV Prevention Messages Targeting Young Latino Immigrant MSM

    PubMed Central

    Solorio, Rosa; Forehand, Mark; Aguirre, Joel

    2014-01-01

    Young Latino immigrant men who have sex with men (MSM) are at risk for HIV and for delayed diagnosis. A need exists to raise awareness about HIV prevention in this population, including the benefits of timely HIV testing. This project was developed through collaboration between University of WA researchers and Entre Hermanos, a community-based organization serving Latinos. Building from a community-based participatory research approach, the researchers developed a campaign that was executed by Activate Brands, based in Denver, Colorado. The authors (a) describe the development of HIV prevention messages through the integration of previously collected formative data; (b) describe the process of translating these messages into PSAs, including the application of a marketing strategy; (c) describe testing the PSAs within the Latino MSM community; and (c) determine a set of important factors to consider when developing HIV prevention messages for young Latino MSM who do not identify as gay. PMID:24864201

  20. Integrating HIV prevention into services for abused women in South Africa.

    PubMed

    Sikkema, Kathleen J; Neufeld, Sharon A; Hansen, Nathan B; Mohlahlane, Rakgadi; Van Rensburg, Madri Jansen; Watt, Melissa H; Fox, Ashley M; Crewe, Mary

    2010-04-01

    The relationship between intimate partner violence (IPV) and HIV risk is well documented, but few interventions jointly address these problems. We developed and examined the feasibility of an intervention to reduce HIV risk behaviors among 97 women seeking services for IPV from a community-based NGO in Johannesburg, South Africa. Two versions of the intervention (a 6-session group and a 1-day workshop) were implemented, both focusing on HIV prevention strategies integrated with issues of gender and power imbalance. Attendance was excellent in both intervention groups. Assessments were conducted at baseline, post-intervention and two-month follow-up to demonstrate the feasibility of an intervention trial. Women in both groups reported reductions in HIV misperceptions and trauma symptoms, and increases in HIV knowledge, risk reduction intentions, and condom use self-efficacy. The 6-session group showed greater improvements in HIV knowledge and decreases in HIV misperceptions in comparison to the 1-day workshop. The study demonstrated the feasibility and potential benefit of providing HIV prevention intervention to women seeking assistance for IPV. PMID:19826941

  1. HIV Prevention Services and Testing Utilization Behaviors among Men Who Have Sex with Men at Elevated Risk for HIV in Chongqing, China

    PubMed Central

    Hu, Yifei; Wu, Guohui; Jia, Yujiang; Lu, Rongrong; Xiao, Yan; Raymond, H. F.; Ruan, Yuhua; Sun, Jiangping

    2014-01-01

    Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services. PMID:24783195

  2. Photovoice for Healthy Relationships: Community-Based Participatory HIV Prevention in a Rural American Indian Community

    ERIC Educational Resources Information Center

    Markus, Susan F.

    2012-01-01

    This article provides an example of a culturally responsive, community-based project for addressing social determinants of health in rural American Indian (AI) communities through: 1) empowering youth and community voices to set directions for HIV, sexually transmitted infections, and unintended pregnancy prevention and education efforts; 2) using…

  3. Historically Black Colleges and Universities' Campus Culture and HIV Prevention Attitudes and Perceptions among Students

    ERIC Educational Resources Information Center

    Warren-Jeanpiere, Lari; Sutton, Madeline; Jones, Sandra

    2011-01-01

    This study provides insight into some sociostructural factors that may impact the experiences of HBCU students and influence their HIV/AIDS-related perceptions or use of prevention strategies on campuses. To the authors' knowledge, this is the first study that addresses the potential influence of campus-related structural risks on the HIV…

  4. Structural approaches for prevention of sexually transmitted HIV in general populations: definitions and an operational approach

    PubMed Central

    Parkhurst, Justin O

    2014-01-01

    Introduction Although biomedical HIV prevention efforts have seen a number of recent promising developments, behavioural interventions have often been described as failing. However, clear lessons have been identified from past efforts, including the need to address influential social, economic and legal structures; to tailor efforts to local contexts; and to address multiple influencing factors in combination. Despite these insights, there remains a pervasive strategy to try to achieve sexual behaviour change through single, decontextualized, interventions or sets of activities. With current calls for structural approaches to HIV as part of combination HIV prevention, though, there is a unique opportunity to define a structural approach to HIV prevention as one which moves beyond these past limitations and better incorporates our knowledge of the social world and the lessons from past efforts. Discussion A range of interlinked concepts require delineation and definition within the broad concept of a structural approach to HIV. This includes distinguishing between “structural factors,” which can be seen as any number of elements (other than knowledge) which influence risk and vulnerability, and “structural drivers,” which should be reserved for situations where an empirically established relationship to a target group is known. Operationalizing structural approaches similarly can take different paths, either working to alter structural drivers or alternatively working to build individual and community resilience to infection. A “structural diagnostic approach” is further defined as the process one undertakes to develop structural intervention strategies tailored to target groups. Conclusions For three decades, the HIV prevention community has struggled to reduce the spread of HIV through sexual risk behaviours with limited success, but equally with limited engagement with the lessons that have been learned about the social realities shaping patterns of

  5. 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

  6. 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. PMID:25059941

  7. 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…

  8. Integrating HIV Care and HIV Prevention: Legal, Policy, and Programmatic Recommendations

    PubMed Central

    Remien, Robert H.; Berkman, Alan; Myer, Landon; Bastos, Francisco I.; Kagee, Ashraf; El-Sadr, Wafaa

    2009-01-01

    Since the start of the HIV epidemic we have witnessed significant advances in our understanding of the impact of HIV disease worldwide. Further, breakthroughs in treatment and the rapid expansion of HIV care and treatment programs in heavily impacted countries over the past five years are potentially critical assets in a comprehensive approach to controlling the continued spread of HIV globally. A strategic approach to controlling the epidemic requires continued and comparable expansion and integration of care, treatment, and prevention programs. As every new infection involves transmission, whether vertically or horizontally, from a person already living with HIV/AIDS (PLWHA), integration of HIV prevention into HIV care settings has the potential to prevent thousands of new infections, as well as improve the lives of PLWHAs. In this paper, we highlight how to better utilize opportunities created by the antiretroviral (ARV) roll-out to achieve more effective prevention, particularly in Sub Saharan Africa. We offer specific recommendations for action in the domains of healthcare policy and practice in order to better utilize the advances in HIV treatment to advance HIV prevention. PMID:18641470

  9. Faith-Based HIV Prevention and Counseling Programs: Findings from the Cincinnati Census of Religious Congregations

    PubMed Central

    Ritchey, P. Neal; Jacobson, C. Jeffrey; Williams, Rhys H.; Grau, Amy Baumann; Meganathan, Karthikeyan; Ellison, Christopher G.; Tsevat, Joel

    2013-01-01

    Congregations are well positioned to address HIV in their communities, but their response to HIV has been mixed. An emerging literature describes HIV programming in urban, predominantly black congregations, but population-based data remain limited. This study examined the levels of HIV prevention and counseling programs and associated factors (e.g., religious, organizational) by using data from a phone census of congregations in the Greater Cincinnati area (N = 447). Over 10 % of congregations (36 % of Black Protestant and 5–18 % of other types of congregations) offered HIV education/prevention alone or in combination with counseling or with counseling and testing. Path analysis results showed notable significant (p < 0.05) total effects of theology-polity on HIV prevention/counseling programs, but these effects were fully mediated by other factors, including other community work and racial composition. The levels of HIV programming in this study were high by national standards, but further outreach is needed in high-risk African American communities. PMID:23568226

  10. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples

    PubMed Central

    Anglemyer, Andrew; Rutherford, George W; Horvath, Tara; Baggaley, Rachel C; Egger, Matthias; Siegfried, Nandi

    2014-01-01

    subgroup analyses among the observational studies to see if the effect of ART on prevention of HIV differed by the index partner’s CD4 cell count. Among couples in which the infected partner had ≥350 CD4 cells/µL, we estimated a rate ratio of 0.12 [95% CI 0.01, 1.99]. In this subgroup, there were 247 transmissions in untreated couples and 30 in treated couples. Authors’ conclusions ART is a potent intervention for prevention of HIV in discordant couples in which the index partner has ≤550 CD4 cells/µL. A recent multicentre RCT confirms the suspected benefit seen in earlier observational studies and reported in more recent ones. Questions remain about durability of protection, the balance of benefits and adverse events associated with earlier therapy, long-term adherence and transmission of ART-resistant strains to partners. Resource limitations and implementation challenges must also be addressed. Counselling, support, and follow up, as well as mutual disclosure, may have a role in supporting adherence, so programmes should be designed with these components. In addition to ART provision, the operational aspects of delivering such programmes must be considered. PMID:23633367

  11. Adolescent HIV Prevention: An Application of the Elaboration Likelihood Model.

    ERIC Educational Resources Information Center

    Metzler, April E.; Weiskotten, David; Morgen, Keith J.

    Ninth grade students (n=298) participated in a study to examine the influence source credibility, message, quality, and personal relevance on HIV prevention message efficacy. A pilot study with adolescent focus groups created the high and low quality messages, as well as the high (HIV+) and low (worried parent) credibility sources. Participants…

  12. School-Based HIV Prevention: A Multidisciplinary Approach.

    ERIC Educational Resources Information Center

    Kerr, Dianne L.; And Others

    This manual was written to help school-based professionals implement school health education programs to prevent the spread of the human immunodeficiency virus (HIV). The manual provides a framework and plan to promote an interdisciplinary approach to HIV education in schools. The manual begins with a review of basic facts about acquired immune…

  13. Just Say Maybe: Working with Uncertainties in HIV Prevention Education

    ERIC Educational Resources Information Center

    Frankham, Jo

    2003-01-01

    The article focuses on a key aspect of the experiences of young gay men and considers how their responses might inform HIV prevention education for all young people. The article first outlines key representations of same-sex desire and of HIV/AIDS through which young gay men learn various certainties about gay men, gay sex and AIDS. As a…

  14. Asserting a Positive Role: HIV-Positive People in Prevention

    ERIC Educational Resources Information Center

    Allan, Brent; Leonard, William

    2005-01-01

    The best HIV prevention programs--those that effect change on a multiplicity of levels by changing knowledge, attitudes, and behaviors and that are sustained over time--are also those that place HIV-positive people at the center of program design, implementation, and evaluation.

  15. HIV Prevention for Adolescents: Where Do We Go from Here?

    ERIC Educational Resources Information Center

    Lightfoot, Marguerita

    2012-01-01

    The World Health Organization estimates that 50% of the 30 million HIV infections worldwide occurred in young people between the ages of 15 and 24 years. In the United States, national statistics estimate that almost 40% of new HIV cases occur in youth ages 13-29 (Centers for Disease Control and Prevention, 2011). Therefore, a focus on preventing…

  16. Mothers' Voices: Enhancing Mother-Child Communication for HIV Prevention

    ERIC Educational Resources Information Center

    Silitsky, Cindy; Jones, Sande Gracia

    2004-01-01

    Parents are an important component of HIV prevention efforts for adolescents. The purpose of this study was to work with a community-based organization, Mothers' Voices South Florida, to evaluate the effectiveness of their educational program that teaches mothers how to talk to their children about HIV and safer sexual practices. Questionnaires…

  17. Improving community support for HIV and AIDS prevention through national partnerships.

    PubMed

    Williams, K R; Scarlett, M I; Jimenez, R; Schwartz, B; Stokes-Nielson, P

    1991-01-01

    If the transmission of human immunodeficiency virus (HIV) is to be prevented, the environment in which people live should predispose them to engage in and sustain safe behaviors. Too often in public health, the range of organizations that make up that environment are overlooked, and prevention strategies are limited to familiar medical and public health institutions. Improvement in public health does not occur in isolation, apart from the other institutions of society--and so it is with the HIV-AIDS epidemic. Education; business and labor; religion; government; voluntary, civic, and social organizations; and the media can all serve as facilitators or as barriers to creating the environment--at the national, regional, State, or local level--that will prevent and control the spread of HIV infection and AIDS and support the needs of those already infected. Collectively, they become a comprehensive HIV prevention network with access to and influence on the total public. One of the most significant benefits of this network is the multiplier effect on the limited resources of public health. Therefore, as part of its HIV and AIDS prevention strategy, the Centers for Disease Control (CDC) has developed national partnerships to involve the leadership of business, labor and industry, religious institutions and organizations, and voluntary organizations in HIV and AIDS prevention and service. Some of these partnerships are federally funded, others are not. The national partnership program described in this paper has produced increased resources for HIV education and services and has demonstrated the synergistic benefits resulting from public and private cooperation in addressing the HIV epidemic. PMID:1659715

  18. Advances in HIV treatment and prevention: should treatment optimism lead to prevention pessimism?

    PubMed

    Lert, F

    2000-12-01

    Advances in HIV treatment have changed the natural history of HIV disease and improved the life of infected people. But, paradoxically, the transformation of a lethal disease into a chronic condition has lead many people to pessimism regarding the future of HIV prevention. Post-exposure prophylaxis and prophylaxis of vertical transmission have added new tools, although they do not change the main features of HIV prevention which still relies on safer drug use and safer sex. The role assigned to HIV testing started to change in some countries where it had not been encouraged; however the impact of these changes appears still very limited, except for prevention of vertical transmission. Recent developments should be placed in the whole historical perspective of HIV infection: after the early period of dramatic favourable changes (around 1990), positive changes in attitudes and behaviour have slowed down or even stabilized. Proofs of 'relapse' are, however, still tenuous. The impact of therapeutic changes is combined with the normalization process of HIV infection issues. In the general population, HIV infection seems a more remote personal and social concern and the perception of risk has decreased. The changes in the social context of prevention are more diverse. On one hand, some social norms renewed during the HIV era may have long-lasting effects. The acknowledgement of social and human rights of homosexuals and drug users, stimulated by the AIDS movement, has entered a long-term process and may continue to support preventive behaviours. On the other hand, the exceptionalist alliance which supported and stimulated the HIV policies is weakening. This process might be accelerated by improved therapeutic perspectives. The main challenge is the success of the integration of HIV prevention in broader public health policies (including prevention of STI transmission, family planning, health promotion, etc.) without losing advances in prevention strategies gained in the

  19. "Let Me Help You Help Me": Church-Based HIV Prevention for Young Black Men Who Have Sex With Men.

    PubMed

    Powell, Terrinieka W; Herbert, Ann; Ritchwood, Tiarney D; Latkin, Carl A

    2016-06-01

    The goal of this study was to identify strategies that could yield more inclusive church-based HIV prevention efforts. In-depth interviews were conducted with 30 young Black men who have sex with men (YBMSM) living in Baltimore, Maryland. The sample had an equal number of regular and infrequent church attendees. Nearly one-fourth of the sample was HIV-positive. Interviews were transcribed verbatim and analyzed inductively using a qualitative content analytic approach. Two main recommendations emerged for churches to offer more inclusive HIV prevention efforts: (1) reduce homosexuality stigma by increasing interpersonal and institutional acceptance, and (2) address the sexual health needs of all congregants by offering universal and targeted sexual health promotion. Thus, results support a tiered approached to providing more inclusive church-based HIV prevention efforts. We conclude that Black churches can be a critical access point for HIV prevention among YBMSM and represent an important setting to intervene. PMID:27244189

  20. The context of condom use among young adults in the Philippines: Implications for HIV prevention

    PubMed Central

    Lucea, Marguerite B.; Hindin, Michelle J.; Gultiano, Socorro; Kub, Joan; Rose, Linda

    2012-01-01

    We examine current perceptions and constraints surrounding condom use among young adults in the Philippines to garner a deeper contextual understanding of this aspect of HIV prevention within Filipino society. Through thematic analysis of focus group data, we found three broad themes, all of which included societal and individual barriers to using condoms. The findings may provide insight for similar settings that have strong religious influences on society. To strengthen HIV prevention efforts in such settings, we suggest that the development of strategies to address these constraints in the cultural setting and promote sexual health of young adults is essential. PMID:23394323

  1. Broadly Neutralizing Anti-HIV Antibodies Prevent HIV Infection of Mucosal Tissue Ex Vivo

    PubMed Central

    Scott, Yanille M.; Park, Seo Young

    2015-01-01

    Broadly neutralizing monoclonal antibodies (nAbs) specific for HIV are being investigated for use in HIV prevention. Due to their ability to inhibit HIV attachment to and entry into target cells, nAbs may be suitable for use as topical HIV microbicides. As such, they would present an alternative intervention for individuals who may not benefit from using antiretroviral-based products for HIV prevention. We theorize that nAbs can inhibit viral transmission through mucosal tissue, thus reducing the incidence of HIV infection. The efficacy of the PG9, PG16, VRC01, and 4E10 antibodies was evaluated in an ex vivo human model of mucosal HIV transmission. nAbs reduced HIV transmission, causing 1.5- to 2-log10 reductions in HIV replication in ectocervical tissues and ≈3-log10 reductions in HIV replication in colonic tissues over 21 days. These antibodies demonstrated greater potency in colonic tissues, with a 50-fold higher dose being required to reduce transmission in ectocervical tissues. Importantly, nAbs retained their potency and reduced viral transmission in the presence of whole semen. No changes in tissue viability or immune activation were observed in colonic or ectocervical tissue after nAb exposure. Our data suggest that topically applied nAbs are safe and effective against HIV infection of mucosal tissue and support further development of nAbs as a topical microbicide that could be used for anal as well as vaginal protection. PMID:26596954

  2. An exploratory study of HIV-prevention advocacy by persons in HIV care in Uganda

    PubMed Central

    Tumwine, Christopher; Nannungi, Annet; Ssegujja, Eric; Nekesa, Nicolate; Ssali, Sarah; Atuyambe, Lynn; Ryan, Gery; Wagner, Glenn

    2013-01-01

    To explore how people living with HIV (PLHIV) and in care encourage others to adopt HIV-protective behaviours, we conducted in-depth interviews with a purposive sample of 40 HIV clinic patients in Kampala, Uganda. Content analysis was used to examine the message content, trigger events, and outcomes of HIV-prevention advocacy events initiated by the HIV clients with members of their social networks. The content themes included encouraging specific behaviours, such as HIV testing and treatment, condom use and non-promiscuity, as well as more general cautionary messages about protecting oneself from HIV infection. Common triggers for bringing up HIV-prevention advocacy information in a discussion or conversation included: wanting to prevent the targeted person from ‘falling into the same problems,’ wanting to benefit oneself with regard to avoiding re-infection, out of concern that the target would engage in higher-risk behaviour, due to observed changes in the target’s health, and to convey information after receiving treatment at the clinic. The participants mostly reported positive or neutral responses to these advocacy events; negative responses were rare. Interventions to empower PLHIV to be agents of change could represent a new frontier for HIV prevention. PMID:24910590

  3. The obligation to provide antiretroviral treatment in HIV prevention trials.

    PubMed

    Lo, Bernard; Padian, Nancy; Barnes, Mark

    2007-06-19

    Providing antiretroviral therapy (ART) to participants who seroconvert during HIV prevention trials in developing countries is an ethical expectation. Promising treatment to the few seroconverters widens disparities within a resource-poor country and would be unjust. Such an assurance should be done in a way that also improves access to ART for others in the country. US funds for ART in poor countries from the PEPFAR should be available to all countries that host HIV prevention and clinical trials. PMID:17545698

  4. Behavioral and Biomedical Combination Strategies for HIV Prevention

    PubMed Central

    Bekker, Linda-Gail; Beyrer, Chris; Quinn, Thomas C.

    2012-01-01

    Around 2.5 million people become infected with HIV each year. This extraordinary toll on human life and public health worldwide will only be reversed with effective prevention. What’s more, in the next few years, it is likely at least, that no single prevention strategy will be sufficient to contain the spread of the disease. There is a need for combination prevention as there is for combination treatment, including biomedical, behavioral, and structural interventions. Expanded HIV prevention must be grounded in a systematic analysis of the epidemic’s dynamics in local contexts. Although 85% of HIV is transmitted sexually, effective combinations of prevention have been shown for people who inject drugs. Combination prevention should be based on scientifically derived evidence, with input and engagement from local communities that fosters the successful integration of care and treatment. PMID:22908192

  5. Acceptability, feasibility and challenges of implementing an HIV prevention intervention for people living with HIV/AIDS among healthcare providers in Mozambique: results of a qualitative study.

    PubMed

    Jaiantilal, Prafulta; Gutin, Sarah A; Cummings, Beverley; Mbofana, Francisco; Rose, Carol Dawson

    2015-01-01

    Despite the Mozambique government's efforts to curb human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), national prevalence is 11.5% and support is needed to expand HIV-related services and improve program quality. Positive prevention (PP) programs, which prioritize HIV prevention with people living with HIV and AIDS (PLHIV), have been recognized as an important intervention for preventing new HIV infections. To address this, an evidence-based PP training intervention was implemented with HIV healthcare providers in Mozambique. This study focuses on the acceptability and feasibility of a PP intervention in HIV clinics from the healthcare provider perspective. In-depth interviews were conducted with 31 healthcare providers from three provinces who participated in PP trainings in Mozambique. Interview data were coded using content analysis. Study data suggest that healthcare providers found PP acceptable, feasible to implement in their HIV work in clinic settings, and valued this strategy to improve HIV prevention. The PP training also led providers to feel more comfortable counseling their patients about prevention, with a more holistic approach that included HIV testing, treatment and encouraging PLHIV to live positively. While overall acceptance of the PP training was positive, several barriers to feasibility surfaced in the data. Patient-level barriers included resistance to disclosing HIV status due to fear of stigma and discrimination, difficulty negotiating for condom use, difficulty engaging men in testing and treatment, and the effects of poverty on accessing care. Providers also identified work environment barriers including high patient load, time constraints, and frequent staff turnover. Recognizing PP as an important intervention, healthcare providers should be trained to provide comprehensive prevention, care and treatment for PLHIV. Further work is needed to explore the complex social dynamics and cultural challenges such as

  6. Acceptability, feasibility and challenges of implementing an HIV prevention intervention for people living with HIV/AIDS among healthcare providers in Mozambique: Results of a qualitative study

    PubMed Central

    Jaiantilal, Prafulta; Gutin, Sarah A.; Cummings, Beverley; Mbofana, Francisco; Rose, Carol Dawson

    2015-01-01

    Abstract Despite the Mozambique government's efforts to curb human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), national prevalence is 11.5% and support is needed to expand HIV-related services and improve program quality. Positive prevention (PP) programs, which prioritize HIV prevention with people living with HIV and AIDS (PLHIV), have been recognized as an important intervention for preventing new HIV infections. To address this, an evidence-based PP training intervention was implemented with HIV healthcare providers in Mozambique. This study focuses on the acceptability and feasibility of a PP intervention in HIV clinics from the healthcare provider perspective. In-depth interviews were conducted with 31 healthcare providers from three provinces who participated in PP trainings in Mozambique. Interview data were coded using content analysis. Study data suggest that healthcare providers found PP acceptable, feasible to implement in their HIV work in clinic settings, and valued this strategy to improve HIV prevention. The PP training also led providers to feel more comfortable counseling their patients about prevention, with a more holistic approach that included HIV testing, treatment and encouraging PLHIV to live positively. While overall acceptance of the PP training was positive, several barriers to feasibility surfaced in the data. Patient-level barriers included resistance to disclosing HIV status due to fear of stigma and discrimination, difficulty negotiating for condom use, difficulty engaging men in testing and treatment, and the effects of poverty on accessing care. Providers also identified work environment barriers including high patient load, time constraints, and frequent staff turnover. Recognizing PP as an important intervention, healthcare providers should be trained to provide comprehensive prevention, care and treatment for PLHIV. Further work is needed to explore the complex social dynamics and cultural challenges

  7. [Gender and HIV/AIDS prevention].

    PubMed

    Cianciara, Dorota

    2005-01-01

    The sociocultural gender norms that interfere with vulnerability to HIV/AIDS in global and Polish context are discussed. The issue of gender related HIV/AIDS vulnerability in Poland is underestimated. Existing data on unemployment rate and average wages seems to indicate that socioeconomic status of women in Poland is rather low and create social suspectibility to HIV infection. Some programmatic and policy recommendations to reduce individual risk and vulnerability of women and men are presented. PMID:16433319

  8. African American Women and HIV/AIDS: A National Call for Targeted Health Communication Strategies to Address a Disparity

    PubMed Central

    Arya, Monisha; Behforouz, Heidi L.; Viswanath, Kasisomayajula

    2013-01-01

    Dr Arya is assistant professor of medicine in the section of infectious diseases at the Baylor College of Medicine and a health services researcher at the Houston Center for Quality of Care and Utilization Studies in Houston. Dr Behforouz is assistant professor of medicine at Harvard Medical School, medical and executive director of the Prevention and Access to Care and Treatment Project, and associate physician in the Brigham Internal Medicine Associates at Brigham and Women’s Hospital, Boston. Dr Viswanath is associate professor of society, human development and health at the Harvard School of Public Health and director of the Health Communication Core of the Dana-Farber/Harvard Cancer Center, Boston. At the time of manuscript submission, Dr Arya was a fellow in the division of infectious diseases at Beth Israel Deaconess Medical Center and Harvard Medical School. African American women are disproportionately affected by the HIV/AIDS epidemic in the United States. To address this disparity, the CDC released a call for targeted communication campaigns in African American communities. The mass media is an HIV/AIDS information source used by African Americans, and media initiatives can be cost-effective for delivering HIV prevention messages. Needed is research in communities at risk to determine the messages needed and the preferred formats and channels with which to deliver the messages so that targeted communication campaigns can be part of the multifaceted approach to ending the HIV/AIDS disparity affecting African American women. PMID:19271331

  9. Engineering broadly neutralizing antibodies for HIV prevention and therapy.

    PubMed

    Hua, Casey K; Ackerman, Margaret E

    2016-08-01

    A combination of advances spanning from isolation to delivery of potent HIV-specific antibodies has begun to revolutionize understandings of antibody-mediated antiviral activity. As a result, the set of broadly neutralizing and highly protective antibodies has grown in number, diversity, potency, and breadth of viral recognition and neutralization. These antibodies are now being further enhanced by rational engineering of their anti-HIV activities and coupled to cutting edge gene delivery and strategies to optimize their pharmacokinetics and biodistribution. As a result, the prospects for clinical use of HIV-specific antibodies to treat, clear, and prevent HIV infection are gaining momentum. Here we discuss the diverse methods whereby antibodies are being optimized for neutralization potency and breadth, biodistribution, pharmacokinetics, and effector function with the aim of revolutionizing HIV treatment and prevention options. PMID:26827912

  10. Transgender People and HIV Prevention: What We Know and What We Need to Know, a Call to Action

    PubMed Central

    Grinsztejn, Beatriz; El-Sadr, Wafaa M.

    2016-01-01

    Abstract: Transgender people have been disproportionally affected by HIV, particularly transgender women. Their increased vulnerability to HIV is due to multiple issues, including biological (eg, increased efficiency of HIV transmission through receptive anal sex), epidemiological (eg, increased likelihood of having HIV-infected partners), structural (eg, social stigma limiting employment options), and individual factors (eg, internalized stigma leading to depression and substance use and risk-taking behaviors). There have been limited culturally appropriate HIV prevention interventions for transgender people, with many key prevention studies (eg, the iPrEx PrEP study) enrolling transgender women in a study focusing on men who have sex with men. This has resulted in limited understanding of the optimal ways to decrease transgender people's risk for HIV acquisition. The current supplement of JAIDS is designed to review what is known about HIV prevention for transgender people and to highlight new insights and best practices. The study reviews recent epidemiologic data, the pharmacology of HIV prophylactic agents in individuals who may be using exogenous hormones, and several recent multi-component interventions designed to address the lived experience of transgender people. Additionally, the study reviews the work going on at the NIH to address transgender health in general and HIV prevention in specific, as well as two important papers related to clinical trial design issues and the ethical conduct of research in this frequently disenfranchised population. It is the hope of the HIV Prevention Trials Network (HPTN) that this supplement will promote new knowledge around transgender health and the requisite issues that need to be addressed in order to conduct optimal clinical trials. The ultimate hope is that the information distilled in this supplement will inform investigators, clinicians, and public health officials in order to design further research to develop

  11. Transgender People and HIV Prevention: What We Know and What We Need to Know, a Call to Action.

    PubMed

    Mayer, Kenneth H; Grinsztejn, Beatriz; El-Sadr, Wafaa M

    2016-08-15

    Transgender people have been disproportionally affected by HIV, particularly transgender women. Their increased vulnerability to HIV is due to multiple issues, including biological (eg, increased efficiency of HIV transmission through receptive anal sex), epidemiological (eg, increased likelihood of having HIV-infected partners), structural (eg, social stigma limiting employment options), and individual factors (eg, internalized stigma leading to depression and substance use and risk-taking behaviors). There have been limited culturally appropriate HIV prevention interventions for transgender people, with many key prevention studies (eg, the iPrEx PrEP study) enrolling transgender women in a study focusing on men who have sex with men. This has resulted in limited understanding of the optimal ways to decrease transgender people's risk for HIV acquisition. The current supplement of JAIDS is designed to review what is known about HIV prevention for transgender people and to highlight new insights and best practices. The study reviews recent epidemiologic data, the pharmacology of HIV prophylactic agents in individuals who may be using exogenous hormones, and several recent multi-component interventions designed to address the lived experience of transgender people. Additionally, the study reviews the work going on at the NIH to address transgender health in general and HIV prevention in specific, as well as two important papers related to clinical trial design issues and the ethical conduct of research in this frequently disenfranchised population. It is the hope of the HIV Prevention Trials Network (HPTN) that this supplement will promote new knowledge around transgender health and the requisite issues that need to be addressed in order to conduct optimal clinical trials. The ultimate hope is that the information distilled in this supplement will inform investigators, clinicians, and public health officials in order to design further research to develop optimal

  12. Modeling and Cost-Effectiveness in HIV Prevention.

    PubMed

    Jacobsen, Margo M; Walensky, Rochelle P

    2016-02-01

    With HIV funding plateauing and the number of people living with HIV increasing due to the rollout of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology and then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral- or community-based interventions, prevention of mother-to-child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact. PMID:26830283

  13. Preventing secondary infections among HIV-positive persons.

    PubMed Central

    Filice, G A; Pomeroy, C

    1991-01-01

    Secondary infectious diseases contribute substantially to morbidity and mortality of people infected with human immunodeficiency virus (HIV). The authors developed comprehensive, practical recommendations for prevention of infectious complications in HIV-infected people. Recommendations are concerned with the pathogens that are more common or more severe in HIV-infected people. Several infectious complications can be prevented by avoiding ingestion of contaminated food or water. Zoonoses can be prevented by precautions to be taken in contacts with animals. The risk of several fungal diseases can be reduced if activities likely to lead to inhalation of spores are avoided. HIV-infected people should be advised how to lower adverse health effects of travel, especially international travel. The potential for infectious complications of sexual activity and illicit drug use should be stressed, and recommendations to reduce the risk are discussed. Recommendations for use of vaccines in HIV-infected people are reviewed. Blood CD4+ lymphocyte concentrations, tuberculin skin testing, Toxoplasma serology, and sexually transmitted disease screening should be performed in certain subsets of HIV-infected people. Guidelines for chemoprophylaxis against Pneumocystis carinii and tuberculosis are presented. Recent data suggest that intravenous immunoglobulin therapy may prevent bacterial infections in HIV-infected children. PMID:1910184

  14. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men

    PubMed Central

    McDougal, Sarah J; Sullivan, Patrick S; Stekler, Joanne D; Stephenson, Rob

    2014-01-01

    Background The Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. Objective The purpose of this study is to understand MSM’s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM’s willingness to use an app for HIV prevention. Methods We conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM’s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. Results Participants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be

  15. HIV-1 transmission linkage in an HIV-1 prevention clinical trial

    SciTech Connect

    Leitner, Thomas; Campbell, Mary S; Mullins, James I; Hughes, James P; Wong, Kim G; Raugi, Dana N; Scrensen, Stefanie

    2009-01-01

    HIV-1 sequencing has been used extensively in epidemiologic and forensic studies to investigate patterns of HIV-1 transmission. However, the criteria for establishing genetic linkage between HIV-1 strains in HIV-1 prevention trials have not been formalized. The Partners in Prevention HSV/HIV Transmission Study (ClinicaITrials.gov NCT00194519) enrolled 3408 HIV-1 serodiscordant heterosexual African couples to determine the efficacy of genital herpes suppression with acyclovir in reducing HIV-1 transmission. The trial analysis required laboratory confirmation of HIV-1 linkage between enrolled partners in couples in which seroconversion occurred. Here we describe the process and results from HIV-1 sequencing studies used to perform transmission linkage determination in this clinical trial. Consensus Sanger sequencing of env (C2-V3-C3) and gag (p17-p24) genes was performed on plasma HIV-1 RNA from both partners within 3 months of seroconversion; env single molecule or pyrosequencing was also performed in some cases. For linkage, we required monophyletic clustering between HIV-1 sequences in the transmitting and seroconverting partners, and developed a Bayesian algorithm using genetic distances to evaluate the posterior probability of linkage of participants sequences. Adjudicators classified transmissions as linked, unlinked, or indeterminate. Among 151 seroconversion events, we found 108 (71.5%) linked, 40 (26.5%) unlinked, and 3 (2.0%) to have indeterminate transmissions. Nine (8.3%) were linked by consensus gag sequencing only and 8 (7.4%) required deep sequencing of env. In this first use of HIV-1 sequencing to establish endpoints in a large clinical trial, more than one-fourth of transmissions were unlinked to the enrolled partner, illustrating the relevance of these methods in the design of future HIV-1 prevention trials in serodiscordant couples. A hierarchy of sequencing techniques, analysis methods, and expert adjudication contributed to the linkage

  16. The promise and limitations of cash transfer programs for HIV prevention.

    PubMed

    Fieno, John; Leclerc-Madlala, Suzanne

    2014-01-01

    As the search for more effective HIV prevention strategies continues, increased attention is being paid to the potential role of cash transfers in prevention programming in sub-Saharan Africa. To date, studies testing the impact of both conditional and unconditional cash transfers on HIV-related behaviours and outcomes in sub-Saharan Africa have been relatively small-scale and their potential feasibility, costs and benefits at scale, among other things, remain largely unexplored. This article examines elements of a successful cash transfer program from Latin America and discusses challenges inherent in scaling-up such programs. The authors attempt a cost simulation of a cash transfer program for HIV prevention in South Africa comparing its cost and relative effectiveness--in number of HIV infections averted--against other prevention interventions. If a cash transfer program were to be taken to scale, the intervention would not have a substantial effect on decreasing the force of the epidemic in middle- and low-income countries. The integration of cash transfer programs into other sectors and linking them to a broader objective such as girls' educational attainment may be one way of addressing doubts raised by the authors regarding their value for HIV prevention. PMID:25174632

  17. A review of the Centers for Disease Control and Prevention's response to the HIV/AIDS crisis among Blacks in the United States, 1981-2009.

    PubMed

    Sutton, Madeline Y; Jones, Rhondette L; Wolitski, Richard J; Cleveland, Janet C; Dean, Hazel D; Fenton, Kevin A

    2009-10-01

    Among US racial/ethnic groups, Blacks are at the highest risk of acquiring HIV/AIDS. In response, the Centers for Disease Control and Prevention (CDC) has launched the Heightened National Response to Address the HIV/AIDS Crisis Among African Americans, which seeks to engage public and nonpublic partners in a synergistic effort to prevent HIV among Blacks. The CDC also recently launched Act Against AIDS, a campaign to refocus attention on the domestic HIV/AIDS crisis. Although the CDC's efforts to combat HIV/AIDS among Blacks have achieved some success, more must be done to address this crisis. New initiatives include President Obama's goal of developing a National HIV/AIDS Strategy to reduce HIV incidence, decrease HIV-related health disparities, and increase access to care, especially among Blacks and other disproportionately affected populations. PMID:19797748

  18. Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review.

    PubMed

    Young, Sean D; Swendeman, Dallas; Holloway, Ian W; Reback, Cathy J; Kao, Uyen

    2015-12-01

    Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic. PMID:26475670

  19. The Global Fund's resource allocation decisions for HIV programmes: addressing those in need

    PubMed Central

    2011-01-01

    Background Between 2002 and 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria's investment in HIV increased substantially to reach US$12 billion. We assessed how the Global Fund's investments in HIV programmes were targeted to key populations in relation to disease burden and national income. Methods We conducted an assessment of the funding approved by the Global Fund Board for HIV programmes in Rounds 1-10 (2002-2010) in 145 countries. We used the UNAIDS National AIDS Spending Assessment framework to analyze the Global Fund investments in HIV programmes by HIV spending category and type of epidemic. We examined funding per capita and its likely predictors (HIV adult prevalence, HIV prevalence in most-at-risk populations and gross national income per capita) using stepwise backward regression analysis. Results About 52% ($6.1 billion) of the cumulative Global Fund HIV funding was targeted to low- and low-middle-income countries. Around 56% of the total ($6.6 billion) was channelled to countries in sub-Saharan Africa. The majority of funds were for HIV treatment (36%; $4.3 billion) and prevention (29%; $3.5 billion), followed by health systems and community systems strengthening and programme management (22%; $2.6 billion), enabling environment (7%; $0.9 billion) and other activities. The Global Fund investment by country was positively correlated with national adult HIV prevalence. About 10% ($0.4 billion) of the cumulative HIV resources for prevention targeted most-at-risk populations. Conclusions There has been a sustained scale up of the Global Fund's HIV support. Funding has targeted the countries and populations with higher HIV burden and lower income. Prevention in most-at-risk populations is not adequately prioritized in most of the recipient countries. The Global Fund Board has recently modified eligibility and prioritization criteria to better target most-at-risk populations in Round 10 and beyond. More guidance is being provided for Round 11

  20. HIV prevention in prisons and jails: obstacles and opportunities.

    PubMed Central

    Polonsky, S; Kerr, S; Harris, B; Gaiter, J; Fichtner, R R; Kennedy, M G

    1994-01-01

    High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of injection drug use, and other high-risk behaviors among inmates create a prime opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the opportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have differing approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or segregated by HIV serostatus, and whether condoms, bleach, or clean needles should be made available to the prisoners, are questions hotly debated by public health and correctional officials. Even accurate assessment of risk-taking within the institutions leads to controversy, as asking questions could imply acceptance of the very behaviors correctional officials are trying to prevent. Education and risk-reduction counseling are the least controversial and most widely employed modes of prevention, but the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined. PMID:7938381

  1. A Network-Individual-Resource Model for HIV Prevention

    PubMed Central

    Johnson, Blair T.; Redding, Colleen A.; DiClemente, Ralph J.; Mustanski, Brian S.; Dodge, Brian M.; Sheeran, Paschal; Warren, Michelle R.; Zimmerman, Rick S.; Fisher, William A.; Conner, Mark T.; Carey, Michael P.; Fisher, Jeffrey D.; Stall, Ronald D.; Fishbein, Martin

    2014-01-01

    HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. To optimize prevention efficacy, a complementary theoretical perspective that bridges key individual level elements with important network elements can be a foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks. PMID:20862606

  2. HIV prevention research: taking stock and the way forward.

    PubMed

    Hayes, Richard; Kapiga, Saidi; Padian, Nancy; McCormack, Sheena; Wasserheit, Judith

    2010-10-01

    Previous papers in this supplement have reviewed the evidence of the effectiveness of alternative HIV prevention methods from randomized controlled trials and other studies. This paper draws together the main conclusions from these reviews. A conceptual framework is presented that maps the proximal and distal determinants of sexual HIV transmission and helps to identify the stages in the causal pathway at which each intervention approach acts. The advances, gaps and challenges emerging from the reviews of individual intervention methods are summarized and cross-cutting themes identified. Approximately 90% of HIV prevention trials have found no effect on HIV incidence and we explore the alternative explanations for the large number of 'flat' trials. We conclude that there is no single explanation for these flat results, which may be due to interventions that are ineffective or inappropriately targeted or implemented, or to factors related to the design or conduct of trials. We examine the lessons from these flat results and provide recommendations on what should be done differently in future trials. HIV prevention remains of critical importance in an era of expanded delivery of antiretroviral therapy. In future HIV prevention research, it is important that resources are used as efficiently as possible to provide rigorous evidence of the effectiveness of a wider array of complementary prevention tools. PMID:21042056

  3. HIV PREVENTION RESEARCH: TAKING STOCK AND THE WAY FORWARD

    PubMed Central

    Hayes, Richard; Kapiga, Saidi; Padian, Nancy; McCormack, Sheena; Wasserheit, Judith

    2011-01-01

    Previous papers in this supplement have reviewed the evidence of the effectiveness of alternative HIV prevention methods from randomised controlled trials and other studies. This paper draws together the main conclusions from these reviews. A conceptual framework is presented that maps the proximal and distal determinants of sexual HIV transmission and helps to identify the stages in the causal pathway at which each intervention approach acts. The advances, gaps and challenges emerging from the reviews of individual intervention methods are summarised and cross-cutting themes identified. Approximately 90% of HIV prevention trials have found no effect on HIV incidence and we explore the alternative explanations for the large number of “flat” trials. We conclude that there is no single explanation for these flat results which may be due to interventions that are ineffective or inappropriately targeted or implemented, or to factors related to the design or conduct of trials. We examine the lessons from these flat results and provide recommendations on what should be done differently in future trials. HIV prevention remains of critical importance in an era of expanded delivery of antiretroviral therapy. In future HIV prevention research, it is important that resources are used as efficiently as possible to provide rigorous evidence of the effectiveness of a wider array of complementary prevention tools. PMID:21042056

  4. Translation of biomedical prevention strategies for HIV: Prospects and pitfalls

    PubMed Central

    Vermund, Sten H.; Tique, José A.; Cassell, Holly M.; Johnson, Megan E.; Ciampa, Philip J.; Audet, Carolyn M.

    2013-01-01

    Early achievements in biomedical approaches for HIV prevention included physical barriers (condoms), clean injection equipment (both for medical use and for injection drug users), blood and blood product safety, and prevention of mother to child transmission. In recent years, antiretroviral drugs to reduce risk of transmission (when the infected person takes the medicines; treatment as prevention or TasP) or reduce risk of acquisition (when the seronegative person takes them; pre-exposure prophylaxis or PrEP) have proven efficacious. Circumcision of men has also been a major tool relevant for higher prevalence regions such as sub-Saharan Africa. Well-established prevention strategies in the control of sexually transmitted diseases and tuberculosis are highly relevant for HIV (i.e., screening, linkage to care, early treatment, and contact tracing). Unfortunately, only slow progress is being made in some available HIV prevention strategies such as family planning for HIV-infected women who do not want more children and prevention mother-to-child HIV transmission. Current studies seek to integrate strategies into approaches that combine biomedical, behavioral, and structural methods to achieve prevention synergies. This review identifies the major biomedical approaches demonstrated to be efficacious that are now available. We also highlight the need for behavioral risk reduction and adherence as essential components of any biomedical approach. PMID:23673881

  5. SOMOS: evaluation of an HIV prevention intervention for Latino gay men.

    PubMed

    Vega, Miriam Y; Spieldenner, Andrew R; DeLeon, Dennis; Nieto, Bolivar X; Stroman, Carolyn A

    2011-06-01

    Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these specific issues, a multilayered HIV intervention was designed to incorporate and integrate psychosocial and community factors through multiple session groups, social marketing and community presentations. Participants learned strategies for effective community leadership and were encouraged to provide HIV education and address internalized homophobia in their communities. There were a total of 113 Latino gay male participants. Pretests and post-tests at 90-day follow-up were administered to measure knowledge, attitudes and behaviors related to HIV infection, self-efficacy, internalized homophobia and connectedness (i.e. gay community affiliation and social provisions); a risk index was calculated to measure level of behavioral risk for HIV infection. Participants demonstrated lower risk indices and a decrease in partners at 3 and 6 months after the intervention. There was also an increase in reported social support resources, along with an increase in group identification. Connectedness was a strong predictor of the number of sexual partners at the 90-day follow-up. This homegrown program represents a culturally responsive, highly needed and relevant intervention that should be subjected to further rigorous testing. PMID:21059799

  6. African American Gay Family Networks: An Entry Point for HIV Prevention.

    PubMed

    Horne, Sharon G; Levitt, Heidi M; Sweeney, Kristin Kay; Puckett, Julia A; Hampton, Martavius L

    2015-01-01

    Gay families are constructed support networks that gay, bisexual, and transgender individuals of color form, often in response to societal marginalization and rejection from biological families. Research on these family structures has been scarce, with little focus on the experience of African American gay family networks in the South. The current grounded theory qualitative study focused on the experiences of 10 African American male and transgender individuals between the ages of 18 and 29 from gay families in the Mid-South, and explored the ways these families addressed safe-sex issues and human immunodeficiency virus (HIV) risk prevention. Results revealed that families can play a role in either increasing HIV risk (e.g., ignoring HIV issues, encouraging such unsafe behaviors as exchanging sex for money or drugs, stigmatizing HIV-positive people) or decreasing it (e.g., intensive, family-level prevention efforts at safe-sex practices and family support for HIV treatment adherence). The potential of these family networks for HIV prevention and adherence efforts is considered. PMID:24992185

  7. Same-sex sexual behavior of men in Kenya: Implications for HIV prevention, programs, and policy

    PubMed Central

    Geibel, S.

    2012-01-01

    Unprotected anal sex has long been recognized as a risk factor for HIV transmission among men who have sex with men (MSM). In Africa, however, general denial of MSM existence and associated stigma discouraged research. To address this gap in the literature, partners conducted the first behavioral surveys of MSM in Kenya. The first study was to assess HIV risk among MSM in Nairobi, and the second study a pre-post intervention study of male sex workers in Mombasa. The 2004 behavioral survey of 500 men in Mombasa revealed that MSM were having multiple sexual partners and failed to access appropriate prevention counseling and care at Kenya clinics. A 2006 capture-recapture enumeration in Mombasa estimated that over 700 male sex workers were active, after which a pre-intervention baseline survey of 425 male sex workers was conducted. Awareness of unprotected anal sex as an HIV risk behavior and consistent condom use with clients was low, and use of oil-based lubricants high. Based on this information, peer educators were trained in HIV prevention, basic counseling skills, and distribution of condoms and lubricants. To assess impact of the interventions, a follow-up survey of 442 male sex workers was implemented in 2008. Exposure to peer educators was significantly associated with increased consistent condom use, improved HIV knowledge, and increased use of water-based lubricants. These results have provided needed information to the Government of Kenya and have informed HIV prevention interventions. PMID:24753921

  8. Impact of Mano a Mano Mujer, an HIV Prevention Intervention, on Depressive Symptoms among Chilean Women

    PubMed Central

    Cianelli, Rosina; Lara, Loreto; Villegas, Natalia; Bernales, Margarita; Ferrer, Lilian; Kaelber, Lorena; Peragallo, Nilda

    2012-01-01

    Background Worldwide, an in Chile, the number of women living with HIV is increasing. Depression is considered a factor that interferes with HIV prevention. Depression may reach 41% among low income Chilean women. Depressed people are less willing to participate in behaviors that protect them against HIV. Objectives To analyze the impact of Mano a Mano-Mujer (MM-M) on depressive symptoms among Chilean women. Methods A quasi-experimental design was used to test the impact of MM-M, an HIV prevention intervention. The research was conducted in Santiago- Chile, a total of 400 women participated in the study (intervention group, n = 182; control group, n = 218). The intervention was guided by the social-cognitive model and the primary health model. The intervention consists of six two-hour sessions delivered in small groups. Sessions covered: HIV prevention, depression, partner's communication, and substance abuse. Face to face interviews were conducted at baseline and at 3 months follow-up Results At 3 months post-intervention, Chilean women who participated in MM-M significantly decreased their reported depressive symptoms. Conclusions MM-M provided significant benefits for women's depression symptoms. This study offers a model that address depression, a risk factor for HIV. It uses nurses as leaders for the screening of depressive symptoms and as facilitators of community interventions. PMID:22452388

  9. Incarceration of people living with HIV/AIDS: Implications for Treatment-As-Prevention

    PubMed Central

    Milloy, M-J; Montaner, Julio S.G.; Wood, Evan

    2015-01-01

    Contact with the criminal justice system, including incarceration, is a common experience for many people living with HIV/AIDS. Optimism has recently been expressed that correctional facilities could be important locations for Treatment-as-Prevention (TasP)-based initiatives. We review recent findings regarding the effect of incarceration on patterns of HIV transmission, testing, treatment initiation and retention. We found that the prevalence of HIV infection among incarcerated individuals remains higher than analogous non-incarcerated populations. Recent studies have shown that voluntary HIV/AIDS testing is feasible in many correctional facilities, although the number of previously undiagnosed individuals identified has been modest. Studies have implied enhanced linkage to HIV/AIDS treatment and care in jails in the United States was associated with improvements in the HIV cascade of care. However, for many individuals living with HIV/AIDS, exposure to the correctional system remains an important barrier to retention in HIV/AIDS treatment and care. Future research should evaluate structural interventions to address these barriers and facilitate the scale-up of TasP-based efforts among individuals living in correctional settings. PMID:24962285

  10. Access to HIV prevention services among gender based violence survivors in Tanzania

    PubMed Central

    Mboya, Beati; Temu, Florence; Awadhi, Bayoum; Ngware, Zubeda; Ndyetabura, Elly; Kiondo, Gloria; Maridadi, Janneth

    2012-01-01

    Introduction Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. Methods In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Salaam regions to represent rural and urban settings respectively. Questionnaires were administered to 283 randomly selected survivors and 37 health providers while 28 in-depth interviews and 16 focus group discussions were conducted among various stakeholders. Quantitative data was analyzed in SPSS by comparing descriptive statistics while qualitative data was analyzed using thematic framework approach. Results Counseling and testing was the most common type of HIV prevention services received by GBV survivors (29%). Obstacles for HIV prevention among GBV survivors included: stigma, male dominance culture and fear of marital separation. Bribery in service delivery points, lack of confidentiality, inadequate GBV knowledge among health providers, and fear of being involved in legal matters were mentioned to be additional obstacles to service accessibility by survivors. Reported consequences of GBV included: psychological problems, physical trauma, chronic illness, HIV infection. Conclusion GBV related stigma and cultural norms are obstacles to HIV services accessibility. Initiation of friendly health services, integration of GBV into HIV services and community based interventions addressing GBV related stigma and cultural norms are recommended. PMID:23467278

  11. 77 FR 23733 - CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-20

    ...) Enhancing Hepatitis Prevention Treatment and Care in the United States; (2) Integrating HIV Prevention and..., CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road,...

  12. Effectiveness of Community Dialogue in Changing Gender and Sexual Norms for HIV Prevention: Evaluation of the Tchova Tchova Program in Mozambique

    PubMed Central

    Figueroa, Maria Elena; Poppe, Patricia; Carrasco, Maria; Pinho, Maria Dirce; Massingue, Felisberto; Tanque, Maria; Kwizera, Amata

    2016-01-01

    Structural HIV prevention interventions have gained prominence as ways to address underlying social and cultural factors that fuel the HIV epidemic. Identifying theories that explain how structural interventions are expected to change such factors can substantially increase their success. The Tchova Tchova community dialogue program, a theory-based intervention implemented in 2009–2010 in the provinces of Zambezia and Sofala, Mozambique, aimed to change gender and sexual norms for HIV prevention. Through facilitated sessions, the program sparked critical thinking and open dialogue among participants. This article measures the program’s effectiveness based on a sample of 462 participants and 453 nonparticipants. The results show that the program was successful in producing changes in three of the underlying structural factors of HIV: gender attitudes, gender roles, and HIV stigma. The program was also successful in changing other factors associated with HIV infection, including HIV prevention knowledge, discussion of HIV between sex partners, and having multiple sex partners. PMID:27123984

  13. Effectiveness of Community Dialogue in Changing Gender and Sexual Norms for HIV Prevention: Evaluation of the Tchova Tchova Program in Mozambique.

    PubMed

    Figueroa, Maria Elena; Poppe, Patricia; Carrasco, Maria; Pinho, Maria Dirce; Massingue, Felisberto; Tanque, Maria; Kwizera, Amata

    2016-05-01

    Structural HIV prevention interventions have gained prominence as ways to address underlying social and cultural factors that fuel the HIV epidemic. Identifying theories that explain how structural interventions are expected to change such factors can substantially increase their success. The Tchova Tchova community dialogue program, a theory-based intervention implemented in 2009-2010 in the provinces of Zambezia and Sofala, Mozambique, aimed to change gender and sexual norms for HIV prevention. Through facilitated sessions, the program sparked critical thinking and open dialogue among participants. This article measures the program's effectiveness based on a sample of 462 participants and 453 nonparticipants. The results show that the program was successful in producing changes in three of the underlying structural factors of HIV: gender attitudes, gender roles, and HIV stigma. The program was also successful in changing other factors associated with HIV infection, including HIV prevention knowledge, discussion of HIV between sex partners, and having multiple sex partners. PMID:27123984

  14. Vaginal microbicides and the prevention of HIV transmission

    PubMed Central

    Cutler, Blayne; Justman, Jessica

    2009-01-01

    Worldwide, nearly half of all individuals living with HIV are now women, who acquire the virus largely by heterosexual exposure. With an HIV vaccine likely to be years away, topical microbicide formulations applied vaginally or rectally are being investigated as another strategy for HIV prevention. A review of preclinical and clinical research on the development of microbicides formulated to prevent vaginal HIV transmission yielded 118 studies: 73 preclinical and 45 clinical. Preclinical research included in-vitro assays and cervical explant models, as well as animal models. Clinical research included phase I and II/IIb safety studies, and phase III efficacy studies. Whereas most phase I and phase II clinical trials have found microbicide compounds to be safe and well tolerated, phase III trials completed to date have not demonstrated efficacy in preventing HIV transmission. Topical microbicides are grouped into five classes of agents, based on where they disrupt the pathway of sexual transmission of HIV. These classes include surfactants/membrane disruptors, vaginal milieu protectors, viral entry inhibitors, reverse transcriptase inhibitors, and a fifth group whose mechanism is unknown. The trajectory of microbicide development has been toward agents that block more specific virus—host cell interactions. Microbicide clinical trials face scientifically and ethically complex issues, such as the choice of placebo gel, the potential for viral resistance, and the inclusion of HIV-infected participants. Assessment of combination agents will most likely advance this field of research. PMID:18992405

  15. Paediatric HIV: Progress on Prevention, Treatment and Cure

    PubMed Central

    Kim, Maria H; Ahmed, Saeed; Abrams, Elaine J.

    2015-01-01

    Purpose of review This review provides an update on current developments with prevention, treatment and cure strategies in the field of pediatric HIV. Recent findings/Summary There has been tremendous progress in the prevention and treatment of pediatric HIV infection. With new strategies for prevention of mother-to-child transmission, we are growing ever closer towards elimination of pediatric HIV, though challenges with retention of pregnant woman and their HIV-exposed infants remain. Ongoing vigilance regarding the potential hazards of in utero ART exposure to infants continues with no significant alarms yet identified. Though cure has not been achieved, evidence of the impact of early treatment on reducing HIV-1 reservoir size with subsequent prolonged remission has enlivened efforts to rapidly identify and treat HIV-infected newborns. There is an increasing array of treatment options for pediatric patients and reassuring evidence regarding long-term complications of ART. Unfortunately, despite evidence suggesting the benefit of early treatment, timely identification and treatment of children remains a challenge. Better strategies for effective case-finding and engagement in care are urgently needed in addition to an improved understanding of how to retain HIV-positive children and adolescents on treatment. However, further emboldened by recent international commitments and robust global support, the future is hopeful. PMID:26709366

  16. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials.

    PubMed

    Phanuphak, Nittaya; Lo, Ying-Ru; Shao, Yiming; Solomon, Sunil Suhas; O'Connell, Robert J; Tovanabutra, Sodsai; Chang, David; Kim, Jerome H; Excler, Jean Louis

    2015-11-01

    An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process. PMID:26107771

  17. A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention

    PubMed Central

    Tomori, Cecilia; Risher, Kathryn; Limaye, Rupali J.; Lith, Lynn Van; Gibbs, Susannah; Smelyanskaya, Marina; Celentano, David D.

    2015-01-01

    Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum in order to evaluate the efficacy of communication components on treatment outcomes. PMID:25007201

  18. A role for health communication in the continuum of HIV care, treatment, and prevention.

    PubMed

    Tomori, Cecilia; Risher, Kathryn; Limaye, Rupali J; Van Lith, Lynn M; Gibbs, Susannah; Smelyanskaya, Marina; Celentano, David D

    2014-08-15

    : Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision, and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum to evaluate the efficacy of communication components on treatment outcomes. PMID:25007201

  19. Addressing Disparities in Stroke Prevention for Atrial Fibrillation: Educational Opportunities.

    PubMed

    Karcher, Rachel; Berman, Adam E; Gross, Hartmut; Hess, David C; Jauch, Edward C; Viser, Paul E; Solenski, Nina J; Wolf, Andrew M D

    2016-07-01

    Disparities in atrial fibrillation (AF)-related stroke and mortality persist, especially racial disparities, within the US "Stroke Belt." This study identified barriers to optimal stroke prevention to develop a framework for clinician education. A comprehensive educational needs assessment was developed focusing on clinicians within the Stroke Belt. The mixed qualitative-quantitative approach included regional surveys and one-on-one clinician interviews. Identified contributors to disparities included implicit racial biases, lack of awareness of racial disparities in AF stroke risk, and lack of effective multicultural awareness and training. Additional barriers affecting disparities included patient medical mistrust and clinician-patient communication challenges. General barriers included lack of consistency in assessing stroke and anticoagulant-related bleeding risk, underuse of standardized risk assessment tools, discomfort with novel anticoagulants, and patient education deficiencies. Effective cultural competency training is one strategy to reduce disparities in AF-related stroke and mortality by improving implicit clinician bias, addressing medical mistrust, and improving clinician-patient communication. PMID:25788477

  20. Antiretroviral-based HIV prevention strategies for women

    PubMed Central

    Chirenje, Z Mike; Marrazzo, Jeanne; Parikh, Urvi M.

    2015-01-01

    Almost three decades have elapsed since researchers identified HIV as the cause of AIDS, with current estimates from UNAIDS that 33.4 million adults were living with HIV/AIDS in 2008. Two-thirds of this burden of disease is in Sub-Saharan Africa, and 60% of those infected are women. The disease still remains incurable and current prevention strategies including abstinence, male/female condom use and male circumcision are only partially effective. New strategies to curb the epidemic are urgently needed. Scientists are diligently exploring HIV prevention methods that are safe, effective and affordable. These new biological interventions include oral pre- exposure prophylaxis using oral antiretroviral (ARV) drugs, ARV treatment in HIV-infected persons to reduce transmission and topical ARV-based microbicide formulations. PMID:20954882

  1. Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study

    PubMed Central

    2010-01-01

    Background A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India. Methods Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants. Results In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services. Conclusions One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV. PMID:20403152

  2. Unheard Voices: The Need for HIV Research and Prevention Priorities for YMSM in the Global Context.

    PubMed

    Hall, Casey D; Murdock, Daniel; Nehl, Eric J; Wong, Frank Y

    2016-06-01

    This commentary considers the AIDS Education and Prevention special issue (volume 28, number 3) entitled "Behavioral HIV Prevention Interventions for Diverse Young Men Who Have Sex with Men (MSM)." The research presented in this special issue highlights the importance of addressing sub-populations of young MSM in order to better understand the unique realities and risk-factors affecting HIV epidemics and intervention needs. Here, we focus on several broad topics raised in this special issue and comment on their implications for HIV research and practice targeting young MSM in low- and middle-income countries. We consider issues relevant to reaching hidden populations, tailoring interventions, and integrating new communications and bio-medical technologies in research and practice in low-resource settings. PMID:27244194

  3. Brief Report: Rethinking Data Collection for HIV Prevention Trials.

    PubMed

    Harel, Ofer; Nazzaro, Valerie

    2016-08-01

    There is a strong push to conduct large-scale randomized controlled study designs in HIV prevention studies. In these randomized controlled studies, the primary research objective is typically to determine the treatment effect based on some biological outcome (eg, HIV infection). But many unused self-reported outcomes are also being collected. We illustrate the extent of this problem using the EXPLORE data as an example. PMID:27031292

  4. HIV prevention with male prostitutes and patrons of hustler bars: replication of an HIV preventive intervention.

    PubMed

    Miller, R L; Klotz, D; Eckholdt, H M

    1998-02-01

    The core objectives of this study were to document the process by which a community-based organization replicated and adapted an experimentally developed intervention to its own use and to explore the effectiveness of that HIV prevention program for male prostitutes and other patrons in New York City "hustler" bars. The intervention model employed was based on previous research with gay men (Kelly, St. Lawrence, Diaz, et al., 1991; Kelly, St. Lawrence, Stevenson, et al., 1992) and inspired by diffusion of innovation theory (Rogers, 1995). The effects of the current intervention were assessed on a sample of 1,741 male prostitutes and bar patrons. Analyses indicated significant reductions in paid, unprotected sexual intercourse and oral sex following the intervention. Analyses further indicated that the data were partially consistent with the program's model, which specified that norms were the putative mediator of behavior change in the intervention. Also, the intervention's effects varied by bar and by participants' race/ethnicity. Data support the utility of the intervention model for an urban sample of men at high risk for HIV infection. The importance of exploring the mechanisms that underlie the intervention is discussed. PMID:9574500

  5. Reframing HIV prevention for gay men in the United States.

    PubMed

    Halkitis, Perry N

    2010-11-01

    The HIV epidemic in the United States has affected at least two generations of gay men. Despite numerous efforts to intervene on this public health crisis, HIV infections continue to escalate, especially among young men. This condition is compounded by an ever-growing number of gay men who are aging and living with HIV. We must enact an innovative and proactive vision and framework for HIV prevention that moves us beyond the undertakings rooted in social-cognitive paradigms that have informed this work for the past 25 years. A new framework for HIV prevention must give voice to gay men; must consider the totality of their lives; must delineate the underlying logic, which directs their relation to sex and HIV; and must concurrently respect their diverse life experiences. This approach should be rooted in a biopsychosocial paradigm, should be informed by both theory and practice, and should be directed by three theoretical lenses--a theory of syndemics, developmental theories, and contextual understandings of HIV disease. Taken together, these elements are a call to action for research and practice psychologists who are working to improve the lives of gay men. PMID:21058777

  6. Collective efficacy and HIV prevention in South African townships

    PubMed Central

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

    2013-01-01

    South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community’s ability to prevent HIV and their personal HIV risk behaviors. Men (n=1581) and women (n=718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV. PMID:23660646

  7. Perspectives on the ethical concerns and justifications of the 2006 Centers for Disease Control and Prevention HIV testing: HIV screening policy changes

    PubMed Central

    2013-01-01

    Background The 2006 Centers for Disease Control and Prevention (CDC) revised recommendations for HIV testing in clinical settings contained seven specific changes to how health care facilities should provide HIV testing. These seven elements have been both supported and challenged in the lay and medical literature. Our first paper in BMC Medical Ethics presented an analysis of the three HIV testing procedural changes included in the recommendations. In this paper, we address the four remaining elements that concern HIV screening policy changes: (1) nontargeted HIV screening, (2) making HIV screening similar to screening for other treatable conditions, (3) increasing HIV screening without assured additional funding for linkage to care, and (4) making patients bear the costs of increased HIV screening in health care settings. Methods We interviewed 25 members from the fields of US HIV advocacy, care, policy, and research about the ethical merits and demerits of the four changes to HIV screening policies. We performed a qualitative analysis of the participant responses in the interviews and summarized the major themes. Results Participants commented that nontargeted HIV screening and making HIV screening similar to screening for other treatable medical conditions was ethical when it broadened the scope of people being tested for HIV. However, they believed it was unethical when it did not respect the exceptional nature of HIV and HIV testing. Some participants favored more testing regardless if there was assured additional funding for linkage to care or if patients might bear the costs of testing because they believed that merely alerting patients of their status was beneficial and would lead to positive consequences. Other participants found ethical flaws with testing without assured linkage to care and patients bearing the costs of testing, as this could discriminate against those who could not pay. Conclusions Our findings suggest that there are fundamental ethical

  8. The Global HIV Archive: Facilitating the Transition from Science to Practice of Efficacious HIV Prevention Interventions*

    PubMed Central

    Card, Josefina J.; Newman, Emily N.; Golden, Rachel E.; Kuhn, Tamara; Lomonaco, Carmela

    2014-01-01

    This paper describes the development, content, and capabilities of the online Global HIV Archive (GHA). With the goal of facilitating widespread adaptation and appropriate use of efficacious HIV prevention programs throughout the globe, GHA has: first, expanded and updated the search for HIV prevention programs originating in low-resource countries; second, identified those meritorious HIV prevention programs meeting established efficacy criteria of technical merit, replicability, and positive outcomes; third, prepared both implementation and evaluation materials from the efficacious programs for public use; fourth, developed interactive wizards or capacity-building tools to facilitate appropriate program selection, implementation, and adaptation; and, fifth, made the efficacious programs and accompanying wizards available to health practitioners throughout the globe in both printed and online formats. PMID:24563820

  9. mHealth for HIV Treatment & Prevention: A Systematic Review of the Literature

    PubMed Central

    Catalani, Caricia; Philbrick, William; Fraser, Hamish; Mechael, , Patricia; Israelski, Dennis M.

    2013-01-01

    This systematic review assesses the published literature to describe the landscape of mobile health technology (mHealth) for HIV/AIDS and the evidence supporting the use of these tools to address the HIV prevention, care, and treatment cascade. The speed of innovation, broad range of initiatives and tools, and heterogeneity in reporting have made it difficult to uncover and synthesize knowledge on how mHealth tools might be effective in addressing the HIV pandemic. To do address this gap, a team of reviewers collected literature on the use of mobile technology for HIV/AIDS among health, engineering, and social science literature databases and analyzed a final set of 62 articles. Articles were systematically coded, assessed for scientific rigor, and sorted for HIV programmatic relevance. The review revealed evidence that mHealth tools support HIV programmatic priorities, including: linkage to care, retention in care, and adherence to antiretroviral treatment. In terms of technical features, mHealth tools facilitate alerts and reminders, data collection, direct voice communication, educational messaging, information on demand, and more. Studies were mostly descriptive with a growing number of quasi-experimental and experimental designs. There was a lack of evidence around the use of mHealth tools to address the needs of key populations, including pregnant mothers, sex workers, users of injection drugs, and men who have sex with men. The science and practice of mHealth for HIV are evolving rapidly, but still in their early stages. Small-scale efforts, pilot projects, and preliminary descriptive studies are advancing and there is a promising trend toward implementing mHealth innovation that is feasible and acceptable within low-resource settings, positive program outcomes, operational improvements, and rigorous study design PMID:24133558

  10. Shifting the HIV Training and Research Paradigm to Address Disparities in HIV Outcomes.

    PubMed

    Levison, Julie H; Alegría, Margarita

    2016-09-01

    Tailored programs to diversify the pool of HIV/AIDS investigators and provide sufficient training and support for minority investigators to compete successfully are uncommon in the US and abroad. This paper encourages a shift in the HIV/AIDS training and research paradigm to effectively train and mentor Latino researchers in the US, Latin America and the Caribbean. We suggest three strategies to accomplish this: (1) coaching senior administrative and academic staff of HIV/AIDS training programs on the needs, values, and experiences unique to Latino investigators; (2) encouraging mentors to be receptive to a different set of research questions and approaches that Latino researchers offer due to their life experiences and perspectives; and (3) creating a virtual infrastructure to share resources and tackle challenges faced by minority researchers. Shifts in the research paradigm to include, retain, and promote Latino HIV/AIDS researchers will benefit the scientific process and the patients and communities who await the promise of HIV/AIDS research. PMID:27501811

  11. Rethinking HIV prevention to prepare for oral PrEP implementation for young African women

    PubMed Central

    Celum, Connie L; Delany-Moretlwe, Sinead; McConnell, Margaret; van Rooyen, Heidi; Bekker, Linda-Gail; Kurth, Ann; Bukusi, Elizabeth; Desmond, Chris; Morton, Jennifer; Baeten, Jared M

    2015-01-01

    Introduction HIV incidence remains high among young women in sub-Saharan Africa in spite of scale-up of HIV testing, behavioural interventions, antiretroviral treatment and medical male circumcision. There is a critical need to critique past approaches and learn about the most effective implementation of evidence-based HIV prevention strategies, particularly emerging interventions such as pre-exposure prophylaxis (PrEP). Discussion Women in sub-Saharan Africa are at increased risk of HIV during adolescence and into their 20s, in part due to contextual factors including gender norms and relationship dynamics, and limited access to reproductive and sexual health services. We reviewed behavioural, behavioural economic and biomedical approaches to HIV prevention for young African women, with a particular focus on the barriers, opportunities and implications for implementing PrEP in this group. Behavioural interventions have had limited impact in part due to not effectively addressing the context, broader sexual norms and expectations, and structural factors that increase risk and vulnerability. Of biomedical HIV prevention strategies that have been tested, daily oral PrEP has the greatest evidence for protection, although adherence was low in two placebo-controlled trials in young African women. Given high efficacy and effectiveness in other populations, demonstration projects of open-label PrEP in young African women are needed to determine the most effective delivery models and whether women at substantial risk are motivated and able to use oral PrEP with sufficient adherence to achieve HIV prevention benefits. Conclusions Social marketing, adherence support and behavioural economic interventions should be evaluated as part of PrEP demonstration projects among young African women in terms of their effectiveness in increasing demand and optimizing uptake and effective use of PrEP. Lessons learned through evaluations of implementation strategies for delivering oral Pr

  12. Addressing HIV in the School Setting: Application of a School Change Model

    ERIC Educational Resources Information Center

    Walsh, Audra St. John; Chenneville, Tiffany

    2013-01-01

    This paper describes best practices for responding to youth with human immunodeficiency virus (HIV) in the school setting through the application of a school change model designed by the World Health Organization. This model applies a whole school approach and includes four levels that span the continuum from universal prevention to direct…

  13. Preventing HIV Among U.S. Women of Color With Severe Mental Illness: Perceptions of Mental Health Care Providers Working in Urban Community Clinics

    PubMed Central

    Agénor, Madina; Collins, Pamela Y.

    2013-01-01

    Given their knowledge of the behavioral issues related to psychiatric illness, mental health care providers are in a unique position to help prevent HIV among women with severe mental illness (SMI). We conducted in-depth interviews with providers at two New York City community clinics. We identified three major, interrelated themes pertaining to HIV prevention among women of color with SMI. Interventions that address the barriers that clinicians face in discussing sex, sexuality, and HIV with patients and train providers in the cultural considerations of cross-cultural mental health care are needed to help prevent HIV among women of color with SMI. PMID:23394326

  14. Inhibition of Heat Shock Protein 90 Prevents HIV Rebound.

    PubMed

    Joshi, Pheroze; Maidji, Ekaterina; Stoddart, Cheryl A

    2016-05-01

    HIV evades eradication because transcriptionally dormant proviral genomes persist in long-lived reservoirs of resting CD4(+) T cells and myeloid cells, which are the source of viral rebound after cessation of antiretroviral therapy. Dormant HIV genomes readily produce infectious virus upon cellular activation because host transcription factors activated specifically by cell stress and heat shock mediate full-length HIV transcription. The molecular chaperone heat shock protein 90 (Hsp90) is overexpressed during heat shock and activates inducible cellular transcription factors. Here we show that heat shock accelerates HIV transcription through induction of Hsp90 activity, which activates essential HIV-specific cellular transcription factors (NF-κB, NFAT, and STAT5), and that inhibition of Hsp90 greatly reduces gene expression mediated by these factors. More importantly, we show that Hsp90 controls virus transcription in vivo by specific Hsp90 inhibitors in clinical development, tanespimycin (17-(allylamino)-17-demethoxygeldanamycin) and AUY922, which durably prevented viral rebound in HIV-infected humanized NOD scid IL-2Rγ(-/-) bone marrow-liver-thymus mice up to 11 weeks after treatment cessation. Despite the absence of rebound viremia, we were able to recover infectious HIV from PBMC with heat shock. Replication-competent virus was detected in spleen cells from these nonviremic Hsp90 inhibitor-treated mice, indicating the presence of a tissue reservoir of persistent infection. Our novel findings provide in vivo evidence that inhibition of Hsp90 activity prevents HIV gene expression in replication-competent cellular reservoirs that would typically cause rebound in plasma viremia after antiretroviral therapy cessation. Alternating or supplementing Hsp90 inhibitors with current antiretroviral therapy regimens could conceivably suppress rebound viremia from persistent HIV reservoirs. PMID:26957545

  15. Inhibition of Heat Shock Protein 90 Prevents HIV Rebound*

    PubMed Central

    Joshi, Pheroze; Maidji, Ekaterina; Stoddart, Cheryl A.

    2016-01-01

    HIV evades eradication because transcriptionally dormant proviral genomes persist in long-lived reservoirs of resting CD4+ T cells and myeloid cells, which are the source of viral rebound after cessation of antiretroviral therapy. Dormant HIV genomes readily produce infectious virus upon cellular activation because host transcription factors activated specifically by cell stress and heat shock mediate full-length HIV transcription. The molecular chaperone heat shock protein 90 (Hsp90) is overexpressed during heat shock and activates inducible cellular transcription factors. Here we show that heat shock accelerates HIV transcription through induction of Hsp90 activity, which activates essential HIV-specific cellular transcription factors (NF-κB, NFAT, and STAT5), and that inhibition of Hsp90 greatly reduces gene expression mediated by these factors. More importantly, we show that Hsp90 controls virus transcription in vivo by specific Hsp90 inhibitors in clinical development, tanespimycin (17-(allylamino)-17-demethoxygeldanamycin) and AUY922, which durably prevented viral rebound in HIV-infected humanized NOD scid IL-2Rγ−/− bone marrow-liver-thymus mice up to 11 weeks after treatment cessation. Despite the absence of rebound viremia, we were able to recover infectious HIV from PBMC with heat shock. Replication-competent virus was detected in spleen cells from these nonviremic Hsp90 inhibitor-treated mice, indicating the presence of a tissue reservoir of persistent infection. Our novel findings provide in vivo evidence that inhibition of Hsp90 activity prevents HIV gene expression in replication-competent cellular reservoirs that would typically cause rebound in plasma viremia after antiretroviral therapy cessation. Alternating or supplementing Hsp90 inhibitors with current antiretroviral therapy regimens could conceivably suppress rebound viremia from persistent HIV reservoirs. PMID:26957545

  16. Preventing HIV Transmission in Nigeria: Role of the Dentists

    PubMed Central

    Azodo, Clement Chinedu; Ehizele, Adebola Oluyemisi; Umoh, Agnes; Ogbebor, Gabriel

    2010-01-01

    Background: As healthcare providers, dentists are in a unique position to foster behavioural changes that are needed to stem the spread of HIV infection. This study was conducted to assess the role of dentists in the prevention of HIV transmission in Nigeria. Methods: This descriptive cross-sectional survey was conducted from June 2006 to January 2007. A multi-stage sampling technique was used to select 300 practising dentists from all parts of Nigeria. Data were collected through a self-administered questionnaire that focused on dentist demographic details, attitudes towards treating HIV-infected persons, involvement in public or clinic-based patient education on HIV and infection control. Results: Two hundred and fifty-seven questionnaires were returned completed, constituting an 86% response rate. The majority of respondents (77.8%) had their dental practice in the southern part of Nigeria, and 89% were in the age bracket of 21–40 years. HIV education by dentists was ranked as poor, as less than a quarter of respondents routinely educated patients on HIV in the clinic. Only a few dentists (33.3%) were involved in public enlightenment programme on HIV in the previous 12 months. Most of the respondents (93%) reported a willingness to treat HIV-infected patients while observing universal precautions. Good infection barrier practices were adopted by 89.9% of dentists, and disposable cartridges for local anaesthetic agents and dental needles were not reused by 93.4% of the respondents. Autoclaving was the most widely used sterilization method (73.2%), but less than half of the respondents knew how to ascertain whether sterilization was effective. Conclusion: This study revealed that efforts by Nigerian dentists to prevent HIV transmission are presently less than optimal. Therefore, there is a need for sensitisation and motivation through seminars, workshops and lectures. PMID:22135532

  17. Components of Quality HIV/STD Prevention & Human Sexuality Education. Report of the HIV/STD Prevention & Human Sexuality Education Task Force.

    ERIC Educational Resources Information Center

    Florida State Dept. of Health and Rehabilitative Services, Tallahassee.

    This report sets forth the essential components of quality HIV/STD prevention and human sexuality education as determined by the HIV/STD Prevention and Human Sexuality Education Task Force. The first part of the report presents the purpose of the task force, background on Florida legislation on HIV/AIDS and sexuality education as part of…

  18. HIV prevention outreach in commercial gay venues in large cities: evaluation findings from London.

    PubMed

    Bonell, Chris; Strange, V; Allen, E; Barnett-Page, E

    2006-08-01

    Human immunodeficiency virus (HIV) prevention delivered in gay venues in US cities has been found to be effective in reducing HIV transmission in the 1990s but effects might not be generalizable to different times and settings. Doubts have been raised about: outreach's ability to address skills and explore personal behaviour; big-city commercial gay venues being appropriate sites for outreach because of gossip and social surveillance; and acceptability of outreach by professionals rather than 'popular opinion formers'. We evaluated coverage, feasibility, acceptability and perceived impact of venue-based HIV prevention outreach by professionals in London, employing observation, surveys and interviews with venue-users, and focus groups/semi-structured interviews with workers. We found high coverage especially among target groups. Addressing negotiation skills and personal behaviour was feasible but required worker motivation and skill. Social surveillance rarely impeded work. Gay men generally found outreach acceptable and useful, and professionals were not regarded negatively. Impact on knowledge was commonly reported; impacts on negotiation skills and reflection on personal behaviour were more common among men experiencing longer contacts. In conclusion, professional HIV prevention outreach in gay venues in large cities is a feasible and acceptable intervention with significant potential impacts. Workers need to be well briefed and trained to maximize impact. PMID:16306218

  19. Exploring the influence of social determinants on HIV risk behaviors and the potential application of structural interventions to prevent HIV in women

    PubMed Central

    Edwards, Arlene E.; Collins, Charles B.

    2016-01-01

    When seeking to prevent HIV/AIDS in women, attending to aspects of their lived experience provides opportunities to address the presence of social determinants in prevention strategies. According to the CDC, in 2010, the rate of new HIV infections among Black women was 20 times that of White women, while among Hispanic/Latino women it was 4 times the rate of White women. Additionally, 86% of HIV infections in women were attributed to heterosexual contact and 14% to injection drug use. The WHO indicates that worldwide, 49% of individuals infected by HIV are women, with a predominant source of infection tied to heterosexual transmission. This paper presents social determinants as influential factors in terms of women’s sexual behavior decision-making, along with suggested structural interventions to address the social determinants of their HIV risks. Secondary analysis was conducted on data from an earlier study (Abdul-Quader and Collins, 2011) which used concept-mapping to examine the feasibility, evaluability, and sustainability of structural interventions for HIV prevention. The current analysis focused on structural interventions applicable to women and their HIV prevention needs. Three themes emerged: economic interventions, responses to violence against women, and integrated health service delivery strategies. The themes provide a foundation for next steps regarding research, policy planning, and intervention implementation that is inclusive of women’s lived experience. The paper concludes with suggestions such as attention to innovative projects and a paradigm shift regarding policy planning as key next steps towards HIV prevention that reflects the contextual complexity of women’s lived experiences. PMID:27134801

  20. Paying for Prevention: Challenges to Health Insurance Coverage for Biomedical HIV Prevention in the United States

    PubMed Central

    Underhill, Kristen

    2014-01-01

    Reducing the incidence of HIV infection continues to be a crucial public health priority in the United States, especially among populations at elevated risk such as men who have sex with men, transgender women, people who inject drugs, and racial and ethnic minority communities. Although most HIV prevention efforts to date have focused on changing risky behaviors, the past decade has yielded efficacious new biomedical technologies designed to prevent infection, such as the prophylactic use of antiretroviral drugs and the first indications of an efficacious vaccine. Access to prevention technologies will be a significant part of the next decade’s response to HIV, and advocates are mobilizing to achieve more widespread use of these interventions. These breakthroughs, however, arrive at a time of escalating healthcare costs; health insurance coverage therefore raises pressing new questions about priority-setting and the allocation of responsibility for public health. The goals of this Article are to identify legal challenges and potential solutions for expanding access to biomedical HIV prevention through health insurance coverage. This Article discusses the public policy implications of HIV prevention coverage decisions, assesses possible legal grounds on which insurers may initially deny coverage for these technologies, and evaluates the extent to which these denials may survive external and judicial review. Because several of these legal grounds may be persuasive, particularly denials on the basis of medical necessity, this Article also explores alternative strategies for financing biomedical HIV prevention efforts. PMID:23356098

  1. Intervention Mapping as a Participatory Approach to Developing an HIV prevention Intervention in Rural African American Communities

    PubMed Central

    Corbie-Smith, Giselle; Akers, Aletha; Blumenthal, Connie; Council, Barbara; Wynn, Mysha; Muhammad, Melvin; Stith, Doris

    2011-01-01

    Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated Intervention Mapping (IM) methodology with community based participatory research (CBPR) principles to develop a multi-level, multi-generational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR. PMID:20528128

  2. Multipurpose prevention technologies: the future of HIV and STI protection.

    PubMed

    Fernández-Romero, José A; Deal, Carolyn; Herold, Betsy C; Schiller, John; Patton, Dorothy; Zydowsky, Thomas; Romano, Joe; Petro, Christopher D; Narasimhan, Manjulaa

    2015-07-01

    Every day, more than 1 million people are newly infected with sexually transmitted infections (STIs) that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. Existing prevention and management strategies, including behavior change, condom promotion, and therapy have not reduced the global incidence and prevalence, pointing to the need for novel innovative strategies. This review summarizes important issues raised during a satellite session at the first HIV Research for Prevention (R4P) conference, held in Cape Town, on October 31, 2014. We explore key STIs that are challenging public health today, new biomedical prevention approaches including multipurpose prevention technologies (MPTs), and the scientific and regulatory hurdles that must be overcome to make combination prevention tools a reality. PMID:25759332

  3. Training Manual for HIV/AIDS Prevention.

    ERIC Educational Resources Information Center

    Epps, Patricia H.; Vallenari, Allison

    This manual includes all necessary information for implementing the Champs program, which trains older elementary school students or middle/high school students to operate puppets to deliver an HIV/AIDS message to kindergarten through sixth graders. Relying on a peer approach, the Program provides scripted, prerecorded lessons intended to reach…

  4. HIV & AIDS Prevention Guide for Parents.

    ERIC Educational Resources Information Center

    Lerro, Marc

    This guide is intended to help parents of adolescents and adults with mental retardation to teach their sons and daughters about HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome). An official resolution on AIDS adopted by The Arc, an organization for citizens with mental retardation, begins the guide. This…

  5. HIV risk behaviors, knowledge, and prevention education among offenders under community supervision: a hidden risk group.

    PubMed

    Belenko, Steven; Langley, Sandra; Crimmins, Susan; Chaple, Michael

    2004-08-01

    Numerous studies have established that incarcerated populations are at substantial risk for HIV infection. In response, many jails and prisons have increased HIV prevention and related services. However, although twice as many offenders are under community supervision as are incarcerated at any given time, HIV prevention needs have been largely ignored among probationers and parolees, and little is known about their HIV risk behaviors or HIV prevention needs. Compared with inmates, probationers and parolees have substantially greater opportunities to engage in HIV risk behaviors. In the present study, we describe HIV risk behaviors, knowledge, and prevention education experiences of probationers and parolees in New York City. We find that probationers and parolees have high rates of unprotected sex, and limited current exposure to effective HIV education and prevention interventions. Probation and parole departments need to improve HIV training for officers and make HIV risk reduction services more available. PMID:15342338

  6. Topical Microbicides and HIV Prevention in the Female Genital Tract

    PubMed Central

    Cottrell, Mackenzie L; Kashuba, Angela D. M.

    2014-01-01

    Worldwide, HIV disproportionately affects women who are often unable to negotiate traditional HIV preventive strategies such as condoms. In the absence of an effective vaccine or cure, chemoprophylaxis may be a valuable self-initiated alternative. Topical microbicides have been investigated as one such option. The first generation topical microbicides were non-specific, broad-spectrum antimicrobial agents, including surfactants, polyanions, and acid buffering gels, that generally exhibited contraceptive properties. After extensive clinical study, none prevented HIV infection, and their development was abandoned. Second generation topical microbicides include agents with selective mechanisms of antiviral activity. Most are currently being used for, or have previously been explored as, drugs for treatment of HIV. The most advanced of these is tenofovir 1% gel: the first topical agent shown to significantly reduce HIV infection by 39% compared to placebo. This review summarizes the evolution of topical microbicides for HIV chemoprophylaxis, highlights important concepts learned, and offers current and future considerations for this area of research. PMID:24664786

  7. HIV Treatment as Prevention: Considerations in the Design, Conduct, and Analysis of Cluster Randomized Controlled Trials of Combination HIV Prevention

    PubMed Central

    Boily, Marie-Claude; Mâsse, Benoît; Alsallaq, Ramzi; Padian, Nancy S.; Eaton, Jeffrey W.; Vesga, Juan F.; Hallett, Timothy B.

    2012-01-01

    The rigorous evaluation of the impact of combination HIV prevention packages at the population level will be critical for the future of HIV prevention. In this review, we discuss important considerations for the design and interpretation of cluster randomized controlled trials (C-RCTs) of combination prevention interventions. We focus on three large C-RCTs that will start soon and are designed to test the hypothesis that combination prevention packages, including expanded access to antiretroviral therapy, can substantially reduce HIV incidence. Using a general framework to integrate mathematical modelling analysis into the design, conduct, and analysis of C-RCTs will complement traditional statistical analyses and strengthen the evaluation of the interventions. Importantly, even with combination interventions, it may be challenging to substantially reduce HIV incidence over the 2- to 3-y duration of a C-RCT, unless interventions are scaled up rapidly and key populations are reached. Thus, we propose the innovative use of mathematical modelling to conduct interim analyses, when interim HIV incidence data are not available, to allow the ongoing trials to be modified or adapted to reduce the likelihood of inconclusive outcomes. The preplanned, interactive use of mathematical models during C-RCTs will also provide a valuable opportunity to validate and refine model projections. PMID:22807657

  8. HIV treatment as prevention: considerations in the design, conduct, and analysis of cluster randomized controlled trials of combination HIV prevention.

    PubMed

    Boily, Marie-Claude; Mâsse, Benoît; Alsallaq, Ramzi; Padian, Nancy S; Eaton, Jeffrey W; Vesga, Juan F; Hallett, Timothy B

    2012-01-01

    The rigorous evaluation of the impact of combination HIV prevention packages at the population level will be critical for the future of HIV prevention. In this review, we discuss important considerations for the design and interpretation of cluster randomized controlled trials (C-RCTs) of combination prevention interventions. We focus on three large C-RCTs that will start soon and are designed to test the hypothesis that combination prevention packages, including expanded access to antiretroviral therapy, can substantially reduce HIV incidence. Using a general framework to integrate mathematical modelling analysis into the design, conduct, and analysis of C-RCTs will complement traditional statistical analyses and strengthen the evaluation of the interventions. Importantly, even with combination interventions, it may be challenging to substantially reduce HIV incidence over the 2- to 3-y duration of a C-RCT, unless interventions are scaled up rapidly and key populations are reached. Thus, we propose the innovative use of mathematical modelling to conduct interim analyses, when interim HIV incidence data are not available, to allow the ongoing trials to be modified or adapted to reduce the likelihood of inconclusive outcomes. The preplanned, interactive use of mathematical models during C-RCTs will also provide a valuable opportunity to validate and refine model projections. PMID:22807657

  9. Topical Prophylaxis for HIV Prevention in Women: Becoming a Reality

    PubMed Central

    Verma, Natasha A.; Lee, Anna C.; Herold, Betsy C.

    2011-01-01

    Strategies to protect against sexual transmission of HIV include the development of products formulated for topical application, which limit the toxicities associated with systemic oral pre-exposure prophylaxis. Following several clinical trial failures, attention is now focused on antiretroviral (ARV) agents. Highly potent ARV topical formulations provide a female-controlled, targeted, and feasible option for HIV prevention. A recently completed tenofovir gel trial was the first to demonstrate significant protection against HIV acquisition. Topical ARVs have the advantage of delivering high concentration of drug at the site of transmission of HIV, with low systemic absorption. Sustained-release formulations, such as intravaginal rings, will likely improve adherence and can be designed to provide controlled and continuous delivery of ARV combinations. Further studies to test alternative dosing strategies and pharmacokinetic/pharmacodynamic relationships in the genital tract will provide valuable information as the field strives to improve upon the promising tenofovir gel trial results. PMID:21424725

  10. Social and Structural HIV Prevention in Alcohol-Serving Establishments

    PubMed Central

    Kalichman, Seth C.

    2010-01-01

    Alcohol use is associated with risks for sexually transmitted infections (STIs), including HIV/AIDS. People meet new sex partners at bars and other places where alcohol is served, and drinking venues facilitate STI transmission through sexual relationships within closely knit sexual networks. This paper reviews HIV prevention interventions conducted in bars, taverns, and informal drinking venues. Interventions designed to reduce HIV risk by altering the social interactions within drinking environments have demonstrated mixed results. Specifically, venue-based social influence models have reduced community-level risk in U.S. gay bars, but these effects have not generalized to gay bars elsewhere or to other populations. Few interventions have sought to alter the structural and physical environments of drinking places for HIV prevention. Uncontrolled program evaluations have reported promising approaches to bar-based structural interventions with gay men and female sex workers. Finally, a small number of studies have examined multilevel approaches that simultaneously intervene at both social and structural levels with encouraging results. Multilevel interventions that take environmental factors into account are needed to guide future HIV prevention efforts delivered within alcohol-serving establishments. PMID:23584060

  11. Combination implementation for HIV prevention: moving from evidence to population-level impact

    PubMed Central

    Chang, Larry W; Serwadda, David; Quinn, Thomas C; Wawer, Maria J; Gray, Ronald H; Reynolds, Steven J

    2013-01-01

    Summary The promise of combination HIV prevention—the application of multiple HIV prevention interventions to maximize population-level impact—has never been greater. However, to succeed in achieving significant reductions in HIV incidence, an additional concept needs to be considered—combination implementation. Combination implementation for HIV prevention is defined here as the pragmatic, localized application of evidence-based strategies to realize high sustained uptake and quality of HIV prevention interventions. This review explores diverse implementation strategies including HIV testing and counseling models, task shifting, linkage to and retention in care, antiretroviral therapy support, behavior change, demand creation, and structural interventions and discusses how they could be used in the provision of HIV prevention interventions such as medical male circumcision and treatment as prevention. Only through careful consideration of how to implement and operationalize HIV prevention interventions will the HIV community be able to move from clinical trial evidence to population-level impact. PMID:23257232

  12. Communication to change behavior. A coordinated approach to HIV / AIDS prevention.

    PubMed

    Flanagan, D

    1996-07-01

    Behavior change communication (BCC) uses the results of epidemiological and social science research to guide the design of creative interventions which call upon the talents of artists, writers, actors, producers, counselors, and other communicators. These interventions are the product of considerable US Agency for International Development experience with development communication. The AIDS Control and Prevention (AIDSCAP) Project uses the term BCC to emphasize the difference between simply providing information and giving people the knowledge, skills, encouragement, and support they need to reduce the risk of acquiring and transmitting HIV and living healthy. BCC activities for HIV/AIDS prevention use multiple channels to transmit and reinforce messages which address the needs of well-defined target audiences. They also provide people with the skills and tools required to prevent HIV and create a supportive social environment which helps people adopt and maintain safer sex behavior. BCC is an integral component of all strategies which comprise AIDSCAP's comprehensive approach to HIV/AIDS prevention. PMID:12347585

  13. Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

    PubMed Central

    2013-01-01

    Background Preventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts. Methods We used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey. Results Ninety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low. Conclusion Youth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth. PMID:24107301

  14. CROI 2016: Hot Spots in HIV Infection and Advances in HIV Prevention.

    PubMed

    Buchbinder, Susan P; Liu, Albert Y

    2016-01-01

    The 2016 Conference on Retroviruses and Opportunistic Infections (CROI) highlighted hot spots in HIV infection. Men who have sex with men (MSM), transgender populations, people who inject drugs, fisherfolk, migrants, adolescents, and older adults are heavily impacted in a number of regions. Stigma contributes to risk behaviors and HIV acquisition across populations. HIV testing is a crucial first step in the HIV care continuum, and several large community-based surveys are underway in Africa to increase HIV testing, linkage to care, and uptake of antiretroviral treatment. Advances in preexposure prophylaxis (PrEP) featured prominently at CROI 2016. Two large efficacy trials of a vaginal ring containing the investigational drug dapivirine demonstrated efficacy and safety in preventing HIV infections in women in Africa. Data on the safety of long-acting injectable PrEP and several investigational PrEP drugs and formulations were also presented. Knowledge and use of PrEP among MSM in the United States appears to be increasing, and high uptake was seen among black MSM when provided as part of a culturally tailored support program. The use of broadly neutralizing antibodies for HIV prevention is a novel and promising approach to be evaluated in efficacy trials. PMID:27398859

  15. Creating partnerships for HIV prevention among YMSM: The Connect to Protect Project and House and Ball Community in Philadelphia

    PubMed Central

    Castillo, Marné; Palmer, Brett J.; Rudy, Brett J.; Fernandez, Maria Isabel

    2012-01-01

    Community participation in prevention research has emerged as an important resource for identifying and addressing HIV risk factors and populations that may be more susceptible to these risks. This paper focuses on the coalition at the Philadelphia site of Connect to Protect®: Partnership for Youth Prevention Interventions (C2P), and the partnerships developed to work with an understudied subgroup of YMSM, the House and Ball Community (HBC). The authors describe the coalition’s process of identifying HIV risk factors, developing objectives and prevention activities, such as increased access to HIV counseling and testing, and building partnerships with the HBC community. Local HIV testing data from C2P affiliated events , additional outcomes, and future directions for the coalition to continue these efforts are presented. PMID:24188356

  16. HIV/AIDS epidemiology, pathogenesis, prevention, and treatment

    PubMed Central

    Simon, Viviana; Ho, David D; Karim, Quarraisha Abdool

    2010-01-01

    The HIV-1 pandemic is a complex mix of diverse epidemics within and between countries and regions of the world, and is undoubtedly the defining public-health crisis of our time. Research has deepened our understanding of how the virus replicates, manipulates, and hides in an infected person. Although our understanding of pathogenesis and transmission dynamics has become more nuanced and prevention options have expanded, a cure or protective vaccine remains elusive. Antiretroviral treatment has transformed AIDS from an inevitably fatal condition to a chronic, manageable disease in some settings. This transformation has yet to be realised in those parts of the world that continue to bear a disproportionate burden of new HIV-1 infections and are most a% ected by increasing morbidity and mortality. This Seminar provides an update on epidemiology, pathogenesis, treatment, and prevention interventions pertinent to HIV-1. PMID:16890836

  17. Transforming social structures and environments to help in HIV prevention.

    PubMed

    Auerbach, Judith

    2009-01-01

    Interest in social and structural interventions for HIV prevention is growing. Such approaches modify social norms, institutions, laws, and policies to reduce vulnerability and create environments in which individuals can protect themselves against HIV infection. Examples include expanding access to sterile syringes for injecting drug users and subsidizing stable housing for low-income people. Evidence of the effectiveness of such interventions is emerging despite scientific and political obstacles to their development, implementation, and evaluation. The U.S. government can help build the evidence base for such interventions. It can also implement those with demonstrated or promising results as part of a cost-effective HIV prevention strategy domestically and globally. PMID:19887406

  18. HIV prevention cost-effectiveness: a systematic review

    PubMed Central

    2009-01-01

    Background After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Methods Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY). Results We found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). Conclusion There are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision

  19. Multipurpose prevention technologies: the future of HIV and STI protection

    PubMed Central

    2015-01-01

    Every day, more than 1 million people are newly infected with sexually transmitted infections (STIs) that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. Existing prevention and management strategies, including behavior change, condom promotion, and therapy have not reduced the global incidence and prevalence, pointing to the need for novel innovative strategies. This review summarizes important issues raised during a satellite session at the first HIV R4P conference, held in Cape Town, on October 31, 2014. We explore key STIs that are challenging public health today; new biomedical prevention approaches including multipurpose prevention technologies (MPTs); and the scientific and regulatory hurdles that must be overcome to make combination prevention tools a reality. PMID:25759332

  20. Psychological Interventions with AIDS and HIV: Prevention and Treatment.

    ERIC Educational Resources Information Center

    Kelly, Jeffrey A.; Murphy, Debra A.

    1992-01-01

    Notes that research to date has yielded important findings for primary prevention efforts for Acquired Immune Deficiency Syndrome (AIDS) and has identified psychological dimensions relevant to mental health interventions for persons with human immunodeficiency virus (HIV). Sees pressing need for more systematic intervention outcome research in…

  1. Client Preferences for STD/HIV Prevention Programs.

    ERIC Educational Resources Information Center

    Hennessy, Michael; Mercier, Michele M.; Williams, Samantha P.; Arno, Janet N.

    2002-01-01

    Conducted a formative research study designed to elicit preferences for sexually transmitted disease (STD)/HIV prevention programs from clients at a midwestern STD clinic. Responses of 126 participants show preferences for mixed group or individual meetings with counselors, with extensive intervention less favored than single sessions. Discusses…

  2. Youth-Initiated HIV Risk and Substance Use Prevention Program.

    ERIC Educational Resources Information Center

    Goggin, K.; Metcalf, K.; Wise, D.; Kennedy, S.; Murray, T.; Burgess, D.; Reese-Smith, J.; Terhune, N.; Broadus, K.; Downes, A.; Buckendahl, H.

    This study evaluates the first year of a novel HIV and substance use prevention program for inner city youth (Offering New Youth eXperiences--ONYX). Baseline and follow-up measures of knowledge, attitudes, and risk behaviors were administered seven months apart to 441 youth participating in the ONYX program. Youth (n=71) who provided data at both…

  3. Engaging Community Businesses in HIV Prevention: A Feasibility Study

    PubMed Central

    Rovniak, Liza S.; Hovell, Melbourne F.; Hofstetter, C. Richard; Blumberg, Elaine J.; Sipan, Carol L.; Batista, Marcia F.; Martinez-Donate, Ana P.; Mulvihill, Mary M.; Ayala, Guadalupe X.

    2009-01-01

    Purpose To explore the feasibility of engaging community businesses in HIV prevention. Design Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-, and post-program. Customer feedback was obtained through an online survey. Setting San Diego, California neighborhood with a high rate of AIDS. Subjects Fifty-one business owners/managers representing 10 retail categories, and 52 customers. Measures Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction and willingness to provide future support for HIV prevention. Analysis Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data. Results The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or refused to participate (41%), p <.05. Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures, p < .05. More than 90% of customers supported distributing condoms and brochures in businesses and 96% of business owners/managers described their program experience as “positive.” Conclusion Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested. PMID:20465150

  4. HIV Prevention in Schools: A Tool Kit for Education Leaders.

    ERIC Educational Resources Information Center

    Office of the Surgeon General (DHHS/PHS), Washington, DC.

    This packet of materials is Phase 1 of a toolkit designed to enlighten education leaders about the need for HIV prevention for youth, especially in communities of color. One element of the toolkit is a VHS videotape that features a brief message from former Surgeon General, Dr. David Satcher. The toolkit also includes a copy of a letter sent to…

  5. Peer Programs for HIV Prevention by and for Incarcerated Adolescents.

    ERIC Educational Resources Information Center

    Horan, Patricia F.; Barthlow, Diana J.

    1995-01-01

    Describes a peer helping program that targets prevention of human immunodeficiency virus (HIV) among incarcerated youth within the context of the National Peer Helper Association's Standards for Peer Programs. The program emphasizes the relative and reciprocal influences among behavioral, personal, and environmental variables hypothesized to…

  6. HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

    PubMed Central

    2012-01-01

    Background Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. Methods We undertook a realist review to answer the research question: ‘How are HIV prevention interventions in high-income countries adapted to suit immigrants’ needs?’ A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. Results Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of ‘consonance’ mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms – ‘understanding’, ‘specificity’ and ‘embeddedness’ – which indicated that using the language of immigrants, usually the ‘mother tongue’, targeting (in terms of ethnicity) and the use of

  7. 30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs

    PubMed Central

    Des Jarlais, D. C.; Pinkerton, S.; Hagan, H.; Guardino, V.; Feelemyer, J.; Cooper, H.; Hatzatkis, A.; Uuskula, A.

    2013-01-01

    After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective. PMID:23840957

  8. Violence prevention among HIV-positive women with histories of violence: healing women in their communities.

    PubMed

    Wyatt, Gail E; Hamilton, Alison B; Myers, Hector F; Ullman, Jodie B; Chin, Dorothy; Sumner, Lekeisha A; Loeb, Tamra B; Carmona, Jennifer V; Zhang, Muyu; Liu, Honghu

    2011-11-01

    Experiences of past and current gender-based violence are common among HIV-positive women in the United States, who are predominantly from ethnic minority groups. However, culturally congruent, feasible interventions for HIV-positive women who have experienced past and/or current violence are not widely available. The Office on Women's Health Gender Forum has made several recommendations for responding to the National HIV/AIDS Strategy Implementation Plan, including recommendations to incorporate gender-based violence prevention into a comprehensive, gender-responsive national strategy. This paper draws on an example of a community-based project for HIV-positive women, the Healing Our Women Project, to illustrate how violence prevention can be achieved within peer-led and community-based programming. Strong community partnerships, responsiveness to community needs and local cultural norms, a trained workforce, and culturally competent care are programmatic cornerstones of gender-responsive services. HIV-positive women with histories of gender-based violence and risk factors for current and future violence deserve the highest quality gender-responsive services to ensure that they can address their health needs within contexts of safety and respect. PMID:22055676

  9. Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

    PubMed Central

    Buckingham, Elizabeth; Schrage, Ezra; Cournos, Francine

    2013-01-01

    People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services. PMID:23401785

  10. The effectiveness of HIV prevention and the epidemiological context.

    PubMed Central

    Grassly, N. C.; Garnett, G. P.; Schwartländer, B.; Gregson, S.; Anderson, R. M.

    2001-01-01

    Planning an intervention to prevent infections with the human immunodeficiency virus (HIV) should be guided by local epidemiological and socioeconomic conditions. The socioeconomic setting and existing public service capacity determine whether an intervention can have a significant outcome in terms of a reduction in a defined risk. The epidemiological context determines whether such risk reduction translates into a measurable impact on HIV incidence. Measurement of variables describing the epidemiological context can be used to determine the local suitability of interventions, thereby guiding planners and policy-makers in their choice of intervention. Such measurements also permit the retrospective analysis of the impact of interventions where HIV incidence was not recorded. The epidemiological context is defined for four different categories of intervention, shown to be effective in lower-income countries by randomized controlled trials. Appropriate indicators for the epidemiological context and methodological guidelines for their measurement are proposed. Their use in the transfer of a successful intervention from one context to another and in scaling up the effort to control HIV infection is explored. These indicators should provide a useful resource for those involved in planning HIV prevention interventions. PMID:11799444

  11. Are MSM willing to SMS for HIV prevention?

    PubMed

    Khosropour, Christine M; Lake, Jason G; Sullivan, Patrick S

    2014-01-01

    Text messaging is a potential HIV-prevention tool for men who have sex with men (MSM), specifically young MSM and MSM of color. To determine the willingness of MSM to receive text messages as part of an HIV-prevention intervention, we administered an online survey to MSM recruited from MySpace.com, which included questions about mobile phone ownership and willingness to participate in a future text message-based HIV research study. Of participants, 85% (n = 5,378) reported owning a mobile phone and 49% (n = 2,483) of mobile phone owners reported being willing to receive text messages in a future HIV research study. Black and Hispanic men were more willing than White non-Hispanic men to receive text messages. Men with a college degree were less willing to receive texts than men with a high school level of education, and men >22 years old were less likely to be willing to receive texts than those younger than 22 years of age. The authors' findings demonstrate that willingness to receive text messages as part of an HIV research study is moderate, and mirrors patterns of text message use in age and race. Variations in willingness should be taken into account when designing and implementing future interventions. PMID:23905653

  12. Access for all: contextualising HIV treatment as prevention in Swaziland.

    PubMed

    Vernooij, Eva; Mehlo, Mandhla; Hardon, Anita; Reis, Ria

    2016-01-01

    This article explores how notions of the individual and population are evoked in two ongoing HIV treatment as prevention (TasP) implementation studies in Swaziland. By contrasting policy discourses with lived kinship experiences of people living with HIV, we seek to understand how TasP unfolds in the Swazi context. Data collection consisted of eight focus group discussions with people living with HIV who were members of support groups to examine their perspectives about TasP. In addition, 18 key informant interviews were conducted with study team members, national-level policy-makers and NGO representatives involved in the design of health communication messages about TasP in Swaziland. Thematic analysis was used to identify recurrent themes in transcripts and field notes. Policy-makers and people living with HIV actively resisted framing HIV treatment as a prevention technology but promoted it as (earlier) access to treatment for all. TasP was not conceptualised in terms of individual or societal benefits, which are characteristic of international public health debates; rather its locally situated meanings were embedded in kinship experiences, concerns about taking responsibility for one's own health and others, local biomedical knowledge about drug resistance, and secrecy. The findings from this study suggest that more attention is needed to understand how the global discourse of TasP becomes shaped in practice in different cultural contexts. PMID:27421047

  13. Agents of change: peer mentorship as HIV prevention among HIV-positive injection drug users.

    PubMed

    Mackenzie, Sonja; Pearson, Charles; Frye, Victoria; Gómez, Cynthia A; Latka, Mary H; Purcell, David W; Knowlton, Amy R; Metsch, Lisa R; Tobin, Karin E; Valverde, Eduardo E; Knight, Kelly R

    2012-04-01

    This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed. This study was funded by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA). PMID:22428820

  14. "I Learned to Accept Every Part of Myself": The Transformative Impact of a Theatre-Based Sexual Health and HIV Prevention Programme

    ERIC Educational Resources Information Center

    Grewe, Mary E.; Taboada, Arianna; Dennis, Alexis; Chen, Elizabeth; Stein, Kathryn; Watson, Sable; Barrington, Clare; Lightfoot, Alexandra F.

    2015-01-01

    Theatre-based interventions have been used in health promotion with young people to address HIV and sexual health. In this study, we explored the experience of undergraduate student performers participating in a theatre-based HIV prevention and sexual health education intervention for high school students in the USA. Undergraduate students…

  15. PHS grants for minority group HIV infection education and prevention efforts.

    PubMed Central

    Bowles, J; Robinson, W A

    1989-01-01

    The Office of Minority Health (OMH) was established in December 1985 in response to recommendations developed by the Secretary's Task Force on Black and Minority Health. Originally, OMH's mission emphasized six health problems identified by the Task Force as priority areas: cancer, cardiovascular disease and stroke; chemical dependency; diabetes; homicide, suicide, and unintentional injuries; and infant mortality and low birth weight. OMH added HIV infection to the six health priority areas after epidemiologic data showed that the representation of blacks and Hispanics was disproportionately high among persons reported with AIDS. Strategies to eliminate or reduce high-risk behaviors associated with HIV infection need to mobilize racial and ethnic minority communities and rebuild social networks in order to foster sustained behavioral changes. OMH created the Minority HIV Education/Prevention Grant Program to demonstrate the effectiveness of strategies to expand the activities of minority community-based and national organizations involved in HIV education and prevention, as well as to encourage innovative approaches to address appropriately the diversities within and among minority populations. In 1988, grants totaling $1.4 million were awarded to four national and 23 community-based minority organizations. Project workers conduct information, education, and prevention interventions directed to specific groups within racial and ethnic minority communities. Interventions include education and prevention training, information activities, developing educational materials, and providing technical assistance. Project innovations include conducting HIV education and prevention training for families at home, presenting a play produced and performed by local teenagers, and developing a workshop and a manual to help minority service organizations to recruit and train volunteer staff members.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2511587

  16. Preventing and Addressing Challenging Behavior: Common Questions and Practical Strategies

    ERIC Educational Resources Information Center

    Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Corso, Robert M.

    2012-01-01

    The purpose of this article is to offer preschool teachers strategies for preventing challenging behavior and supporting the development of social skills and emotional competencies. This article is framed in a question and answer format using questions from teachers who the authors have worked with in the past. These questions and strategies are…

  17. Antiretroviral Therapy for the Prevention of HIV-1 Transmission.

    PubMed

    Cohen, Myron S; Chen, Ying Q; McCauley, Marybeth; Gamble, Theresa; Hosseinipour, Mina C; Kumarasamy, Nagalingeswaran; Hakim, James G; Kumwenda, Johnstone; Grinsztejn, Beatriz; Pilotto, Jose H S; Godbole, Sheela V; Chariyalertsak, Suwat; Santos, Breno R; Mayer, Kenneth H; Hoffman, Irving F; Eshleman, Susan H; Piwowar-Manning, Estelle; Cottle, Leslie; Zhang, Xinyi C; Makhema, Joseph; Mills, Lisa A; Panchia, Ravindre; Faesen, Sharlaa; Eron, Joseph; Gallant, Joel; Havlir, Diane; Swindells, Susan; Elharrar, Vanessa; Burns, David; Taha, Taha E; Nielsen-Saines, Karin; Celentano, David D; Essex, Max; Hudelson, Sarah E; Redd, Andrew D; Fleming, Thomas R

    2016-09-01

    Background An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission. Methods We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 to 550 cells per cubic millimeter). In the delayed-ART group, 877 participants started therapy after two consecutive CD4+ counts fell below 250 cells per cubic millimeter or if an illness indicative of the acquired immunodeficiency syndrome (i.e., an AIDS-defining illness) developed. The primary study end point was the diagnosis of genetically linked HIV-1 infection in the previously HIV-1-negative partner in an intention-to-treat analysis. Results Index participants were followed for 10,031 person-years; partners were followed for 8509 person-years. Among partners, 78 HIV-1 infections were observed during the trial (annual incidence, 0.9%; 95% confidence interval [CI], 0.7 to 1.1). Viral-linkage status was determined for 72 (92%) of the partner infections. Of these infections, 46 were linked (3 in the early-ART group and 43 in the delayed-ART group; incidence, 0.5%; 95% CI, 0.4 to 0.7) and 26 were unlinked (14 in the early-ART group and 12 in the delayed-ART group; incidence, 0.3%; 95% CI, 0.2 to 0.4). Early ART was associated with a 93% lower risk of linked partner infection than was delayed ART (hazard ratio, 0.07; 95% CI, 0.02 to 0.22). No linked infections were observed when HIV-1 infection was stably suppressed by ART in the index participant. Conclusions The early initiation of ART led to a sustained

  18. Update on the Epidemiology and Prevention of HIV/AIDS in the United States

    PubMed Central

    Castel, Amanda D.; Magnus, Manya; Greenberg, Alan E.

    2015-01-01

    This update on the epidemiology and prevention of HIV in the United States is intended to provide contextual background that will help inform an understanding of recent developments in the domestic HIV epidemic. We describe the epidemiology of HIV disease in the US and the HIV continuum of care based on data collected primarily through HIV surveillance systems led by the Centers for Disease Control and Prevention including HIV incidence, prevalence, comorbidities and death. Populations and geographic regions disparately impacted by HIV are also highlighted. The HIV prevention armamentarium is also described including behavioral approaches to prevention, the emerging availability of biomedical prevention interventions such as pre-exposure prophylaxis, and structural and population-level interventions including treatment as prevention. Finally gaps in our understanding of the epidemic are underscored and suggestions for future epidemiologic research are proposed. PMID:25960941

  19. YELLOW FEVER PREVENTION STRATEGIES AWARENESS AMONG HIV-INFECTED PATIENTS IN SÃO PAULO, BRAZIL

    PubMed Central

    Avelino-Silva, Vivian Iida; Francelino, Hilario Sousa; Kallás, Esper Georges

    2014-01-01

    Introduction: Vaccination is the main preventive strategy against Yellow Fever (YF), which is a public health concern in Brazil. However, HIV-infected patients might have insufficient knowledge regarding YF, YF prevention, and vaccines in general. Methods: In this questionnaire-based study, data from 158 HIV-infected individuals were addressed in three distinct outpatient clinics in São Paulo. Information was collected on demographic and clinical characteristics, as well as patients' knowledge of vaccines, YF and YF preventive strategies. In addition, individual YF vaccine recommendations and vaccine status were investigated. Results: Although most participants adequately ascertain the vaccine as the main prevention strategy against YF, few participants were aware of the severity and lack of specific treatment for YF. Discrepancy in YF vaccine (patients who should have taken the vaccine, but did not) was observed in 18.8% of participants. Conclusion: YF is an important and preventable public health concern, and these results demonstrate that more information is necessary for the HIV-infected population. PMID:25229222

  20. Raising a chorus of voices to prevent HIV.

    PubMed

    Howard, J

    1995-01-01

    Many goods are transported from Bangalore and Bombay along the highway which cuts across the farmlands of Belgaum district, Karnataka state. As they pass through Belgaum, truck drivers have sex with prostitutes. Local devadasis, women who belong to a Hindu sect, rely upon sex work, concubinage, and begging to survive. In 1993, MYRADA, a nongovernmental organization (NGO), determined that more than 9% of these women seeking HIV testing in the district were seropositive for the virus. Acting upon this finding, MYRADA launched an HIV prevention program among the devadasis. The program soon expanded to include the general population amid concerns that targeting devadasis would further marginalize them and not enhance their risk reduction behavior. Less than half of the sex workers and less than 25% of all women interviewed had heard of AIDS. MYRADA therefore focused upon training specific groups, such as volunteer health workers, traditional midwives, barbers, and government employees with extensive public contact, to act as HIV educators. The NGO also uses village meetings, folk and popular music, billboards, traveling programs of movies and music videos, street theater, and newspaper advertisements to communicate HIV prevention messages. Moreover, in the interest of getting prevention messages to the large number of illiterate people, print materials were redesigned to carry fewer words and more pictures. MYRADA is close to ensuring that no one in the area needs to walk more than 10 minutes to buy a condom. PMID:12319990

  1. Perceptions of Black College Women on Barriers to HIV-Risk Reduction and Their HIV Prevention Intervention Needs.

    PubMed

    Chandler, Rasheeta; Anstey, Erica H; Ross, Henry; Morrison-Beedy, Dianne

    2016-01-01

    HIV prevention interventions can help college students engage in safe sexual behaviors. We used the Information, Motivation, Behavioral Skills model to frame four focus group discussions with Black women (n = 32) attending a historically Black college/university or a traditional university to understand their HIV prevention needs. Participants wanted clear information about sexually transmitted infections/HIV and access to contraception. Motivators for practicing safe sex were related to cultural and religious expectations, desire to avoid pregnancy, and conscious efforts to defy racial stereotypes. Barriers to practicing safe sex included issues of accountability, stigma associated with accessing HIV testing/prevention services, and media influences. We found general consensus about the need to develop skill-building HIV prevention interventions focused on communication skills, condom negotiation, access to services, and empowerment. We offer insight into culture- and age-appropriate HIV prevention for Black college women to guide the development of future interventions. PMID:26875473

  2. 78 FR 43055 - Accelerating Improvements in HIV Prevention and Care in the United States Through the HIV Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-18

    ....) THE WHITE HOUSE, July 15, 2013. [FR Doc. 2013-17478 Filed 7-17-13; 11:15 am] Billing code 3295-F3 ... and Care in the United States Through the HIV Care Continuum Initiative #0; #0; #0; Presidential... Improvements in HIV Prevention and Care in the United States Through the HIV Care Continuum Initiative By...

  3. HIV prevention among transgender women in Latin America: implementation, gaps and challenges

    PubMed Central

    Silva-Santisteban, Alfonso; Eng, Shirley; de la Iglesia, Gabriela; Falistocco, Carlos; Mazin, Rafael

    2016-01-01

    Introduction Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America. Methods We conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations. Results and discussion Overall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate

  4. 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

  5. Investigating combination HIV prevention: isolated interventions or complex system

    PubMed Central

    Brown, Graham; Reeders, Daniel; Dowsett, Gary W.; Ellard, Jeanne; Carman, Marina; Hendry, Natalie; Wallace, Jack

    2015-01-01

    Introduction Treatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects. Discussion Drawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation. To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for understanding these

  6. HIV testing for HIV prevention: a comparative analysis of policies in Britain, Hungary and Sweden.

    PubMed

    Danziger, R

    1998-10-01

    This paper compares policies on named HIV testing in the context of HIV prevention in Britain, Hungary and Sweden, and considers the extent to which these policies are based on evidence of effectiveness or on other, more contextual, factors. In Britain, testing has not featured significantly as a prevention strategy, and named testing has generally been carried out only with the voluntary, informed consent of individuals. In Hungary, testing is central to HIV prevention, and is required by law of certain groups. HIV testing is carried out mainly on a voluntary basis in Sweden, but, unlike in Britain, it has been actively promoted by public health authorities. The paper contrasts the 'right not to know' one's HIV status which is widely respected in Britain, with the 'responsibility to find out' which is more pervasive in Hungary and Sweden. Although policy makers in all three countries appear convinced that their's is the right approach, there appears to be as yet a dearth of convincing evidence to support their arguments. PMID:9828953

  7. Prevention policies addressing packaging and packaging waste: Some emerging trends.

    PubMed

    Tencati, Antonio; Pogutz, Stefano; Moda, Beatrice; Brambilla, Matteo; Cacia, Claudia

    2016-10-01

    Packaging waste is a major issue in several countries. Representing in industrialized countries around 30-35% of municipal solid waste yearly generated, this waste stream has steadily grown over the years even if, especially in Europe, specific recycling and recovery targets have been fixed. Therefore, an increasing attention starts to be devoted to prevention measures and interventions. Filling a gap in the current literature, this explorative paper is a first attempt to map the increasingly important phenomenon of prevention policies in the packaging sector. Through a theoretical sampling, 11 countries/states (7 in and 4 outside Europe) have been selected and analyzed by gathering and studying primary and secondary data. Results show evidence of three specific trends in packaging waste prevention policies: fostering the adoption of measures directed at improving packaging design and production through an extensive use of the life cycle assessment; raising the awareness of final consumers by increasing the accountability of firms; promoting collaborative efforts along the packaging supply chains. PMID:27372152

  8. Planning ahead for implementation of long acting HIV prevention: challenges and opportunities

    PubMed Central

    Meyers, Kathrine

    2015-01-01

    Purpose of Review Broad-based access, uptake, and dissemination of daily oral HIV pre-exposure prophylaxis (PrEP) have been slow, despite strong evidence for efficacy. Effective and efficient implementation of long-acting (LA) HIV prevention products will require both analysis of the dynamics and determinants of daily oral PrEP implementation and identification of the distinct challenges and opportunities inherent in emerging technologies. Recent Findings Evidence suggests the importance of addressing implementation issues at three levels: patient, provider, and system. Patient-level factors include targeted education and messaging, tailored supports to enhance acceptability and uptake, and effective strategies for promoting adherence/persistence and retention in care. Provider-level factors include engaging a broad mix of providers, while ensuring adequate training and support for patient assessment, counseling, and follow-up. Systems-level factors include optimal delivery modalities, resource allocation, and ensuring access to populations most in need of new prevention options. Summary Formative social/behavioral research must be undertaken proactively in order to prepare for and address future implementation challenges and reduce the gap between proving efficacy in clinical trials and assuring real-world effectiveness. Conceptualizing new HIV prevention technologies as behavioral interventions at the level of the patient, provider, and system will be paramount to effective and efficient implementation. PMID:26049956

  9. Integrated Strategies for Combination HIV Prevention: Principles and examples for men who have sex with men in the Americas and heterosexual African populations

    PubMed Central

    Celum, Connie; Baeten, Jared M.; Hughes, James P.; Barnabas, Ruanne; Liu, Albert; Van Rooyen, Heidi; Buchbinder, Susan

    2013-01-01

    Combination HIV prevention is a high priority for increasing the impact of partially efficacious HIV prevention interventions for specific populations and settings. Developing the package requires critical review of local epidemiology of HIV infection regarding populations most impacted and most at risk, drivers of HIV infection, and available interventions to address these risk factors. Interventions should be considered in terms of the evidence basis for efficacy, potential synergies, feasibility of delivery at scale, which is important in order to achieve high coverage and impact, coupled with high acceptability to populations, which will impact uptake, adherence, and retention. Evaluation requires process measures of uptake, adherence, retention, and outcome measures of reduction in HIV infectiousness and acquisition. Three examples of combination prevention concepts are summarized for men who have sex with men (MSM) in the Americas, young women in sub-Saharan Africa, and HIV-1 serodiscordant couples. PMID:23764638

  10. Quality of Care for HIV/AIDS and for Primary Prevention by HIV Specialists and Nonspecialists.

    PubMed

    Landovitz, Raphael J; Desmond, Katherine A; Gildner, Jennifer L; Leibowitz, Arleen A

    2016-09-01

    The role of HIV specialists in providing primary care to persons living with HIV/AIDS is evolving, given their increased incidence of comorbidities. Multivariate logit analysis compared compliance with sentinel preventive screening tests and interventions among publicly insured Californians with and without access to HIV specialists in 2010. Quality-of-care indicators [visit frequency, CD4 and viral load (VL) assessments, influenza vaccine, tuberculosis (TB) testing, lipid profile, glucose blood test, and Pap smears for women] were related to patient characteristics and provider HIV caseload. There were 9377 adult Medicare enrollees (71% also had Medicaid coverage) and 2076 enrollees with only Medicaid coverage. Adjusted for patient characteristics, patients seeing providers with greater HIV caseloads (>50 HIV patients) were more likely to meet visit frequency guidelines in both Medicare [98%; confidence interval (CI 97.5-98.2) and Medicaid (97%; CI 96.2-98.0), compared to 60% (CI 57.1-62.3) and 45% (CI 38.3-50.4), respectively, seeing providers without large HIV caseloads (p < 0.001). Patients seeing providers with larger caseloads were significantly more likely to have CD4 (p < 0.001), VL (p < 0.001), and TB testing (p < 0.05). A larger percentage of patients seeing large-volume Medicare providers received influenza vaccinations. Provider caseload was unrelated to lipid or glucose assessments or Pap Smears for women. Patients with access to large-volume providers were more likely to meet clinical guidelines for visits, CD4, VL, tuberculosis testing, and influenza vaccinations, and were not less likely to receive primary preventive care. Substantial insufficiencies remain in both monitoring to assess viral suppression and in preventive care. PMID:27610461

  11. 76 FR 66721 - CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-27

    ... HUMAN SERVICES Centers for Disease Control and Prevention CDC/HRSA Advisory Committee on HIV and STD... and control of HIV/AIDS and other STDs, the support of health care services to persons living with HIV/AIDS, and education of health professionals and the public about HIV/AIDS and other STDs. Matters To...

  12. Information Vaccine: Using Graphic Novels as an HIV/AIDS Prevention Resource for Young Adults

    ERIC Educational Resources Information Center

    Albright, Kendra S.; Gavigan, Karen

    2014-01-01

    HIV/AIDS infections are growing at an alarming rate for young adults. In 2009, youth, ages 13-29, accounted for 39% of all new HIV infections in the U.S. (Division of HIV/ AIDS Prevention, Centers for Disease Control (CDC), 2011). South Carolina ranks eighth in the nation for new HIV cases, while the capital city of Columbia ranks seventh…

  13. Opportunities for HIV Combination Prevention to Reduce Racial and Ethnic Health Disparities

    ERIC Educational Resources Information Center

    Grossman, Cynthia I.; Purcell, David W.; Rotheram-Borus, Mary Jane; Veniegas, Rosemary

    2013-01-01

    Despite advances in HIV prevention and care, African Americans and Latino Americans remain at much higher risk of acquiring HIV, are more likely to be unaware of their HIV-positive status, are less likely to be linked to and retained in care, and are less likely to have suppressed viral load than are Whites. The first National HIV/AIDS Strategy…

  14. [Experiences from two HIV prevention projects among drug abusers in Oslo. Is methadone maintenance treatment useful?].

    PubMed

    Skogstad, M

    1990-06-10

    Experience from two HIV-preventive projects among drug abusers in Oslo, Norway, shows that HIV-positive drug abusers carry on their drug abuse independent of visits to residential drug-free treatment or prison. HIV-positive former drug abusers show a tendency to relapse to drug abuse. In terms of HIV-prevention among drug abusers it is important to reduce injection of drugs among HIV-positive drug abusers. Thus, methadone maintenance programmes should be considered in HIV-prevention in Norway. PMID:2363170

  15. HIV prevention responsibilities in HIV vaccine trials: complexities facing South African researchers.

    PubMed

    Essack, Zaynab; Slack, Catherine; Koen, Jennifer; Gray, Glenda

    2010-01-01

    Researchers should protect the welfare of research participants through providing methods to reduce their risk of acquiring HIV. This is especially important given that late-phase HIV vaccine trials enrol HIV-uninfected trial volunteers from high-risk populations. Current ethical guidelines may be difficult for stakeholders to implement, and we know very little about what prevention services researchers are currently providing to participants or their successes, best practices and challenges. We recommend that current normative guidance be systematically reviewed and actual practice at vaccine sites be documented. Adding new tools to the current package of prevention services will involve complex decision making with few set standards, and regulatory and scientific challenges. We recommend that stakeholders (including regulators) convene to consider standards of evidence for new tools, and that decision-making processes be explicitly documented and researched. A further critical ethical task is exploring the threshold at which adding new tools will compromise the validity of trial results. PMID:20429488

  16. HIV prevention among psychiatric inpatients: a pilot risk reduction study.

    PubMed

    Meyer, I; Cournos, F; Empfield, M; Agosin, B; Floyd, P

    1992-01-01

    An HIV prevention program was piloted on an acute inpatient admission ward. Patients who volunteered to participate had significantly higher rates of histories of substance use than non-participants, suggesting that patients participated based on rational concerns about past HIV risk behavior. The program consisted of 75 minute sessions once a week for seven weeks and was co-led by an HIV counselor and the ward's social worker. Each session focused on a specific topic and included a short presentation of informational material, viewing of an educational videotape, a discussion, and role play and other educational games. In spite of a wide range in functioning among the participants, discussion was lively and participation was good. The pilot program demonstrates that chronic mentally ill patients can engage in, and benefit from, risk reduction programs and that frank and explicit discussion of sexual issues is well tolerated. Recommendations for improvement in the program are discussed. PMID:1488461

  17. Resources and obstacles to developing and implementing a structural intervention to prevent HIV in San Salvador, El Salvador.

    PubMed

    Dickson-Gomez, Julia; Corbett, A Michelle; Bodnar, Gloria; Rodriguez, Karla; Guevara, Carmen E

    2010-02-01

    HIV prevention researchers have increasingly advocated structural interventions that address factors in the social, political and economic context to reduce disparities of HIV/AIDS among disadvantaged populations. This paper draws on data collected in three different types of low-income communities (n=6) in the San Salvador metropolitan area in El Salvador. Nine focus group discussions were conducted between January 2006 and July 2007, 6 with community leaders, and 3 with crack cocaine users, as well as in-depth interviews with 20 crack users and crack dealers. We explore opportunities and barriers to the implementation of a community-level, structural intervention. We first analyze the different forms of leadership, and other community resources including existing HIV prevention activities that could potentially be used to address the related problems of crack use and HIV in the communities, and the structural factors that may act as barriers to capitalizing on communities' strengths in interventions. Each of the communities studied demonstrated different resources that stem from each community's unique history and geographic location. HIV testing and prevention resources varied widely among the communities, with resources concentrated in one Older Central community despite a strong need in all communities. In many communities, fear of gang violence and non-responsiveness by government agencies to communities' needs have discouraged community organizing. In the discussion, we offer concrete suggestions for developing and implementing structural interventions to reduce HIV risks that use communities' different but complementary resources. PMID:19910099

  18. Resources and obstacles to developing and implementing a structural intervention to prevent HIV in San Salvador, El Salvador

    PubMed Central

    Corbett, A. Michelle; Bodnar, Gloria; Rodriguez, Karla; Guevara, Carmen E

    2009-01-01

    HIV prevention researchers have increasingly advocated structural interventions that address factors in the social, political and economic context to reduce disparities of HIV/AIDS among disadvantaged populations. This paper draws on data collected in three different types of low-income communities (n=6) in the San Salvador metropolitan area in El Salvador. Nine focus group discussions were conducted between January 2006 - July 2007, six with community leaders, and three with crack cocaine users, as well as in-depth interviews with 20 crack users and crack dealers. We explore opportunities and barriers to the implementation of a community-level, structural intervention. We first analyze the different forms of leadership, and other community resources including existing HIV prevention activities that could potentially be used to address the related problems of crack use and HIV in the communities, and the structural factors that may act as barriers to capitalizing on communities’ strengths in interventions. Each of the communities studied demonstrated different resources that stem from each community's unique history and geographic location. HIV testing and prevention resources varied widely among the communities, with resources concentrated in one Older Central community despite a strong need in all communities. In many communities, fear of gang violence and non-responsiveness by government agencies to communities’ needs have discouraged community organizing. In the discussion, we offer concrete suggestions for developing and implementing structural interventions to reduce HIV risks that use communities’ different but complementary resources. PMID:19910099

  19. Perceived HIV-related sexual risks and prevention practices of African American women in the southeastern United States.

    PubMed

    Timmons, S M; Sowell, R L

    1999-01-01

    African American women in the southeastern United States constitute the fastest growing segment of those infected with the human immunodeficiency virus (HIV). Little data exist about the relationships between HIV infection risks and preventive practices. In this article, we describe a focus group investigation of how HIV-related sexual risks are perceived by 19 heterosexual African American women, ages 18 to 44. Data were analyzed and interpreted using content analysis, where key ideas, words, and phrases were grouped based on their relation to the purpose of the study. Four themes were revealed: "a man will be a man," inconsistent and/or no condom use, safe relationships, and racism and discrimination. Perceived safety within relationships mediated both perceptions of HIV-related risks and sexual practices. In light of beliefs about the riskiness of sex with high-risk partners, fear of HIV, and the importance of self love in minimizing HIV infection risks, the women continued to practice unsafe sexual behaviors. Results indicate that women perceive themselves as victims in society and that this perception limits their propensity to take action to protect themselves from HIV. Successful HIV infection prevention interventions need to address negative social and economic factors that define the context of many women's lives. PMID:10889636

  20. Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand

    PubMed Central

    2010-01-01

    Background Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand. Methods A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY) gained were also included. All studies were assessed against quality criteria. Results The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner. Conclusion We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand. PMID:20604975

  1. Sustainability of Gains Made in a Primary School HIV Prevention Programme in Kenya into the Secondary School Years

    ERIC Educational Resources Information Center

    Maticka-Tyndale, Eleanor

    2010-01-01

    The question addressed in this paper is whether the beneficial effects of Primary School Action for Better Health (PSABH), an HIV prevention programme delivered in Kenyan primary schools, continue once students move on to secondary schools. Questionnaires were completed in December 2005 and January 2006 by all form 1-3 students in 154 randomly…

  2. Ancillary care in South African HIV vaccine trials: addressing needs, drafting protocols, and engaging community.

    PubMed

    Slack, Catherine M

    2014-02-01

    There has been debate about sponsor-investigator ethical responsibilities to address participants' medical needs in trials in resource-constrained contexts. Certain ethical guidelines make detailed recommendations. This study explored whether ethical guideline recommendations for care in HIV vaccine trials were being met, and whether stakeholders were facing difficulties addressed by guidelines. It sampled key stakeholders involved in two trials across five sites in South Africa, and reviewed relevant documentation. It concluded that sites were largely meeting guideline recommendations for addressing needs, with some exceeding these. Recommendations for writing protocols were only partially achieved. Recommendations for engaging participating community were mostly met, except for "moral negotiation" recommendations. Suggestions are made to strengthen practices, and to improve guidelines so they address empirical concerns. PMID:24572086

  3. Taking culture seriously in biomedical HIV prevention trials: a meta-synthesis of qualitative studies.

    PubMed

    Rubincam, Clara; Lacombe-Duncan, Ashley; Newman, Peter A

    2016-01-01

    A substantial gap exists between widespread acknowledgement of the importance of incorporating cultural sensitivity in biomedical HIV prevention trials and empirical evidence to guide the operationalization of cultural sensitivity in these trials. We conducted a systematic literature search and qualitative meta-synthesis to explore how culture is conceptualized and operationalized in global biomedical HIV prevention trials. Across 29 studies, the majority (n = 17) were conducted in resource-limited settings. We identified four overarching themes: (1) semantic cultural sensitivity - challenges in communicating scientific terminology into local vernaculars; (2) instrumental cultural sensitivity - understanding historical experiences to guide tailoring of trial activities; (3) budgetary, logistical, and personnel implications of operationalizing cultural sensitivity; and (4) culture as an asset. Future investigations should address how sociocultural considerations are operationalized across the spectrum of trial preparedness, implementation, and dissemination in particular sociocultural contexts, including intervention studies and evaluations of the effectiveness of methods used to operationalize culturally sensitive practices. PMID:26560332

  4. Exploring the Context of Trafficking and Adolescent Sex Industry Involvement in Tijuana, Mexico: Consequences for HIV Risk and Prevention

    PubMed Central

    Goldenberg, Shira M.; Silverman, Jay G.; Engstrom, David; Bojorquez-Chapela, Ietza; Usita, Paula; Rolón, María Luisa; Strathdee, Steffanie A.

    2015-01-01

    Coerced and adolescent sex industry involvement are linked to serious health and social consequences, including enhanced risk of HIV infection. Using ethnographic fieldwork, including interviews with 30 female sex workers with a history of coerced or adolescent sex industry involvement, we describe contextual factors influencing vulnerability to coerced and adolescent sex industry entry and their impacts on HIV risk and prevention. Early gender-based violence and economic vulnerabilities perpetuated subsequent vulnerability to coercion and adolescent sex exchange, while HIV risk mitigation capacities improved with increased age, control over working conditions, and experience. Structural interventions addressing gender-based violence, economic factors, and HIV prevention among all females who exchange sex are needed. PMID:25648946

  5. Exploring the context of trafficking and adolescent sex industry involvement in Tijuana, Mexico: consequences for HIV risk and prevention.

    PubMed

    Goldenberg, Shira M; Silverman, Jay G; Engstrom, David; Bojorquez-Chapela, Ietza; Usita, Paula; Rolón, María Luisa; Strathdee, Steffanie A

    2015-04-01

    Coerced and adolescent sex industry involvement are linked to serious health and social consequences, including enhanced risk of HIV infection. Using ethnographic fieldwork, including interviews with 30 female sex workers with a history of coerced or adolescent sex industry involvement, we describe contextual factors influencing vulnerability to coerced and adolescent sex industry entry and their impacts on HIV risk and prevention. Early gender-based violence and economic vulnerability perpetuated vulnerability to coercion and adolescent sex exchange, while HIV risk mitigation capacities improved with increased age, control over working conditions, and experience. Structural interventions addressing gender-based violence, economic factors, and HIV prevention among all females who exchange sex are needed. PMID:25648946

  6. Women who use or inject drugs: an action agenda for women-specific, multilevel and combination HIV prevention and research

    PubMed Central

    El-Bassel, Nabila; Strathdee, Steffanie A.

    2016-01-01

    Women account for more than half of all individuals living with HIV globally. Despite increasing drug and HIV epidemics among women, females who use drugs are rarely found in research, harm reduction programs, or drug and HIV treatment and care. Women who use drugs continue to face challenges that increase their vulnerability to HIV and other co-morbidities due to high rates of gender-based violence, human rights violations, incarceration, and institutional and societal stigmatization. This special issue emphasizes how the burdens of HIV, drug use and their co-occurring epidemics affect women in a global context. Papers included focus on the epidemiology of HIV, HCV and other co-morbidities; HIV treatment, prevention, and care; and policies affecting the lives of female who use drugs. This issue also highlights the state of the science of biomedical and behavioral research related to women who use drugs. The final paper highlights the major findings of papers covered and presents a call to action regarding needed research, treatment, and preventive services for women who use drugs. To address these needs, we advocate for women-specific thinking and approaches that considers the social, micro, and macro contexts of women’s lives. We present a woman-specific risk environment framework that reflects the unique lives and contexts of women who use drugs and provide a call to action for intervention, prevention, and policies. PMID:25978486

  7. Exploring Barriers and Facilitators to Participation of Male-To-Female Transgender Persons in Preventive HIV Vaccine Clinical Trials

    PubMed Central

    Yoon, Ro; Mooney, Jessica; Broder, Gail; Bolton, Marcus; Votto, Teress; Davis-Vogel, Annet

    2013-01-01

    Observed seroincidence and prevalence rates in male to female (MTF) transgender individuals highlight the need for effective targeted HIV prevention strategies for this community. In order to develop an effective vaccine that can be used by transgender women, researchers must understand and address existing structural issues that present barriers to this group’s participation in HIV vaccine clinical trials. Overcoming barriers to participation is important for ensuring HIV vaccine acceptability and efficacy for the MTF transgender community. To explore barriers and facilitators to MTF transgender participation in preventive HIV vaccine clinical trials, the HIV Vaccine Trials Network (HVTN) conducted focus groups among transgender women in four urban areas (Atlanta, Boston, Philadelphia and San Francisco). Barriers and facilitators to engagement of transgender women in preventive HIV vaccine clinical trials led to the following recommendations: (1) transgender cultural competency training; (2) creating trans-friendly environments; (3) true partnerships with local trans-friendly organizations and health care providers; (4) protocols that focus on transgender specific issues; and (5) data collection and tracking of transgender individuals. These results have implications for the conduct of HIV vaccine trials, as well as engagement of transgender women in research programs in general. PMID:23446435

  8. Women Who Use or Inject Drugs: An Action Agenda for Women-Specific, Multilevel, and Combination HIV Prevention and Research.

    PubMed

    El-Bassel, Nabila; Strathdee, Steffanie A

    2015-06-01

    Women account for more than half of all individuals living with HIV globally. Despite increasing drug and HIV epidemics among women, women who use drugs are rarely found in research, harm reduction programs, or drug and HIV treatment and care. Women who use drugs continue to face challenges that increase their vulnerability to HIV and other comorbidities because of high rates of gender-based violence, human rights violations, incarceration, and institutional and societal stigmatization. This special issue emphasizes how the burdens of HIV, drug use, and their co-occurring epidemics affect women in a global context. Articles included focus on the epidemiologies of HIV and hepatitis C virus and other comorbidities; HIV treatment, prevention, and care; and policies affecting the lives of women who use drugs. This issue also highlights the state of the science of biomedical and behavioral research related to women who use drugs. The final article highlights the major findings of articles covered and presents a call to action regarding needed research, treatment, and preventive services for women who use drugs. To address these needs, we advocate for women-specific thinking and approaches that consider the social, micro, and macro contexts of women's lives. We present a women-specific risk environment framework that reflects the unique lives and contexts of women who use drugs and provides a call to action for intervention, prevention, and policies. PMID:25978486

  9. Clinical Trial Design for HIV Prevention Research: Determining Standards of Prevention.

    PubMed

    Dawson, Liza; Zwerski, Sheryl

    2015-06-01

    This article seeks to advance ethical dialogue on choosing standards of prevention in clinical trials testing improved biomedical prevention methods for HIV. The stakes in this area of research are high, given the continued high rates of infection in many countries and the budget limitations that have constrained efforts to expand treatment for all who are currently HIV-infected. New prevention methods are still needed; at the same time, some existing prevention and treatment interventions have been proven effective but are not yet widely available in the countries where they most urgently needed. The ethical tensions in this field of clinical research are well known and have been the subject of extensive debate. There is no single clinical trial design that can optimize all the ethically important goals and commitments involved in research. Several recent articles have described the current ethical difficulties in designing HIV prevention trials, especially in resource limited settings; however, there is no consensus on how to handle clinical trial design decisions, and existing international ethical guidelines offer conflicting advice. This article acknowledges these deep ethical dilemmas and moves beyond a simple descriptive approach to advance an organized method for considering what clinical trial designs will be ethically acceptable for HIV prevention trials, balancing the relevant criteria and providing justification for specific design decisions. PMID:25230397

  10. Addressing sleep disturbances: An opportunity to prevent cardiometabolic disease?

    PubMed Central

    GRANDNER, MICHAEL A.

    2014-01-01

    There is increasing awareness of the role of sleep disturbance as an important factor in health and disease. Although subclinical sleep disturbances (insufficient sleep duration or inadequate sleep quality) may be difficult to assess with conceptual and/or methodological clarity, this review attempts to summarize and synthesize these findings. First, the concept of sleep disturbance in a public health context is introduced, to provide context and rationale. Second, operational definitions of ‘cardiometabolic disease’ and ‘sleep disturbance’ are offered, to address many unclear operationalizations. Third, the extant literature is summarized regarding short or long sleep duration and/or insufficient sleep, insomnia and insomnia symptoms, general (non-specific sleep disturbances), circadian rhythm abnormalities that result in sleep disturbances, and, briefly, sleep-disordered breathing. Fourth, the review highlights the social/behavioural context of sleep, including discussions of sleep and race/ethnicity, socio-economic position, and other social/environmental factors, in order to place these findings in a social-environmental context relevant to public health. Fifth, the review highlights the issue of sleep as a domain of health behaviour and addresses issues regarding development of healthy sleep interventions. Finally, a research agenda of future directions is proposed. PMID:24892892

  11. "Being faithful" in a sexual relationship: perceptions of Tanzanian adolescents in the context of HIV and pregnancy prevention.

    PubMed

    Baumgartner, Joy Noel; Lugina, Helen; Johnson, Laura; Nyamhanga, Tumaini

    2010-09-01

    Little is known about what adolescents think about faithfulness and partner reduction for HIV prevention (the "B" in the ABC HIV prevention behavior change strategy), including how they understand its implementation within relationships. In addition, because adolescents face the twin threats of HIV and unintended pregnancy, it is important to understand how adolescents may integrate their thinking on pregnancy prevention if they are using faithfulness or partner reduction as their HIV prevention strategy. This study gathered evidence by conducting 20 focus group discussions (FGDs) with 158 adolescents, aged 14-20. The FGDs were stratified by sex, age, current school attendance, rural or urban residence, and marital status. Results showed that the vast majority of groups felt that "B" messages are important and relevant for unmarried (as well as married) youth to hear for HIV prevention, but the messages need to be explicit (e.g., "being faithful means having only one tested sexual partner at a time"). Faithful relationships are perceived as ideal in terms of romantic expectations and HIV prevention, but were considered unrealistic if the relationship had a power imbalance. Adolescents acknowledged the risks of multiple partners and a few recognized that concurrent partnerships are riskier than serial partnerships. Condoms were given as the primary method for pregnancy prevention among youth, yet faithfulness was usually seen as precluding condom use and many youth considered condom use as evidence of a lack of faithfulness. Overall, adolescents recognized that practicing fidelity is complex. Young people need life skills education for how to establish and maintain faithful relationships with one tested partner and how to integrate condom use for pregnancy prevention within that relationship. Programs also need to more explicitly address the issues of trust and repeat HIV testing within "faithful" relationships which is an uncomfortable but necessary reality for

  12. The costs of HIV prevention strategies in developing countries.

    PubMed Central

    Söderlund, N.; Lavis, J.; Broomberg, J.; Mills, A.

    1993-01-01

    Since many evaluations of HIV (human immunodeficiency virus) prevention programmes do not include data on costs, a preliminary analysis of the costs and outputs of a sample of HIV prevention projects was attempted. Case studies, representing six broad HIV prevention strategies in developing countries with differing levels of per capita gross domestic product, were sought on the basis of availability of data and potential generalizability. The six prevention strategies studied were mass media campaigns, peer education programmes, sexually transmitted disease treatment, condom social marketing, safe blood provision, and needle exchange/bleach provision programmes. Financial cost data were abstracted from published studies or were obtained directly from project coordinators. Although estimates of cost-effectiveness were not made, calculations of the relative cost per common process measure of output were compared. Condom distribution costs ranged from US$ 0.02 to 0.70 per condom distributed, and costs of strategies involving personal educational input ranged from US$ 0.15 to 12.59 per contact. PMID:8261563

  13. MTV's "Staying Alive" Global Campaign Promoted Interpersonal Communication about HIV and Positive Beliefs about HIV Prevention

    ERIC Educational Resources Information Center

    Geary, Cynthia Waszak; Burke; Holly McClain; Castelnau, Laure; Neupane; Shailes; Sall, Yacine Ba; Wong, Emily; Tucker, Heidi Toms

    2007-01-01

    In 2002 MTV launched a global multicomponent HIV prevention campaign, "Staying Alive," reaching over 166 countries worldwide. An evaluation of this campaign focused on three diverse sites: Kathmandu, Nepal; Sao Paulo, Brazil; and Dakar, Senegal. Data were collected before and after campaign implementation through population-based household…

  14. Voluntary medical male circumcision: an HIV prevention priority for PEPFAR.

    PubMed

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2012-08-15

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  15. Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR

    PubMed Central

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C.; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2013-01-01

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  16. Strategies to prevent HIV transmission among heterosexual African-American women.

    PubMed

    Essien, E James; Meshack, Angela F; Peters, Ronald J; Ogungbade, Go; Osemene, Nora I

    2005-03-17

    BACKGROUND: African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. METHODS: Twenty five low income African American women, ages 18-29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. RESULTS: The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and personal experience with

  17. Strategies to prevent HIV transmission among heterosexual African-American women

    PubMed Central

    Essien, E James; Meshack, Angela F; Peters, Ronald J; Ogungbade, GO; Osemene, Nora I

    2005-01-01

    Background African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. Methods Twenty five low income African American women, ages 18–29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. Results The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and personal experience with

  18. Optimizing ART Adherence: Update for HIV Treatment and Prevention

    PubMed Central

    Robbins, Reuben N.; Spector, Anya Y.; Mellins, Claude A.; Remien, Robert H.

    2014-01-01

    Optimal adherence to antiretroviral therapy (ART) is central to achieving viral suppression and positive health outcomes in HIV-infected individuals. Virally suppressed individuals can also reduce the risk of HIV transmission to uninfected partners. Hence, adherence to ART has become both an HIV treatment and an HIV prevention strategy. However, achieving optimal ART adherence can be challenging, especially over the long term. It is increasingly important for clinicians and researchers to be abreast of the most recent developments in the field as new biomedical approaches to treatment emerge, and as guidelines for the use of pre-exposure prophylaxis (PrEP) are disseminated to providers serving HIV affected populations. Several reviews have described numerous ART adherence interventions that have been developed and/or tested with the most recent review including literature up to 2012. To augment the literature, we present a review of ART adherence interventions from 2013 – present. We included peer-reviewed journals as well as abstracts from two key conferences. PMID:25304006

  19. Traditional women's associations as channels for HIV / AIDS / STD prevention.

    PubMed

    Niang, C I

    1995-01-01

    Women of the Laobe ethnic group and the Dimba, a traditional women's association, provide advice about sexuality and reproductive health in southern Senegal. Research was initiated in October 1992 by the Cheikh Anta Diop University to determine whether these women could also help in HIV/AIDS and STD prevention activities. The study investigated men's and women's knowledge, attitudes, beliefs, and practices (KABP) related to sexuality and HIV/AIDS/STDs in the community of Kolda; practices potentially increasing women's risk of HIV/STD infection; and possibilities for integrating HIV/STD prevention messages into the interactions which take place between the Laobe and Dimba groups and the Kolda community. The KABP study was a questionnaire administered to 250 men and 250 women of reproductive age representing five ethnic groups residing in Kolda. 11 men and 14 women older than age 40 participated in in-depth sexual life history interviews. The survey and interviews indicate that people in Kolda do not generally see a link between sexual relations and STD transmission. Instead, STDs are attributed to behaviors such as urinating, walking barefoot on the urine of an already-infected person, encountering a "bad wind", and being cursed. Women may be at increased risk of HIV infection through practices designed to enhance sexual pleasure, including the insertion of organic and mineral product into the vagina, and the cutting of bumps and warts in and around the vagina. Sexual practices, knowledge, prevention through the Laobe and Dimba, and outcome and follow-up are discussed. PMID:12346870

  20. Sex isn't that simple: culture and context in HIV prevention interventions for gay and bisexual male adolescents.

    PubMed

    Harper, Gary W

    2007-11-01

    Gay and bisexual male adolescents and young adults in the United States have been disproportionately impacted by the HIV pandemic. Despite the steadily increasing rise in their HIV infection rates, there has not been a commensurate increase in HIV prevention programs targeted to the unique social and sexual lives of these youths. Programs that address cultural and contextual factors that influence sexual risk and protective behaviors need to be developed, implemented, and rigorously evaluated. These interventions should address the potential influences of sexual and gay culture on the HIV risk/protective behaviors of gay and bisexual adolescents, as well as the influence of more traditional cultural factors related to ethnicity. The influence of contextual developmental factors should also be addressed. This may include an incorporation into prevention programs of the societal-level influences of heterosexism and masculinity ideology and the individual-level influences of sexual identity and ethnic identity development. Researchers and interventionists need to be creative and innovative in their HIV prevention approaches and ensure that programs are grounded in the lives and realities of gay and bisexual adolescents and young adults. PMID:18020756

  1. A perspective on progress and gaps in HIV prevention science.

    PubMed

    Kiser, Patrick F; Mesquita, Pedro M M; Herold, Betsy C

    2012-11-01

    In the past few years, the transdisciplinary field of HIV prevention has reached several milestones. Topically applied tenofovir gel provided significant protection from sexual transmission of HIV in a large-scale clinical trial and oral Truvada (emtricitabine/tenofovir disoproxil fumarate) was recently approved for preexposure prophylaxis (PrEP) following two successful clinical trials in men and women. These achievements are tempered by the disappointing results of other clinical trials, which highlight the complexities of prevention research. In this perspective, we discuss scientific and developmental gaps for topical chemoprophylaxis of the sexual transmission of HIV, which depends on the complex interactions between the pharmacokinetics and pharmacodynamics of drugs, formulation and delivery systems, anatomic site of transmission, and host mucosal immune defenses. Despite the considerable time and resources devoted to unraveling the initial steps in sexual transmission of HIV, current knowledge is based on animal models and human explanted tissue, which may not fully recapitulate what happens clinically. Understanding these events, including the role that sex hormones, semen, and mucosal secretions play in transmission, and the interplay between innate immunity, the mucosal environment, and drug efficacy is paramount. This drives some of the most pressing questions in the field. PMID:22966871

  2. Funding of community-based interventions for HIV prevention.

    PubMed

    Poku, Nana K; Bonnel, René

    2016-07-01

    Since the start of the HIV epidemic, community responses have been at the forefront of the response. Following the extraordinary expansion of global resources, the funding of community responses rose to reach at least US$690 million per year in the period 2005-2009. Since then, many civil society organisations (CSOs) have reported a drop in funding. Yet, the need for strong community responses is even more urgent, as shown by their role in reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track targets. In the case of antiretroviral treatment, interventions need to be adopted by most people at risk of HIV in order to have a substantial effect on the prevention of HIV at the population level. This paper reviews the published literature on community responses, funding and effectiveness. Additional funding is certainly needed to increase the coverage of community-based interventions (CBIs), but current evidence on their effectiveness is extremely mixed, which does not provide clear guidance to policy makers. This is especially an issue for adolescent girls and young women in Eastern and Southern Africa, who face extremely high infection risk, but the biomedical prevention tools that have been proven effective for the general population still remain pilot projects for this group. Research is especially needed to isolate the factors affecting the likelihood that interventions targeting this group are consistently successful. Such work could be focused on the community organisations that are currently involved in delivering gender-sensitive interventions. PMID:27399046

  3. Associations between Social Capital and HIV Stigma in Chennai, India: Considerations for Prevention Intervention Design

    ERIC Educational Resources Information Center

    Sivaram, Sudha; Zelaya, Carla; Srikrishnan, A. K.; Latkin, Carl; Go, V. F.; Solomon, Suniti; Celentano, David

    2009-01-01

    Stigma against persons living with HIV/AIDS (PLHA) is a barrier to seeking prevention education, HIV testing, and care. Social capital has been reported as an important factor influencing HIV prevention and social support upon infection. In the study, we explored the associations between social capital and stigma among men and women who are…

  4. 75 FR 39264 - CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ... CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment In accordance with section 10(a)(2..., CDC and the Administrator, HRSA, regarding activities related to prevention and control of HIV/AIDS and other STDs, the support of health care services to persons living with HIV/AIDS, and education...

  5. "It's Crazy Being a Black, Gay Youth." Getting Information about HIV Prevention: A Pilot Study

    ERIC Educational Resources Information Center

    Voisin, Dexter R.; Bird, Jason D. P.; Shiu, Chen-Shi; Krieger, Cathy

    2013-01-01

    Background: Access and adoption of HIV prevention information are important criteria for reducing HIV infection rates among men who have sex with men. Methods: Using focus group data, researchers sought to identify sources of HIV prevention information and barriers to adopting protective behaviors among young African American men who have sex with…

  6. Combination HIV Prevention Interventions: The Potential of Integrated Behavioral and Biomedical Approaches

    PubMed Central

    Brown, Jennifer L.; Sales, Jessica M.; DiClemente, Ralph J.

    2014-01-01

    Background Combination HIV prevention interventions that integrate efficacious behavioral and biomedical strategies offer the potential to reduce new HIV infections. Purpose We overview the efficacy data for three biomedical HIV prevention approaches: microbicides, pre-exposure prophylaxis (PrEP), and an HIV vaccination, review factors associated with differential acceptability and uptake of these methods, and suggest strategies to optimize the effectiveness and dissemination of combination HIV prevention approaches. Methods A narrative review was conducted highlighting key efficacy data for microbicides, PrEP, and an HIV vaccination and summarizing acceptability data for each of the three biomedical HIV prevention approaches. Recommendations for the integration and dissemination of combined behavioral and biomedical HIV prevention approaches are provided. Results To date, microbicides and an HIV vaccination have demonstrated limited efficacy for the prevention of HIV. However, PrEP has demonstrated efficacy in reducing HIV incident infections. A diverse array of factors influences both hypothetical willingness and actual usage of each biomedical prevention method. Conclusions Strategies to effectively integrate and evaluate combination HIV prevention interventions are urgently needed. PMID:25216985

  7. Sources of HIV-Prevention Information for Individuals at High Risk.

    ERIC Educational Resources Information Center

    Sagrestano, Lynda M.; Heiss-Wendt, Renate M.; Mizan, Ainon N.; Kittleson, Mark J.; Sarvela, Paul D.

    2001-01-01

    Identified the best methods of reaching people at high risk with HIV-prevention messages. Data from men who had sex with men, injection drug users, sex workers, HIV-positive people, heterosexuals, migrant workers, and perinatal women indicated that over 70 percent were exposed to HIV-prevention messages, though sources of exposure varied by risk…

  8. Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs

    ERIC Educational Resources Information Center

    Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol

    2009-01-01

    The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

  9. Emtricitabine + tenofovir to prevent HIV transmission. More evaluation needed.

    PubMed

    2013-07-01

    Regular condom use is the standard method for preventing HIV transmission during insertive intercourse. Effective treatment of infected individuals also reduces the risk of transmission. However, even when these preventive measures are used correctly, they are not completely reliable. Emtricitabine (a nucleoside) and tenofovir (a nucleotide) are HIV reverse transcriptase inhibitors. The combination of these 2 drugs has been authorised in the United States for the prevention of HIV-1 infection in adults at high risk, in combination with other preventive measures. Clinical evaluation is based mainly on two double-blind placebo-controlled trials. In a trial involving 2499 men or transgender women (born male) who have sex with men, conducted outside Europe, the incidence of infection was lower among patients treated with emtricitabine + tenofovir than with placebo (2.3 versus 4.3 per 100 person-years, p = 0.005). A subgroup analysis showed no added preventive effect of this treatment among condom users. Another trial including 4758 heterosexual couples in which only one partner was infected, conducted in Uganda and Kenya, showed a lower incidence of HIV infection in the emtricitabine + tenofovir group than in the placebo group after one year of treatment (0.50 versus 1.99 per 100 person-years). No statistically significant difference was found between the emtricitabine + tenofovir combination and tenofovir single-agent prophylaxis. Drug prevention showed no added efficacy in this trial among patients who regularly used condoms. Other trials conducted in Africa among heterosexuals favour the preventive efficacy of emtricitabine + tenofovir, except in one trial in which adherence appeared to be very poor. These trials did not identify any previously unknown adverse effects of emtricitabine + tenofovir. Tenofovir can cause kidney failure. Data from a US registry of pregnancies exposed to emtricitabine or tenofovir rule out any major risk of teratogenicity. In situations

  10. (Not) getting political: indigenous women and preventing mother-to-child transmission of HIV in West Papua.

    PubMed

    Munro, Jenny; McIntyre, Lynn

    2015-01-01

    This paper builds on critiques that call for a more nuanced and contextualised understanding of conditions that affect HIV prevention by looking at West Papuan women's experiences of prevention of mother-to-child transmission services. Drawing on qualitative, ethnographic research with indigenous women and health workers, the paper demonstrates that women experience poor-quality HIV education and counselling, and that indigenous practices and concerns are largely not addressed by HIV services. We attribute this to a combination of national anti-indigenous and anti-separatist political concerns with donor-led interventions that result in limited localisation and reduced effectiveness of HIV prevention measures. In West Papua, services are needed that enhance cooperation and shared commitment, and that acknowledge and work to overcome existing inequalities, ethnic tensions and discrimination in the health system. Beyond Indonesia, donor-led HIV programmes and interventions need to balance avoidance of politically sensitive issues with complicity in perpetuating health inequalities. Translating global health interventions and donor priorities into locally compelling HIV prevention activities involves more than navigating local cultural and religious beliefs. Programme development and implementation strategies that entail confronting structural questions as well as social hierarchies, cleavages and silences are needed to render more effective services; strategies that are inherently political. PMID:26305182

  11. Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

    PubMed Central

    Collins, Pamela Y.

    2009-01-01

    Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers’ perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

  12. Building a Mobile HIV Prevention App for Men Who Have Sex With Men: An Iterative and Community-Driven Process

    PubMed Central

    McDougal, Sarah J; Sullivan, Patrick S; Stekler, Joanne D; Stephenson, Rob

    2015-01-01

    Background Gay, bisexual, and other men who have sex with men (MSM) account for a disproportionate burden of new HIV infections in the United States. Mobile technology presents an opportunity for innovative interventions for HIV prevention. Some HIV prevention apps currently exist; however, it is challenging to encourage users to download these apps and use them regularly. An iterative research process that centers on the community’s needs and preferences may increase the uptake, adherence, and ultimate effectiveness of mobile apps for HIV prevention. Objective The aim of this paper is to provide a case study to illustrate how an iterative community approach to a mobile HIV prevention app can lead to changes in app content to appropriately address the needs and the desires of the target community. Methods In this three-phase study, we conducted focus group discussions (FGDs) with MSM and HIV testing counselors in Atlanta, Seattle, and US rural regions to learn preferences for building a mobile HIV prevention app. We used data from these groups to build a beta version of the app and theater tested it in additional FGDs. A thematic data analysis examined how this approach addressed preferences and concerns expressed by the participants. Results There was an increased willingness to use the app during theater testing than during the first phase of FGDs. Many concerns that were identified in phase one (eg, disagreements about reminders for HIV testing, concerns about app privacy) were considered in building the beta version. Participants perceived these features as strengths during theater testing. However, some disagreements were still present, especially regarding the tone and language of the app. Conclusions These findings highlight the benefits of using an interactive and community-driven process to collect data on app preferences when building a mobile HIV prevention app. Through this process, we learned how to be inclusive of the larger MSM population without

  13. A faith-based community partnership to address HIV/AIDS in the southern United States: implementation, challenges, and lessons learned.

    PubMed

    Abara, Winston; Coleman, Jason D; Fairchild, Amanda; Gaddist, Bambi; White, Jacob

    2015-02-01

    Though race and region are not by themselves risk factors for HIV infection, regional and racial disparities exist in the burden of HIV/AIDS in the US. Specifically, African Americans in the southern US appear to bear the brunt of this burden due to a complex set of upstream factors like structural and cultural influences that do not facilitate HIV/AIDS awareness, HIV testing, or sexual risk-reduction techniques while perpetuating HIV/AIDS-related stigma. Strategies proposed to mitigate the burden among this population have included establishing partnerships and collaborations with non-traditional entities like African American churches and other faith-based organizations. Though efforts to partner with the African American church are not necessarily novel, most of these efforts do not present a model that focuses on building the capacity of the African American church to address these upstream factors and sustain these interventions. This article will describe Project Fostering AIDS Initiatives That Heal (F.A.I.T.H), a faith-based model for successfully developing, implementing, and sustaining locally developed HIV/AIDS prevention interventions in African American churches in South Carolina. This was achieved by engaging the faith community and the provision of technical assistance, grant funding and training for project personnel. Elements of success, challenges, and lessons learned during this process will also be discussed. PMID:24173601

  14. Your blues ain't like mine: considering integrative antiracism in HIV prevention research with black men who have sex with men in Canada and the United States.

    PubMed

    Nelson, LaRon E; Walker, Ja'Nina J; DuBois, Steve N; Giwa, Sulaimon

    2014-12-01

    Evidence-based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, PsychInfo, MEDLINE and the CDC compendium of evidence-based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM. PMID:24894761

  15. Where are the young men in HIV prevention efforts? Comments on HIV prevention programs and research from young men who sex with men in Los Angeles county.

    PubMed

    Holloway, Ian W; Cederbaum, Julie A; Ajayi, Antonette; Shoptaw, Steven

    2012-12-01

    Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N = 100, M(age) = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0 % of all participants had previously attended an HIV prevention program, and that 21.3 % of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6 months compared to those who had not (p < .05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0 %), not perceiving themselves to be at risk for HIV infection (14.0 %), and believing that they already knew everything they needed to know about HIV transmission (23.0 %). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM. PMID:23132515

  16. Where are the young men in HIV prevention efforts? Comments on HIV prevention programs and research from young men who have sex with men in Los Angeles County

    PubMed Central

    Holloway, Ian W.; Cederbaum, Julie A.; Ajayi, Antonette; Shoptaw, Steven

    2012-01-01

    Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted in a diverse sample of YMSM (N = 100, Mage = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0% of all participants had previously attended an HIV prevention program, and that 21.3% of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6 months compared to those who had not (p < .05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0%), not perceiving themselves to be at risk for HIV infection (14.0%), and believing that they already knew everything they needed to know about HIV transmission (23.0%). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM. PMID:23132515

  17. Thirty years of condom-based HIV prevention by gay men in New Zealand.

    PubMed

    Hughes, Anthony J; Saxton, Peter J

    2015-12-01

    Three decades after the first government-funded HIV prevention campaign in 1985, gay and bisexual men (GBM) remain the population most at risk of infection in New Zealand. We review the major determinants of the elevated HIV risk for GBM, describe New Zealand's prevention response over the first 30 years, and summarise the public health record. HIV incidence among GBM is driven by the heightened biological efficiency of HIV transmission during unprotected anal intercourse, dense sexual partnering networks, and endemic HIV prevalence. Responses in New Zealand have emphasised evidence-based primary prevention by condom use, which were implemented in communities and supported by comprehensive public health action. New Zealand has a good international HIV prevention record among GBM, however HIV diagnosis rates are now higher than they were during the epidemic nadir of the late 1990s. Lessons from the first three decades must underpin future HIV control efforts. PMID:26913905

  18. Awareness of HIV/AIDS prevention and acceptance of HIV testing among residents in Likoma Island, northern Malawi.

    PubMed

    Chiang, Hung Che; Yu, Kwong Leung; Yap, Shue Fang; Goh, Kah Kheng; Mo, Meng Hsuan; Yang, Ta Wei; Ngo, Yeh Giin; Hsu, Shu Jung; Wu, Yi Ching; Lai, Chung Sheng; Ko, Ying Chin; Chang, Po Ya

    2009-09-01

    To evaluate the awareness of HIV/AIDS prevention education, and the acceptance of HIV testing among residents on Likoma Island, Malawi, a cross-sectional, population-based study of 579 residents aged > or =15 years from seven villages on Likoma Island was conducted during July and August 2007. Most of the subjects studied could correctly answer questions about their awareness of AIDS and knowledge of the ways to reduce HIV transmission. Moreover, the proportion of respondents (65.8%) who possessed complete knowledge of HIV/AIDS prevention was greater than the national average. By contrast, condom utilization was slightly lower. Our results also showed that a high proportion of respondents (70.3%) had been HIV tested at any time, 93.5% of them voluntarily. Among correlated factors, females [adjusted odds ratio (AOR)=1.7, 95% CI 1.1-1.6] and polygamous individuals (AOR=3.3, 95% CI 1.5-7.0) were more likely to receive an HIV test. Past experience of being HIV tested was a strong predictor of possessing good knowledge and attitudes towards HIV/AIDS prevention. We conclude that antiretroviral treatment provided by Likoma District Hospital has led to the successful scale-up of HIV testing in Likoma Island and consequently improved the awareness of HIV/AIDS. However, the use of condoms remains largely unsupported, and there is therefore still a need to intensify general HIV/AIDS education on the island. PMID:19628236

  19. Predictors of Self-Efficacy for HIV Prevention Among Hispanic Women in South Florida

    PubMed Central

    Villegas, Natalia; Cianelli, Rosina; Gonzalez-Guarda, Rosa; Kaelber, Lorena; Ferrer, Lilian; Peragallo, Nilda

    2012-01-01

    Self-efficacy is a critical element for HIV prevention, however little is known about the predictors of self-efficacy for HIV prevention among Hispanic women. In this cross-sectional study we assessed if age, living with a partner, employment status, HIV knowledge, self-esteem, and intimate partner violence (IPV) predicted self-efficacy for HIV prevention in 548 Hispanic women in South Florida who participated in a randomized controlled trial (SEPA). The majority of Hispanic women reported high levels of self-efficacy for HIV prevention. Women who were older, living with a partner, with less HIV knowledge, and a history of IPV reported significantly lower levels of self-efficacy for HIV prevention. HIV knowledge was the most important predictor of self-efficacy for HIV prevention. Employment was not a significant predictor of self-efficacy for HIV prevention. Predictors identified in the study can be used to identify high-risk Hispanic women who are in need of HIV prevention interventions. PMID:22795758

  20. Predictors of self-efficacy for HIV prevention among Hispanic women in South Florida.

    PubMed

    Villegas, Natalia; Cianelli, Rosina; Gonzalez-Guarda, Rosa; Kaelber, Lorena; Ferrer, Lilian; Peragallo, Nilda

    2013-01-01

    Self-efficacy is a critical element for HIV prevention, however little is known about the predictors of self-efficacy for HIV prevention among Hispanic women. In this cross-sectional study we assessed if age, living with a partner, employment status, HIV knowledge, self-esteem, and intimate partner violence (IPV) predicted self-efficacy for HIV prevention in 548 Hispanic women in South Florida who participated in a randomized controlled trial (SEPA). The majority of Hispanic women reported high levels of self-efficacy for HIV prevention. Women who were older, living with a partner, had less HIV knowledge, and had a history of IPV reported significantly lower levels of self-efficacy for HIV prevention. HIV knowledge was the most important predictor of self-efficacy for HIV prevention. Employment was not a significant predictor of self-efficacy for HIV prevention. Predictors identified in the study can be used to identify high-risk Hispanic women who are in need of HIV prevention interventions. PMID:22795758

  1. Ethical Issues in HIV Prevention Research with People Who Inject Drugs

    PubMed Central

    Sugarman, Jeremy; Rose, Scott M.; Metzger, David

    2013-01-01

    Background Injection drug use continues to significantly contribute to new infections with HIV. Moreover, conducting HIV prevention research with people who inject drugs (PWIDs) can be complicated for an array of practical, social, legal and ethical reasons. It is critical that these research efforts are sensitive to the particular vulnerabilities associated with injection drug use as well as those related to being at risk for acquiring HIV so as to minimize harm to participants in research. Purpose To describe how we addressed some of these ethical challenges during the course of a large-scale multinational randomized HIV prevention trial involving PWIDs, which was successfully completed. Methods The ethical issues encountered during the life-cycle of the trial were catalogued by the principal investigator, study coordinator and ethicist working on the trial. Relevant study documents were then reviewed to provide pertinent details. The ethical issues unique to the trial were then described. Results Before implementation, the trial faced particularly complex challenges related to the vulnerability of PWIDs where HIV seroincidence rates in the population were high and legal policies and stigma regarding injection drug use was severe. Accordingly, a rapid policy assessment was commissioned and a series of community engagement activities were conducted. During the trial, in addition to using careful standard operating procedures regarding all aspects of trial conduct and extensive staff training, the trial standardized informed consent procedures and assessed them. Further, social harms were monitored along with physical harms and adverse events. Following the decision to close the study, it was critical to develop an orderly and safe process for closing it. The issue of post-trial access to the study medication and a complex intervention also surfaced for consideration. Limitations The issues described in this paper are necessarily limited to how they manifested

  2. Health Care and HIV Testing Experiences Among Black Men in the South: Implications for “Seek, Test, Treat, and Retain” HIV Prevention Strategies

    PubMed Central

    Malebranche, David; Bowleg, Lisa; Sangaramoorthy, Thurka

    2013-01-01

    Abstract Few studies have explored how overall general health care and HIV/STI testing experiences may influence receipt of “Seek, Test, Treat, and Retain” (STTR) HIV prevention approaches among Black men in the southern United States. Using in-depth qualitative interviews with 78 HIV-negative/unknown Black men in Georgia, we explored factors influencing their general health care and HIV/STI testing experiences. The Andersen behavioral model of health care utilization (Andersen model) offers a useful framework through which to examine the general health care experiences and HIV testing practices of Black men. It has four primary domains: Environment, Population characteristics, Health behavior, and Outcomes. Within the Andersen model framework, participants described four main themes that influenced HIV testing: access to insurance, patient–provider communication, quality of services, and personal belief systems. If STTR is to be successful among Black men, improving access and quality of general health care, integrating HIV testing into general health care, promoting health empowerment, and consumer satisfaction should be addressed. PMID:23268586

  3. Implications of Mobility Patterns and HIV Risks for HIV Prevention Among Migrant Market Vendors in Kazakhstan

    PubMed Central

    Gilbert, Louisa; Terlikbayeva, Assel; West, Brooke; Bearman, Peter; Wu, Elwin; Zhussupov, Baurzhan; Platais, Ingrida; Brisson, Anne

    2011-01-01

    Objectives. We examined the relationships between mobility characteristics and sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. Methods. Participants completed a structured interview covering sociodemographics, mobility characteristics, sexual behaviors, and biomarkers for HIV, HCV, and syphilis. We used multivariate analyses to examine associations between mobility patterns and HIV risks after adjusting for sociodemographics. Results. Longer duration of a participant's last trip outside Almaty increased the odds of reporting multiple sexual partners. More frequent travel to visit family or friends was associated with multiple sexual partners and unprotected sex with steady partners. More frequent travel to buy goods in the past year was associated with multiple sexual partners. Men who traveled more often to buy goods were more likely to have purchased sex within the previous 90 days. Conclusions. Relationships between mobility patterns and sexual risk behaviors underscore the need for HIV-prevention strategies targeting the specific transmission dynamics that migrant vendors are likely to present. PMID:21493929

  4. Treating High-grade Lesions to Prevent Anal Cancer in HIV-infected People

    Cancer.gov

    This study, called the ANCHOR trial, will investigate whether screening and prevention methods similar to those used to prevent cervical cancer can help prevent anal cancer in HIV-infected men and women.

  5. Expanding the partnership. The private sector's role in HIV / AIDS prevention.

    PubMed

    Lamptey, P

    1996-07-01

    The public sector supports most HIV/AIDS prevention and care activities in developing countries, with significant funding provided by the US Agency for International Development, the Overseas Development Authority, the European Community, and international banking institutions such as the World Bank. Local nongovernmental organizations (NGOs) and international private voluntary organizations (PVOs) implement many of the grassroots prevention and care efforts in developing countries, but often require support from donor agencies. While the private commercial sector has played a minor role in supporting HIV/AIDS prevention and care efforts, a number of local and multinational companies are beginning to recognize the importance of protecting their workers from HIV infection. These companies are motivated by a sense of moral obligation and/or view HIV/AIDS prevention as a cost-effective investment. Mainly affecting the most economically productive age groups, the HIV/AIDS epidemic will have a significant impact upon private industry. Workplace-based prevention programs and policies, private sector resources for HIV/AIDS prevention and care, how HIV/AIDS programs can benefit from the private sector's experience in commercial service delivery, research and development, and corporate direct cash and in-kind contributions to government and NGO HIV/AIDS prevention activities are discussed. The AIDS Control and Prevention (AIDSCAP) Project's Businesses Managing AIDS Project helps owners and managers understand the potential impact of HIV/AIDS upon their businesses and the benefits of HIV/AIDS prevention. PMID:12347592

  6. International Collaboration in HIV Prevention Research: Evidence from a Research Seminar in Russia

    PubMed Central

    Batluk, Julia V.; Bryant, Kendall J.; Shaboltas, Alla V.

    2015-01-01

    Abstract HIV transmission is a major health concern. Global efforts are necessary to control the spread of infection. International collaborative studies in countries with high rates of new infections are essential for increasing knowledge on the behavioral, social, and biomedical aspects of HIV/AIDS and HIV transmission. Statistics indicate a growing HIV epidemic in Russia. There are alarming proportions of new cases attributed to heterosexual contact, and HIV is increasingly affecting people in the general population who are not part of any traditional high-risk group. Despite recent advances in HIV prevention, data on effective behavioral prevention approaches are limited. There is minimal evidence to suggest which types of prevention will be effective in reducing the risk for HIV transmission among people at risk in the general population. This article presents a review and discussion of an international research seminar, HIV Prevention Research: Evidence-Based Behavioral Approaches. Local and international interdisciplinary researchers gathered for the purposes of exchanging research results and information about ongoing studies, identifying gaps in knowledge, and discussing promising prevention strategies. The overarching goal was to advance HIV prevention research through scientific integration. The seminar provided an excellent platform for building research capacity in interdisciplinary HIV research in Russia and integrating research efforts with the international research community to contribute to HIV prevention research throughout the world. PMID:25430518

  7. "Typhoid Mary" and "HIV Jane": responsibility, agency and disease prevention.

    PubMed

    Chan, Kit Yee; Reidpath, Daniel D

    2003-11-01

    The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency. PMID:14708397

  8. Exploring Social Networking Technologies as Tools for HIV Prevention for Men Who Have Sex With Men.

    PubMed

    Ramallo, Jorge; Kidder, Thomas; Albritton, Tashuna; Blick, Gary; Pachankis, John; Grandelski, Valen; Grandeleski, Valen; Kershaw, Trace

    2015-08-01

    Social networking technologies are influential among men who have sex with men (MSM) and may be an important strategy for HIV prevention. We conducted focus groups with HIV positive and negative participants. Almost all participants used social networking sites to meet new friends and sexual partners. The main obstacle to effective HIV prevention campaigns in social networking platforms was stigmatization based on homosexuality as well as HIV status. Persistent stigma associated with HIV status and disclosure was cited as a top reason for avoiding HIV-related conversations while meeting new partners using social technologies. Further, social networking sites have different social etiquettes and rules that may increase HIV risk by discouraging HIV status disclosure. Overall, successful interventions for MSM using social networking technologies must consider aspects of privacy, stigma, and social norms in order to enact HIV reduction among MSM. PMID:26241381

  9. Sexual Risk Behaviors for HIV/AIDS in Chuuk State, Micronesia: The Case for HIV Prevention in Vulnerable Remote Populations

    PubMed Central

    Russell, Toya V.; Do, Ann N.; Setik, Eleanor; Sullivan, Patrick S.; Rayle, Victoria D.; Fridlund, Carol A.; Quan, Vu M.; Voetsch, Andrew C.; Fleming, Patricia L.

    2007-01-01

    Background After the first two cases of locally-acquired HIV infection were recognized in Chuuk State, Federated States of Micronesia (FSM), a public health response was initiated. The purpose of the response was to assess the need for HIV education and prevention services, to develop recommendations for controlling further spread of HIV in Chuuk, and to initiate some of the prevention measures. Methodology/Principal Findings A public health team conducted a survey and rapid HIV testing among a sample of residents on the outer islands in Chuuk. Local public health officials conducted contact tracing and testing of sex partners of the two locally-acquired cases of HIV infection. A total of 333 persons completed the survey. The majority knew that HIV is transmitted through unprotected sexual contact (81%), injection drug use (61%), or blood transfusion (64%). Sexual activity in the past 12 months was reported among 159 participants, including 90 females and 69 males. Compared to women, men were more likely to have had multiple sex partners, to have been drunk during sex, but less likely to have used a condom in the past 12 months. The two men with locally acquired HIV infection had unprotected anal sex with a third Chuukese man who likely contracted HIV while outside of Chuuk. All 370 persons who received voluntary, confidential HIV counseling and testing had HIV negative test results. Conclusions/Significance Despite the low HIV seroprevalence, risky sexual behaviors in this small isolated population raise concerns about the potential for rapid spread of HIV. The lack of knowledge about risks, along with stigmatizing attitudes towards persons infected with HIV and high risk sexual behaviors indicate the need for resources to be directed toward HIV prevention in Chuuk and on other Pacific Islands. PMID:18074009

  10. The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention

    PubMed Central

    Rotheram-Borus, Mary Jane; Swendeman, Dallas; Chovnick, Gary

    2010-01-01

    In the past 25 years, the field of HIV prevention research has been transformed repeatedly. Today, effective HIV prevention requires a combination of behavioral, biomedical, and structural intervention strategies. Risk of transmitting or acquiring HIV is reduced by consistent male and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, male circumcision, and treatment with antiretroviral medications. At least 144 behavioral prevention programs have been found effective in reducing HIV transmission acts; however, scale up of these programs has not occurred outside of the United States. A series of recent failures of HIV-prevention efficacy trials for biomedical innovations such as HIV vaccines, treating herpes simplex 2 and other sexually transmitted infections, and diaphragm and microbicide barriers highlights the need for behavioral strategies to accompany biomedical strategies. This challenges prevention researchers to reconceptualize how cost-effective, useful, realistic, and sustainable prevention programs will be designed, delivered, tested, and diffused. The next generation of HIV prevention science must draw from the successes of existing evidence-based interventions and the expertise of the market sector to integrate preventive innovations and behaviors into everyday routines. PMID:19327028

  11. Challenges and opportunities for HIV prevention and care: insights from focus groups of HIV-infected African American men.

    PubMed

    Buseh, Aaron G; Stevens, Patricia E; McManus, Patricia; Addison, Reverend Jim; Morgan, Sarah; Millon-Underwood, Sandra

    2006-01-01

    Given the inordinate burden of HIV illness borne by African American men, investigations of HIV prevention and care in this population are urgently needed. In this qualitative study, a sample of 20 HIV-infected African American men participated in two focus groups in which they exchanged experiences and ideas about living with HIV. They shared details about how they were personally impacted by HIV, and together they constructed a perspective on the larger societal context in which the HIV infection rate among African American men continues unabated. The men focused on growing complacency about HIV/AIDS in the United States, underfunding of supports and services, stigmas operative in African American communities, and differential care based on race, gender, and diagnosis. They saw opportunity in personal strategies that help individual men infected with HIV to take a more empowered stance to deal with the disease and improve their health but looked for changes undertaken by African Americans at the community level to make a real difference in the epidemic. Their vision included enhanced support for HIV prevention and care from influential community institutions like Black churches, more open dialogue about drugs and sexual behavior, and capacity-building for families whose members are HIV-infected or at risk for HIV. PMID:16849084

  12. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM

    PubMed Central

    Aliabadi, Negar; Carballo-Dieguez, Alex; Bakken, Suzanne; Rojas, Marlene; Brown, William; Carry, Monique; Mosley, Jocelyn Patterson; Gelaude, Deborah; Schnall, Rebecca

    2016-01-01

    HIV remains a significant public health problem among men who have sex with men (MSM). MSM comprise 2% of the U.S. population, but constitute 56% of persons living with HIV. Mobile health technology is a promising tool for HIV prevention. The purpose of this study was to identify the desired content, features and functions of a mobile application (app) for HIV prevention in high-risk MSM. We conducted five focus group sessions with 33 MSM. Focus group recordings were transcribed and coded using themes informed by the information-motivation-behavioral (IMB) skills model. Participants identified information needs related to HIV prevention: HIV testing and prophylaxis distribution centers, support groups/peers, and HIV/STI disease/treatment information. Areas of motivation to target for the app included: attitudes and intentions. Participants identified behavioral skills to address with an app: using condoms correctly, negotiating safer sex, recognizing signs of HIV/STI. Findings from this work provide insight into the desired content of a mobile app for HIV prevention in high-risk MSM. PMID:26595265

  13. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM.

    PubMed

    Aliabadi, Negar; Carballo-Dieguez, Alex; Bakken, Suzanne; Rojas, Marlene; Brown, William; Carry, Monique; Mosley, Jocelyn Patterson; Gelaude, Deborah; Schnall, Rebecca

    2015-12-01

    HIV remains a significant public health problem among men who have sex with men (MSM). MSM comprise 2% of the U.S. population, but constitute 56% of persons living with HIV. Mobile health technology is a promising tool for HIV prevention. The purpose of this study was to identify the desired content, features and functions of a mobile application (app) for HIV prevention in high-risk MSM. We conducted five focus group sessions with 33 MSM. Focus group recordings were transcribed and coded using themes informed by the information-motivation-behavioral (IMB) skills model. Participants identified information needs related to HIV prevention: HIV testing and prophylaxis distribution centers, support groups/peers, and HIV/STI disease/treatment information. Areas of motivation to target for the app included: attitudes and intentions. Participants identified behavioral skills to address with an app: using condoms correctly, negotiating safer sex, recognizing signs of HIV/STI. Findings from this work provide insight into the desired content of a mobile app for HIV prevention in high-risk MSM. PMID:26595265

  14. Effectiveness of HIV prevention social marketing with injecting drug users.

    PubMed

    Gibson, David R; Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M

    2010-10-01

    Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide. PMID:20724686

  15. Harmonizing disease prevention and police practice in the implementation of HIV prevention programs: Up-stream strategies from Wilmington, Delaware

    PubMed Central

    2012-01-01

    Introduction Improving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference. Case description In 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation. A program designed to prevent, monitor, and respond to these barriers was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals. Discussion We report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety. Conclusions A cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations. PMID:22591836

  16. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention

    PubMed Central

    Kennedy, Caitlin E.; Fonner, Virginia A.; O'Reilly, Kevin R.; Sweat, Michael D.

    2013-01-01

    Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. We conducted a systematic review by searching electronic databases from 1990-2012, examining secondary references, and hand searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of 5,218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with 6 conducted in sub-Saharan Africa, 3 in South or Southeast Asia, and 3 in Latin America and the Caribbean. Target populations included adult women (N=6), female sex workers/bar workers (N=3), and youth/orphans (N=3). All studies targeted females except 2 among youth/orphans. Study rigor was moderate, with 2 group-randomized trials and 2 individual-randomized trials. All interventions except 3 included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these interventions may have important effects

  17. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention.

    PubMed

    Kennedy, Caitlin E; Fonner, Virginia A; O'Reilly, Kevin R; Sweat, Michael D

    2014-01-01

    Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these

  18. Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa.

    PubMed

    Toska, Elona; Gittings, Lesley; Hodes, Rebecca; Cluver, Lucie D; Govender, Kaymarlin; Chademana, K Emma; Gutiérrez, Vincent Evans

    2016-07-01

    Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with behavioural and social interventions to alleviate the socio-structural determinants of HIV infection. There is growing evidence that social protection has the potential to reduce the risk of HIV infection among children and adolescents. This research combined expert consultations with a rigorous review of academic and policy literature on the effectiveness of social protection for HIV prevention among children and adolescents, including prevention for those already HIV-positive. The study had three goals: (i) assess the evidence on the effectiveness of social protection for HIV prevention, (ii) consider key challenges to implementing social protection programmes that promote HIV prevention, and (iii) identify critical research gaps in social protection and HIV prevention, in Eastern and Southern Africa. Causal pathways of inequality, poverty, gender and HIV risk require flexible and responsive social protection mechanisms. Results confirmed that HIV-inclusive child-and adolescent-sensitive social protection has the potential to interrupt risk pathways to HIV infection and foster resilience. In particular, empirical evidence (literature and expert feedback) detailed the effectiveness of combination social protection particularly cash/in-kind components combined with "care" and "capability" among children and adolescents. Social protection programmes should be dynamic and flexible, and consider age, gender, HIV-related stigma, and context, including cultural norms, which offer opportunities to improve programmatic coverage, reach and uptake. Effective HIV prevention also requires integrated social protection policies, developed through strong national

  19. The effects of psychiatric comorbidity on response to an HIV prevention intervention.

    PubMed

    Compton, W M; Cottler, L B; Ben-Abdallah, A; Cunningham-Williams, R; Spitznagel, E L

    2000-03-01

    Drug abusers with psychiatric comorbidity are at high risk for becoming exposed to HIV. To address this compelling public health issue, our randomized HIV prevention study compares the effectiveness of the NIDA standard HIV testing and counseling protocol to a four session, peer-delivered, educational intervention for out-of-treatment cocaine users with and without antisocial personality disorder (ASPD) and major depression. Among the 966 out-of-treatment cocaine users who have completed the 3 month follow-up, all groups, regardless of assignment to standard vs. peer-delivered intervention or psychiatric status, improved significantly in: crack cocaine use, injection drug use, number of IDU sex partners and overall number of sex partners, but not in condom use. Nevertheless, when stratified by psychiatric status, ASPD was associated with significantly less improvement in crack cocaine use (P = 0.04) and with a trend for less improvement in having multiple sex partners and having IDU sex partners (P = 0.06 and 0.08, respectively). ASPD status was not associated with change in injection drug use or condom use. Depression was associated with a trend (P = 0.07) for greater improvement in crack cocaine use but not in any of the other behaviors. When examining the standard and peer intervention groups separately, no consistent differences in the association of psychiatric comorbidity with outcome were discerned between the two groups. We conclude that persons with ASPD and depression respond well to standard HIV prevention interventions, but these psychiatric disorders respectively attenuate and enhance response somewhat. Behavioral interventions tailored for persons with these conditions may be indicated if long-term change in HIV risk behaviors is to be achieved. PMID:10759035

  20. Replicating impact of a primary school HIV prevention programme: primary school action for better health, Kenya.

    PubMed

    Maticka-Tyndale, E; Mungwete, R; Jayeoba, O

    2014-08-01

    School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term when delivered on a small scale. The question addressed here is whether results obtained with small-scale delivery are replicable in large-scale roll-out. Primary School Action for Better Health (PSABH), a programme to train teachers to deliver HIV-prevention education in upper primary-school grades in Kenya demonstrated positive impact when tested in Nyanza Province. This article reports pre-, 10-month post- and 22-month post-training results as PSABH was delivered in five additional regions of the country. A total of 26 461 students from 110 primary schools in urban and rural, middle- and low-income settings participated in this repeated cross-sectional study. Students ranged in age from 11 to 16 years, were predominantly Christian (10% Muslim), and the majority were from five different ethnic groups. Results demonstrated positive gains in knowledge, self-efficacy related to changes in sexual behaviours and condom use, acceptance of HIV+ students, endorsement of HIV-testing and behaviours to post-pone sexual debut or decrease sexual activity. These results are as strong as or stronger than those demonstrated in the original impact evaluation conducted in Nyanza Province. They support the roll-out of the programme across Kenyan primary schools. PMID:23962492

  1. Implementing Implementation Science: An Approach for HIV Prevention, Care and Treatment Programs.

    PubMed

    Lambdin, Barrot H; Cheng, Ben; Peter, Trevor; Mbwambo, Jessie; Apollo, Tsitsi; Dunbar, Megan; Udoh, Ifeoma C; Cattamanchi, Adithya; Geng, Elvin H; Volberding, Paul

    2015-01-01

    Though great progress has been realized over the last decade in extending HIV prevention, care and treatment in some of the least resourced settings of the world, a substantial gap remains between what we know works and what we are actually achieving in HIV programs. To address this, leaders have called for the adoption of an implementation science framework to improve the efficiency and effectiveness of HIV programs. Implementation science (IS) is a multidisciplinary scientific field that seeks generalizable knowledge about the magnitude of, determinants of and strategies to close the gap between evidence and routine practice for health in real-world settings. We propose an IS approach that is iterative in nature and composed of four major components: 1) Identifying Bottlenecks and Gaps, 2) Developing and Implementing Strategies, 3) Measuring Effectiveness and Efficiency, and 4) Utilizing Results. With this framework, IS initiatives draw from a variety of disciplines including qualitative and quantitative methodologies in order to develop new approaches responsive to the complexities of real world program delivery. In order to remain useful for the changing programmatic landscape, IS research should factor in relevant timeframes and engage the multi-sectoral community of stakeholders, including community members, health care teams, program managers, researchers and policy makers, to facilitate the development of programs, practices and polices that lead to a more effective and efficient global AIDS response. The approach presented here is a synthesis of approaches and is a useful model to address IS-related questions for HIV prevention, care and treatment programs. This approach, however, is not a panacea, and we will continue to learn new ways of thinking as we move forward to close the implementation gap. PMID:25986374

  2. Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention.

    PubMed

    Hoshi, Tomonori; Fuji, Yoshito; Nzou, Samson Muuo; Tanigawa, Chihiro; Kiche, Ibrahim; Mwau, Matilu; Mwangi, Anne Wanjiru; Karama, Mohamed; Hirayama, Kenji; Goto, Kensuke; Kaneko, Satoshi

    2016-01-01

    HIV is still a major health problem in developing countries. Even though high HIV-risk-taking behaviors have been reported in African fishing villages, local distribution patterns of HIV infection in the communities surrounding these villages have not been thoroughly analyzed. The objective of this study was to investigate the geographical distribution patterns of HIV infection in communities surrounding African fishing villages. In 2011, we applied age- and sex-stratified random sampling to collect 1,957 blood samples from 42,617 individuals registered in the Health and Demographic Surveillance System in Mbita, which is located on the shore of Lake Victoria in western Kenya. We used these samples to evaluate existing antibody detection assays for several infectious diseases, including HIV antibody titers. Based on the results of the assays, we evaluated the prevalence of HIV infection according to sex, age, and altitude of participating households. We also used Kulldorff's spatial scan statistic to test for HIV clustering in the study area. The prevalence of HIV at our study site was 25.3%. Compared with the younger age group (15-19 years), adults aged 30-34 years were 6.71 times more likely to be HIV-positive, and the estimated HIV-positive population among women was 1.43 times larger than among men. Kulldorff's spatial scan statistic detected one marginally significant (P = 0.055) HIV-positive and one significant HIV-negative cluster (P = 0.047) in the study area. These results suggest a homogeneous HIV distribution in the communities surrounding fishing villages. In addition to individual behavior, more complex and diverse factors related to the social and cultural environment can contribute to a homogeneous distribution pattern of HIV infection outside of African fishing villages. To reduce rates of transmission in HIV-endemic areas, HIV prevention and control programs optimized for the local environment need to be developed. PMID:26862764

  3. Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention

    PubMed Central

    Hoshi, Tomonori; Fuji, Yoshito; Nzou, Samson Muuo; Tanigawa, Chihiro; Kiche, Ibrahim; Mwau, Matilu; Mwangi, Anne Wanjiru; Karama, Mohamed; Hirayama, Kenji; Goto, Kensuke; Kaneko, Satoshi

    2016-01-01

    HIV is still a major health problem in developing countries. Even though high HIV-risk-taking behaviors have been reported in African fishing villages, local distribution patterns of HIV infection in the communities surrounding these villages have not been thoroughly analyzed. The objective of this study was to investigate the geographical distribution patterns of HIV infection in communities surrounding African fishing villages. In 2011, we applied age- and sex-stratified random sampling to collect 1,957 blood samples from 42,617 individuals registered in the Health and Demographic Surveillance System in Mbita, which is located on the shore of Lake Victoria in western Kenya. We used these samples to evaluate existing antibody detection assays for several infectious diseases, including HIV antibody titers. Based on the results of the assays, we evaluated the prevalence of HIV infection according to sex, age, and altitude of participating households. We also used Kulldorff’s spatial scan statistic to test for HIV clustering in the study area. The prevalence of HIV at our study site was 25.3%. Compared with the younger age group (15–19 years), adults aged 30–34 years were 6.71 times more likely to be HIV-positive, and the estimated HIV-positive population among women was 1.43 times larger than among men. Kulldorff’s spatial scan statistic detected one marginally significant (P = 0.055) HIV-positive and one significant HIV-negative cluster (P = 0.047) in the study area. These results suggest a homogeneous HIV distribution in the communities surrounding fishing villages. In addition to individual behavior, more complex and diverse factors related to the social and cultural environment can contribute to a homogeneous distribution pattern of HIV infection outside of African fishing villages. To reduce rates of transmission in HIV-endemic areas, HIV prevention and control programs optimized for the local environment need to be developed. PMID:26862764

  4. Between Individual Agency and Structure in HIV Prevention: Understanding the Middle Ground of Social Practice

    PubMed Central

    Kippax, Susan; Parker, Richard G.; Aggleton, Peter

    2013-01-01

    When HIV prevention targets risk and vulnerability, it focuses on individual agency and social structures, ignoring the centrality of community in effective HIV prevention. The neoliberal concept of risk assumes individuals are rational agents who act on information provided to them regarding HIV transmission. This individualistic framework does not recognize the communities in which people act and connect. The concept of vulnerability on the other hand acknowledges the social world, but mainly as social barriers that make it difficult for individuals to act. Neither approach to HIV prevention offers understanding of community practices or collective agency, both central to success in HIV prevention to date. Drawing on examples of the social transformation achieved by community action in Australia and Brazil, this article focuses on this middle ground and its role in effective HIV prevention. PMID:23763397

  5. Ensuring Access to HIV Prevention Services in South African HIV Vaccine Trials: Correspondence Between Guidelines and Practices

    PubMed Central

    Essack, Zaynab

    2014-01-01

    Researchers and sponsors are required to assist HIV prevention trial participants to remain HIV-uninfected by ensuring access to prevention services. Ethics guidelines require that these HIV risk-reduction services be state of the art. This and related ethics recommendations have been intensely debated. This descriptive study aimed to identify actual HIV prevention practices for two HIV vaccine trials at five South African sites, to explore whether actual practices meet guideline recommendations and to discuss implications for practices and ethics guidelines. Practices were examined through a review of site documents and interviews with site staff and network representatives, as well as community advisory board and research ethics committee representatives. A thematic analysis of HIV prevention practices, perspectives and perceived challenges was undertaken. Findings indicated that there was a high degree of correspondence between actual practices in South African HIV vaccine trials and guideline recommendations. Key challenges for implementing prevention services were identified as partnerships, provider-promotion of services and participant uptake of services. Practices deviated most from guidelines with regard to the description of prevention plans in informed consent forms. Recommendations are made for both practices and ethics guidelines. PMID:25031609

  6. Impact of HIV Testing and Counseling (HTC) Knowledge on HIV Prevention Practices Among Traditional Birth Attendants in Nigeria

    PubMed Central

    Osuji, Alice; Pharr, Jennifer R.; Nwokoro, Uche; Ike, Anulika; Ali, Christiana; Ejiro, Ogheneaga; Osuyali, John; Obiefune, Michael; Fiscella, Kevin; Ezeanolue, Echezona E.

    2015-01-01

    Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT). Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs) play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and counseling (HTC) knowledge on the HIV prevention practices among TBAs in Nigeria. Five hundred TBAs were surveyed. Chi-square and logistic regression were used to assess differences in HIV prevention practices between TBAs with and without HTC knowledge. TBAs with HTC knowledge are significantly more likely to engage in HIV prevention practices than TBAs without HTC. Prevention practices included: wearing gloves during delivery (p < 0.01), sterilization of delivery equipment (p < 0.01), participation in blood safety training (p < 0.01), and disposal of sharps (p < 0.01). As long as a high percent of births occur outside health care facilities in Nigeria, there will be a need for TBAs. Providing TBAs with HTC training increases HIV prevention practices and can be a key to improve maternal and child health. PMID:25674783

  7. An empiric risk scoring tool for identifying high-risk heterosexual HIV-1 serodiscordant couples for targeted HIV-1 prevention

    PubMed Central

    KAHLE, Erin M.; HUGHES, James P.; LINGAPPA, Jairam R.; JOHN-STEWART, Grace; CELUM, Connie; NAKKU-JOLOBA, Edith; NJUGUNA, Stella; MUGO, Nelly; BUKUSI, Elizabeth; MANONGI, Rachel; BAETEN, Jared M.

    2012-01-01

    Background and objectives Heterosexual HIV-1 serodiscordant couples are increasingly recognized as an important source of new HIV-1 infections in sub-Saharan Africa. A simple risk assessment tool could be useful for identifying couples at highest risk for HIV-1 transmission. Methods Using data from three prospective studies of HIV-1 serodiscordant couples from seven African countries and standard methods for development of clinical prediction rules, we derived and validated a risk scoring tool developed from multivariate modeling and composed of key predictors for HIV-1 risk that could be measured in standard research and clinical settings. Results The final risk score included age of the HIV-1 uninfected partner, married and/or cohabiting partnership, number of children, unprotected sex, uncircumcised male HIV-1 uninfected partner, and plasma HIV-1 RNA in the HIV-1 infected partner. The maximum risk score was 12, scores ≥5 were associated with an annual HIV-1 incidence of >3%, and couples with a score ≥6 accounted for only 28% of the population but 67% of HIV-1 transmissions. The area under the curve for predictive ability of the score was 0.74 (95% CI 0.70–0.78). Internal and external validation showed similar predictive ability of the risk score, even when plasma viral load was excluded from the risk score. Conclusions A discrete combination of clinical and behavioral characteristics defines highest-risk HIV-1 serodiscordant couples. Discriminating highest-risk couples for HIV-1 prevention programs and clinical trials using a validated risk score could improve research efficiency and maximize the impact of prevention strategies for reducing HIV-1 transmission. PMID:23187945

  8. Advancing Biosocial Pedagogy for HIV Education

    ERIC Educational Resources Information Center

    Davis, Mark David McGregor

    2011-01-01

    This article develops the concept of biosocial pedagogy in HIV education for this era of expanding biomedical forms of HIV control. With reference to critical pedagogy and teaching and learning materials addressing HIV treatment and prevention, I explain how HIV education can problematize its own role in HIV control. I also discuss how educational…

  9. Increasing Parent Involvement in Youth HIV Prevention: A Randomized Caribbean Study

    ERIC Educational Resources Information Center

    Baptiste, Donna R.; Kapungu, Chisina; Miller, Steve; Crown, Laurel; Henry, David; Da Costa Martinez, Dona; Jo-Bennett, Karen

    2009-01-01

    This article presents preliminary findings of a randomized HIV prevention study in Trinidad and Tobago in the Caribbean. The study centers on a family HIV workshop aimed at strengthening parenting skills that are empirically linked to reducing adolescent HIV exposure and other sexual risks. These skills include parental monitoring; educating youth…

  10. Effectiveness of a Theory-Based Risk Reduction HIV Prevention Program for Rural Vietnamese Adolescents

    ERIC Educational Resources Information Center

    Kaljee, Linda M.; Genberg, Becky; Riel, Rosemary; Cole, Matthew; Tho, Le Huu; Thoa, Le Thi Kim; Stanton, Bonita; Li, Xiaoming; Minh, Tuong Tan

    2005-01-01

    As of April 2003, 64,801 HIV cases have been documented in Vietnam (Policy Project 2003), 53.9% of which are among individuals 20-29 years of age. Although HIV education efforts have increased, there remains a need for proven effective programs. We present findings from a randomized-controlled effectiveness trial of an HIV prevention program for…

  11. Storytelling for Empowerment for Latino Teens: Increasing HIV Prevention Knowledge and Attitudes

    ERIC Educational Resources Information Center

    Nelson, Annabelle; Cordova, David; Walters, Andrew S.; Szecsy, Elsie

    2016-01-01

    Latino adolescents are disproportionately impacted by HIV, but researchers have documented few programs to prevent and reduce HIV risk. The Storytelling for Empowerment (SFE) "HIV StoryBook" was designed with an innovative ecodevelopment approach combining empowerment, family communication, and positive cultural identity. A mixed method…

  12. Prevention Interventions with Persons Living with HIV/AIDS: State of the Science and Future Directions

    ERIC Educational Resources Information Center

    Gordon, Christopher M.; Forsyth, Andrew D.; Stall, Ron; Cheever, Laura W.

    2005-01-01

    The National Institutes of Health (NIH/NIMH), the Centers for Disease Control and Prevention (CDC), and the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) support the CDC's Serostatus Approach to Fighting the HIV Epidemic (SAFE; Janssen et al., 2001). One aim of the strategy is to help individuals living with HIV (and…

  13. HIV Prevention Among Mexican Migrants at Different Migration Phases: Exposure to Prevention Messages and Association With Testing Behaviors.

    PubMed

    Martinez-Donate, Ana P; Rangel, M Gudelia; Zhang, Xiao; Simon, Norma-Jean; Rhoads, Natalie; Gonzalez-Fagoaga, J Eduardo; Gonzalez, Ahmed Asadi

    2015-12-01

    Mobile populations are at increased risk for HIV infection. Exposure to HIV prevention messages at all phases of the migration process may help decrease im/migrants' HIV risk. We investigated levels of exposure to HIV prevention messages, factors associated with message exposure, and the association between exposure to prevention messages and HIV testing behavior among Mexican im/migrants at different phases of the migration process. We conducted a cross-sectional, probability survey of Mexican im/migrants (N = 3,149) traveling through the border city of Tijuana, Mexico. The results indicate limited exposure to prevention messages (57-75%) and suboptimal last 12-month HIV testing rates (14-25%) across five migration phases. Compared to pre-departure levels (75%), exposure to messages decreases at all post-departure migration phases (57-63%, p < .001). In general, exposure to prevention messages is positively associated with greater odds of HIV testing at the pre-departure, destination, and interception phases. Binational efforts need to be intensified to reach and deliver HIV prevention to Mexican im/migrants across the migration continuum. PMID:26595267

  14. Efficacy of HIV Prevention Interventions in Latin American and Caribbean Nations, 1995–2008: A Meta-Analysis

    PubMed Central

    Huedo-Medina, Tania B.; Boynton, Marcella H.; Warren, Michelle R.; LaCroix, Jessica M.; Carey, Michael P.; Johnson, Blair T.

    2014-01-01

    This meta-analysis synthesized 34 HIV prevention interventions (from 27 studies) that were evaluated in Latin American and Caribbean nations. These studies were obtained through systematic searches of English, Spanish, and Portuguese-language databases available as of January 2009. Overall, interventions significantly increased knowledge (d = 0.51) and condom use (d = 0.28) but the effects varied widely. Interventions produced more condom use when they focused on high-risk individuals, distributed condoms, and explicitly addressed socio-cultural components. The best-fitting models utilized factors related to geography, especially indices of a nations’ human development index (HDI) and income inequality (i.e., Gini index). Interventions that provided at least three hours of content succeeded better when HDI and income inequality were lower, suggesting that intensive HIV prevention activities succeed best where the need is greatest. Implications for HIV intervention development in Latin America and the Caribbean are discussed. PMID:20661768

  15. Multipurpose Prevention Technologies: Biomedical Tools to Prevent HIV-1, HSV-2, and Unintended Pregnancies

    PubMed Central

    Thurman, Andrea Ries; Clark, Meredith R.; Doncel, Gustavo F.

    2011-01-01

    Statistics clearly show an unmet need for highly effective contraception, especially in less developed countries. Many of these countries are at the core of the HIV/AIDS epidemic and show very high prevalence rates for other sexually transmitted infections (STIs) such as that caused by HSV-2. A woman at risk of unintended pregnancy due to unprotected intercourse is also at risk for HIV/STI. Owing to their causative interrelationship, combining protection against these conditions will result in enhanced prevention and health benefits. Existing multipurpose prevention modalities such as condoms and physical barriers, albeit efficacious, face cultural hurdles that have so far hindered their widespread use. Success has recently been demonstrated in large clinical trials, demonstrating proof of concept of microbicides in reducing the incidence of HIV-1 and HSV-2 among at-risk populations. The challenge heretofore is to refine these products to make them more potent, convenient, accessible, and acceptable. Potent antiviral drugs released topically in the female reproductive tract by innovative delivered systems and formulations will provide safe, effective, and acceptable multipurpose prevention tools. This paper provides an overview of existing and novel approaches to multipurpose prevention strategies. PMID:21836811

  16. Pregnancy, Contraceptive Use, and HIV Acquisition in HPTN 039: Relevance for HIV Prevention Trials Among African Women

    PubMed Central

    Reid, Stewart E.; Dai, James Y.; Wang, Jing; Sichalwe, Bupe N.; Akpomiemie, Godspower; Cowan, Frances M.; Delany-Moretlwe, Sinead; Baeten, Jared M.; Hughes, James P.; Wald, Anna; Celum, Connie

    2009-01-01

    Background Biomedical HIV prevention trials enroll sexually active women at risk of HIV and often discontinue study product during pregnancy. We assessed risk factors for pregnancy and HIV acquisition, and the effect of pregnancy on time off study drug in HPTN 039. Methods 1358 HIV negative, HSV-2 seropositive women from South Africa, Zambia, and Zimbabwe were enrolled and followed for up to 18 months. Results 228 pregnancies occurred; time off study drug due to pregnancy accounted for 4% of woman-years of follow-up among women. Being pregnant was not associated with increased HIV risk (hazard ratio [HR] 0.64 95% CI [0.23, 1.80], p=0.40). However, younger age was associated with increased risk for both pregnancy and HIV. There was no association between condom use as a sole contraceptive and reduced pregnancy incidence; hormonal contraception was not associated with increased HIV risk. Bacterial vaginosis at study entry was associated with increased HIV risk (HR 2.03, p=0.02). Conclusions Pregnancy resulted in only a small amount of woman-time off study drug. Young women are at high risk for HIV and are an appropriate population for HIV prevention trials but also have higher risk of pregnancy. Condom use was not associated with reduced incidence of pregnancy. PMID:19838129

  17. Concurrent sexual partnerships among married Zimbabweans – implications for HIV prevention

    PubMed Central

    Mugweni, Esther; Pearson, Stephen; Omar, Mayeh

    2015-01-01

    Background Concurrent sexual partnerships play a key role in sustaining the HIV epidemic in Zimbabwe. Married couples are at an increased risk of contracting HIV from sexual networks produced by concurrent sexual partnerships. Addressing these partnerships is an international HIV prevention priority. Methods Our qualitative study presents the socioeconomic factors that contribute to the occurrence of concurrent sexual partnerships among married people in Zimbabwe. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008 to understand the organizations of concurrent sexual partnerships. Data were analyzed using framework analysis. Results Our study indicates that relationship dissatisfaction played a key role in the engagement of concurrent sexual partnerships. Depending on the source of the dissatisfaction, there were four possible types of concurrent sexual relationships that were formed: sex worker, casual partner, regular girlfriend or informal polygyny which was referred to as “small house”. These relationships had different levels of intimacy, which had a bearing on practicing safer sex. Participants described three characteristics of hegemonic masculinity that contributed to the sources of dissatisfaction leading to concurrent sexual activity. Similarly, various aspects of emphasized femininity were described as creating opportunities for the occurrence of concurrent sexual relationships. Economic status was also listed as a factor that contributed to the occurrence of concurrent sexual partnerships. Conclusion Marital dissatisfaction was indicated as a contributing factor to the occurrence of concurrent sexual relationships. There were several reports of satisfying marital relationships in which affairs did not occur. Lessons from these marriages can be made part of future HIV prevention interventions targeted at preventing concurrent sexual partnerships by married couples. PMID:26491372

  18. Domestic violence among adolescents in HIV prevention research in Tanzania: Participant experiences and measurement issues

    PubMed Central

    Baumgartner, Joy Noel; Kaaya, Sylvia; Karungula, Happy; Kaale, Anna; Headley, Jennifer; Tolley, Elizabeth

    2014-01-01

    Objectives Under-representation of female adolescents in HIV clinical trials may inhibit their access to future prevention technologies. Domestic violence, broadly defined as violence perpetrated by intimate partners and/or family members, may affect trial participation. This study describes violence in the lives of adolescents and young women in Tanzania, explores use of the Women’s Experience with Battering (WEB) Scale to measure battering, and examines the associations between battering and socio-demographic and HIV risk factors. Methods Community formative research (CFR) and a mock clinical trial (MCT) were conducted to examine the challenges of recruiting younger (15-17) versus older (18-21) participants into HIV prevention trials. The CFR included qualitative interviews with 23 participants and there were 135 MCT participants. The WEB was administered in both the CFR and MCT. Results Nineteen CFR participants experienced physical/sexual violence and 17% scored positive for battering. All married participants reported partner-related domestic violence, and half scored positive for battering. Many believed beatings were normal. None of the single participants scored positive on battering, but one-third reported abuse by relatives. Among MCT participants, 15% scored positive for battering; most perpetrators were relatives. Younger participants were more likely to report battering. Conclusions Adolescents experienced high rates of domestic violence and the WEB captured battering from both partners and relatives. The level of familial violence was unexpected and has implications for parental roles in study recruitment. Addressing adolescent abuse in HIV prevention trials and in the general population should be a public health priority. PMID:24740725

  19. "You're Really Gonna Kick Us All Out?" Sustaining Safe Spaces for Community-Based HIV Prevention and Control among Black Men Who Have Sex with Men.

    PubMed

    Garcia, Jonathan; Parker, Caroline; Parker, Richard G; Wilson, Patrick A; Philbin, Morgan M; Hirsch, Jennifer S

    2015-01-01

    Black men who have sex with men (BMSM) experience among the highest rates of HIV infection in the United States. We conducted a community-based ethnography in New York City to identify the structural and environmental factors that influence BMSMs vulnerability to HIV and their engagement with HIV prevention services. Methods included participant observation at community-based organizations (CBOs) in New York City, in-depth interviews with 31 BMSM, and 17 key informant interviews. Our conceptual framework shows how creating and sustaining safe spaces could be a critical environmental approach to reduce vulnerability to HIV among BMSM. Participant observation, in-depth and key informant interviews revealed that fear and mistrust characterized men's relation to social and public institutions, such as churches, schools, and the police. This fear and mistrust created HIV vulnerability among the BMSM in our sample by challenging engagement with services. Our findings suggest that to be successful, HIV prevention efforts must address these structural and environmental vulnerabilities. Among the CBOs that we studied, "safe spaces" emerged as an important tool for addressing these environmental vulnerabilities. CBOs used safe spaces to provide social support, to address stigma, to prepare men for the workforce, and to foster a sense of community among BMSM. In addition, safe spaces were used for HIV and STI testing and treatment campaigns. Our ethnographic findings suggest that safe spaces represent a promising but so far under-utilized part of HIV prevention infrastructure. Safe spaces seem integral to high impact comprehensive HIV prevention efforts, and may be considered more appropriately as part of HIV capacity-building rather than being nested within program-specific funding structures. PMID:26492412

  20. The challenge of HIV prevention among high-risk adolescents.

    PubMed

    Sullivan, T R

    1996-02-01

    This article reports findings from an exploratory study of HIV knowledge and risk behaviors among 60 teenagers and young men engaged in the street life of Hollywood, California. The sample was composed largely of youths of homosexual or bisexual orientation who were substance abusers, prostitutes, or both. The data suggest that although community-based education efforts may be associated with lower-risk behavior among this population, the overall risk profiles of these socially marginalized youths remained high. Inferences are drawn about the cofactors of risk that must be addressed and the education needed to enhance the health prospects of these youths. PMID:8626159

  1. Barriers and Facilitators of HIV Prevention With Heterosexual Latino Couples: Beliefs of Four Stakeholder Groups

    PubMed Central

    Pérez-Jiménez, David; Seal, David W.; Serrano-García, Irma

    2012-01-01

    Although HIV prevention interventions for women are efficacious, long-term behavior change maintenance within power-imbalanced heterosexual relationships has been difficult. To explore the feasibility, content, and format of an HIV intervention for Latino couples, the authors conducted 13 focus groups with HIV/AIDS researchers, service providers, and heterosexual men and women in Puerto Rico, the Dominican Republic, and Mexico. Reasons that participants thought that men should be involved in prevention efforts included promotion of shared responsibility, creation of a safe environment for open conversation about sex, and increased sexual negotiation skills. Perceived barriers to men’s involvement included cultural taboos, sexual conservatism associated with Catholicism and machismo, and power-imbalanced relationships. Participants stressed the need for recruitment of men within naturally occurring settings or by influential community leaders. Participants indicated that couples-level interventions would be successful if they used strong coed facilitators, included both unigender and mixed-gender discussion opportunities, and addressed personally meaningful topics. Implications of these findings are discussed. PMID:19209976

  2. Barriers and facilitators of HIV prevention with heterosexual Latino couples: beliefs of four stakeholder groups.

    PubMed

    Pérez-Jiménez, David; Seal, David W; Serrano-García, Irma

    2009-01-01

    Although HIV prevention interventions for women are efficacious, long-term behavior change maintenance within power-imbalanced heterosexual relationships has been difficult. To explore the feasibility, content, and format of an HIV intervention for Latino couples, the authors conducted 13 focus groups with HIV/AIDS researchers, service providers, and heterosexual men and women in Puerto Rico, the Dominican Republic, and Mexico. Reasons that participants thought that men should be involved in prevention efforts included promotion of shared responsibility, creation of a safe environment for open conversation about sex, and increased sexual negotiation skills. Perceived barriers to men's involvement included cultural taboos, sexual conservatism associated with Catholicism and machismo, and power-imbalanced relationships. Participants stressed the need for recruitment of men within naturally occurring settings or by influential community leaders. Participants indicated that couples-level interventions would be successful if they used strong coed facilitators, included both unigender and mixed-gender discussion opportunities, and addressed personally meaningful topics. Implications of these findings are discussed. PMID:19209976

  3. Differential Challenges in Coalition Building among HIV Prevention Coalitions Targeting Specific Youth Populations

    PubMed Central

    Robles-Schrader, Grisel M.; Harper, Gary W.; Purnell, Marjorie; Monarrez, Veronica; Ellen, Jonathan M.

    2012-01-01

    Coalitions provide the potential for merging the power, influence, and resources of fragmented individuals and institutions into one collective group that can more effectively focus its efforts on a specific community health issue. Connect to Protect® coalitions devote resources to address the HIV epidemic at a structural level. This research examines differential challenges in coalition processes that may facilitate/hinder coalition building to achieve HIV prevention through structural change. Qualitative interviews conducted with community partners participating across 10 coalitions were analyzed to compare responses of those individuals working on HIV prevention coalitions targeting adolescent and young adult gay and bisexual men versus those targeting adolescent and young adult heterosexual women. Community partner responses revealed differences across several key areas including: a) acceptability and goals in discussing sexual issues with adolescents, b) goals of sexual health promotion activities, and c) competition among collaborating agencies. Themes highlighted in this research can complement existing community intervention literature by helping community mobilizers, interventionists, and researchers understand how cultural norms affect youth-specific coalition work. PMID:24188354

  4. HIV EPIDEMIC CONTROL — A MODEL FOR OPTIMAL ALLOCATION OF PREVENTION AND TREATMENT RESOURCES

    PubMed Central

    Alistar, Sabina S.; Long, Elisa F.; Brandeau, Margaret L.; Beck, Eduard J.

    2013-01-01

    With 33 million people living with human immunodeficiency virus (HIV) worldwide and 2.7 million new infections occurring annually, additional HIV prevention and treatment efforts are urgently needed. However, available resources for HIV control are limited and must be used efficiently to minimize the future spread of the epidemic. We develop a model to determine the appropriate resource allocation between expanded HIV prevention and treatment services. We create an epidemic model that incorporates multiple key populations with different transmission modes, as well as production functions that relate investment in prevention and treatment programs to changes in transmission and treatment rates. The goal is to allocate resources to minimize R0, the reproductive rate of infection. We first develop a single-population model and determine the optimal resource allocation between HIV prevention and treatment. We extend the analysis to multiple independent populations, with resource allocation among interventions and populations. We then include the effects of HIV transmission between key populations. We apply our model to examine HIV epidemic control in two different settings, Uganda and Russia. As part of these applications, we develop a novel approach for estimating empirical HIV program production functions. Our study provides insights into the important question of resource allocation for a country's optimal response to its HIV epidemic and provides a practical approach for decision makers. Better decisions about allocating limited HIV resources can improve response to the epidemic and increase access to HIV prevention and treatment services for millions of people worldwide. PMID:23793895

  5. Primary prevention lessons learned from those with HIV in Chennai, India

    PubMed Central

    Hendriksen, Ellen Setsuko; Sri Krishnan, A. K.; Vallabhaneni, Snigda; Johnson, Sethu; Raminani, Sudha; Kumarasamy, N.; Solomon, Suniti; Mayer, Kenneth K. H.; Safren, Steven S.

    2013-01-01

    Background As each HIV-infected individual represents a breakdown of HIV primary prevention measures, formative data from representative individuals living with HIV can help shape future primary prevention interventions. Little is known about sexual behaviours and other transmission risk factors of high-risk group members who are already HIV-infected in Chennai, India. Methods Semi-structured qualitative interviews were conducted with 27 HIV-infected individuals representing each high-risk group in Chennai (five men who have sex with men (MSM), five female commercial sex workers (CSW), four truckers and other men who travel for business, four injecting drug users (IDU), five married male clients of CSW, and four wives of CSW clients, MSM, truckers, and IDU). Results Themes relevant to HIV primary prevention included: (1) HIV diagnosis as the entry into HIV education and risk reduction, (2) reluctance to undergo voluntary counselling and testing, (3) gender and sexual roles as determinants of condom use, (4) misconceptions about HIV transmission, and (5) framing and accessibility of HIV education messages. Conclusions These qualitative data can be used to develop hypotheses about sexual risk taking in HIV-infected individuals in South India, inform primary prevention intervention programs, and improve primary prevention efforts overall. PMID:21592434

  6. HIV prevention, structural change and social values: the need for an explicit normative approach

    PubMed Central

    Parkhurst, Justin O

    2012-01-01

    Background The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals. Methods This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses. Results HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values. Conclusions While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well. PMID:22713355

  7. HIV Prevention: The Key to Ending AIDS by 2030

    PubMed Central

    Poku, Nana K.

    2016-01-01

    There is no viable substitute for re-energizing, funding and supporting culturally attuned, locally staffed HIV advocacy and prevention programmes, especially in resource poor settings. The evidence that such interventions are effective remains compelling; and although the cost implications are not negligible, the medium to long-term outcomes must be regarded not as complementary, but as integral, to biomedical interventions. The success of the anti-retroviral drugs upscale has enabled a noticeable improvement in AIDS related morbidity and mortality in the recent years; yet the underlying dynamics of the epidemic remains undetermined by the rate at which new infections are taking place in relation to the number of AIDS deaths. While the rate of new HIV infections is stabilising in some of the hardest hit countries, it remains far too high and the future cost of maintaining an ever-expanding pool of people reliant on daily drugs for survival is unsustainable. Countries must exercise caution in continuing to focus on treatment as a ‘quick fix’ to end AIDS as a public health concern. HIV is a socially culturally induced crisis and, as such, a variety of measures are needed simultaneously to appeal to different people, groups and circumstances. PMID:27347272

  8. HIV Prevention: The Key to Ending AIDS by 2030.

    PubMed

    Poku, Nana K

    2016-01-01

    There is no viable substitute for re-energizing, funding and supporting culturally attuned, locally staffed HIV advocacy and prevention programmes, especially in resource poor settings. The evidence that such interventions are effective remains compelling; and although the cost implications are not negligible, the medium to long-term outcomes must be regarded not as complementary, but as integral, to biomedical interventions. The success of the anti-retroviral drugs upscale has enabled a noticeable improvement in AIDS related morbidity and mortality in the recent years; yet the underlying dynamics of the epidemic remains undetermined by the rate at which new infections are taking place in relation to the number of AIDS deaths. While the rate of new HIV infections is stabilising in some of the hardest hit countries, it remains far too high and the future cost of maintaining an ever-expanding pool of people reliant on daily drugs for survival is unsustainable. Countries must exercise caution in continuing to focus on treatment as a 'quick fix' to end AIDS as a public health concern. HIV is a socially culturally induced crisis and, as such, a variety of measures are needed simultaneously to appeal to different people, groups and circumstances. PMID:27347272

  9. Seroconversion risk perception among jail populations: a call for gender-specific HIV prevention programming.

    PubMed

    Alarid, Leanne Fiftal; Hahl, Jeannie M

    2014-04-01

    The prevalence of HIV/AIDS infection among prisoners is 3 to 4 times higher than in the U.S. population. Given that one in seven HIV-positive Americans pass through a correctional facility every year, the criminal justice system is in an ideal position to aggressively implement effective HIV education, treatment, and prevention. This study examines barriers to the effective delivery of these services and evaluates differences in risk perception among nearly 600 female and male inmates. The results underscore gender differences in Perceived Risk of Seroconversion and Exposure to HIV Education, suggesting that jails should implement gender-specific HIV prevention programming. PMID:24659758

  10. Innate immunity against HIV: a priority target for HIV prevention research

    PubMed Central

    2010-01-01

    This review summarizes recent advances and current gaps in understanding of innate immunity to human immunodeficiency virus (HIV) infection, and identifies key scientific priorities to enable application of this knowledge to the development of novel prevention strategies (vaccines and microbicides). It builds on productive discussion and new data arising out of a workshop on innate immunity against HIV held at the European Commission in Brussels, together with recent observations from the literature. Increasing evidence suggests that innate responses are key determinants of the outcome of HIV infection, influencing critical events in the earliest stages of infection including the efficiency of mucosal HIV transmission, establishment of initial foci of infection and local virus replication/spread as well as virus dissemination, the ensuing acute burst of viral replication, and the persisting viral load established. They also impact on the subsequent level of ongoing viral replication and rate of disease progression. Modulation of innate immunity thus has the potential to constitute a powerful effector strategy to complement traditional approaches to HIV prophylaxis and therapy. Importantly, there is increasing evidence to suggest that many arms of the innate response play both protective and pathogenic roles in HIV infection. Consequently, understanding the contributions made by components of the host innate response to HIV acquisition/spread versus control is a critical pre-requisite for the employment of innate immunity in vaccine or microbicide design, so that appropriate responses can be targeted for up- or down-modulation. There is also an important need to understand the mechanisms via which innate responses are triggered and mediate their activity, and to define the structure-function relationships of individual innate factors, so that they can be selectively exploited or inhibited. Finally, strategies for achieving modulation of innate functions need to be

  11. Systematic Review of Couple-Based HIV Intervention and Prevention Studies: Advantages, Gaps, and Future Directions

    PubMed Central

    El-Bassel, Nabila

    2015-01-01

    We conducted a systematic review of couple-based HIV biobehavioral (skills-building, VCT, and adherence) and biomedical (ART, circumcision) prevention and intervention studies designed to reduce sexual-and drug-risk behaviors and HIV transmission and acquisition. Of the 11,162 papers identified in the search, 93 peer-reviewed papers met the inclusion criteria and yielded a total of 33 studies conducted globally. Biobehavioral couple-based prevention and intervention studies have been efficacious in reducing sexual- and drug-risk behaviors, increasing access to HIV testing and care, and improving adherence. Biomedical couple-based studies were found to reduce HIV incidence among HIV-negative sex partners and viral load among HIV-positive partners. Despite much progress, couple-based HIV prevention and intervention studies remain limited; a number of methodological gaps exist and studies focusing on MSM, people who inject drugs, and sex workers are scarce. PMID:24980246

  12. Where Are the Young Men in HIV Prevention Efforts? Comments on HIV Prevention Programs and Research from Young Men Who Sex with Men in Los Angeles County

    ERIC Educational Resources Information Center

    Holloway, Ian W.; Cederbaum, Julie A.; Ajayi, Antonette; Shoptaw, Steven

    2012-01-01

    Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N = 100, M[subscript age] = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to…

  13. Intensifying action to address HIV and tuberculosis in Mozambique's cross-border mining sector.

    PubMed

    Barwise, Katy; Lind, Andrew; Bennett, Rod; Martins, Emilia

    2013-01-01

    The southern provinces of Mozambique have some of the world's highest recorded levels of HIV and tuberculosis (TB). They are also characterized by high levels of cross-border migration, particularly to mines in South Africa. Through the Declaration on Tuberculosis in the Mining Sector in August 2012, heads of state of the Southern African Development Community showed an increased commitment to addressing TB and HIV among migrant mine workers, but there is much left to do. This article analyzes the importance of recent policy developments, both regional and national. We report new research from 2011-2012 on health-related attitudes and behaviors of Mozambican mine workers and their families and present an estimate of the financial burden of disease related to migrant mine work for Mozambique's public services and migrant-sending communities. We recommend that the Declaration be operationalized and enforced. Practical measures should include training of health workers in migrants' right to health; user-friendly health information in Portuguese and local languages; building the advocacy capacity of mine workers' representatives; and more attention to social, cultural, and economic factors that affect migrant mine workers' health, including better access to health information and services and livelihoods for wives, widows, and orphans in communities of origin. PMID:24397235

  14. HIV counseling and testing for the prevention of mother-to-child transmission of HIV in Swaziland: a multilevel analysis.

    PubMed

    Sagna, Marguerite L; Schopflocher, Donald

    2015-01-01

    HIV counseling and voluntary testing during antenatal care have been proven to reduce the risk of HIV transmission from mother to child, through increasing knowledge about safe behaviors, ascertaining HIV status and increasing coverage of effective antiretroviral regimens. However, it remains that, in developing countries where 95 % of mother-to-child HIV transmissions (MTCT) take place, such interventions are not widely accessible or available. Using a nationally representative cross-sectional household survey, the present study aimed to examine individual- and contextual-level influences on the receipt of HIV pre-test counseling and uptake of HIV testing during the antenatal care period in Swaziland, a country highly burdened by HIV/AIDS. The study sample was restricted to women aged 15-49 years with a live birth in the past five years preceding the survey and who received antenatal care for the most recent birth. The findings of this study indicated that only 62 % of women received pre-test counseling for the prevention of MTCT and no more than 56 % of women consented to be tested for HIV during antenatal care. The multilevel regression analysis revealed that the likelihood of receiving HIV pre-test counseling increases significantly with higher parity, education level, household wealth and antenatal visits while it is lower in areas where poverty is pervasive (OR = 0.474) and in rural regions (OR = 0.598) as well. Beyond all the significant predictors, undergoing pre-test counseling has emerged as an important determinant of HIV testing. Receiving pre-test counseling increases the odds of accepting an HIV test by 77 %. Evidence from this analysis underscores bottlenecks and challenges that persist in increasing the need for and uptake of HIV preventive and treatment services to stop new HIV infections among children. PMID:24810361

  15. Epidemic Impacts of a Community Empowerment Intervention for HIV Prevention among Female Sex Workers in Generalized and Concentrated Epidemics

    PubMed Central

    Wirtz, Andrea L.; Pretorius, Carel; Beyrer, Chris; Baral, Stefan; Decker, Michele R.; Sherman, Susan G.; Sweat, Michael; Poteat, Tonia; Butler, Jennifer; Oelrichs, Robert; Semini, Iris; Kerrigan, Deanna

    2014-01-01

    Introduction Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. Methods We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5–65% in Kenya and Ukraine; 10–70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012–2016 and, compared to status quo when all interventions are held constant. Results Optimistic but feasible coverage (65%–70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. Discussion A community empowerment approach to HIV prevention and

  16. Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research

    PubMed Central

    2011-01-01

    Operational research is necessary to improve the access to and delivery of tuberculosis prevention, diagnosis and treatment interventions for people living with HIV. We conducted an extensive review of the literature and reports from recent expert consultations and research-related meetings organized by the World Health Organization and the Stop TB Partnership to identify a TB/HIV operational research agenda. We present critical operational research questions in a series of key areas: optimizing TB prevention by enhancing the uptake of isoniazid preventive therapy and the implementation of infection control measures; assessing the effectiveness of existing diagnostic tools and scaling up new technologies; improving service delivery models; and reducing risk factors for mortality among TB patients living with HIV. We discuss the potential impact that addressing the operational research questions may have on improving programmes’ performance, assessing new strategies or interventions for TB control, or informing global or national policy formulation. Financial resources to implement these operational research questions should be mobilized from existing and new funding mechanisms. National TB and HIV/AIDS programmes should develop their operational research agendas based on these questions, and conduct the research that they consider crucial for improving TB and HIV control in their settings in collaboration with research stakeholders. PMID:21967874

  17. Preventing HIV Transmission in Chinese Internal Migrants: A Behavioral Approach

    PubMed Central

    Erasmus, Vicki; Sun, Xinying; Shi, Yuhui; Richardus, Jan Hendrik

    2014-01-01

    This study is a step towards a behavioral intervention to prevent HIV transmission among Chinese internal migrants. To explore important and changeable determinants of condom use and inspect effective and feasible methods to increase condom use for the target population, we conducted a three-round web-based Delphi study among a panel of 62 experts between October 2012 and March 2013. The panelists were purposely selected using a stepwise procedure to represent topic-related areas of expertise. The response rate per round ranges from 21% to 81%. The panelists identified 19 possible determinants of condom use and reported 16 intervention methods they considered successful. They agreed that attitude towards condom use was the most important and changeable determinant, while applying behavioral theory, increasing sexual education and condom access, performing worksite health promotion, detecting risk factors, and working closely with relevant organizations and the government were effective and feasible methods to increase condom use among internal migrants in China. In conclusion, results of this study highlight the importance of attitude in changing condom use and underscore the need to apply behavior theory and integrate multiple educational approaches for developing behavioral HIV prevention interventions targeting internal migrants in China. PMID:25610903

  18. Preventing HIV transmission in Chinese internal migrants: a behavioral approach.

    PubMed

    Liu, Xiaona; Erasmus, Vicki; Sun, Xinying; Cai, Rui; Shi, Yuhui; Richardus, Jan Hendrik

    2014-01-01

    This study is a step towards a behavioral intervention to prevent HIV transmission among Chinese internal migrants. To explore important and changeable determinants of condom use and inspect effective and feasible methods to increase condom use for the target population, we conducted a three-round web-based Delphi study among a panel of 62 experts between October 2012 and March 2013. The panelists were purposely selected using a stepwise procedure to represent topic-related areas of expertise. The response rate per round ranges from 21% to 81%. The panelists identified 19 possible determinants of condom use and reported 16 intervention methods they considered successful. They agreed that attitude towards condom use was the most important and changeable determinant, while applying behavioral theory, increasing sexual education and condom access, performing worksite health promotion, detecting risk factors, and working closely with relevant organizations and the government were effective and feasible methods to increase condom use among internal migrants in China. In conclusion, results of this study highlight the importance of attitude in changing condom use and underscore the need to apply behavior theory and integrate multiple educational approaches for developing behavioral HIV prevention interventions targeting internal migrants in China. PMID:25610903

  19. Addressing Unmet Need for HIV Testing in Emergency Care Settings: A Role for Computer-facilitated Rapid HIV Testing?

    PubMed Central

    Kurth, Ann E.; Severynen, Anneleen; Spielberg, Freya

    2014-01-01

    HIV testing in emergency departments (EDs) remains underutilized. We evaluated a computer tool to facilitate rapid HIV testing in an urban ED. Randomly assigned non-acute adult ED patients to computer tool (‘CARE’) and rapid HIV testing before standard visit (n=258) or to standard visit (n=259) with chart access. Assessed intervention acceptability and compared noted HIV risks. Participants were 56% non-white, 58% male; median age 37 years. In the CARE arm nearly all (251/258) completed the session and received HIV results; 4 declined test consent. HIV risks were reported by 54% of users and there was one confirmed HIV-positive and 2 false-positives (seroprevalence 0.4%, 95% CI 0.01–2.2%). Half (55%) preferred computerized, over face-to-face, counseling for future HIV testing. In standard arm, one HIV test and 2 referrals for testing occurred. Computer-facilitated HIV testing appears acceptable to ED patients. Future research should assess cost-effectiveness compared with staff-delivered approaches. PMID:23837807

  20. Drug-involved Mexican-origin girls' HIV prevention needs: A pilot study.

    PubMed

    Lopez, Vera; Dustman, Patricia; Williams, Tiffany

    2016-04-01

    The purpose of this pilot study was to collect data to inform the development of an HIV prevention program for drug-involved Mexican-origin (MO) adolescent girls. Eighteen in-depth semi-structured interviews were conducted with drug-involved MO girls in addition to focus group discussions with nineteen other drug-involved MO girls and eight clinical service providers in 2009-2010. Emergent themes indicated that HIV prevention programs for drug-involved MO girls should be girl-centered, focused on relationship development, and include trained peer facilitators who share the same cultural and "street" background as the girls. The program should omit scare tactics associated with risky sexual behaviors and emphasize individual empowerment skills useful to negotiate sexual decisions successfully. In addition, a girl-centered intervention for MO girls should address important concerns for this group, including resistance skills and strategies regarding relationships with older men, teenage motherhood, sexual infidelity, sexual coercion, and dating violence. Intervention activities should also be interactive with an emphasis on guiding girls as they learn to critically assess personal risk while at the same time learning skills and resources to address these issues in real life. PMID:26362876

  1. Knowledge about HIV prevention and transmission among recently diagnosed tuberculosis patients: a cross sectional study

    PubMed Central

    2013-01-01

    Background Patients with Tuberculosis (TB) are a vulnerable group for acquiring HIV infection. Therefore, countries with a concentrated HIV epidemic and high prevalence of TB should provide adequate information about HIV prevention to TB patients. Methods We conducted a cross-sectional study to evaluate the level of knowledge on HIV prevention and transmission among newly diagnosed TB patients in Lima, Peru. The survey evaluated knowledge about HIV infection and prevention and was administered before HIV counseling and blood sampling for HIV testing were performed. Results A total of 171 TB patients were enrolled; mean age was 31.1 years, 101 (59%) were male. The overall mean level of knowledge of HIV was 59%; but the specific mean level of knowledge on HIV transmission and prevention was only 33.3% and 41.5%, respectively. Age and level of education correlated with overall level of knowledge in the multivariate model (P-value: 0.02 and <0.001 respectively). Conclusions The study shows inadequate levels of knowledge about HIV transmission and prevention among newly-diagnosed TB patients in this setting, and underscores the need for implementing educational interventions in this population. PMID:24373517

  2. Positive Transitions (POST): Evaluation of an HIV Prevention Intervention for HIV-Positive Persons Releasing from Correctional Facilities.

    PubMed

    MacGowan, Robin J; Lifshay, Julie; Mizuno, Yuko; Johnson, Wayne D; McCormick, Lyle; Zack, Barry

    2015-06-01

    People with HIV who are released from custody frequently do not maintain the viral suppression and other health benefits achieved while incarcerated. This study was conducted to provide preliminary evidence of efficacy of an intervention to reduce HIV risk behaviors and increase use of HIV medical services following release from custody. People with HIV were recruited from San Francisco County jails, San Quentin State Prison and the California Medical Facility (Vacaville, CA), and randomly assigned to the "standard of care" or POST intervention. POST consisted of 4 sessions pre-release and 2 sessions post-release, focusing on HIV prevention and access to care. Behavioral data were obtained for the 3 months before incarceration and 3 months after release. Although POST participants reported a statistically significant increase in receiving health care at HIV clinics (62.5-84.4 %), there were no significant differences between the POST and control participants with respect to any primary outcomes. PMID:25190222

  3. Ethical Implications of Social Stigma Associated with the Promotion and Use of Pre-Exposure Prophylaxis for HIV Prevention.

    PubMed

    Herron, Patrick D

    2016-04-01

    Identifying sources of and eliminating social stigma associated with the promotion and use of pre-exposure prophylaxis (PrEP) for the prevention of sexually acquired HIV infection among men who have sex with men (MSM) is both a moral imperative and necessary requirement to ensure that public health objectives of HIV prevention can be met. This article will examine and address ethical concerns and criticisms regarding the use of PrEP, barriers to its promotion, and use among MSM and examine the types of social stigma associated with PrEP. An ethical justification for both healthcare and LGBT communities to address and overcome social stigma regarding the use of PrEP among MSM is offered. PMID:26859191

  4. Reducing the Risk: Building Skills To Prevent Pregnancy, STD & HIV. Second Edition.

    ERIC Educational Resources Information Center

    Barth, Richard P.

    This book presents a high school curriculum that has clearly demonstrated success in postponing sexual intercourse. In this second edition, the curriculum has been expanded and updated to include human immunodeficiency virus (HIV) prevention. Two new class sessions emphasizing HIV prevention have been added, bringing the total number of class…

  5. Humanizing Pedagogy through HIV and AIDS Prevention: Transforming Teacher Knowledge. Series in Critical Narrative

    ERIC Educational Resources Information Center

    Paradigm Publishers, 2006

    2006-01-01

    This book explores the power of educators to serve as HIV and AIDS prevention agents. The definitive text represents the work of a distinguished panel of teacher educators and health scientists who identify core information and skills effective educators of HIV and AIDS prevention should learn as they prepare to attend to the academic and human…

  6. Preparing Teachers as HIV/AIDS Prevention Leaders in Malawi: Evidence from Focus Groups

    ERIC Educational Resources Information Center

    Kachingwe, Sitingawawo I.; Norr, Kathleen; Kaponda, Chrissie P. N.; Norr, James; Mbweza, Ellen; Magai, Dorothy

    2005-01-01

    Although many countries offer school-based HIV/AIDS prevention programs, little is known about how teachers feel about being part of these programs. This paper presents the views of primary school teachers in Malawi regarding their potential role in HIV/AIDS prevention. Data come from two focus groups with 12 male and 12 female primary school…

  7. EveryBody[TM]: Preventing HIV and Other Sexually Transmitted Diseases among Young Teens.

    ERIC Educational Resources Information Center

    Schoeberlein, Deborah

    EveryBody is a curriculum that emphasizes prevention of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among early adolescents. It fosters active learning and facilitates communication about HIV/STD prevention and promotes safer behaviors. EveryBody incorporates current research on adolescent development so it…

  8. Building Program Acceptability: Perceptions of Gay and Bisexual Men on Peer or Prevention Case Manager Relationships in Secondary HIV Prevention Counseling

    PubMed Central

    DRISKELL, JEFFREY R.; O’CLEIRIGH, CONALL; COVAHEY, CHARLES; RIPTON, JESSICA; MAYER, KENNETH; PERRY, D’HANA; SALOMON, ELIZABETH; SAFREN, STEVEN

    2013-01-01

    There is growing interest in integrating HIV prevention counseling for HIV-infected gay and bisexual men into HIV primary care. HIV-infected peers and professionally trained prevention case managers (PCMs) have been used to provide prevention counseling services. The current qualitative study seeks to examine participant perceptions of the acceptability of HIV-infected peer counselors and of trained prevention case managers from the perspective of 41 HIV-infected gay and bisexual men. Semi-structured interviews were conducted with HIV-infected men who were currently receiving primary HIV health care. Positive peer counselor themes included shared experiences and para-professional. Positive themes specific to the PCM relationships included were provision of resources and professional skills and knowledge. Common themes identified across both peer and PCM counselor relationships were creating a comfortable environment, non-judgmental stance, and rapport building/communication skills. Recommendations for HIV secondary prevention interventions are presented. PMID:23710120

  9. Combination HIV prevention among MSM in South Africa: results from agent-based modeling.

    PubMed

    Brookmeyer, Ron; Boren, David; Baral, Stefan D; Bekker, Linda-Gail; Phaswana-Mafuya, Nancy; Beyrer, Chris; Sullivan, Patrick S

    2014-01-01

    HIV prevention trials have demonstrated the effectiveness of a number of behavioral and biomedical interventions. HIV prevention packages are combinations of interventions and offer potential to significantly increase the effectiveness of any single intervention. Estimates of the effectiveness of prevention packages are important for guiding the development of prevention strategies and for characterizing effect sizes before embarking on large scale trials. Unfortunately, most research to date has focused on testing single interventions rather than HIV prevention packages. Here we report the results from agent-based modeling of the effectiveness of HIV prevention packages for men who have sex with men (MSM) in South Africa. We consider packages consisting of four components: antiretroviral therapy for HIV infected persons with CD4 count <350; PrEP for high risk uninfected persons; behavioral interventions to reduce rates of unprotected anal intercourse (UAI); and campaigns to increase HIV testing. We considered 163 HIV prevention packages corresponding to different intensity levels of the four components. We performed 2252 simulation runs of our agent-based model to evaluate those packages. We found that a four component package consisting of a 15% reduction in the rate of UAI, 50% PrEP coverage of high risk uninfected persons, 50% reduction in persons who never test for HIV, and 50% ART coverage over and above persons already receiving ART at baseline, could prevent 33.9% of infections over 5 years (95% confidence interval, 31.5, 36.3). The package components with the largest incremental prevention effects were UAI reduction and PrEP coverage. The impact of increased HIV testing was magnified in the presence of PrEP. We find that HIV prevention packages that include both behavioral and biomedical components can in combination prevent significant numbers of infections with levels of coverage, acceptance and adherence that are potentially achievable among MSM in

  10. Combination HIV Prevention among MSM in South Africa: Results from Agent-based Modeling

    PubMed Central

    Brookmeyer, Ron; Boren, David; Baral, Stefan D.; Bekker, Linda- Gail; Phaswana-Mafuya, Nancy; Beyrer, Chris; Sullivan, Patrick S.

    2014-01-01

    HIV prevention trials have demonstrated the effectiveness of a number of behavioral and biomedical interventions. HIV prevention packages are combinations of interventions and offer potential to significantly increase the effectiveness of any single intervention. Estimates of the effectiveness of prevention packages are important for guiding the development of prevention strategies and for characterizing effect sizes before embarking on large scale trials. Unfortunately, most research to date has focused on testing single interventions rather than HIV prevention packages. Here we report the results from agent-based modeling of the effectiveness of HIV prevention packages for men who have sex with men (MSM) in South Africa. We consider packages consisting of four components: antiretroviral therapy for HIV infected persons with CD4 count <350; PrEP for high risk uninfected persons; behavioral interventions to reduce rates of unprotected anal intercourse (UAI); and campaigns to increase HIV testing. We considered 163 HIV prevention packages corresponding to different intensity levels of the four components. We performed 2252 simulation runs of our agent-based model to evaluate those packages. We found that a four component package consisting of a 15% reduction in the rate of UAI, 50% PrEP coverage of high risk uninfected persons, 50% reduction in persons who never test for HIV, and 50% ART coverage over and above persons already receiving ART at baseline, could prevent 33.9% of infections over 5 years (95% confidence interval, 31.5, 36.3). The package components with the largest incremental prevention effects were UAI reduction and PrEP coverage. The impact of increased HIV testing was magnified in the presence of PrEP. We find that HIV prevention packages that include both behavioral and biomedical components can in combination prevent significant numbers of infections with levels of coverage, acceptance and adherence that are potentially achievable among MSM in

  11. Antagonist Models for Relapse Prevention and Reducing HIV Risk.

    PubMed

    Woody, George E; Krupitsky, Evgeny; Zvartau, Edwin

    2016-09-01

    Naltrexone is an antagonist that binds tightly to μ-opioid receptors and blocks the subjective and analgesic effects of opioids. It does not produce physiologic dependence and precipitates withdrawal if administered to an opioid dependent person, thus starting it must begin with detoxification. It was first available in the mid-1970s as a 50 mg tablet that blocked opioids for 24-36 h if taken daily, or every 2-3 days at higher doses - for example: 100 mg Monday and Wednesday, 150 mg on Friday. From a pharmacological perspective it worked very well and was hoped to be an effective treatment but results were disappointing due to low patient interest and high dropout followed by relapse. Interest in it waned but rose again in the late 1990's when injecting opioid use and the rapid spread of HIV in the Russian Federation converged with an international interest in reducing the spread of HIV. One result was a series of meetings sponsored by the U.S. National Institute on Drug Abuse (NIDA) and Pavlov State Medical University in St. Petersburg, Russian Federation, on ways to reduce the spread of HIV in that country. Addiction treatment was a clear priority and discussions showed that naltrexone could have a role since agonist treatment is against Russian law but naltrexone is approved and the government funds over 25,000 beds for detoxification, which is the first step in starting naltrexone treatment. These meetings were followed by NIDA studies that showed better compliance to oral naltrexone than in prior U.S. studies with the expected reductions in HIV injecting risk for those that stayed in treatment. These events and findings provided a background and identified an infrastructure for the study that led to FDA approval of extended release injectable naltrexone for preventing relapse to opioid dependence. This paper will briefly review findings from these studies and end with comments on the potential role of extended release naltrexone as a meaningful addition

  12. Online Social Networking for HIV Education and Prevention: A Mixed Methods Analysis

    PubMed Central

    Young, Sean D.; Jaganath, Devan

    2013-01-01

    Background The purpose of this study is to use mixed (qualitative/quantitative) methods to determine 1) the feasibility and acceptability of using online social networking to facilitate HIV-related discussions, and 2) the relationship between HIV-related online discussions and requests for a home-based HIV testing kit, among men who have sex with men (MSM). Methods Participants, primarily African American and Latino, were invited to join a “secret” group on the social networking website, Facebook. Peer leaders, trained in HIV prevention, posted HIV-related content. Participants were not obligated to respond to discussions or remain within the group. Participant public group conversations were qualitatively and thematically analyzed. Quantitative methods tested associations between qualitative data, participants’ demographic information, and likelihood of requesting a home-based HIV testing kit. Results Latino and African-American participants (N=57) voluntarily used Facebook to discuss the following HIV-related topics (N=485 conversations): Prevention and Testing; Knowledge; Stigma; and Advocacy. Older participants more frequently discussed Prevention and Testing, Stigma, and Advocacy, though younger participants more frequently discussed HIV Knowledge-related conversations. As the study progressed, the proportion of messages related to Prevention and Testing and HIV Stigma increased. Multivariate analysis showed that participants posting about HIV Prevention and Testing (compared to those who did not) were significantly more likely to request an HIV testing kit (OR 11.14, p = 0.001). Conclusions Facebook can serve as an innovative forum to increase both HIV prevention discussions and HIV testing requests among at-risk groups. PMID:23324979

  13. [HIV prevention program for young people--the WYSH Project as a model of "combination prevention"].

    PubMed

    Ono-Kihara, Masako

    2010-03-01

    In face of the HIV pandemic that still grows, unsuccessful efforts of developing biomedical control measures or the failure of cognitive-behavioral approach to show sustained social level effectiveness, behavioral strategy is now expected to evolve into a structural prevention ("combination prevention") that involves multiple behavioral goals and multilevel approaches. WYSH Project is a combination prevention project for youth developed through socio-epidemiological approach that integrates epidemiology with social science such as social marketing and mixed method. WYSH Project includes mass education programs for youth in schools and programs for out-of-school youth through cyber network and peer communication. Started in 2002, it expanded nationwide with supports from related ministries and parent-teacher associations and has grown into a single largest youth prevention project in Japan. PMID:20229804

  14. Exploring Ivorian perspectives on the effectiveness of the current Ivorian science curriculum in addressing issues related to HIV/AIDS

    NASA Astrophysics Data System (ADS)

    Ado, Gustave Firmin

    School-based HIV/AIDS science education has the potential to impact students when integrated into the science curriculum. However, this mixed method study shows that school-based HIV/AIDS science education is often not infused into career subjects such as science education but integrated into civics education and taught by teachers who lack the skills, knowledge, and the training in the delivery of effective school HIV/AIDS education. Since science is where biological events take place, it is suggested that HIV/AIDS science merits being taught in the science education classroom. This study took place in nine public middle schools within two school districts in Abidjan, Ivory Coast, one major urban city in the southern region. The study utilized triangulation of multiple data sources---both qualitative and quantitative. To substantiate the claims made in this study, a range of qualitative methods such as field notes and individual interviews with 39 teachers, 63 sixth grade students, 8 school administrators, and 20 community elders were used. For the quantitative portion 140 teachers and 3510 sixth grade students were surveyed. The findings from the study prioritize science education that includes HIV/AIDS science education for all, with emphasis on HIV/AIDS prevention in Ivory Coast. The factors that influence the implementation of HIV/AIDS curricula within the Ivorian sixth grade classrooms are discussed. Interview and survey data from students, teachers, school administrators, and community elders indicate that in the Ivorian school setting, "gerontocratic" cultural influences, religious beliefs, personal cultural beliefs, and time spent toward the discourse on HIV/AIDS have led to HIV/AIDS education that is often insufficient to change either misconceptions about HIV/AIDS or risky practices. It was also found that approaches to teaching HIV/AIDS does not connect with youth cultures. By reframing and integrating current HIV/AIDS curricula into the science

  15. Where does public funding for HIV prevention go to? The case of condoms versus microbicides and vaccines

    PubMed Central

    2010-01-01

    This study analyses the priorities of public donors in funding HIV prevention by either integrated condom programming or HIV preventive microbicides and vaccines in the period between 2000 and 2008. It further compares the public funding investments of the USA government and European governments, including the EU, as we expect the two groups to invest differently in HIV prevention options, because their policies on sexual and reproductive health and rights are different. We use two existing officially UN endorsed databases to compare the public donor funding streams for HIV prevention of these two distinct contributors. In the period 2000-2008, the relative share of public funding for integrated condom programming dropped significantly, while that for research on vaccines and microbicides increased. The European public donors gave a larger share to condom programming than the United States, but exhibited a similar downward trend in favour of funding research on vaccines and microbicides. Both public donor parties invested progressively more in research on vaccines and microbicides rather than addressing the shortage of condoms and improving access to integrated condom programming in developing countries. PMID:21192787

  16. HIV Epidemic Appraisals for Assisting in the Design of Effective Prevention Programmes: Shifting the Paradigm Back to Basics

    PubMed Central

    Mishra, Sharmistha; Sgaier, Sema K.; Thompson, Laura H.; Moses, Stephen; Ramesh, B. M.; Alary, Michel; Wilson, David; Blanchard, James F.

    2012-01-01

    Background To design HIV prevention programmes, it is critical to understand the temporal and geographic aspects of the local epidemic and to address the key behaviours that drive HIV transmission. Two methods have been developed to appraise HIV epidemics and guide prevention strategies. The numerical proxy method classifies epidemics based on current HIV prevalence thresholds. The Modes of Transmission (MOT) model estimates the distribution of incidence over one year among risk-groups. Both methods focus on the current state of an epidemic and provide short-term metrics which may not capture the epidemiologic drivers. Through a detailed analysis of country and sub-national data, we explore the limitations of the two traditional methods and propose an alternative approach. Methods and Findings We compared outputs of the traditional methods in five countries for which results were published, and applied the numeric and MOT model to India and six districts within India. We discovered three limitations of the current methods for epidemic appraisal: (1) their results failed to identify the key behaviours that drive the epidemic; (2) they were difficult to apply to local epidemics with heterogeneity across district-level administrative units; and (3) the MOT model was highly sensitive to input parameters, many of which required extraction from non-regional sources. We developed an alternative decision-tree framework for HIV epidemic appraisals, based on a qualitative understanding of epidemiologic drivers, and demonstrated its applicability in India. The alternative framework offered a logical algorithm to characterize epidemics; it required minimal but key data. Conclusions Traditional appraisals that utilize the distribution of prevalent and incident HIV infections in the short-term could misguide prevention priorities and potentially impede efforts to halt the trajectory of the HIV epidemic. An approach that characterizes local transmission dynamics provides a

  17. Photovoice for healthy relationships: community-based participatory HIV prevention in a rural American Indian community.

    PubMed

    Markus, Susan F

    2012-01-01

    This article provides an example of a culturally responsive, community-based project for addressing social determinants of health in rural American Indian (AI) communities through: 1) empowering youth and community voices to set directions for HIV, sexually transmitted infections, and unintended pregnancy prevention and education efforts; 2) using Photovoice to promote healthy relationships among AI youth; 3) using the socioecological model (Centers for Disease Control and Prevention, 2004; 2011) as a framework for organizing the creation and subsequent sharing of Photovoice messages from individual empowerment, to relationships, communities, institutions, and general society; and 4) framing analysis of Photovoice projects in alignment with Bell's (2010) model of storytelling for social justice that connects narrative and the arts in anti-racist teaching. A discussion on future steps and recommendations for future research is provided. PMID:22569727

  18. Can the Heterosexual HIV Epidemic be Eliminated in South Africa Using Combination Prevention? A Modeling Analysis.

    PubMed

    Abuelezam, Nadia N; McCormick, Alethea W; Fussell, Thomas; Afriyie, Abena N; Wood, Robin; DeGruttola, Victor; Freedberg, Kenneth A; Lipsitch, Marc; Seage, George R

    2016-08-01

    Little is known about how combining efficacious interventions for human immunodeficiency virus (HIV) prevention could lead to HIV elimination. We used an agent-based simulation model, the HIV calibrated dynamic model, to assess the potential for HIV elimination in South Africa. We examined several scenarios (from continuation of the current status quo to perfect achievement of targets) with differing combinations of male condom use, adult male circumcision, HIV testing, and early antiretroviral therapy (ART). We varied numerous parameters, including the proportion of adult males circumcised, the frequency of condom use during sex acts, acceptance of HIV testing, linkage to health care, criteria for ART initiation, ART viral suppression rates, and loss to follow-up. Maintaining current levels of combination prevention would lead to increasing HIV incidence and prevalence in South Africa, while the perfect combination scenario was projected to eliminate HIV on a 50-year time scale from 2013 to 2063. Perfecting testing and treatment, without changing condom use or circumcision rates, resulted in an 89% reduction in HIV incidence but not elimination. Universal adult male circumcision alone resulted in a 21% incidence reduction within 20 years. Substantial decreases in HIV incidence are possible from sufficient uptake of both primary prevention and ART, but with continuation of the status quo, HIV elimination in South Africa is unlikely within a 50-year time scale. PMID:27416841

  19. An ecological approach to addressing HIV/AIDS in the African American community.

    PubMed

    Moore, Dennis; Carr, Carey A; Williams, Carlton; Richlen, Windy; Huber, Mary; Wagner, Joseph

    2010-01-01

    The disproportionate impact of HIV/AIDS on African Americans is a significant public health challenge. The complex constellation of individual, social, and environmental factors influencing transmission, require ecological solutions that recognize these multiple levels of influence and actively involve communities. This article describes the formation of a community-based coalition and highlights three initiatives it has undertaken in the areas of mobile HIV testing, HIV education, and faith-based work to improve HIV services for African Americans. PMID:20178031

  20. HIV Prevention 2020: a framework for delivery and a call for action.

    PubMed

    Dehne, Karl L; Dallabetta, Gina; Wilson, David; Garnett, Geoff P; Laga, Marie; Benomar, Elizabeth; Fakoya, Ade; Baggaley, Rachel C; Nelson, Lisa J; Kasedde, Susan; Bermejo, Alvaro; Warren, Mitchell; Benedikt, Clemens

    2016-07-01

    Although effective programmes are available and several countries have seen substantial declines in new HIV infections, progress in the reduction of adult HIV incidence has been slower than expected worldwide and many countries have not had large decreases in new infections in adults despite large reductions in paediatric infections. Reasons for slow progress include inadequate commitment, investment, focus, scale, and quality of implementation of prevention and treatment interventions. The UNAIDS-Lancet Commission on Defeating AIDS-Advancing Global Health reported that the provision of large-scale, effective HIV prevention programmes has failed and called on stakeholders to "get serious about HIV prevention". An ambitious worldwide target has been set by UNAIDS to reduce new infections below 500 000 by 2020-a 75% reduction from 2010. Models show that such a reduction requires a combination of primary prevention interventions and preventative effects of treatment. Achievement of the target will require more effective delivery of HIV prevention for sufficient coverage in populations at greatest risk of infection ensuring that interventions that have proved effective are made available, barriers to their uptake are overcome, demand is created, and use is consistent and occurs at the right scale with high coverage. This paper discusses how programmatic targets for prevention in a worldwide plan could be used to re-energise the HIV prevention approach. A management framework is proposed outlining global, regional, national, and subnational actions and is summarised in a call for action on HIV prevention for 2020. PMID:27365207

  1. Psychosocial Implications of Homophobia and HIV Stigma in Social Support Networks: Insights for High-Impact HIV Prevention Among Black Men Who Have Sex With Men.

    PubMed

    Garcia, Jonathan; Parker, Caroline; Parker, Richard G; Wilson, Patrick A; Philbin, Morgan; Hirsch, Jennifer S

    2016-04-01

    Black men who have sex with men (BMSM) bear an increasingly disproportionate burden of HIV in the United States. The Centers for Disease Control and Prevention recommends high-impact combination prevention for populations at high risk for HIV infection, such as BMSM. However, few scholars have considered the types of behavioral interventions that combined with biomedical prevention could prove effective for mitigating the epidemic among BMSM. Between June 2013 and May 2014, we conducted three in-depth interviews each with 31 BMSM, interviews with 17 community stakeholders, and participant observation in New York City to understand the sociocultural and structural factors that may affect the acceptance of and adherence to oral preexposure prophylaxis among BMSM and to inform an adherence clinical trial. BMSM and community leaders frequently described condomless sex as a consequence of psychosocial factors and economic circumstances stemming from internalized homophobia resulting from rejection by families and religious groups. BMSM revealed that internalized homophobia and HIV stigma resulted in perceived lack of self- and community efficacy in accepting and adhering to preexposure prophylaxis. Our results indicate that addressing internalized homophobia and fostering emotional social support in peer networks are key elements to improve the effectiveness of combination prevention among BMSM. PMID:27037286

  2. The Lifetime Medical Cost Savings from Preventing HIV in the United States

    PubMed Central

    Schackman, Bruce R.; Fleishman, John A.; Su, Amanda E.; Berkowitz, Bethany K.; Moore, Richard D.; Walensky, Rochelle P.; Becker, Jessica E.; Voss, Cindy; Paltiel, A. David; Weinstein, Milton C.; Freedberg, Kenneth A.; Gebo, Kelly A.; Losina, Elena

    2015-01-01

    Objective Enhanced HIV prevention interventions, such as pre-exposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting one HIV infection in the United States. Methods We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing one HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV-infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range $1,854–$4,545/month) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range $73–$628/month). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 US dollars). Results The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% non-drug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding one HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided. Conclusions The economic value of HIV prevention in the US is substantial given the high cost of HIV disease treatment. PMID:25710311

  3. Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention

    PubMed Central

    Makofane, Keletso; Santos, Glenn-Milo; Beck, Jack; Do, Tri D.; Wilson, Patrick A.; Pyun, Thomas; Arreola, Sonya

    2013-01-01

    Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed. PMID:26316968

  4. Acceptability and feasibility of cash transfers for HIV prevention among adolescent South African women.

    PubMed

    MacPhail, Catherine; Adato, Michelle; Kahn, Kathleen; Selin, Amanda; Twine, Rhian; Khoza, Samson; Rosenberg, Molly; Nguyen, Nadia; Becker, Elizabeth; Pettifor, Audrey

    2013-09-01

    Women are at increased risk of HIV infection in much of sub-Saharan Africa. Longitudinal and cross-sectional studies have found an association between school attendance and reduced HIV risk. We report feasibility and acceptability results from a pilot of a cash transfer intervention conditional on school attendance paid to young women and their families in rural Mpumalanga, South Africa for the prevention of HIV infection. Twenty-nine young women were randomised to intervention or control and a cash payment based on school attendance made over a 2-month period. Quantitative (survey) and qualitative (focus group and interview) data collection was undertaken with young women, parents, teachers and young men in the same school. Qualitative analysis was conducted in Atlas.ti using a framework approach and basic descriptive analysis in Excel was conducted on the quantitative data. Results indicate it was both feasible and acceptable to introduce such an intervention among this population in rural South Africa. There was good understanding of the process of randomisation and the aims of the study, although some rumours developed in the study community. We address some of the changes necessary to ensure acceptability and feasibility of the main trial. PMID:23435698

  5. Predictors of Success in Implementing HIV Prevention in Rural America: A State-Level Structural Factor Analysis of HIV Prevention Targeting Men who have Sex with Men

    PubMed Central

    Horvath, Keith J.

    2013-01-01

    Relatively few studies have examined the impact of modifying structural factors on HIV prevention efforts in the United States despite their high potential for lowering HIV prevalence rates. The aim of this study was to identify state-level characteristics of successful HIV prevention implementation. Structured interviews with 73 key informants in 13 rural states identified ‘more successful’ and ‘less successful’ states in HIV prevention. States were compared on demographic, religious, gay community, and funding variables. The 7 more successful states had both a wider variety and more MSM-targeted interventions. Overall funding, degree of epidemic, and “ruralness” were not significantly associated with success. Rather, successful states had less religious and Evangelical Protestant adherents and more ‘gay community’ infrastructure. They also spent a greater proportion of funds contracting community-based organizations and on MSMtargeted programming. Success in HIV prevention varies across rural states. Key demographic, social and economic indicators distinguish success in HIV prevention. PMID:17440806

  6. Interventions to Address Chronic Disease and HIV: Strategies to Promote Exercise and Nutrition Among HIV-Infected Individuals

    PubMed Central

    Botros, Diana; Somarriba, Gabriel; Neri, Daniela; Miller, Tracie L.

    2012-01-01

    Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments. PMID:22933247

  7. Mano a Mano-Mujer: an effective HIV prevention intervention for Chilean women.

    PubMed

    Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F; Miner, Sarah; Irarrazabal, Lisette; Bernales, Margarita; Peragallo, Nilda; Levy, Judith; Norr, James L; McElmurry, Beverly

    2012-01-01

    The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries. PMID:22420675

  8. HIV prevention in gay bathhouses and sex clubs across the United States.

    PubMed

    Woods, William J; Euren, Jason; Pollack, Lance M; Binson, Diane

    2010-12-01

    Gay bathhouses (including sex clubs) contributed to HIV prevention from the early days of the AIDS epidemic, but the extent to which prevention interventions are implemented in bathhouses is unknown. Using telephone survey methodology, bathhouse managers provided data about HIV prevention in their bathhouses. All the bathhouses provided free condoms, and nearly all displayed educational posters in public areas and had informational pamphlets available for patrons. A few of the bathhouses offered outreach services and counseling services. Almost all promoted testing for HIV/sexually transmitted infection (which included providing information about where to get tested), and 75.5% had HIV testing programs in their venues. Most of the HIV testing programs were started during the past 5 years, initiated by the bathhouse management or a community agency, and operated by community-based agencies. About one third of the programs offered rapid HIV testing. The results of the telephone survey revealed that all the bathhouses engaged in prevention and many offered a wide range of prevention services, suggesting that managers have embraced the issue of HIV and collaborated in bringing prevention to high-risk men. The absence of studies evaluating these prevention efforts remains a concern and an obstacle for efficient use of the prevention resources. PMID:21406994

  9. Defining success with HIV pre-exposure prophylaxis: A prevention-effective adherence paradigm

    PubMed Central

    Haberer, Jessica E.; Bangsberg, David R.; Baeten, Jared M.; Curran, Kathryn; Koechlin, Florence; Amico, K. Rivet; Anderson, Peter; Mugo, Nelly; Venter, Francois; Goicochea, Pedro; Caceres, Carlos; O’Reilly, Kevin

    2015-01-01

    Clinical trial data have shown that oral pre-exposure prophylaxis (PrEP) is efficacious when taken as prescribed; however, PrEP adherence is complex and must be understood within the context of variable risk for HIV infection and use of other HIV prevention methods. Different levels of adherence may be needed in different populations to achieve HIV prevention, and the optimal methods for achieving the necessary adherence for both individual and public health benefits are unknown. Guidance for PrEP use must consider these questions to determine the success of PrEP-based HIV prevention programs. In this article, we propose a new paradigm for understanding and measuring PrEP adherence, termed prevention-effective adherence, which incorporates dynamic HIV acquisition risk behaviors and the use of HIV alternative prevention strategies. We discuss the need for daily PrEP use only during periods of risk for HIV exposure, describe key issues for measuring and understanding relevant behaviors, review lessons from another health prevention field (i.e., family planning), and provide guidance for prevention-effective PrEP use. Moreover, we challenge emerging calls for sustained, near perfect PrEP adherence regardless of risk exposure and offer a more practical and public health-focused vision for this prevention intervention. PMID:26103095

  10. Pulling together: interagency coordination and HIV/STD prevention.

    PubMed

    Thomas, James C; Carter, Craig; Torrone, Elizabeth; Levandowski, Brooke A

    2008-01-01

    Using multiple network comparisons, we determined whether sexually transmitted disease (STD) rates or black-white STD rate differences are related to how HIV prevention agencies interact through exchanges of information, clients, or funds. In 10 North Carolinian counties, we conducted a cross-sectional analysis, using each county's network as the unit of interest. Using data from face-to-face interviews, measures of the density (overall connectedness) and degree centralization (amount of centralized information hubs) were calculated with UCINET. Statistical significance of the associations between county characteristics and STD rates was assessed with exact Wilcoxon rank sum test. Syphilis rates were lower (P = .01) in counties with a high network density, on the basis of exchanges of information or clients. The effect on black-white rate differences was in the same direction but weaker. Where network degree centralization was high, syphilis rates were higher and the black-white rate differences were larger. Gonorrhea rates demonstrated similar but attenuated patterns of association with network characteristics. STD prevention is more effective when all agencies interact with each other (density) but less effective when interactions are predominantly with a few central agencies (degree centralization). The measures of network exchanges employed in this study may be appropriate for future assessment of service provision of funded prevention programs. PMID:18091030

  11. The role of Fc receptors in HIV prevention and therapy.

    PubMed

    Boesch, Austin W; Brown, Eric P; Ackerman, Margaret E

    2015-11-01

    Over the past decade, a wealth of experimental evidence has accumulated supporting the importance of Fc receptor (FcR) ligation in antibody-mediated pathology and protection in many disease states. Here we present the diverse evidence base that has accumulated as to the importance of antibody effector functions in the setting of HIV prevention and therapy, including clinical correlates, genetic associations, viral evasion strategies, and a rapidly growing number of compelling animal model experiments. Collectively, this work identifies antibody interactions with FcR as important to both therapeutic and prophylactic strategies involving both passive and active immunity. These findings mirror those in other fields as investigators continue to work toward identifying the right antibodies and the right effectors to be present at the right sites at the right time. PMID:26497529

  12. [Prospects of using miramistin for individual prevention of sexual HIV transmission].

    PubMed

    Krivorutchenko, Iu L; Andronovskaia, I B

    2013-03-01

    For more than 20 years cationic surfactant Miramistin has been used in Russia and Ukraine as an antiseptic mean for individual prophylaxis of venereal diseases and for the treatment of genitourinary tract and other systems infections. Complete inhibition of HIV-1 activity in vitro by Miramistin in concentrations higher than 0.0075%, has been demonstrated, that allows to consider this detergent as a potent first-generation vaginal microbicide for the prevention of HIV transmission. Higher anti-HIV effect of Miramistin than of nonoxynol-9 and low local toxicity show good prospects of using Miramistin for individual prevention of HIV transmission. PMID:24605621

  13. Clinical challenges in HIV/AIDS: Hints for advancing prevention and patient management strategies.

    PubMed

    Sued, Omar; Figueroa, María Inés; Cahn, Pedro

    2016-08-01

    Acquired immune deficiency syndrome has been one of the most devastating epidemics of the last century. The current estimate for people living with the HIV is 36.9 million. Today, despite availability of potent and safe drugs for effective treatment, lifelong therapy is required for preventing HIV re-emergence from a pool of latently infected cells. However, recent evidence show the importance to expand HIV testing, to offer antiretroviral treatment to all infected individuals, and to ensure retention through all the cascade of care. In addition, circumcision, pre-exposure prophylaxis, and other biomedical tools are now available for included in a comprehensive preventive package. Use of all the available tools might allow cutting the HIV transmission in 2030. In this article, we review the status of the epidemic, the latest advances in prevention and treatment, the concept of treatment as prevention and the challenges and opportunities for the HIV cure agenda. PMID:27117711

  14. Participation in Counseling Programs: High-Risk Participants Are Reluctant to Accept HIV-Prevention Counseling

    PubMed Central

    Earl, Allison; Albarracín, Dolores; Durantini, Marta R.; Gunnoe, Joann B.; Leeper, Josh; Levitt, Justin H.

    2013-01-01

    HIV-prevention intervention effectiveness depends on understanding whether clients with highest need for HIV-prevention counseling accept it. With this objective, a field study with a high-risk community sample from the southeastern United States (N = 350) investigated whether initial knowledge about HIV, motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use correlate with subsequent acceptance of an HIV-prevention counseling session. Ironically, participants with high (vs. low) motivation to use condoms, high (vs. low) condom-use-relevant behavioral skills, and high (vs. low) prior condom use were more likely to accept the HIV-prevention counseling. Moreover, the influence of motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use on acceptance of the counseling was mediated by expectations that the counseling session would be useful. Methods to reduce barriers to recruitment of clients for counseling programs are discussed. PMID:19634960

  15. Use of human papillomavirus vaccine in HIV-infected men for the prevention of anal dysplasia and cancer.

    PubMed

    Cachay, Edward R; Mathews, Wm Christopher

    2014-01-01

    There are two commercially available vaccines licensed worldwide for the prevention of cervical cancer and other human papillomavirus-associated cancers such as anal cancer. However, only two countries have implemented healthcare programs that include human papillomavirus vaccination for boys and men. Although most of the human papillomavirus-related cancers in the world are attributable to cervical cancer, in developed countries anal cancer accounts for a larger proportion of human papillomavirus-related cancers. Most cases of anal cancer occur in HIV-infected men who have sex with men. In this review, we discuss the burden of human papillomavirus-related cancers in men, the most plausible immune mechanism associated with the high efficacy of the human papillomavirus vaccine, and address key issues of vaccination for HIV-infected men. Finally, we review cost-effectiveness considerations for the use of the vaccine in boys and recent guidelines for vaccination in boys, with attention to HIV-infected men. PMID:24818632

  16. A Tailored Approach to Launch Community Coalitions Focused on Achieving Structural Changes: Lessons Learned From a HIV Prevention Mobilization Study.

    PubMed

    Chutuape, Kate S; Willard, Nancy; Walker, Bendu C; Boyer, Cherrie B; Ellen, Jonathan

    2015-01-01

    Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition. PMID:26785397

  17. An Assessment of the Policies and Programmes of Zimbabwe in Addressing the HIV/Aids Epidemic in the Education Sector

    ERIC Educational Resources Information Center

    Rembe, Symphorosa

    2006-01-01

    This study assessed the policies, strategic plans and structures that have been put in place in Zimbabwe to address the HIV/AIDS epidemic in the education sector. It also examined the comprehensiveness of projects and programmes currently being implemented by the government in collaboration with partner organisations and NGOs. The findings show…

  18. Maximizing the impact of HIV prevention efforts: Interventions for couples

    PubMed Central

    Medley, Amy; Baggaley, Rachel; Bachanas, Pamela; Cohen, Myron; Shaffer, Nathan; Lo, Ying-Ru

    2015-01-01

    Despite efforts to increase access to HIV testing and counseling services, population coverage remains low. As a result, many people in sub-Saharan Africa do not know their own HIV status or the status of their sex partner(s). Recent evidence, however, indicates that as many as half of HIV-positive individuals in ongoing sexual relationships have an HIV-negative partner and that a significant proportion of new HIV infections in generalized epidemics occur within serodiscordant couples. Integrating couples HIV testing and counseling (CHTC) into routine clinic- and community-based services can significantly increase the number of couples where the status of both partners is known. Offering couples a set of evidence-based interventions once their HIV status has been determined can significantly reduce HIV incidence within couples and if implemented with sufficient scale and coverage, potentially reduce population-level HIV incidence as well. This article describes these interventions and their potential benefits. PMID:23656251

  19. 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. PMID:25863466

  20. PrEP as Peri-conception HIV Prevention for Women and Men.

    PubMed

    Heffron, Renee; Pintye, Jillian; Matthews, Lynn T; Weber, Shannon; Mugo, Nelly

    2016-06-01

    Daily oral tenofovir (TDF)-based pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy and recommended for men and women with substantial risk of HIV acquisition. The peri-conception period, the stage prior to pregnancy when condom use is necessarily reduced, has elevated HIV risk that can be mitigated by PrEP use. Data from a randomized trial suggest that peri-conception PrEP use by HIV-seronegative women does not increase the risk of pregnancy loss, birth defects or congenital anomalies, preterm birth, or infant growth faltering. Women considering PrEP use throughout pregnancy must weigh the known increased risk of HIV acquisition with unknown risks of drug effects on infant growth. PrEP has been used safely by HIV-seronegative men with HIV-seropositive female partners who have become pregnant. As an effective user-controlled HIV prevention strategy, PrEP offers autonomy and empowerment for HIV prevention and can be recommended alongside antiretroviral therapy, fertility screening, vaginal self-insemination, intercourse timed to peak fertility, medically assisted reproduction, and other safer conception strategies to provide multiple options. The integration of PrEP into safer conception programs is warranted and will safely reduce HIV transmission to women, men, and children during the peri-conception period. PMID:26993627

  1. Biomedical HIV prevention research and epidemic control in Thailand: two sides of the same coin.

    PubMed

    van Griensven, Frits; Phanuphak, Nittaya; Srithanaviboonchai, Kriengkrai

    2014-07-01

    For a country with a moderate adult HIV prevalence of just over 1% in 2012, Thailand is widely perceived as having made some extraordinary contributions to the global management of the HIV/AIDS pandemic. It has been promoted as a model of effective HIV control and applauded for its leadership in providing access to antiretroviral treatment. Thailand has also received international recognition for its contribution to biomedical HIV prevention research, which is generally perceived as exceptional. In this paper, Thailand's global role model function as an example of effective HIV/AIDS control and high-quality biomedical HIV prevention research is re-evaluated against the background of currently available data and more recent insights. The results indicate that Thailand's initial response in raising the level of the political significance of HIV/AIDS was indeed extraordinary, which probably prevented a much larger epidemic from occurring. However, this response transpired in unusual extraconstitutional circumstances and its effectiveness declined once the country returned to political normalcy. Available data confirm the country's more than exceptional contribution to biomedical HIV prevention research. Thailand has made a huge contribution to the global management and control of the HIV/AIDS pandemic. PMID:25000363

  2. Does MTV reach an appropriate audience for HIV prevention messages? Evidence from MTV viewership data in Nepal and Brazil.

    PubMed

    Geary, Cynthia Waszak; Burke, Holly McClain; Neupane, Shailes; Castelnau, Laure; Brown, Jane D

    2006-01-01

    In response to the growing numbers of young people affected by HIV around the world, MTV (Music TV), the world's largest television network, has aired a global HIV prevention campaign since 1999, expanding it into a multicomponent campaign in 2002. Questions have been raised, however, about whether MTV is an appropriate channel for these messages, given its provocative content and its reach to those at the upper end of the socioeconomic scale. To address questions about who MTV reaches, viewership data were analyzed from baseline surveys conducted as part of an evaluation of the 2002 HIV prevention campaign. The two sites included in this analysis were Kathmandu, Nepal, and São Paulo, Brazil-each with very different cultures and media environments. We found that, in general, heavier viewers of MTV are younger, better educated, and more dependent on their parents, and they have more access to satellite television and the Internet. MTV viewing was associated with positive attitudes toward HIV prevention behaviors (except for abstinence until marriage) but not with premarital sexual activity. PMID:17074734

  3. An Online Randomized Controlled Trial Evaluating HIV Prevention Digital Media Interventions for Men Who Have Sex with Men

    PubMed Central

    Hirshfield, Sabina; Chiasson, Mary Ann; Joseph, Heather; Scheinmann, Roberta; Johnson, Wayne D.; Remien, Robert H.; Shaw, Francine Shuchat; Emmons, Reed; Yu, Gary; Margolis, Andrew D.

    2012-01-01

    Background As HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men (MSM). Engaging MSM online where they meet sexual partners is critical for HIV prevention efforts. Methods A randomized controlled trial (RCT) conducted online among U.S. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention webpage compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and unprotected anal intercourse (UAI) at 60-day follow-up. Video conditions were pooled due to reduced power from low retention (53%, n = 1,631). No participant incentives were provided. Principal Findings Follow-up was completed by 1,631 (53%) of 3,092 eligible men. In the 60 days after the intervention, men in the pooled video condition were significantly more likely than men in the control to report full serostatus disclosure (‘asked and told’) with their last sexual partner (OR 1.32, 95% CI 1.01–1.74). Comparing baseline to follow-up, HIV-negative men in the pooled video (OR 0.70, 95% CI 0.54–0.91) and webpage condition (OR 0.43, 95% CI 0.25–0.72) significantly reduced UAI at follow-up. HIV-positive men in the pooled video condition significantly reduced UAI (OR 0.38, 95% CI 0.20–0.67) and serodiscordant UAI (OR 0.53, 95% CI 0.28–0.96) at follow-up. Conclusions/Significance Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention designed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing

  4. Reducing HIV and AIDS through Prevention (RHAP): A Theoretically Based Approach for Teaching HIV Prevention to Adolescents through an Exploration of Popular Music

    PubMed Central

    McLaughlin, Nadine; Gray, Angela; Ogedegbe, Anthony; Hageman, Ivan; Knowlton, Courtney; Rodriguez, Anna; Beeder, Ann

    2010-01-01

    Using popular culture to engage students in discussions of HIV prevention is a nontraditional approach that may complement current prevention efforts and enhance the ability to reach youth who are at high risk of contracting HIV and other sexually transmitted infections. Hip-hop or rap music is the dominant genre of music among adolescents, especially Black and Latino youth who are disproportionately impacted by HIV and AIDS. This paper describes the rationale and development of the Reducing HIV and AIDS through Prevention (RHAP) program, a school-based program that uses hip-hop/rap music as a vehicle for raising awareness among adolescents about HIV/AIDS. Constructs from the Social Cognitive Theory and the Sexual Script Theory were used in developing the program. It was piloted and evaluated among 26 middle school students in East Harlem, New York. The lessons learned from a formative evaluation of the program and the implications for developing other programs targeting public health problems are discussed. The RHAP program challenges the traditional pedagogue–student paradigm and provides an alternative approach to teaching about HIV prevention and awareness. PMID:20195778

  5. Reducing HIV and AIDS through Prevention (RHAP): a theoretically based approach for teaching HIV prevention to adolescents through an exploration of popular music.

    PubMed

    Boutin-Foster, Carla; McLaughlin, Nadine; Gray, Angela; Ogedegbe, Anthony; Hageman, Ivan; Knowlton, Courtney; Rodriguez, Anna; Beeder, Ann

    2010-05-01

    Using popular culture to engage students in discussions of HIV prevention is a nontraditional approach that may complement current prevention efforts and enhance the ability to reach youth who are at high risk of contracting HIV and other sexually transmitted infections. Hip-hop or rap music is the dominant genre of music among adolescents, especially Black and Latino youth who are disproportionately impacted by HIV and AIDS. This paper describes the rationale and development of the Reducing HIV and AIDS through Prevention (RHAP) program, a school-based program that uses hip-hop/rap music as a vehicle for raising awareness among adolescents about HIV/AIDS. Constructs from the Social Cognitive Theory and the Sexual Script Theory were used in developing the program. It was piloted and evaluated among 26 middle school students in East Harlem, New York. The lessons learned from a formative evaluation of the program and the implications for developing other programs targeting public health problems are discussed. The RHAP program challenges the traditional pedagogue-student paradigm and provides an alternative approach to teaching about HIV prevention and awareness. PMID:20195778

  6. Brief Report: HIV Drug Resistance in Adults Failing Early Antiretroviral Treatment: Results From the HIV Prevention Trials Network 052 Trial.

    PubMed

    Fogel, Jessica M; Hudelson, Sarah E; Ou, San-San; Hart, Stephen; Wallis, Carole; Morgado, Mariza G; Saravanan, Shanmugam; Tripathy, Srikanth; Hovind, Laura; Piwowar-Manning, Estelle; Sabin, Devin; McCauley, Marybeth; Gamble, Theresa; Zhang, Xinyi C; Eron, Joseph J; Gallant, Joel E; Kumwenda, Johnstone; Makhema, Joseph; Kumarasamy, Nagalingeswaran; Chariyalertsak, Suwat; Hakim, James; Badal-Faesen, Sharlaa; Akelo, Victor; Hosseinipour, Mina C; Santos, Breno R; Godbole, Sheela V; Pilotto, Jose H; Grinsztejn, Beatriz; Panchia, Ravindre; Mayer, Kenneth H; Chen, Ying Q; Cohen, Myron S; Eshleman, Susan H

    2016-07-01

    Early initiation of antiretroviral treatment (ART) reduces HIV transmission and has health benefits. HIV drug resistance can limit treatment options and compromise use of ART for HIV prevention. We evaluated drug resistance in 85 participants in the HIV Prevention Trials Network 052 trial who started ART at CD4 counts of 350-550 cells per cubic millimeter and failed ART by May 2011; 8.2% had baseline resistance and 35.3% had resistance at ART failure. High baseline viral load and less education were associated with emergence of resistance at ART failure. Resistance at ART failure was observed in 7 of 8 (87.5%) participants who started ART at lower CD4 cell counts. PMID:26859828

  7. A Five Step Process for Interactive Parent-Adolescent Communication About HIV Prevention: Advice from Parents Living With HIV/AIDS

    PubMed Central

    Edwards, Laura L.; Reis, Janet S.

    2014-01-01

    AIM This study investigated how parents living with HIV communicated about HIV prevention with their 10–18 year old children. METHODS Interviews with 76 mothers and fathers were analyzed for (1) their experiences discussing HIV prevention with adolescents, and (2) advice on how to best broach HIV-related topics. RESULTS Interactive conversations, where both parents and adolescents participated, were regarded as effective. Parents emphasized that adolescents should have a “voice” (be able to voice their concerns) and a “choice” (have a variety of effective prevention strategies to choose from) during HIV-related talks. DISCUSSION A five step process for interactive communication emerged as a result of these discussions. IMPLICATIONS Health care professionals can facilitate adolescent sexual health by encouraging parents to actively involve their children in discussions about HIV prevention. CONCLUSION Future HIV prevention programs could benefit by providing parents with appropriate tools to foster interactive discussions about sexual health with adolescents. PMID:24683366

  8. Social justice and HIV vaccine research in the age of pre-exposure prophylaxis and treatment as prevention.

    PubMed

    Bailey, Theodore C; Sugarman, Jeremy

    2013-09-01

    The advent of pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) as means of HIV prevention raises issues of justice concerning how most fairly and equitably to apportion resources in support of the burgeoning variety of established HIV treatment and prevention measures and further HIV research, including HIV vaccine research. We apply contemporary approaches to social justice to assess the ethical justification for allocating resources in support of HIV vaccine research given competing priorities to support broad implementation of HIV treatment and prevention measures, including TasP and PrEP. We argue that there is prima facie reason to believe that a safe and effective preventive HIV vaccine would offer a distinct set of ethically significant benefits not provided by current HIV treatment or prevention methods. It is thereby possible to justify continued support for HIV vaccine research despite tension with priorities for treatment, prevention, and other research. We then consider a counter-argument to such a justification based on the uncertainty of successfully developing a safe and effective preventive HIV vaccine. Finally, we discuss how HIV vaccine research might now be ethically designed and conducted given the new preventive options of TasP and PrEP, focusing on the ethically appropriate standard of prevention for HIV vaccine trials. PMID:24033297

  9. Defining, Designing, Implementing, and Evaluating Phase 4 HIV Prevention Effectiveness Trials for Vulnerable Populations

    PubMed Central

    Kelly, Jeffrey A.; Spielberg, Freya; McAuliffe, Timothy L.

    2008-01-01

    Summary The efficacy of behavioral HIV prevention interventions has been convincingly demonstrated in a large number of randomized controlled phase 3 research outcome trials. Little research attention has been directed toward studying the effectiveness of the same interventions when delivered by providers to their own clients or community members, however. This article argues for the need to conduct phase 4 effectiveness trials of HIV prevention interventions that have been found efficacious in the research arena. Such trials can provide important information concerning the impact of interventions when applied in heterogeneous “real-world” circumstances. This article raises design issues and methodologic questions that need to be addressed in the conduct of phase 4 trials of behavioral interventions. These issues include the selection and training of service providers engaged in such trials, maintenance of fidelity to intervention protocol in provider-delivered interventions, determination of intervention core elements versus aspects that require tailoring, selection of relevant phase 4 study outcomes, interpretation of findings indicative of field effectiveness, sustainability, and other aspects of phase 4 trial design. PMID:18301131

  10. Enhancing HIV Prevention Among Young Men Who Have Sex With Men: A Systematic Review of HIV Behavioral Interventions for Young Gay and Bisexual Men.

    PubMed

    Hergenrather, Kenneth C; Emmanuel, Diona; Durant, Sarah; Rhodes, Scott D

    2016-06-01

    Men who have sex with men (MSM) represent 64.0% of people living with HIV (PLWH) over the age of 13 years. Young men who have sex with men (YMSM) are particularly affected by HIV/AIDS; the rate of HIV infection for YMSM between the ages of 13 and 24 represents 72.0% of new infections among youth. To understand the current state of the science meant to prevent HIV for YMSM, we reviewed studies of HIV behavioral prevention interventions for YMSM. Five literature databases were searched, from their inception through October 2015, using key words associated with HIV prevention intervention evaluation studies for YMSM. The review criteria included behavioral HIV/AIDS prevention interventions, articles published in English-language peer-reviewed journals, YMSM between 13 and 24 years of age, and longitudinal repeated measures design. A total of 15 YMSM behavioral HIV prevention intervention studies were identified that met inclusion criteria and reported statistically significant findings. Common outcomes included unprotected sexual intercourse, HIV/AIDS risk behavior, condom use, HIV testing, safer sex attitude, and HIV prevention communication. Participant age, representation of Black/African American YMSM, application of theoretical and model underpinnings, congruence of assessment measures used, follow-up assessment times, and application of process evaluation were inconsistent across studies. To advance HIV prevention intervention research for YMSM, future studies should be theory-based, identify common constructs, utilize standard measures, include process evaluation, and evaluate sustained change over standard periods of time. HIV prevention interventions should incorporate the needs of the diverse, well-educated, web-connected millennial generation and differentiate between adolescent YMSM (13 to 18 years of age) and young adulthood YMSM (19 to 24 years of age). Because Black/African American YMSM represent more than 50% of new HIV infections, future HIV

  11. Successes and challenges of HIV prevention in men who have sex with men

    PubMed Central

    Sullivan, Patrick S; Carballo-Diéguez, Alex; Coates, Thomas; Goodreau, Steven M; McGowan, Ian; Sanders, Eduard J; Smith, Adrian; Goswami, Prabuddhagopal; Sanchez, Jorge

    2013-01-01

    Men who have sex with men (MSM) have been substantially affected by HIV epidemics worldwide. Epidemics in MSM are re-emerging in many high-income countries and gaining greater recognition in many low-income and middle-income countries. Better HIV prevention strategies are urgently needed. Our review of HIV prevention strategies for MSM identified several important themes. At the beginning of the epidemic, stand-alone behavioural interventions mostly aimed to reduce unprotected anal intercourse, which, although somewhat efficacious, did not reduce HIV transmission. Biomedical prevention strategies reduce the incidence of HIV infection. Delivery of barrier and biomedical interventions with coordinated behavioural and structural strategies could optimise the effectiveness of prevention. Modelling suggests that, with sufficient coverage, available interventions are sufficient to avert at least a quarter of new HIV infections in MSM in diverse countries. Scale-up of HIV prevention programmes for MSM is difficult because of homophobia and bias, suboptimum access to HIV testing and care, and financial constraints. PMID:22819659

  12. Tenofovir-based Oral PrEP Prevents HIV Infection among Women

    PubMed Central

    Thomson, Kerry A.; Baeten, Jared M.; Mugo, Nelly R.; Bekker, Linda-Gail; Celum, Connie L.; Heffron, Renee

    2016-01-01

    Purpose of review Despite tremendous promise as a female-controlled HIV prevention strategy, implementation of pre-exposure prophylaxis (PrEP) among women has been limited, in part because of disparate efficacy results from randomized trials in this population. This review synthesizes existing evidence regarding PrEP efficacy for preventing HIV infection in women and considerations for delivering PrEP to women. Recent findings In three efficacy trials, conducted among men and women, tenofovir-based oral PrEP reduced HIV acquisition in subgroups of women by 49–79% in intent-to-treat analyses, and by >85% when accounting for PrEP adherence. Two trials did not demonstrate an HIV prevention benefit from PrEP in women, but substantial evidence indicates those results were compromised by very low adherence to the study medication. Qualitative research has identified risk perception, stigma, and aspects of clinical trial participation as influencing adherence to study medication. Pharmacokinetic studies provide supporting evidence that PrEP offers HIV protection in women who are adherent to the medication. Summary Tenofovir-based daily oral PrEP prevents HIV acquisition in women. Offering PrEP as an HIV prevention option for women at high risk of HIV acquisition is a public health imperative and opportunities to evaluate implementation strategies for PrEP for women are needed. PMID:26417954

  13. Towards a Comprehensive Approach to HIV Prevention for People who use Drugs

    PubMed Central

    Marshall, Brandon DL; Wood, Evan

    2010-01-01

    Comprehensive HIV prevention interventions are increasingly recognized as critical in the global effort to reduce HIV transmission among people who use injection drugs (IDU). Scientific evidence clearly shows that a variety of biomedical, behavioral and structural interventions can prevent and reduce IDU-driven HIV epidemics, yet social and structural barriers to their implementation remain. This review discusses the scientific evidence on the effectiveness of individual programs for reducing HIV incidence among IDU and how, by integrating individual programs as complements within a comprehensive HIV prevention approach, it is possible to achieve, and to sustain, greater results than those of individual programs alone. The paper concludes with a discussion of a critical research priority; namely, to improve the implementation of comprehensive HIV prevention interventions in settings of prevalent injection drug use, and to overcome the often complex barriers that impede them. Such an effort will require more than research alone, however. It will also require the ongoing commitment of policy makers, public health officials, and the affected communities themselves to employ comprehensive HIV treatment and prevention as the most effective strategy to reduce new HIV infections. PMID:21045595

  14. Macro-Level Approaches to HIV Prevention Among Ethnic Minority Youth

    PubMed Central

    Prado, Guillermo; Lightfoot, Marguerita; Brown, C. Hendricks

    2013-01-01

    The HIV epidemic continues to disproportionately affect ethnic minority youth. These disconcerting health disparities indicate that although existing HIV preventive strategies for ethnic minority youth have been efficacious, they have not significantly reduced the impact of the epidemic in this population. Macro-level interventions, such as structural or policy interventions, have the potential to impact the HIV epidemic at a population level, and thus reduce the HIV health disparities that exist among ethnic minority youth and other segments of the U.S. population. This article calls for a paradigm shift to develop, evaluate, and disseminate interventions that target upstream/macro-level factors or that, at a minimum, integrate both a macro and individual level perspective. The article also discusses the challenges in developing and evaluating such interventions. Psychologists and other behavioral scientists can play a critical role in reducing the impact of HIV on ethnic minority youth by integrating macro-level approaches to future HIV prevention strategies. PMID:23688095

  15. Prevention Needs of HIV-Positive Men and Women Awaiting Release from Prison

    PubMed Central

    Thibodeau, Laura; BlueSpruce, June; Yard, Samantha S.; Seal, David W.; Amico, K. Rivet; Bogart, Laura M.; Mahoney, Christine; Balderson, Benjamin H. K.; Sosman, James M.

    2011-01-01

    Greater understanding of barriers to risk reduction among incarcerated HIV+ persons reentering the community is needed to inform culturally tailored interventions. This qualitative study elicited HIV prevention-related information, motivation and behavioral skills (IMB) needs of 30 incarcerated HIV+ men and women awaiting release from state prison. Unmet information needs included risk questions about viral loads, positive sexual partners, and transmission through casual contact. Social motivational barriers to risk reduction included partner perceptions that prison release increases sexual desirability, partners’ negative condom attitudes, and HIV disclosure-related fears of rejection. Personal motivational barriers included depression and strong desires for sex or substance use upon release. Behavioral skills needs included initiating safer behaviors with partners with whom condoms had not been used prior to incarceration, disclosing HIV status, and acquiring clean needles or condoms upon release. Stigma and privacy concerns were prominent prison context barriers to delivering HIV prevention services during incarceration. PMID:21553252

  16. Topical application of entry inhibitors as "virustats" to prevent sexual transmission of HIV infection

    PubMed Central

    Lederman, Michael M; Jump, Robin; Pilch-Cooper, Heather A; Root, Michael; Sieg, Scott F

    2008-01-01

    With the continuing march of the AIDS epidemic and little hope for an effective vaccine in the near future, work to develop a topical strategy to prevent HIV infection is increasingly important. This stated, the track record of large scale "microbicide" trials has been disappointing with nonspecific inhibitors either failing to protect women from infection or even increasing HIV acquisition. Newer strategies that target directly the elements needed for viral entry into cells have shown promise in non-human primate models of HIV transmission and as these agents have not yet been broadly introduced in regions of highest HIV prevalence, they are particularly attractive for prophylaxis. We review here the agents that can block HIV cellular entry and that show promise as topical strategies or "virustats" to prevent mucosal transmission of HIV infection PMID:19094217

  17. HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes

    PubMed Central

    Delva, Wim; Eaton, Jeffrey W.; Meng, Fei; Fraser, Christophe; White, Richard G.; Vickerman, Peter; Boily, Marie-Claude; Hallett, Timothy B.

    2012-01-01

    Until now, decisions about how to allocate ART have largely been based on maximising the therapeutic benefit of ART for patients. Since the results of the HPTN 052 study showed efficacy of antiretroviral therapy (ART) in preventing HIV transmission, there has been increased interest in the benefits of ART not only as treatment, but also in prevention. Resources for expanding ART in the short term may be limited, so the question is how to generate the most prevention benefit from realistic potential increases in the availability of ART. Although not a formal systematic review, here we review different ways in which access to ART could be expanded by prioritising access to particular groups based on clinical or behavioural factors. For each group we consider (i) the clinical and epidemiological benefits, (ii) the potential feasibility, acceptability, and equity, and (iii) the affordability and cost-effectiveness of prioritising ART access for that group. In re-evaluating the allocation of ART in light of the new data about ART preventing transmission, the goal should be to create policies that maximise epidemiological and clinical benefit while still being feasible, affordable, acceptable, and equitable. PMID:22802738

  18. The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention

    PubMed Central

    Cáceres, Carlos F; Koechlin, Florence; Goicochea, Pedro; Sow, Papa-Salif; O'Reilly, Kevin R; Mayer, Kenneth H; Godfrey-Faussett, Peter

    2015-01-01

    Introduction Towards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework. Discussion After a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in real-life settings due to stigma, cost, adherence, and potential risk compensation barriers. Conclusions The strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV

  19. Role of STD Detection and Treatment in HIV Prevention

    MedlinePlus

    ... on Facebook Sexually Transmitted Diseases (STDs) STDs and HIV – CDC Fact Sheet Language: English Español (Spanish) Recommend ... who have STDs are more likely to get HIV, when compared to people who do not have ...

  20. Protocol for a Controlled Experiment to Identify the Causal Role of Acute Alcohol Consumption in Condomless Sex among HIV-Positive MSM: Study Procedures, Ethical Considerations, and Implications for HIV Prevention.

    PubMed

    Shuper, Paul A; Joharchi, Narges; Rehm, Jürgen

    2016-01-01

    Although alcohol consumption is frequently perceived as a driver of condomless sex and subsequent HIV acquisition, the causal nature of this relationship remains unclear, and little is known about alcohol's direct versus indirect impact on the sexual risk dynamics of those who are HIV-positive. To address this gap, we present the protocol for an in-progress NIAAA-funded controlled experiment, wherein a sample of HIV-positive men-who-have-sex-with-men (MSM) undergoes an alcohol consumption manipulation (alcohol/placebo/control) and sexual arousal induction (sexually aroused/non-aroused), and then reports intentions to engage in condom-protected and condomless sexual acts with hypothetical sexual partners differing in HIV serostatus (HIV+/HIV-/HIV status unknown), condom use preference (use/don't use/not stated), and physical attractiveness (attractive/unattractive). Study outcomes will identify alcohol's impact on HIV-positive MSM's condomless sex intentions in the context of experimentally-manipulated factors as well as risk-relevant personality traits and alcohol-related expectancies. Detailed experimental procedures, ethical considerations, and potential implications for HIV prevention are discussed. PMID:26163147

  1. Novel Nanotechnology Strategies for the Treatment and Prevention of HIV Infection

    NASA Astrophysics Data System (ADS)

    Tan, Jian Jun; Sun, Xiao Hui; Ma, Xue Ting; Guan, Jian Qing; Wang, Cun Xin

    2013-09-01

    It is a hard work to develop an hightly effective cure and prevention of HIV/AIDS. The widespread used of some therapy approaches such as highly active anti retroviral therapy (HAART) has improved life quality and span of infected individuals. However, some limitations of these approaches prevent them achieving further advancement. Recent research on drug delivery approaches indicates that engineered nanosystems may bring positive effect on the improvement of current antiretroviral therapy. Furthermore, the basic researches of nanotechnology- based systems which prevent HIV transmission have been started. Therefore, nanotechnology may become a potential approach in the field of HIV/AIDS treatment and prevention. This chapter reviews the latest advancement in the field of nanotechnology-based systems which improve the fields of HIV/AIDS treatment and prevention.

  2. Public health and church-based constructions of HIV prevention: black Baptist perspective.

    PubMed

    Roman Isler, Malika; Eng, Eugenia; Maman, Susanne; Adimora, Adaora; Weiner, Bryan

    2014-06-01

    The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social construction of HIV prevention within black Baptist churches in North Carolina. Data collection included interviews with church leaders (n = 12) and focus groups with congregants (n = 7; 36 participants). Analytic tools included open coding and case-level comparisons. Social constructions of HIV/AIDS prevention were influenced by two worldviews: public health and church-based. Areas of compatibility and incompatibility exist between the two worldviews that inform acceptability and adaptability of current evidence-based strategies. These findings offer insight into ways to increase the compatibility of evidence-based HIV prevention strategies within the black Baptist church context. PMID:24643141

  3. Identification of structural interventions for HIV/AIDS prevention: the concept mapping exercise.

    PubMed

    Abdul-Quader, Abu S; Collins, Charles

    2011-01-01

    Structural interventions have been defined as those prevention interventions that include physical, social, cultural, organizational, community, economic, legal, and policy factors. In an effort to examine the feasibility, evaluability, and sustainability of structural interventions for HIV prevention, the Centers for Disease Control and Prevention implemented a project that involved asking experts in HIV prevention and other areas of public health-including injury and violence prevention, tobacco control, drug abuse, and nutrition-to provide input on the identification of structural interventions based on the aforementioned definition. The process resulted in a list of 123 interventions that met the definition. The experts were asked to group these interventions into categories based on similarity of ideas. They were also asked to rate these interventions in terms of impact they would have, if implemented, on reducing HIV transmission. The findings highlight the need for conducting further research on structural interventions, including feasibility of implementation and effectiveness of reducing HIV transmission risks. PMID:22043093

  4. Behavioral Interventions to Prevent HIV Transmission and Acquisition for Transgender Women: A Critical Review

    PubMed Central

    Kuhns, Lisa M.; Reisner, Sari L.; Mimiaga, Matthew J.

    2016-01-01

    Abstract: Worldwide, transgender women are at disproportionately higher risk of HIV infection, with the primary mode of infection being condomless anal intercourse. Although very few HIV prevention interventions have been developed and tested specifically for transgender women, growing evidence suggests that behavioral HIV risk reduction interventions for other marginalized groups are efficacious. We outline the current state of knowledge and areas in need of further development in this area. PMID:27429186

  5. Oral preexposure prophylaxis to prevent HIV infection: clinical and public health implications.

    PubMed

    Baker, Jonathan; OʼHara, Kevin Michael

    2014-12-01

    This article reviews the use of combination emtricitabine (FTC)/tenofovir as preexposure prophylaxis (PrEP) for HIV-negative patients at high risk of acquiring HIV, including heterosexual men and women, men who have sex with men, and IV drug users. When used with classic prevention strategies such as condoms, PrEP has been found effective in reducing the risk of HIV transmission. PMID:25390822

  6. Behavioral Interventions to Prevent HIV Transmission and Acquisition for Transgender Women: A Critical Review.

    PubMed

    Garofalo, Robert; Kuhns, Lisa M; Reisner, Sari L; Mimiaga, Matthew J

    2016-08-15

    Worldwide, transgender women are at disproportionately higher risk of HIV infection, with the primary mode of infection being condomless anal intercourse. Although very few HIV prevention interventions have been developed and tested specifically for transgender women, growing evidence suggests that behavioral HIV risk reduction interventions for other marginalized groups are efficacious. We outline the current state of knowledge and areas in need of further development in this area. PMID:27429186

  7. HIV-infected men who have sex with men who engage in very high levels of transmission risk behaviors: establishing a context for novel prevention interventions.

    PubMed

    Wade Taylor, S; O'Cleirigh, Conall; Mayer, Kenneth H; Safren, Steven A

    2013-01-01

    Men who have sex with men (MSM) comprise the largest risk group of individuals living with HIV in the USA and have the highest rates of new infections. A minority of HIV-infected MSM engage in unprotected anal intercourse after learning about their infection, potentially transmitting the virus to others. The current study sought to generate self-generated descriptive themes, from a group of HIV-infected MSM who reported high rates of sexual transmission risk behavior that may be relevant for understanding sexual risk in this group. Five descriptive themes emerged during content analysis: (a) serostatus attribution, (b) assumption of sexual partner's responsibility for safer sex, (c) sexual sensation seeking, (d) ongoing substance use, and (e) dissatisfaction with current relationships. Traditional HIV transmission risk reduction interventions that have been known to have only modest effects should be augmented by developing HIV prevention strategies for this subgroup of MSM to address these salient themes. PMID:23323526

  8. A quarter-century of HIV prevention intervention efforts among children and adolescents across the globe

    PubMed Central

    Stanton, Bonita; Li, Xiaoming

    2014-01-01

    In 1988 a group of pediatricians, developmental, clinical, child and social psychologists, anthropologists and health educators began researching in Baltimore, Maryland, on an Human Immunodefiency Virus (HIV) prevention intervention, Focus on Youth (FOY). Over the next 25 years, the questions being addressed by FOY reflected those of the global HIV research experience. During the first phase, the questions being addressed by the broader research community included: Can HIV risk behaviors be purposefully impacted by behavioral interventions? If so, how do successful interventions differ from those that are not effective? Are theory-based interventions more likely to be effective than information-only-based interventions? Can theories be translated into culturally and developmentally appropriate interventions including those that are appropriate for children and adolescents? Should parents be involved – and if so, how? During its next phase, the FOY team increasingly became concerned with a disturbing reality. A large number of interventions had been developed and some had been shown to have evidence of impact. But virtually all of these interventions had been conducted in the USA or Europe. The questions facing researchers included: With the global burden of HIV disproportionately impacting low- and middle-income countries (LMIC), especially those in southern Africa, the Caribbean and parts of Asia, what is known about the effectiveness of western-based interventions in these culturally, racially and economically disparate settings? With the exciting proliferation of interventions, federal agencies in the USA and international agencies including Joint United Nations Programme on HIV/AIDS realized the importance of assessing the research portfolio and developing metrics of effectiveness. The questions during this phase included: What is an “effective” intervention? How are effective interventions implemented in a new setting? This phase merged with the next

  9. An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men

    PubMed Central

    2014-01-01

    with information to help prevent transmission of HIV and to address increasing motivation and changing norms towards precautionary behaviours. However, the limitations of mass media in imparting skills in effecting behaviour change should be recognised, and campaigns supplemented by additional components may be better-suited to achieving these goals. PMID:24939013

  10. HIV Treatment as Prevention: Models, Data, and Questions—Towards Evidence-Based Decision-Making

    PubMed Central

    2012-01-01

    Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different aspects of HIV treatment as prevention with a forward-looking research agenda. Interlocking themes across these articles are discussed in this introduction. We hope that this article, and others in the collection, will provide a foundation upon which greater collaborations between disciplines will be formed, and will afford deeper insights into the key factors involved, to help strengthen the support for evidence-based decision-making in HIV prevention. PMID:22802739

  11. A typology of structural approaches to HIV prevention: a commentary on Roberts and Matthews.

    PubMed

    Tsai, Alexander C

    2012-11-01

    Renewed enthusiasm for biomedical HIV prevention strategies has followed the recent publication of several high-profile HIV antiretroviral therapy-based HIV prevention trials. In a recent article, Roberts and Matthews (2012) accurately note some of the shortcomings of these individually targeted approaches to HIV prevention and advocate for increased emphasis on structural interventions that have more fundamental effects on the population distribution of HIV. However, they make some implicit assumptions about the extent to which structural interventions are user-independent and more sustainable than biomedical or behavioral interventions. In this article, I elaborate a simple typology of structural interventions along these two axes and suggest that they may be neither user-independent nor sustainable and therefore subject to the same sustainability concerns, costs, and potential unintended consequences as biomedical and behavioral interventions. PMID:22877933

  12. A dynamic social systems model for considering structural factors in HIV prevention and detection

    PubMed Central

    Latkin, Carl; Weeks, Margaret; Glasman, Laura; Galletly, Carol; Albarracin, Dolores

    2010-01-01

    We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection. PMID:20838871

  13. Current status of drug use and HIV/AIDS prevention in drug users in China

    PubMed Central

    Li, Jianhua; Li, Xinyue

    2014-01-01

    The objective of this paper is to review the current status of drug use and HIV/AIDS prevention for drug users in China and provide scientific evidence for HIV/AIDS prevention and control in drug users. Literature and articles related to drug abuse in China, as well as the results of prevention efforts and successful cases regarding HIV/AIDS prevention in drug users, are reviewed. Lessons learned are drawn out for the future improvement of work and the sustainable development of treatment programs. The number of drug users in China is increasing. Even though the number of opioid-type drug users is growing more slowly than in the past, the number of amphetamine-type stimulant users has increased sharply. It has been proven that methadone maintenance treatment and syringe exchange programs gradually and successfully control HIV/AIDS transmission in drug users. However, it is necessary to enhance these prevention methods and expand their coverage. In addition, the strengthening of antiretroviral therapy (ART) treatment for HIV-infected drug users is crucial for HIV/AIDS prevention and control. The rapidly growing number of amphetamine-type stimulant users, along with their high-risk behavior, poses a hidden danger of greater HIV/AIDS transmission through sexual intercourse in the near future. PMID:25284965

  14. Epistemic fault lines in biomedical and social approaches to HIV prevention

    PubMed Central

    2011-01-01

    This paper raises the question of how knowledge creation is organized in the area of HIV prevention and how this concatenation of expertise, resources, at-risk people and viruses shapes the knowledge used to impede the epidemic. It also seeks to trouble the discourses of biomedical pre-eminence in the field of HIV prevention by examining the claim for treatment as prevention, looking at evidence constructed through the biomedical frame and through the lens of the sociology of science. These questions lie within a larger socio-historical context of lagging worldwide attention and funding to prevention in the HIV area and, in particular, neglect of populations at greatest risk. Much contemporary HIV prevention research relies on a population science divided over an epistemic fault line from the communities and individuals who must make sense of the intrusion of a life-threatening disease into their pursuit of pleasure and intimacy. There are, nevertheless, lessons to be learned from prevention success stories among sex workers, injection drug users, and gay and bisexual men. The success stories point to a need for a robust social science agenda that examines: the ways that people are socially organized and networked; the popular strategies and folk wisdoms developed in the face of HIV risk; socio-historical movement of sexual and drug cultures; the dynamics of popular mobilization to advance health; the institutional sources of HIV discourses; and popular understandings of HIV technologies and messages. PMID:21968038

  15. The Solaar HIV Prevention Program for Gay and Bisexual Latino Men: Using Social Marketing to Build Capacity for Service Provision and Evaluation

    ERIC Educational Resources Information Center

    Conner, Ross F.; Takahashi, Lois; Ortiz, Eloy; Archuleta, Eduardo; Muniz, Juan; Rodriguez, Julio

    2005-01-01

    Community-researcher partnerships can be powerful mechanisms to understand and effectively address health and social problems such as HIV/AIDS prevention. When the partnership is a positive, productive one, the combined expertise and energy of both parties result in a more effective program and a better evaluation of its effects. This article…

  16. Factors that influence utilisation of HIV/AIDS prevention methods among university students residing at a selected university campus.

    PubMed

    Ndabarora, Eléazar; Mchunu, Gugu

    2014-01-01

    Various studies have reported that university students, who are mostly young people, rarely use existing HIV/AIDS preventive methods. Although studies have shown that young university students have a high degree of knowledge about HIV/AIDS and HIV modes of transmission, they are still not utilising the existing HIV prevention methods and still engage in risky sexual practices favourable to HIV. Some variables, such as awareness of existing HIV/AIDS prevention methods, have been associated with utilisation of such methods. The study aimed to explore factors that influence use of existing HIV/AIDS prevention methods among university students residing in a selected campus, using the Health Belief Model (HBM) as a theoretical framework. A quantitative research approach and an exploratory-descriptive design were used to describe perceived factors that influence utilisation by university students of HIV/AIDS prevention methods. A total of 335 students completed online and manual questionnaires. Study findings showed that the factors which influenced utilisation of HIV/AIDS prevention methods were mainly determined by awareness of the existing university-based HIV/AIDS prevention strategies. Most utilised prevention methods were voluntary counselling and testing services and free condoms. Perceived susceptibility and perceived threat of HIV/AIDS score was also found to correlate with HIV risk index score. Perceived susceptibility and perceived threat of HIV/AIDS showed correlation with self-efficacy on condoms and their utilisation. Most HBM variables were not predictors of utilisation of HIV/AIDS prevention methods among students. Intervention aiming to improve the utilisation of HIV/AIDS prevention methods among students at the selected university should focus on removing identified barriers, promoting HIV/AIDS prevention services and providing appropriate resources to implement such programmes. PMID:25444096

  17. Condoms for the prevention of HIV transmission: cultural dimensions.

    PubMed

    Potts, M; Short, R V

    1989-01-01

    Humans being fundamentally polygamous, condoms should be recognized and promoted as central to an integrated approach for family planning, HIV prevention, and the control of sexually transmitted diseases. They must be more widely and effectively distributed and promoted in both more developed and developing nations. Available data on the ability of condoms to stem the transmission of HIV are limited, yet nonetheless indicative of condoms' general protective effect. Comparatively high prevalence and use of condoms are, however, found only in Japan, Sweden, Finland, Denmark, Singapore, and Trinidad and Tobago. Use in the U.S. is under that of a generation ago, while only extremely low levels are found throughout most of Africa, Asia, and South America. The industrialized nations of the West are most readily in the position of affording increased condom prevalence and use through increased manufacturing capacity and intensified promotion of moderate behavioral change among users. The nations of the 3rd World, however, lack the monetary and logistical resources to finance a rapid increase in condom prevalence, and are demanded to focus their energies more than ever where they are most needed, and expected to produce most significant impact. Up to $1 billion/year would be needed from donor agencies to meet universal need for condoms in Africa alone. Simple and cheap though condoms may be, such cost is too high to bear. The use of social marketing is therefore endorsed to target high-risk groups of populations as a means of maximizing resources for greatest potential impact. NGOs will play a major role in condom distribution, and should expect to work with, instead of through, ministries of health. PMID:2514745

  18. 'Conceiving kothis': men who have sex with men in India and the cultural subject of HIV prevention.

    PubMed

    Boyce, Paul

    2007-01-01

    HIV prevention with men who have sex with men in India has, in large part, been premised on the reification of "cultural categories"--kothi being among the most popularized terms in this context, broadly designating men who have a feminine sense of self and who enact "passive" sexual roles. Countering prevailing research trends, this article explores ways in which local, national, and global processes inform contemporary kothi sexual subjectivities--disrupting simplistic perspectives on the cultural coherence of the category. Derivative uses of anthropological knowledge in public health and activist milieux are seen to have propounded limited representations of men who have sex with men in India. Drawing on ethnographic research in Calcutta, conceptualization of time in ethnography is examined and a critique of positivist epistemologies is put forward as a basis for advancing more conceptually cogent and effective HIV prevention research and programming strategies, especially those that aim to address sexuality between men. PMID:17469015

  19. HIV prevention service utilization in the Los Angeles House and Ball communities: past experiences and recommendations for the future.

    PubMed

    Holloway, Ian W; Traube, Dorian E; Kubicek, Katrina; Supan, Jocelyn; Weiss, George; Kipke, Michele D

    2012-10-01

    African-American young men who have sex with men and transgender persons are at elevated risk for HIV infection. House and Ball communities, networks of mostly African-American gay, bisexual, and transgender individuals who compete in modeling and dance, represent a prime venue for HIV prevention with these difficult-to-reach populations; however, little research exists on effective approaches to HIV prevention within these communities. Using a mixed-methods approach, the present study sought to document participation in HIV prevention activities of a sample from the Los Angeles House and Ball communities (n = 263) in order to inform future service development. While 80% of participants were tested for HIV within the past 6 months, only 26% report HIV preven