Central Asia has experienced a rapid increase in HIV. HIV interventions and prevention programmes are needed that adequately appreciate and account for the ways that ongoing cultural, political and economic changes in this region affect HIV risk reduction efforts. Drawing on relevant literature, this paper provides a contextual foundation to better understand the impact of context on HIV risk behaviour in the countries of Central Asia and to begin the conversation on the contextual factors of Islam and polygamy.
Clifton, Soazig; Nardone, Anthony; Field, Nigel; Mercer, Catherine H.; Tanton, Clare; Macdowall, Wendy; Johnson, Anne M.; Sonnenberg, Pam
Objective: To examine the relationship between HIV risk behaviour, risk perception and testing in Britain. Design: A probability sample survey of the British population. Methods: We analyzed data on sexual behaviour, self-perceived HIV risk and HIV testing (excluding testing because of blood donation) from 13 751 sexually experienced men and women aged 16–74, interviewed between 2010 and 2012 using computer-assisted face-to-face and self-interviewing. Results: Altogether, 3.5% of men and 5.4% of women reported having an HIV test in the past year. Higher perceived risk of HIV was associated with sexual risk behaviours and with HIV testing. However, the majority of those rating themselves as ‘greatly’ or ‘quite a lot’ at risk of HIV (3.4% of men, 2.5% of women) had not tested in the past year. This was also found among the groups most affected by HIV: MSM and black Africans. Within these groups, the majority reporting sexual risk behaviours did not perceive themselves as at risk and had not tested for HIV. Overall, 29.6% of men and 39.9% of women who tested for HIV in the past year could be classified as low risk across a range of measures. Conclusion: Most people who perceive themselves as at risk of HIV have not recently tested, including among MSM and black Africans. Many people tested in Britain are at low risk, reflecting current policy that aims to normalize testing. Strategies to further improve uptake of testing are needed, particularly in those at greatest risk, to further reduce undiagnosed HIV infection at late diagnoses. PMID:26963528
Thanh, Duong Cong; Hien, Nguyen Tran; Tuan, Nguyen Anh; Thang, Bui Duc; Long, Nguyen Thanh; Fylkesnes, Knut
There is a potentially high risk of HIV spreading from people living with HIV/AIDS. We conducted a cross-sectional study to examine HIV risk behaviours and their determinants among people living with HIV/AIDS. Eighty-two percent had been sexually active. Sex with multiple partners was reported by 20% and consistent condom use by about one third. More than half of the participants (52%) reported having injected drugs during the previous month, and 35% of those had shared needles and syringes. Voluntary HIV testing and having received condoms or injection equipment from the local HIV prevention program, were found to be significantly associated with fewer HIV risk behaviours. Having learned recently about personal HIV status, multiple sex partners, low educational attainment and young age were found to be associated with higher HIV risk behaviours. Giving high priority to targeted preventive and support programmes is likely to be a highly cost-effective strategy.
Dolan, Kate; Larney, Sarah
Background & Objectives: HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Methods: Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered prison management and population statistics, general conditions in prisons, provision of general medical care and the HIV situation in prison. Results: No data on drug injection in prison were identified. Sex between men was reported to be common in some Indian prisons. A national study found that 1.7 per cent of inmates were HIV positive. Some prisons provided HIV education. Condom provision was considered illegal. A few prisoners received drug treatment for drug use, HIV infection or co-infection with sexually transmitted infections (STIs). Interpretation & conclusions: HIV prevalence in prisons in India was higher than that in the general community. Regular monitoring of information on HIV risk behaviours and prevalence in Indian prisons is strongly recommended. Evidence based treatment for drug injectors and nation-wide provision of HIV prevention strategies are urgently required. Voluntary counselling, testing and treatment for HIV and STIs should be provided. PMID:21245617
Taylor, Tory M.; Hembling, John; Bertrand, Jane T.
Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes. PMID:24834462
Gibney, L; Choudhury, P; Khawaja, Z; Sarker, M; Vermund, SH
Summary A review of published and unpublished data indicates the prevalence of high-risk behaviours for HIV transmission in segments of the Bangladeshi population. These include casual unprotected sex, heterosexual as well as between males, prior to and after marriage. Intravenous drug use (IVDU) exists though illicit drugs are more commonly inhaled. There is a fear, however, that inhalers may turn to injecting drugs, as is common in neighbouring countries. The lack of public awareness of HIV/AIDS, and misconceptions about the disease, may contribute to continued high-risk behaviours by segments of the population and, thus, to the spread of HIV. Bangladesh’s proximity to India and Myanmar (countries with high HIV endemicity and a rapidly growing number of cases) increases fears of an epidemic in Bangladesh. This proximity will only be a risk factor, however, if high-risk contacts occur between nationals of these countries. PMID:10340200
Ankunda, Racheal; Atuyambe, Lynn Muhimbuura; Kiwanuka, Noah
Introduction As young people living with HIV grow their sexual behaviour and it's implication on HIV prevention is of concern. This study describes the sexual risk related-behaviours and factors associated with abstinence among Youth Living with HIV in central Uganda. Methods We conducted a cross-sectional study among 338 unmarried youth between 15 and 24 years accessing HIV care in central Uganda. Data was collected using interviewer administered structured questionnaires. Adjusted prevalence proportion ratios (adj. PPRs) of factors associated with sexual abstinence for at least six months were determined by multivariable log-binomial regression. Results Overall, 79% (269/338) of respondents were abstaining from sexual intercourse for atleast six months, although, 45% (150/338) had ever been sexually active. Of the 283 respondents who desired to get married in future, 40% preferred negative marriage partners. Only 31% (39/126) of respondents in boy/girl relationships had disclosed their HIV status to their partners. Among those currently sexually active (n = 69), 57% did not consistently use condoms and 30% had more than one sexual partner in the past six months. The adj.PRR of abstinence was higher among youth between 15 and 19 years compared to those between 20 and 24 years (adj. PPR = 1.26, 95% CI; 1.08-1.46). The prevalence of abstinence was significantly lower among respondent who consumed alcohol (adj. PPR = 0.31, 95% CI 0.16-0.61). Conclusion Tailored interventions promoting disclosure, consistent condoms use and discouraging alcohol consumption among sero-positive youth could reduce HIV transmission risk. PMID:27642390
Noor, Syed W B; Ross, Michael W; Lai, Dejian; Risser, Jan M
This study examines the association between drug and sexual HIV risk behaviours and knowledge of HIV serostatus among a sample of injection drug users, recruited into the 2009 National HIV Behavioral Surveillance project. We calculated prevalence ratios and associated 95% confidence intervals of reporting a given risk behaviour comparing injection drug users unaware of their serostatus and HIV-negative to HIV-positive injection drug users. Of 523 participants, 21% were unaware of their HIV serostatus. The three groups were not different from each other in terms of drug-use behaviours; however, injection drug users unaware of their HIV serostatus were 33% more likely to report having more than three sexual partners in the past 12 months and 45% more likely to report having unprotected sex compared to HIV-positive injection drug users. We observed markedly higher prevalence of sexual risk behaviours among injection drug users unaware of their serostatus, but drug-use risk behaviours were similar across the groups.
Levina, Olga S.; Osipenko, Victoria; Ruiz, Monica S.; Sergeyev, Boris; Sirotkin, Aleksander V.; Vyshemirskaya, Inna
Background: The Russian human immunodeficiency virus (HIV) epidemic among people who inject drugs (PWID) originated in Kaliningrad, but research into risk behaviours among PWID has been lacking. The potential for heterosexual spread has not been analysed. Methods: A sample of PWID was accrued using two methods. A questionnaire was administered to assess HIV-related risk behaviours for parenteral and sexual transmission, sociodemographic factors, HIV knowledge and attitudes about sexual risks. Data were analysed focusing on the role of imprisonment, factors associated with awareness of being HIV infected and condom use. Results: More than a quarter of the sample reported having been diagnosed with HIV infection, with higher prevalence among women and those with a history of incarceration. More than half reported having been diagnosed with hepatitis C virus infection. Those reporting being HIV positive were less likely to distribute used syringes to other PWID and more likely to have used a condom the last time they had sex. A history of incarceration was associated with higher rates of receptive syringe sharing among those not having ever received an HIV-positive diagnosis and a lower likelihood of believing that condoms are needed when having sex with a casual partner. Conclusion: Although extensive HIV testing has alerted many PWID to their HIV-positive status, which is associated with less distributive syringe sharing and higher likelihood of condom use, substantial risk for parenteral and especially sexual HIV transmission remains. More active prevention programs will be required to control the heterosexual spread of HIV. PMID:26381650
Chariyeva, Z; Colaco, R; Maman, S
This paper describes HIV risk behaviour patterns among street- and bar-based female sex workers in the Turkmenistan cities of Ashgabat and Mary. Street-based sex workers had little to no knowledge of HIV and primarily used condoms when condom use was initiated by clients. Bar-based sex workers had HIV knowledge and reported regularly using condoms mainly with first-time clients. While sex workers perceived themselves to be at low risk for acquiring HIV, they were aware of other sexually transmitted infections (STI) and expressed a strong desire for free STI testing and treatment services.
Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar; Merely, Cindy; Welles, Brandi; Pellowski, Jennifer; Kegler, Christopher
Introduction Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI). Objectives To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load). Methods Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load. Results Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners. Conclusions Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART. PMID:26249127
Thapa, Subash; Bista, Nirmala; Timilsina, Suraj; Buntinx, Frank; Mathei, Catharina
Summary Labour migration has increased the risk of HIV infection among the wives of labour migrants in Nepal. We conducted a matched case-control study to identify the social and behavioural factors for HIV infection among the wives of labour migrants in Nepal. We interviewed 112 wives of labour migrants diagnosed with HIV (cases) and 112 wives of labour migrants testing negative for HIV (controls) and used logistic regression analysis to assess independent factors associated with HIV infection. Literacy status was the only one woman-related social factor associated with HIV infection. Meanwhile literacy status, age when going abroad for the first time and country of migration were the husband-related social factors and alcohol consumption, living alone abroad and having an unpaid partner abroad were the husband-related behavioural factors associated with HIV infection in the wives. Given the husband-related social and behavioural factors are mostly determining the risk of HIV infection in the wives in our study, prevention efforts must incorporate behaviour change approaches targeting specifically to labour migrants and also to their wives.
Helal, H; Momas, I; Prétet, S; Marsal, L; Poinsard, R
This study was designed to analyse sexual and drug use behaviour, to determine whether increased awareness can lead to behaviour change, and to evaluate the association between HIV seropositivity and potential risk factors. A 4-month survey was carried out on 147 IVDUs attending three HIV counselling and testing centres, 98% of whom had been using heroin for an average of 7 years, 85% in association with other drugs. Two-thirds of injectors reported having used "safer" injecting practices in the previous year. Most of the IVDUs were heterosexual, and had had an average of three sexual partners in the previous year. More than half of them had had high risk partners. Condoms were used by only 25% of IVDUs, and were more likely to be used with seropositive partners (38% versus 12.7%, p = 0.02). Patients considering themselves to be well informed about HIV transmission shared syringes significantly less often, but had the same sexual behaviour patterns as other subjects. The HIV prevalence rate (8.2%) in our sample was not statistically related to any risk factor apart from drug use duration, the latter possibly reflecting a cumulative exposure to HIV risks. Since sexual risk appears to be a potential long-term hazard for IVDUs, it is important that more attention be paid to providing counselling to specifically address this issue.
McGrath, Nuala; Eaton, Jeffrey W; Newell, Marie-Louise; Hosegood, Victoria
Summary Background Increased sexual risk behaviour and HIV prevalence have been reported in migrants compared with non-migrants in sub-Saharan Africa. We investigated the association of residential and migration patterns with sexual HIV risk behaviours and HIV prevalence in an open, general population cohort in rural KwaZulu-Natal, South Africa. Methods In a mainly rural demographic surveillance area in northern KwaZulu-Natal, South Africa, we collected longitudinal demographic, migration, sexual behaviour, and HIV status data through household surveillance twice per year and individual surveillance once per year. All resident household members and a sample of non-resident household members (stratified by sex and migration patterns) were eligible for participation. Participants reported sexual risk behaviours, including data for multiple, concurrent, and casual sexual partners and condom use, and gave a dried blood spot sample via fingerprick for HIV testing. We investigated population-level differences in sexual HIV risk behaviours and HIV prevalence with respect to migration indicators using logistic regression models. Findings Between Jan 1, 2005, and Dec 31, 2011, the total eligible population at each surveillance round ranged between 21 129 and 22 726 women (aged 17–49 years) and between 20 399 and 22 100 men (aged 17–54 years). The number of eligible residents in any round ranged from 24 395 to 26 664 and the number of eligible non-residents ranged from 17 002 to 18 891 between rounds. The stratified sample of non-residents included between 2350 and 3366 individuals each year. Sexual risk behaviours were significantly more common in non-residents than in residents for both men and women. Estimated differences in sexual risk behaviours, but not HIV prevalence, varied between the migration indicators: recent migration, mobility, and migration type. HIV prevalence was significantly increased in current residents with a recent history of
Anastario, M; Manzanero, R; Blanco, R; Reyes, E; Jaramillo, R; Black, L; Dann, G E; Leonard, E; Boryc, K; Chun, H
This study is the first Biological and Behavioral Surveillance Survey to be conducted among personnel in the Belize Defense Force. The purpose of the study was to understand the prevalence of HIV infection and risk behaviours, and to identify key correlates of sexual risk behaviours. A representative sample of personnel underwent serological testing and an Audio Computer-Assisted Self Interview. Of those sampled, 351 completed a blood test and 334 completed a behavioural interview. The prevalence of HIV was 1.14%. Twelve percent had ever reported being diagnosed with a sexually transmitted infection (STI) or screened positive for HIV infection. The odds of ever having an STI/HIV were higher among those who had less education, those who had sex with a commercial sex worker (CSW), those who ever engaged in receptive anal sex and those with post-traumatic stress disorder (PTSD). Alcohol abuse and PTSD were prevalent and associated with HIV risk behaviours. These results are being used to inform current prevention efforts.
Woodward, Aniek; Howard, Natasha; Kollie, Sarah; Souare, Yaya; von Roenne, Anna; Borchert, Matthias
A common assumption underpinning health communications design in humanitarian settings is that increasing knowledge and risk perception will lead to appropriate behaviour change. This study compares associations of HIV knowledge and perceived risk with reported HIV-avoidant behaviour changes and sexual health choices from a community survey of 698 sexually experienced male and female Sierra Leonean refugees in Guinea. HIV knowledge was not significantly associated with reported HIV-avoidant changes (OR 1.25; adjusted for gender; 95%CI 0.76-2.04), while perceived HIV risk was negatively associated (OR 0.38, adjusted for age at sexual debut; 95%CI 0.22-0.66). Trying to conceive was the main reason reported for not using condoms or other contraception (28%; 138/498), followed by current pregnancy/lactation (19%; 93/498). Results suggest contextual factors (e.g. desire for children) can be as important as knowledge and risk-perception, and HIV prevention initiatives in stable and chronic humanitarian settings should account for these.
Young, Sean D; Szekeres, Greg; Coates, Thomas
This study explores the feasibility of recruiting minority men who have sex with men Facebook users for human immunodeficiency virus (HIV) prevention studies and notes demographic and sexual risk behaviours. Facebook-registered men who have sex with men (MSM; N = 118) were recruited using online and offline methods. Participants validated Facebook-user status through using a Facebook Connect (computer science) application. Participants were primarily Latino (60.2%) and African-American (28.0%), with 33.1% using social media to find sex partners. Black MSM social networking users reported engaging in a lower frequency (coefficient = -0.48, p < 0.05) of unprotected receptive anal intercourse compared to Latino MSM. Results suggest that minority social media users can be recruited for HIV studies and that sexual risk behavioural differences exist among minority social networking users. Findings highlight the importance of incorporating technologies into population-focused HIV interventions.
Clarke, Amanda; Kerr, Stephen; Honeybrook, Adam; Cooper, David A; Avihingsanon, Anchalee; Duncombe, Chris; Phanuphak, Praphan; Ruxrungtham, Kiat; Ananworanich, Jintanat; Kaldor, John
It could be postulated that due to lifestyle factors, patients with poor antiretroviral therapy (ART) adherence may also have risky sexual behaviour potentially leading to HIV transmission. There are limited data regarding unprotected sex risk and ART adherence in resource limited settings and our study set out to investigate these in an HIV clinic in Bangkok. Patients completed an anonymous questionnaire regarding their relationship details, ART adherence, sexual behaviour, alcohol and drug use and HIV transmission beliefs. Laboratory findings and medical history were also collected. Unprotected sex risk (USR) was defined as inconsistent condom use with a partner of negative or unknown HIV status. Five hundred and twelve patients completed the questionnaire. Fifty seven per cent of patients reported having taken ARV >95% of the time in the last month and 58% had been sexually active in the previous 30 days. Only 27 patients (5%) were classified as having USR in our cohort. Multivariate analysis showed USR was associated with female gender (OR 2.9, 95% CI 1.2-7.0, p0.02) but not with adherence, age, type or number of partners, recreational drug or alcohol use nor beliefs about HIV transmission whilst taking ART. Levels of USR in this resource limited setting were reassuringly low and not associated with poor ART adherence; as all USR patients had undetectable viral loads onward HIV transmission risk is likely to be low but not negligible. Nonetheless condom negotiation techniques, particularly in women, may be useful in this group.
Brooks, R A; Lee, S-J; Stover, G N; Barkley, T W
This study examined HIV testing behaviours, perceived vulnerability to HIV and correlates of sexual risk behaviours of young adult Latino and African American male gang members in Los Angeles, California. Data were collected from 249 gang members aged 18-26 years. The majority (59%) of gang members reported unprotected vaginal intercourse (UVI) in the past 12 months. Only one-third (33.2%) of gang members had ever been tested for HIV. In our multivariate analysis, gang members who reported UVI were more likely to have engaged in the following behaviours: had sex with someone they just met (adjusted odds ratio [AOR] = 4.51), had sex with someone they think or know had a sexually transmitted infection (STI; AOR = 4.67) or had sex while incarcerated (AOR = 8.92). In addition, gang members with a higher perceived vulnerability to HIV were less likely to report UVI in the previous 12 months (AOR = 0.75). These findings offer implications for development of an HIV prevention intervention for young Latino and African American male gang members.
Schuyler, Ashley C.; Edelstein, Zoe R.; Mathur, Sanyukta; Sekasanvu, Joseph; Nalugoda, Fred; Gray, Ronald; Wawer, Maria J.; Serwadda, David M.; Santelli, John S.
Mobility, including migration and travel, influences risk of HIV. This study examined time trends and characteristics among mobile youth (15-24 years) in rural Uganda, and the relationship between mobility and risk factors for HIV. We used data from an annual household census and population-based cohort study in the Rakai district, Uganda. Data on in-migration and out-migration were collected among youth (15-24 years) from 43 communities from 1999-2011 (N=112,117 observations) and travel among youth residents from 2003-2008 (N=18,318 observations). Migration and travel were more common among young women than young men. One in five youth reported out-migration. Over time, out-migration increased among youth and in-migration remained largely stable. Primary reasons for migration included work, living with friends or family, and marriage. Recent travel within Uganda was common and increased slightly over time in teen women (15-19 years old), and young adult men and women (20-24 years old). Mobile youth were more likely to report HIV risk behaviours including: alcohol use, sexual experience, multiple partners, and inconsistent condom use. Our findings suggest that among rural Ugandan youth, mobility is increasingly common and associated with HIV risk factors. Knowledge of patterns and characteristics of a young, high-risk mobile population has important implications for HIV interventions. PMID:26313708
Schuyler, Ashley C; Edelstein, Zoe R; Mathur, Sanyukta; Sekasanvu, Joseph; Nalugoda, Fred; Gray, Ronald; Wawer, Maria J; Serwadda, David M; Santelli, John S
Mobility, including migration and travel, influences risk of HIV. This study examined time trends and characteristics among mobile youth (15-24 years) in rural Uganda, and the relationship between mobility and risk factors for HIV. We used data from an annual household census and population-based cohort study in the Rakai district, Uganda. Data on in-migration and out-migration were collected among youth (15-24 years) from 43 communities from 1999 to 2011 (N = 112,117 observations) and travel among youth residents from 2003 to 2008 (N = 18,318 observations). Migration and travel were more common among young women than young men. One in five youth reported out-migration. Over time, out-migration increased among youth and in-migration remained largely stable. Primary reasons for migration included work, living with friends or family, and marriage. Recent travel within Uganda was common and increased slightly over time in teen women (15-19 years old), and young adult men and women (20-24 years old). Mobile youth were more likely to report HIV-risk behaviours including: alcohol use, sexual experience, multiple partners, and inconsistent condom use. Our findings suggest that among rural Ugandan youth, mobility is increasingly common and associated with HIV-risk factors. Knowledge of patterns and characteristics of a young, high-risk mobile population has important implications for HIV interventions.
Schneider, J A; Dude, A; Dinaker, M; Kumar, V; Laumann, E O; Holloway-Beth, A; Oruganti, G; Saluja, G S; Chundi, V; Yeldandi, V; Mayer, K H
The relationships between hygiene, sexual behaviour and HIV infection are poorly understood. We examine these relationships in Indian truck drivers, a group at high risk for HIV infection. Truck drivers (n = 189) were recruited into an integrated HIV and hygiene Information Motivation (IM) programme. Sociodemographic characteristics, sexual and hygiene behaviour and HIV prevalence were determined. Multivariate logistic regression and linear generalized estimating equation models were utilized. At baseline, 2.1% of drivers were HIV infected and 34% who reported having contact with female sex workers (FSWs) had contact within the previous six months. Those who washed their hands postdefecation were less likely to report genital symptoms (OR 0.02; P = 0.01) and have sex with an FSW (OR [odds ratio] 0.21; P = 0.05). After an IM intervention, there were no changes in sexual risk-taking behaviour (coefficient -0.15 to -0.02; P = 0.13-0.75); however, hygiene behaviour improved from baseline (coefficient 0.09-0.31; P < 0.01 to P = 0.03). Personal hygiene habits, like handwashing, seem to be a modifiable behaviour after a modest intervention, whereas HIV risk-taking behaviour was not. The association between hygiene and HIV risk-taking suggests the need for further evaluation of the relationship and that of other hygiene practices in high-risk men in India.
Suominen, Tarja; Karanja-Pernu, Caroline; Kylmä, Jari; Houtsonen, Jarmo; Välimäki, Maritta
The purpose of this pilot study was to illustrate international university students' knowledge of HIV and AIDS, attitudes towards HIV and AIDS and risk behaviours in relation to HIV and AIDS. Questionnaires were posted to 140 students, and 32 responded. Data were analysed statistically. The results indicated a fairly good knowledge level of HIV and AIDS. The majority of students were well aware of the general facts about HIV and AIDS, modes of transmission and main risk groups, and they were also aware of the universal precautions. The majority of students had positive attitudes towards persons with HIV and AIDS and were willing to care for them. The students identified well with risk behaviours. Most agreed that their knowledge level of HIV and AIDS did affect their risk behaviours, while others felt it was a matter of choice, personal attitude and practice. Choice is a determining factor for decisions made by students in relation to HIV and AIDS. Future research focusing on factors influencing these choices that put them at risk of contracting the HIV virus is recommended. Students also need to be enlightened on matters concerning symptoms of HIV and AIDS.
Townsend, Loraine; Giorgio, Maggie; Zembe, Yanga; Cheyip, Mireille; Mathews, Catherine
HIV prevalence and risk behaviour among foreign migrants in South Africa has not been explored. This paper describes the effectiveness of respondent-driven sampling (RDS) to recruit foreign migrant women residing in Cape Town, reports HIV prevalence, and describes key characteristics among them. We conducted a biological and behavioural surveillance survey using RDS. After written informed consent, participants completed an audio computer assisted self-interview and provided a dried blood sample for HIV analysis. HIV prevalence was estimated to be 7 % (CI 4.9-9.5) among 935 women. HIV sero-positivity was associated with older age (p = 0.001), country of origin (p < 0.000), being unmarried (p < 0.000), having lived in South Africa for 3-5 years (p = 0.023), sexual debut at ≥15 years (p = 0.047), and having used a condom at last sex with a main partner (p = 0.007). Few women reported early sexual debut, or multiple sexual partners. RDS was successful in recruiting foreign migrant women.
Ward, Catherine L.; Mertens, Jennifer R.; Bresick, Graham F.; Little, Francesca; Weisner, Constance M.
Purpose: To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours. Methods: Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up. Results: Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours. Conclusions: Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction. PMID:25731180
Delgado-Rodríguez, M; dé lá Fuente, L; Bravo, M J; Lardelli, P; Barrio, G
STUDY OBJECTIVE--To determine whether HIV positive intravenous drug users (IVDUs) who were receiving outpatient treatment for opiate and cocaine abuse or dependence used practices aimed at reducing the spread of HIV. DESIGN--Cross sectional study of behaviour and HIV serostatus in IVDUs. SETTING--A nationwide sample, from 83 health centres for outpatient treatment, stratified by autonomous regions. PARTICIPANTS--Altogether 1074 IVDUs were recruited. HIV serostatus could be verified in 738 (68.7%) of these. MEASUREMENTS AND MAIN RESULTS--Crude and adjusted odds ratios and their 95% confidence intervals were estimated to assess the association between HIV serostatus and behavioural changes. In their daily interactions with other members of the same household, seropositive subjects more frequently used preventive methods aimed at avoiding transmission than seronegative patients. Treatment for abuse or dependency before the current regimen had a greater impact in HIV positive than HIV negative subjects in terms of abstaining from risk behaviours. There was a significant trend toward lower drug consumption in HIV positive subjects, and the number of seropositive and seronegative IVDUs who stopped injecting their drugs was significantly higher among the former. Seropositive subjects were also more likely to stop sharing drug injecting equipment and to change their sexual habits; they reported an increased consistent use of condoms. CONCLUSIONS--HIV positive IVDUs were more likely to change their risk behaviours than their HIV negative counterparts. PMID:7964355
Khalajabadi Farahani, Farideh; Akhondi, Mohammad Mahdi; Shirzad, Mehdi; Azin, Ali
Recent evidence indicates a rising trend in premarital sexual activity among young people in Iran. However, little is known about the extent to which young people's sexual behaviours expose them to HIV and STI risks. This study aimed to assess HIV/STI-related sexual risk-taking behaviours (correlates and determinants) and HIV/STI risk perception among male university students in Tehran. A representative sample of male university students (N=1322) studying in government and private Tehran universities completed an anonymous questionnaire survey in 2013-14. Respondents were selected using two-stage stratified cluster sampling. About 35% of respondents had ever had premarital sex (n=462). The majority (about 85%) of the sexually experienced students reported having multiple sexual partners in their lifetime. More than half (54%) reported inconsistent condom use over the previous month. Despite this exposure to HIV/STI risk, the respondents had a very low level of HIV/STI risk perception. Only 6.5% were highly concerned about contracting HIV over the previous year, and an even lower percentage (3.4%) were concerned about contracting STIs in the near future. Early sexual debut (<18 years), studying in a private university, ever watching pornography and work experience were found to be significant predictors of having multiple sexual partners. Younger age at sexual debut, having one lifetime sexual partner and poor HIV knowledge were significant predictors of inconsistent condom use over the preceding month. HIV prevention programmes among Iranian youth need to focus on the postponement of first sex and enhancement of HIV/STI knowledge in the light of increasing access of young people to pornography.
Williams, Whitney; Goldenberg, Tamar; Andes, Karen L; Finneran, Catherine; Stephenson, Rob
Recent studies have called for more nuanced research into the relationships between behaviourally bisexual men and their sexual partners. To address this, we conducted a longitudinal qualitative study with self-identifying gay men; participants took part in timeline-based interviews and relationship diaries. We conducted a thematic analysis of verbatim transcripts to understand how relationship motivations, emotions and relationship dynamics influenced perceptions of HIV risk with behaviourally bisexual male partners. Participants described how partnership types (main and casual) and relationship dimensions (exclusivity, commitment, emotional attachment and relationship designation) strongly influenced perceptions of HIV risk and shaped their decisions to choose behaviourally bisexual male sex partners. Results reveal the crucial role relationship dynamics play in the shaping of HIV risk perceptions, sexual decision-making and HIV risk between partners, and provide potential insight on how to message HIV risk to gay men and their behaviourally bisexual male partners. It is imperative that HIV prevention is able to message key concepts of risk, decision-making and partner negotiation in a way that does not act to stereotype or create stigma against behaviourally bisexual men and their male partners.
Mwakagile, D; Mmari, E; Makwaya, C; Mbwana, J; Biberfeld, G; Mhalu, F; Sandstrom, E
Objectives: To investigate sex specific sexual behaviour in youths visiting a youth clinic for sexual and reproductive health in Dar es Saalam. Methods: A questionnaire was administered to a random sample of youths between 10 and 24 years of age attending the youth health clinic in Dar es Saalam. The clinical investigation included testing for syphilis and HIV-1 antibodies Results: 1423 youths attended the clinic between September 1997 and August 1998. The study population comprised 213 (53.5%) males and 185 (46.5%) females. 97 (24.4%) were below 20 years. The mean age at coitarche was 16.5 and 17.0 years of age for males and females, respectively. The coitarche was involuntary in 15 females (8.6%). 49.5% males reported more than five lifetime partners compared with 14.1% for females (p<0.0001). Males reported recent partners to be 2.5 years younger, while females reported them to be 5.0 years older. No contraceptive use was reported by 29.7% of the males and 40.3% of females. 52.7% females had been pregnant and 26 (14.1%) reported induced abortions. Genital discharge was found in 69.5% and 73.9% and GUD in 36.6% and 27.1% of males and females respectively. 12 males (5.9%) and 43 females (24.6%) were found to be HIV-1 infected. 13.8% of the females with only one lifetime partner were HIV-1 infected compared with 40.9% with more than five partners (p = 0.028). Conclusions: Many youths in Dar es Salaam engage in sexual behaviours that put them at risk of unwanted pregnancies and STIs including HIV infection. Female youths were more likely to contract HIV infection than males. In African urban areas youth oriented clinics can have a pivotal role in HIV/STI prevention and control Key Words: youth; sexual behaviour; HIV PMID:11463924
Michalopoulos, Lynn Murphy; Ncube, Nomagugu; Simona, Simona J; Kansankala, Brian; Sinkala, Emmanuel; Raidoo, Jasmin
Truck drivers are part of mobile populations which have been noted as a key population at risk of HIV in Zambia. This study was aimed at: (1) determining potentially traumatic events (PTEs), labour migrant-related stressors, psychosocial problems and HIV risk behaviours among truck drivers in Zambia; and (2) examining the relationship between PTEs, migrant-related stressors, psychosocial outcomes and HIV sexual risk behaviour among truck drivers in Zambia. We conducted 15 semi-structured interviews with purposively sampled male truck drivers at trucking companies in Lusaka, Zambia. Findings indicate that truck drivers experience multiple stressors and potentially traumatic incidences, including delays and long waiting hours at borders, exposure to crime and violence, poverty, stress related to resisting temptation of sexual interactions with sex workers or migrant women, and job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, loneliness, anxiety and depression-like symptoms were noted. Transactional sex, coupled with inconsistent condom use, were identified as HIV sexual risk behaviours. Findings suggest the critical need to develop HIV-prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key population.
Belza, M J; Llácer, A; Mora, R; Morales, M; Castilla, J; de la Fuente, L
This paper describes the sociodemographic and work characteristics, prevalence of HIV infection and associated risk behaviours among male sex workers (MSWs) in Madrid (Spain). Using an anonymous semi-structured questionnaire, educators attached to a mobile unit under a street-based prostitution programme surveyed 84 MSWs from several Madrid areas. Of the total surveyed: 35% were immigrants, mean age was 23 years, mean period in prostitution was four years; 21% had no primary education; 16% had injected drugs at some time; 11% reported private sexual relationships exclusively with women; 89% always used condoms in anal practices with clients; and 41% were in sexual relationships with their partners. Only 11% had ever used fortified condoms. In the preceding month, 37% had experienced condom failure, 82% without having used any lubricant. In all, 67% reported having undergone HIV testing, with a higher percentage of positive results among injecting (60%) versus non-injecting drug users (17%). Immigrants had a lower level of education, made less use of condoms, had more condom failures and, in their private lives, a greater proportion reported sexual relationships exclusively with women. In Spain, MSWs should be included in HIV prevention programmes, which ought to be specifically adapted to immigrants. Priority should be given to reducing the condom failure rate in anal intercourse, by improving access to fortified condoms.
Simooya, O O; Sanjobo, N E; Kaetano, L; Sijumbila, G; Munkonze, F H; Tailoka, F; Musonda, R
Inmate populations include a large number of individuals at risk of HIV infection. However, there is insufficient data about HIV/AIDS epidemiology in prisons. Our study, conducted in Zambia, a sub-Saharan African nation with an estimated HIV prevalence of 19% in adults, was designed to address this shortfall.
Bloor, M J; McKeganey, N P; Finlay, A; Barnard, M A
Much the most common models of HIV-related risk behaviour are those psychosocial models derived from studies of health behaviour and tested on large interview samples of American gay men. These models were not appropriate for understanding risk behaviour among 32 Glasgow male prostitutes. Whereas psycho-social models conceive of risk behaviour as volitional and individualistic, ethnographic data indicate that the male prostitutes' risk practices were constrained and emergent from the immediate circumstances of the sexual encounter. Unsafe sex was associated with client control. Safer sex was associated with countervailing prostitute strategies of influence. These data confirm the utility of self-empowerment approaches to health education.
This study examines gender and class differences in young people's beliefs about sexuality and HIV/AIDS risk-taking behaviours in Thailand. Sixty young people aged 15-19, divided equally by gender and socioeconomic background, participated in focus groups and in-depth interviews. Four topics were explored: the differences between 'good' and 'bad' girls/boys; young people's perceptions of sexuality; social class variations in young people's knowledge of HIV/AIDS and perceptions of risk; and the most influential institutions shaping young people's sexual attitudes. Results showed that young people screened potential sexual partners utilizing an image of 'good girls/boys' as potential HIV/AIDS-free partners; young people defined sexuality in terms of love/sexual relationships, premarital sex, promiscuity, and virginity; and HIV/AIDS awareness varied according to class. Young people of all classes failed to demonstrate an in-depth understanding of how they can contract AIDS. They neither viewed themselves as being in an at-risk group, nor considered their sexual behaviours to be at-risk behaviours. Finally, family, friends, and mass media were reported to be among the most influential institutions shaping young people's sexual attitudes. In the struggle against HIV/AIDS, these institutions together with health education not only protect but also can empower young people in Thailand.
Bai, Xue; Xu, Jie; Yang, Jie; Yang, Bo; Yu, Maohe; Gao, Yongjun; Dong, Willa M; Wu, Zunyou
Introduction Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high-risk sexual behaviours between repeat and first-time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China. Methods Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high-risk sexual behaviours between repeat and first-time testers were assessed using the chi-square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection. Results Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first-time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first-time (13.3%, 125/943) testers. The HIV prevalence increased with age among first-time testers (χtrend2=9.816, p=0.002). First-time MB testers had the highest HIV prevalence of 34.5%. Conclusions MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs. PMID:24993457
Zhang, Xiao; Martinez-Donate, Ana P; Simon, Norma-Jean E; Hovell, Melbourne F; Rangel, Maria Gudelia; Magis-Rodriguez, Carlos; Sipan, Carol L
The Mexico-US border region is a transit point in the trajectory of Mexican migrants travelling to and from the USA and a final destination for domestic migrants from other regions in Mexico. This region also represents a high-risk environment that may increase risk for HIV among migrants and the communities they connect. We conducted a cross-sectional, population-based survey, in Tijuana, Mexico, and compared Mexican migrants with a recent stay on the Mexico-US border region (Border, n = 553) with migrants arriving at the border from Mexican sending communities (Northbound, n = 1077). After controlling for demographics and migration history, border migrants were more likely to perceive their risk for HIV infection as high in this region and regard this area as a liberal place for sexual behaviours compared to Northbound migrants reporting on their perceptions of the sending communities (p < .05). Male border migrants were more likely to engage in sex, and have unprotected sex, with female sex workers during their recent stay on the border compared to other contexts (rate ratio = 3.0 and 6.6, respectively, p < .05). Binational and intensified interventions targeting Mexican migrants should be deployed in the Mexican border region to address migration related HIV transmission in Mexico and the USA.
King, Rachel; Min, Jeong; Birungi, Josephine; Nyonyintono, Maureen; Muldoon, Katherine A.; Khanakwa, Sarah; Kaleebu, Pontiano; Moore, David M.
Background We examined several measures of self-reported HIV risk behaviour in mutually disclosed sero-discordant couples over time to see if a couples counselling intervention was associated with changes in these behaviors. Methods We analysed data from a prospective cohort study of HIV sero-discordant couples in Jinja, Uganda collected between June 2009 and December 2011. Participants received couples counselling, at 3-monthly intervals. We examined trends in reported condom-use, number of concurrent sexual partners, knowledge of HIV serostatus of concurrent partners and condom use of concurrent partners using Generalized Estimating Equation models, comparing responses at study enrollment with responses at six, 12 18 and 24 months of follow-up. Results A total of 586 couples were enrolled and the female member was HIV positive in 255 (44%) of them. The median age for female participants was 35 years and 42 years for men. Reported condom use at last sex with spouse increased over time (p<0.001) with the largest increases found among couples where the positive participant never received ART during the study(an increase from 68.8% at enrollment to 97.1% at 24 months). Male participants reported reductions in the number of concurrent sexual partners (p<0.001), increase in the knowledge of the HIV serostatus of these partners (p = 0.001) and a trend towards improved condom-use among non-primary partners (p = 0.070). Reported reduced risky behaviors did not wane over the study period. Conclusion Couples counselling resulted in increased condom use among all participants and among men the intervention resulted in reductions in risk behaviour with concurrent sexual partners. Routine counselling for serodiscordant couples should be integrated in routine ART care programs. PMID:26384103
Lewis, Nathaniel M; Wilson, Kathi
HIV surveillance systems show that gay, bisexual, and other men who have sex with men (MSM) bear a disproportionate burden of HIV in North American and European countries. Within the MSM category, HIV prevalence is often elevated among ethnic minority (i.e., Latino, Asian, and Black) MSM, many of whom are also foreign-born immigrants. Little research has focused specifically on foreign-born populations, though studies that provide data on the nativity of their samples offer an opportunity to investigate the potential role of transnational migration in informing HIV risk among ethnic minority MSM. This systematic review of ethnic minority MSM studies where the nativity of the sample is known provides a robust alternative to single studies measuring individual-level predictors of HIV risk behaviour. In this review, HIV prevalence, unprotected sex, drug use, and HIV testing are analysed in relation to the ethnicity, nativity, and location of the samples included. The results, which include high rates of HIV, unprotected sex, and stimulant use in foreign-born Latino samples and high rates of alcohol and club drug use in majority foreign-born Asian Pacific Islander (API) samples, provide baseline evidence for the theory of migration and HIV risk as syndemics within ethnic minority populations in North American and European countries. The findings also suggest that further research on the contextual factors influencing HIV risk among ethnic minority MSM groups and especially immigrants within these groups is needed. These factors include ethnic networks, individual post-migration transitions, and the gay communities and substance use cultures in specific destination cities. Further comparative work may also reveal how risk pathways differ across ethnic groups.
Saewyc, Elizabeth; Clark, Terryann; Barney, Lucy; Brunanski, Dana; Homma, Yuko
Enacted stigma has been linked to increased HIV risk behaviours among sexual minority youth, but despite higher rates of HIV and other STIs, there is very little research with Indigenous youth. In this study, secondary analyses of three population-based, school surveys were conducted to explore the associations between HIV risk and enacted stigma among sexual minority Indigenous youth in Canada, the US, and New Zealand. Data were analyzed and interpreted with guidance from Indigenous and sexual minority research team members, Indigenous advisory groups, and community consultations. In all three countries, Indigenous sexual minority youth were more likely to experience enacted stigma (such as bullying, discrimination, exclusion, harassment, or school-based violence) and report increased HIV risk behaviours (such as lack of condom use, multiple sexual partners, pregnancy involvement, and injection drug use) compared to heterosexual peers. Data were analyzed by age, gender, and sexual orientation, and for some groups, higher levels of enacted stigma was associated with higher HIV risk. The findings highlight the need for more research, including identifying protective factors, and developing interventions that focus on promoting resilience, addressing the levels of stigma and homophobic violence in school, and restoring historical traditions of positive status for Indigenous sexual minority people. PMID:26793243
Khajehkazemi, Razieh; Osooli, Mehdi; Sajadi, Leily; Karamouzian, Mohammad; Sedaghat, Abbas; Fahimfar, Noushin; Safaie, Afshin; Mostafavi, Ehsan; Haghdoost, Ali-Akbar
Objectives To assess the prevalence of HIV and related risk behaviours among people who inject drugs (PWID) in Iran. Methods We conducted a national cross-sectional bio-behavioural surveillance survey between March and July 2010, interviewing male PWID from a geographically dispersed sample through a facility-based sampling method. Results We recruited 2480, and tested 2290 PWID. The overall prevalence of HIV was 15.2% (95% CI 9.7% to 23.1%). Among those who had injected drugs over the last month, 36.9% had used a non-sterile needle, and 12.6% had practiced shared injection. Over the past 12 months preceding the interview, 30.4% had sold sex for money, drugs, goods or a favour. In the multivariate analysis, the prevalence of HIV had a positive association with age, while having above high school education, and permanent job were protective. Conclusions Unsafe injection, and sexual risk behaviours are still frequent and the prevalence of HIV among PWID remains high. Intensified efforts are needed to prevent the further spread of HIV among Iranian PWID and their sexual partners. PMID:24037249
Stark, K; Müller, R; Wirth, D; Bienzle, U; Pauli, G; Guggenmoos-Holzmann, I
This study investigated differences in prevalence and determinants of HIV infection, and in recent risk behaviour (previous 6 months) among injecting drug users (IDUs) who are in contact with different types of services for IDUs in Berlin. Participants (n = 557) were recruited from drug-free long-term treatment centres, a storefront agency and a syringe exchange bus. HIV seroprevalence was lowest (3.9%) at the treatment centres, and highest among IDUs at the storefront agency (20.7%). In logistic regression, independent risk factors for HIV infection were duration of injecting drug use, borrowing syringes in prison, sex with HIV-positive partners, and prostitution. Syringe sharing in prison was the most important independent determinant of HIV infection among all three subpopulations of IDUs. Participants entering long-term treatment were most likely, and IDUs at the syringe exchange bus were least likely to have borrowed and passed on syringes in the previous 6 months. In logistic regression, site of recruitment was independently associated with recent borrowing of syringes, but not with condom use. Injection of drugs other than heroin only, and injecting in prisons, were also independent predictors of recent borrowing. The results indicate that IDUs entering treatment form an important target group for health education. There is a need for AIDS prevention measures in prisons. The comparatively low levels of recent injection risk behaviour among IDUs at the syringe exchange bus suggest that this type of intervention may be effective in harm reduction.
Tuan, Nguyen Anh; Fylkesnes, Knut; Thang, Bui Duc; Hien, Nguyen Tran; Long, Nguyen Thanh; Van Kinh, Nguyen; Thang, Pham Hong; Manh, Pham Duc
Abstract Objective To study patterns and determinants of HIV prevalence and risk-behaviour characteristics in different population groups in four border provinces of Viet Nam. Methods We surveyed four population groups during April–June 2002. We used stratified random-cluster sampling and collected data concomitantly on HIV status and risk behaviours. The groups included were female sex workers (n = 2023), injecting drug users (n = 1391), unmarried males aged 15–24 years (n = 1885) and different categories of mobile groups (n = 1923). Findings We found marked geographical contrasts in HIV prevalence, particularly among female sex workers (range 0–24%). The HIV prevalence among injecting drug users varied at high levels in all provinces (range 4–36%), whereas lower prevalences were found among both unmarried young men (range 0–1.3%) and mobile groups (range 0–2.5%). All groups reported sex with female sex workers. Less than 40% of the female sex workers had used condoms consistently. The strongest determinants of HIV infection among female sex workers were inconsistent condom use (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 2.4–11.8), history of injecting drug use and mobility, and, among injecting drug users, sharing of injection equipment (adjusted OR, 7.3; 95% CI, 2.3–24.0) and sex with non-regular partners (adjusted OR 3.4; 95% CI 1.4–8.5). Conclusion The finding of marked geographical variation in HIV prevalence underscores the value of understanding local contexts in the prevention of HIV infection. Although lacking support from data from all provinces, there would appear to be a potential for sex work to drive a self-sustaining heterosexual epidemic. That the close links to serious injecting drug use epidemics can have an accelerating effect in increasing the spread of HIV merits further study. PMID:17242756
Rogers, Marla Rochelle; Lemstra, Mark Edgar; Moraros, John Simeon
Objectives: To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use. Methods: Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices. Results: The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours. Conclusions: Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR. PMID:26720823
Background Young people in Laos are more vulnerable to STIs/HIV due to their sexual risk behaviours, low perceptions of risk and their socio-cultural environments. Perceived risk of contracting STIs/HIV is crucial for the assessment of their risk regarding their actual sexual risk behaviors. Thus, the objective of this paper is to explore perceptions of risk related to STIs/HIV and identify factors associated with this perceived risk among adolescents. Methods This was a cross sectional study of sexually experienced adolescents aged 14 to 19 years old in the Luangnamtha province. The multistage sampling techniques were used for selecting 1008 adolescents aged 14-19 years old. Of these, 483 respondents reported having had sexual experience was selected for analysis. Univariate and Logistic regression were performed. Result Six per cent of respondents reported ever having had anal sex. Slightly less than two thirds initiated their first sexual intercourse before age 15. Two thirds of the sexually experienced males reported two or more sexual partners during their lifetime with the mean 3.1 + 3.65 while only twelve per cent of girls reported this cumulative number of partners. Slightly more than half (57.6%) regarded themselves to have no risk at all with 17.2 per cent considered themselves to have low risk. Respondents had poor knowledge on STIs/HIV. Factors associated with risk perception of getting STIs were: being male, high level of knowledge about STIs and having had symptoms of STIs in last six months. Perceived risk of getting HIV was significantly associated with being male, having more knowledge about STIs and HIV. Conclusion Adolescents in this study engaged in sexual risk behaviours, but they have low perception of risk getting STI/HIV. Socio-demographic factors, knowledge of STIs/HIV, and the level of exposure to STIs were the main determinants of the risk perception of STIs/HIV. Our finding supports the need to target adolescents in Luangnamtha
Kiwanuka, Noah; Ssetaala, Ali; Mpendo, Juliet; Wambuzi, Matthias; Nanvubya, Annet; Sigirenda, Simon; Nalutaaya, Annet; Kato, Paul; Nielsen, Leslie; Kaleebu, Pontiano; Nalusiba, Josephine; Sewankambo, Nelson K
Introduction HIV epidemics in sub-Saharan Africa are generalized, but high-risk subgroups exist within these epidemics. A recent study among fisher-folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person-years). However, those findings may not reflect population-wide HIV rates in FFC since the study population was selected for high-risk behaviour. Methods Between September 2011 and March 2013, we conducted a community-based cohort study to determine the population representative HIV rates and willingness to participate (WTP) in hypothetical vaccine trials among FFC, Uganda. At baseline (September 2011–January 2012), a household enumeration census was done in eight fishing communities (one lakeshore and seven islands), after which a random sample of 2200 participants aged 18–49 years was selected from 5360 individuals. Interviewer-administered questionnaire data were collected on HIV risk behaviours and WTP, and venous blood was collected for HIV testing using rapid HIV tests with enzyme-linked immunosorbent assay (EIA) confirmation. Adjusted prevalence proportion ratios (adj.PPRs) of HIV prevalence were determined using log-binomial regression models. Results Overall baseline HIV prevalence was 26.7% and was higher in women than men (32.6% vs. 20.8%, p<0.0001). Prevalence was lower among fishermen (22.4%) than housewives (32.1%), farmers (33.1%) and bar/lodge/restaurant workers (37%). The adj.PPR of HIV was higher among women than men (adj.PPR =1.50, 95%; 1.20, 1.87) and participants aged 30–39 years (adj.PPR=1.40, 95%; 1.10, 1.79) and 40–49 years (adj.PPR=1.41, 95%; 1.04, 1.92) compared to those aged 18–24 years. Other factors associated with HIV prevalence included low education, previous marriage, polygamous marriage, alcohol and marijuana use before sex. WTP in hypothetical vaccine trials was 89.3% and was higher in men than women (91.2% vs. 87.3%, p=0.004) and among island communities compared to lakeshore
Anita, S; Zahir, W M; Sa'iah, A; Rahimah, M A; Sha'ari, B N
Orang Asli, the indigenous people of Peninsular Malaysia comprises only 0.5% of total Malaysia population but contribute to 0.06% of total notified HIV cases in the country. Their current knowledge, attitude and practice related to HIV was not known. A cross-sectional study on knowledge, attitude and practice among Orang Asli in Peninsular Malaysia was carried out involving 2706 Orang Asli from 33 remote and 47 fringe villages. Generally, the level of knowledge was fair (30%-50%) with mean scores of 55.7% (SD 31.7) while attitudes were negative. There was gender bias towards misconception on HIV transmission and sources of information. HIV seroprevalence of 0.3% was detected while risk behaviors were low. This study provides baseline information for HIV/AIDS preventive programs to the Orang Asli communities.
Milloy, M-J S; Buxton, Jane; Wood, Evan; Li, Kathy; Montaner, Julio SG; Kerr, Thomas
Background While incarceration has consistently been associated with a higher risk of HIV infection for individuals who use injection drugs (IDU), the effect of incarceration on the post-release risk environment remains poorly described. We sought to assess the impact of incarceration on risk factors for HIV infection after release from prison in a sample of active IDU in Vancouver, Canada. Methods Using a prospective cohort of community-recruited IDU followed from May 1, 1996 to November 30, 2005, we examined contingency tables and performed linear growth curve analyses to assess changes in the prevalence of independent risk factors for HIV infection from before to after a period of incarceration among participants reporting incarceration and a matched control group. Results Of the 1603 participants followed-up over the study period, 147 (9.2%) were eligible for an analysis of post-incarceration risk behaviours and 742 (46.3%) were used as matched controls. Significant differences were found in one or both groups for the prevalence of frequent cocaine injection, requiring help injecting, binge drug use, residence in the HIV outbreak epicentre, sex-trade participation and syringe sharing (all p < 0.05) after incarceration. In linear growth curve adjusted for age, gender and ethnicity, syringe sharing was significantly more common in those recently released from prison (p = 0.03) than in the control group. Conclusion In a sample of Canadian IDU, we did not observe any effect of incarceration on the prevalence of several behaviours that are risk factors for HIV infection, including intensity of drug use or participation in the sex trade. However, those recently released from prison were more likely to report syringe sharing that those in a matched control group. PMID:19473508
Navadeh, Soodabeh; Mirzazadeh, Ali; Gouya, Mohammad Mehdi; Farnia, Marziyeh; Alasvand, Ramin; Haghdoost, Ali-Akbar
Objectives To estimate the prevalence of HIV and related risk behaviours among prisoners in Iran in 2009. Methods Using multistage random sampling, we recruited 5,530 prisoners from 27 prisons in Iran. Behavioural data were collected using a face-to-face questionnaire-based interview, and HIV status was determined by ELISA of dried blood spots. Weighted estimates were calculated based on the sampling probability and response rate. Results HIV prevalence was 2.1% (95% CI 1.2 to 3.6). One in eight prisoners (12.3%, 95% CI 8.0% to 16.6%) had been tested for HIV in the last year and received results, 20.5% (95% CI 15.1 to 27.4%) had comprehensive knowledge about HIV and 24.7% (95% CI 17.9% to 32.9%) reported condom use at last vaginal/anal sex in prison. Although 16.5% (95% CI 12.5% to 21.5%) acknowledged a lifetime history of drug injection, only 22 prisoners reported drug injection inside the prison in the month preceding the interview. Of note, 12.9% (95% CI 10.6% to 15.6%) had been tattooed in prison. There were significant associations between HIV prevalence and a history of drug injection (adjusted odds ratio (AOR): 7.8, 95% CI 4.7 to 13.2), tattooing (AOR: 2.1, 95% CI 1.1 to 4.2) and age over 30 years (AOR: 1.4, 95% CI 1.1 to 1.9). Conclusions Considerable HIV prevalence among prisoners is found in Iran. Expanding harm reduction programmes inside prisons with inclusion of sexual risk reduction programmes and post-release programmes will help directly prevent acquisition and transmission of infection inside prisons and indirectly slow onward transmission in the outside communities. PMID:23986417
Davis, Alissa; Best, John; Luo, Juhua; Van Der Pol, Barbara; Dodge, Brian; Meyerson, Beth; Aalsma, Matthew; Wei, Chongyi; Tucker, Joseph D
Differences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.
Hart, G J; Sonnex, C; Petherick, A; Johnson, A M; Feinmann, C; Adler, M W
To study a range of possible risk factors for HIV among injecting drug user patients attending a clinic in London were interviewed from November 1986 to November 1987. Serum samples were tested for viral markers. Of 116 patients, 101 had shared injecting equipment, 75 on the first occasion of injecting and 76 during the past year. Seventy said that sharing was because equipment was not available. In the past year 102 had been sexually active, a third having two to 20 partners; a quarter of the women had exchanged sexual intercourse for money. The four patients who were positive for antibody to HIV antigen had shared equipment or had intercourse with drug users from areas with a high prevalence of HIV. Eleven patients had injected drugs while in prison. Despite a low prevalence of HIV infection this infection remains a threat to drug users in London; strenuous efforts are still needed to prevent its further transmission.
George, C; Alary, M; Hogg, R S; Otis, J; Remis, R S; Mâsse, B; Turmel, B; Leclerc, R; Lavoie, R; Vincelette, J; Parent, R; Chan, K; Martindale, S; Miller, M L; Craib, K J P; Schechter, M T
There is a dearth of information on the HIV risk-taking behaviour of foreign-born men who have sex with men (MSM) in Canada. This study focused on identifying sexual risk behaviour among MSM who immigrated to Canada and compared them to MSM who were born in Canada. Baseline data from the Omega Cohort in Montreal and the Vanguard Project in Vancouver were combined to form four ethnicity/race analytical categories (n = 1,148): White born in Canada (WBIC), White born outside of Canada, non-White born in Canada (NBIC) and non-White born outside of Canada (NBOC). Psychological, demographic and sexual behaviour characteristics of the groups were similar except: NBOC were more likely to be unemployed, less likely to be tattooed, had fewer bisexual experiences and less likely worried of insufficient funds. WBOC were more likely to report unprotected sex with seropositives and more likely to have had unprotected sex while travelling. NBIC were more likely to have ever sold sex and to have had body piercing. WBOC are at high risk of acquiring as well as transmitting HIV. It is important to consider place of birth in addition to ethnicity when developing programmes to prevent the transmission of HIV.
Paone, D; Cooper, H; Alperen, J; Shi, Q; Des Jarlais, D C
Existing research indicates that sex workers who inject drugs are vulnerable to HIV infection through both risky sexual and drug use practices. This study is the first attempt to learn whether this increased risk persists among current sex workers who participate in syringe exchange programmes (SEPs). With data from interviews with randomly selected participants in five US cities, we compared the demographic characteristics, sexual risk behaviours, drug use practices, emotional and physical health, and SEP utilization patterns of currently active female sex workers who attend SEPs with female SEP participants who do not engage in sex work. Data indicate that women enrolled in SEPs who were currently trading sex typically reported greater HIV risk than women non-sex workers. Current sex workers reported higher levels of risk for every drug risk variable examined in bivariate analysis. They were more likely than other women to inject with a syringe previously used by someone else, to inject daily and to attend shooting galleries; they were less likely to use a condom with their primary partners and to report higher levels of psychological distress than their counterparts. The relationship between sex work status and risky injection practices persisted when potential confounders were controlled for in multivariate analysis. SEPs can serve a pivotal role in providing sex workers with services and referrals which would help them reduce risk behaviours.
Background HIV/AIDS in India disproportionately affects women, not by their own risks, but by those of their partners, generally their spouses. We address two marginalized populations at elevated risk of acquiring HIV: women who are married to men who also have sex with men (MSM) and wives of injection drug users (IDUs). Methods We used a combination of focus groups (qualitative) and structured surveys (quantitative) to identify the risks that high-risk men pose to their low-risk wives and/or sexual partners. Married MSM were identified using respondent-driven recruitment in Tamil Nadu, India, and were interviewed by trainer assessors. A sample of wives of injection drug users in Chennai were recruited from men enrolled in a cohort study of the epidemiology of drug use among IDUs in Chennai, and completed a face-to-face survey. Focus groups were held with all groups of study participants, and the outcomes transcribed and analyzed for major themes on family, HIV and issues related to stigma, discrimination and disclosure. Results Using mixed-methods research, married MSM are shown to not disclose their sexual practices to their wives, whether due to internalized homophobia, fear of stigma and discrimination, personal embarrassment or changing sexual mores. Married MSM in India largely follow the prevailing norm of marriage to the opposite sex and having a child to satisfy social pressures. Male IDUs cannot hide their drug use as easily as married MSM, but they also avoid disclosure. The majority of their wives learn of their drug-using behaviour only after they are married, making them generally helpless to protect themselves. Fear of poverty and negative influences on children were the major impacts associated with continuing drug use. Conclusions We propose a research and prevention agenda to address the HIV risks encountered by families of high-risk men in the Indian and other low- and middle-income country contexts. PMID:20573289
Juita, G; Osman, A
To examine the risk factors of HIV type-I infection among male drug addicts in Malaysia, a case-control study was conducted on inmates, aged 20-40 years, at a drug rehabilitation centre in January, 1994. Stratified random sampling was performed. A total of 87 cases and 261 controls, chosen by frequency matching for age and ethnicity, answered self-administered questionnaires. About 59.8% of the subjects administered drugs intravenously and of these, 71.2% shared needles. Practices significantly associated with HIV infection were needle-sharing (OR = 8.53; 95% CI = 3.36-5.52), sexual relationship with prostitutes (OR = 3.70; 95% CI = 2.10-6.56), homosexuality (OR = 4.05; 95% CI = 1.49-11.11) and non-condom use while having sex with prostitutes (OR = 2.27; 95% CI = 1.05-4.97).
Kanter, J; Koh, C; Razali, K; Tai, R; Izenberg, J; Rajan, L; Van Griensven, F; Kamarulzaman, A
This research aimed to determine HIV prevalence, risk behaviour and knowledge of transmission methods among men who have sex with men (MSM) in Kuala Lumpur, Malaysia. Venue-day-time sampling (VDTS) was applied to identify venues where men congregate to solicit sex from other men. Participants recruited from clubs, massage parlours, saunas and one park self-completed a computerized behavioural questionnaire, were administered an oral rapid HIV test and given the opportunity to return later to receive full counselling and learn their HIV status. A total of 517 men were enrolled into the study. The majority were Malays (47.0%) and Chinese (43.7%). Twenty tested HIV positive (3.9%). Significant predictors of HIV infection included having unprotected anal sex with a casual partner (44.9% of participants, odds ratio [OR] = 2.99; 95% confidence interval [CI] 1.13-7.90; P = 0.027), having unprotected receptive anal sex (27.9%, OR = 2.71; 95% CI 1.10-6.54; P = 0.030) and having group sex (33.3%, OR = 3.95; 95% CI 1.55-10.09; P = 0.004). One in five participants (20.1% and 19.5%) did not believe that HIV could be transmitted through insertive or receptive anal sex, respectively. Risk behaviour is high and knowledge of HIV transmission methods was low among MSM in Kuala Lumpur. Future prevention efforts should focus on providing risk reduction education to this community.
Sipetić, Sandra; Ilić, Dragan; Marinković, Jelena; Vlajinac, Hristina; Bjegović, Vesna; Cucić, Viktorija; Laaser, Ulrich
The aim of this cross-sectional study was to analyze differences between Roma and non-Roma sex workers (SWs) according to their HIV/AIDS risk behaviors. In this study 91 Roma and 100 non-Roma SWs were included. They offered sex services at Belgrade hot spots during the period 2006-2007. Roma SW were significantly younger and with lower education and they were significantly more often without reading and writing skills than non Roma SW. They also significantly more often had the first sexual intercourse before an age of 14 years. Roma and non-Roma SWs did not differ significantly in their risky sex behaviors. Out of all SWs (both Roma and non-Roma) 13.6% had more than 5 clients daily, 61.3% always used a condom with the commercial sex partners and 17.3% always used a condom with the steady partner. More than half of all participants (55.0%) reported daily use of some psychoactive substance. Correct answers to all 6 standardized questions regarding HIV transmission gave only 9.9% Roma and 5.0% non-Roma SW and mean scores were 2.87 for Roma and 3.03 for non-Roma SW. These differences were not significant. According to multivariate analysis, Roma SWs were significantly younger, less educated, and with more testing to HIV during life in comparison with non Roma SWs. Significantly protective determinants for Roma SWs were knowledge of reading and writing and less frequently daily using of ecstasy during last month in comparison with non Roma SWs. It is necessary to continue work on education of both Roma and non-Roma SWs and to reconsider and revise the existing prevention programs regarding their impact on HIV transmission knowledge and the respective protective behaviors.
Korhonen, Teija; Kylmä, Jari; Houtsonen, Jarmo; Välimäki, Maritta; Suominen, Tarja
This study describes Finnish university students' knowledge and attitudes towards HIV and AIDS, homosexuality and sexual risk behaviour. Finnish-speaking students were randomly selected from all registered students at two universities in Finland (N = 9715, n = 950). The data were collected by using a modified version of the State University of New York at Buffalo School of Nursing AIDS Study Questionnaire on sexual risk behaviour developed by Held and Chng. The total response rate was 35% (n = 333). The data were analysed using quantitative statistical methods. Normally distributed data were analysed by t-test and one-way ANOVA, with Bonferroni corrections. Non-normally distributed data were analysed using the Mann-Whitney U-test and Kruskal-Wallis test, followed by a post-hoc test. The majority of students were familiar with HIV and AIDS, including its mode of transmission. However, there were still some misconceptions concerning HIV and AIDS. The oldest students and women had a more positive attitude towards people living with HIV and AIDS (PLWHA). Of patients with HIV or AIDS, intravenous drug users were perceived most negatively. Male students had more homophobic attitudes. Students who reported that religion had an important role in their lives had significantly stricter attitudes towards sexual risk behaviour. Students' knowledge correlated positively with general attitudes towards HIV and AIDS. Knowledge about HIV and AIDS will lead to more positive attitudes towards HIV and AIDS as a disease, towards those infected as well as homosexual people. There is a need to focus on preventive health care and sexual health promotion by educating young people and changing their attitudes towards sexual risk behaviour.
Lunze, Karsten; Raj, Anita; Cheng, Debbie M; Quinn, Emily K; Lunze, Fatima I; Liebschutz, Jane M; Bridden, Carly; Walley, Alexander Y; Blokhina, Elena; Krupitsky, Evgeny; Samet, Jeffrey H
Introduction Police violence against people who inject drugs (PWID) is common in Russia and associated with HIV risk behaviours. Sexual violence from police against women who use drugs has been reported anecdotally in Russia. This mixed-methods study aimed to evaluate sexual violence from police against women who inject drugs via quantitative assessment of its prevalence and HIV risk correlates, and through qualitative interviews with police, substance users and their providers in St. Petersburg, Russia. Methods Cross-sectional analyses with HIV-positive women who inject drugs (N=228) assessed the associations between sexual violence from police (i.e. having been forced to have sex with a police officer) and the following behaviours: current drug use, needle sharing and injection frequency using multiple regression models. We also conducted in-depth interviews with 23 key informants, including PWID, police, civil society organization workers, and other stakeholders, to explore qualitatively the phenomenon of sexual violence from police in Russia and strategies to address it. We analyzed qualitative data using content analysis. Results Approximately one in four women in our quantitative study (24.1%; 95% CI, 18.6%, 29.7%) reported sexual violence perpetrated by police. Affected women reported more transactional sex for drugs or money than those who were not; however, the majority of those reporting sexual violence from police were not involved in these forms of transactional sex. Sexual violence from police was not significantly associated with current drug use or needle sharing but with more frequent drug injections (adjusted incidence rate ratio 1.43, 95% CI 1.04, 1.95). Qualitative data suggested that sexual violence and coercion by police appear to be entrenched as a norm and are perceived insurmountable because of the seemingly absolute power of police. They systematically add to the risk environment of women who use drugs in Russia. Conclusions Sexual violence
Sajadi, Leily; Mirzazadeh, Ali; Navadeh, Soodabeh; Osooli, Mehdi; Khajehkazemi, Razieh; Gouya, Mohammad Mehdi; Fahimfar, Noushin; Zamani, Omid; Haghdoost, Ali-Akbar
Objectives To determine the prevalence of HIV and related behavioural risks among Iranian female sex workers (FSW) via the first national biobehavioural surveillance survey. Methods In 2010, 1005 FSW were approached and 872 recruited using facility-based sampling from 21 sites in 14 cities in Iran. We collected dried blood samples and conducted face-to-face interviews using a standardised questionnaire. Data were weighted based on the response rate and adjusted for the clustering effect of the sampling site. Adjustment was performed by weighting based on the sampling fraction of each site using a prior estimate of its total size of the FSW population. Results The prevalence of HIV infection (95% CI) was 4.5% (2.4 to 8.3) overall, 4.8% (2.2 to 9.8) among those who had reported a history of drug use and 11.2% (5.4 to 21.5) among those who had a history of injection drug use. The frequencies of condom use in the last sexual act with paying clients and non-paying partners were 57.1% and 36.3%, respectively. Any drug use was reported by 73.8% of participants, and among this subgroup, 20.5% had a history of injection drug use. Conclusions The prevalence of HIV was considerable among FSW particularly those who had a history of drug injection. A combination of prevention efforts addressing unsafe sex and injection are needed to prevent further transmission of HIV infection. PMID:24191292
Blignaut, Rénette J; Jacobs, Joachim; Vergnani, Tania
The aim of the research on which this article is based was to understand the behavioural changes of the target student population over time to ensure that future prevention programmes are more effective in changing behaviour. This study reports on quantitative data collected at the University of the Western Cape over a six-year period between 2007 and 2012. All the students attending the orientation sessions and who were willing to complete the anonymous questionnaire during each of the six years were included in the study. Data were collected on the following aspects and subjects: sexual activity, age at first sexual encounter, number of sexual partners, condom usage, knowledge of how to use a condom, perceived ability to discuss condoms usage with a sexual partner, perception of HIV risk and HIV testing as well as the intention to be tested. Reported alcohol and drug usage, as well as depressive symptoms, was also recorded. The percentage of students reporting having had vaginal sex prior to entering university increased from 44% in 2007 to 51% in 2012 but, alarmingly, the consistent use of condoms decreased from 60% in 2007 to 51% in 2012. The average onset age of about 15.6 years for males and 16.7 years for females for vaginal sex did not change over the six-year period. No difference in smoking patterns or drug use was seen over the period of the study, but the number of entering students who indicated that they consumed alcohol increased significantly from 48% in 2007 to 58% in 2012. HIV testing increased from 19% in 2007 to 47% in 2012, whereas the intention to be tested showed no significant change over the period. Although students increasingly reported that they knew enough about HIV/AIDS (63% in 2007 and 69% in 2012), about a third reported suffering from AIDS fatigue. Prevention efforts targeted at those incoming first-year students who are not yet sexually active (about 45% in this study) should be developed and should take into account the
Maughan-Brown, Brendan; Evans, Meredith; George, Gavin
Background Age-disparate partnerships are hypothesized to increase HIV-risk for young women. However, the evidence base remains mixed. Most studies have focused only on unprotected sex among women in the partnership. Consequently, little is known about other risky behaviours, such as transactional sex, alcohol use, and concurrency, as well as the behaviours of the men who partner with young women. We therefore examined differences in various sexual behaviours of both young women and their male partners by partnership age difference. Methods We used nationally representative data from South Africa (2012) on partnerships reported by 16–24 year old black African women (n = 818) and by black African men in partnerships with 16–24 year old women (n = 985). We compared sexual behaviours in age-disparate partnerships and age-similar partnerships, using multiple logistic regression to control for potential confounders and to assess rural/urban differences. Results Young women in age-disparate partnerships were more likely to report unprotected sex than young women in similar-aged partnerships (aOR:1.51; p = 0.014; 95%CI:1.09–2.11). Men in partnerships with young women were more likely to report unprotected sex (aOR:1.92; p<0.01; 95%CI:1.31–2.81), transactional sex (aOR:2.73; p<0.01; 95%CI:1.64–4.56), drinking alcohol before sex (aOR:1.60; p = 0.062; 95%CI:0.98–2.61), and concurrency (aOR:1.39; p = 0.097; 95%CI:0.94–2.07) when their partners were five or more years younger. The association between age-disparate partnerships and transactional sex (aOR:4.14; p<0.01; 95%CI: 2.03–8.46) and alcohol use (aOR:2.24; p<0.013; 95%CI:1.20–4.19) was only found in urban areas. Conclusions Results provide evidence that young women’s age-disparate partnerships involve greater sexual risk, particularly through the risky behaviours of their male partners, with the risk amplified for young women in urban areas. PMID:27526116
Alipour, Abbas; Haghdoost, Ali Akbar; Sajadi, Leily; Zolala, Farzaneh
Objective Sexual partners of injecting drug users (IDUs) are at high risk of HIV infection, yet data for such populations are scarce worldwide, particularly in the Middle East and North African region. This study measured and compared the prevalence of HIV, hepatitis C (HCV), hepatitis B (HBV) and related behavioural factors in male IDUs (MIDUs), their main female sexual partners who were also injecting drug users (FIDUPs) and their main non-injecting female partners (FNIDUPs). Method Using convenience sampling, MIDUs were recruited at drop-in health centres in three cities (Tehran, Mashhad and Shiraz), who in turn recruited their main female partners. Behavioural data were collected using a standard questionnaire, and blood samples were drawn for HIV and HCV antibody testing and HBV surface antigen. Results HIV prevalence was 9.4% (95% CI 2.96% to 26.2%) among MIDUs (n=226), 7.7% (95% CI 1.9% to 26.3%) among FIDUPs (n=42) and 2.8% (95% CI 0.65% to 11.3%) among FNIDUPs (n=184). HCV prevalence was 38.6% (95% CI 20.3% to 60.7%) among MIDUs, 36.6% (95% CI 13.6% to 67.9%) among FIDUPs and 8.4% (95% CI 5.67% to 12.4%) among FNIDUPs. HBV surface antigen prevalence was 3.6% (95% CI 1.5% to 8.3%), 7.3% (95% CI 1.9% to 24.8%) and 1.1% (95% CI 0.3% to 4.7%), respectively. Among MIDUs, 19.5% (95% CI 3.4% to 62.2%) had a history of sexual contact with other men. Mean age at first sexual contact in MIDUs was 19.2 years (95% CI 18.6 to 25.2) and in FIDUPs and FNIDUPs 16.4 years (95% CI 14.1 to 22.1) and 18.2 years (95% CI 15.7 to 23.1), respectively. FIDUPs and FNIDUPs had a higher mean number of sexual partners (other than their main partner) in the previous month than MIDUs (5.5 (95% CI 0 to 14.1) and 2.5 (95% CI 1.1 to 4) vs 1.3 (95% CI 0.37 to 2.2), respectively). FIDUPs tended to use drugs before or during sex with their main and casual partners more often than MIDUs (with main partner: 69% (95% CI 41.5% to 87.5%) vs 54.4% (95% CI 27% to 79.4%), respectively, and with
Mahapatra, Bidhubhusan; Saggurti, Niranjan
Objective Research on pornography and its association with HIV-related sexual behaviours is limited in India. This study aims to examine the prevalence and correlates of viewing pornographic videos and examine its associations with HIV-related sexual risk behaviours among male migrant workers in India. Methods Data were drawn from a cross-sectional survey conducted in 2007–08 across 21 districts in four states of India. Respondents included 11,219 male migrants aged 18 years or older, who had migrated to at least two places in the past two years for work. Bivariate and multivariate methods were used to examine the association between viewing pornography and HIV-related sexual risk behaviours. Results Two-fifths (40%) of the migrants had viewed pornographic videos in one month prior to the survey. Migrants aged 25–29 years, literate, unmarried and away from native village for more than five years were more likely to view pornography than their counterparts. Migrants who viewed pornographic videos were more likely to engage in paid (Adjusted odds ratio [AOR]: 4.2, 95% confidence interval [CI]: 3.7–4.8) and unpaid sex (AOR: 4.2, 95% CI: 3.7–4.7), report inconsistent condom use in paid sex (AOR: 2.3, 95% CI: 1.7–3.0) and experience STI-like symptoms (AOR: 1.7, 95% CI: 1.5–1.8) than their counterparts. Conclusions The findings regarding migrants' exposure to pornography and its linkage with high HIV risk behaviour suggest that the HIV prevention programmes for migrants need to be more innovative to communicate on the negative-effects of viewing pornography. More importantly, programmes need to find alternative ways to engage migrants in infotainment activities during their leisure time in an effort to reduce their exposure to pornographic videos as well as risky sexual behaviours. PMID:25423311
Polonsky, Maxim; Azbel, Lyuba; Wegman, Martin P; Izenberg, Jacob M; Bachireddy, Chethan; Wickersham, Jeffrey A; Dvoriak, Sergii; Altice, Frederick L
Introduction The expanding HIV epidemic in Azerbaijan and Kyrgyzstan is concentrated among people who inject drugs (PWID), who comprise a third of prisoners there. Detention of PWID is common but its impact on health has not been previously studied in the region. We aimed to understand the relationship between official and unofficial (police harassment) detention of PWID and HIV risk behaviours. Methods In a nationally representative cross-sectional study, soon-to-be released prisoners in Kyrgyzstan (N=368) and Azerbaijan (N=510) completed standardized health assessment surveys. After identifying correlated variables through bivariate testing, we built multi-group path models with pre-incarceration official and unofficial detention as exogenous variables and pre-incarceration composite HIV risk as an endogenous variable, controlling for potential confounders and estimating indirect effects. Results Overall, 463 (51%) prisoners reported at least one detention in the year before incarceration with an average of 1.3 detentions in that period. Unofficial detentions (13%) were less common than official detentions (41%). Optimal model fit was achieved (X2=5.83, p=0.44; Goodness of Fit Index (GFI) GFI=0.99; Comparative Fit Index (CFI) CFI=1.00; Root Mean Square Error of Approximation (RMSEA) RMSEA=0.00; PCLOSE=0.98) when unofficial detention had an indirect effect on HIV risk, mediated by drug addiction severity, with more detentions associated with higher addiction severity, which in turn correlated with increased HIV risk. The final model explained 35% of the variance in the outcome. The effect was maintained for both countries, but stronger for Kyrgyzstan. The model also holds for Kyrgyzstan using unique data on within-prison drug injection as the outcome, which was frequent in prisoners there. Conclusions Detention by police is a strong correlate of addiction severity, which mediates its effect on HIV risk behaviour. This pattern suggests that police may target drug
Coniglio, Maria Anna; Garofalo, Sergio; Giammanco, Giuseppe; Pignato, Sarina
A questionnaire was administered to 160 injection drug users, enrolled in a methadone or buprenorphine maintenance treatment program at their local Drug Addiction Treatment Service (Ser.T), in order to measure their attitudes and risk-taking behaviours towards HIV. Despite being on a maintenance treatment program, almost half of the interviewed subjects (43,75%) declared that they continued to use drugs, occasionally (15,62%), monthly (6,25%), weekly (10,62%) or daily (11,25%). Moreover, a high rate of risk-taking behaviour for HIV was found among the interviewed drug addicts, such as sharing of injection equipment (39,40%), irregular condom use (15,00%) and unprotected sex with casual partners (9,40%). When asked about which interventions they would consider to be most effective for HIV prevention, more than half of the interviewed subjects (58,12%) indicated qualified information regarding HIV transmission, while a lower but not negligible proportion of subjects thought the free distribution of syringes (21,25%) or condoms (20,63%) would be most effective. In contrast to other studies, our results show that pharmacological maintenance treatments may not have a role in preventing HIV infection among injection drug users. On the other hand, our results suggest that the presence, within the Ser.T team, of professional educators specialized in the prevention of sexually transmitted diseases may be more useful.
Davis, Alissa; Best, John; Luo, Juhua; Van Der Pol, Barbara; Dodge, Brian; Meyerson, Beth; Aalsma, Matthew; Wei, Chongyi; Tucker, Joseph D
Background Differences in risk behaviours between men who have sex with men and men who have sex with both men and women have important implications for HIV and STI transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between men who have sex with men and men who have sex with both men and women across China. Methods Participants were recruited through three men who have sex with men-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. Results Men who have sex with both men and women were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to men who have sex with men. Self-reported HIV/STI testing and positivity rates between men who have sex with men and men who have sex with both men and women were similar. Among HIV-infected men who have sex with men, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing men who have sex with men and men who have sex with both men and women. Conclusions Chinese men who have sex with men and men who have sex with both men and women may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese men who have sex with men and men who have sex with both men and women will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours. PMID:26185041
Suzan-Monti, Marie; Lorente, Nicolas; Demoulin, Baptiste; Marcellin, Fabienne; Préau, Marie; Dray-Spira, Rosemary; Lert, France; Spire, Bruno
Introduction People living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load (sUVL) and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT). We aimed to characterize, in a representative sample of French PLHIV, the sexual behaviour of LRT PLHIV compared with non-LRT PLHIV. Methods The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. The LRT PLHIV group included participants with sUVL and no sexually transmitted infection for at least 12 months. Socio-behavioural and medical data were collected. Chi-square tests helped compare sexual risk indicators between LRT and non-LRT PLHIV. The survey's retrospective nature allowed us to perform complementary category-based analyses of LRT PLHIV according to whether they had sUVL for at least 18, 24 or 36 months in three socio-epidemiological groups: men who have sex with men (MSM), other men and women. Results Analysis included 2638 PLHIV diagnosed >12 months with available viral load data. The proportion of LRT PLHIV varied from 58% (≥12 months sUVL) to 38% (≥36 months sUVL). Irrespective of sUVL duration, we found the following: 1) LRT men (MSM and other men) were more likely to report having no sexual partner than their non-LRT counterparts. Among men having sexual partners in the previous 12 months, no significant difference was seen between LRT and non-LRT men in the number of sexual partners. LRT women were less likely to report having more than one sexual partner than non-LRT women; 2) LRT MSM were more likely to report being in sexually inactive couples than their non-LRT counterparts; 3) among sexually active participants, no difference was observed between LRT and non-LRT PLHIV concerning condom use with their serodiscordant steady partner or with their most recent casual sexual partners. Conclusions LRT PLHIV with sUVL ≥12 months did not
The literature shows that there are important differences between women and men in the underlying mechanisms of transmission of HIV infection and AIDS, as well as in the social and economic consequences of HIV/AIDS. These stem from sexual behaviour and socially constructed 'gender' differences between women and men in roles and responsibilities. Despite the fact that numerous gender-related sociocultural factors influence HIV/AIDS protective behaviours, little gender specificity is included in HIV prevention among the elderly. In order to close this gap, this study explored gender-related perceptions of risk of HIV infection among elderly men and women of Ga-Rankuwa in Gauteng Province, South Africa. This qualitative study used purposive sampling to conduct three focus group interviews with 22 women and 10 men who were above 60 years of age. Findings revealed that both genders blame each other for the spreading of HIV/AIDS. Male participants displayed the tendency to have multiple partners, whereas females accepted that males are promiscuous. Mixed perceptions about disclosure of HIV status were found. Condom use was a challenge, as men did not know how to introduce it with their wives, and some female participants indicated that men are resistant to using condoms. The elderly men also believed that women will have sex in exchange for money. It is concluded that there is a need for substantial behaviour change among both elderly males and females, which should address gender power relations. More in-depth and extensive research in this area is recommended.
Pitisuttithum, P; Migasena, S; Laothai, A; Suntharasamai, P; Kumpong, C; Vanichseni, S
Out of 91 volunteers enrolled for the HIV vaccine trial, only 33 volunteers were eligible for vaccination. Of 33 volunteers recruited, 59 per cent of them had incomes of more than 5,000 Baht/ month. The median duration of drug addicts was 15 years (range 1-26 years) and 42 per cent never used condoms during sexual intercourse. As far as consent comprehension was concerned, all of them understood.
Leprêtre, Annie; Ba, Idrissa; Lacombe, Karine; Maynart, Maryvonne; Toufik, Abdalla; Ndiaye, Ousseynou; Kane, Coumba Toure; Gozlan, Joël; Tine, Judicaël; Ndoye, Ibrahim; Raguin, Gilles; Girard, Pierre-Marie
Objectives Data on the extent of drug use and associated HIV, hepatitis C and hepatitis B infection in West Africa are lacking. The objectives of ANRS12244 UDSEN study were to estimate the size of the heroin and/or cocaine drug user (DU) population living in the Dakar area (Senegal), and assess the prevalence and risk factors of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), including behavioural determinants in this population, in order to set up an integrated prevention and treatment programme for DUs. Design and methods A capture-recapture method was applied for population size estimation, whereas the respondent-driven sampling (RDS) method was used to recruit a sample of DUs living in the Dakar area and determine HIV, HBV and HCV prevalence. Behavioural data were gathered during face-to-face interviews, and blood samples were collected on dried blood spots for analysis in a central laboratory. Data analysis was performed using the RDS analysis tool, and risk factors were determined by logistic regression. Access to laboratory results was organized for the participants. Results The size of the DU population in the Dakar area was estimated to reach 1324 (95% confidence interval (95% CI: 1281–1367)). Based on the 506 DUs included in the study, the HIV, HCV and HBV prevalence were 5.2% (95% CI: 3.8–6.3), 23.3% (95% CI: 21.2–25.2) and 7.9% (95% CI: 5.2–11.1), respectively. In people who inject drugs (PWID), prevalence levels increased to 9.4% for HIV and 38.9% for HCV (p=0.001 when compared to those who never injected). Women were more at risk of being HIV infected (prevalence: 13.04% versus 2.97% in males, p=0.001). Being PWID was a risk factor for HCV and HIV infection (odds ratio, OR: 2.7, 95% CI: 1.7–4.3, and OR: 4.3, 95% CI: 1.7–10.7, respectively), whereas older age and female sex were additional risk factors for HIV infection (10% increase per year of age, p=0.03 and OR: 4.9, 95% CI: 1.6–156, respectively). No specific determinant was
Khosropour, Christine M; Sullivan, Patrick S
As the frequency of internet-based research has increased, it is important for researchers to consider how the conditions in which data are collected may influence the risks to participants. In particular, because internet-based data collection often occurs outside a clinical or research setting, there may be unintentional disclosures of a participant's involvement in a research study of which the researcher is unaware. The current analysis examined the responses of men who have sex with men participating in an internet-based HIV behavioural risk study when queried about the possible disclosure of their participation in the study. Fewer than 2% of participants indicated that their participation in the research study was disclosed, and all but one indicated no negative outcomes associated with the disclosure. As the field of online research continues to expand, it is important to consider risks that are unique to internet-based research, and to monitor these risks to ensure that the confidentiality of research subjects is maintained.
Mantell, Joanne E.; LeVasseur, Michael T.; Sun, Xiaoming; Zhou, Jiangfang; Mao, Jingshu; Peng, Yanhui; Zhou, Feng; DiCarlo, Abby L.; Kelvin, Elizabeth A.
China’s rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of STIs, having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings. PMID:26274897
Hussen, Sophia A; Bowleg, Lisa; Sangaramoorthy, Thurka; Malebranche, David J
Black men in the USA experience disproportionately high rates of HIV infection, particularly in the Southeastern part of the country. We conducted 90 qualitative in-depth interviews with Black men living in the state of Georgia and analysed the transcripts using Sexual Script Theory to: (1) characterise the sources and content of sexual scripts that Black men were exposed to during their childhood and adolescence and (2) describe the potential influence of formative scripts on adult HIV sexual risk behaviour. Our analyses highlighted salient sources of cultural scenarios (parents, peers, pornography, sexual education and television), interpersonal scripts (early sex- play, older female partners, experiences of child abuse) and intrapsychic scripts that participants described. Stratification of participant responses based on sexual-risk behaviour revealed that lower- and higher-risk men described exposure to similar scripts during their formative years; however, lower-risk men reported an ability to cognitively process and challenge the validity of risk-promoting scripts that they encountered. Implications for future research are discussed.
Spittal, P M; Bruneau, J; Craib, K J P; Miller, C; Lamothe, F; Weber, A E; Li, K; Tyndall, M W; O'Shaughnessy, M V; Schechter, M T
In Canada, very little is known about the factors and processes that cause drug-related harm among female intravenous drug users (IDUs). Women who inject drugs and participate in the survival sex trade are considered to be at increased risk for sexual and drug-related harms, including HIV infection. Between September 1999 and September 2000, women participating in the VIDUS cohort in Vancouver and the St. Luc Cohort in Montreal completed interviewer-administered questionnaires. Analyses were conducted to compare the demographic characteristics, sexual risk behaviours, risky injection practices and drug use patterns among women who self-identified as participating in the sex trade with those who did not identify as participating in the sex trade. Logistic regression was used to identify factors independently associated with exchanging sex for money or drugs. HIV prevalence at the study visit (September 1999-2000) was 29% for sex trade workers and 29.2% for non-sex trade workers. While patterns of sexual risk were similar, the risky injection practice and drug use patterns between sex trade workers and non-sex trade workers were markedly different. Logistic regression analysis of cross-sectional data revealed that independent behaviours associated with the sex trade included: greater than once per day use of heroin (adjusted OR 2.7), smokeable crack cocaine (adjusted OR = 3.3) and borrowing used syringes (adjusted OR = 2.0). Creative, client-driven interventions are urgently needed for women who trade sex for money or for drugs.
Francis, Suzanna C.; Baisley, Kathy; Lees, Shelley S.; Andrew, Bahati; Zalwango, Flavia; Seeley, Janet; Vandepitte, Judith; Ao, Trong T.; van de Wijgert, Janneke; Watson-Jones, Deborah; Kapiga, Saidi; Grosskurth, Heiner; Hayes, Richard J.
Background Intravaginal practices (IVP) are highly prevalent in sub-Saharan African and have been implicated as risk factors for HIV acquisition. However, types of IVP vary between populations, and detailed information on IVP among women at risk for HIV in different populations is needed. We investigated IVP among women who practice transactional sex in two populations: semi-urban, facility workers in Tanzania who engage in opportunistic sex work; and urban, self-identified sex workers and bar workers in Uganda. The aim of the study was to describe and compare IVP using a daily pictorial diary. Methodology/Principal Findings Two hundred women were recruited from a HIV prevention intervention feasibility study in Kampala, Uganda and in North-West Tanzania. Women were given diaries to record IVP daily for six weeks. Baseline data showed that Ugandan participants had more lifetime partners and transactional sex than Tanzanian participants. Results from the diary showed that 96% of Tanzanian participants and 100% of Ugandan participants reported intravaginal cleansing during the six week study period. The most common types of cleansing were with water only or water and soap. In both countries, intravaginal insertion (e.g. with herbs) was less common than cleansing, but insertion was practiced by more participants in Uganda (46%) than in Tanzania (10%). In Uganda, participants also reported more frequent sex, and more insertion related to sex. In both populations, cleansing was more often reported on days with reported sex and during menstruation, and in Uganda, when participants experienced vaginal discomfort. Participants were more likely to cleanse after sex if they reported no condom use. Conclusions While intravaginal cleansing was commonly practiced in both cohorts, there was higher frequency of cleansing and insertion in Uganda. Differences in IVP were likely to reflect differences in sexual behaviour between populations, and may warrant different approaches to
Uhrig, Jennifer D.; Davis, Kevin C.; Rupert, Doug; Fraze, Jami
Objective: To examine whether there is an association between knowledge, attitudes and beliefs, reported intentions to get an HIV test, and reported HIV testing behaviour at a later date among a sample of African American women. Design: Secondary analysis of data collected from October 2007 through March 2008 for a randomized controlled experiment…
... incidence could be reduced if people changed their sexual behaviors. Our research has demonstrated remarkable success in reducing HIV risk-associated sexual behaviors among African American adolescents and adults." Spring 2008 ...
Kyegombe, Nambusi; Abramsky, Tanya; Devries, Karen M; Starmann, Elizabeth; Michau, Lori; Nakuti, Janet; Musuya, Tina; Heise, Lori; Watts, Charlotte
Introduction Intimate partner violence (IPV) violates women's human rights, and it is a serious public health concern associated with increased HIV risk. SASA!, a phased community mobilization intervention, engages communities to prevent IPV and promote gender equity. The SASA! study assessed the community-level impact of SASA! on reported HIV-related risk behaviours and relationship dynamics. Methods Data were collected as part of a cluster randomized controlled trial conducted between 2007 and 2012 in eight communities in Kampala. An adjusted cluster-level intention to treat analysis, compares secondary outcomes in intervention and control communities at follow-up. The qualitative evaluation explored participants’ subjective experience of SASA!. A total of 82 in-depth interviews were audio recorded at follow-up, transcribed verbatim and analyzed using thematic analysis. Results Men in intervention communities were significantly more likely than controls to report a broad range of HIV-protective behaviours, including higher levels of condom use (aRR 2.03, 95% CI 1.22–3.39), HIV testing (aRR 1.50, 95% CI 1.13–2.00) and fewer concurrent partners (aRR 0.60, 95% CI 0.37–0.97). They were also more likely to report increased joint decision-making (aRR 1.92, 95% CI 1.27–2.91), greater male participation in household tasks (aRR 1.48, 95% CI 1.09–2.01), more open communication and greater appreciation of their partner's work inside (aRR 1.31, 95% CI 1.04–1.66) and outside (aRR 1.49, 95% CI 1.08–2.06) the home. For women, all outcomes were in the hypothesized direction, but effect sizes were smaller. Only some achieved statistical significance. Women in intervention communities were significantly more likely to report being able to refuse sex with their partners (aRR 1.16, 95% CI 1.00–1.35), joint decision-making (aRR 1.37, 95% CI 1.06–1.78) and more open communication on a number of indicators. Qualitative interviews suggest that shifts operated through
Rhodes, S D; Yee, L J; Hergenrather, K C
Because the southeastern USA is experiencing a disproportionate HIV infection rate compared to other regions of the country, we explored HIV behavioural risk disparities by race/ethnicity among self-identifying gay men. Conceived and implemented as a community-based participatory research (CBPR) study, this rapid assessment collected demographic and HIV risk-behaviour data from men in five gay bars in the northwestern part of the state of North Carolina, using an assessment available in English and Spanish. Of 719 participants, 34.8% reported inconsistent condom use during anal intercourse in the past three months, 11.4% reported ever having had a sexually transmitted disease (STD), 3.6% reported being HIV-seropositive and 26% reported illicit drug use during the past 30 days. Compared to white participants, African American/black and Hispanic/Latino participants were more likely to report inconsistent condom use during anal intercourse with multiple partners during the past three months. African American/black participants were more likely to report illicit drug use during the past 30 days. Hispanic/Latino participants were more likely to have never been tested for HIV. Rates of HIV risk behaviours among gay men remain high and racial/ethnic differences indicate the need for targeted and tailored prevention strategies.
Brito, Maximo O; Hodge, David; Donastorg, Yeycy; Khosla, Shaveta; Lerebours, Leonel; Pope, Zachary
Objectives The objectives of this study were to estimate the point prevalence of sexually transmitted infection (STI) and to investigate the sexual practices and behaviours associated with STIs in a group of gay men, other men who have sex with men and transgender women (GMT) in the province of La Romana, Dominican Republic. Design A cross-sectional study of a convenience sample of GMT persons. Setting The study was conducted in the province of La Romana, Dominican Republic, in June–July 2013. Participants Out of 117 GMT persons screened, a total of 100 completed the study. Participants had to be at least 18 years of age, reside in La Romana and have had sex with another man in the preceding 12 months. All participants were interviewed and tested for STI. Primary outcome measure The main outcome of interest was the detection of any STI (HIV, herpes simplex virus type 2 (HSV-2), syphilis, hepatitis B or C) by serology. Results Among 100 participants, the median age was 22 years (range 18–65). One-third had consumed illicit drugs the preceding year and only 43% consistently used condoms. Prevalence was 38% for HSV-2, 5% for HIV and 13% for syphilis. There were no cases of hepatitis B or C. Factors associated with the odds of a STI were age >22 years (OR=11.1, 95% CI 3.6 to 34.5), receptive anal intercourse (OR=4.2, 95% CI 1.3 to 13.6) and having ≥2 male sexual partners during the preceding month (OR=4, 95% CI 1.3 to 12.5). Conclusions In this group of GMT persons, seroprevalence of STI was high, and a number of risk behaviours were associated with STI. These preliminary data will help inform policy and programmes to prevent HIV/STI in GMT persons in the region. PMID:25926151
Maher, L; Phlong, P; Mooney-Somers, J; Keo, S; Stein, E; Page, K
Background Use of amphetamine-type substances (ATS) has been linked to increased risk of HIV and other sexually transmitted infections (STI) worldwide. In Cambodia, recent ATS use is independently associated with incident STI infection among young female sex workers (FSW). Methods We conducted 33 in-depth interviews with women (15–29 years old) engaged in sex work to explore ATS use and vulnerability to HIV/STI. Results Participants reported that ATS, primarily methamphetamine in pill and crystalline forms (yama), were cheap, widely available and commonly used. Yama was described as a “power drug” (thnam kamlang) which enabled women to work long hours and serve more customers. Use of ATS by clients was also common, with some providing drugs for women and/or encouraging their use, often resulting in prolonged sexual activity. Requests for unprotected sex were also more common among intoxicated clients and strategies typically employed to negotiate condom use were less effective. Conclusion ATS use was highly functional for young women engaged in sex work, facilitating a sense of power and agency and highlighting the occupational significance and normalization of ATS in this setting. This highly gendered dynamic supports the limited but emerging literature on women’s use of ATS, which to date has been heavily focused on men. Results indicate an urgent need to increase awareness of the risks associated with ATS use, to provide women with alternative and sustainable options for income generation, to better regulate the conditions of sex work, and to work with FSWs and their clients to develop and promote culturally appropriate harm reduction interventions. PMID:21316935
Katsivo, M N; Muthami, L N
Forty seven women food handlers who were considered to be at high risk of HIV infection in Thika town of Central Province of Kenya were studied. The women were interviewed individually for information related to their social characteristics and sexual behaviour. The study showed that 91% were bar attendants, 58% had less than 7 years of formal education and 95% were either unmarried or divorced. All the women had at least one child. One of them practised anal sex but the rest practised vaginal sex. Their opinions on condom use revealed that they lacked knowledge on the advantages of condom use. Certain issues have been raised by this study, which call for in depth studies or incorporation into ongoing studies.
Ross, M W; Kajubi, P; Mandel, J S; McFarland, W; Raymond, H F
We investigated the relationship of internalized homonegativity/homophobia (IH) to sexual risk behaviours among 216 Ugandan gay and bisexual men, using the 7-item IH scale previously developed on this population. IH was significantly associated with unprotected anal intercourse, and more so with unprotected receptive anal intercourse. Higher IH was also associated with more sex while intoxicated. There was a strong association between anal intercourse of any type and IH, suggesting a complex relationship between anal sex and identification with, or internalization of, homonegativity/homophobia. Specifically, it may be the anal component of sex rather than the sex with another man that is seen as labeling one as homosexual or stigmatizing. Those men who stated that they engaged in sex with other men for love, rather than for the physical feeling or for money, had higher IH scores. These data suggest that there may be an interactive relationship between IH and sexual behaviour, with greater internalization being associated with more stereotypically gay activities, which in turn may lead to more self-identification as gay and thus greater susceptibility to internalization.
Taylor, S. Wade; O’Cleirigh, Conall; Mayer, Kenneth H.; Safren, Steven A.
Men who have sex with men (MSM) comprise the largest risk group of individuals living with HIV in the United States 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
Jayaraman, Gayatri C; Kumar, Shiv; Isac, Shajy; Javalkar, Prakash; Gowda, Pushpalatha Rama Narayana; Raghunathan, N; Gowda, Chandra Shekhar; Bhattacharjee, Parinita; Moses, Stephen; Blanchard, James F
The primary objectives of this study were to assess the changing demographic characteristics of female sex workers (FSWs) in the urban Bangalore district, India, and trends in programme coverage, HIV/sexually transmitted infection prevalence rates and condom use. Cross-sectional, integrated behavioural and biological assessments of FSWs were conducted in 2006, 2009 and 2011. Univariate and multivariate analyses were used to describe trends over time. The results indicate the mean age of initiation into sex work has increased (26.9 years in 2006 vs 27.6 years in 2011, p<0.01), a higher proportion of FSWs reported being in 'stable' relationships in 2011 (70.2% vs 43.2% in 2006, p<0.01) and having conducted sex work outside the district in the past 6 months (10.0% in 2011 vs 16.0% in 2006 p=0.01). There was an increase in the proportion of FSWs using cellphones to solicit clients (4.4% in 2006 vs 57.5% in 2011, p<0.01) and their homes for sex work (61.4% in 2006 vs 77.8% in 2011, p<0.01). Reactive syphilis prevalence declined (12.6% in 2006 to 4% in 2011, p=0.02), as did high-titre syphilis prevalence (9.5% in 2006 to 2.5% in 2011, p=0.01). HIV prevalence declined but not significantly (12.7% in 2006 and 9.3% in 2011, p=0.39). Condom use remained above 90% increasing significantly among repeat (paying) clients (66.6% in 2006 to 93.6% in 2011, p<0.01). However, condom use remained low with non-paying partners when compared with occasional paying partners (17.6% vs 97.2% in 2011, p<0.01). Given the changing dynamics in the FSW population at multiple levels, there is a need to develop and customise strategies to meet local needs.
Riley, Gerard Anthony; Baah-Odoom, Dinah
In the context of social representation theory and the AIDS risk reduction model, it has been claimed that stigmatizing, blaming and stereotyping attitudes make people feel less at risk of contracting HIV/AIDS, and that this, in turn, results in them taking fewer precautions in their sexual behaviour. Previous research has failed to provide convincing evidence to support these claims. The present study provided a test of the claims that addressed some of the methodological issues identified in the earlier research. A sample of 460 young people from Ghana, ranging in age from 15 to 28 years (mean=18), completed a questionnaire that measured the relevant constructs. The results supported the claims in relation to stigmatizing and intended sexual risk behaviour, but not stigmatizing and actual sexual risk behaviour. Although the latter two were correlated, this was not mediated by reduced perceptions of vulnerability. Claims in relation to blaming and stereotyping were not supported. Contrary to expectation, specific blaming and stereotyping attitudes that constructed HIV/AIDS as a sexual disease were associated with safer intended sexual behaviour, and this relationship was mediated by feeling at greater risk.
Musyoki, Helgar; Kellogg, Timothy A; Geibel, Scott; Muraguri, Nicholas; Okal, Jerry; Tun, Waimar; Fisher Raymond, H; Dadabhai, Sufia; Sheehy, Meredith; Kim, Andrea A
We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7-34.9). Median age was 30 years (IQR 25-38 years); median duration of sex work was 12 years (IQR 8-17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4-18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at 'great risk' for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population.
Background The increasing number of people living with HIV aged 50 years and older has been recognised around the world yet non-pharmacologic HIV behavioural and cognitive interventions specifically targeted to older adults are limited. Evidence is needed to guide the response to this affected group. Methods We conducted a systematic review of the available published literature in MEDLINE, Embase and the Education Resources Information Center. A search strategy was defined with high sensitivity but low specificity to identify behavioural interventions with outcomes in the areas of treatment adherence, HIV testing uptake, increased HIV knowledge and uptake of prevention measures. Data from relevant articles were extracted into excel. Results Twelve articles were identified all of which originated from the Americas. Eight of the interventions were conducted among older adults living with HIV and four for HIV-negative older adults. Five studies included control groups. Of the included studies, four focused on general knowledge of HIV, three emphasised mental health and coping, two focused on reduced sexual risk behaviour, two on physical status and one on referral for care. Only four of the studies were randomised controlled trials and seven – including all of the studies among HIV-negative older adults – did not include controls at all. A few of the studies conducted statistical testing on small samples of 16 or 11 older adults making inference based on the results difficult. The most relevant study demonstrated that using telephone-based interventions can reduce risky sexual behaviour among older adults with control reporting 3.24 times (95% CI 1.79-5.85) as many occasions of unprotected sex at follow-up as participants. Overall however, few of the articles are sufficiently rigorous to suggest broad replication or to be considered representative and applicable in other settings. Conclusions More evidence is needed on what interventions work among older adults to
Capili, Bernadette; Anastasi, Joyce K.; Ogedegbe, Olugbenga
The incidence of cardiovascular disease (CVD) is increasing in HIV-infected people. Risk factors such as hyperlipidemia, impaired glucose tolerance, and insulin resistance have become common. CVD in HIV may also be related to non-traditional risk factors including accumulation of visceral fat, inflammation secondary to HIV, and effects of some antiretroviral drugs. This cross-sectional study described the CVD risk factors of 123 adults living with HIV and calculated the 10-year estimate for general cardiovascular risk score. Results showed that approximately 25% of the participants were considered to be at high risk for developing CVD in the next 10 years. Increased waist circumference and longer duration of smoking habit were associated with elevated general cardiovascular risk scores. Similar to the general population, most of the identified risks could be modified through lifestyle management. PMID:21277230
Choon, S E; Sapiah, W; Ismail, Z; Balan, V
A study was conducted in the Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru to determine a local population's knowledge of HIV and their sexual behaviour in relation to it. A total of 231 men and 217 women were interviewed. The sexual culture seen is one of relatively late age of first sexual intercourse, low level of partner change and low level of condom use. Men reported a higher involvement in risk behaviour. Nearly all the respondents (95.8%) have heard of HIV/AIDS but had incorrect perceptions of its mode of transmission and its associations with risk groups. This study enable us to gain background information about our patients sexual behaviour and HIV knowledge. There is a need to continue HIV education to improve our public's HIV knowledge and the results of this study provides a baseline against which future educational interventions can be gauged.
Odek, Willis Omondi; Busza, Joanna; Morris, Chester N; Cleland, John; Ngugi, Elizabeth N; Ferguson, Alan G
This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May-July 2003 and July-August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research.
Velloza, Jennifer; Watt, Melissa H.; Choi, Karmel W.; Abler, Laurie; Kalichman, Seth C.; Skinner, Donald; Pieterse, Desiree; Sikkema, Kathleen J.
Alcohol-serving venues in South Africa are sites for high-risk behaviours that may lead to HIV transmission. Prevention and treatment interventions are sorely needed in these settings, but HIV-related stigma may limit their effectiveness. This study explored expressions of stigma among alcohol-serving venue patrons in Cape Town and examined the potential impact of stigma on HIV disclosure, testing, and treatment-seeking behaviours. A total of 92 in-depth interviews with male and female, Black and Coloured patrons were conducted. Transcripts were analysed via memo-writing and diagramming techniques. Many participants mentioned knowing other patrons living with HIV/AIDS (PLWH), and this visibility of HIV impacted expressions of HIV-related stigma. Participants discussed four forms of HIV-related stigma in the venues: fearing PLWH, fearing HIV acquisition, blaming others for spreading HIV, and isolating PLWH. HIV visibility and expressions of HIV-related stigma, particularly fear of isolation, influenced participants’ willingness to disclose their status. HIV-related stigma in the venues also appeared to indirectly influence testing and treatment-seeking behaviour outside the venue. Results suggest that efforts to change norms and reduce expressions of HIV-related stigma in alcohol-serving venues are necessary to successfully deliver tailored HIV prevention interventions and increase uptake of HIV testing and care in this important social setting. PMID:25630531
Greener, Robert; Sarkar, Swarup
HIV epidemics in Asia have been mainly concentrated among certain population groups such as injecting drug users, sex workers and their clients and men who have sex with men (MSM). HIV risk has also been associated with labour migrants and their partners. Many of the people at risk through these behaviours are very poor, and this raises the question that poverty and social deprivation may be underlying factors that drive the adoption of risk behaviours and can be regarded as 'determinants' of vulnerability to HIV infection in Asia. The study presents some observations of the socioeconomic pattern of HIV spread in Asia, using country-level and household-level data. The discussion then draws tentative conclusions about what is known concerning the mechanisms influencing the risk of HIV acquisition in Asia and what they might imply for programme design and policy. In summary, the data presented here do not support the hypothesis that HIV epidemics in Asia are primarily driven by poverty and social deprivation, though sex inequality and education for women and girls are strongly associated factors. There is clearly a multidimensional relationship between the risk of HIV infection and a host of underlying social and cultural factors that confound any attempt at a single explanation for the HIV epidemic in Asia or elsewhere. There is an undeniable need for further research through multicountry studies and better analysis of existing household data, as well as through further investigation of the quantitative relationship between the barriers to HIV services and the risk of infection. The key message for policy is to seek a broad balance between a focus on prevention and treatment for the higher-risk behaviours without losing sight of the importance of programmes that address vulnerability and behavioural change among the sexually active adult population. The implication of these findings for the allocation of resources for downstream factors such as risk behaviours as
Poteat, Tonia; Wirtz, Andrea L; Radix, Anita; Borquez, Annick; Silva-Santisteban, Alfonso; Deutsch, Madeline B; Khan, Sharful Islam; Winter, Sam; Operario, Don
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
Green, Adam; Kolar, Kat
Social scientific and public health literature on National Institutes of Health-funded HIV behavioural prevention science often assumes that this body of work has a strong biomedical epistemological orientation. We explore this assumption by conducting a systematic content analysis of all NIH-funded HIV behavioural prevention grants for men who have sex with men between 1989 and 2012. We find that while intervention research strongly favours a biomedical orientation, research into the antecedents of HIV risk practices favours a sociological, interpretive and structural orientation. Thus, with respect to NIH-funded HIV prevention science, there exists a major disjunct in the guiding epistemological orientations of how scientists understand HIV risk, on the one hand, and how they engineer behaviour change in behavioural interventions, on the other. Building on the extant literature, we suggest that the cause of this disjunct is probably attributable not to an NIH-wide positivist orientation, but to the specific standards of evidence used to adjudicate HIV intervention grant awards, including randomised controlled trials and other quantitative measures of intervention efficacy.
Coates, Thomas J; Richter, Linda; Caceres, Carlos
This paper makes five key points. First is that the aggregate effect of radical and sustained behavioural changes in a sufficient number of individuals potentially at risk is needed for successful reductions in HIV transmission. Second, combination prevention is essential since HIV prevention is neither simple nor simplistic. Reductions in HIV transmission need widespread and sustained efforts, and a mix of communication channels to disseminate messages to motivate people to engage in a range of options to reduce risk. Third, prevention programmes can do better. The effect of behavioural strategies could be increased by aiming for many goals (eg, delay in onset of first intercourse, reduction in number of sexual partners, increases in condom use, etc) that are achieved by use of multilevel approaches (eg, couples, families, social and sexual networks, institutions, and entire communities) with populations both uninfected and infected with HIV. Fourth, prevention science can do better. Interventions derived from behavioural science have a role in overall HIV-prevention efforts, but they are insufficient when used by themselves to produce substantial and lasting reductions in HIV transmission between individuals or in entire communities. Fifth, we need to get the simple things right. The fundamentals of HIV prevention need to be agreed upon, funded, implemented, measured, and achieved. That, presently, is not the case. PMID:18687459
Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine
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
Bulled, Nicola L
Extensive research over the past 30 years has revealed that individual and social determinants impact HIV risk. Even so, prevention efforts focus primarily on individual behaviour change, with little recognition of the dynamic interplay of individual and social environment factors that further exacerbate risk engagement. Drawing on long-term research with young adults in Lesotho, I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis, I developed novel scales to measure social control, adoption of modernity, and HIV knowledge. In survey research, I examined the effects of individual characteristics (i.e., socioeconomic status, HIV knowledge, adoption of modernity) and social environment (i.e., social control) on HIV risk behaviours. In addition, I measured the impact of altered environments by taking advantage of an existing situation whereby young adults attending a national college are assigned to either a main campus in a metropolitan setting or a satellite campus in a remote setting, irrespective of the environment in which they were socialised as youth. This arbitrary assignment process generates four distinct groups of young adults with altered or constant environments. Regression models show that lower levels of perceived social control and greater adoption of modernity are associated with HIV risk, controlling for other factors. The impact of social control and modernity varies with environment dynamics.
Yang, H; Li, X; Stanton, B; Fang, X; Lin, D; Mao, R; Liu, H; Chen, X; Severson, R
Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in 'stalls' or 'domestic service' tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.
Bennetts, A; Shaffer, N; Phophong, P; Chaiyakul, P; Mock, P A; Neeyapun, K; Bhadrakom, C; Mastro, T D
In a Bangkok antenatal clinic, we interviewed 102 HIV-infected pregnant women and their husbands, 30% of whom were HIV-negative. We evaluated these data by matched and unmatched analysis, compared men and women in stable couple relationships on a number of sociodemographic and risk factor indicators and investigated further whether there were any differences in sociodemographic or risk factor profiles between HIV-serodiscordant couples and seroconcordant couples. When compared to wives, more of the husbands were working (p = 0.001), earning more money (p = 0.001), had had more than two sex partners (p = 0.001) and had had syphilis (p = 0.001). Serodiscordant couples did not differ greatly from seroconcordant couples except that women married to HIV-negative men were more likely to have been divorced or separated than their husbands which was not the case for women married to HIV-positive men (p = 0.02). There was poor agreement between husband and wife reports of husband risk behaviour and this did not differ between concordant and discordant couples. These findings suggest that assessment of risk and counselling of Thai women is incomplete without information on the HIV status and risk behaviour of her partner. Prevention strategies to decrease heterosexual transmission among couples need to target both the man and the woman.
Pao, Vivian; Lee, Grace A.; Grunfeld, Carl
People with HIV infection have metabolic abnormalities that resemble metabolic syndrome (hypertriglyceridemia, low high-density lipoprotein cholesterol, and insulin resistance), which is known to predict increased risk of cardiovascular disease (CVD). However, there is not one underlying cause for these abnormalities and they are not linked to each other. Rather, individual abnormalities can be affected by the host response to HIV itself, specific HIV drugs, classes of HIV drugs, HIV-associated lipoatrophy, or restoration to health. Furthermore, one component of metabolic syndrome, increased waist circumference, occurs less frequently in HIV infection. Thus, HIV infection supports the concept that metabolic syndrome does not represent a syndrome based on a common underlying pathophysiology. As might be predicted from these findings, the prevalence of CVD is higher in people with HIV infection. It remains to be determined whether CVD rates in HIV infection are higher than might be predicted from traditional risk factors, including smoking. PMID:18366987
Bohlin, Margareta C; Erlandsson, Soly I
Adolescents in Western society often expose themselves to high levels of sound in gyms, rock concerts, discotheques etc. As these behaviours are as threatening to young people's health as more traditional risk behaviours are, our aim in the present study was to analyze the relationship between self-exposure to noise, risk behaviours and risk judgements among 310 Swedish adolescents aged 15-20 (167 men; 143 women). Adolescents' behaviour in different traditional risk situations correlated with behaviour in noisy environments, while judgements about traditional risks correlated with judgements regarding noise exposure. It is an interesting finding that although young women judge risk situations as generally more dangerous than young men do, they nevertheless behave in the same way. We suggest that this difference is a social and cultural phenomenon which underscores the importance of adopting a gender perspective in the analysis of risk factors. Adolescents reporting permanent tinnitus judged loud music as more risky than adolescents with no symptoms and they did not listen to loud music as often as those with occasional tinnitus. Research on hearing prevention for young people needs to acknowledge and make use of theories on risk behaviour, especially due to the existence of a relationship between adolescents' risk-taking in noisy environments and other types of risk-taking. Similarly, theories on risk behaviour should acknowledge noise as a risk factor.
Pascoe, Sophie J. S.; Langhaug, Lisa F.; Mavhu, Webster; Hargreaves, James; Jaffar, Shabbar; Hayes, Richard; Cowan, Frances M.
Background Despite a recent decline, Zimbabwe still has the fifth highest adult HIV prevalence in the world at 14.7%; 56% of the population are currently living in extreme poverty. Design Cross-sectional population-based survey of 18–22 year olds, conducted in 30 communities in south-eastern Zimbabwe in 2007. Objective To examine whether the risk of HIV infection among young rural Zimbabwean women is associated with socio-economic position and whether different socio-economic domains, including food sufficiency, might be associated with HIV risk in different ways. Methods Eligible participants completed a structured questionnaire and provided a finger-prick blood sample tested for antibodies to HIV and HSV-2. The relationship between poverty and HIV was explored for three socio-economic domains: ability to afford essential items; asset wealth; food sufficiency. Analyses were performed to examine whether these domains were associated with HIV infection or risk factors for infection among young women, and to explore which factors might mediate the relationship between poverty and HIV. Results 2593 eligible females participated in the survey and were included in the analyses. Overall HIV prevalence among these young females was 7.7% (95% CI: 6.7–8.7); HSV-2 prevalence was 11.2% (95% CI: 9.9–12.4). Lower socio-economic position was associated with lower educational attainment, earlier marriage, increased risk of depression and anxiety disorders and increased reporting of higher risk sexual behaviours such as earlier sexual debut, more and older sexual partners and transactional sex. Young women reporting insufficient food were at increased risk of HIV infection and HSV-2. Conclusions This study provides evidence from Zimbabwe that among young poor women, economic need and food insufficiency are associated with the adoption of unsafe behaviours. Targeted structural interventions that aim to tackle social and economic constraints including insufficient food should
Raiteri, R; Albonico, M; Deiana, R; Marietti, G; Sinicco, A
From September 1987 to February 1990, repeated tests were performed in 325 HIV-1 infected subjects at different clinical stages using a radial immunodiffusion method to determine serum IgD behaviour in HIV-1 infection. Four patients had acute HIV-1 infection, 72 asymptomatic infection, 163 PGL, 49 ARC and 37 AIDS. During the study, 57 seropositive patients developed AIDS. The correlation between serum IgD and the clinical stage of HIV-1 infection, CD4+ and CD8+ lymphocyte levels, CD4+/CD8+ ratio, HIV-1 (p24) antigenemia and reactivity to core proteins, IgG, IgA, IgM isotypes and serum beta 2-microglobulin concentration. A significant correlation was noted between HIV-1 (p24) antigenemia, the disappearance of the antibodies reactivity to core proteins and IgD levels in ARC patients. A progressive increase of serum IgD before the occurrence of the symptomatic stage of HIV-1 infection was observed in HIV-1 infected patients who developed AIDS.
Ingersoll, K S; Van Zyl, C; Cropsey, K L
The purpose of this paper is to report on characteristics of journals that publish manuscripts in the HIV/AIDS behavioural science realm, with the goal of providing assistance to authors seeking to disseminate their work in the most appropriate outlet. Fifty journals who publish behavioural research on HIV/AIDS in English were identified through library and electronic searches. Although ten of the journals focused specifically on HIV/AIDS, the majority of journals are in related fields, including health psychology/behavioural medicine, sexual behaviour, substance abuse, public health/prevention or general medicine. Acceptance rates ranged from 8- 89% with a mean acceptance rate of 39%. Reported review times ranged from 1-12 months with three months the mode, while publication lag following acceptance averages six months. Acceptance rates were related to impact factors, with more selective journals evidencing higher impact factors. The variety of publication outlets available to authors of HIV/AIDS behavioral science studies creates ample opportunity for dissemination, as well as challenge for readers in discerning the quality of published work.
Ramjee, Gita; Moonsamy, Suri; Abbai, Nathlee Samantha; Wand, Handan
We aimed to estimate the individual and joint impact of age, marital status and diagnosis with sexually transmitted infections (STIs) on HIV acquisition among young women at a population level in Durban, KwaZulu-Natal, South Africa. A total of 3,978 HIV seronegative women were recruited for four biomedical intervention trials from 2002–2009. Point and interval estimates of partial population attributable risk (PAR) were used to quantify the proportion of HIV seroconversions which can be prevented if a combination of risk factors is eliminated from a target population. More than 70% of the observed HIV acquisitions were collectively attributed to the three risk factors: younger age (<25 years old), unmarried and not cohabiting with a stable/regular partner and diagnosis with STIs. Addressing these risks requires targeted structural, behavioural, biomedical and cultural interventions in order to impact on unacceptably high HIV incidence rates among young women and the population as a whole. PMID:27104835
Caceres, C; Mendoza, W
Objectives: To review and summarise various types of Peruvian evidence on sexual behaviour, HIV/STI exposure and risk, and discuss how to increase its usefulness for HIV/STI risk trend monitoring in Peru. Methods: Review HIV sentinel surveillance conducted by the Ministry of Health; data from the Demographic and Health Surveys (DHS); and academic publications on sexual behaviour in combination with biological markers. Changes over time, quality of data, size of studies, and intended audience are discussed. Results: Data from HIV sentinel surveillance showed very high (8–23%) HIV seroprevalence among men having sex with men, but stable, relatively low figures among female sex workers (1%) and antenatal clinic patients (under 0.5%). DHS data suggest that single women increased their sexual activity throughout the 1990s but did not raise their contraceptive use accordingly, resulting in increased early conceptions. The contribution of condoms to overall contraceptive protection increased threefold in 1992–2000. According to the 1996 survey, men become sexually active 2.5 years earlier than women, but marry or cohabit four years later than women; women marry or cohabit 1.5–2.5 years after first sex, whereas men take eight years to do so. Finally, published studies confirmed dramatic differences in HIV prevalence between men who have sex with men and other populations, and also suggested patterns of bridging from men to women. Conclusions: Data available from the three sources are numerous, although limitations of each approach reduce their monitoring utility: Ministry of Health studies should select better sentinel populations and timely process behavioural data. Future demographic surveys should incorporate an AIDS risk perspective and include men. PMID:15572646
Izenberg, Jacob; Bachireddy, Chethan; Wickersham, Jeffrey A.; Soule, Michael; Kiriazova, Tetiana; Dvoriak, Sergii; Altice, Frederick L.
Background In Ukraine, HIV-infection, injection drug use, and incarceration are syndemic; however, few services are available to incarcerated people who inject drugs (PWIDs). While data are limited internationally, within-prison drug injection (WP-DI) appears widespread and may pose significant challenges in countries like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI has not been specifically examined among HIV-infected prisoners, the only persons that can transmit HIV. Methods A convenience sample of 97 HIV-infected adults recently released from prison within 1–12 months was recruited in two major Ukrainian cities. Post-release surveys inquired about WP-DI and injection equipment sharing, as well as current and prior drug use and injection, mental health, and access to within-prison treatment for HIV and other comorbidities. Logistic regression identified independent correlates of WP-DI. Results Complete data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of 4.4 (range 0–30) other injectors per needle/syringe. Independent correlates of WP-DI were recruitment in Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07, p=0.006), and active pre-incarceration opioid use (AOR 8.66, p=0.005). Conclusions Among these recently released HIV-infected prisoners, WP-DI and injection equipment sharing were frequent and involved many injecting partners per needle/syringe. The overwhelming majority of respondents reporting WP-DI used opioids both before and after incarceration, suggesting that implementation of evidence-based harm reduction practices, such as opioid substitution therapy and/or needle/syringe exchange programs within prison, is crucial to addressing continuing HIV transmission among PWIDs within prison settings. The positive correlation between Kyiv site and WP-DI suggests that additional structural interventions may be useful. PMID
Background Data on knowledge, attitudes, behaviour and practices (KABP) of persons with recent HIV infection compared to controls with negative HIV test result provide information on current risk patterns and can help to re-focus HIV prevention strategies. Methods From March 2008 through May 2010, persons newly diagnosed with HIV (cases) and HIV-negative controls were recruited by physicians in Germany. To distinguish recent (< 5 months) from longstanding (> 5 months) infection, dried blood spots from people newly diagnosed with HIV were tested with the BED IgG-capture ELISA. Cases and controls completed a KABP-questionnaire. We compared cases with recent infection and controls among men having sex with men (MSM) regarding reported risk behaviour in the previous 6 months. To detect differences, unadjusted Odds Ratios (OR) were calculated and multivariate analysis was performed. Results Cases and controls did not differ in terms of knowledge on transmission risks, HIV testing frequency, partnership status, or regarding the frequency of any unprotected sex with partners known to be HIV-positive or assumed to be HIV-negative. Cases more often reported a shorter duration of partnership (< 6 months) with a primary partner than controls (OR = 3.9; p = 0.003) and indicated lower rates of condom use outside of primary relationships, with acquaintances (OR = 2.5; p = 0.01), and with persons met online (OR = 4.5; p = 0.04). Unprotected sex with persons of unknown HIV-serostatus was more often indicated by cases than controls (OR = 3.0; p = 0.003). Having a conversation about HIV serostatus before having sex was associated with a lower risk of infection (OR = 0.2; p = 0.01). In multivariate analysis “being always safe” (always using a condom when having sex in different situations outside of a relationship) and talking about serostatus before sex (OR = 0.23; p = 0.004; OR = 0.14; p = 0.014) were negatively
Westreich, Daniel; Cates, Jordan; Cohen, Mardge; Weber, Kathleen M.; Seidman, Dominika; Cropsey, Karen; Wright, Rodney; Milam, Joel; Young, Mary A.; Mehta, C. Christina; Gustafson, Deborah R.; Golub, Elizabeth T.; Fischl, Margaret A.; Adimora, Adaora A.
Objective: Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. Design: We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014. Methods: We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach. Results: Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9–27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0–19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. Conclusion: Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant. PMID:27902507
Shisana, Olive; Risher, Kathryn; Celentano, David D; Zungu, Nompumelelo; Rehle, Thomas; Ngcaweni, Busani; Evans, Meredith G B
South Africa has experienced declining marriage rates and the increasing practice of cohabitation without marriage. This study aims to improve the understanding of the relationship between marital status and HIV in South Africa, an HIV hyperendemic country, through an analysis of findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The nationally representative population-based cross-sectional survey collected data on HIV and socio-demographic and behavioural determinants in South Africa. This analysis considered respondents aged 16 years and older who consented to participate in the survey and provided dried blood spot specimens for HIV testing (N = 17,356). After controlling for age, race, having multiple sexual partners, condom use at last sex, urban/rural dwelling and level of household income, those who were married living with their spouse had significantly reduced odds of being HIV-positive compared to all other marital spouses groups. HIV incidence was 0.27% among respondents who were married living with their spouses; the highest HIV incidence was found in the cohabiting group (2.91%). Later marriage (after age 24) was associated with increased odds of HIV prevalence. Our analysis suggests an association between marital status and HIV prevalence and incidence in contemporary South Africa, where odds of being HIV-positive were found to be lower among married individuals who lived with their spouses compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socio-economic status, low social cohesion and the resulting destabilization of sexual relationships may explain the increased risk of HIV among unmarried populations, it is necessary to address structural issues including poverty that create an environment unfavourable to stable sexual relationships.
Shisana, Olive; Risher, Kathryn; Celentano, David D; Zungu, Nompumelelo; Rehle, Thomas; Ngcaweni, Busani; Evans, Meredith GB
Recently, South Africa has experienced declining marriage rates and the increasing practice of cohabitation without marriage. This study aims to improve the understanding of the relationship between marital status and HIV in South Africa, an HIV hyperendemic country, through an analysis of findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The nationally representative population-based cross-sectional survey collected data on HIV and socio-demographic and behavioural determinants in South Africa. This analysis considered respondents aged 16 years and older who consented to participate in the survey and provided dried blood spot specimens for HIV testing (N=17,356). After controlling for age, race, having multiple sexual partners, condom use at last sex, urban/rural dwelling and level of household income, those who were married living with their spouse had significantly reduced odds of being HIV positive compared to all other marital status groups. HIV incidence was 0.27% among respondents who were married living with their spouses; the highest HIV incidence was found in the cohabiting group (2.91%). Later marriage (after age 24) was associated with increased odds of HIV prevalence. Our analysis suggests an association between marital status and HIV prevalence and incidence in contemporary South Africa, where odds of being HIV positive were found to be lower among married individuals who lived with their spouse compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socioeconomic status, low social cohesion and the resulting destabilization of sexual relationships may explain the increased risk of HIV among unmarried populations, it is necessary to address structural issues including poverty that create an environment unfavourable to stable sexual relationships. PMID:26551532
Schulkind, Jasmine; Mbonye, Martin; Watts, Charlotte; Seeley, Janet
Abstract This paper explores the interaction between gender-based violence and alcohol use and their links to vulnerability to HIV-infection in a population of women and their regular male partners in Kampala, Uganda. Data derive from 20 life history interviews (10 women and 10 men). Participants were drawn from a cohort of women at high risk of sexually transmitted infection (including HIV). Six of the women were current or former sex workers. Findings reveal that life histories are characterised by recurrent patterns of gender inequity related to violence, limited livelihood options and socioeconomic disadvantage. Overall, findings suggest women are able to negotiate safer sex and protect themselves better against abuse and violence from clients than from their intimate partners, although the status of men as ‘client’ or ‘partner’ is transitory and fluid. Among male respondents, alcohol led to intimate partner violence and high levels of sexual-risk taking, such as engagement with sex workers and reduced condom use. However, male partners are a heterogeneous group, with distinct and contrasting attitudes towards alcohol, condom use and violence. Actions to address gender-based violence need to be multi-pronged in order to respond to different needs and circumstances, of both women and men. PMID:26786739
Dipeolu, I. O.
Background Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV and AIDS) constitutes one of the major challenges to development worldwide. Actions taken by employers of labour against staff or applicants living with HIV have great impacts in the labour force and in the fight to mitigate the impact of the disease condition. In Nigeria, there's paucity of documented work about employers of labour's behavioural intentions when they are faced with staff/applicant living with the virus. This study explored the behavioural antecedents and intentions of employers of labour in Ibadan North Local Government Area, Oyo state, Nigeria. Methods The study was cross-sectional survey in design. A multistage sampling technique was used to select 400 study respondents (38 public and 362 private sectors) for interview. The instrument for data collection was a pre-tested semi–structured questionnaire. Attitude was categorised as negative (score ≤ 54) and positive (score ≥55). Data were analysed and presented using descriptive and inferential statistics. Results There were more males (68.2%) respondents than females (31.8%). A large majority, 79.0%, in the public sector (PuS) and 72.9% in the private sector (PrS) knew that an infected healthy looking person could harbour and transmit HIV to others. A majority, 80.0%, of which 2.3% with no formal education, 1.0% primary education, 13.5% high school education, 41.5% bachelor, 21.0% postgraduate and 0.8% with other qualifications were of the view that workers infected with HIV should not be sacked. Slightly less than half (48.0%) would keep their staff's HIV status secret while more than half, 57.0%, would not recruit a PLWHA. More PrS respondents (47.8%) claimed to have ever organised HIV/AIDS-related educational programmes for staff than PuS (42.1%) (p<0.05). Almost equal respondents (PuS 36.8%) and (PrS 36.2%) would require mandatory test for HIV before employment. Only 1.8% (PuS) and 6% (PrS) reported that
Feng, Yingbin; Wu, Peng
The purpose of this study was to test whether the construction workers have the tendency of engaging in risk compensation behaviours, and identify the demographic variables, which may influence the extent to which the construction workers may show risk compensation behaviours. Both quantitative (survey) and qualitative (interviews) approaches were used in this study. A questionnaire survey was conducted with all the construction workers on three building construction sites of a leading construction company in Australia. Semi-structured interviews were then conducted to validate the findings of the quantitative research. The findings indicate that workers tend to show risk compensation behaviours in the construction environment. The workers with more working experience, higher education, or having never been injured at work before have a higher tendency to show risk compensation in their activities than the others. The implication is that contractors need to assess the potential influence of workers' risk compensation behaviours when evaluating the effect of risk control measures. It is recommended that supervisors pay more attention to the behavioural changes of those workers who have more experience, higher education, and have never been injured before after the implementation of new safety control measures on construction site.
Beauclair, Roxanne; Helleringer, Stéphane; Hens, Niel; Delva, Wim
Patterns of age differences between sexual partners – “age-mixing” – may partially explain the magnitude of HIV epidemics in Sub-Saharan Africa. However, evidence of age-disparity as a risk factor for HIV remains mixed. We used data from a socio-centric study of sexual behaviour in Malawi to quantify the age-mixing pattern and to find associations between relationship characteristics and age differences for 1,922 participants. Three age difference measures were explored as predictors of prevalent HIV infection. We found that for each year increase in male participant age, the average age difference with their partners increased by 0.26 years, while among women it remained approximately constant around 5 years. Women in the study had larger within-individual variation in partner ages compared to men. Spousal partnerships and never using a condom during sex were associated with larger age differences in relationships of both men and women. Men who were more than five years younger than their partners had 5.39 times higher odds (95% CI: 0.93–31.24) of being HIV-infected than men 0–4 years older. The relationship between HIV-infection and age-asymmetry may be more complex than previously described. The role that women play in HIV transmission should not be under-estimated, particularly in populations with large within-individual variation in partner ages. PMID:27805053
McCord, Laneshia R
Understanding sexual-risk behaviours as defined by a culture presents new challenges for human service professionals. Older African American women constitute the fastest growing group of new cases of HIV in the USA. With heterosexual sex as the primary mode of transmission among this group, there exist minimal programmes that are culture and age-specific in terms of primary and secondary prevention. In an attempt to address this gap in knowledge, this study examined how a group of older African American women defined sexual-risk behaviour. A focus group was conducted with seven women age 45 and older, who were recruited from a community centre. This paper examines the way that sexual-risk behaviour was defined through thematic analysis and conceptualises the locus of sexual risk behaviour as defined by the participants. The major theme of the study was social prescription, how to behave sexually as an ageing adult. Underlying ideas that arose were that unprotected sex occurred out of habit, that impulsivity was associated with risky sex and that older women needed to be aware of warning signs and behaviours of potential mates. Micro- and macro-level implications for human service professionals are discussed.
Rogers, Anna Joy; Achiro, Lillian; Bukusi, Elizabeth A; Hatcher, Abigail M; Kwena, Zachary; Musoke, Pamela L; Turan, Janet M; Weke, Elly; Darbes, Lynae A
Introduction HIV infection is frequently transmitted within stable couple partnerships. In order to prevent HIV acquisition in HIV-negative couples, as well as improve coping in couples with an HIV-positive diagnosis, it has been suggested that interventions be aimed at strengthening couple relationships, in addition to addressing individual behaviours. However, little is known about factors that influence relationships to impact joint decision-making related to HIV. Methods We conducted qualitative in-depth interviews with 40 pregnant women and 40 male partners in southwestern Kenya, an area of high HIV prevalence. Drawing from the interdependence model of communal coping and health behaviour change, we employed thematic analysis methods to analyze interview transcripts in Dedoose software with the aim of identifying key relationship factors that could contribute to the development of a couples-based intervention to improve health outcomes for pregnant women and their male partners. Results In accordance with the interdependence model, we found that couples with greater relationship-centred motivations described jointly engaging in more health-enhancing behaviours, such as couples HIV testing, disclosure of HIV status, and cooperation to improve medication and clinic appointment adherence. These couples often had predisposing factors such as stronger communication skills and shared children, and were less likely to face potential challenges such as polygamous marriages, wife inheritance, living separately, or financial difficulties. For HIV-negative couples, joint decision-making helped them face the health threat of acquiring HIV together. For couples with an HIV-positive diagnosis, communal coping helped reduce risk of interspousal transmission and improve long-term health prospects. Conversely, participants felt that self-centred motivations led to more concurrent sexual partnerships, reduced relationship satisfaction, and mistrust. Couples who lacked
Stephenson, J; Imrie, J; Davis, M; Mercer, C; Black, S; Copas, A; Hart, G; Davidson, O; Williams, I
Background/objective: There is concern that use of highly active antiretroviral therapy (HAART) may be linked to increased sexual risk behaviour among homosexual men. We investigated sexual risk behaviour in HIV positive homosexual men and the relation between use of HAART and risk of HIV transmission. Methods: A cross sectional study of 420 HIV positive homosexual men attending a London outpatient clinic. Individual data were collected from computer assisted self interview, STI screening, and clinical and laboratory databases. Results: Among all men, sexual behaviour associated with a high risk of HIV transmission was commonly reported. The most frequently reported type of partnership was casual partners only, and 22% reported unprotected anal intercourse with one or more new partners in the past month. Analysis of crude data showed that men on HAART had fewer sexual partners (median 9 versus 20, p=0.28), less unprotected anal intercourse (for example, 36% versus 27% had insertive unprotected anal intercourse with a new partner in the past year, p=0.03) and fewer acute sexually transmitted infections (33% versus 19%, p=0.004 in the past 12 months) than men not on HAART. Self assessed health status was similar between the two groups: 72% on HAART and 75% not on HAART rated their health as very or fairly good, (p=0.55). In multivariate analysis, differences in sexual risk behaviour between men on HAART and men not on HAART were attenuated by adjustment for age, time since HIV infection. CD4 count and self assessed health status. Conclusion: HIV positive homosexual men attending a London outpatient clinic commonly reported sexual behaviour with a high risk of HIV transmission. However, behavioural and clinical risk factors for HIV transmission were consistently lower in men on HAART than men not on HAART. Although use of HAART by homosexual men with generally good health is not associated with higher risk behaviours, effective risk reduction interventions targeting
Mathiti, V; Simbayi, L C; Jooste, S; Kekana, Q; Nibe, X P; Shasha, L; Bidla, P; Magubane, P; Cain, D; Cherry, C; Kalichman, S C
South Africa urgently needs HIV prevention interventions that can be disseminated for use in clinical and community settings. A brief theory-based HIV risk reduction counselling intervention originally developed in the USA has recently been adapted for use in a South African sexually transmitted infection clinic. The 60-minute risk reduction counselling intervention was grounded in the Information-Motivation-Behavioural Skills (IMB) model of HIV preventive behaviour change, adapted through a series of interdisciplinary collaborative workshops. This paper reports the process of developing and culturally adapting the brief risk reduction counselling intervention. The processes used for adapting the HIV risk reduction counselling for South Africa provides a potential model for conducting technology transfer activities with other HIV prevention interventions. Several lessons learned from this process may help guide future efforts to transfer HIV prevention technologies.
Saxton, Peter; Dickson, Nigel; Hughes, Anthony
Repeated behavioural surveillance should sample all epidemiologically relevant subgroups to provide a complete picture of trends in HIV risk behaviours. Web-based recruitment has been mooted but little empirical data exist on country experiences. We describe who is omitted from three rounds of a conventional offline-only surveillance programme among men who have sex with men (MSM) 2006-2011, but recruited subsequently on Internet dating sites, and the implications of this for understanding trends. The latter were younger, less gay identified and less gay community attached. Importantly, they reported different partnering patterns, lower condom use with casual and fuckbuddy-type male partners, and lower rates of HIV testing, compared to MSM routinely captured in offline surveillance. The replacement of offline socio-sexual activity by the Internet among many MSM means that current venue-based surveillance systems may underestimate risk behaviours, overlook trends among unsampled online MSM, and misinterpret trends observed in sampled MSM due to "sample drift" of most-at-risk MSM.
O'Sullivan, Lucia F.; Dolezal, Curtis; Brackis-Cott, Elizabeth; Traeger, Lara; Mellins, Claude A.
Little is known about how mothers living with HIV communicate to their children about HIV risk. The current study explored communication between mothers and children about prevention and risk behaviors, the impact of maternal HIV infection and child knowledge of HIV, and concordance in reports from mothers and their children. The sample comprised…
Cederbaum, Julie A; Hutchinson, M Katherine; Duan, Lei; Jemmott, Loretta S
Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.
Mnguni, Lindelani; Abrie, Mia; Ebersohn, Liesel
Debates on the role of scientific knowledge to affect behaviour are continuing. The theory of planned behaviour suggests that behaviour is influenced by attitudes, subjective norms and perceived behavioural control and not by knowledge. However, a large body of knowledge argues that increased HIV/AIDS-related knowledge leads to the adoption of…
Roberts, Amanda J; Maung, Ricky; Sejbuk, Natalia E; Ake, Christopher; Kaul, Marcus
The use of drugs for recreational purposes, in particular Methamphetamine, is associated with an increased risk of infection with human immunodeficiency virus (HIV)-1. HIV-1 infection in turn can lead to HIV-associated neurological disorders (HAND) that range from mild cognitive and motor impairment to HIV-associated dementia (HAD). Interestingly, post mortem brain specimens from HAD patients and transgenic (tg) mice expressing the viral envelope protein gp120 in the central nervous system display similar neuropathological signs. In HIV patients, the use of Methamphetamine appears to aggravate neurocognitive alterations. In the present study, we injected HIV/gp120tg mice and non-transgenic littermate control animals with Methamphetamine dissolved in Saline or Saline vehicle and assessed locomotion and stereotyped behaviour. We found that HIVgp120-transgenic mice differ significantly from non-transgenic controls in certain domains of their behavioural response to Methamphetamine. Thus this experimental model system may be useful to further study the mechanistic interaction of both the viral envelope protein and the psychostimulant drug in behavioural alterations and neurodegenerative disease.
Friedman, S R; Neaigus, A; Jose, B; Curtis, R; Goldstein, M; Ildefonso, G; Rothenberg, R B; Des Jarlais, D C
OBJECTIVES: This study examined whether networks of drug-injecting and sexual relationships among drug injectors are associated with individual human immunodeficiency virus (HIV) serostatus and with behavioral likelihood of future infection. METHODS: A cross-sectional survey of 767 drug injectors in New York City was performed with chain-referral and linking procedures to measure large-scale (sociometric) risk networks. Graph-theoretic algebraic techniques were used to detect 92 connected components (drug injectors linked to each other directly or through others) and a 105-member 2-core within a large connected component of 230 members. RESULTS: Drug injectors in the 2-core of the large component were more likely than others to be infected with HIV. Seronegative 2-core members engaged in a wide range of high-risk behaviors, including engaging in risk behaviors with infected drug injectors. CONCLUSIONS: Sociometric risk networks seem to be pathways along which HIV travels in drug-injecting peer groups. The cores of large components can be centers of high-risk behaviors and can become pockets of HIV infection. Preventing HIV from reaching the cores of large components may be crucial in preventing widespread HIV epidemics. PMID:9279263
Hargreaves, James R; Delany-Moretlwe, Sinead; Hallett, Timothy B; Johnson, Saul; Kapiga, Saidi; Bhattacharjee, Parinita; Dallabetta, Gina; Garnett, Geoff P
Theories of epidemiology, health behaviour, and social science have changed the understanding of HIV prevention in the past three decades. The HIV prevention cascade is emerging as a new approach to guide the design and monitoring of HIV prevention programmes in a way that integrates these multiple perspectives. This approach recognises that translating the efficacy of direct mechanisms that mediate HIV prevention (including prevention products, procedures, and risk-reduction behaviours) into population-level effects requires interventions that increase coverage. An HIV prevention cascade approach suggests that high coverage can be achieved by targeting three key components: demand-side interventions that improve risk perception and awareness and acceptability of prevention approaches; supply-side interventions that make prevention products and procedures more accessible and available; and adherence interventions that support ongoing adoption of prevention behaviours, including those that do and do not involve prevention products. Programmes need to develop delivery platforms that ensure these interventions reach target populations, to shape the policy environment so that it facilitates implementation at scale with high quality and intensity, and to monitor the programme with indicators along the cascade.
Mindry, Deborah L; Knight, Lucia; van Rooyen, Heidi
Various interventions have resulted in increased rates of HIV testing. However, encouraging men to acknowledge their risk for HIV, to test and link to treatment remains a challenge. In this study, we examine men's perspectives on navigating HIV risk in rural KwaZulu-Natal, South Africa. Qualitative interviews were conducted at four intervals over a three-year time period with a baseline cohort of 126 men and women. We found that men navigated HIV risk in their sexual relationships mainly by monitoring their partner's behaviour. Men expressed concerns about female respectability, invoking discourses on hlonipha rooted in Zulu cultural ideals and Christian ideals about women staying close to home. In the post-apartheid era, these concerns were inflected by anxieties over changing gender norms and the high rates and risks of infection in the region. HIV prevention discourses on behaviour intersected with men's efforts to assert their masculinity through the monitoring and controlling of women's behaviour. The potential negative impacts of this should be addressed. Prevention efforts need to focus on men's vulnerability to infection in terms of their own behaviour as well as the contexts in which they live.
The 11th U.S. Circuit Court of Appeals upheld Alabama's policy of segregating inmates by HIV status. The Alabama prison system tests all entering inmates; those who are HIV-positive are sent to one of two facilities. A range of prison services, including vocational training and sports competitions is often denied to them. The Department of Corrections argued that this policy has led to one of the lowest seroconversion rates of any State correctional system. The Court's ruling is a shift in its attitude on "significant" risk of HIV transmission in disallowing people from participation in employment, public services, or public accommodations. Rulings in dissenting cases are reviewed. The American Civil Liberties Union, representing the HIV-positive inmates, called the policy of segregating inmates blatant discrimination.
Tung, Wei-Chen; Hu, Jie; Efird, Jimmy Thomas; Yu, Liping; Su, Wei
Objectives: To assess the knowledge, attitudes, sources of HIV information and behaviours related to HIV, and to explore the difference in the HIV knowledge and attitudes between genders and school years among college students in China. Design: Descriptive, cross-sectional. Setting: 475 college students from two universities in China. Method: Data…
Kakoko, Deodatus Conatus; Astrøm, A N; Lugoe, Wycliffe L; Lie, Gro T
The theory of planned behaviour (TPB) provides a conceptual model for understanding individual cognitions that influence behavioural intentions and enactment of the actual behaviours. This study examined the applicability of the TPB and the additional predictive role of perceived risk in predicting intended use of voluntary HIV counselling and testing (VCT) services. We conducted a cross-sectional questionnaire survey among 918 primary school teachers in the Mwanza region, Tanzania between September 2003 and November 2003. Analysis was based on 737 teachers (mean age 38.9) who had never tested for HIV. Results of the hierarchical regression analysis indicate that perceived behavioural control and attitude toward using VCT services were significant predictors of intention to use VCT services in the TPB model. Perceived behavioural control added 12% of variance to intention over and above attitudes and subjective norms, while perceived risk added 3% of variance. Socio-economic status did not moderate the predictive value of the TPB components. The present study demonstrates that the TPB is a useful conceptual framework for predicting intended use of HIV counselling and testing services among Tanzanian teachers. A theory-based VCT intervention programme among Tanzanian teachers should mainly focus on reducing social and psychological barriers related to the use of VCT services.
Nguyen, Nam T; Keithly, Sarah C
Understanding HIV-related behaviours and the factors that influence these behaviours among people living with HIV (PLHIV) is critical to the design of effective HIV-prevention strategies; however, this subject has yet to receive the attention it deserves in Vietnam. Given that greater proportions of new HIV infections in the country stem from heterosexual transmission, it is essential to examine the sexual behaviours of Vietnamese PLHIV. The purpose of this qualitative study was to explore the sexual behaviour of individuals following HIV diagnosis and to gain insight into how and why HIV diagnosis affects sexual practices and relationships. Seventy PLHIV in Thaibinh province participated in semi-structured, in-depth interviews. Qualitative data were supported by a quantitative questionnaire on demographics and sexual and drug use history. Nearly all of the participants reported adopting safer sexual practices following HIV diagnosis by using condoms consistently and reducing the number of sex partners. This was true for injecting drug users, female sex workers, unmarried individuals and participants in both HIV serodiscordant and seroconcordant marriages. Motivations for adopting these preventive measures included avoiding HIV transmission, reinfection or cross-resistance as well as preservation of one's own health. Due to stigma, depression, fear of transmission, health status and/or drug addiction, HIV diagnosis dramatically impacted the sexual health of most participants by reducing sexual desire, pleasure and frequency. Implications for HIV prevention and care programmes and policies in Vietnam are discussed.
Newman, Peter A.; Seiden, Danielle S.; Roberts, Kathleen J.; Kakinami, Lisa; Duan, Naihua
Existing knowledge and beliefs related to HIV vaccines provide an important basis for the development of risk communication messages to support future HIV vaccine dissemination. This study explored HIV vaccine mental models among adults from segments of the population disproportionately affected by HIV/AIDS. Nine focus groups were conducted with…
Donovan, B; Rohrsheim, R; Bassett, I; Mulhall, B P
OBJECTIVE--To determine the incidence of bullous impetigo in a group of homosexual men at high risk of HIV-1 infection. DESIGN--A longitudinal descriptive study (1984-9). SETTING--A private primary care and STD clinic in Sydney, Australia. SUBJECTS--88 homosexual men documented to seroconvert to HIV-1, and 37 homosexual controls who had practised unprotected anal intercourse with another man known to be HIV-1 positive but who remained HIV-1 negative. MAIN OUTCOME MEASURE--Incidence of bullous impetigo. RESULTS--The crude annual incidence of bullous impetigo was 0.015 in subjects while they remained HIV-1 negative (10 cases) and 0.045 in early HIV-1 positive subjects (2 cases). Overall, 9% of the HIV-1 seroconverters and 9% of the HIV-1 negative controls were documented as suffering bullous impetigo over a mean of 29.2 and 39.3 months, respectively. CONCLUSIONS--Bullous impetigo in an adult could prove to be a clinical indication that a person is either infected with HIV-1 or is in close (possibly sexual) contact with a person with HIV-1 infection. If true, the recognition of bullous impetigo could provide an opportunity for behavioural intervention to limit the spread of HIV-1. Images PMID:1607190
Baruth, M.; Addy, C. L.; Wilcox, S.; Dowda, M.
Objectives: Individuals may engage in more than one risk behaviour at any given time. The extent to which risk behaviours cluster among African American adults has been largely unexplored. This study examined the prevalence and clustering of three risk behaviours among African American church members: smoking; low moderate-to-vigorous intensity…
Hart, G J; Carvell, A L; Woodward, N; Johnson, A M; Williams, P; Parry, J V
From November 1987 to October 1988, numbers of clients, visits made and syringes dispensed and returned were monitored at the needle exchange of the Middlesex Hospital, London, UK. A sample of clients were interviewed 1 month after entry to the scheme and again 3 months later to evaluate changes in injecting and sexual risk behaviours for HIV infection. Clients were asked to donate saliva for anti-HIV immunoglobulin G (IgG) antibody capture radioimmunoassay (GACRIA). The rate of lending and borrowing used injecting equipment fell, both compared with rates prior to entry to the scheme and during the period of study. Frequency of injecting did not increase and there was reduced incidence of abscesses. There was a highly significant correlation between multiple sexual partners and condom use and a reduction in the proportion of clients with multiple partners. On entry to the study, seven out of 121 (6%) clients were anti-HIV positive; after 3 months, a further two clients tested were found to be anti-HIV positive. Anti-HIV positivity prevalence for the year of study was nine out of 121 (7%). The scheme attracts clients, reduces injecting-related risk for HIV infection and has high equipment return rates. Saliva testing is acceptable to clients. Continued monitoring of anti-HIV in saliva is indicated.
Wallins, Amy; Toledo, Lauren; Murray, Ashley; Gaul, Zaneta; Sutton, Madeline Y.; Gillespie, Scott; Leong, Traci; Graves, Chanda; Chakraborty, Rana
Abstract Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18–24 years, from Atlanta, GA. We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined transcribed focus group responses on HIV education, contributors to HIV transmission, and pre-sex HIV status disclosure. The 68 participants had the following characteristics: mean age 21.5 years (standard deviation: 1.8 years), 85% male, 90% black, 68% HIV-infected. HIV risk behaviors included the perception of condomless sex (Likert scale mean: 8.0) and transactional sex (88% of participants); no differences were noted by HIV status. Qualitative analyses revealed two main themes: (1) HIV risk factors among AYAs, and (2) barriers to discussing HIV status before sex. Participants felt the use of social media, need for immediate gratification, and lack of concern about HIV disease were risk factors for AYAs. Discussing HIV status with sex partners was uncommon. Key reasons included: fear of rejection, lack of confidentiality, discussion was unnecessary in temporary relationships, and disclosure negatively affecting the mood. HIV prevention strategies for AYAs should include improving condom use frequency and HIV disclosure skills, responsible utilization of social media, and education addressing HIV prevention including the risks of transactional sex. PMID:26588663
Meade, Christina S.; Bevilacqua, Lisa A.; Key, Mary D.
This study examined HIV transmission risk behavior among 63 patients with bipolar disorder (BD), major depressive disorder (MDD), and no mood disorder (NMD); half had substance use disorders (SUDs). Patients with BD were more likely than others to report unprotected intercourse with HIV-negative partners and < 95% adherence to antiretroviral medications. In multivariate models, BD and SUD were independent predictors of both risk behaviors. Participants with poorer medication adherence were more likely to have detectable HIV viral loads and unprotected intercourse with HIV-negative partners. Patients with BD deserve careful evaluation and HIV prevention services to reduce HIV transmission risk behaviors. PMID:22614744
Graves, Susannah K; Little, Susan J; Hoenigl, Martin
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing.
Graves, Susannah K.; Little, Susan J.; Hoenigl, Martin
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 –July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25–49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing. PMID:28165056
Chow, Eric P. F.; Lau, Joseph T. F.; Zhang, Xiaohu; Wang, Yanjie
Purpose of Review. Numerous studies reported the rapid spread of HIV/AIDS epidemic among men who have sex with men (MSM) in China. This paper aims to investigate the overall epidemic trend and associated high-risk behaviours among Chinese MSM and to explore the governmental and community responses to the epidemic. Recent Findings. HIV prevalence among Chinese MSM increased rapidly in all Chinese regions in the past decade and disproportionally affected the Southwest China. In addition to the high-risk homosexual behaviours, overlapping bisexual, commercial, and drug use behaviours are commonly observed among Chinese MSM. The Chinese government has significantly expanded the surveillance efforts among MSM over the past decade. Community responses against HIV have been substantially strengthened with the support of international aid. However, lack of enabling legal and financial environment undermines the role of community-based organisations (CBOs) in HIV surveillance and prevention. Conclusion. HIV continues to spread rapidly among MSM in China. The hidden nature of MSM and the overlapping homosexual, bisexual, and commercial behaviours remain a challenge for HIV prevention among MSM. Strong collaboration between the government and CBOs and innovative intervention approaches are essential for effective HIV surveillance and prevention among MSM in China. PMID:24822214
Johnston, Lisa G; Sabin, Miriam Lewis; Prybylski, Dimitri; Sabin, Keith; McFarland, Willi; Baral, Stefan; Kim, Andrea A; Raymond, H Fisher
In bio-behavioural surveys measuring prevalence of infection with human immunodeficiency virus (HIV), respondents should be asked the results of their last HIV test. However, many government authorities, nongovernmental organizations, researchers and other civil society stakeholders have stated that respondents involved in such surveys should not be asked to self-report their HIV status. The reasons offered for not asking respondents to report their status are that responses may be inaccurate and that asking about HIV status may violate the respondents' human rights and exacerbate stigma and discrimination. Nevertheless, we contend that, in the antiretroviral therapy era, asking respondents in bio-behavioural surveys to self-report their HIV status is essential for measuring and improving access to - and coverage of - services for the care, treatment and prevention of HIV infection. It is also important for estimating the true size of the unmet needs in addressing the HIV epidemic and for interpreting the behaviours associated with the acquisition and transmission of HIV infection correctly. The data available indicate that most participants in health-related surveys are willing to respond to a question about HIV status - as one of possibly several sensitive questions about sexual and drug use behaviours. Ultimately, normalizing the self-reporting of HIV status could help the global community move from an era of so-called exceptionalism to one of destigmatization - and so improve the epidemic response worldwide.
There is ample evidence in the literature that supports the notion that diet, lifestyle and behaviour influence the risk of developing cancer. It was opined that the most dramatic reduction in cancer incidence and mortality are likely to result from population shift in unhealthy behaviour such as smoking, intake of high fat and high calorie food, physical inactivity and unprotected exposure to the sun or unprotected sex. In this paper, I will discuss different strategies that have been used in the control of cancer in the past and at present. I will also explore different concepts of health education and health promotion, as well as various applications of theories and models for ensuring behavioural modifications. In conclusion, I suggest strategies for influencing health promotion and health education for effective behavioural modification that could change the future risk of cancer particularly in the West African sub region.
Rasmussen, Dlama Nggida; Wejse, Christian; Larsen, Olav; Da Silva, Zacarias; Aaby, Peter; Sodemann, Morten
Introduction Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV is crucial and can increase insight into the HIV epidemic in Africa. Methods We used data from two retrospective HIV surveys conducted in Guinea-Bissau from 1993 to 1996 (1996 cohort) and from 2004 to 2007 (2006 cohort). Multivariate logistical models were used to investigate the relationships between HIV risk and circumcision status, timing, method of circumcision, and socio-demographic factors. Results MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years) circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised. However, the difference between pre-pubertal (≤12 years) and post-pubertal (≥13 years) circumcision was not significant in the multivariate analysis. Seventy-six percent (678/888) of circumcised males in the 2006 cohort were circumcised traditionally, and 7.7% of those males were HIV-infected compared to 1.9% of males circumcised medically, with AOR of 2.7 (95% CI 0.91-8.12). Conclusion MC is highly prevalent in Guinea-Bissau, but ethnic variations in method and timing may affect its protection against HIV. Our findings suggest that sexual risk behaviour and traditional circumcision may increases HIV risk. The relationship between circumcision age, sexual behaviour and HIV status remains unclear and warrants further research. PMID:27200126
Uusküla, Anneli; McNutt, Louise Anne; Dehovitz, Jack; Fischer, Krista; Heimer, Robert
Summary The HIV epidemic in Estonia is rapidly expanding, and injection drug users (IDUs) are the major risk group contributing to the expansion. A convenience sample of 159 IDUs visiting syringe-exchange programmes (SEPs) was selected to quantify the association of HIV-risk behaviours and blood-borne infections. A high prevalence of HIV, hepatitis B core antibody (HBVcore), hepatitis B surface antigen (HbsAg) and hepatitis C virus antibodies (56, 85.1, 21.3, and 96.2%, respectively) was associated with high-risk injections, unsafe sexual behaviour and alcohol abuse. These findings emphasize the importance of evidence-based secondary prevention among the HIV-infected, especially given the uncertain sustainability of antiretroviral and substance abuse treatments. PMID:17326862
Sentjens, R. E. J. H.; Sisay, Y.; Vrielink, H.; Kebede, D.; Adèr, H. J.; Leckie, G.; Reesink, H. W.
The aim was to determine the prevalence of HIV infection and risk factors for HIV infection in various population subgroups in Ethiopia. Serum panels from blood donors (n = 2610), from various population subgroups in Ethiopia were tested for anti-HIV-1/2 by ELISA. All ELISA repeatedly reactive samples were subjected for confirmation by immunoblot (IB) and anti-HIV-1 and anti-HIV-2 specific ELISAs. 155/2610 (5.9%) blood donors were HIV-1 infected. Of pregnant women, 84/797 (10.5%) were HIV-1 infected, and 1/797 (0.1%) was HIV-2 infected. 1/240 (0.4%) individuals from the rural population were HIV-1 infected. 198/480 (41.3%) female attendees, and 106/419 (25.3%) male attendees at sexual transmitted disease (STD) clinics were HIV-1 infected. One (0.2%) male, and 2 (0.4%) female STD patients were infected with both HIV-1 and HIV-2. It was concluded that the prevalence of HIV-1 infection varied from 0.4% among urban residents to 25.3-41.3% among STD attendees. There is a low prevalence of HIV-2 present in Ethiopian subjects. Risky sexual behaviour is significantly associated with HIV-infection in Ethiopia. PMID:12002540
Benotsch, E G; Somlai, A M; Pinkerton, S D; Kelly, J A; Ostrovski, D; Gore-Felton, C; Kozlov, A P
Countries of the former Soviet Union are experiencing the steepest increases in annual HIV incidence in the world. Over 80% of registered HIV cases in Russia have occurred among intravenous drug users (IDUs), but current conditions set the stage for a heterosexually-transmitted epidemic. IDUs who also trade sex for money or drugs may serve as a conduit, or 'bridge' group, through which HIV could make inroads into the general Russian population. The present study examined the prevalence of sex trading among female Russian IDUs, and further examined drug use, sexual behaviour, and perceived vulnerability in this group. Female IDUs (n=100) in St Petersburg, Russia participated; 37% reported a history of sex trading. This group reported a mean of 49.5 male sexual partners in the previous month and an average of 15.4 unprotected vaginal intercourse acts in the previous 30 days. A significant minority (44%) also reported sharing injection equipment with others. Mathematical models to calculate risk estimates for HIV seroconversion indicated that participants were at significant risk of contracting HIV and infecting sexual partners. Despite significant rates of risk behaviours, most participants perceived themselves to be at little risk of contracting HIV. Effective HIV prevention programmes targeted at this group are urgently needed and are likely to be a cost-effective step in curtailing the spread of HIV in the region.
Inciardi, J A
Limited attention has been focused on HIV risk behaviors of crack smokers and their sex partners, yet there is evidence that the crack house and the crack-using life-style may be playing significant roles in the transmission of HIV and other sexually transmitted diseases. The purposes of this research were to study the attributes and patterns of "sex for crack" exchanges, particularly those that occurred in crack houses, and to assess their potential impact on the spread of HIV. Structured interviews were conducted with 17 men and 35 women in Miami, Florida, who were regular users of crack and who had exchanged sex for crack (or for money to buy crack) during the past 30 days. In addition, participant observation was conducted in 8 Miami crack houses. Interview and observational data suggest that individuals who exchange sex for crack do so with considerable frequency, and through a variety of sexual activities. Systematic data indicated that almost a third of the men and 89% of the women had had 100 or more sex partners during the 30-day period prior to study recruitment. Not only were sexual activities anonymous, extremely frequent, varied, uninhibited (often undertaken in public areas of crack houses), and with multiple partners but, in addition, condoms were not used during the majority of contacts. Of the 37 subjects who were tested for HIV and received their test results 31% of the men and 21% of the women were HIV seropositive.
Ohshige, K.; Morio, S.; Mizushima, S.; Kitamura, K.; Tajima, K.; Ito, A.; Suyama, A.; Usuku, S.; Saphonn, V.; Heng, S.; Hor, L. B.; Tia, P.; Soda, K.
To describe epidemiological features on HIV prevalence among female commercial sex workers (CSWs), a cross-sectional study on sexual behaviour and serological prevalence was carried out in Cambodia. The CSWs were interviewed on their demographic characters and behaviour and their blood samples were taken for testing on sexually transmitted diseases, including HIV, Chlamydia trachomatis, syphilis, and hepatitis B. Associations between risk factors and HIV seropositivity were analysed. High seroprevalence of HIV and Chlamydia trachomatis IgG antibody (CT-IgG-Ab) was shown among the CSWs (54 and 81.7%, respectively). Univariate logistic regression analyses showed an association between HIV seropositivity and age, duration of prostitution, the number of clients per day and CT-IgG-Ab. Especially, high-titre chlamydial seropositivity showed a strong significant association with HIV prevalence. In multiple logistic regression analyses, CT-IgG-Ab with higher titre was significantly independently related to HIV infection. These suggest that existence of Chlamydia trachomatis is highly related to HIV prevalence. PMID:10722142
Trick, Sarah; Jantzer, Vanessa; Haffner, Johann; Parzer, Peter; Resch, Franz
Parental Monitoring and its Relation to Behaviour Problems and Risk Behaviour in an Adolescent School Sample Numerous research studies emphasize parental monitoring as a protective factor for adolescent problem behaviour. The purpose of the study presented was to use Stattin and Kerr's (2000) monitoring subscales for the first time in a German-speaking area and to explore the relations to behaviour problems in an adolescent school sample. The two active monitoring strategies "parental control" and "parental solicitation" as well as "parental knowledge" and "child disclosure" relating to behaviour problems and risk behaviour were examined. A sample of 494 pupils, grades 5, 7 and 9, of German secondary schools and their parents answered questions on "parental knowledge", "control", "solicitation" and "child disclosure". Adolescents also answered the German version of the Strengths and Difficulties Questionnaire (SDQ) and items about risk behaviour like frequency of violence, delinquency, substance abuse, self-injuring behaviour and school absenteeism. Behaviour problems in terms of the SDQ could be predicted sufficiently by "parental knowledge", but for the prediction of risk behaviour, the active parental monitoring strategies were of importance, too. More "parental knowledge", more "control" and less "solicitation" could predict less risk behaviour. Results confirm "parental knowledge" as a general protective factor for problem behaviour. However, they show the importance of "parental control" for adolescent risk behaviour.
MELENDEZ, RITA M.; PINTO, ROGÉRIO
Scientific studies demonstrate high rates of HIV infection among male-to-female (MTF) transgender individuals and that stigma and discrimination place MTFs at increased risk for infection. However, there is little research examining how gender roles contribute to HIV risk. This paper reports on in-depth interviews with 20 MTFs attending a community clinic. Data reveal that stigma and discrimination create a heightened need for MTFs to feel safe and loved by a male companion and that in turn places them at a higher risk for acquiring HIV. Male-to-female transgender individuals appear to turn to men to feel loved and affirmed as women; their main HIV risk stems from their willingness to engage with sexual partners who provide a sense of love and acceptance but who also may also request unsafe sexual behaviours. A model illustrating how HIV risk is generated from stigma and discrimination is presented. PMID:17457728
Fedor, Theresa M; Kohler, Hans-Peter; McMahon, James M
Female empowerment and positive attitudes towards women's rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women's rights within sexual relationships. Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. Results suggest that female intervention participants were more likely than non-participants to believe that: (1) women have more rights within sexual relationships in general and (2) women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). Male intervention participants showed no substantial positive change in attitudes towards women's rights. These results highlight an important positive effect of HIV prevention programmes on women's attitudes towards their own rights.
Perez-Brumer, Amaya G; Oldenburg, Catherine E; Biello, Katie B; Novak, David S; Rosenberger, Joshua G; Mimiaga, Matthew J
In Venezuela, members of a social and sexual partner networking site for men who have sex with men (MSM) completed an online survey regarding sexual behaviours and HIV medical care. Among the 2851 respondents, self-reported HIV prevalence was 6.6%. Of participants living with HIV, 73.2% reported taking antiretroviral medication and 56.6% reported complete adherence within the past month. Participants living with HIV were more likely to be older (aOR = 1.04 per one-year increase in age, 95% CI: 1.02, 1.06) and diagnosed with a sexually transmitted infection in the previous year (aOR 3.26, 95% CI: 2.11, 5.04). These data provide further understanding of the HIV epidemic among MSM in Venezuela, and potential targets for HIV prevention interventions.
Shaw, Stacey A; El-Bassel, Nabila
This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.
Holt, Martin; Lea, Toby; Mao, Limin; Zablotska, Iryna; Lee, Evelyn; de Wit, John B F; Prestage, Garrett
Background: In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. Results: Between 2000 and 2015, there were significant increases (P<0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
Tempalski, Barbara; McQuie, Hilary
Although considerable research has been conducted to identify the behavioural characteristics that predispose individuals to inject drugs or become infected with HIV via injection drug use, much less research has been conducted on structural and policy determinants, cultural norms, stigma, and ecological factors which may affect drug use risk behaviour, users' networks and HIV rates associated with drug use across geographic areas. For programme planners, whether official or grassroots, an understanding of place-based characteristics can help better identify risk environments to injection drug use-related HIV, and determine how to facilitate actions regarding public policy and harm reduction to aid in the reduction of risk. As such, we consider in this commentary the importance of geographic place and the socio-spatial and political processes related to place that may help determine where IDU-related HIV risk environments occur.
Tempalski, Barbara; McQuie, Hilary
Although considerable research has been conducted to identify the behavioural characteristics that predispose individuals to inject drugs or become infected with HIV via injection drug use, much less research has been conducted on structural and policy determinants, cultural norms, stigma, and ecological factors which may affect drug use risk behaviour, users’ networks and HIV rates associated with drug use across geographic areas. For programme planners, whether official or grassroots, an understanding of place-based characteristics can help better identify risk environments to injection drug use-related HIV, and determine how to facilitate actions regarding public policy and harm reduction to aid in the reduction of risk. As such, we consider in this commentary the importance of geographic place and the socio-spatial and political processes related to place that may help determine where IDU-related HIV risk environments occur. PMID:18554896
There is a paucity of studies that have systematically and comprehensively investigated the knowledge level, attitudes and the pattern of sexual behaviours related to HIV and AIDS in higher education settings in sub-Saharan Africa in general and Tanzania in particular. This study attempted to fill a void in knowledge. A cross-sectional descriptive design was used, employing a self-administered questionnaire as the main data collection tool. More than 400 higher education students completed a questionnaire assessing their knowledge, attitudes and behaviours related to HIV and AIDS. About three quarters of respondents demonstrated comprehensive knowledge about HIV and AIDS, and the majority of respondents expressed positive attitudes towards people living with HIV and AIDS. Despite demonstrating high knowledge level about HIV and AIDS, the results show that sexual behaviours among students in higher education are characteristically risky, and do not significantly differ from youth in the general population.
Moore, J; Beeker, C; Harrison, J S; Eng, T R; Doll, L S
At least 10 former Peace Corps volunteers are believed to have acquired human immunodeficiency virus (HIV) during their time of service. To assess HIV risk behavior among current Peace Corps volunteers, cross-sectional data were collected from 1242 randomly selected volunteers in 28 countries in 1991. 474 (38%) were stationed in sub-Saharan Africa. Non-sexual HIV-related risk activities included injection from local health facilities (209) and ears or body parts pierced (59). Of the 1018 volunteers who were unmarried or not living with a spouse, 61% of men and 60% of women indicated they had at least one sexual partner during their time of service; 30% and 20%, respectively, had three or more partners. Only 17 men and 12 women reported having a same-sex partner. 52% of sexually active Peace Corps volunteers stationed in Eastern Europe, 43% of those in Central or South America, 36% in sub-Saharan Africa, and 32% in Asia and the Pacific had a sexual partner from the host country. 32% of these volunteers used condoms on every occasion with partners from the host country, 49% used condoms some of the time, and 19% never used them. For male volunteers, consistent condom use was negatively associated with alcohol use and positively related to the perception that HIV was a problem in the host country; for female volunteers, younger age and fewer partners were the significant correlates of condom use. The inconsistent use of condoms in countries where HIV is widespread suggests a need for Peace Corps leaders to educate volunteers about local seroprevalence rates, cultural differences in sexual negotiation, and the importance of condom use.
Levin, Kate A.; Kirby, Joanna; Currie, Candace
Family structure is associated with a range of adolescent risk behaviours, with those living in both parent families generally faring best. This study describes the association between family structure and adolescent risk behaviours and assesses the role of the family meal. Data from the 2006 Health Behaviour in School-Aged Children survey were…
Lundberg, Patric; Johansson, Eva; Okello, Elialilia; Allebeck, Peter; Thorson, Anna
Persons with severe mental illness (SMI) engage in risky sexual behaviours and have high prevalence of HIV in high-income countries. Little is known about sexual behaviours and HIV risk among persons with SMI in sub-Saharan Africa. In this qualitative study we explored how SMI may influence sexual risk behaviours and sexual health risks in Uganda. Individual semi-structured interviews were conducted with 7 male and 13 female psychiatric patients aged 18–49 years. Participants were interviewed in hospital when clinically stable and capable of giving informed consent. Interview transcripts were analysed using manifest content analysis, generating the categories: (1) casual sex during illness episodes, (2) rape by non-partners, (3) exploitation by partners, (4) non-monogamous partners, and (5) sexual inactivity. Our findings suggest that SMI exacerbated sexual vulnerability in the women interviewed, by contributing to casual sex, to exploitative and non-monogamous sexual relationships, and to sexual assault by non-partners. No link could be established between SMI and increased sexual risk behaviours in the men interviewed, due to a small sample of men, and given that men's accounts showed little variability. Our findings also suggest that SMI caused sexual inactivity due to decreased sexual desire, and in men, due to difficulties forming an intimate relationship. Overall, our study highlights how SMI and gender inequality can contribute to the shaping of sexual risk behaviours and sexual health risks, including HIV risk, among persons with SMI in this Ugandan setting. PMID:22253770
Nöthling, Jani; Martin, Cherie L; Laughton, Barbara; Cotton, Mark F; Seedat, Soraya
Objectives HIV and psychiatric disorders are prevalent and often concurrent. Childbearing women are at an increased risk for both HIV and psychiatric disorders, specifically depression and post-traumatic stress disorder (PTSD). Poor mental health in the peripartum period has adverse effects on infant development and behaviour. Few studies have investigated the relationship between maternal PTSD and child behaviour outcomes in an HIV vertically infected sample. The aim of this study was to investigate whether maternal postpartum trauma exposure and PTSD were risk factors for child behaviour problems. In addition, maternal depression, alcohol abuse and functional disability were explored as cofactors. Setting The study was conducted in Cape Town, South Africa. Participants 70 mother–child dyads infected with HIV were selected from a group of participants recruited from community health centres. Design The study followed a longitudinal design. Five measures were used to assess maternal trauma exposure, PTSD, depression, alcohol abuse and functional disability at 12 months postpartum: Life Events Checklist (LEC), Harvard Trauma Scale (HTS), Alcohol Use Disorders Identification Test (AUDIT), Center for Epidemiological Studies Depression (CESD) Scale and the Sheehan Disability Scale (SDS). Child behaviour was assessed at 42 months with the Child Behaviour Checklist (CBCL). Results The rate of maternal disorder was high with 50% scoring above the cut-off for depression, 22.9% for PTSD and 7% for alcohol abuse. Half of the children scored within the clinical range for problematic behaviour. Children of mothers with depression were significantly more likely to display total behaviour problems than children of mothers without depression. Maternal PTSD had the greatest explanatory power for child behaviour problems, although it did not significantly predict child outcomes. Conclusions This study highlights the importance of identifying and managing maternal PTSD and
Robertson, Angela A.; St. Lawrence, Janet S.; McCluskey, D. Lee
Drug abusing offenders have high rates of HIV and other sexually transmitted infections (STI). To date, the HIV/STI prevention needs of offenders in drug court programs have been ignored. This multi-method study employed interviews to assess drug court professionals' perceptions of the need for an HIV risk reduction intervention to be integrated…
Leonard, Noelle R.; Gwadz, Marya Viorst; Cleland, Charles M.; Vekaria, Pooja C.; Ferns, Bill
We examined the risk and protective factors and mental health problems of 105 low SES, urban adolescents whose mothers were coping with alcohol abuse and other drug problems. Approximately half of the mothers were also HIV-infected. As hypothesized, there were few differences between adolescents of HIV-infected and HIV-uninfected mothers in…
van Vliet, C.; Meester, E. I.; Korenromp, E. L.; Singer, B.; Bakker, R.; Habbema, J. D.
Using a sexually transmitted diseases simulation model (STDSIM), we made projections of HIV spread for four profiles of sexual behaviour reflecting patterns encountered across the developing world: 1) much commercial sex, no short relationships; 2) commercial sex, concurrent short relationships; 3) concurrent relationships, no commercial sex; 4) serial short relationships, some commercial sex. We studied the effects of increasing condom use in three target groups: commercial sex workers (CSWs); men engaging in commercial contacts and short relationships; and females in steady relationships. The projections indicated that the CSW and male strategies were more effective in reducing HIV incidence than the strategy focusing on females in steady relationships. In the long run, even the group of men and women with one recent partner were better protected against HIV infection by condom use in high-risk contacts than by condom use in steady relationships. Furthermore, the numbers of HIV cases prevented per condom used were 7 to 500 times higher for condoms used by CSWs or men engaging in short relationships and commercial sex than for ones used by females in steady relationships. The results indicated the merit of focusing on high-risk groups irrespective of the pattern of sexual behaviour, even in epidemics that had already spread throughout populations. PMID:11417040
Mellins, Claude A; Dolezal, Curtis; Brackis-Cott, Elizabeth; Nicholson, Ouzama; Warne, Patricia; Meyer-Bahlburg, Heino F L
HIV-negative, inner-city adolescents with HIV-infected parents are considered to be at high risk for acquiring HIV themselves. Using a modified theory of health behavior, this study examined the effects of maternal HIV infection and psychosocial variables on the onset of sexual and drug risk behavior in 144 HIV-negative adolescents with and without HIV-positive mothers. Adolescents and their mothers were interviewed when the youths were 10-14 years old and again when they were 13-19 years old. By follow-up, 42% of youths reported the onset of vaginal sex (vs 5% at baseline). Marijuana and alcohol use increased from 6 and 38%, respectively, at baseline to 25 and 60% at follow-up. Among those reporting risk behaviors, 40--50% reported onset prior to 14 years. Youth and family psychosocial variables, but not maternal HIV status, were associated with risk behaviour outcomes.
Wenzel, Suzanne L; Rhoades, Harmony; Tucker, Joan S; Golinelli, Daniela; Kennedy, David P; Zhou, Annie; Ewing, Brett
HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV testing behavior of homeless men. This study examined the association between individual (HIV risk) and structural (service access) factors and past year HIV testing. Participants were a representative sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Logistic regression examined the association between past year HIV testing and demographic characteristics, HIV risk behavior, and access to other services in the Skid Row area in the past 30 days. Despite high rates of past year HIV testing, study participants also reported high rates of HIV risk behavior, suggesting there is still significant unmet need for HIV prevention among homeless men. Having recently used medical/dental services in the Skid Row area (OR: 1.91; CI: 1.09, 3.35), and being a military veteran (OR: 2.10; CI: 1.01-4.37) were significantly associated with HIV testing service utilization. HIV testing was not associated with HIV risk behavior, but rather with access to services and veteran status, the latter of which prior research has linked to increased service access. We suggest that programs encouraging general medical service access may be important for disseminating HIV testing services to this high-risk, vulnerable population.
Kalichman, Seth C.; Rompa, David; Cage, Marjorie
Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the…
Kaufman, Michelle R; Shefer, Tamara; Crawford, Mary; Simbayi, Leickness C; Kalichman, Seth C
The Gender Attitudes-Power-Risk (GAPR) model of HIV risk behavior was tested using survey data collected from among 309 men who were attending STI services in a primary health care clinic in Cape Town, South Africa. Results showed that negative attitudes towards women were significantly positively associated with a high level of HIV risk behavior, and that endorsement of traditional male roles was negatively associated with HIV risk behavior. Endorsement of traditional male gender roles was also inversely related to relationship control but positively to a high degree of decision-making dominance in one's relationship. Sexual relationship power did not significantly mediate the relationships between gender attitudes and HIV risk behavior. A better understanding of gender roles and ideologies in combination with one's power in sexual relationships as they relate to HIV risk behavior among men could better inform future HIV prevention interventions.
Klein, Hugh; Tilley, David L
The current study examines the risk perceptions of HIV-negative men who have sex with men (MSM) who use the Internet to seek unprotected sex. The research questions include the following: How great do these men perceive their HIV risk to be? Are their perceptions based on HIV knowledge or related to their risk behaviors? What factors are associated with greater/lesser perceived risk? Results revealed that more than half of the men believed that they had no or only a slight chance of contracting HIV. Risk perceptions were not related to HIV knowledge or to involvement in HIV risk practices. Four factors were identified as being associated with greater perception of HIV risk: self-identity as a sexual "bottom," having sex while high, greater use of bareback-focused websites, and younger age. Internet-using HIV-negative men who have sex with men tend to underestimate their risk for acquiring HIV, and interventions need to help them accurately assess their risk.
Eaton, L A; Cain, D N; Agrawal, A; Jooste, S; Udemans, N; Kalichman, S C
We examined the relationship between HIV prevention beliefs related to male circumcision and sexual behaviour/sexually transmitted infection (STI) acquisition among traditionally circumcised men in Cape Town, South Africa. HIV-negative men (n = 304), circumcised for cultural/religious reasons, attending a health clinic in Cape Town, South Africa, completed cross-sectional surveys. Generalized linear models were used to analyse the relationships between unprotected vaginal sex acts, number of female sexual partners, STI diagnoses and male circumcision-related beliefs and risk perceptions. Men who were aware that circumcision offers protection against HIV (relative risk [RR] = 1.19, 95% confidence interval [CI] = 1.06-1.32, P < 0.01), endorsed risk compensation related to male circumcision (RR = 1.15, 95% CI = 1.11-1.12, P < 0.01) and perceived lower risk of HIV infection when circumcised (RR = 1.08, 95% CI = 1.04-1.12, P < 0.01) were more likely to report unprotected vaginal sex acts. Similar patterns were also identified when predicting number of female sexual partners. Men who were more likely to endorse risk compensation related to male circumcision were also more likely to be diagnosed with a chronic STI (odds ratio [OR] = 1.64, 95% CI = 1.06-2.53, P < 0.05). Our findings suggest that we must not overlook the effects of beliefs towards male circumcision for HIV prevention among men traditionally circumcised; doing so may undermine current efforts to reduce HIV transmission through male circumcision.
Neundorfer, Marcia M.; Harris, Phyllis Braudy; Britton, Paula J.; Lynch, Delores A.
Purpose: The number of women aged 45 years and older infected with the HIV virus continues to increase. This study sought to identify, from the voices of midlife and older women living with HIV, the factors in their lives that put them at risk for HIV, so as to improve HIV-prevention efforts for women of this age group. Design and Methods: In this…
Hammond, Edward R; Crum, Rosa M; Treisman, Glenn J; Mehta, Shruti H; Marra, Christina M; Clifford, David B; Morgello, Susan; Simpson, David M; Gelman, Benjamin B; Ellis, Ronald J; Grant, Igor; Letendre, Scott L; McArthur, Justin C
Detectable human immunodeficiency virus (HIV) RNA in the cerebrospinal fluid (CSF) is associated with central nervous system (CNS) complications. We developed the CSF HIV risk score through prediction modeling to estimate the risk of detectable CSF HIV RNA (threshold >50 copies/mL) to help identify persons who might benefit most from CSF monitoring. We used baseline data from 1,053 participants receiving combination antiretroviral therapy who were enrolled in the 6-center, US-based CNS HIV Antiretroviral Therapy Effects Research (CHARTER) prospective cohort in 2004-2007. Plasma HIV RNA, CNS penetration effectiveness, duration of combination antiretroviral therapy, medication adherence, race, and depression status were retained correlates of CSF HIV RNA, displaying good discrimination (C statistic = 0.90, 95% confidence interval (CI): 0.87, 0.93) and calibration (Hosmer-Lemeshow P = 0.85). The CSF HIV risk score ranges from 0 to 42 points, with a mean of 15.4 (standard deviation, 7.3) points. At risk scores greater than 25, the probability of detecting CSF HIV RNA was at least 42.9% (95% CI: 36.6, 49.6). For each 1-point increase, the odds of detecting CSF HIV RNA increased by 26% (odds ratio = 1.26, 95% CI: 1.21, 1.31; P < 0.01). The risk score correlates with detection of CSF HIV RNA. It represents an advance in HIV management and monitoring of CNS effects, providing a potentially useful tool for clinicians.
Hammond, Edward R.; Crum, Rosa M.; Treisman, Glenn J.; Mehta, Shruti H.; Marra, Christina M.; Clifford, David B.; Morgello, Susan; Simpson, David M.; Gelman, Benjamin B.; Ellis, Ronald J.; Grant, Igor; Letendre, Scott L.; McArthur, Justin C.
Detectable human immunodeficiency virus (HIV) RNA in the cerebrospinal fluid (CSF) is associated with central nervous system (CNS) complications. We developed the CSF HIV risk score through prediction modeling to estimate the risk of detectable CSF HIV RNA (threshold >50 copies/mL) to help identify persons who might benefit most from CSF monitoring. We used baseline data from 1,053 participants receiving combination antiretroviral therapy who were enrolled in the 6-center, US-based CNS HIV Antiretroviral Therapy Effects Research (CHARTER) prospective cohort in 2004–2007. Plasma HIV RNA, CNS penetration effectiveness, duration of combination antiretroviral therapy, medication adherence, race, and depression status were retained correlates of CSF HIV RNA, displaying good discrimination (C statistic = 0.90, 95% confidence interval (CI): 0.87, 0.93) and calibration (Hosmer-Lemeshow P = 0.85). The CSF HIV risk score ranges from 0 to 42 points, with a mean of 15.4 (standard deviation, 7.3) points. At risk scores greater than 25, the probability of detecting CSF HIV RNA was at least 42.9% (95% CI: 36.6, 49.6). For each 1-point increase, the odds of detecting CSF HIV RNA increased by 26% (odds ratio = 1.26, 95% CI: 1.21, 1.31; P < 0.01). The risk score correlates with detection of CSF HIV RNA. It represents an advance in HIV management and monitoring of CNS effects, providing a potentially useful tool for clinicians. PMID:24966216
Sok, Phan; Harwell, Joseph I.; Dansereau, Lynne; McGarvey, Stephen; Lurie, Mark; Mayer, Kenneth H.
Background Sexual behaviours among HIV-positive male patients in Cambodia have not been fully evaluated. Objectives The patterns of sexual behaviours and social factors were compared between married and single men. Methods A retrospective cross-sectional survey of 174 male HIV patients was undertaken during March 1999–June 2000 in Phnom Penh. Results Many participants (61%) reported that they were unaware that their sexual behaviours may have put them at risk of HIV infection. Sexual behaviours included having sex with a sex worker (90%), multiple sexual partners (41%), and both of these behaviours (37%). Two-thirds (69%) reported using a condom when having sex with a sex worker. Condom use with multiple sexual partners was low (24%). A history of condom use with a sex worker was less likely to be reported among married men than single men (P = 0.008). Always using condoms with a sex worker did not differ between married men and single men. Social factors that influenced visiting a sex worker included invitation by a friend (88%), alcohol consumption (74%), and having extra spending money (72%). Multivariate analysis suggests that alcohol consumption (P = 0.008) and having extra spending money (P = 0.02) were strongly associated with visiting a sex worker. Conclusions In Cambodia, HIV-infected men frequently reported a history of using sex workers. Having multiple sex partners or using a sex worker and multiple sexual partners were not rare. Interventions should target men in settings where alcohol is consumed and to encourage married men to use condoms. PMID:19061555
Galanaki, Evangelia P.; Polychronopoulou, Stavroula A.; Babalis, Thomas K.
The aim of this study was to examine the associations between loneliness/social dissatisfaction and teacher-identified behavioural risk during late childhood. A broad range of behaviour problems, as well as academic adjustment, are assessed, in order to specify in which types of behaviour and academic problems loneliness/social dissatisfaction is…
Donenberg, Geri R.; Emerson, Erin; Mackesy-Amiti, Mary Ellen; Udell, Wadiya
Youth involved in the juvenile justice system are at elevated risk for HIV as a result of high rates of sexual risk taking, substance use, mental health problems and sexually transmitted infections. Yet few HIV prevention programs exist for young offenders. This pilot study examined change in juvenile offenders’ sexual activity, drug/alcohol use, HIV testing and counseling, and theoretical mediators of risk taking following participation in PHAT Life, an HIV-prevention program for teens on probation. Participants (N=54) were 13–17 year-old arrested males and females remanded to a detention alternative setting. Youth participated in a uniquely tailored HIV prevention intervention and completed a baseline and 3-month follow up assessment of their HIV and substance use knowledge, attitudes, beliefs, and behaviors. At 3-month follow up, teens reported less alcohol use, more positive attitudes toward peers with HIV, greater ability to resist temptation to use substances, and for males, improved HIV prevention self-efficacy and peer norms supporting prevention. Teens were also more likely to seek HIV counseling and males were more likely to get tested for HIV. Effect sizes revealed moderate change in sexual behavior. Findings support PHAT Life as a promising intervention to reduce HIV-risk among youth in juvenile justice. PMID:26097376
Nicholas, P K; Voss, J G; Corless, I B; Lindgren, T G; Wantland, D J; Kemppainen, J K; Canaval, G E; Sefcik, E F; Nokes, K M; Bain, C A; Kirksey, K M; Eller, L S; Dole, P J; Hamilton, M J; Coleman, C L; Holzemer, W L; Reynolds, N R; Portillo, C J; Bunch, E H; Tsai, Y-F; Mendez, M R; Davis, S M; Gallagher, D M
The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.
Rowan, Grace A.; Joe, George W.; Lehman, Wayne E. K.; Knight, Kevin
Targeted HIV screens may help identify some risk-related concerns of drug-using offenders. The present study describes the Texas Christian University HIV/Hepatitis Risk Assessment (TCU HVHP) form, a 19-item self-report instrument measuring HIV and hepatitis risks based on a sample (N = 1,056) of offenders in eight prisons. Principal components analysis indicated four scales (Injection Risk, Condom Attitudes, Sex Risk, and AIDS Concern) with reliable psychometric properties with coefficient α reliabilities ranging from .72 to .88. Concurrent validities indicated the four scales were related to motivation for treatment, level of drug use, psychosocial functioning, and criminal thinking, although the patterns varied by gender. The TCU HVHP Form should be attractive to programs needing a brief assessment measuring HIV risk behaviors, attitudes toward condom use, and concerns about acquiring and transmitting HIV. PMID:27302708
Sirivongrangson, Pachara; Lolekha, Rangsima; Charoenwatanachokchai, Angkana; Siangphoe, Umaporn; Fox, Kimberley K; Jirarojwattana, Naiyana; Bollen, Liesbeth; Yenyarsan, Naruemon; Lokpichat, Somchai; Suksripanich, Orapin; McConnell, Michelle
We assessed prevalence of sexually transmitted infection (STIs), sexual risk behaviors, and factors associated with risk behaviors among HIV-infected MSM attending a public STI clinic serving MSM in Bangkok, Thailand. Between October 2005-October 2007, 154 HIV-infected MSM attending the clinic were interviewed about sexual risk behaviors and evaluated for STIs. Patients were examined for genital ulcers and had serologic testing for syphilis and PCR testing for chlamydia and gonorrhea. Results showed that sexual intercourse in the last 3 months was reported by 131 men. Of these, 32% reported anal sex without a condom. STIs were diagnosed in 41%. Factors associated with having sex without a condom were having a steady male partner, having a female partner and awareness of HIV status <1 month. Sexual risk behaviors and STIs were common among HIV-infected MSM in this study. This highlights the need for increased HIV prevention strategies for HIV-infected MSM.
Castilla, J; Barrio, G; Belza, M J; de la Fuente, L
To study the association of the consumption of alcohol and other psychoactive drugs with sexual risk behaviour for HIV infection, data from a representative sample of the Spanish population aged 18-39 years were analysed. A national household survey was carried out in 1996 using a combination of face-to-face interviews and self-administered questionnaires. The survey included 5253 subjects aged 18-39 years who provided information on alcohol and drug consumption, number of sexual partners and condom use with the steady partner and with casual partners in the 12 months before the survey. Of those surveyed, 27.4% had been drunk at least once and 20.5% had consumed drugs. Both behaviours were associated with male sex, younger age, higher educational level, being single and having had more than one sexual partner. In the logistic regression analysis adjusting for the sociodemographic variables, the greater frequency of drunkenness and cannabis use were associated with having more than one sexual partner. Regular condom use was significantly less frequent among cocaine users and more frequent among opiate users, but was not associated with the use of other drugs. Sexual risk behaviour (i.e. more than one partner and failure to use a condom regularly) was more frequent among persons who had been drunk or used cannabis or cocaine. Excessive consumption of alcohol, and cannabis and cocaine use are independently associated with sexual behaviour involving greater risk of HIV infection or transmission.
Wright, Eric R
Although the importance of human mobility in the spread of infectious disease has been recognized for quite some time, surprisingly little attention has been given to older adults' travel-related HIV risk behavior. This essay discusses the importance of studying the role travel and tourism play in the spread of HIV infection in older adults, reviewing select research on travel/tourism and HIV risk and highlighting the theoretical and methodological challenges confronting researchers in this area.
Figueroa, J P; Fox, K; Minor, K
A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population, 60% of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18% of the women and 8% of the men were hypertensive and 4.8% of the women and 3.3% of the men were diabetic. 26% of the men and 8% of the women had never had their blood pressure taken. 40% of the women had never had a Papanicolaou smear, 29% had never had a breast examination and 33% said that they were overweight compared with 18% of men. Smoking cigarettes and marijuana was more common among men (36%) than women (11%), as were drinking alcohol (79% of men, 41% of women) and heavy alcohol use (30% of men, 9% of women). Injuries requiring medical attention in the previous five years were reported by 40% of the men and 15% of the women. 34% of the men and 12% of the women regularly carried a weapon and 18% of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10% were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54% vs 17%, p < 0.001) or reported ever having a sexually transmitted disease (29% vs 9%, p < 0.001). Younger persons were more sexually active and more likely to use condoms during their most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.
Lewis, John E.; Miguez-Burban, Maria-Jose; Malow, Robert M.
Objective: This article updates our 1997 review that examined the literature on HIV risk behavior among college students. Methods: The current review focuses on college student sex-risk behaviors related to HIV-related knowledge, communication with sex partners, self efficacy, and behavioral skills. Results: As reported in our original review, the…
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
Background: Studies of people with intellectual disability suggest that several individual characteristics and environmental factors are associated with behaviour disorder. To date there are few studies looking at risk factors within specific syndromes and the relationship between early risk markers and later behaviour disorder. The key aim of the…
Bogart, Laura M; Galvan, Frank H; Wagner, Glenn J; Klein, David J
Research is needed to identify culturally relevant factors that may contribute to sexual risk among African Americans. We investigated HIV-specific medical mistrust as one such cultural factor, often exhibited as conspiracy beliefs about HIV (e.g., "AIDS was produced in a government laboratory"), which may be indicative of general suspicion of HIV treatment and prevention messages. Over a 6-month time-period, we measured endorsement of HIV conspiracy beliefs three times and frequency of condom use monthly among 181 HIV-positive African American males. A hierarchical multivariate repeated-measures logistic random effects model indicated that greater belief in HIV conspiracies was associated with a higher likelihood of reporting unprotected intercourse across all time-points. An average of 54% of participants who endorsed conspiracies reported unprotected intercourse, versus 39% who did not endorse conspiracies. Secondary prevention interventions may need to address medical mistrust as a contributor to sexual risk among African Americans living with HIV.
Speizer, Ilene S.; Gómez, Anu Manchikanti; Stewart, James; Voss, Paul
Most studies on HIV risk in sub-Saharan Africa focus on individual-level socio-demographic and behavioral correlates of risk. Only recently have researchers and programmers considered the context within which individuals live. This study uses the 2005–6 Zimbabwe Demographic and Health Survey to examine the correlation between the prevalence of HIV at the community level and the prevalence of HIV risk-taking behaviors. Results show that women and men living in communities with higher HIV prevalence in the opposite sex are at increased risk of HIV. In addition, rural women and men living in communities with greater premarital and non-marital sex are at greater risk of HIV. Finally, HIV prevalence is higher among women and men living in urban areas with higher intimate partner violence. Programs should address community-level social norms that make high-risk behaviors acceptable and thus increase all women and men’s risk of HIV, not just those engaged in high-risk behaviors. PMID:22010807
Wintemute, Garen J
Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have ≥5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have ≥60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours.
Tinsley, Barbara J; Lees, Nancy B; Sumartojo, Esther
The authors' goal is to review and integrate theory and research focused on the impact of the family, within a cultural perspective, on HIV prevention in childhood and adolescence. Families' impact on adolescents' HIV risk and prevention is examined through the lens of culture, focusing on the individual adolescent factors and family-level influences that converge to determine adolescents' HIV risk status. Family-based risk and health socialization during childhood and adolescence is theoretically and empirically evaluated, from developmental, cultural, and communication perspectives. The influence of families on adolescents' HIV knowledge, risk, and prevention strategies is explored from a developmental perspective. Finally, a future research agenda, focused on remaining issues that affect the ability to understand and modify HIV risk in adolescence, is outlined.
Santos, Teresa; Ferreira, Mafalda; Simões, Maria Celeste; Machado, Maria Céu; de Matos, Margarida Gaspar
Living with a chronic condition (CC) in adolescence has been historically considered protective for risk behaviours. However, research from the last decade suggest that when compared with healthy peers, adolescents living with a chronic condition can engage in risky behaviours in a similar if not higher rate than their counterparts living with out a CC. This study aims to characterize and evaluate the impact of 1) living with a chronic condition (CC), and 2) how the perception of living with a CC affects school participation, and its association with risk/protective behaviours (drunkenness, physical fight, sadness and self-harm). For this purpose 4 groups were identified: adolescents with mostly healthy behaviours, adolescents with mostly risk behaviours, adolescents with mostly risk-internalizing behaviours and adolescents with mostly risk-externalizing behaviours. A large sample was included in this study, composed by 3494 Portuguese adolescents with an average age of 15 years, who participated in the Portuguese Survey of Health Behaviour in School-aged Children/WHO (HBSC). Main results show that adolescents living with a CC have more risk-internalizing behaviours when compared to adolescents without CC, who present more healthy behaviors. Furthermore, adolescents that report that having a CC affects school participation show more risky behaviours than those not affected by a CC who present more healthy behaviours. Boys with a CC show more healthy behaviours, and those who feel that the CC affects school participation present more risky behaviours. On the other hand, girls with a CC have more risk-internalizing behaviours and less healthy behaviours It is important to point out that dolescents living with a CC represent a vulnerable group, and may engage in experimental/risky behaviours as likely as their non CC peers. Thus, potential benefits can arise from reinforcing interventions within protective contexts (family/peers/school setting). Health
Mathur, Sanyukta; Higgins, Jenny A; Thummalachetty, Nityanjali; Rasmussen, Mariko; Kelley, Laura; Nakyanjo, Neema; Nalugoda, Fred; Santelli, John S
Compared to a large body of work on how gender may affect young women's vulnerability to HIV, we know little about how masculine ideals and practices relating to marriage and fertility desires shape young men's HIV risk. Using life-history interview data with 30 HIV-positive and HIV-negative young men aged 15-24 years, this analysis offers an in-depth perspective on young men's transition through adolescence, the desire for fatherhood and experience of sexual partnerships in rural Uganda. Young men consistently reported the desire for fatherhood as a cornerstone of masculinity and transition to adulthood. Ideally young men wanted children within socially sanctioned unions. Yet, most young men were unable to realise their marital intentions. Gendered expectations to be economic providers combined with structural constraints, such as limited access to educational and income-generating opportunities, led some young men to engage in a variety of HIV-risk behaviours. Multiple partnerships and limited condom use were at times an attempt by some young men to attain some part of their aspirations related to fatherhood and marriage. Our findings suggest that young men possess relationship and parenthood aspirations that - in an environment of economic scarcity - may influence HIV-related risk.
Abstract The literature pertaining to the elderly shows that HIV infection among this population is on the increase, suggesting that the elderly population engages in activities risky for HIV infection. Reports on such behaviour include frequent sexual relations with much younger people and having multiple partners. A study was carried out in Ga-Rankuwa, a black township in Gauteng Province, South Africa to explore and describe the understanding of these elderly people regarding their risks of HIV infection and AIDS. Using a qualitative, exploratory design, three focus-group interviews were conducted with 32 women aged over 50 years. Findings revealed that older persons have knowledge about transmission of HIV infection and AIDS. However, a few had misconceptions as to how HIV infection is transmitted, as they believed that poor nutrition and sharing facilities play a role. Knowledge of mechanisms of protecting themselves against infection, such as use of a condom during coitus and wearing gloves when caring for infected family members, was also evident. The elderly indicated that they would prefer an older person, who they could identify with, to educate them more about HIV infection and AIDS. Although majority of participants had knowledge of how HIV is transmitted, and issues that put them at risk of transmission, a few the older persons had misconceptions about how HIV is transmitted due to lack of knowledge, as they believed that poor nutrition and sharing facilities can transmit infection. The lack of knowledge underscores the importance of addressing sexual risk with older people. It was very clear that more needs to be done in terms of education campaigns to dispel the myths of HIV infection and to empower the elderly. PMID:24957136
The literature pertaining to the elderly shows that HIV infection among this population is on the increase, suggesting that the elderly population engages in activities risky for HIV infection. Reports on such behaviour include frequent sexual relations with much younger people and having multiple partners. A study was carried out in Ga-Rankuwa, a black township in Gauteng Province, South Africa to explore and describe the understanding of these elderly people regarding their risks of HIV infection and AIDS. Using a qualitative, exploratory design, three focus-group interviews were conducted with 32 women aged over 50 years. Findings revealed that older persons have knowledge about transmission of HIV infection and AIDS. However, a few had misconceptions as to how HIV infection is transmitted, as they believed that poor nutrition and sharing facilities play a role. Knowledge of mechanisms of protecting themselves against infection, such as use of a condom during coitus and wearing gloves when caring for infected family members, was also evident. The elderly indicated that they would prefer an older person, who they could identify with, to educate them more about HIV infection and AIDS. Although majority of participants had knowledge of how HIV is transmitted, and issues that put them at risk of transmission, a few the older persons had misconceptions about how HIV is transmitted due to lack of knowledge, as they believed that poor nutrition and sharing facilities can transmit infection. The lack of knowledge underscores the importance of addressing sexual risk with older people. It was very clear that more needs to be done in terms of education campaigns to dispel the myths of HIV infection and to empower the elderly.
Chidrawi, H. Christa; Greeff, Minrie; Temane, Q. Michael
Abstract All over the world, health behaviour is considered a complex, far reaching and powerful phenomenon. People's lives are influenced by their own or others' health behaviour on a daily basis. Whether it has to do with smoking, drinking, pollution, global warming or HIV management, it touches lives and it challenges personal and community responses. Health behaviour, and health behaviour change, probably holds the key to many a person's immediate or prolonged life or death outcomes. The same can be said about communities, culture groups and nations. This SANPAD-funded study focused on research questions relating to health behaviour change for people living with HIV (PLWH) in the North-West Province in South Africa. It investigated whether a comprehensive community-based HIV stigma reduction intervention caused health behaviour change in PLWH. An quantitative single system research design with one pre- and four repetitive post-tests utilizing purposive sampling was used to test change-over-time in the health behaviour of 18 PLWH. The results of the study indicated statistical and/or practical significant change-over-time. The intervention not only addressed the health behaviour of PLWH, but also their HIV stigma experiences, HIV signs and symptoms and their quality of life in the context of being HIV positive. The recommendations include popularization of the comprehensive community-based HIV stigma reduction intervention and extending it to include a second intervention to strengthen health behaviour and quality of life for PLWH in the community at large. PMID:25495580
Taveras, Janelle; Trepka, Mary Jo; Khan, Hafiz; Madhivanan, Purnima; Gollub, Erica L; Devieux, Jessy
Latina women in the United States (US) are disproportionately affected by human immunodeficiency virus (HIV) infection. Data are limited on the risk differences in HIV among Latinas by country of birth. This paper describes the risk behaviors among Latina women tested for HIV at public sites in Florida. Multivariate logistic regression was used to assess the demographic characteristics associated with the report of specific risk behaviors. Results indicate that foreign-born Latina women were 54 % less likely to report partner risk [95 % confidence interval (CI) 0.40, 0.54] than US-born Latina women. Reported risk behaviors varied by race/ethnicity, US-born versus foreign-born status, and by Latina country of origin. Knowledge of these differences can aid in targeting HIV prevention messaging, program decision-making, and allocation of resources, corresponding to the central approach of High Impact Prevention and the National HIV/AIDS Strategy.
Croce, Francesco; Fedeli, Paolo; Dahoma, Mohamed; Dehò, Lorenzo; Ramsan, Mahdi; Adorni, Fulvio; Corvasce, Stefano; Galli, Massimo
We conducted a hospital-based survey on prevalence and risk factors of HIV-1/2 and other viral infections in Zanzibar archipelago. Blood samples, socio-demographic and behavioural data were collected from 2697 patients. The overall HIV prevalence was 2.9%. About 1.4%, 2.1%, 4.2% of antenatal clinic (ANC) attendees and 2.1%, 3.7%, 5.3% of blood donors were, respectively, HIV-Abs-, HTLV-Abs- and HBs-Ag-positive; 5.5% of blood donors were HCV-affected. Co-infections were rare. Exactly 3.4% of the children aged 6-10 years were HIV-positive. People aged 26-35 years [adjusted odds ratio (AOR) 4.4, 95% CI (confidence interval) 1.72-11.22; P = 0.002], illiterate subjects (AOR 3.6, 95% CI 1.65-7.98; P = 0.001) mobile workers (AOR 7.0, 95% CI 1.41-34.62; P = 0.02) and previously operated patients (AOR 1.9, 95% CI 1.02-3.66; P = 0.04) were at higher risk for HIV/AIDS. Any of the examined factors were associated with hepatitis B virus, hepatitis C virus and human T lymphotropic virus type 1/2 transmission. HIV/AIDS prevention strategies must primarily be addressed to traditional high-risk groups and secondarily to unsafe health care procedures in relatively preserved sub-Saharan areas.
Humphrey, J H; Nathoo, K J; Hargrove, J W; Iliff, P J; Mutasa, K E; Moulton, L H; Chidawanyika, H; Malaba, L C; Zijenah, L S; Zvandasara, P; Ntozini, R; Zunguza, C D; Ward, B J
Studies of antenatal women form the predominant source of data on HIV-1 prevalence in Africa. Identifying factors associated with prevalent HIV is important in targeting diagnostic services and care. Between November 1997 and January 2000, 14,110 postnatal women from Harare, Zimbabwe were tested by ELISAs reactive to both HIV-1 and HIV-2; a subset of positive samples was confirmed with assays specific for HIV-1 and HIV-2. Baseline characteristics were elicited and modelled to identify risk factors for prevalent HIV infection. HIV-1 and HIV-2 prevalences were 32.0% (95% CI 31.2-32.8) and 1.3% (95% CI 1.1-1.5), respectively; 4% of HIV-1-positive and 99% of HIV-2-positive women were co-infected. HIV-1 prevalence increased from 0% among 14-year-olds to >45% among women aged 29-31 years, then fell to <20% among those aged>40 years. In multivariate analyses, prevalence increased with parity, was lower in married women than in single women, divorcees and widows, and higher in women with the lowest incomes and those professing no religion. Adjusted HIV-1 prevalence increased during 1998 and decreased during 1999. Age modified the effects of parity, home ownership and parental education. Among older women, prevalence was greater for women who were not homeowners. Among younger women, prevalence increased with parity and low parental education. None of these factors distinguished women co-infected with HIV-2 from those infected with HIV-1 alone. Prevalent HIV-1 infection is associated with financial insecurity and weak psychosocial support. The ZVITAMBO study apparently spanned the peak of the HIV-1 epidemic among reproductive women in Harare.
Gilbart, V L; Williams, D I; Macdonald, N D; Rogers, P A; Evans, B G; Hart, G; Williams, I G
An unmatched retrospective case control study was conducted to test the feasibility of investigating social and behavioural factors which may have contributed to recent HIV seroconversion in a group of homosexual men. Participants, recruited from a London sexually transmitted disease (STD) clinic, were sexually active and had had a negative HIV test with a subsequent test (positive (cases) or negative (controls)) within three to 15 months. Twenty cases and 22 controls were recruited between February and October 1995. There was no difference between cases and controls in: the number of regular or casual sexual partners, the proportion who were unaware of their regular partners' serostatus (cases 60%, controls 59%), or the proportion who had known HIV-positive regular partners (cases 20%, controls 23%). A significant difference in sexual behaviour was found only when the HIV status of partners, if known, was taken into account: cases were more likely than controls to have had unprotected receptive anal intercourse with a partner not known to be HIV-negative (OR = 5.5, CI = 1.15-29.50). Fifty per cent of the cases and 27% of the controls acquired acute STDs between the two HIV tests. All participants achieved high self-efficacy scores, but the controls believed their peers placed a greater value on safer sex. Cases cited emotional issues and the use of drugs and alcohol as contributing to their seroconversion, whereas controls cited a commitment to safer sex and the avoidance of high-risk situations as contributing to their remaining HIV-negative. The results illustrate the importance of acknowledging the concept of 'negotiated safety' in studies of sexual behaviour; seroconversion was only associated with unprotected sex with a partner not known to be HIV-negative. Despite high self-efficacy scores, indicating the skills to negotiate safer sex, high levels of unsafe anal intercourse were reported. Differences between cases and controls included the importance of
Kubicek, Katrina; Carpineto, Julie; McDavitt, Bryce; Weiss, George; Iverson, Ellen F.; Au, Chi-Wai; Kerrone, Dustin; Martinez, Miguel; Kipke, Michele D.
Risks associated with HIV are well documented in research literature. Although a great deal has been written about high-risk sex, little research has been conducted to examine how young men who have sex with men (YMSM) perceive and define high-risk sexual behavior. In this study, we compare the "professional" and "folk" models of HIV risk based on…
Seth, Puja; Lang, Delia L.; DiClemente, Ralph J.; Braxton, Nikia D.; Crosby, Richard A.; Brown, Larry K.; Hadley, Wendy; Donenberg, Geri R.
Background Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. Methods Three hundred and seventy nine sexually active adolescents, aged 13–18 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. Results After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR) = 3.2, P = 0.0001), obtain their HIV test results (AOR = 2.9, P = 0.03), refuse sex out of fear for STI acquisition (AOR = 1.7, P = 0.04), or avoid a situation that might lead to sex (AOR = 2.4, P = 0.001), and were less likely to have a casual sex partner (AOR = 0.40, P = 0.002). Additionally, females were more likely to report inconsistent condom use (AOR = 2.60, P = 0.001) and have a STI (AOR = 9.1, P = 0.0001) than their male counterparts. Conclusions Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills. PMID:22697141
Stahlman, Shauna; Liestman, Benjamin; Ketende, Sosthenes; Kouanda, Seni; Ky-Zerbo, Odette; Lougue, Marcel; Diouf, Daouda; Anato, Simplice; Tchalla, Jules; Bamba, Amara; Drame, Fatou Maria; Ezouatchi, Rebecca; Kouamé, Abo; Baral, Stefan D
Introduction Transgender women are at high risk for the acquisition and transmission of HIV. However, there are limited empiric data characterizing HIV-related risks among transgender women in sub-Saharan Africa. The objective of these analyses is to determine what factors, including sexual behaviour stigma, condom use and engagement in sex work, contribute to risk for HIV infection among transgender women across three West African nations. Methods Data were collected via respondent-driven sampling from men who have sex with men (MSM) and transgender women during three- to five-month intervals from December 2012 to October 2015 across a total of six study sites in Togo, Burkina Faso and Côte d'Ivoire. During the study visit, participants completed a questionnaire and were tested for HIV. Chi-square tests were used to compare the prevalence of variables of interest between transgender women and MSM. A multilevel generalized structural equation model (GSEM) was used to account for clustering of observations within study sites in the multivariable analysis, as well as to estimate mediated associations between sexual behaviour stigma and HIV infection among transgender women. Results In total, 2456 participants meeting eligibility criteria were recruited, of which 453 individuals identified as being female/transgender. Transgender women were more likely than MSM to report selling sex to a male partner within the past 12 months (p<0.01), to be living with HIV (p<0.01) and to report greater levels of sexual behaviour stigma as compared with MSM (p<0.05). In the GSEM, sexual behaviour stigma from broader social groups was positively associated with condomless anal sex (adjusted odds ratio (AOR)=1.33, 95% confidence interval (CI)=1.09, 1.62) and with selling sex (AOR=1.23, 95% CI=1.02, 1.50). Stigma from family/friends was also associated with selling sex (AOR=1.42, 95% CI=1.13, 1.79), although no significant associations were identified with prevalent HIV infection
Lauby, Jennifer L; Bond, Lisa; Eroğlu, Dogan; Batson, Heather
Improving our understanding of how individuals decide to take an HIV test is essential for designing effective programs to increase testing. This paper assesses the relationship of decisional balance and perceived risk to HIV testing history in a cross-sectional community sample of 1523 HIV-negative men and women at risk due to drug use or sexual behavior. We developed scales to measure perceived advantages (pros) and perceived disadvantages (cons) of taking an HIV test and assessed their content using factor analysis. Perceived risk was highly related to the pros and cons scales. Multivariate analyses revealed that the pros scale had positive associations with having ever tested and the number of tests taken, while the cons scale had negative associations with these testing measures. Perceived risk was not related to testing practices. These results suggest that interventions to increase HIV testing need to address anticipated positive and negative outcomes of getting tested.
ROBERTSON, ANGELA A.; ST LAWRENCE, JANET S.; MCCLUSKEY, D. LEE
Drug abusing offenders have high rates of HIV and other sexually transmitted infections (STI). To date, the HIV/STI prevention needs of offenders in drug court programs have been ignored. This multi-method study employed interviews to assess drug court professionals’ perceptions of the need for an HIV risk reduction intervention to be integrated into the services provided to drug court participants. Then, surveys were completed by 235 drug court participants to assess whether their sexual risk behaviors affirmed the need for such an intervention. The survey also assessed demographic characteristics, drug use prior to program entry, HIV knowledge, and condom attitudes. The relationship between duration in the drug court program and sexual risk behavior was also examined. Implications for the development and delivery of HIV risk reduction interventions within drug court programs are discussed. PMID:23658472
Bates, Christopher J; Singer, Merrill; Needle, Richard; Trotter, Robert T
The impact of the HIV/AIDS epidemic on minority communities called for interventions to stem the increase in new HIV infections and identify HIV-positive individuals for referral to care and treatment services. The Rapid Assessment, Response and Evaluation (RARE) project was designed to provide highly affected communities with a tool that would quickly identify conditions that fuel new infections and serve as barriers to HIV-positive individuals getting HIV testing, care, and treatment. RARE brought indigenous community health outreach workers and key community-level stakeholders together to advocate for the transfer of findings into programmatic and policy responses in places where high risk behaviors were practiced. This article describes RARE's qualitative methods that captured the voice of those most affected by the HIV/AIDS threat and identified critical insights and dynamics about factors that lead to HIV infections and those that can move positive individuals into care and treatment.
Beaulaurier, Richard; Fortuna, Karen; Lind, Danielle; Emlet, Charles A
Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.
Guilamo-Ramos, Vincent; Lee, Jane J; Ruiz, Yumary; Hagan, Holly; Delva, Marlyn; Quiñones, Zahira; Kamler, Alexandra; Robles, Gabriel
While the Caribbean has the second highest global human immunodeficiency virus (HIV) prevalence, insufficient attention has been paid to contributing factors of the region's elevated risk. Largely neglected is the potential role of drugs in shaping the Caribbean HIV/acquired immune deficiency syndrome epidemic. Caribbean studies have almost exclusively focused on drug transportation and seldom acknowledged local user economies and drug-related health and social welfare consequences. While tourism is consistently implicated within the Caribbean HIV epidemic, less is known about the intersection of drugs and tourism. Tourism areas represent distinct ecologies of risk often characterised by sex work, alcohol consumption and population mixing between lower and higher risk groups. Limited understanding of availability and usage of drugs in countries such as the Dominican Republic (DR), the Caribbean country with the greatest tourist rates, presents barriers to HIV prevention. This study addresses this gap by conducting in-depth interviews with 30 drug users in Sosúa, a major sex tourism destination of the DR. A two-step qualitative data analysis process was utilised and interview transcripts were systematically coded using a well-defined thematic codebook. Results suggest three themes: (1) local demand shifts drug routes to tourism areas, (2) drugs shape local economies and (3) drug use facilitates HIV risk behaviours in tourism areas.
Rimoin, A W; Hoff, N A; Djoko, C F; Kisalu, N K; Kashamuka, M; Tamoufe, U; LeBreton, M; Kayembe, P K; Muyembe, J J; Kitchen, C R; Saylors, K; Fair, J; Doshi, R; Papworth, E; Mpoudi-Ngole, E; Grillo, M P; Tshala, F; Peeters, M; Wolfe, N D
Despite recent declines in HIV incidence, sub-Saharan Africa remains the most heavily affected region in the global HIV/AIDS epidemic. Estimates of HIV prevalence in African military personnel are scarce and inconsistent. We conducted a serosurvey between June and September 2007 among 4043 Armed Forces personnel of the Democratic Republic of Congo (FARDC) stationed in Kinshasa, Democratic Republic of Congo (DRC) to determine the prevalence of HIV and syphilis infections and describe associated risk behaviours. Participants provided blood for HIV and syphilis testing and responded to a demographic and risk factor questionnaire. The prevalence of HIV was 3.8% and the prevalence of syphilis was 11.9%. Women were more likely than men to be HIV positive, (7.5% vs. 3.6% respectively, aOR: 1.66, 95% C.I: 1.21-2.28, p < 0.05). Factors significantly associated with HIV infection included gender and self-reported genital ulcers in the 12 months before date of enrollment. The prevalence of HIV in the military appears to be higher than the general population in DRC (3.8% vs. 1.3%, respectively), with women at increased risk of infection.
Williams, A B
This qualitative, exploratory study investigated knowledge about perinatal transmission of human immunodeficiency virus (HIV) and perceptions of the childbearing role among women at risk for acquired immunodeficiency syndrome (AIDS) through injection drug use. Content analysis was used to analyze the results of 21 face-to-face, semistructured interviews with women who had a personal history of injection drug use or who were the sexual partners of men who injected drugs. Contextual variables influencing women at risk for HIV infection that were identified included fear of HIV antibody testing, a belief that perinatal HIV transmission is inevitable, support for pregnancy termination in the event of HIV-associated pregnancy, a strong desire for children, pride in mothering behavior, and guilt about the possibility of transmitting HIV to unborn children. AIDS education and counseling for these women will be most effective if these variables are considered.
Tagoe, Michael; Aggor, R A
This study assesses knowledge, attitudes and behaviour in respect of risk of HIV infection of students through behavioral surveillance survey. The study used the systematic sampling approach to select 375 students. Interviews and focus group discussions were conducted to solicit information from respondents. The study found out that the students engaged in pre-marital sex, although this was more common among the male than female students. Students did not use condoms consistently and were not likely to use condoms when the relationship was considered as stable because of trust. Students revealed that they were all at risk of infection; however, a significant number of them did not know their HIV status and were not ready to take the test for fear of stigmatization. There low level knowledge among female students of the different types of STI. The results suggest that there is need for an appropriate education program for students. Peer education clubs need to be established to provide education on condom management. In addition, edutainment-education through entertainment program on HIV/AIDS -- needs to be an integral part of the university's curriculum. More recreational centers need to be established to allow students to channel their energies towards sports.
Mbonye, Martin; Siu, Godfrey E; Kiwanuka, Thadeus; Seeley, Janet
Regular male partners of female sex workers (FSWs) represent an important population to reach with HIV-prevention interventions. This paper discusses the relationship dynamics and HIV/sexually transmitted infection risk behaviour of men involved with self-identified FSWs in Kampala. Between 2011 and 2014 we conducted repeat in-depth interviews with 42 male partners of FSWs attending a clinic for women at high risk of HIV-infection in Kampala. Men publicly struggled with the stigma of dating women who are considered to be engaged in a shamed profession, but privately saw meaning in these relationships. In coping with the stigma, some described the work of their partners in terms that distanced them from sex work, while others struggled to have the control that "being a man" demanded since they could not monitor all movements of their partners. Dealing with HIV disclosure was hard and seeking support was difficult for some of the men, leading to missed opportunities and guilt. Despite challenges, relationships with sex workers offered men some benefits such as access to much needed care and treatment. A few men also admitted to being motivated by material and financial benefits from sex workers who they perceived as being rich and this was one factor that helped them sustain the relationships. These findings offer insights into the complex relationship dynamics within high risk sexual partnerships. However, the findings suggest that effective interventions that are couple centred can be established to promote better health.
Speakman, Andrew; Phillips, Andrew N; Lampe, Fiona C; Miltz, Ada; Gilson, Richard; Asboe, David; Nwokolo, Nneka; Scott, Christopher; Day, Sara; Clarke, Amanda; Anderson, Jane; O'Connell, Rebecca; Apea, Vanessa; Dhairyawan, Rageshri; Gompels, Mark; Farazmand, Paymaneh; Allan, Sris; Mann, Susan; Dhar, Jyoti; Tang, Alan; Sadiq, S Tariq; Taylor, Stephen; Collins, Simon; Sherr, Lorraine; Hart, Graham; Johnson, Anne M; Miners, Alec; Elford, Jonathan; Rodger, Alison
Background The annual number of new human immunodeficiency virus (HIV) infections in the United Kingdom among men who have sex with men (MSM) has risen, and remains high among heterosexuals. Increasing HIV transmission among MSM is consistent with evidence of ongoing sexual risk behavior in this group, and targeted prevention strategies are needed for those at risk of acquiring HIV. Objective The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study was designed to collect information on HIV negative adults at risk of HIV infection in the United Kingdom, based on the following parameters: physical and mental health, lifestyle, patterns of sexual behaviour, and attitudes to sexual risk. Methods Cross-sectional questionnaire study of HIV negative or undiagnosed sexual health clinic attendees in the United Kingdom from 2013-2014. Results Of 2630 participants in the AURAH study, 2064 (78%) were in the key subgroups of interest; 580 were black Africans (325 females and 255 males) and 1484 were MSM, with 27 participants belonging to both categories. Conclusions The results from AURAH will be a significant resource to understand the attitudes and sexual behaviour of those at risk of acquiring HIV within the United Kingdom. AURAH will inform future prevention efforts and targeted health promotion initiatives in the HIV negative population. PMID:27091769
Smith, Michael D.; Seal, David Wyatt; Hartley, Shannon
An HIV knowledge survey and qualitative interview were administered to 20 case managers in community-based programs for troubled youth to assess HIV knowledge and their perception of client HIV risk behaviors. Participants had good HIV knowledge. Case managers perceived client youth to be at high risk for HIV infection due to unsafe sexual…
Asher, Alice K.; Hahn, Judith A.; Couture, Marie-Claude; Maher, Kelsey; Page, Kimberly
Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account for increasingly more infections in a region already overwhelmed by the HIV epidemic. There is no known estimate of the number of people who inject drugs (PWID) in the region, or the associated HIV prevalence in PWID. We reviewed literature with the goal of describing high-risk practices and exposures in PWID in sub-Saharan Africa, as well as current HIV prevention activities aimed at drug use. The literature search looked for articles related to HIV risk, injection drug users, stigma, and HIV testing in sub-Saharan Africa. This review found evidence demonstrating high rates of HIV in IDU populations in sub-Saharan Africa, high-risk behaviors of the populations, lack of knowledge regarding HIV, and low HIV testing uptake. There is an urgent need for action to address IDU in order to maintain recent decreases in the spread of HIV in sub-Saharan Africa. PMID:23164598
Li, L; Morrow, M; Kermode, M
HIV prevalence is increasing in China. The proportion of infection attributable to heterosexual sex in China is also on the rise. The scale of internal migration for work is likely to be one of the factors contributing to these changing patterns, but little is known about HIV-related knowledge, perceptions and risk behaviours of China's migrant workers. This study aimed to investigate HIV-related knowledge, attitudes and risk behaviours of male rural-to-urban migrant workers in Chengdu and to identify factors associated with risk behaviours. In 2005, a cross-sectional questionnaire survey was completed by 163 male construction- and factory-based migrant workers aged 18-35 years. With a mean age of 26 years, just 30% had completed senior middle school and 47% were currently married. Respondents were highly mobile, worked long hours and were relatively poorly paid. As migrants, their access to urban services and benefits was restricted, making it difficult for family members to join them. Knowledge of HIV transmission was generally poor and discriminatory attitudes towards people with HIV were commonplace. Seventy-five percent were sexually experienced, among whom 88% had had sexual relations in the last 12 months. Of these, 30% had had two or more partners and 20% had paid for sex. Just 36% had used a condom during the most recent sexual encounter with a sex worker. Around 70% thought it was 'impossible' for them to become infected, yet a significant sub-group were engaging in sexual behaviours that place them at risk of infection with HIV and sexually transmitted infections (STIs). Logistic Regression found a significant association between having multiple sexual partners and both education level and marital status. Education was also found to be significantly associated with purchasing sex. Targeted HIV-prevention programs for male migrant workers in Chengdu, especially for those who are single and less educated, are urgently needed.
Reniers, Renate L E P; Murphy, Laura; Lin, Ashleigh; Bartolomé, Sandra Para; Wood, Stephen J
This study investigated the influence of personality characteristics and gender on adolescents' perception of risk and their risk-taking behaviour. Male and female participants (157 females: 116 males, aged 13-20) completed self-report measures on risk perception, risk-taking and personality. Male participants perceived behaviours as less risky, reportedly took more risks, were less sensitive to negative outcomes and less socially anxious than female participants. Path analysis identified a model in which age, behavioural inhibition and impulsiveness directly influenced risk perception, while age, social anxiety, impulsiveness, sensitivity to reward, behavioural inhibition and risk perception itself were directly or indirectly associated with risk-taking behaviour. Age and behavioural inhibition had direct relationships with social anxiety, and reward sensitivity was associated with impulsiveness. The model was representative for the whole sample and male and female groups separately. The observed relationship between age and social anxiety and the influence this may have on risk-taking behaviour could be key for reducing adolescent risk-taking behaviour. Even though adolescents may understand the riskiness of their behaviour and estimate their vulnerability to risk at a similar level to adults, factors such as anxiety regarding social situations, sensitivity to reward and impulsiveness may exert their influence and make these individuals prone to taking risks. If these associations are proven causal, these factors are, and will continue to be, important targets in prevention and intervention efforts.
Teva, Inmaculada; Bermudez, Maria Paz; Buela-Casal, Gualberto
The aim of this study was to assess whether coping styles, social stress, and sexual sensation seeking were predictors of HIV/STD risk behaviours in adolescents. A representative sample of 4,456 female and male Spanish high school students aged 13 to 18 years participated. A stratified random sampling procedure was used. Self-report questionnaires…
Kiene, Susan M; Sileo, Katelyn; Wanyenze, Rhoda K; Lule, Haruna; Bateganya, Moses H; Jasperse, Joseph; Nantaba, Harriet; Jayaratne, Kia
In Uganda, a nationwide scale-up of provider-initiated HIV testing and counselling presents an opportunity to deliver HIV-prevention services to large numbers of people. In a rural Ugandan hospital, focus group discussions and key informant interviews were conducted with outpatients receiving provider-initiated HIV testing and counselling and staff to explore the HIV-prevention information, motivation and behavioural skills strengths and weaknesses, and community-level and structural barriers to provider-initiated HIV testing and counselling acceptability and HIV prevention among this population. Strengths and weakness occurred at all levels, and results suggest brief client-centred interventions during provider-initiated HIV testing and counselling may be an effective approach to increase prevention behaviours in outpatient settings.
Drawing on 15 months of ethnographic research on HIV prevention programs in Poland, I explore the consequences of the shift from models of HIV prevention that emphasize “risk groups” and AIDS blame, to models that focus on “risky behaviors” and universal risk. The centrality of choice making and individual risk management in these models suggests objective risk assessment free from moralizing arguments. The Polish national prevention strategy shifted to focus on choice making, address all risk groups, and include concrete prevention strategies. This shift created a backlash that resulted in the reassertion of moral arguments about risk and risk groups that positioned those most vulnerable to HIV outside the purview of prevention efforts. AIDS organizations working with marginalized, “morally problematic” populations used the label “at risk” to legitimize claims to resources. They enacted a model of risk reduction in which the relevant actor is the individual buffeted by social forces, and behavior change, and therefore HIV risk reduction, is a long process because of myriad forms of vulnerability clients face. Despite efforts to reconceptualize risk, organizations positioned the individual as the locus of HIV prevention interventions, rather than attempting to address the social context that shapes risk. PMID:20092052
Greensides, Dawn R.; Berkelman, Ruth; Lansky, Amy; Sullivan, Patrick S.
OBJECTIVE: The purpose of this study was to determine the levels of awareness and use of alternative HIV tests (home collection kit, oral mucosal transudate collection kit, and rapid tests) among people at high risk for HIV infection. METHODS: Data were collected as part of an anonymous, cross-sectional interview study--the HIV Testing Survey (HITS)--conducted in seven states from September 2000 to February 2001. Three high-risk populations were recruited: men who have sex with men, injection drug users, and high-risk heterosexuals. Respondents were asked about their awareness and use of alternative HIV tests. RESULTS: The overall awareness and use of the alternative tests was limited: 54% of respondents were aware of the home collection kit, 42% were aware of the oral mucosal transudate collection kit test, and 13% were aware of rapid tests. Among those aware of alternative tests, self-reported use of the tests was also low. The most common reasons given for not using alternative HIV tests were: preference for the standard test; concern that the results could be less accurate; and that alternative tests were not offered. CONCLUSIONS: The low levels of awareness and use of alternative HIV tests suggest that the potential for promoting testing among individuals at high risk for HIV by encouraging use of alternative HIV tests has not been fully realized. Alternative tests should be made more broadly available and should be accompanied by education about these tests for physicians and people at risk. Educational efforts should be evaluated to determine if promoting alternative HIV tests increases the numbers of people at risk for HIV who are tested. PMID:14563910
O'Dell, Brennan L; Rosser, B R Simon; Miner, Michael H; Jacoby, Scott M
An understanding of men's motivations to avoid risk behavior is needed to create efficacious HIV prevention programs for HIV-positive men who have sex with men (MSM). This study investigates the relationship between sexual risk behavior and HIV prevention altruism, which is defined as the values, motivations, and practices of caretaking towards one's sexual partners to prevent the transmission of HIV. In a sample of 637 HIV-positive MSM, HIV prevention altruism significantly protects against serodiscordant unprotected anal intercourse (SDUAI) in crude analysis, but not after adjustment for drug use and compulsive sexual behavior. HIV prevention altruism is also related to not engaging in anal intercourse, but is not related to serodisclosure to secondary partners. Lack of altruism appears related to sexual risk behavior in HIV-positive MSM, although other psychological and contextual factors play significant roles. The promotion of HIV prevention altruism may provide a formidable new direction for HIV prevention programs.
Hanege, F M; Kalcioglu, M T; Sargin, F; Cetinkaya, Z; Tekin, M; Vahaboglu, H
Human immunodeficiency virus (HIV) is mainly transmitted via sexual activity, mother-to-child transmission, and contact with body fluids, such as saliva and semen. Cerumen, however, has not been investigated for its capability to transmit HIV. The purpose of this study was to evaluate the potential of cerumen for transmission of HIV infection. This study was conducted among 42 treatment-naive HIV-infected patients with positive HIV RNA and 27 HIV-infected patients with negative HIV RNA receiving antiviral treatment. Simultaneous blood samples were studied as positive controls. Sixty-nine prospectively collected cerumen specimens were analyzed for the presence of HIV RNA by real-time polymerase chain reaction (PCR). None of the 69 cerumen specimens were positive for HIV RNA. These results conclude that cerumen in HIV-positive patients with or without antiretroviral therapy (ART) carry only an insignificant risk of transmission. However, standard infection control precautions should be applied carefully in all examinations and surgical operations of the ears.
Drake, Alison L.; Wilson, Suzanne K.; Kinuthia, John; Roxby, Alison C.; Matemo, Daniel; Farquhar, Carey; Rao, Deepa
Healthcare-seeking behaviours of HIV-infected mothers in sub-Saharan Africa are poorly characterized and typically focus on individual health conditions rather than overall health. We conducted a qualitative study to understand how HIV-infected mothers, their male partners, and their HIV-exposed infants seek medical services. We performed 32 in-depth interviews (17 female, 15 male) and four focus group discussions (FGDs) among HIV-infected postpartum women and their male partners in Nairobi, Kenya. We used a grounded theory approach to explore the paths followed for health-related concerns. Female participants reported that willingness to be tested for HIV influences whether women sought antenatal care and the type of facility they preferred for childbirth. The need for medical care outside regular clinic hours and securing safe transportation at night were also significant barriers to seeking care. Most men sought services from traditional healers and chemists before HIV diagnosis, and at governmental facilities afterwards. Both men and women sent infants to traditional healers for non-medical conditions such as bewitching and massage, but rarely for medical conditions. Strategies to reduce HIV-related stigma and fears in antenatal and maternity settings, increase access to care after-hours, and improve linkage to HIV care for men early in their infection are needed. PMID:25646645
Luttbeg, Barney; Sih, Andrew
Many animals exhibit behavioural syndromes-consistent individual differences in behaviour across two or more contexts or situations. Here, we present adaptive, state-dependent mathematical models for analysing issues about behavioural syndromes. We find that asset protection (where individuals with more 'assets' tend be more cautious) and starvation avoidance, two state-dependent mechanisms, can explain short-term behavioural consistency, but not long-term stable behavioural types (BTs). These negative-feedback mechanisms tend to produce convergence in state and behaviour over time. In contrast, a positive-feedback mechanism, state-dependent safety (where individuals with higher energy reserves, size, condition or vigour are better at coping with predators), can explain stable differences in personality over the long term. The relative importance of negative- and positive-feedback mechanisms in governing behavioural consistency depends on environmental conditions (predation risk and resource availability). Behavioural syndromes emerge more readily in conditions of intermediate ecological favourability (e.g. medium risk and medium resources, or high risk and resources, or low risk and resources). Under these conditions, individuals with higher initial state maintain a tendency to be bolder than individuals that start with low initial state; i.e. later BT is determined by state during an early 'developmental window'. In contrast, when conditions are highly favourable (low risk, high resources) or highly unfavourable (high risk, low resources), individuals converge to be all relatively bold or all relatively cautious, respectively. In those circumstances, initial differences in BT are not maintained over the long term, and there is no early developmental window where initial state governs later BT. The exact range of ecological conditions favouring behavioural syndromes depends also on the strength of state-dependent safety.
Parry, Charles; Petersen, Petal; Carney, Tara; Dewing, Sarah; Needle, Richard
This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known 'hotspots' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.
Adedimeji, Adebola A; Hoover, Donald R; Shi, Qiuhu; Gard, Tracy; Mutimura, Eugene; Sinayobye, Jean d'Amour; Cohen, Mardge H; Anastos, Kathryn
It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75 % of participants were HIV positive and ~50 % reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents' age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors.
ADEDIMEJI, Adebola A.; HOOVER, Donald R.; SHI, Qiuhu; GARD, Tracy; MUTIMURA, Eugene; SINAYOBYE, Jean d’Amour; COHEN, Mardge H.; ANASTOS, Kathryn
It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75% of participants were HIV positive and ~50% reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents’ age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors. PMID:25488169
Bui, T. D.; Pham, C. K.; Pham, T. H.; Hoang, L. T.; Nguyen, T. V.; Vu, T. Q.; Detels, R.
OBJECTIVE: A cross-sectional survey was conducted in three districts of Quang Ninh province, Viet Nam, to find out what proportion of the people who lived there engaged in behaviour that put them at risk of becoming infected with HIV, and to measure their knowledge about HIV infection and AIDS. METHODS: The survey was conducted in a rural district, Yen Hung; a mountainous district inhabited primarily by ethnic minority groups, Binh Lieu; and an urban district, Ha Long. Participants aged 15-45 years were randomly selected from the general population to be interviewed. FINDINGS: A total of 630 people from 707 households were interviewed; 8% were not home despite repeated visits and 3% refused to participate. The prevalence of premarital intercourse ranged from 9% to 16% among married men and 4% to 7% among married women. Among single men the proportion who had ever had intercourse ranged from 6% to 16%. Fewer than 3% reported having ever had sex with a sex worker. The median number of extramarital sex partners was 1. Knowledge about HIV/AIDS was high in the urban and rural areas but low in the mountainous area. Being male and being 20-29 years old were associated with having multiple sex partners. CONCLUSION: The low prevalence of individuals reporting that they had had intercourse with sex workers and partners other than their spouse may explain the low rates of HIV infection among the heterosexual population; these rates are in contrast to the high rates of HIV infection found among injecting drug users. The association between having extramarital partners and being a younger man suggests that the tendency to have more sexual partners may increase in the future. If this happens, the potential for HIV to be spread through heterosexual sex will increase. PMID:11217661
Du, Hongfei; Li, Xiaoming
This review examines the global literature regarding the relationship between acculturation and HIV-related sexual behaviours among international migrants. Seventy-nine articles published in English-language journals prior to July 2012 met the criteria for inclusion. We conducted a systematic review and subset meta-analysis of correlations between acculturation and five types of sexual behaviours including condom use, multiple partnerships, early sexual initiation, sexually transmitted diseases (STDs) and other unsafe sexual practices. Immigrants high in mainstream acculturation were more likely to have multiple partnerships, early sexual initiation, STDs and unsafe sex (rs ranged from 0.10 to 0.16), but acculturation was not associated with condom use (r = 0.02). Gender moderated the relationships between acculturation and multiple partnerships, STDs and unsafe sex. The relationship between acculturation and unsafe sex also varied across ethnicity. These findings suggest that acculturation may serve as a risk factor towards immigrants' HIV-related sexual health. We offered a theoretical framework and suggested applying cross-cultural and longitudinal designs in future research on acculturation and health behaviours.
van der Knaap, Linda; Jedeloo, Susan
Young people living with HIV are challenged when it comes to exploring their sexuality. Their sex education is hampered by the fact that their preferences and attitudes towards sexual behaviour are little known about. In this study from the Netherlands, Q-methodology was used to identify sizeable and meaningful sub-groups sharing common attitudes…
Sivaram, Sudha; Srikrishnan, Aylur Kailasom; Murgavel, Kailapuri G; Mayer, Kenneth H; Anand, S; Celentano, David D; Solomon, Suniti
Community-based assessment of HIV prevalence and behavioural risk factors is the basis for deciding priorities of prevention and care programmes. Here, upholding the human rights of participants in assessment is of utmost importance. The objective of the paper was to describe the process of implementation of an epidemiological survey to assess HIV-related behavioural and biological factors in Chennai city in South India and to suggest an ethical framework for conducting similar assessment activities in developing-country settings. A survey was conducted with participation from residents (n=1,659) of low-income urban communities (slums) as part of a community-based HIV/STD-prevention trial. Administration of the survey was preceded by extensive community contact and household visits to inform community members about the trial and assessment activities. Formative research further strengthened rapport with community, highlighted community concerns, and identified HIV-related risk behaviours that informed questionnaire design. The process of obtaining informed consent began before assessment activities and provided an opportunity for individuals to discuss participation with their families and friends. Privacy during assessment, comprehensive follow-up care for those who tested positive for HIV/STDs, such as nutritional and prevention counselling, referral services for opportunistic infections, and antenatal-care options for pregnant women increased trust and credibility of the project. The sustained availability of trial staff to facilitate access to resources to address non-HIV/STD-related felt-needs further strengthened participation of the community members. These resources included liaison services with local government to obtain public services, such as water and electricity and resources, to address concerns, such as alcohol abuse and domestic violence. Based on this experience, an ethical framework is suggested for conducting HIV epidemiological risk assessment
van Benthem, B H B; Spaargaren, J; van den Hoek, J A R; Merks, J; Coutinho, R; Prins, M
Objectives: To investigate the prevalence and risk factors of HSV-1 and HSV-2 antibodies in HIV infected women and the association between recurrent genital ulcerations and HIV disease progression in HSV-2 positive women. Methods: The presence of HSV antibodies was tested in 276 of the 487 women participating in a European cohort study of HIV infected women. Prevalence rate ratios described the association between HSV infection and its risk factors, using log binomial regression. Generalised estimating equations (GEE) analysis was performed to determine the impact of markers of HIV disease progression on recurrent genital ulcerations. Results: The prevalence of HSV-1 and HSV-2 antibodies was 76% (95% confidence interval (95% CI): 71–81) and 42% (95% CI: 36–50); 30% (95% CI: 24–35) of the women had antibodies against both HSV-1 and HSV-2. The prevalence of HSV-1 was 86% (95% CI: 80–92) in southern Europe compared with 69% (95% CI: 57–79) and 67% (95% CI: 55–77) in central and northern Europe (p=0.002). This geographical variation remained after adjustment for other risk factors. An increasing number of years of sexual activity (p=0.0002) and a history of prostitution (p=0.0001) were independently associated with HSV-2 prevalence. In HSV-2 positive women, symptomatic cases of HSV infection were minimal, but increased with decreasing CD4 count. Conclusion: In HIV infected women, the prevalence of HSV antibodies is high and symptomatic cases of HSV infection are minimal, but increase with decreasing CD4 count. HSV-2 but not HSV-1 was related to sexual behaviour (that is, a history of prostitution and the number of sexually active years) in this group of HIV infected women. Key Words: herpes simplex viruses; genital ulcerations; HIV infection; women; Europe PMID:11287691
Taylor, Myra; Dlamini, Siyabonga B; Meyer-Weitz, Anna; Sathiparsad, Reshma; Jinabhai, Champak C; Esterhuizen, Tonya
This community household survey undertaken in Melmoth, a rural area in KwaZulu-Natal, South Africa, investigated the influence of cumulative exposure of complementary interventions by a non-governmental organisation, LoveLife which aimed to bring changes in beliefs about HIV and AIDS prevention and treatment, and to reduce sexual risk behaviour. Amongst the 1294 respondents (15-40 years of age) increasing the number of exposures to different LoveLife interventions included use of television and radio messages, billboards, a free monthly magazine for youth, special school sports and community events, involvement of youth peer educators, and support for schools through classroom programmes and by linking clinic staff and peer educators. Cumulative exposure to LoveLife interventions resulted in more respondents believing that HIV could be prevented (p<0.005) and treated (p=0.007) and that people should test for HIV (p=0.03). Half of the respondents reported using a condom at last sex and cumulative exposure to LoveLife was associated with increased condom use (p<0.005). However, despite exposure to LoveLife, only 41.9% respondents had ever tested for HIV and cumulative exposure to LoveLife did not significantly influence respondents going to hospital for anti-retroviral treatment. The dose-response effect of cumulative LoveLife exposure appeared to have a positive influence on some beliefs and practices, but did not discriminate the extent of LoveLife exposure nor exposure to other HIV/AIDS interventions.
Lahat, Ayelet; Hong, Melanie; Fox, Nathan A
Behavioural inhibition is a stable temperamental trait that is identifiable during infancy and toddlerhood and is characterized by fearful reactivity to novelty. Children identified as behaviourally inhibited have been shown to be at increased risk for developing anxiety disorders such as social phobia. The current review addresses the link between behavioural inhibition and the risk for developing anxiety disorders. Research suggests that this risk may be modulated by a number of extrinsic and intrinsic factors. Extrinsic factors include particular parental beliefs, parenting styles, and childrearing contexts. Intrinsic factors include executive function capacities such as attention bias, attention shifting, inhibitory control, and self-monitoring. In the present paper we review the contribution of these factors to the development of anxiety in behaviourally inhibited children.
Ballester-Arnal, Rafael; Gil-Llario, María Dolores; Castro-Calvo, Jesús; Giménez-García, Cristina
The prevalence of HIV risk behaviors among young people facilitates the spread of HIV, in particular regarding unsafe sex behavior, although this trend is different within this population. For this reason, identifying the riskier young population is required to prevent HIV infection. The main purpose of this study was to develop and validate a risk index to assess the different sexual HIV risk exposure among Hispanic Young people. For this purpose, 9861 Spanish young people were randomly distributed into two groups (derivation and validation group). According to the results, the factor analyses grouped the nine items of the HIV- risk index into two factors (factor 1, direct sexual risk indicators and factor 2, indirect sexual risk indicators) with an equal structure for men and women by a multi-group confirmatory factor analysis. The variance explained was 54.26 %. Moreover, the Cronbach's alpha coefficient revealed high internal reliability (α = .79) and the convergent validity supported its evidence based on different HIV risk indexes. Therefore, the HIV-risk index seem to be a rigorous and valid measure to estimate HIV risk exposure among young people.
Mimiaga, M J; Thomas, B; Mayer, K H; Reisner, S L; Menon, S; Swaminathan, S; Periyasamy, M; Johnson, C V; Safren, S A
Men who have sex with men (MSM) in India are a core risk group for HIV. Heavy alcohol consumption is associated with increased sexual risk-taking behaviours in many cultures, in particular among MSM. However, no studies to date have explored alcohol use and HIV risk among MSM in India. MSM in Chennai, India (n = 210) completed an interviewer-administered behavioural and psychosocial assessment. Bivariate and multivariable logistic regression procedures examined behavioural and demographic associations with weekly alcohol consumption. Twenty-eight percent of the sample (n = 58) reported using alcohol at least weekly to the point of being buzzed/intoxicated, which was associated with older age, being married to a woman, being panthi (masculine appearing, predominantly insertive partners) versus kothi (feminine acting/appearing and predominantly receptive partners), weekly tobacco use, unprotected anal sex and unprotected vaginal sex in the three months prior to study enrollment (all P < 0.05). In a multivariable model, unprotected vaginal sex in the previous three months and being married to a women were unique variables associated with weekly alcohol use (all P < 0.01). Further investigation of alcohol use within the context of sexual risk taking is warranted among Indian MSM. Panthis and MSM who are married to women may be particularly likely to benefit from interventions to decrease alcohol intake and concurrent unsafe sex.
Tarkang, Elvis Enowbeyang
Introduction Since learners in secondary schools fall within the age group hardest hit by HIV/AIDS, it is obvious that these learners might be at high risk of contracting HIV/AIDS. However, little has been explored on the perception of risk of contracting HIV among secondary school learners in Cameroon. This study aimed at examining the perception of risk of contracting HIV among secondary school learners in Mbonge subdivision of rural Cameroon using the Health Belief Model (HBM) as framework. Methods A quantitative, correlational design was adopted, using a self-administered questionnaire to collect data from 210 female learners selected through disproportional, stratified, simple random sampling technique, from three participating senior secondary schools. Statistics were calculated using SPSS version 20 software program. Results Only 39.4% of the respondents perceived themselves to be at high risk of contracting HIV, though the majority, 54.0% were sexually active. Multinomial logistic regression analyses show that sexual risk behaviours (p=0.000) and the Integrated Value Mapping (IVM) of the perception components of the HBM are the most significant factors associated with perception of risk of contracting HIV at the level p<0.05. Conclusion The findings of this study can play an instrumental role in the development of effective preventive and interventional messages for adolescents in Cameroon. PMID:25309659
Gaydos, C A; Hsieh, Y-H; Galbraith, J S; Barnes, M; Waterfield, G; Stanton, B
A community-based intervention, Focus-on-Kids (FOK) has demonstrated risk-behaviour reduction of urban youth. We modified FOK to Focus-on-Teens (FOT) for high schools. High school adolescents (n=1190) were enrolled over successive school semesters. The small-group sessions were presented during the school-lunch hours. Confidential surveys were conducted at baseline, immediate, six-, and 12-month postintervention for demographics, parental communication/monitoring, sexual risk behaviours and sexually transmitted diseases (STDs)/HIV/condom-usage knowledge. Sexually active participants were encouraged to volunteer for urine-based STDs testing at the School-Based Health Centres. Many (47.4%) students reported having had sexual intercourse at baseline. Overall behaviours changed towards 'safer' sex behaviours (intent-to-use and using condoms, communicating with partner/parents about sex/condoms/STDs) with time (P<0.05). Proportion of students with complete correct knowledge of STDs/HIV increased to 88% at time 4 from 80% at baseline after adjusting for age, gender and sexual activity (P<0.05). High prevalence of STDs was detected in 875 participants who reported for urine testing at time 1: trichomonas, 11.8%; chlamydia, 10.1% and gonorrhoea, 4.1%. Prevalence decreased significantly for 310 participants who re-tested; chlamydia: 27.4% to 6.1% and gonorrhoea: 11.3% to 3.2%. FOT was successfully implemented as an STDs/HIV risk-reduction intervention. Sustained improvements of knowledge about STDs/HIV/condom usage, decreases in sexual risk behaviours supported the effectiveness of this intervention.
Wallace, Victoria C J; Blackbeard, Julie; Pheby, Timothy; Segerdahl, Andrew R; Davies, Meirion; Hasnie, Fauzia; Hall, Susan; McMahon, Stephen B; Rice, Andrew S C
A painful neuropathy is frequently observed in people living with human immunodeficiency virus type 1 (HIV-1). The HIV coat protein, glycoprotein 120 (gp120), implicated in the pathogenesis of neurological disorders associated with HIV, is capable of initiating neurotoxic cascades via an interaction with the CXCR4 and/or CCR5 chemokine receptors, which may underlie the pathogenesis of HIV-associated peripheral neuropathic pain. In order to elucidate the mechanisms underlying HIV-induced painful peripheral neuropathy, we have characterised pathological events in the peripheral and central nervous system following application of HIV-1 gp120 to the rat sciatic nerve. Perineural HIV-1 gp120 treatment induced a persistent mechanical hypersensitivity (44% decrease from baseline), but no alterations in sensitivity to thermal or cold stimuli, and thigmotactic (anxiety-like) behaviour in the open field. The mechanical hypersensitivity was sensitive to systemic treatment with gabapentin, morphine and the cannabinoid WIN 55,212-2, but not with amitriptyline. Immunohistochemical studies reveal: decreased intraepidermal nerve fibre density, macrophage infiltration into the peripheral nerve at the site of perineural HIV-1 gp120; changes in sensory neuron phenotype including expression of activating transcription factor 3 (ATF3) in 27% of cells, caspase-3 in 25% of cells, neuropeptide Y (NPY) in 12% of cells and galanin in 13% of cells and a spinal gliosis. These novel findings suggest that this model is not only useful for the elucidation of mechanisms underlying HIV-1-related peripheral neuropathy but may prove useful for preclinical assessment of drugs for the treatment of HIV-1 related peripheral neuropathic pain.
Wallace, Victoria C.J.; Blackbeard, Julie; Pheby, Timothy; Segerdahl, Andrew R.; Davies, Meirion; Hasnie, Fauzia; Hall, Susan; McMahon, Stephen B.; Rice, Andrew S.C.
A painful neuropathy is frequently observed in people living with human immunodeficiency virus type 1 (HIV-1). The HIV coat protein, glycoprotein 120 (gp120), implicated in the pathogenesis of neurological disorders associated with HIV, is capable of initiating neurotoxic cascades via an interaction with the CXCR4 and/or CCR5 chemokine receptors, which may underlie the pathogenesis of HIV-associated peripheral neuropathic pain. In order to elucidate the mechanisms underlying HIV-induced painful peripheral neuropathy, we have characterised pathological events in the peripheral and central nervous system following application of HIV-1 gp120 to the rat sciatic nerve. Perineural HIV-1 gp120 treatment induced a persistent mechanical hypersensitivity (44% decrease from baseline), but no alterations in sensitivity to thermal or cold stimuli, and thigmotactic (anxiety-like) behaviour in the open field. The mechanical hypersensitivity was sensitive to systemic treatment with gabapentin, morphine and the cannabinoid WIN 55,212-2, but not with amitriptyline. Immunohistochemical studies reveal: decreased intraepidermal nerve fibre density, macrophage infiltration into the peripheral nerve at the site of perineural HIV-1 gp120; changes in sensory neuron phenotype including expression of activating transcription factor 3 (ATF3) in 27% of cells, caspase-3 in 25% of cells, neuropeptide Y (NPY) in 12% of cells and galanin in 13% of cells and a spinal gliosis. These novel findings suggest that this model is not only useful for the elucidation of mechanisms underlying HIV-1-related peripheral neuropathy but may prove useful for preclinical assessment of drugs for the treatment of HIV-1 related peripheral neuropathic pain. PMID:17433546
Mantell, Joanne E; Kelvin, Elizabeth A; Sun, Xiaoming; Zhou, Jianfang; Exner, Theresa M; Hoffman, Susie; Zhou, Feng; Sandfort, Theo G M; Leu, Cheng-Shiun
Large-scale internal migration in China may be an important mechanism for the spread of HIV/sexually transmitted infections (STIs) because of the risk behaviours of migrants. We conducted a self-administered survey among 724 employees of a high-end entertainment centre in Kunshan, Jiangsu Province, China. Using logistic regression, we examined the association of hometown of origin (Kunshan city, elsewhere in Jiangsu Province, or another province in China) and consecutive years living in Kunshan with measures of HIV/STI risk behaviour. We found that increased time living in Kunshan was associated with lower odds of using condoms as contraception [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.95] and consistent condom use with a casual partner (OR = 0.66, 95% CI: 0.47-0.93), after controlling for gender, marital status age and income. The odds of having had an STI were significantly lower for Kunshan natives than those originally from outside provinces (OR = 0.25, 95% CI: 0.07-0.96), but increasing years living in Kunshan was not related to lower risk for an STI. Our findings do not support the hypothesis that migrants living far from home participate in higher risk behaviour than locals. Findings suggest that adaptation to local culture over time may increase HIV/STI risk behaviours, a troublesome finding.
Mojola, Sanyu A
Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition-to-adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high-school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested.
Campbell, Chadwick K; Gomez, Anu Manchikanti; Hoff, Colleen; Grisham, Kirk K; Wilson, Patrick A; Dworkin, Shari L
Research has suggested that men who have sex with men and who have older sexual partners are at increased risk of HIV infection. However, while several studies have explored risk among men in age-discrepant non-primary partnerships, only two have explored age discrepancy and risk in primary same-sex male relationships. We used data from semi-structured in-depth interviews to explore sexual behaviour and HIV risk among 14 Black, white and interracial (Black/white) same-sex male couples with an age difference of 10 or more years. Most couples regularly used condoms, and sexual positioning tended to lead to lower risk for younger partners. Some serodiscordant couples abstained from anal sex, while others used seropositioning to avoid transmission within the relationship. Within some couples, older partners acted as mentors on HIV prevention and broader life lessons. Future studies should further explore the potential risks and benefits of large age differences in same-sex male primary relationships.
Cooper, Hannah L. F.; Osborne, Andrew H.
HIV continues to be transmitted at unacceptably high rates among African Americans, and most HIV-prevention interventions have focused on behavioral change. To theorize additional approaches to HIV prevention among African Americans, we discuss how sexual networks and drug-injection networks are as important as behavior for HIV transmission. We also describe how higher-order social structures and processes, such as residential racial segregation and racialized policing, may help shape risk networks and behaviors. We then discuss 3 themes in African American culture—survival, propriety, and struggle—that also help shape networks and behaviors. Finally, we conclude with a discussion of how these perspectives might help reduce HIV transmission among African Americans. PMID:19372519
Anthony, M N; Gardner, L; Marks, G; Anderson-Mahoney, P; Metsch, L R; Valverde, E E; Del Rio, C; Loughlin, A M
The delay between testing positive for human immunodeficiency virus (HIV) and entering medical care can be better understood by identifying variables associated with use of HIV primary care among persons recently diagnosed with the virus. We report findings from 270 HIV-positive persons enrolled in the Antiretroviral Treatment Access Study (ARTAS). 74% had not seen an HIV care provider before enrollment; 26% had one prior visit only. Based on Andersen's behavioural model of health care utilization, several variables reflecting demographic, healthcare, illness, behavioural, and psychosocial dimensions were assessed and used to predict the likelihood that participants had seen an HIV care provider six months after enrollment. Overall, 69% had seen an HIV care provider by six months. In multivariate analysis, the likelihood of seeing a provider was significantly (p<.05) higher among men, Hispanics (vs. non-Hispanic Blacks), those with higher education, those who did not use injection drugs, those with three or more HIV-related symptoms, those with public health insurance (vs. no insurance), and those who received short-term case management (vs. passive referral). The findings support several conceptual categories of Andersen's behavioural model of health services utilization as applied to the use of HIV medical care among persons recently diagnosed with HIV.
OBJECTIVES—As self rated health and mortality represent different dimensions of public health and as risk behaviours have been closely related to mortality, we wanted to examine whether (poor) self rated health on the one hand and risk behaviours on the other can be attributed to different causes. METHODS—The Taganrog household survey (1998) was conducted in the form of face to face interviews and included 1009 people and their families. To estimate health differences and differences in risk behaviours between groups, logistic regressions were performed. RESULTS—In Taganrog between 1993/94 and 1998, changes in self rated health seem to have been much more dramatic than changes in smoking and different in direction from changes in heavy alcohol consumption. Moreover, self rated "poor" health was especially common among those whose economic situation was worse in 1998 than 10 years before. However, having a poorer economy during the period 1988-1998, does not seem to have affected drinking or smoking habits significantly. CONCLUSIONS—Self rated health seems to be closely related to three indicators of economic circumstances. Risk behaviours are probably important for the poor state of public health in Russia, but may be less sensitive to the economic aspects of the transition than is self rated health. Keywords: self rated health; risk behaviours PMID:11604437
Adeomi, Adeleye Abiodun; Adeoye, Oluwatosin Adediran; Asekun-Olarinmoye, Esther Olufunmilayo; Abodunrin, Olugbemiga Lanre; Olugbenga-Bello, Adenike Iyanuoluwa; Sabageh, Adedayo Olukemi
Introduction. Young people are at the centre of the global HIV/AIDS epidemic. This study therefore aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and preventive practices among in-school adolescents in Osun State, Nigeria. Methods. This was an intervention study that was carried out among in-school adolescents attending mixed secondary schools in Osun State, Nigeria. The study was in three stages: before intervention, intervention, and after intervention. The impact of peer education was evaluated twelve weeks after intervention. Data were collected using pretested semistructured questionnaires and data analysis was done with SPSS version 16. Results. At the preintervention stage, the study and control groups were similar in their sociodemographic characteristics, HIV knowledge, attitude, and preventive practices, including high risk behaviours for HIV/AIDS transmission. After the peer education intervention, those with good knowledge and positive attitudes towards HIV/AIDS increased significantly from 50.0% to 86.7% and from 49.0% to 85.6%, respectively (P < 0.05). Conclusion. The study showed that peer education is effective in improving knowledge, attitude, and some preventive practices towards HIV/AIDS among in-school adolescents. Educational programmes about HIV/AIDS should therefore be designed to target this age group putting into consideration their unique characteristics. PMID:25478212
The World Health Organization estimated that 2.2% of Nigeria's adult population was infected with HIV by the end of 1995. A 1993-94 sentinel surveillance report found a 3.8% HIV seroprevalence level among sexually active Nigerians sampled. HIV prevalence is rising in the country. Incidence and prevalence data are presented on HIV and AIDS in sections on antenatal clinics, HIV-1 and HIV-2, group variations, regional variations, age variations, prostitutes, and infection by blood. The Nigerian government has projected that there could be 7 million people infected with HIV in the country by the year 2000. Background is presented on the economy, living standards, health, and population. Vulnerability is then considered with regard to population mobility, drug trafficking, the vulnerability of women, the international sex trade, the military presence in Liberia, sexual attitudes, poverty, and ignorance. The responses of the government and the domestic nongovernment sector are then presented followed by description of external assistance from the World Bank, the US Agency for International Development, the British Overseas Development Agency, the World Health Organization, the private sector, and the European Commission.
Steel, Jennifer; Herlitz, Claes; Matthews, Jesse; Snyder, Wendy; Mazzaferro, Kathryn; Baum, Andy; Theorell, Töres
This study examined the relationship between pre-migration trauma and HIV-risk behavior in refugees from sub-Saharan Africa. The sample comprised 122 persons who had emigrated from sub-Saharan Africa and were currently residing in Sweden. Qualitative methods including individual interviews, focus groups, and interviews with key informants addressed questions regarding trauma experience and HIV-risk behavior. A history of pre-migration trauma was found to be associated with HIV-risk behavior. According to the participants, symptoms associated with post-traumatic stress disorder, depression, adjustment disorder, and substance use mediated the relationship between pre-migration trauma and sexual risk behavior. In contrast, a minority of the participants who reported pre-migration trauma but not psychological sequelae, or experienced post-traumatic growth, reported safer sexual practices. It appears that for some individuals, pre-migration trauma resulted in psychiatric sequelae, which may increase an individual's risk to be infected with HIV. Interventions targeted at individuals at increased risk (i.e. pre-migration trauma with unresolved psychiatric symptomatology) may facilitate the prevention of HIV and other sexually transmitted diseases in this population. Integration of multiple psychosocial and health issues is recommended for comprehensive treatment and prevention programs.
Delva, Wim; Helleringer, Stéphane
Introduction Concerns about risk compensation—increased risk behaviours in response to a perception of reduced HIV transmission risk—after the initiation of ART have largely been dispelled in empirical studies, but other changes in sexual networking patterns may still modify the effects of ART on HIV incidence. Methods We developed an exploratory mathematical model of HIV transmission that incorporates the possibility of ART clusters, i.e. subsets of the sexual network in which the density of ART patients is much higher than in the rest of the network. Such clusters may emerge as a result of ART homophily—a tendency for ART patients to preferentially form and maintain relationships with other ART patients. We assessed whether ART clusters may affect the impact of ART on HIV incidence, and how the influence of this effect-modifying variable depends on contextual variables such as HIV prevalence, HIV serosorting, coverage of HIV testing and ART, and adherence to ART. Results ART homophily can modify the impact of ART on HIV incidence in both directions. In concentrated epidemics and generalized epidemics with moderate HIV prevalence (≈ 10%), ART clusters can enhance the impact of ART on HIV incidence, especially when adherence to ART is poor. In hyperendemic settings (≈ 35% HIV prevalence), ART clusters can reduce the impact of ART on HIV incidence when adherence to ART is high but few people living with HIV (PLWH) have been diagnosed. In all contexts, the effects of ART clusters on HIV epidemic dynamics are distinct from those of HIV serosorting. Conclusions Depending on the programmatic and epidemiological context, ART clusters may enhance or reduce the impact of ART on HIV incidence, in contrast to serosorting, which always leads to a lower impact of ART on HIV incidence. ART homophily and the emergence of ART clusters should be measured empirically and incorporated into more refined models used to plan and evaluate ART programmes. PMID:27657492
Saleh, Lena D; van den Berg, Jacob J; Chambers, Christopher S; Operario, Don
Previous research has suggested a need to understand the social-psychological factors contributing to HIV risk among African American men who have sex with men (MSM). We conducted individual in-depth interviews with 34 adult African American MSM to examine their personal experiences about: (i) sources of social support, (ii) psychological responses to the presence or absence of social support and (iii) influences of social support on sexual behaviours. The majority of participants described limited positive encouragement and lack of emotional support from family, as well as few meaningful personal relationships. Feelings of isolation and mistrust about personal relationships led many participants to avoid emotional intimacy and seek physical intimacy through sexual encounters. Findings highlight a need for multilevel interventions that enhance social support networks and address the social-psychological, emotional and interpersonal factors that contribute to HIV risk among African American MSM.
Barnard, M; McKeganey, N
In this paper we present data on the HIV-related risks for adolescents growing up in an area where injecting drug use is prevalent and HIV infection has been identified among local injecting drug users. We report on young peoples' knowledge, attitudes and perceptions of drug use and injectors; HIV and AIDS; sex, safer sex and condom use. These adolescents had an extensive and practically oriented knowledge of illicit drugs and drug injectors. The majority of adolescents contacted had an unsophisticated but approximate understanding of HIV transmission dynamics and how to guard against infection. Our data suggest that many adolescents find issues relating to sex awkward, embarrassing and difficult subjects for discussion. In a final section we consider some of the policy implications of our work focussing in particular on the prevention of injecting, the promotion of condom use, and the necessity of avoiding a focus upon risk groups.
Kariuki, Wanjiku; Manuel, Jennifer I; Kariuki, Ngaruiya; Tuchman, Ellen; O’Neal, Johnnie; Lalanne, Genevieve A
High rates of smoking among persons living with HIV (PLWH) may reduce the effectiveness of HIV treatment and contribute to significant morbidity and mortality. Factors associated with smoking in PLWH include mental health comorbidity, alcohol and drug use, health-related quality of life, smoking among social networks and supports, and lack of access to care. PLWH smokers are at a higher risk of numerous HIV-associated infections and non-HIV related morbidity, including a decreased response to antiretroviral treatment, impaired immune functioning, reduced cognitive functioning, decreased lung functioning, and cardiovascular disease. Seventeen smoking cessation interventions were identified, of which seven were randomized controlled trials. The most effective studies combined behavioral and pharmacotherapy treatments that incorporated comprehensive assessments, multiple sessions, and cognitive-behavioral and motivational strategies. Smoking cessation interventions that are tailored to the unique needs of diverse samples and incorporate strategies to reduce the risk of relapse are essential to advancing health outcomes in PLWH. PMID:26766919
Kennedy, David P.; Brown, Ryan A.; Golinelli, Daniela; Wenzel, Suzanne L.; Tucker, Joan S.; Wertheimer, Samuel R.
HIV continues to be a serious public health problem for men who have sex with women (MSW), especially homeless MSW. Although consideration of gender has improved HIV prevention interventions, most of the research and intervention development has targeted how women’s HIV risk is affected by gender roles. The effect of gender roles on MSW has received relatively little attention. Previous studies have shown mixed results when investigating the association between internalization of masculine gender roles and HIV risk. These studies use a variety of scales that measure individual internalization of different aspects of masculinity. However, this ignores the dynamic and culturally constructed nature of gender roles. The current study uses cultural consensus analysis (CCA) to test for the existence of culturally agreed upon masculinity and gender role beliefs among homeless MSW in Los Angeles, as well as the relationship between these beliefs and HIV-related behaviors and attitudes. Interviews included 30 qualitative and 305 structured interviews with homeless MSW in Los Angeles’s Skid Row area. Analysis identified culturally relevant aspects of masculinity not represented by existing masculinity scales, primarily related to barriers to relationships with women. Behaviors, attitudes, and knowledge related to HIV were significantly associated with men’s level of agreement with the group about masculinity. The findings are discussed in light of implications for MSW HIV intervention development. PMID:23730216
Peterson, John L; Miner, Michael H; Brennan, David J; Rosser, B R Simon
The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.
Wolff L, Claudia; Alvarado M, Rubén; Wolff R, Marcelo
Depression is one of the main psychiatric co-morbidities in HIV infection, presenting with a significantly higher prevalence than in the general population (around 35%). Its presence has been associated with poor quality of life, HIV disease progression and poor adherence to antiretroviral therapy. Although antidepressive treatment has demonstrated effectiveness on the management of depressive symptoms, improvement of clinical and laboratory parameters, and enhancement of antiretroviral adherence, depression is frequently under diagnosed and under treated in these patients. We analyzed the main international findings on depression prevalence, risk factors, con-sequences and management in people with HIV disease.
Luo, Rutao; Piovoso, Michael J.; Martinez-Picado, Javier; Zurakowski, Ryan
The development of resistant strains of HIV is the most significant barrier to effective long-term treatment of HIV infection. The most common causes of resistance development are patient noncompliance and pre-existence of resistant strains. In this paper, methods of antiviral regimen switching are developed that minimize the risk of pre-existing resistant virus emerging during therapy switches necessitated by virological failure. Two distinct cases are considered; a single previous virological failure and multiple virological failures. These methods use optimal control approaches on experimentally verified mathematical models of HIV strain competition and statistical models of resistance risk. It is shown that, theoretically, order-of-magnitude reduction in risk can be achieved, and multiple previous virological failures enable greater success of these methods in reducing the risk of subsequent treatment failures. PMID:22073250
... Sites Podcasts QR Codes RSS Feeds Social Bookmarking Social Network Sites Text Messaging Twitter Video Games Video Sharing ... but it is much riskier for an HIV-negative partner to be the receptive partner. Vaginal sex ...
Dillard, Dorothy; Bincsik, Arlene K; Zebley, Christopher; Mongare, Kefa; Harrison, James; Gerardi, Kimberly E; Parcher, David W
Treating minority substance abusers at risk of HIV or HIV positive is a critical public health issue. Delaware has achieved success in treating this population through its integrated nested services approach. Through three Center for Substance Abuse funded projects, Delaware has synthesized a number of evidence-based and best practices from the HIV medical treatment, substance abuse treatment and mental health treatment. Evaluation findings show that Project HOPE and Meeting the Challenges are having a positive impact on clients in a number of areas, including medical compliance, physical health, sobriety, employment/income and living situations. Clearly, this approach benefits all stakeholders, including the State of Delaware, local communities, staff and clients.
Mbonye, Martin; Rutakumwa, Rwamahe; Weiss, Helen; Seeley, Janet
Alcohol consumption has been associated with high risk sexual behaviour among key populations such as female sex workers. We explored the drivers of alcohol consumption and its relationship to high risk sexual behaviour. Participants were drawn from a cohort of 1027 women selected from 'hot spots' in the suburbs of Kampala city. We conducted 3 in-depth interviews with 40 female sex workers between 2010 and 2011. Data were analysed thematically, focusing on alcohol use within the context of sex work. Alcohol consumption was very high with only seven women reporting that they did not drink. Alcohol consumption was driven by the emotional and economic needs of the participants, but also promoted by clients who encouraged consumption. Many sex workers only started drinking alcohol when they joined sex work on the advice of more experienced peers, as a way to cope with the job. Alcohol was blamed for unsafe sex, acts of violence and poor decision making which increased sexual and physical violence. Alcohol was reported to affect medication adherence for HIV-positive women who forgot to take medicine. The findings suggest that the drivers of alcohol consumption are multifaceted in this group and require both individual and structural interventions. Alcohol reduction counselling can be supportive at the individual level and should be an integral part of HIV prevention programmes for female sex workers and others such as patrons in bars. The counselling should be addressed in a sensitive manner to bar owners and managers.
Cioe, Patricia A.; Crawford, Sybil L.; Stein, Michael D.
Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in non-infected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk (F[1,117] = 0.13, p > .05). Estimated risk and perceived risk were weakly, but significantly, correlated, r(126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative. PMID:24070645
Malow, R M; Cassagnol, T; McMahon, R; Jennings, T E; Roatta, V G
This study describes the prevalence of HIV risk behaviors among low-income, Haitian women, identifies theoretically relevant mediating psychosocial HIV risk predictors, and provides formative data for developing culturally and gender sensitive interventions for this distinctive, high risk, and understudied population. Confidential interview surveys were administered to 101 women of Haitian descent while they awaited their medical appointments at a local low-income, community medical clinic. Moderately high levels of sexual risk behavior (i.e., unprotected sex with nonmonogamous partners; multiple lifetime partners) were reported. On average, these women reported a belief in their HIV susceptibility, relatively little HIV-related anxiety, somewhat inadequate levels of communication regarding safer sex practices, and lack of adequate confidence in their ability to negotiate safer behaviors in sexual encounters. Both personal and partner condom attitudes were unfavorable and these attitudes predicted condom use levels. It was concluded that interventions need to be developed for Haitian women to improve their attitudes toward condom use and their confidence in negotiating safer sexual practices. However, these interventions cannot be developed in a vacuum. Although it is crucial to consider the woman's individual attitudes and behaviors, it is also important to consider the male partner's attitudes toward sex and the woman's relationship with her male partner within the context of Haitian culture. Only by determining and targeting important potential motivations for safe sex within the cultural context can we most effectively reduce HIV sex risk behavior in Haitian women.
Lau, Bryan; Justice, Amy C.; Engels, Eric; Gill, M. John; Goedert, James J.; Kirk, Gregory D.; D’Souza, Gypsyamber; Bosch, Ronald J.; Brooks, John T.; Napravnik, Sonia; Hessol, Nancy A.; Jacobson, Lisa P.; Kitahata, Mari M.; Klein, Marina B.; Moore, Richard D.; Rodriguez, Benigno; Rourke, Sean B.; Saag, Michael S.; Sterling, Timothy R.; Gebo, Kelly A.; Press, Natasha; Martin, Jeffrey N.; Dubrow, Robert
Background. Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends. Methods. In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34 189 HIV-infected (55% MSM, 19% other men, 26% women) and 114 260 HIV-uninfected individuals (90% men). Results. Among men, the unadjusted anal cancer incidence rates per 100 000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7–151.1) for HIV-infected MSM and 26.7 (95% CI, 11.5–61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100 000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8–6.0), but no difference was observed comparing women with other men (RR, 1.0; 95% CI, 0.5–2.2). In comparison with the period 2000–2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI, .3–.9) in 1996–1999 and 0.9 (95% CI, .6–1.2) in 2004–2007. Conclusions. Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued. PMID:22291097
Martin, Eileen; Gonzalez, Raul; Vassileva, Jasmin; Maki, Pauline M; Bechara, Antoine; Brand, Matthias
HIV+ individuals with and without substance use disorders make significantly poorer decisions when information about the probability and magnitude of wins and losses is not available. We administered the Game of Dice Task, a measure of decision making under risk that provides this information explicitly, to 92 HIV+ and 134 HIV- substance-dependent men and women. HIV+ participants made significantly poorer decisions than HIV- participants, but this deficit appeared more prominent among HIV+ women. These data indicate that decision making under risk is impaired among HIV+ substance-dependent individuals (SDIs). Potential factors for the HIV+ women's relatively greater impairment are discussed.
Lee, A; Tsang, C K K
This cross-sectional study investigated the prevalence rates of different categories of youth risk behaviour by age, sex and parental education. The study population consisted of 26,111 Hong Kong students, aged 10-19 years, recruited from 48 primary (primary grades 4-6) and secondary schools (secondary grades 1-7). Less than one-third of subjects participated in vigorous exercise regularly, about one-third consumed an unhealthy diet frequently, 18% had tried smoking, and 14.5% had seriously considered attempting suicide. Although only 3.4% of students reported experience of sexual intercourse, less than half used a contraceptive device. Older students had higher prevalence rates of health-compromising behaviours than younger students. Female students were more likely to report suicide-related behaviour, attempting weight loss, and non-participation in vigorous physical activities. Students with parents of a lower educational background were more likely to report rarely or never wearing seat belts and bicycle helmets, suicide-related behaviour, smoking, sexual intercourse before 13 years of age, and attempting weight loss. The availability of data on youth health risk behaviours would enable health educators, public health practitioners and clinicians to plan appropriate screening and counselling for risk behaviours in early adolescents.
Lamptey, P R; Price, J E
This paper proposes that international sexually transmitted disease (STD)/HIV prevention efforts might be enhanced by the application of social marketing principles. It first outlines the conceptual basis of social marketing approaches to health behaviour change generally and then explores key issues and opportunities for using these principles to improve current STD/HIV prevention efforts.
Manner, Ingjerd W.; Pedersen, Karin K.; Haissman, Judith M.; Kvale, Dag; Nielsen, Susanne D.
Abstract The widespread access to antiretroviral treatment during the past decades has transformed HIV infection from a lethal disease to a chronic condition, in which the relative burden of non-AIDS-related chronic disorders such as cardiovascular disease, malignancy, renal, liver, and bone disease has increased. The adjusted relative risk for myocardial infarction is reported to be around 2-fold compared to that of the general population, which over time is likely to translate into increased absolute risk in an aging population. Thus, delineating potentially HIV-specific pathogenetic mechanisms is crucial in order to tailor novel strategies for prophylaxis and treatment. This review will focus on advances in the field that possibly link HIV-induced alterations of the gut mucosa and consequent microbial translocation to cardiometabolic risk factors in HIV infection. Recent work suggests that markers of microbial translocation are closely associated with several cardiovascular risk factors such as dyslipidemia, insulin resistance, hypertension, coagulation abnormalities, endothelial dysfunction, and carotid atherosclerosis. Future studies should investigate whether associations between microbial translocation and cardiovascular risk factors will translate into increased risk of acute events, and whether strategies to target gut microbiota and microbial translocation might reduce such a risk. PMID:24521167
Djumalieva, D; Imamshah, W; Wagner, U; Razum, O
Crack use is an important risk factor for HIV infection because of its association with unsafe sexual practices. We investigated factors promoting the initiation of crack cocaine use; the sexual behaviour of crack users; and their rehabilitation care seeking behaviour in Trinidad and Tobago. We conducted 40 in-depth interviews with drug users. Respondents frequently reported a history of parental desertion, alcohol abuse, and physical abuse within the family. They perceived peer pressure and drug use in the family as important factors promoting first drug use. Exchanging sex for drugs was common, and practising oral sex was considered safe. Female drug users rarely seek rehabilitative care because of stigmatization and lack of care for their children. In Trinidad, attitudes towards drugs in society and families need to be changed. Campaigns promoting safer sex should emphasize the risk of oral sex. Rehabilitation facilities caring for female drug users should offer child care.
Koprivnikar, Janet; Gibson, Chris H; Redfern, Julia C
Behavioural consistency or predictability through time and/or different contexts ('syndromes' or 'personality types') is likely to have substantial influence on animal life histories and fitness. Consequently, there is much interest in the forces driving and maintaining various syndromes. Individual host behaviours have been associated with susceptibility to parasitism, yet the role of pre-existing personality types in acquiring infections has not been investigated experimentally. Using a larval amphibian-trematode parasite model system, we report that tadpoles generally showed consistency in their activity level in response to both novel food and parasite exposure. Not only were individual activity level and exploration in the novel food context correlated with each other and with anti-parasite behaviour, all three were significant predictors of host parasite load. This is the first empirical demonstration that host behaviours in other contexts are related to behaviours mitigating infection risk and, ultimately, host parasite load. We suggest that this system illustrates how reliably high levels of activity and exploratory behaviour in different contexts might maximize both energy acquisition and resistance to trematode parasites. Such benefits could drive selection for the behavioural syndrome seen here owing to the life histories and ecological circumstances typical of wood frog (Lithobates sylvaticus) larvae.
Ellison, Adrian B; Bliemer, Michiel C J; Greaves, Stephen P
New road safety strategies continue to be devised by researchers and policy makers with pay-as-you-drive (PAYD) schemes gaining increasing attention. However, empirically measuring the effectiveness of these strategies is challenging due to the influence of the road environment and other factors external to the driver. The analysis presented here applies Temporal and Spatial Identifiers to control for the road environment and Driver Behaviour Profiles to provide a common measure of driving behaviour based on the risk of a casualty crash for assessing the effectiveness of a PAYD scheme on reducing driving risks. The results show that in many cases personalised feedback alone is sufficient to induce significant changes, but the largest reductions in risk are observed when drivers are also awarded a financial incentive to change behaviour. Importantly, the more frequent the exposure to the speeding information, the greater the magnitude of the change. However, the changes are disproportionately associated with those that were already safer drivers in the baseline period suggesting that some drivers may be predisposed to changing their behaviour. These results suggest that it would be beneficial to provide real-time or daily feedback on speeding behaviour in conjunction with a financial reward scheme, potentially as a component of insurance premiums.
Udell, Wadiya; Donenberg, Geri; Emerson, Erin
We investigated the relationship between parenting practices (i.e., parental monitoring, parent permissiveness, and parent-teen communication), and probation youth's HIV-related sexual risk behavior (i.e., ever having sex, condom use, alcohol and marijuana use before sex). Participants were 61 male and female juvenile offenders, ages 13-17, on probation and awaiting sentencing. Results indicated different relationships between parenting and HIV-related sexual risk behavior for probation boys and girls. Parental monitoring, parenting permissiveness, and parent-teen communication were collectively related to whether girls' ever had sex and with boys' use of alcohol and marijuana use before last sex. Findings underscore the important role of parenting on probation teens' HIV risk behaviors.
Ellen, J M; Boyer, C B; Tschann, J M; Shafer, M A
In 1991, 881 urban US high school students participated in a survey designed to determine their perceptions of risk for acquiring sexually transmitted diseases (STDs) and to test whether results of a previously reported clinic-based study on perceptions of risk are generalizable. Of the students, 278 had engaged in sexual intercourse, and 231 of these returned questionnaires with usable answers to each question. The analysis was based on this latter cohort. The mean age of this group was 15.5 years. 53% were male, 34% Black, 27% Hispanic, 14% Asian, 9% White, and 16% other. The perceived relative risks for STDs and HIV (dependent measures) were submitted to separate analysis using the 5-point Likert scales. Independent measures included demographic variables, STD and HIV anxiety, condom use, number of partners, and STD and HIV beliefs. It was found that 24% never used a condom and 43% always used condoms. The subjects showed no optimistic bias in their perceptions of the relative risk of STDs or HIV (they believed their risks to be the same as those of other people their age). The only variance found was that the White subjects believed themselves at less relative risk than the other subjects. These findings contrast those of the clinic-based study and suggest that perceptions of risk may vary among different cohorts. Higher levels of anxiety were also found to be associated with higher levels of perceived risk whereas other factors were not. A possible limitation of this study was that the group to which the study population was asked to compare itself was not clearly defined. However, this study indicates that sexually active adolescents are well aware of their STD and HIV risks and that their decision to engage in risky behavior may be due to factors other than a heightened sense of invulnerability (such as perception of social norms or alcohol use).
PAVLINAC, PB; JOHN-STEWART, GC; NAULIKHA, JM; ONCHIRI, FM; DENNO, DM; ODUNDO, EA; SINGA, BO; RICHARDSON, BA; WALSON, JL
Objective HIV-infection is an established risk for diarrheal severity, less is known about specific enteric pathogens associated with HIV status. We determined associations of selected enteric pathogens with HIV-infection and HIV-exposure among Kenyan children. Design Cross-sectional study among 6 months to 15 year olds presenting to two Western Kenya District hospitals with acute diarrhea between 2011–2013. Methods Stool was tested using standard bacterial culture and microscopy for ova and parasites. HIV testing was obtained on children and mothers. Enteric pathogen prevalence was compared between HIV-infected and HIV-uninfected children and between HIV-exposed uninfected (HEU) and HIV-unexposed. Unadjusted and adjusted prevalence ratios (PR) for selected pathogens by HIV-status were estimated using relative risk (RR) regression and P-values. Age, site, income, household crowding, water source/treatment, anthropometrics, cotrimoxazole use, and breastfeeding history were accounted for in multivariable models. Results Among 1,076 children, median age was 22 months (interquartile range: 11–42), 56 (5.2%) were HIV-infected, and 10.3%(105/1020) of HIV-uninfected children were HIV-exposed. The following organisms were most frequently isolated from stool: enteroaggregative Escherichia coli (13.3%), Giardia spp. (11.1%) Campylobacter (6.3%), enteropathogenic Escherichia coli (EPEC) (6.1%) and Cryptosporidium spp. (3.7%). Accounting for age, HIV-infection was associated with EPEC infection (PR: 3.70, P=0.002) while HIV-exposure was associated with Cryptosporidium among HIV-uninfected children (PR: 2.81, P=0.005). Conclusion EPEC and Cryptosporidium infections were more common in HIV-infected and HIV-exposed children, respectively. This could explain the increased mortality attributed to these pathogens in other studies. Interventions targeting EPEC and Cryptosporidium may reduce morbidity and mortality in high HIV-prevalence settings. PMID:25028987
Nititham, Joanne; Gupta, Rashmi; Zeng, Xue; Hartogensis, Wendy; Nixon, Douglas F; Deeks, Steven G; Hecht, Frederick M; Liao, Wilson
Human evolution has resulted in selection for genetic polymorphisms beneficial in the defense against pathogens. However, such polymorphisms may have the potential to heighten the risk of autoimmune disease. Here, we investigated whether psoriasis-associated single nucleotide polymorphisms influence host control of HIV-1 infection. We studied psoriasis and viral immune response variants in three HIV-positive cohorts: (1) HIV-1 controllers and non-controllers in the Study of the Consequences of the Protease Inhibitor Era (SCOPE) cohort (n=366), (2) Individuals with primary HIV infection in the Options cohort (n=675), and (3) HIV-positive injection drug users from the Urban Health Study (UHS) (n=987). We found a strong association of two psoriasis MHC variants, rs9264942 and rs3021366, with both HIV-1 controller status and viral load, and identified another Class III MHC variant rs9368699 to be strongly associated with viral load. A number of genetic variants outside the MHC (SOX5, TLR9, SDC4, PROX1, IL12B, TLR4, MBL-2, TYK2, IFIH1) demonstrated nominal significance. Overall, our data suggest that several psoriasis variants within the MHC have a robust impact on HIV-1 control, while variants outside the MHC require further investigation.
Dunkle, Kristin L; Jewkes, Rachel K; Brown, Heather C; Gray, Glenda E; McIntryre, James A; Harlow, Siobán D
Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing. Private face-to-face interviews covered socio-demographics, sexual history and experience of gender-based violence. 21.1% of participants reported having ever had sex with a non-primary male partner in exchange for material goods or money. Women who reported past experience of violence by male intimate partners, problematic substance use, urban residence, ever earning money, or living in substandard housing were more likely to report transactional sex, while women who reported delayed first coitus, were married, or had a post-secondary education were less likely to report transactional sex. Transactional sex was associated with HIV seropositivity after controlling for lifetime number of male sex partners and length of time a woman had been sexually active (OR = 1.54, 95% CI: 1.07, 2.21). Women who reported non-primary partners without transactional sex did not have increased odds of being HIV seropositive (OR = 1.04, 95% CI: 0.75, 1.43). We conclude that transactional sex may place women at increased risk for HIV, and is associated with gender-based violence, substance use and socio-economic disadvantage. Research, policy and programmatic initiatives should consider the role of transactional sex in women's HIV risk, with attention to the intersecting roles of violence, poverty
Belcher, Lisa; Sternberg, Maya R; Wolitski, Richard J; Halkitis, Perry; Hoff, Colleen
This study examined the association between HIV transmission risk perception and the sexual risk behaviors of HIV-positive men who have sex with men. Respondents rated the degree of risk of transmitting HIV through insertive anal intercourse and insertive oral sex. We examined (a) the perceived level of HIV transmission risk assigned to each sexual behavior and (b) the association between perceived risk for HIV transmission and condom use during insertive anal intercourse and insertive oral sex. We found for behaviors that have achieved less risk consensus that as transmission risk perception increases, so too does the likelihood of condom use. This study highlights the need for more research in understanding how perceived health risk to others influences protective behaviors.
Dai, Zhenzhen; Zhong, Xiaoni; Peng, Bin; Zhang, Yan; Liang, Hao; Peng, HongBin; Zhong, Xiao Hua; Liu, Xiyao; Huang, Ailong
This paper looks into the differences of sexual risk behaviours and prevention services among men who have sex with men and women and men who have sex with men only. The data from a cross-sectional survey of 159 men who have sex with men and women and 1186 men who have sex with men only in western China is analysed. It is found that men who have sex with men and women, with multiple anal sex partners, have higher rates of selling and buying sex than men who have sex with men only, but obtain less HIV-related knowledge from partners or HIV consulting and testing services. More efforts should be made to promote safer sexual behaviours and reduce the barriers for access to health services.
Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann; Souza Júnior, Paulo Roberto Borges de
OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues.
Some clinicians claim that the potential association between oral contraceptive (OC) use and HIV infection is cause for concern. A study of prostitutes conducted in Kenya showed OC use to be the single most common cofactor in sexually transmitted human immunodeficiency virus infection. A similar study conducted in the US was unable to confirm an association. In the Kenya study, 123 HIV seronegative prostitutes in Nairobi were followed for 54 months and assessed for seroconversion to HIV and occurrence of sexually transmitted diseases. 91% of the women who seroconverted were using OCs; 73% of the women who remained seronegative were using OCs. Demographic features, sexual behavior, number of daily sex partners, and parenteral exposure were not related to seroconversion. No significant associations were found between HIV infection and sexual activity and condom use. Independent associations were found between seroconversion and OC use, genital ulcer disease (GUD), and chlamydia trachomatis infections. It is possible that OCs increase the risk of acquiring chlamydia because cervical ectropion creates a greater exposure of columnar epithelium to infecting agents. The multicenter, cross-sectional, collaborative study of 638 prostitutes in 8 areas of the US found that HIV infection was totally unrelated to OC use. Prostitutes with no evidence of intravenous drug use were studied. 5% of the women were found to be infected with HIV. The most common variables associated with HIV infection were seromarkers for hepatitis B and syphilis and sex with "nonpaying partners." About 80% of the prostitutes reported using condoms regularly with clients; only 16% used condoms with their boyfriends or husbands. About 30% (194) of the prostitutes reported they had used OCs for at least 1 month out of the past 5 years. 9 of those women (4.6%) were positive for HIV. Of 444 prostitutes who had never used OC during the past 5 years, 21 or 4.73% were HIV positive.
Stemmler, M. Susan; Hall, Timothy M.; Prokopík, Petr; Shoptaw, Steven
Summary Aim The rates of HIV acquired through heterosexual contact are increasing in the Czech Republic. This study explored potential HIV risk associations with alcohol, illicit drugs and sexual behaviours among adults from a community-based sample attending gay- and non-gay venues in Prague. Methods Women attending bars, cafes and beer gardens in central Prague responded to the self-administered, time-site survey. Alcohol use was measured by the AUDIT-C and CAGE questionnaires. Sexual network structuring identified number, gender and coital frequency with current and recent sexual partners. Statistical analysis included central tendency, chi-square and logistic regression. Female participants (n = 124) ranged from 18 to 67 years of age (mean 29 years); 25% self-identified as non-heterosexual. Results We found alcohol to be the preferred drug of choice. Younger heterosexual women with new and casual sexual partners were more likely to use alcohol excessively. Women with children reported the least alcohol use. Sixty percent of the sample had never used condoms; condom-use was associated with longer relationship duration and discussions about HIV status with a sexual partner; non-use tended to occur among unmarried women with multiple male partners in short, serial sexual relationships. Women who sought HIV testing tended to be younger and more self-identified as non-heterosexual. Protective practices were rarely reported even when HIV transmission increases via heterosexual sexual partnering. Conclusion Further research is recommended regarding cultural and contextual influences on HIV risk behaviours among Czech women. PMID:26851424
Cederbaum, Julie A.; Marcus, Steven C.; Hutchinson, M. Katherine
Research indicates that knowing someone with HIV/AIDS is associated with greater perceived risk of contracting HIV and changes in sexual risk behaviors. The current study with a sample of 1,172 examined whether knowing someone with HIV/AIDS influenced sexual risk communication and youth engagement in sexual intercourse using the Philadelphia…
Blackstock, Oni J; Frew, Paula; Bota, Dorothy; Vo-Green, Linda; Parker, Kim; Franks, Julie; Hodder, Sally L; Justman, Jessica; Golin, Carol E; Haley, Danielle F; Kuo, Irene; Adimora, Adaora A; Rompalo, Anne; Soto-Torres, Lydia; Wang, Jing; Mannheimer, Sharon B
Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community's HIV/STI risk. We explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women's HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/STI risk driven by structural factors.
Fethers, K.; Marks, C.; Mindel, A.; Estcourt, C.
Objectives: To assess the prevalence of sexually transmitted infections (STIs) and blood borne viruses, risk behaviours, and demographics in women who have sex with women (WSW). Methods: Retrospective cross sectional study using a multivariate model. Demographic, behavioural, and morbidity data were analysed from standardised medical records of patients attending a public STI and HIV service in Sydney between March 1991 and December 1998. All women with any history of sex with a woman were compared with women who denied ever having sex with another woman (controls). Results: 1408 WSW and 1423 controls were included in the study. Bacterial vaginosis (BV) was significantly more common among WSW (OR 1.7, p<0.001). Abnormalities on cervical cytology were equally prevalent in both groups, except for the higher cytological BV detection rate in WSW (OR 5.3, p=0.003). Genital herpes and genital warts were common in both groups, although warts were significantly less common in WSW (OR 0.7, p=0.001). Prevalence of gonorrhoea and chlamydia were low and there were no differences between the groups. The prevalence of hepatitis C was significantly greater in WSW (OR 7.7, p<0.001), consistent with the more frequent history of injecting drug use in this group (OR 8.0, p<0.001). WSW were more likely to report previous sexual contact with a homo/bisexual man (OR 3.4, p<0.001), or with an injecting drug user (OR 4.2, p<0.001). Only 7% of the WSW reported never having had sexual contact with a male. Conclusion: We demonstrated a higher prevalence of BV, hepatitis C, and HIV risk behaviours in WSW compared with controls. A similar prevalence of cervical cytology abnormalities was found in both groups. Measures are required to improve our understanding of STI/HIV transmission dynamics in WSW, to facilitate better health service provision and targeted education initiatives. Key Words: sexually transmitted infections; lesbians; HIV PMID:11141849
Pallás, J.; Fariñas-Alvarez, C.; Prieto, D.; Llorca, J.; Delgado-Rodríguez, M.
A cross-sectional study was conducted in prisons of Cantabria (northern Spain) from June 1992 to December 1994. Inmates were asked to participate in a survey on prevalence and risk factors for monoinfections and coinfections with HIV, HBV and HCV. Crude and multiple odds ratios of risk factors were calculated (by polychotomous logistic regression). Prevalence of coinfections was higher than that of monoinfections. IDU risk factors were the main independent variables associated with monoinfections and coinfections with these agents. The strength of association increased with the degree of coinfection for IDU risk factors and penal status, e.g. duration of injecting drug use for more than 5 years yielded an adjusted OR ranging from 1.3 (95% CI: 0.4-5.1) for HBV monoinfection to 180 (95% CI: 61.0-540.0) for HIV-HBV-HCV coinfection. In comparison, sexual behaviours were less important than IDU risk factors. PMID:10487645
Field, H E; Smith, C S; de Jong, C E; Melville, D; Broos, A; Kung, N; Thompson, J; Dechmann, D K N
Hendra virus causes sporadic fatal disease in horses and humans in eastern Australia. Pteropid bats (flying-foxes) are the natural host of the virus. The mode of flying-fox to horse transmission remains unclear, but oro-nasal contact with flying-fox urine, faeces or saliva is the most plausible. We used GPS data logger technology to explore the landscape utilisation of black flying-foxes and horses to gain new insight into equine exposure risk. Flying-fox foraging was repetitious, with individuals returning night after night to the same location. There was a preference for fragmented arboreal landscape and non-native plant species, resulting in increased flying-fox activity around rural infrastructure. Our preliminary equine data logger study identified significant variation between diurnal and nocturnal grazing behaviour that, combined with the observed flying-fox foraging behaviour, could contribute to Hendra virus exposure risk. While we found no significant risk-exposing difference in individual horse movement behaviour in this study, the prospect warrants further investigation, as does the broader role of animal behaviour and landscape utilisation on the transmission dynamics of Hendra virus.
Dickson-Gomez, Julia; Quinn, Katherine; Broaddus, Michelle; Pacella, Maria
High-risk sexual behaviours include practices such as relationship violence and substance use, which often cluster together among young people in high-risk settings. Youth gang members often show high rates of such behaviours, substance use and relationship violence. This paper draws on data from in-depth interviews with male and female gang members from six different gangs to explore the role of powerful socialising peer groups that set gender, sexual and relationship roles and expectations for their male and female members. High-risk sexual behaviours among gang members included sex with multiple partners and group sex. Gang norms included the belief that male members were sexually insatiable with multiple sexual partners and that female gang members should be sexually available to male members. Alcohol and drugs were seen to have a large influence on sexual desire and the inability to use condoms. Much sexual behaviour with gangs, such as group sex, was viewed with ambivalence and seen as somewhat coercive. Finally, gendered sexual expectations (boys as sexually insatiable and girls as sexually available) made forming long-term romantic relationships problematic for gang members. The influence of gang norms such as these must be addressed in future programmes and interventions with gang members.
Skinta, Matthew D.; Murphy, Jessie L.; Paul, Jay P.; Schwarcz, Sandra K.; Dilley, James W.
This study presents survey data collected from a sample of HIV-positive men (N = 182) who had high transmission-risk sex, defined as unprotected anal intercourse with a man whose HIV-status was negative or unknown, in the previous 6 months. Despite the tremendous changes in HIV treatment and their impact on people living with HIV, little recent…
Belza, M; t for
Objective: To assess HIV prevalence and predictive factors for HIV among male sex workers in Spain. Methods: In this study we analysed all male sex workers who visited HIV testing clinics in 19 Spanish cities between 2000 and 2002. The information was obtained during examination by means of a brief questionnaire. For repeating testers, only the last confirmed result was taken into account. Results: 418 male sex workers were included in the analysis; 58% visited these clinics for the first time and 42% were repeating testers. 67% were of foreign origin, mostly from Latin America (91%). 96% had had sex with men, 18% were transvestites or transsexuals, and 3.3% had used injected drugs. HIV prevalence was 12.2% (95% CI, 9.3 to 15.8%), and rose to 16.9% among first time testers. No differences in HIV prevalence were found between injecting drug users, transvestites/transsexuals, and men from foreign countries. Conclusion: Because of the high risk of HIV infection, male sex workers should be the target of specific preventive activities. Preventive and healthcare strategies that are culturally adapted to migrants are required. PMID:15681730
Forney, Jason C; Miller, Robin L
The objective of this study was to assess and compare the prevalence of high-risk sexual behaviors among young HIV-negative (n=8064) and HIV-positive (n=171) men who have sex with men (MSM) on predictors of unprotected anal intercourse (UAI). Using venue-based time-space sampling, 8235 MSM aged 15-25 were anonymously surveyed as a part of the Community Intervention Trial for Youth (CITY). The Project was conducted in 13 communities across the USA from 1999 to 2002. Forty percent of HIV-positive men and 34% of HIV-negative men reported that they had UAI in the previous 3 months. HIV-positive MSM were more likely than their uninfected peers to have traded sex within the previous year, to have had sex while high during their last sexual encounter, and to have UAI with a greater number of partners. Multivariate analyses indicated that for HIV-negative men, positive peer norms regarding safer sex and being Black or Latino predicted avoidance of UAI. Among HIV-positive men, having social support for safer sex and positive peer norms predicted avoidance of UAI. Young HIV-positive MSM are a relevant subgroup for prevention because they constitute a significant source from which future infections could be generated.
Gellert, G A; Maxwell, R M; Higgins, K V; Mai, K K; Lowery, R; Doll, L
OBJECTIVES--Vietnamese immigration to the U.S. since the conclusion of the Vietnam war has been substantial and in Orange County, CA, Vietnamese Americans comprise 3% of the population (the largest community in the US). Our objective was to collect data on the HIV/AIDS knowledge, attitudes and self-reported high risk behaviours within this community. METHODS--A survey instrument was administered anonymously in Vietnamese to 532 respondents in their homes. Individuals from three population strata were randomly sampled: men 18 to 35 years old (N = 193); men 36 to 45 years old (N = 137); and women 18 to 35 years old (N = 202). Data were gathered on: (1) degree of acculturation; (2) knowledge and attitudes towards HIV/AIDS; and (3) self-reported sexual and other high risk practices. RESULTS--Survey data indicated that 38% of respondents were very worried about themselves and 83% were worried about a family member getting AIDS. Knowledge about actual modes of HIV transmission was generally accurate, but a substantial minority still believed that HIV can be transmitted through casual contact, and 68% from needles used in hospitals. Women demonstrated less accurate knowledge than men on five key items. Quarantine of the HIV infected was agreed to by 45%. Twenty-nine percent did not believe that the epidemic would affect them personally, and 49% stated that they did not have enough information about AIDS to protect themselves. Regarding sexual practices, 31% reported never having had sex. Of the others, 8% had two or more sexual partners in the prior 12 months. No same sex behaviour was reported. Six percent of men had visited a female prostitute; of these, 24% had visited 2 or more in the prior 12 months; half of encounters in this time period were outside the US. Substantial percentages of sexually active, unmarried respondents indicated that they never use (17-40%) or only sometimes use (10-32%) condoms. Less than 1% had used injection drugs. CONCLUSIONS
Schmälzle, Ralf; Schupp, Harald T.; Barth, Alexander; Renner, Britta
Field studies on HIV risk suggest that people may rely on impressions they have about the safety of their partner at the dispense of more objective risk protection strategies. In this study, ERP recordings were used to investigate the brain mechanisms that give rise to such impressions. First, in an implicit condition, participants viewed a series of photographs of unacquainted persons while performing a task that did not mention HIV risk. Second, in an explicit condition, participants estimated the HIV risk for each presented person. Dense sensor EEG was recorded during the implicit and explicit conditions. In the analysis, explicit risk ratings were used to categorize ERP data from the implicit and explicit conditions into low and high HIV risk categories. The results reveal implicit ERP differences on the basis of subsequent ratings of HIV risk. Specifically, the processing of risky individuals was associated with an early occipital negativity (240–300 ms) and a subsequent central positivity between 430 and 530 ms compared to safe. A similar ERP modulation emerged in the explicit condition for the central positivity component between 430 and 530 ms. A subsequent late positive potential component between 550 and 800 ms was specifically enhanced for risky persons in the explicit rating condition while not modulated in the implicit condition. Furthermore, ratings of HIV risk correlated substantially with ratings of trustworthiness and responsibility. Taken together, these observations provide evidence for theories of intuitive risk perception, which, in the case of HIV risk, seem to operate via appearance-based stereotypic inferences. PMID:21633492
Lescano, Celia M.; Brown, Larry K.; Puster, Kristie L.; Miller, Paul M.
Adolescents with a history of sexual abuse are at particular risk for HIV because of difficulties with affect regulation and dysfunctional thinking that are thought to be sequelae of the abuse. These difficulties can lead to impulsivity and failure to assertively set limits in sexual situations. Cognitive behavior therapy (CBT) has frequently been…
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…
Wambach, K. G.; And Others
Surveyed 620 nonpregnant, culturally diverse women at risk for human immunodeficiency virus (HIV) infection concerning alcohol, marijuana, powder cocaine, crack cocaine, and intravenous drug use. Found consumption levels which exceeded expectations based on general estimates of female substance use. Substance use was associated with specific…
... Español You Are Here: Home → Latest Health News → Article URL of this page: https://medlineplus.gov/news/fullstory_163344.html Diabetes Risk May Be Higher for HIV-Positive Adults Longer survival with the virus might ...
Bockting, W O; Robinson, B E; Forberg, J; Scheltema, K
Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.
Meadowbrooke, Chrysta C; Veinot, Tiffany C; Loveluck, Jimena; Hickok, Andrew; Bauermeister, José A
Health research shows that knowing about health risks may not translate into behavior change. However, such research typically operationalizes health information acquisition with knowledge tests. Information scientists who investigate socially embedded information behaviors could help improve understanding of potential associations between information behavior-as opposed to knowledge-and health behavior formation, thus providing new opportunities to investigate the effects of health information. We examine the associations between information behavior and HIV testing intentions among young men who have sex with men (YMSM), a group with high rates of unrecognized HIV infection. We used the theory of planned behavior (TPB) to predict intentions to seek HIV testing in an online sample of 163 YMSM. Multiple regression and recursive path analysis were used to test two models: (a) the basic TPB model and (b) an adapted model that added the direct effects of three information behaviors (information exposure, use of information to make HIV-testing decisions, prior experience obtaining an HIV test) plus self-rated HIV knowledge. As hypothesized, our adapted model improved predictions, explaining more than twice as much variance as the original TPB model. The results suggest that information behaviors may be more important predictors of health behavior intentions than previously acknowledged.
Saggurti, Niranjan; Verma, Ravi K; Halli, Shiva S; Swain, Suvakanta N; Singh, Rajendra; Modugu, Hanimi Reddy; Ramarao, Saumya; Mahapatra, Bidhubhusan; Jain, Anrudh K
This paper assesses the reasons for entry into sex work and its association with HIV risk behaviours among mobile female sex workers (FSWs) in India. Data were collected from a cross-sectional survey conducted in 22 districts across four high HIV prevalence states in India during 2007-2008. Analyses were limited to 5498 eligible mobile FSWs. The reasons given by FSWs for entering sex work and associations with socio-demographic characteristics were assessed. Reported reasons for entering sex work include poor or deprived economic conditions; negative social circumstances in life; own choice; force by an external person; and family tradition. The results from multivariate analyses indicate that those FSWs who entered sex work due to poor economic conditions or negative social circumstances in life or force demonstrated elevated levels of current inconsistent condom use as well as in the past in comparison with those FSWs who reported entering sex work by choice or family tradition. This finding indicates the need for a careful assessment of the pre-entry contexts among HIV prevention interventions since these factors may continue to hinder the effectiveness of efforts to reduce the spread of HIV/AIDS in India and elsewhere.
Atuyambe, Lynn; Bazeyo, William; Tanga, Erasmus Otolok
Recent studies reveal that teachers are more likely to engage in high-risk sexual behavior compared to the rest of the adult population. Yet the education sector could be a major vehicle for imparting knowledge and skills of avoiding and/or coping with the pandemic. This study set out to establish HIV risk behaviors among teachers in Uganda, to inform the design of a behavior change communication strategy for HIV prevention among teachers. It was a cross sectional rapid assessment conducted among primary and secondary school teachers in Kampala and Kalangala districts, in Uganda. A total of 183 teachers were interviewed. HIV risk behavior, in this study was measured as having multiple sexual partners and/or sex with a partner of unknown status without using a condom. We also considered transactional/sex for favors and alcohol use as exposures to HIV risk behavior. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were calculated. All data analysis was performed using SPSS version 17.0 and EPI Info Version 3.5.1. Forty five per cent of teachers reported having multiple concurrent sexual partners in the last three months, of these, only 24% acknowledged having used a condom at their last sexual encounter yet only 9.8% knew their partners’ HIV status. Teachers below 30years of age were more likely to have two or more concurrent sexual partners (OR 2.6, CI 1.31-5.34) compared to those above 30 years. Primary school teachers were less likely to involve with partners of unknown HIV status compared to secondary school teachers (OR 0.43, CI 0.19-0.97). Teachers aged below 30 years were also more likely to engage with partners of unknown HIV status compared to those above 30 years (OR 2.47, CI 1.10-5.59). Primary teachers were also less likely to have given or received gifts, money or other favors in exchange for sex (OR 0.24, CI 0.09-0.58). Teachers engage in risky sexual behaviors, which lead to HIV infection. There is need to promote individual
Brown, Larry K.; Houck, Christopher; Lescano, Celia; Donenberg, Geri; Tolou-Shams, Marina; Mello, Justin
The acquisition of affect regulation skills is often impaired or delayed in youth with mental health problems but the relationship between affect dysregulation and risk behaviors has not been well studied. Baseline data from adolescents (N =418; ages 13–19) recruited from therapeutic school settings examined the relationship between affect dysregulation, substance use, self-cutting, and sexual risk behavior. Analyses of covariance demonstrated that adolescents who did not use condoms at last sex, ever self-cut, attempted suicide, used alcohol and other drugs and reported less condom use self-efficacy when emotionally aroused were significantly more likely (p < .01) to report greater difficulty with affect regulation than peers who did not exhibit these behaviors. General patterns of difficulty with affect regulation may be linked to HIV risk behavior, including condom use at last sex. HIV prevention strategies for youth in mental health treatment should target affect regulation in relation to multiple risk behaviors. PMID:22669595
Rosińska, Magdalena; Simmons, Ruth; Marzec-Bogusławska, Anna; Janiec, Janusz; Porter, Kholoud
The aim of the study was to understand HIV testing patterns needed to improve access to early HIV diagnosis, and to investigate the spread of the virus in different populations. We examined prior testing history of individuals presenting for an HIV test across all 30 voluntary testing and counselling sites in Poland, 2008-2010 to determine factors associated with the testing rate using zero-truncated Poisson regression. Of 2397 persons presenting for an HIV test, 25 (1%) were HIV positive and 470 (19.6%) were repeat testers. The proportion of repeat testers was higher among men who have sex with men (MSM) at 37% (90/246), and people who inject drugs (PWID) at 32% (21/65). Higher testing rate was independently associated with exposure category (testing rate ratio, RR for MSM = 2.0, 95% CI 1.6-2.6, and 1.6, 0.9-2.6 for PWID), >5 sex partners (1.9, 1.4-2.7), high-risk partner (1.3, 1.1-1.6), urban residence (2.1, 1.3-3.5) and higher education attainment (1.1, 1.0-1.5). Inconsistent condom use with casual partners and sex under the influence of alcohol were associated with lower testing rates. There is a need to increase HIV testing uptake in Poland, especially among the rural population. Despite testing rates being higher among populations with higher risk of exposure to HIV (MSM and PWID), they still remain low, indicating the existence of barriers to testing.
O'Neill, Gillian; Martin, Neil; Birch, Jennifer; Oldam, Alison; Newbury-Birch, Dorothy
Objective. To examine risk taking behaviours associated with alcohol consumption amongst UK undergraduate students. Design and Methods. A cross-sectional web survey was used to assess attitudes and health behaviours. The survey included the Alcohol Use Disorders Identification Test (AUDIT). Students were also asked about why they drank alcohol; about their preferred alcoholic beverage; and if they had experienced any consequences associated with drinking alcohol as well as questions relating to sexual risk taking, drug use, and smoking. Results. 2779 (65% female; 84% White British) students completed some part of the survey. Of these, 98% (n = 2711) completed the AUDIT. Of the 92% that drank 66% (n = 1,643) were categorised as being AUDIT positive. 8% (n = 224) were categorised as probably alcohol dependent. Higher AUDIT scores were significantly associated with negative consequences such as unplanned sexual activity, physical injuries, and arguments. Other risk taking behaviours such as drug use and smoking were also found to be positively correlated with higher AUDIT scores; drug use; and smoking. Conclusions. The results from this study provide insight into students' alcohol consumption and associated risk taking. University policies need to protect students' overall health and wellbeing to ensure academic potential is maximised. PMID:26713168
Background The university environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. Despite recently gained decline of the overall incidence of HIV infection, still significant proportion of youth population are at high risk of HIV infection. The aims of this study were to assess the perception of HIV risk and factors associated with risk perception among students at University of Gondar, Northwest Ethiopia. Methods A cross sectional study was conducted between February and April, 2012 among health science students. A total of 384 students were involved in the study using stratified sampling technique. Chi-square test and logistic regression analysis were employed. P-value < 0.05 was considered statistically significant for all cases. Results Of the total 384 participated students, 200(52.1%) were females. Out of the total study respondents, 202(52.6%) were sexually experienced. One hundred and nine (59.2%) out of 184 males and 93(46.5%) out of 200 females had had sexual experience. About 23(57.5%) of those age below 20 years, 70(52.2%) of 20-24 years old, and 13(61.9%) of those ages of 25 years or older were perceived themselves as if they have no chance of acquiring HIV infection. Students initiated sexual intercourse at early age (≤8 years) were significantly associated with having multiple partnerships (crude OR =3.6, p = 0.002 for male and crude OR = 1.7, p = 0.04 for female). Statistically significant difference was observed in the distribution of condom use during sexual intercourse among various age groups (p-value = 0.001). Sexual initiation at younger age, having multiple partnerships, inconsistent condom use and alcohol and/or drug abuse were significantly perceived as predictor for an increased risks for HIV infection. Conclusion Students were engaged in various HIV risk behaviors. Early sexual initiation and alcohol and/or drug abuse were important factors for having
Blumberg, Stephen J; Dickey, Wayne C
Persons with mental disorders may lack the knowledge, skills, and social networks that help limit the spread of HIV by reducing risk behaviors. Nationally representative data from the 1999 U.S. National Health Interview Survey were used to estimate the prevalence of HIV risk behaviors among civilian noninstitutionalized adults with and without at least one of three psychiatric conditions (depression, generalized anxiety disorder, and panic attacks) in the previous 12 months. Relative to adults without these mental disorders, adults with a mental disorder (8.8% of adults nationally) were more likely to have engaged in HIV risk behaviors since 1980 (5.5% vs. 1.6%). Adults with a mental disorder were also more likely to report a high or medium chance of becoming infected, were more likely to have been tested for HIV infection, and were more likely to expect to be tested within the next 12 months.
O'Farrell, N; Morison, L; Moodley, P; Pillay, K; Vanmali, T; Quigley, M; Sturm, A W
Objectives A study of men with genital ulcer disease (GUD) in Durban, South Africa, at the start of the local HIV epidemic in 1988/1989 found that 36% of men with GUD continued with sexual intercourse despite symptoms. The aim of this study was to determine whether this high‐risk behaviour was still prevalent and to enquire about similar risk behaviours with other sexually transmitted infection (STI)‐related problems. Methods 650 Men attending the main Durban STI clinic with a new complaint were enrolled. A standard questionnaire was administered. Polymerase chain reaction (PCR) tests were performed to diagnose genital herpes from ulcer specimens and gonorrhoea and chlamydia from those with urethral discharge and/or dysuria. Serology tests were performed for HIV, herpes simplex virus type 2 (HSV‐2) and syphilis. Results Sex since the start of symptoms was reported by between 33.3% and 43.9% of men with GUD, herpetic ulcers, gonorrhoea and/or chlamydia or dysuria. The incidence of condom use was very low in all groups having sex despite symptoms. In 87 men with genital ulcers confirmed positive for genital herpes by PCR testing, 30 (34.4%) had had sex since the start of symptoms, 28 (93.3%) of whom had had unprotected sex. Conclusions There is a high level of risk behaviour in this group of men in whom genital herpes is the most common cause of GUD. This risky sexual behaviour could reflect disinhibition, possibly because so many have already been infected with HSV‐2, lack of education or other unknown factors. Syndromic STI management should be strengthened with intensive health education to promote community awareness of both genital ulceration and genital herpes and their role in facilitating HIV transmission. The low level of condom use indicates that condom promotion programmes still have much to achieve. PMID:17971375
Ryoo, Hyeon-Ju; Nazareth, Kristina; Chan, Philip A; Reinert, Steven E; Koster, Michael
Early detection of HIV has great potential to reduce transmission, especially when newly diagnosed individuals are treated early. Early treatment and suppression of viral loads is known to effectively attenuate HIV transmission. However, little is known about whether persons at high risk for HIV are being appropriately tested during healthcare encounters according to national guidelines. Specifically, the at-risk adolescent population may be under tested and are not routinely monitored by state-level surveillance system. This study reviewed HIV testing rates for at-risk adolescents from 2005-2012 at the main tertiary care and pediatric center in Rhode Island. While the absolute number of HIV tests for at-risk adolescents continued to increase, the HIV testing rates for this population decreased during the seven year period. Increasing awareness of HIV testing for patients, their families, and physicians may improve the HIV testing rate among at-risk adolescents in Rhode Island.
Camoni, Laura; Regine, Vincenza; Colucci, Anna; Conte, Ivano Dal; Chiriotto, Monica; Vullo, Vincenzo; Sebastiani, Marina; Cordier, Laura; Beretta, Rosangela; Fiore, Josè Ramon; Tateo, Mariagrazia; Affronti, Mario; Cassarà, Giuseppina; Suligoi, Barbara
Many HIV-positive persons reportedly continue to engage in at-risk behavior. We compared the sexual and drug-using practices of HIV-positive persons before and after the diagnosis of HIV infection to determine whether their behavior had changed. To this end, in 2006, we conducted a cross-sectional study involving clinical centers in five Italian cities. Each center was asked to enroll 100 persons aged 18 years or older who had a diagnosis of HIV infection that dated back at least 2 years. Data were collected with a specifically designed questionnaire, administered during a structured interview. The McNemar chi2 test was used to compare the data before and after the diagnosis. A total of 497 persons participated (65.5% males; median age of 40 years; age range, 34-45 years). The most common exposure categories were: heterosexual contact (43.4%), homosexual contact (27.2%), and injecting drug use (20.6%). Although the percentage of drug users significantly decreased after diagnosis, 32.4% of injectors continued to use drugs, and approximately half of them exchanged syringes. Regarding sexual behavior, after diagnosis there was a significant decrease in the number of sexual partners and in stable relationships and an increase in condom use, both for persons with stable partners and those with occasional partners, although the percentage varied according to the specific sexual practice. These results indicate that though at-risk behavior seems to decrease after the diagnosis of HIV infection, seropositive persons continue to engage in at-risk practices, indicating the need for interventions specifically geared toward HIV-positive persons.
Probst, Charlotte; Simbayi, Leickness C; Parry, Charles D H; Shuper, Paul A; Rehm, Jürgen
The present study investigated the associations among alcohol use, socioeconomic status (SES), and human immunodeficiency virus (HIV) status, in the South African context. It was hypothesized that SES (predictor; measured as median split asset score) and alcohol use in the past 12 months (predictor) would interact such that current drinkers of low SES would be at an increased risk of testing HIV-positive (outcome). Nationally representative, cross-sectional survey data from 2005 (N = 16,110), 2008 (N = 13,055), and 2012 (N = 25,979) were analyzed using multinomial regression models. Current drinkers of low SES had an elevated risk of HIV infection in all survey years, ranging from a relative risk ratio (RRR) of 1.94 (95% confidence interval (CI) 1.29-3.00, t = 2.93, p = 0.002) in 2012 to RRR of 3.51 (95% CI 2.02-6.08, t = 4.47, p < 0.001) in 2008. Targeting preventive strategies to alcohol users of low SES could help reduce HIV burden and associated socioeconomic differences.
Buchecker, M.; Maidl, E.
In the last decade, in most of the European countries risk maps on natural hazards have been elaborated but there is so far little experience how to efficiently communicate these maps to the public. Recently, the public authorities of Zurich informed the owners of buildings located within the hazard zone on urban flood risks The owners received official letters containing information on potential danger, the probability of flood events, constructional safety measures, and guidelines for appropriate actions in case of an immediate flood. In the cover letter they were also encouraged to achieve more detailed information about the particular risks for their building using an online accessible risk map within a geographic information system (GIS). This risk communication campaign was based on the expectation that informing citizens increases their risk awareness and that citizens aware of risks are more likely to undertake actions to protect themselves and their property. There is, however, little empirical evidence that these expected outcomes can be achieved by written forms of risk communication. With this project we aim to find out to which degree a campaign of written risk communication can shape land owners risk perception and risk behaviour, and which other factors (e.g. trust in authorities, risk, risk zone category of the building) contributed to these outcomes... In collaboration with public authorities we conducted a survey among 1500 owners of buildings in the hazard zones in Zurich (50 % in blue zone, 50 % in yellow and yellow-white zone), that is 14% of all persons who were addressed by the authorities of the city. The standardized questionnaire comprises in particular items measuring respondents' evaluation of the virtual and physical information material, the time they spent for studying the information material, the dimensions of their risk perception, their acceptability of risks and their preparedness to implement constructional and other safety
Harrison, Abigail; Smit, Jenni; Hoffman, Susie; Nzama, Thobile; Leu, Cheng-Shiun; Mantell, Joanne; Stein, Zena; Exner, Theresa
Background and methods In preparation for a school-based intervention in KwaZulu-Natal, South Africa, a cross-sectional survey of potential HIV risk factors in youth aged 14–17 (n = 983) was conducted. Results Boys were significantly more likely than girls to report lifetime sexual activity (37.7% v. 13.8%, P < 0.01). Among boys and girls, 46.1% reported condom use at last sex. Discussion of condom use with a partner was the strongest predictor of condom use (boys, odds ratio (OR) = 7.39; girls, OR = 5.58, P < 0.0001). Age was independently associated with sexual activity for boys (OR = 1.49, P < 0.0001) and girls (OR = 1.74, P = 0.02). For boys, perceptions of male peer behaviour were associated with both ever having participated in sexual activity (OR = 1.48, P < 0.01) and condom use at last sex (OR = 1.79, P < 0.01). Girls who equated condom use with having numerous partners were more likely to use them. Among boys, results challenged some expected gender beliefs: support for girls’ initiative in relationship formation and refusal of sex were significant predictors of sexual activity. Among girls, higher pregnancy risk perception (OR = 1.32, P = 0.02) and knowledge (OR = 4.85, P = 0.055) were associated with sexual activity. Conclusions Creating more gender equitable norms can reduce HIV risk behaviours. HIV prevention interventions should build on existing gender equitable beliefs, and work to promote others, including sexual communication and negotiation skills, and modelling of positive peer norms. PMID:22498163
Bijlmakers, L A
In July-August 1992, a directory was made of research projects on socio-behavioural aspects of HIV infection and AIDS in Zimbabwe. A total of 92 research projects were identified, most of which were already completed. Whilst there was a wide variety of topics, populations and geographical areas covered, there was a strong bias towards AIDS awareness and knowledge, attitudes and practices (KAP) studies. Many of these were not linked with any specific AIDS prevention programme or with policy making. Suggestions are given to make better use of existing scientific information. A call is made upon researchers to conduct action-oriented studies and to consult HIV/AIDS programme implementers when specifying 'researchable' problems, so as to increase the likelihood that the study results will indeed have an impact on policy making and programme implementation.
Hankins, C; Coutlée, F; Lapointe, N; Simard, P; Tran, T; Samson, J; Hum, L
BACKGROUND: Concurrent infection with HIV and human papillomavirus (HPV) in women is associated with increased rates of cervical dysplasia and shorter survival following the development of cervical cancer. The authors examined risk factors for HPV infection at study entry in HIV-positive women enrolled in the Canadian Women's HIV Study, a prospective open cohort study. METHODS: Subjects eligible for this analysis included the 375 HIV-positive women in the Canadian Women's HIV Study for whom HPV test results were available. Questionnaires on behavioural and clinical information, Pap smears, cervicovaginal lavage specimens and vaginal tampon specimens for HPV detection and typing by polymerase chain reaction were obtained at study entry. RESULTS: Overall, 67.2% (252/375) of the women were HPV-positive; the global prevalence of intermediate- and high-risk oncogenic HPV types was 49.1% (184/375). Women with squamous cell dysplasia (32/294) were more likely to have HPV infection than those without dysplasia (90.6% v. 62.6%; p = 0.002). Multivariate logistic regression analysis, with adjustment for number of lifetime partners and history of STD, revealed that the following risk factors were independently associated with HPV infection: CD4 count of less than 0.20 x 10(9)/L (adjusted odds ratio [OR] 1.99 [95% confidence interval (Cl) 1.17-3.37 (p = 0.011)]), non-white race (adjusted OR 2.00 [95% Cl 1.17-3.42 (p = 0.011)]), inconsistent condom use in the 6 months before study entry (adjusted OR 2.02 [95% Cl 1.16-3.50 (p = 0.013)]), and lower age, with women age 30-39 years (adjusted OR 0.51 [95% Cl 0.30-0.87 (p = 0.013)]) and age 40 years or older (adjusted OR 0.52 [95% Cl 0.26-1.01 (p = 0.052)]) compared with women less than 30 years of age. INTERPRETATION: Close monitoring for HPV-related effects is warranted in all HIV-positive women, particularly younger, non-white women who do not always use condoms. Counselling for women living with HIV, particularly younger women
Des Jarlais, Don C.; Braine, Naomi; Yi, Huso; Turner, Charles
This study assessed relationships between residual risk behavior (risk behavior among persons participating in effective HIV prevention programs) and HIV infection. Structured interviews and HIV tests were obtained from participants in six large U.S. syringe exchange programs. Program characteristics were obtained through interviews with the…
Martinez-Donate, Ana P.; Blumberg, Elaine J.; Hovell, Melbourne F.; Sipan, Carol L.; Zellner, Jennifer A.; Hughes, Suzanne
Previous studies have suggested high rates of HIV infection and other sexually transmitted infections in theU.S.-Mexico border region. However, no information is available on the risk for HIV infection among Mexican adolescents living in this geographic area. This study examines the prevalence of HIV risk practices and psychosocial correlates…
Aho, Josephine; Hakim, Avi; Vuylsteke, Bea; Semde, Gisèle; Gbais, Honorat G.; Diarrassouba, Mamadou; Thiam, Marguerite; Laga, Marie
Men who have sex with men (MSM) are at high risk of HIV. Few data are available on MSM and HIV-related risk behaviors in West Africa. We aimed to describe risk behaviors and vulnerability among MSM in Abidjan, Cote d′Ivoire. We conducted a cross-sectional respondent-driven sampling survey with 601 MSM in 2011–2012. Sociodemographic and behavioural data as well as data related to emotional state and stigma were collected. Population estimates with 95% confidence intervals were produced. Survey weighted logistic regression was used to assess factors associated with inconsistent condom use in the prior 12 months. Most MSM were 24 years of age or younger (63.9%) and had attained at least primary education (84.4%). HIV risk behaviors such as low condom and water-based lubricant use, high numbers of male and female sex partners, and sex work were frequently reported as well as verbal, physical and sexual abuse. Inconsistent condom use during anal sex with a male partner in the prior 12 months was reported by 66.0% of the MSM and was positively associated with history of forced sex, alcohol consumption, having a regular partner and a casual partner, having bought sex, and self-perception of low HIV risk. MSM in Abidjan exhibit multiple and frequent HIV-related risk behaviors. To address those behaviours, a combination of individual but also structural interventions will be needed given the context of stigma, homophobia and violence. PMID:24959923
Aho, Josephine; Hakim, Avi; Vuylsteke, Bea; Semde, Gisèle; Gbais, Honorat G; Diarrassouba, Mamadou; Thiam, Marguerite; Laga, Marie
Men who have sex with men (MSM) are at high risk of HIV. Few data are available on MSM and HIV-related risk behaviors in West Africa. We aimed to describe risk behaviors and vulnerability among MSM in Abidjan, Cote d'Ivoire. We conducted a cross-sectional respondent-driven sampling survey with 601 MSM in 2011-2012. Sociodemographic and behavioural data as well as data related to emotional state and stigma were collected. Population estimates with 95% confidence intervals were produced. Survey weighted logistic regression was used to assess factors associated with inconsistent condom use in the prior 12 months. Most MSM were 24 years of age or younger (63.9%) and had attained at least primary education (84.4%). HIV risk behaviors such as low condom and water-based lubricant use, high numbers of male and female sex partners, and sex work were frequently reported as well as verbal, physical and sexual abuse. Inconsistent condom use during anal sex with a male partner in the prior 12 months was reported by 66.0% of the MSM and was positively associated with history of forced sex, alcohol consumption, having a regular partner and a casual partner, having bought sex, and self-perception of low HIV risk. MSM in Abidjan exhibit multiple and frequent HIV-related risk behaviors. To address those behaviours, a combination of individual but also structural interventions will be needed given the context of stigma, homophobia and violence.
Jürgens, Ralf; Nowak, Manfred; Day, Marcus
The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centres a high risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return upon their release. We reviewed the evidence regarding HIV prevalence, risk behaviours and transmission in prisons. We also reviewed evidence of the effectiveness of interventions and approaches to reduce the risk behaviours and, consequently, HIV transmission in prisons. A large number of studies report high levels of risk behaviour in prisons, and HIV transmission has been documented. There is a large body of evidence from countries around the world of what prison systems can do to prevent HIV transmission. In particular, condom distribution programmes, accompanied by measures to prevent the occurrence of rape and other forms of non-consensual sex, needle and syringe programmes and opioid substitution therapies, have proven effective at reducing HIV risk behaviours in a wide range of prison environments without resulting in negative consequences for the health of prison staff or prisoners.The introduction of these programmes in prisons is therefore warranted as part of comprehensive programmes to address HIV in prisons, including HIV education, voluntary HIV testing and counselling, and provision of antiretroviral treatment for HIV-positive prisoners. In addition, however, action to reduce overcrowding and improve conditions in detention is urgently needed.
The high prevalence of HIV infection among prisoners and pre-trial detainees, combined with overcrowding and sub-standard living conditions sometimes amounting to inhuman or degrading treatment in violation of international law, make prisons and other detention centres a high risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return upon their release. We reviewed the evidence regarding HIV prevalence, risk behaviours and transmission in prisons. We also reviewed evidence of the effectiveness of interventions and approaches to reduce the risk behaviours and, consequently, HIV transmission in prisons. A large number of studies report high levels of risk behaviour in prisons, and HIV transmission has been documented. There is a large body of evidence from countries around the world of what prison systems can do to prevent HIV transmission. In particular, condom distribution programmes, accompanied by measures to prevent the occurrence of rape and other forms of non-consensual sex, needle and syringe programmes and opioid substitution therapies, have proven effective at reducing HIV risk behaviours in a wide range of prison environments without resulting in negative consequences for the health of prison staff or prisoners. The introduction of these programmes in prisons is therefore warranted as part of comprehensive programmes to address HIV in prisons, including HIV education, voluntary HIV testing and counselling, and provision of antiretroviral treatment for HIV-positive prisoners. In addition, however, action to reduce overcrowding and improve conditions in detention is urgently needed. PMID:21595957
Golin, C.; Wang, J.; Hughes, J.; Justman, J.; Haley, D.; Kuo, I.; Adimora, A.; Chege, W.; Hodder, S.
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
Roman Isler, M; Golin, C; Wang, J; Hughes, J; Justman, J; Haley, D; Kuo, I; Adimora, A; Chege, W; Hodder, S
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.
Martin, Eileen; Gonzalez, Raul; Vassileva, Jasmin; Maki, Pauline M.; Bechara, Antoine; Brand, Matthias
HIV+ individuals with and without substance use disorders make significantly poorer decisions when information about the probability and magnitude of wins and losses is not available. We administered the Game of Dice Task, a measure of decision making under risk that provides this information explicitly, to 92 HIV+ and 134 HIV− substance dependent men and women. HIV+ participants made significantly poorer decisions compared with HIV− participants, but this deficit appeared more prominent among HIV+ women. These data indicate that decision making under risk is impaired among HIV+ SDIs. Potential factors for the HIV+ women’s relatively greater impairment are discussed. PMID:26882176
Sherman, Susan G; Brantley, Meredith R; Zelaya, Carla; Duong, Quyen; Taylor, Ralph B; Ellen, Jon M
Exotic dancers have received little research attention despite evidence of high-risk behaviours within exotic dance clubs (EDCs). We developed and assessed the reliability and validity of a risk environment score, examining differences between dancers (n = 107) and other staff (n = 172). In the summer of 2013, anonymous surveys were administered via A-CASI in EDCs (N = 26) in Baltimore among exotic dancers and staff. Surveys consisted of a brief demographic section followed by 65 statements. The overall domain had an alpha = 0.77 and subdomains had the following: social (alpha = 0.87), economic (alpha = 0.92), drug (alpha = 0.89), and policy (alpha = 0.66). In a factor analysis, each domain contributed significantly to the overall latent construct. The results indicate a high level of HIV/STI risk for dancers in EDCs and underscore the need for targeted interventions in these environments. As we continue to unpack the function of the broader environment in STI/HIV risk transmission, the scale could be instructive for other settings.
Cook, Stephanie H.; Valera, Pamela
The rate of HIV infection among young men who have sex with men (YMSM) is increasing in the United States, and targeted research is needed to inform interventions aimed at reducing HIV transmission in this population. This study aims to understand the association between HIV status disclosure and sexual risk behavior among HIV-positive YMSM. A particular focus is given to depressive symptoms and their potential role in explaining the association between HIV disclosure and sexual risk behavior. In a sample of 991 YMSM receiving care at 20 clinics across the United States, Univariate and multivariate analyses were conducted to explore these associations. Approximately one-half (52.4 %) of participants reported disclosing to their current sexual/romantic partner. Disclosure to family members was negatively associated with sexual risk behavior. Also, depressive symptoms were positively associated with sexual risk behavior. We discuss the implications of our findings for future research and intervention. PMID:25773478
Ngak, Song; Srean, Chhim; Sansothy, Neth; Mills, Stephen; Ferradini, Laurent
Introduction Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia. Methods Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited. Results The majority of the 891 participants self-identified as third gender or female (94.5%), were young (median age 23, IQR [20–27]), had secondary education or higher (80.5%), not married (89.7%), and employed (90.2%). The majority had first sex before 18 years (66.8%), with a male (79.9%), 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%). The majority of participants reported having experienced discrimination in their lifetime (54.8%) and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35–44 and adjusted OR = 7.63 [2.55, 22.81] for age 30–34), only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37,23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09,7.73]), inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33]), and reporting low self-esteem (adjusted OR
Djawe, Kpandja; Levin, Linda; Swartzman, Alexandra; Fong, Serena; Roth, Brenna; Subramanian, Anuradha; Grieco, Katherine; Jarlsberg, Leah; Miller, Robert F.; Huang, Laurence; Walzer, Peter D.
Background. Pneumocystis pneumonia (PcP) is the second leading cause of morbidity and mortality in human immunodeficiency virus (HIV)–infected patients in the United States. Although the host risk factors for the development of PcP are well established, the environmental (climatological, air pollution) risk factors are poorly understood. The major goal of this study was to determine the environmental risk factors for admissions of HIV-positive patients with PcP to a single medical center. Methods. Between 1997 and 2008, 457 HIV-positive patients with microscopically confirmed PcP were admitted to the San Francisco General Hospital. A case-crossover design was applied to identify environmental risk factors for PcP hospitalizations. Climatological and air pollution data were collected from the Environmental Protection Agency and Weather Warehouse databases. Conditional logistic regression was used to evaluate the association of each environmental factor and PcP hospital admission. Results. Hospital admissions were significantly more common in the summer than in the other seasons. Increases in temperature and sulfur dioxide levels were independently associated with hospital admissions for PcP, but the effects of sulfur dioxide were modified by increasing carbon monoxide levels. Conclusions. This study identifies both climatological and air pollution constituents as independent risk factors for hospitalization of HIV-positive patients with PcP in San Francisco. Thus, the environmental effects on PcP are more likely complex than previously thought. Further studies are needed to understand how these factors exert their effects and to determine if these factors are associated with PcP in other geographic locations. PMID:23042978
Mann, Lilli; Valera, Erik; Hightow-Weidman, Lisa B.; Barrington, Clare
Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina (NC), a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health. PMID:24866206
How much risk can we expose our research subjects to? There is a special challenge answering this question when the evidence on which we base our assessments of risk is fragmentary, conflicting or sparse. Such evidence does not support precise assignments of risk (eg, there is a 24.8% chance that this patient will develop AIDS in the next year if she participates in my study). At best it supports imprecise assignments of risk (eg, there is between a 5% and 35% chance that this patient will develop AIDS in the next year if she participates in my study). Here I discuss three approaches to evaluating risk when probability assignments are imprecise—an optimistic approach, a moderate approach and a pessimistic approach. I offer a practical reason to favour the pessimistic approach. PMID:27670811
Coma Auli, Núria; Mejía-Lancheros, Cília; Berenguera, Anna; Pujol-Ribera, Enriqueta
Objective This study aimed to determine in detail the risk perception of sexually transmitted infections (STIs) and HIV, and the contextual circumstances, in Nigerian commercial sex workers (CSWs) in Barcelona. Design A qualitative study with a phenomenological approach. Setting Raval area in Barcelona. Participants 8 CSWs working in Barcelona. Methods A phenomenological study was carried out with Nigerian CSWs in Barcelona. Sampling was theoretical, taking into account: different age ranges; women with and without a partner; women with and without children; and women participating or not in STI/HIV-prevention workshops. Information was obtained by means of eight semistructured individual interviews. An interpretative content analysis was conducted by four analysts. Results Illegal immigrant status, educational level, financial situation and work, and cultural context had mixed effects on CSW knowledge of, exposure to, and prevention and treatment of STI and HIV. CSWs were aware of the higher risk of STI associated with their occupation. They identified condoms as the best preventive method and used them during intercourse with clients. They also implemented other preventive behaviours such as personal hygiene after intercourse. Control of sexual services provided, health education and healthcare services had a positive effect on decreasing exposure and better management of STI/HIV. Conclusions Nigerian CSWs are a vulnerable group because of their poor socioeconomic status. The perception of risk in this group and their preventive behaviours are based on personal determinants, beliefs and experiences from their home country and influences from the host country. Interventions aimed at CSWs must address knowledge gaps, risk behaviours and structural elements. PMID:26078307
Valadez, Joseph J.; Berendes, Sima; Jeffery, Caroline; Thomson, Joanna; Ben Othman, Hussain; Danon, Leon; Turki, Abdullah A.; Saffialden, Rabea; Mirzoyan, Lusine
Background Publications on Libya’s HIV epidemic mostly examined the victims of the tragic nosocomial HIV outbreak in the 1990s and the related dispute about the detention of foreign medical workers. The dispute resolution in 2003 included an agreement with the European Union on humanitarian cooperation and the development of Libya’s first National HIV Strategy. As part of this we conducted Libya’s first bio-behavioural survey among men having sex with men (MSM) and female sex workers (FSW). Methods Using respondent-driven sampling, we conducted a cross-sectional study to estimate the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and related risk factors among 227 MSM and 69 FSW in Tripoli (FSW recruitment ended prematurely due to the political events in 2011). Results For MSM we estimated an HIV prevalence of 3.1%, HBV prevalence of 2.9%, and HCV prevalence of 7.3%, and for FSW an HIV prevalence of 15.7%, HBV prevalence of 0%, and HCV prevalence of 5.2%. We detected high levels of risk behaviours, poor HIV-related knowledge, high stigma and lack of prevention programmes. These results must be interpreted in the context of the political situation which prohibited reaching an ideal sample size for FSW. Conclusion There is urgent need to implement an effective National HIV Strategy informed by the results of this research. The risk of transmission within different risk groups and to the general population may be high given the recent military events that led to increased violence, migration, and the disruption of essential HIV-related services. PMID:23840521
Dandona, Rakhi; Dandona, Lalit; Gutierrez, Juan Pablo; Kumar, Anil G; McPherson, Sam; Samuels, Fiona; Bertozzi, Stefano M
Background Heterosexual contact is the most common mode of HIV transmission in India that is largely linked to sex work. We assessed the non-use of condoms in sex work and with regular sex partners by female sex workers (FSWs), and identified its associations that could assist in planning HIV prevention programmes. Methods Detailed documentation of various aspects of sex work, and sexual behaviour with regular sex partners, was done through confidential interviews for 6648 FSWs in 13 districts in the Indian state of Andhra Pradesh. Multivariate analysis was done to understand condom non-use with clients. Results 5010 (75.4%), 1499 (22.5%), and 139 (2.1%) FSWs were street-, home-, and brothel-based, respectively. Of the total 6648 FSWs, 6165 (92.7%) had penetrative vaginal/anal sex with at least one client in the last 15 days, and of these 2907 (47.2%; 95% CI 41.2–53.2%) reported non-use of condom with at least one of her last three clients. Lack of knowledge that HIV could be prevented (odds ratio 5.01; 95% CI 4.38–5.73), no access to free condoms (odds ratio 3.45; 95% CI 2.99–3.98), being street-based as compared with brothel-based (odds ratio 3.36; 95% CI 1.87–6.04), and no participation in FSW support groups (odds ratio 2.02; 95% CI 1.50–2.70) were the most significant predictors of condom non-use with clients. Other associations included lower social support, lower income, age >24 years, illiteracy, and living in medium-size urban or rural areas. Of the 2582 who had penetrative sex with regular sex partner within the last 7 days, 2428 (94%; 95% CI 92.1–95.9%) had not used condom at last sex, and 1032 (41.8%) had neither used condom consistently with clients nor with regular sex partner. Conclusion About half the FSWs do not use condom consistently with their clients in this Indian state putting them at high risk of HIV infection. Non-brothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher risk of HIV
Wojcicki, Janet Maia
countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.
Bantjes, Jason; Kagee, Ashraf; Saal, Wylene
Suicidal ideation and behaviour (SIB) are among the psychiatric sequela of HIV/AIDS. Few studies have however examined the prevalence and correlates of SIB among persons seeking HIV testing. We set out to document the prevalence and correlates of SIB among people seeking HIV testing in peri-urban areas of Cape Town, South Africa (SA). A cross-sectional research design was used to recruit a sample (n = 500) of individuals seeking HIV testing. Self-report measures were used to assess two-week prevalence of SIB as well as life-time prevalence of suicide attempt. A structured clinical interview was used to assess common mental disorders (CMDs). Regression analysis was used to determine if CMD and socio-demographic variables predicted suicidal ideation. The mean age of the sample was 36 years, 51.6% were female and 46.6% were unemployed. The two-week prevalence of suicidal ideation was 24.27% while the two-week prevalence of suicide attempt and suicide plans was 2.8%. Suicidal ideation was not associated with age, gender, employment status, family income or household food insecurity. CMDs were significantly associated with suicidal ideation; individuals with depressive disorders were approximately 5.5 times more likely to report suicidal ideation, while those with generalised anxiety disorder, trauma-related disorders and alcohol use disorder were approximately 7, 4.7 and 2.8 times more likely to report suicidal ideation, respectively. Results suggest that persons seeking HIV testing may be a well-delineated group of persons at risk of suicide in this region of SA. Contact with the health care system during HIV testing provides an opportunity for targeted suicide prevention interventions in what appears to be a high risk group.
Mizuno, Yuko; Purcell, David W.; Knowlton, Amy R.; Wilkinson, James D.; Gourevitch, Marc N.; Knight, Kelly R.
Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n=1052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p<0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons. PMID:25249392
Al-Jabri, A A; Youssef, R M; Hasson, S S; Balkhair, A A; Al-Belushi, M; Al-Saadoon, M; Mathew, M; Al-Mahroqi, S; Said, E; Koh, C Y; Idris, M A
Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women (51.9%) reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy.
Kaaya, S F; Leshabari, M T; Mbwambo, J K
Focusing on increased vulnerability to HIV infection, this article examines some of the contexts within which these risk-taking behaviors occur and illustrates that the risk of contracting the disease is just one of the many risks with which Tanzanian youths are confronted. The sexual and substance use behaviors, and the relationship between such behaviors and economic factors, are discussed. Where evidences exist, attempts are made to compare the prevalence of these behaviors among male and female youths, as well as urban and rural youths. The extent to which males and females engage in risk-taking behaviors is unknown; however, studies show that, depending on age and gender, between 17% and 61% of youths are sexually active. Rates in HIV transmission vary by gender and by whether the youths are rural or urban inhabitants. Factors like adverse socioeconomic conditions, unemployment, lack of parental guidance and supervision, and culture all influence sexual risk-taking behaviors among youths. Meanwhile, increasing use of drugs and alcohol among the young population has been closely linked to increased vulnerability to unprotected sexual intercourse. Again, survival needs play a major role in sustaining risk behaviors. The paper concludes by outlining policy implications of youth risk behaviors, taking into account a multisectoral approach in dealing with the problem.
Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted. In South Africa, while gender identities show diversity, the dominant ideal of black African manhood emphasizes toughness, strength and expression of prodigious sexual success. It is a masculinity women desire; yet it is sexually risky and a barrier to men engaging with HIV treatment. Hegemonically masculine men are expected to be in control of women, and violence may be used to establish this control. Instead of resisting this, the dominant ideal of femininity embraces compliance and tolerance of violent and hurtful behaviour, including infidelity. The women partners of hegemonically masculine men are at risk of HIV because they lack control of the circumstances of sex during particularly risky encounters. They often present their acquiescence to their partners' behaviour as a trade off made to secure social or material rewards, for this ideal of femininity is upheld, not by violence per se, by a cultural system of sanctions and rewards. Thus, men and women who adopt these gender identities are following ideals with deep roots in social and cultural processes, and thus, they are models of behaviour that may be hard for individuals to critique and in which to exercise choice. Women who are materially and emotionally vulnerable are least able to risk experiencing
Paydary, Koosha; Mahin Torabi, Somayeh; SeyedAlinaghi, SeyedAhmad; Noori, Mehri; Noroozi, Alireza; Ameri, Sara; Ekhtiari, Hamed
Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS). Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people.
Bobashev, Georgiy V.; Morris, Robert J.; Zule, William A.
Longitudinal studies of health outcomes for HIV could be very costly cumbersome and not representative of the risk population. Conversely, cross-sectional approaches could be representative but rely on the retrospective information to estimate prevalence and incidence. We present an Agent-based Modeling (ABM) approach where we use behavioral data from a cross-sectional representative study and project the behavior into the future so that the risks of acquiring HIV could be studied in a dynamical/temporal sense. We show how the blend of behavior and contact network factors (sexual, injecting) play the role in the risk of future HIV acquisition and time till obtaining HIV. We show which subjects are the most likely persons to get HIV in the next year, and whom they are likely to infect. We examine how different behaviors are related to the increase or decrease of HIV risks and how to estimate the quantifiable risk measures such as survival HIV free.
Johnson, Maree; Tran, Duong Thuy; Young, Helen
The aim of this study was to define risk management behaviours related to medication safety. Mixed methods were used to analyze 318 nursing related medication incidents reported in an Australian metropolitan hospital. Most incidents did not result in patient harm (93%). Omission of medications was the most frequent often related to patient absences from the unit or nurses failing to sign for medications. Thematic analysis resulted in the Medication Safety Subscales including 29 behavioural statements within three domains-administering medications, storage and management of medications, managing adverse events related to medications. The Medication Safety Subscales can be used by managers, educators and clinicians to reinforce the importance of medication safety. Early action by nurses may reduce patient injury.
Wyżgowski, Przemysław; Rosiek, Anna; Grzela, Tomasz; Leksowski, Krzysztof
Virtually created panic among health care workers about pandemic acquired immune deficiency syndrome prompted us to review the scientific literature to investigate the risk of human immunodeficiency virus (HIV) transmission in the daily works of health care workers, especially surgeons and anesthesiologists. In this review, we report worldwide valuations of the number of HIV infections that may occur from unsafe daily work in health care. We also present how to minimize the risk of infection by taking precautions and how to utilize postexposure prophylaxis in accordance with the latest reports of the Centers for Disease Control and Prevention. HIV-infected patients will be aging, and most of them will become the candidates for procedures such as major vascular reconstruction and artery bypass grafting, where the risks of blood contact and staff injury are high. For these reasons, all health care workers need to know how to prevent, and fight following the accidental exposure to HIV. PMID:27366077
Yi, Huso; Sandfort, Theo G. M.; Shidlo, Ariel
Objective This study examined how disengagement coping with HIV risk mediated the association between internalized homophobia and unprotected anal intercourse (UAI) and how sexual encounters in public venues (public sex) and drug use moderated the association between disengagement coping and UAI among HIV-negative gay men. Disengagement coping included fatalistic beliefs about maintaining HIV-negative seronegative serostatus (fatalism), optimistic attitudes toward medical seriousness of HIV infection and reduced concern about HIV risk due to HAART (optimism), and negative affective states associated with sexual risk (anxiety). Design A survey was conducted among 285 HIV-negative gay men at an HIV prevention counseling program in New York City. Main Outcome Measures Sexual risk was defined as having had UAI with non-primary partners in the past six months. Results In addition to the positive association between internalized homophobia, disengagement coping, and UAI, fatalism mediated the association between internalized homophobia and UAI; and optimism mediated the association between anxiety and UAI. A significant moderation effect of public sex was found between fatalism and UAI. Conclusions The findings highlight the importance of understanding disengagement coping as it affects sexual risk practices among HIV-negative gay men in the continuing epidemic. PMID:20230094
Raag, Mait; Rosenthal, Marika; Uusküla, Anneli
Abstract Regular interactions with people living with HIV/AIDS (PLWHA) who are receiving care provide caregivers opportunities to deliver interventions to reduce HIV-related risks. We conducted a systematic review of behavioral interventions for PLWHA (provided at individual level by caregivers at HIV care settings) to determine their efficacy in reducing sexual risk behavior. Conference websites and biomedical literature databases were searched for studies from 1981 to 2013. Randomized and quasi-randomized controlled trials (with standard-of-care control groups), considering at least one of a list of HIV-related behavioral or biological outcomes in PLWHA aged ≥18 receiving HIV care with at least 3-month follow-up were included. No language or publication status restrictions were set. Standardized search, data abstraction, and evaluation methods were used. Five randomized controlled trials were included in the review. We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts, and reduce the number of (casual) sexual partners. We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV. PMID:25844941
Laisaar, Kaja-Triin; Raag, Mait; Rosenthal, Marika; Uusküla, Anneli
Regular interactions with people living with HIV/AIDS (PLWHA) who are receiving care provide caregivers opportunities to deliver interventions to reduce HIV-related risks. We conducted a systematic review of behavioral interventions for PLWHA (provided at individual level by caregivers at HIV care settings) to determine their efficacy in reducing sexual risk behavior. Conference websites and biomedical literature databases were searched for studies from 1981 to 2013. Randomized and quasi-randomized controlled trials (with standard-of-care control groups), considering at least one of a list of HIV-related behavioral or biological outcomes in PLWHA aged ≥18 receiving HIV care with at least 3-month follow-up were included. No language or publication status restrictions were set. Standardized search, data abstraction, and evaluation methods were used. Five randomized controlled trials were included in the review. We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts, and reduce the number of (casual) sexual partners. We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV.
Renner, Britta; Schmälzle, Ralf; Schupp, Harald T.
Research indicates that many people do not use condoms consistently but instead rely on intuition to identify sexual partners high at risk for HIV infection. The present studies examined neural correlates for first impressions of HIV risk and determined the association of perceived HIV risk with other trait characteristics. Participants were presented with 120 self-portraits retrieved from a popular online photo-sharing community (www.flickr.com). Factor analysis of various explicit ratings of trait characteristics yielded two orthogonal factors: (1) a ‘valence-approach’ factor encompassing perceived attractiveness, healthiness, valence, and approach tendencies, and (2) a ‘safeness’ factor, entailing judgments of HIV risk, trustworthiness, and responsibility. These findings suggest that HIV risk ratings systematically relate to cardinal features of a high-risk HIV stereotype. Furthermore, event-related brain potential recordings revealed neural correlates of first impressions about HIV risk. Target persons perceived as risky elicited a differential brain response in a time window from 220–340 ms and an increased late positive potential in a time window from 350–700 ms compared to those perceived as safe. These data suggest that impressions about HIV risk can be formed in a split second and despite a lack of information about the actual risk profile. Findings of neural correlates of risk impressions and their relationship to key features of the HIV risk stereotype are discussed in the context of the ‘risk as feelings’ theory. PMID:22291959
Farrelly, Colleen; Cordova, David; Huang, Shi; Estrada, Yannine; Prado, Guillermo
The present study examined the relationship between Berry's acculturation typology and HIV risk behaviors and whether family functioning mediated any such effects. A total of 235 high risk Hispanic adolescents were categorized into one of Berry's four acculturation typologies through the use of cut-off scores on measures of Hispanicism and Americanism. Structural equation modeling was used to examine the effects of acculturation typology on HIV risk behaviors and the indirect effects of acculturation typology on HIV risk behaviors through family functioning. Acculturation typology was related to HIV risk behaviors. Family functioning partially mediated the effects of acculturation typology on the HIV risk behavior outcomes. These findings suggest that both Americanism and Hispanicism play an important role in the etiology of HIV risk behaviors among Hispanic youth and that both, along with family functioning, are important to consider when designing preventive interventions for this population.
Farrelly, Colleen; Cordova, David; Huang, Shi; Estrada, Yannine
The present study examined the relationship between Berry’s acculturation typology and HIV risk behaviors and whether family functioning mediated any such effects. A total of 235 high risk Hispanic adolescents were categorized into one of Berry’s four acculturation typologies through the use of cut-off scores on measures of Hispanicism and Americanism. Structural equation modeling was used to examine the effects of acculturation typology on HIV risk behaviors and the indirect effects of acculturation typology on HIV risk behaviors through family functioning. Acculturation typology was related to HIV risk behaviors. Family functioning partially mediated the effects of acculturation typology on the HIV risk behavior outcomes. These findings suggest that both Americanism and Hispanicism play an important role in the etiology of HIV risk behaviors among Hispanic youth and that both, along with family functioning, are important to consider when designing preventive interventions for this population. PMID:22532299
Vu, Bao Ngoc; Mulvey, Kevin P; Baldwin, Simon; Nguyen, Son Thanh
Knowledge about drug use and its association with HIV risk among men who have sex with men is limited. Although the HIV epidemic among this population in Vietnam is increasingly acknowledged, understanding the impact of drug use on the spread of HIV is largely lacking. Using qualitative data from in-depth interviews and focus group discussions with 93 drug users, 15 non-drug users and 9 community stakeholders, this analysis explores emerging patterns of drug use and risk factors for engaging in risk behaviours among drug-using men having sex with men, men selling sex and transgender individuals in Hanoi and Ho Chi Minh City. Findings revealed that drug use is shifting from heroin to ecstasy and ice. Drug users reported unsafe sex associated with drug use and men selling sex were particularly at elevated risk because of using drugs as a tool for sex work and trading sex for drugs. These findings are guiding development of programmes addressing unmet HIV-prevention needs in Vietnam.
Elías, María Jesús Pérez; Gómez-Ayerbe, Cristina; Elías, Pilar Pérez; Muriel, Alfonso; de Santiago, Alberto Diaz; Martinez-Colubi, María; Moreno, Ana; Santos, Cristina; Polo, Lidia; Barea, Rafa; Robledillo, Gema; Uranga, Almudena; Espín, Agustina Cano; Quereda, Carmen; Dronda, Fernando; Casado, Jose Luis; Moreno, Santiago
Abstract The aim of our study was to develop a Spanish-structured HIV risk of exposure and indicator conditions (RE&IC) questionnaire. People attending to an emergency room or to a primary clinical care center were offered to participate in a prospective, 1 arm, open label study, in which all enrolled patients filled out our developed questionnaire and were HIV tested. Questionnaire accuracy, feasibility, and reliability were evaluated. Valid paired 5329 HIV RE&IC questionnaire and rapid HIV tests were performed, 69.3% in the primary clinical care center, 49.6% women, median age 37 years old, 74.9% Spaniards, 20.1% Latin-Americans. Confirmed hidden HIV infection was detected in 4.1%, while HIV RE&IC questionnaire was positive in 51.2%. HIV RE&IC questionnaire sensitivity was 100% to predict HIV infection, with a 100% negative predictive value. When considered separately, RE or IC items sensitivity decreases to 86.4% or 91%, and similarly their negative predictive value to 99.9% for both of them. The majority of people studied, 90.8% self-completed HIV RE&IC questionnaire. Median time to complete was 3 minutes. Overall HIV RE&IC questionnaire test-retest Kappa agreement was 0.82 (almost perfect), likewise for IC items 0.89, while for RE items was lower 0.78 (substantial). A feasible and reliable Spanish HIV RE&IC self questionnaire accurately discriminated all non–HIV-infected people without missing any HIV diagnoses, in a low prevalence HIV infection area. The best accuracy and reliability were obtained when combining HIV RE&IC items. PMID:26844471
Elías, María Jesús Pérez; Gómez-Ayerbe, Cristina; Elías, Pilar Pérez; Muriel, Alfonso; de Santiago, Alberto Diaz; Martinez-Colubi, María; Moreno, Ana; Santos, Cristina; Polo, Lidia; Barea, Rafa; Robledillo, Gema; Uranga, Almudena; Espín, Agustina Cano; Quereda, Carmen; Dronda, Fernando; Casado, Jose Luis; Moreno, Santiago
The aim of our study was to develop a Spanish-structured HIV risk of exposure and indicator conditions (RE&IC) questionnaire. People attending to an emergency room or to a primary clinical care center were offered to participate in a prospective, 1 arm, open label study, in which all enrolled patients filled out our developed questionnaire and were HIV tested. Questionnaire accuracy, feasibility, and reliability were evaluated.Valid paired 5329 HIV RE&IC questionnaire and rapid HIV tests were performed, 69.3% in the primary clinical care center, 49.6% women, median age 37 years old, 74.9% Spaniards, 20.1% Latin-Americans. Confirmed hidden HIV infection was detected in 4.1%, while HIV RE&IC questionnaire was positive in 51.2%. HIV RE&IC questionnaire sensitivity was 100% to predict HIV infection, with a 100% negative predictive value. When considered separately, RE or IC items sensitivity decreases to 86.4% or 91%, and similarly their negative predictive value to 99.9% for both of them. The majority of people studied, 90.8% self-completed HIV RE&IC questionnaire. Median time to complete was 3 minutes. Overall HIV RE&IC questionnaire test-retest Kappa agreement was 0.82 (almost perfect), likewise for IC items 0.89, while for RE items was lower 0.78 (substantial).A feasible and reliable Spanish HIV RE&IC self questionnaire accurately discriminated all non-HIV-infected people without missing any HIV diagnoses, in a low prevalence HIV infection area. The best accuracy and reliability were obtained when combining HIV RE&IC items.
Pilowsky, Daniel J; Wu, Li-Tzy
Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50-59 years (24.3%; 95% confidence interval, 15.6-35.8) and declined with age, with a 17.1% prevalence among those aged 60-69 years (17.1%; 95% confidence interval, 7.3-34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.
Alcaide, Maria L; Rodriguez, Violeta J; Fischl, Margaret A; Jones, Deborah L; Weiss, Stephen M
Intravaginal practices (IVPs), include intravaginal cleansing (cleansing the inside of the vagina) or intravaginal insertion of products for hygiene, health or sexuality reasons. IVPs are associated with adverse female health outcomes, development of bacterial vaginosis, HIV acquisition and transmission. A mixed methods approach was used in this study to examine the prevalence of IVP, assess reasons for engagement, and perceptions of IVP among a sample of minority (African-American and Hispanic) women infected, or at-risk, for HIV in Miami, USA, a city with increasing numbers of sexually transmitted infections (STIs) and HIV. Three focus groups (total n=20) and quantitative assessments (n=72) were conducted with women infected or uninfected with HIV. In the qualitative assessments, most women reported engaging in both intravaginal cleansing and intravaginal insertion, and stated the main motivation for IVP was hygiene. The quantitative assessments confirmed that cleansing with water alone, soap with water or using commercial douches was common, as well as intravaginal insertion using a cloth or a rag in both HIV-infected and uninfected women. Women with HIV infection reported less use of water and water and soap for IVPs, and reported learning about the potential harm of IVP from their HIV health care providers. Despite their health risks, IVP appeared common in both HIV-infected and at-risk minority women, and interventions to decrease IVP could have important health implications among populations with high rates of IVP, STIs and HIV. PMID:28280394
Alcaide, Maria L; Rodriguez, Violeta J; Fischl, Margaret A; Jones, Deborah L; Weiss, Stephen M
Intravaginal practices (IVPs), include intravaginal cleansing (cleansing the inside of the vagina) or intravaginal insertion of products for hygiene, health or sexuality reasons. IVPs are associated with adverse female health outcomes, development of bacterial vaginosis, HIV acquisition and transmission. A mixed methods approach was used in this study to examine the prevalence of IVP, assess reasons for engagement, and perceptions of IVP among a sample of minority (African-American and Hispanic) women infected, or at-risk, for HIV in Miami, USA, a city with increasing numbers of sexually transmitted infections (STIs) and HIV. Three focus groups (total n=20) and quantitative assessments (n=72) were conducted with women infected or uninfected with HIV. In the qualitative assessments, most women reported engaging in both intravaginal cleansing and intravaginal insertion, and stated the main motivation for IVP was hygiene. The quantitative assessments confirmed that cleansing with water alone, soap with water or using commercial douches was common, as well as intravaginal insertion using a cloth or a rag in both HIV-infected and uninfected women. Women with HIV infection reported less use of water and water and soap for IVPs, and reported learning about the potential harm of IVP from their HIV health care providers. Despite their health risks, IVP appeared common in both HIV-infected and at-risk minority women, and interventions to decrease IVP could have important health implications among populations with high rates of IVP, STIs and HIV.
Ritchie, Adam J.; Kuldanek, Kristin; Moodie, Zoe; Wang, Z. Maggie; Fox, Julie; Nsubuga, Rebecca N.; Legg, Kenneth; Birabwa, Esther F.; Kaleebu, Pontiano; McMichael, Andrew J.; Watera, Christine; Goonetilleke, Nilu; Fidler, Sarah
Background The CHAVI002 study was designed to characterize immune responses, particularly HIV-specific T-cell responses, amongst 2 cohorts of HIV-exposed seronegative (HESN) individuals. The absence of a clear definition of HESNs has impaired comparison of research within and between such cohorts. This report describes two distinct HESN cohorts and attempts to quantify HIV exposure using a ‘HIV risk index’ (RI) model. Methods HIV serodiscordant couples (UK; 24, Uganda; 72) and HIV unexposed seronegative (HUSN) controls (UK; 14, Uganda; 26 couples, 3 individuals) completed sexual behavior questionnaires every 3 months over a 9 month period. The two cohorts were heterogeneous, with most HESNs in the UK men who have sex with men (MSM), while all HESNs in Uganda were in heterosexual relationships. Concordance of responses between partners was determined. Each participant’s sexual behavior score (SBS) was estimated based on the number and type of unprotected sex acts carried out in defined time periods. Independent HIV acquisition risk factors (partner plasma viral load, STIs, male circumcision, pregnancy) were integrated with the SBS, generating a RI for each HESN. Results 96 HIV serodiscordant couples completed 929 SBQs. SBSs remained relatively stable amongst the UK cohort, whilst decreasing from Visit 1 to 2 in the Ugandan cohort. Compared to the Ugandan cohort, SBSs and RIs in the UK cohort were lower at visit 1, and generally higher at later visits. Differences between the cohorts, with lower rates of ART use in Uganda and higher risk per-act sex in the UK, had major impacts on the SBSs and RIs of each cohort. There was one HIV transmission event in the UK cohort. Conclusions Employment of a risk quantification model facilitated quantification and comparison of HIV acquisition risk across two disparate HIV serodiscordant couple cohorts. PMID:22629447
Rothberg, Madeleine A.; Sandberg, Sonja; Awerbuch, Tamara E.
The AIDS epidemic is still growing rapidly and the disease is thought to be uniformly fatal. With no vaccine or cure in sight, education during high school years is a critical component in the prevention of AIDS. We propose the use of computer software with which high school students can explore via simulation their own risk of acquiring an HIV infection given certain sexual behaviors. This particular software is intended to help students understand the three factors that determine their risk of HIV infection (number of sexual acts, probability that their partners are infected, and riskiness of the specific sexual activities they choose). Users can explicitly calculate their own chances of becoming infected based on decisions they make. Use of the program is expected to personalize the risk of HIV infection and thus increase users' concern and awareness. Behavioral change may not result from increased knowledge alone. Therefore the effectiveness of this program in changing attitudes toward risky sexual behaviors would be enhanced when the simulation is embedded in an appropriate curriculum. A description of the program and an example of its use are presented.
Hayes, R B; Pottern, L M; Strickler, H; Rabkin, C; Pope, V; Swanson, G M; Greenberg, R S; Schoenberg, J B; Liff, J; Schwartz, A G; Hoover, R N; Fraumeni, J F
A population-based case-control study was carried out among 981 men (479 black, 502 white) with pathologically confirmed prostate cancer and 1315 controls (594 black, 721 white). In-person interviews elicited information on sexual behaviour and other potential risk factors for prostate cancer. Blood was drawn for serologic studies in a subset of the cases (n = 276) and controls (n = 295). Prostate cancer risk was increased among men who reported a history of gonorrhoea or syphilis (odds ratio (OR) = 1.6; 95% confidence internal (CI) 1.2–2.1) or showed serological evidence of syphilis (MHA-TP) (OR = 1.8; 95% CI 1.0–3.5). Patterns of risk for gonorrhoea and syphilis were similar for blacks (OR = 1.7; 95% CI 1.2–2.2) and whites (OR = 1.6; 95% CI 0.8–3.2). Risks increased with increasing occurrences of gonorrhoea, rising to OR = 3.3 (95% CI 1.4–7.8) among subjects with three or more events (Ptrend= 0.0005). Frequent sexual encounters with prostitutes and failure to use condoms were also associated with increased risk. Syphilis, gonorrhoea, sex with prostitutes and unprotected sexual intercourse may be indicators of contact with a sexually transmissible factor that increases the risk of prostate cancer. © 2000 Cancer Research Campaign PMID:10682688
Oppong Asante, Kwaku; Meyer-Weitz, Anna; Petersen, Inge
Background: Homeless youth, as a vulnerable population are susceptible to various mental and health risk behaviours. However, less is known of the mental health status of these homeless youth and its role in risky sexual behaviours; neither do we understand the reasons homeless youth give for their engagement in various health risk behaviour.…
Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill
Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.
Background Understanding people’s views about HIV transmission by investigating a specific population may help to design effective HIV prevention strategies. In addition, knowing the inherent sexual practices of such a population, as well as the risky circumstances that may facilitate HIV transmission, is crucial for the said strategies to become effective. In this article, we report how police officers in Dar es Salaam, Tanzania, perceived the problem of HIV and AIDS in their local context, particularly in relation to unsafe sexual practices. The study was done with the view to recommending ways by which HIV transmission could be minimised within the police force. Methods The study was conducted among members of the police force in Dar es Salaam, Tanzania. Eight focus group discussions (FGDs) were conducted, with a total of 66 participants who were mixed in terms of age, gender, and marital status. Some of these were caregivers to patients with AIDS. Data were analysed using the interpretive description approach. Results The participants believed that both individual sexual behaviour and work-related circumstances were sources of HIV infection. They also admitted that they were being tempted to engage in risky sexual practices because of the institutional rules that prohibit officers from getting married during their training and for three years after. Nevertheless, as members of the Police Force, they stressed the fact that the risky sexual behaviour that exposes them to HIV is not limited to the force; it is rather a common problem that is faced by the general population. However, they complained, the nature of their job exposes them to road accident victims, subjecting them further to possible infection, especially when they have to handle these road accident casualties without proper protective gear. Conclusion Individual sexual behaviour and job-related circumstances are worth investigating if proper advice is to be given to the police regarding HIV
Koenig, Julian; Brunner, Romuald; Fischer-Waldschmidt, Gloria; Parzer, Peter; Plener, Paul L; Park, JiYeon; Wasserman, Camilla; Carli, Vladimir; Hoven, Christina W; Sarchiapone, Marco; Wasserman, Danuta; Resch, Franz; Kaess, Michael
Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.
Nadel, J; Holloway, C J
HIV infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Increased risk of CAD in HIV-infected patients has been associated with the inflammatory sequelae of the infection as well as the greater prevalence of cardiac risk factors in HIV-positive populations and the side effects of life-prolonging antiretroviral therapies. Patients with HIV infection now have a 1.5 to 2-fold greater risk of developing CAD compared with noninfected individuals, raising the independent risk of CAD in HIV infection to levels similar to those in diabetes. Despite this increased risk, screening and other adjuvant assessment tools are lacking. In this paper we explore the current climate of CAD in the contemporary HIV-infected population and look at the tools used in the assessment and management of patients as well as the limitations of these approaches for this at-risk population group.
Vaccher, S; Grulich, A; McAllister, J; Templeton, D J; Bloch, M; McNulty, A; Holden, J; Poynten, I M; Prestage, G; Zablotska, I
Introduction Despite a number of HIV prevention strategies, the number of new HIV infections remains high. In Australia, over three-quarters of new HIV diagnoses are in gay and bisexual men (GBM). Pre-exposure prophylaxis (PrEP) has been shown to be effective at preventing new HIV infections in several randomised trials. The PRELUDE study aims to evaluate the implementation of PrEP in healthcare settings in New South Wales (NSW), Australia, among a sample of high-risk adults. Methods and analysis PRELUDE is an ongoing open-label, single-arm demonstration project, conducted in public and private clinics across NSW, Australia. Enrolment began in November 2014. The study is designed for 300 high-risk participants—mainly GBM and heterosexual women. Participants receive daily oral PrEP, composed of emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF), for up to 2.5 years. Quarterly study visits include testing for HIV and sexually transmitted infections (STIs), assessment of ongoing eligibility and side effects, and self-reported adherence. Following each study visit, online behavioural surveys are administered to collect information on medication adherence, risk behaviours and attitudes. Blood samples will be collected in a subset of patients 1, 6 and 12 months after PrEP initiation to measure FTC/TDF concentrations. Analyses using longitudinal regression models will focus on feasibility, adherence, safety, tolerability and effects of PrEP on behaviour. This study will inform PrEP policy and guide the implementation of PrEP in Australia in people at high risk of HIV. Ethics and dissemination The study will be conducted in accordance with the Declaration of Helsinki. All patients will provide written informed consent prior to participation in the study. Publications relating to each of the primary end points will be gradually released after 12 months of follow-up is complete. Trial registration number NCT02206555; Pre-results. PMID:27324719
McFarland, Willi; Wilson, Erin C; Raymond, Henry F
We surveyed 122 trans men using a hybrid sampling method that included randomly selected physical and online venues and peer referral to measure HIV prevalence and risk behaviors. HIV prevalence was 0% (one-sided 97.5% confidence interval 0-3.3%). Of 366 partnerships described, 44.8% were with cisgender women, 23.8% with cisgender men, 20.8% with trans men, and 10.7% with trans women. Condomless receptive anal and front hole/vaginal sex averaged one to three episodes per six months. HIV prevalence in trans men is likely closer to heterosexual cisgender men and women in San Francisco than trans women or MSM. Prevention prioritizing trans women and MSM, coupled with individualized and relevant sexual health education for trans men with partners from these populations, may best address the HIV prevention needs of trans men. Systematic collection of transgender status in Census and health data is needed to understand other health disparities among trans men.
Vioque, J.; Hernandez-Aguado, I.; Fernandez, G; d Garcia; Alvarez-Dardet, C.
OBJECTIVE: To measure the incidence of HIV infection over a 10 year follow up in a cohort of female commercial sex workers in Alicante (Spain), and to determine factors associated with high risk of infection. METHODS: A prospective cohort study was carried in an AIDS information and prevention centre in Alicante, Spain. Of the 1388 female sex workers who initially sought the services of the centre since September 1986, 657 completed at least one additional follow up visit before December 1996. Main outcome measures were infection with HIV-1 and reported risk behaviours. RESULTS: During 1815 person years of observation among 657 female sex workers who were free of HIV infection (negative test), 16 women developed of HIV infection (incidence rate of HIV infection = 8.8 cases/1000 woman years, 95% confidence interval (CI): 5.4-14.4). Reported current use of injecting drugs at the first visit was associated with an increased risk of HIV infection (relative risk, RR = 12.87, 95% CI: 4.81-34.15) as well as having an usual partner with injecting drug addiction (RR = 20.89, 95% CI: 7.44-58.70). Infection also was associated with younger age (RR for 1 year = 0.86, 95% CI: 0.76-0.96). After multivariate adjustment using Poisson regression analysis, the factors that remained significantly associated with the risk of HIV infection were current use of injecting drugs (RR = 4.61, 95% CI: 1.37-15.46), and having a usual partner with injecting drug addiction (RR = 10.08, 95% CI: 2.94-34.57). There was also some evidence that a younger age could be related to infection. CONCLUSION: These data suggest that the risk of HIV infection among this cohort of female sex workers in Alicante is predominately associated with the use of injecting drugs, and having a regular partner with injecting drug addiction. An increasing number of clients did not play a role in the risk of infection. PMID:9924471
Peltzer, Karl; Tabane, Cily; Matseke, Gladys; Simbayi, Leickness
Objective: To evaluate the feasibility, fidelity, and effect of a human immunodeficiency virus (HIV) risk reduction intervention delivered to HIV-infected patients by lay counsellors during routine HIV counselling and testing (HCT) public service in Mpumalanga, South Africa. Methods: A total of 488 HIV-infected patients, aged 18 years and older,…
Sagrestano, Lynda M.; Heiss-Wendt, Renate M.; Mizan, Ainon N.; Kittleson, Mark J.; Sarvela, Paul D.
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…
Earl, Allison; Albarracin, Dolores; Durantini, Marta R.; Gunnoe, Joann B.; Leeper, Josh; Levitt, Justin H.
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,…
Cederbaum, Julie A.
Mother-daughter communication plays an influential role in adolescent development. The impact of maternal HIV infection on family communication is not clear. This study explores how living with HIV impacts sexual risk communication between mothers and daughters and whether maternal HIV status influences adolescent choices about engagement in HIV…
Cole, Jennifer; Logan, TK; Shannon, Lisa
Previous research indicates that many individuals who perceive themselves to be at no risk of HIV have recently engaged in risky sexual behaviors (Klein et al., 2003; Schroder et al., 2001). Because HIV risk has been associated with partner violence (Maman et al., 2000), it is important to examine self-perceived risk and actual sexual risk…
Prado, Guillermo; Huang, Shi; Maldonado-Molina, Mildred; Bandiera, Frank; Schwartz, Seth J.; de la Vega, Pura; Brown, C. Hendricks; Pantin, Hilda
Ecodevelopmental theory is a theoretical framework used to explain the interplay among risk and protective processes associated with HIV risk behaviors among adolescents. Although ecodevelopmentally based interventions have been found to be efficacious in preventing HIV risk behaviors among Hispanic youth, this theory has not yet been directly…
Munakata, T; Tajima, K
This study is to identify the risk behaviors of the Japanese that may lead to HIV infection and the behaviors that prevent such infection, as well as their background factors. Two behavioral surveys were conducted for the present study. (1) For international comparison on knowledge, attitudes, beliefs, and practices (KABP) related to HIV/AIDS, we conducted a survey on a sample of 10,000 adults, randomly selected from a nationwide population in Japan; and (2) for sexual partner relation, we conducted a survey on a sample of 10,000 adults randomly selected from a population in five major cities of Japan. Our main findings include: (1) Most of the Japanese adult did not regard AIDS as a major threat in the area where they lived; (2) People in their twenties are too casual about "having sex without using a condom with someone they've met for the first time and know little about"; (3) Thirteen percent (19% male, 8% female) of those with a steady sex partner including a spouse, on average, had sex with 2.4 non-steady partners in the previous year; and (4) Only 25 percent used condoms always when they engaged in casual sex during the previous four weeks. These risk behaviors of the Japanese adults might lead to an explosive rise in the number of HIV-infected in the near future unless steps are taken immediately to prevent it.
Muchomba, Felix M; Wang, Julia Shu-Huah; Agosta, Laura Maria
Theory predicts that land ownership empowers women to avoid HIV acquisition by reducing their reliance on risky survival sex and enhancing their ability to negotiate safer sex. However, this prediction has not been tested empirically. Using a sample of 5511 women working in the agricultural sector from the 1998, 2003 and 2008-09 Kenya Demographic and Health Surveys, we examined the relationship between women's land ownership and participation in transactional sex, multiple sexual partnerships and unprotected sex, and HIV infection status. We controlled for demographic characteristics and household wealth, using negative binomial and logistic regression models. Women's land ownership was associated with fewer sexual partners in the past year (incidence rate ratio, 0.98; 95% confidence interval [CI], 0.95-1.00) and lower likelihood of engaging in transactional sex (odds ratio [OR], 0.67; 95% CI: 0.46-0.99), indicators of reduced survival sex, but was not associated with unprotected sex with casual partners (OR, 0.64; 95% CI, 0.35-1.18) or with unprotected sex with any partner among women with high self-perceived HIV risk (OR, 1.02; 95% CI, 0.57-1.84), indicating no difference in safer sex negotiation. Land ownership was also associated with reduced HIV infection among women most likely to engage in survival sex, i.e., women not under the household headship of a husband (OR, 0.40; 95% CI, 0.18-0.89), but not among women living in husband-headed households, for whom increased negotiation for safer sex would be more relevant (OR, 1.74; 95% CI, 0.92-3.29). These findings suggest that reinforcing women's land rights may reduce reliance on survival sex and serve as a viable structural approach to HIV prevention, particularly for women not in a husband's household, including unmarried women and female household heads.
Smith, Rachel A; Morrison, Daniel
People often perceive risks for others and themselves differently. This study examines whether personal beliefs about HIV and experience with those living with HIV influence personal risk assessments of contracting HIV in an interview sample of northern Namibians (N=400), but not others' assessments as explained by singular-distribution theory [Klar, Medding, & Sarel (1996). Nonunique invulnerability: Singular versus distributional probabilities and unrealistic optimism in comparative risk judgments. Organizational Behavior and Human Decision Processes, 67, 229-245]. Findings indicate that personal risk perceptions decrease with more HIV stigmatizing beliefs and increase with greater experience, but that those characteristics had no impact on assessments for others' risk. The study also examines whether the size and characteristics of the referent group, peers and the general Namibian population, influence others' risk assessments. Optimistic biases for personal risk versus others' risk appear with the highest discrepancy emerging between personal and general population risk assessments. Further, we found that personal risk perceptions did not mediate the relationship between personal characteristics, beliefs and experiences, and intentions to seek HIV testing.
Onorato, I M; O'Brien, T R; Schable, C A; Spruill, C; Holmberg, S D
OBJECTIVES. We conducted sentinel surveillance in persons practicing behaviors known to transmit retroviruses to determine the US presence and extent of human immunodeficiency virus type 2 (HIV-2). METHODS. Sentinel surveillance for HIV-2 was conducted by testing 31,533 anonymous blood specimens from patients at sexually transmitted disease clinics, injecting drug users at treatment centers, and clients at HIV counseling and testing sites in 14 US cities where West African immigrants often settle. Specimens were tested by HIV-1 and HIV-2 whole virus and synthetic peptide enzyme immunoassay and confirmed by HIV-1 and HIV-2 Western blots. RESULTS. Nearly 10% of 31,533 sera were positive for HIV-1. Two heterosexual Black male sexually transmitted disease patients were infected with HIV-2. One of the HIV-2 positive specimens did not cross-react on HIV-1 enzyme immunoassay screening. One client had antibodies consistent with malarial infection in West Africa; the other, who had syphilis, did not have antibodies to malaria or to any of 20 arboviruses present in Africa. CONCLUSIONS. Clinics serving clients from HIV-2 endemic areas should test persons practicing risk behaviors for both HIV-1 and HIV-2. Sentinel surveillance for HIV-2 serves as an early warning system for the possible spread of this virus in the United States. PMID:8460726
Background There is limited understanding of the factors that influence decisions to seek HIV care and treatment services in community settings. The aim of this study was to explore the socio-cultural and health system factors affecting health-seeking behaviour among deceased women in Kenya who were living with HIV at the time of death. Methods Out of a total of 796 deaths for which a caregiver was available to provide information, retrospective data were drawn from verbal and social autopsies administered to caregivers of 218 women who had died of AIDS-related illnesses aged 15 to 49 years. Information was collected on essential elements of the care-seeking process from the onset of severe illness episodes and analysed using qualitative and quantitative techniques. Results Results from the quantitative data showed that poor women were less likely to access formal health services (OR = 0.2; p < 0.001) compared to non-poor women. The qualitative data showed that socioeconomic status, poor knowledge and understanding of AIDS-related illness, distance to facility and transportation costs, medical pluralism, stigma, low HIV risk perception, lack of family support and health care system barriers contributed to delays/constraints in seeking care. Conclusions The findings highlight important issues that have implications for addressing challenges faced by women living with HIV, including non-adherence to treatment regimen and late diagnosis of HIV. Provision of transportation subsidies as part of the national social safety-net strategy can help in addressing financial constraints associated with transportation costs among poor women living with HIV. PMID:24968717
van Oers, Kees; Drent, Piet J.; de Goede, Piet; van Noordwijk, Arie J.
Personalities are general properties of humans and other animals. Different personality traits are phenotypically correlated, and heritabilities of personality traits have been reported in humans and various animals. In great tits, consistent heritable differences have been found in relation to exploration, which is correlated with various other personality traits. In this paper, we investigate whether or not risk-taking behaviour is part of these avian personalities. We found that (i) risk-taking behaviour is repeatable and correlated with exploratory behaviour in wild-caught hand-reared birds, (ii) in a bi-directional selection experiment on 'fast' and 'slow' early exploratory behaviour, bird lines tend to differ in risk-taking behaviour, and (iii) within-nest variation of risk-taking behaviour is smaller than between-nest variation. To show that risk-taking behaviour has a genetic component in a natural bird population, we bred great tits in the laboratory and artificially selected 'high' and 'low' risk-taking behaviour for two generations. Here, we report a realized heritability of 19.3 +/- 3.3% (s.e.m.) for risk-taking behaviour. With these results we show in several ways that risk-taking behaviour is linked to exploratory behaviour, and we therefore have evidence for the existence of avian personalities. Moreover, we prove that there is heritable variation in more than one correlated personality trait in a natural population, which demonstrates the potential for correlated evolution. PMID:15002773
Rose, Carol Dawson; Courtenay-Quirk, Cari; Knight, Kelly; Shade, Starley B; Vittinghoff, Eric; Gomez, Cynthia; Lum, Paula J; Bacon, Oliver; Colfax, Grant
Clinician-delivered prevention interventions offer an opportunity to integrate risk-reduction counseling as a routine part of medical care. The HIV Intervention for Providers study, a randomized controlled trial, developed and tested a medical provider HIV prevention training intervention in 4 northern California HIV care clinics. Providers were assigned to either the intervention or control condition (usual care). The intervention arm received a 4-hour training on assessing sexual risk behavior with HIV-positive patients and delivering risk-reduction-oriented prevention messages to patients who reported risk behaviors with HIV-uninfected or unknown-status partners. To compare the efficacy of the intervention versus control on transmission risk behavior, 386 patients of the randomized providers were enrolled. Over six-months of follow-up, patients whose providers were assigned the intervention reported a relative increase in provider-patient discussions of safer sex (OR = 1.49; 95% CI = 1.06 to 2.09), assessment of sexual activity (OR = 1.60; 95% CI = 1.05 to 2.45), and a significant decrease in the number of sexual partners (OR = 0.49, 95% CI = 0.26 to 0.92). These findings show that a brief intervention to train HIV providers to identify risk and provide a prevention message results in increased prevention conversations and significantly reduced the mean number of sexual partners reported by HIV-positive patients.
Lucea, Marguerite B; Hindin, Michelle J; Kub, Joan; Campbell, Jacquelyn C
A person's ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15-31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women.
Afolabi, Olukayode Ayooluwa; Adesina, Ayobami Adekunle
The study observed the influence of neuroticism, agreeableness, extraversion and HIV awareness on risky sexual behaviour of Nigerian undergraduates. Two hundred (215) undergraduates in the Faculties of Engineering and Social sciences, Ambrose Alli University, Ekpoma, Nigeria, took part in the research. They consisted of 135 (62.7%) males and 80…
Oyefara, John Lekan
This article examines the sexual behaviour and the HIV/AIDS knowledge and vulnerability of female street hawkers in Lagos metropolis, Nigeria. A total of 126 female street hawkers under 18 were sampled in a cross-sectional survey and six Focus Group Discussions (FGDs) were conducted to generate data from respondents. Data on sexual behaviour…
Alarid, Leanne Fiftal; Hahl, Jeannie M
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.
Stewart, Jennifer M.; Rogers, Christopher K.; Bellinger, Dawn; Thompson, Keitra
HIV/AIDS has a devastating impact on African Americans (AA), particularly women and young adults. We sought to characterize risks, barriers, content and delivery needs for a faith-based intervention to reduce HIV risk among AA women ages 18–25. In a convergent parallel mixed methods study we conducted four focus groups (n=38) and surveyed 71 young adult women. Data were collected across 4 AA churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting and financial burdens into faith-based HIV risk reduction interventions (RRIs). Incorporating additional social context related factors into HIV RRIs for young AA women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings. PMID:26879828
Birdthistle, Isolde; Floyd, Sian; Nyagadza, Auxillia; Mudziwapasi, Netsai; Gregson, Simon; Glynn, Judith R
As the population of orphans grows in AIDS-affected settings, recent studies describe a heightened risk of HIV and sexual risk behaviours among adolescent orphans compared to their non-orphaned peers. This study explores the role of education in explaining the excess sexual risk previously documented among unmarried female orphans in urban Zimbabwe. School attendance and attainment were assessed by type of orphanhood, and for their association with markers of sexual risk (HIV and/or HSV-2 infection) among 743 participants drawn from a random sample of 15-19-year-old girls identified in a cross-sectional survey in Highfield, Harare, in 2004. Multivariable logistic regression was used to assess the role of educational status in explaining the higher prevalence of adverse sexual outcomes among unmarried orphans compared to non-orphans, adjusting for possible confounders. Double orphans had significantly lower educational attendance and attainment than non-orphans. Maternal orphans had higher odds of school drop-out, although this association disappeared when adjusted for recent mobility. Educational status was strongly associated with HIV/HSV-2 risk, but explained only a small part of double orphans' sexual risk and did not explain the HIV/HSV-2 risk of maternal and paternal orphans. High overall levels of secondary school participation and school fee assistance provided to vulnerable families may have reduced the schooling disparities between orphans and non-orphans in Highfield. However, further efforts are needed to rectify the schooling inequities that persist, while additional research is needed to identify other socio-economic and emotional factors driving orphans' sexual risk so that prevention and support programmes can meet the needs of this growing population.
Favot, I; Ngalula, J; Mgalla, Z; Klokke, A H; Gumodoka, B; Boerma, J T
Infertility is common in Africa. Anthropological studies conducted on the continent have found infertile women to have higher risks of marital instability and possibly more sex partners than fertile women. Findings are reported from a study conducted during 1994 and 1995 in a hospital in northwest Tanzania to determine the prevalence of HIV infection among infertile women. Women presenting with infertility problems to the outpatient clinic were interviewed, examined, and blood was drawn. Women who came to deliver in the hospital, excluding primiparae, comprised the control group. A total of 154 infertile and 259 fertile women were included in the study, all age 24 years and older. 18.2% of infertile women and 6.6% of fertile women were infected with HIV. Data on past sex behavior indicated that infertile women had more marital breakdowns, more lifetime sex partners, and a higher level of exposure to sexually transmitted diseases.
Shedlin, Michele G.; Decena, Carlos Ulises; Oliver-Velez, Denise
PURPOSE: Research on the initial stage of acculturation of new immigrants is crucial for identifying AIDS prevention policies and priorities for this vulnerable population. METHODS: This study employed an exploratory approach and qualitative data collection methods to identify and describe social and behavioral factors influencing risk for HIV infection among recent Hispanic immigrants (<3 years in the United States). Immigrants from Guatemala, El Salvador, Honduras, the Dominican Republic and Mexico were interviewed in urban, suburban and semirural settings in the New York Metropolitan Area. Data were collected through ethnographic fieldwork, in-depth interviews (N=51), focus groups (N=11; total number of participants=86) and individual interviews with health and social service providers (N=26). RESULTS: Initial stages of acculturation for immigrants reflect both retention and change in attitudes and behaviors involving their mental health, gender role norms, social and sexual behavior, and alcohol and other drug use. Current living environments may introduce conditions affecting HIV risk and prevention, while sustained connections to countries of origin may support retention of attitudes and behaviors with positive and negative risk implications. CONCLUSIONS: Specific epidemiological, environmental, economic, social and psychosocial factors are identified that provide the context for risk and prevention. The challenges and opportunities faced by these new communities must be distinguished from those of more acculturated immigrant populations if culturally appropriate interventions are to be developed. PMID:16080455
Rana, Manu S; Nepali, Bobin; Sathian, Brijesh; Aryal, Ram Prasad; Thapalia, Madav; Bhatta, Dharm R.
Background: The clients of Female Sex Workers (FSWs) have been represented from different socio-demographic backgrounds and their risk behaviour depends upon their learning skills and attitudes and its impacts on practice. Objective: The general objective of this study was to find the socio-demographic characteristics, background, knowledge, behaviour, and the attitude on STIs, HIV and AIDS of the clients of female sex workers. Material and Methods: This questionnaire based, cross sectional study was conducted on 109 clients of FSWs during the time period from January 2010 to July 2010 in Pokhara (submetropolitan city of the Kaski district), Nepal. The locations were the Baglung Bus Park, Lakeside and Mahendrapool. Result: Among the 109 respondents, the mininum and the maximum age were 18 and 50 years. According to the religion-wise distribution, 77.1% of the respondents were Hindus, 10.1% were Buddhists, 8.3% were Christians, 1% were Muslims and 3.7% were from other religions. 67.9% of the respondents were tested for HIV at least once, whereas nearly one third (32.1%) of the respondents were never tested for HIV. 49.5% of the respondents answered that there was no difference between HIV and AIDS. Among the respondents, 89.9% respondents knew how to be safe from STIs and the HIV infections and 99.1% knew about HIV and AIDS. Conclusion: HIV and AIDS is a cross cutting issue in the present situation rather than a health issue. One of the most at risk groups is the clients of female workers who frequently have risk behaviours like having sex with female sex workers. The sexual behaviour among these clients depends upon their attitude, knowledge and perception, which also influence several internal and external factors. In our study, the clients of the female sex workers had some extent of knowledge about the condom, sexually transmitted infections and HIV/AIDS. They were made aware on these by different organizations who were working in the field of HIV and AIDS, but
Boone, Melissa R; Cherenack, Emily M; Wilson, Patrick A
Little is known about the correlates of sexual risk behavior among HIV-positive adolescent girls and women in the United States. This study investigates two potential factors related to unprotected vaginal and anal intercourse (UVAI) that have yet to be thoroughly studied in this group: self-efficacy for sexual risk reduction and partner HIV status. Data was analyzed from 331 HIV-positive adolescent girls and women between 12 and 24 years old who reported vaginal and/or anal intercourse with a male partner in the past 3 months at fifteen sites across the United States. Results show that overall self-efficacy (B=-0.15, p=0.01), self-efficacy to discuss safe sex with one's partner (B=-0.14, p=0.01), and self-efficacy to refuse unsafe sex (B=-0.21, p=0.01) are related to UVAI episodes. Participants with only HIV-positive partners or with both HIV-positive and HIV-negative partners showed a trend towards higher percentages of UVAI episodes compared to participants with only HIV-negative partners (F(2, 319)=2.80, p=0.06). These findings point to the importance of including self-efficacy and partner HIV status in risk-reduction research and interventions developed for HIV-positive adolescent girls and young women.
O'Donnell, Karen J.; Fair, Cynthia D.
This report describes the activities and outcomes of Project RISK, a 3+2 years service delivery demonstration and replication project that was based on the assumption that infants of HIV positive women are at significant developmental risk from prenatal exposure to HIV infection and, possibly, teratogenic drugs, as well as from the complex…
Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer
The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.
The work on this thesis began in 2003 when the global HIV epidemic was out of control. A minority of persons with HIV were benefitting fully from the recently introduced highly efficacious antiretroviral therapy (ART) combinations. Among the global challenges were lack of access to good healthcare, drug toxicity, and emergence of drug-resistant virus. It was unknown how long the drugs could maintain their efficacy in the individual even if administered as intended, and there was a fear that the increased drug pressure would increase the prevalence of drug resistance, subsequently leading to transmission of resistant virus from one individual to another, and thereby waning the treatment options available. Hence, we were far from the ideal conditions where an HIV-infected individual gets to know immediately that he/she is infected, has access to specialized medical and social support, receives a drug combination which effectively suppresses the virus and has no side effects, and is free of co-morbid conditions both before and after he/she gets infected. The nine papers on which this thesis is based each aimed to provide new knowledge to aspects of the above. Late diagnosis and late presentation to clinical care continue to be major barriers to improved HIV management. We used nation-wide hospital registries to explore the potential for an indicator disease-based HIV testing strategy. A range of conditions that were manifestations of the HIV infection itself were found to be associated with highly increased risk of HIV diagnosis during the coming year, but less so three to five years later. Other conditions were associated with an almost constant five-year long increased risk of being diagnosed with HIV because they share behavioural risk factors with HIV, making them indicators of not only current HIV but also of future HIV acquisition. Hence, indicator condition-based testing should be adapted to the local epidemic and could be a valuable addition to the existing
Nguyen, Huyen; Nguyen, Hoang Quan; Colby, Donn Joseph
Rapid economic and social development in Vietnam has resulted in increased opportunities for travel and new potential routes of HIV transmission. We conducted a cross-sectional study examining demographics, knowledge, and sexual risk behaviour amongst 100 Vietnamese men who have sex with men who traveled abroad in the previous 12 months. Men who have sex with men surveyed were mostly university-educated, single, and under 30. Most travel (73%) was within Southeast Asia and was undertaken for tourism (51%) or for work (29%). Casual sex with a foreign partner occurred on 39% of trips. Only four were reported to have involved in unsafe sex with a casual partner. Four reported illicit drug use. Alcohol was widely consumed. Multivariate analysis showed that two variables, travelling alone (OR = 5.26,p < 0.001) and a university education (OR = 4.05,p = 0.004), were significantly associated with casual sex abroad. More HIV prevention education on the risks of sex while travelling abroad is needed for men who have sex with men in Vietnam.
Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above
Muessig, Kathryn E.; Baltierra, Nina B.; Pike, Emily C.; LeGrand, Sara; Hightow-Weidman, Lisa B.
Young, Black men who have sex with men and transgender women who have sex with men (YBMSM/TW) are at disproportionate risk for HIV and other sexually transmitted infections (HIV/STI). HealthMpowerment.org (HMP) is a mobile phone optimised online intervention that utilises behaviour change and gaming theories to reduce risky sexual behaviours and build community among HIV-positive and negative YBMSM/TW. The intervention is user-driven, provides social support, and utilises a point reward system. A four-week pilot trial was conducted with a diverse group of 15 YBMSM/TW. During exit interviews, participants described how HMP components led to behaviour changes such as asking partners' sexual history, increased condom use, and HIV/STI testing. The user-driven structure, interactivity, and rewards appeared to facilitate sustained user engagement and the mobile platform provided relevant information in real-time. Participants described the reward elements of exceeding their previous scores and earning points toward prizes as highly motivating. HMP showed promise for being able to deliver a sufficient intervention dose and we found a trend toward higher dose received and more advanced stages of behaviour change. In this pilot trial, HMP was well accepted and demonstrates promise for translating virtual intervention engagement into actual behaviour change to reduce HIV risk behaviours. PMID:25593616
Nideröst, Sibylle; Gredig, Daniel; Roulin, Christophe; Rickenbach, Martin
This prospective study applies an extended Information-Motivation-Behavioural Skills (IMB) model to establish predictors of HIV-protection behaviour among HIV-positive men who have sex with men (MSM) during sex with casual partners. Data have been collected from anonymous, self-administered questionnaires and analysed by using descriptive and backward elimination regression analyses. In a sample of 165 HIV-positive MSM, 82 participants between the ages of 23 and 78 (M=46.4, SD=9.0) had sex with casual partners during the three-month period under investigation. About 62% (n=51) have always used a condom when having sex with casual partners. From the original IMB model, only subjective norm predicted condom use. More important predictors that increased condom use were low consumption of psychotropics, high satisfaction with sexuality, numerous changes in sexual behaviour after diagnosis, low social support from friends, alcohol use before sex and habitualised condom use with casual partner(s). The explanatory power of the calculated regression model was 49% (p<0.001). The study reveals the importance of personal and social resources and of routines for condom use, and provides information for the research-based conceptualisation of prevention offers addressing especially people living with HIV ("positive prevention").
Guillard, A; Tirtaine, C; Ouzan, D; Follana, R
From December 1988 to September 1989, 973 blood donors, deferred for anti-HBc reactivity, Ag-HBs positivity, elevated ALT, isolated or associated, but negative for anti-HIV, were interviewed in our blood center in the weeks after donation. Among these 973 donors, 53 (5.4%, 46 males, 7 females) were found at risk for HIV infection: intravenous drug abuse: 24 cases; heterosexuality with multiple partners: 17 cases; homosexuality: 8 cases; sexual relations with persons at risk: 4 cases. These 53 donors did not recognize their risk behaviour during the medical talk before donation. 25 out of these 53 donors were seen afterwards and one of them, homosexual man, seroconverted for anti-HIV seven months after the anti HIV negative but anti-HBc positive blood donation. We conclude that, in our experience, director surrogate viral hepatitis markers help to identify donors at risk for HIV infection, and, in one case, earlier in the course of demonstrated HIV infection than the enzyme immunoassays currently licensed.
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
Paxton, Keisha C.; Williams, John K.; Bolden, Sherica; Guzman, Yesenia; Harawa, Nina T.
Background HIV continues to impact African American women at alarming rates. Yet, few researchers have examined the relationship factors promoting unprotected sex within African American communities, especially instances in which women are aware that their male partners are engaging in high risk behaviors. This qualitative study explored the sexual behaviors, relationship characteristics, and HIV prevention strategies utilized by African American women in relationships with African American men at-risk for HIV. Method To understand the issues that should be addressed in a sexual risk-reduction intervention, data were collected from three, two-hour focus group discussions (n=24) comprised primarily of low-income African American women with histories of at-risk male sex partners. At-risk partners included specifically men who had sex with other men or with transgender individuals, used crack cocaine or injection drugs, had lengthy incarceration periods, or an unknown sexual history. Discussion questions examined external factors affecting sexual risk behaviors such as societal pressures, peer norms, and financial vulnerability. Discussions were audiotaped, transcribed, and analyzed using a consensual qualitative research approach. Results Five themes, including self-esteem, social influences on behavior, relationship fidelity, sexual risk behavior, and partners' sexual behaviors, were identified as placing women at increased risk for HIV. Reasons for inconsistent condom use included concern for maintaining the relationship and substance use before and during sex. African American women also believed that men who have sex with men and women (MSMW) were dishonest about their sexuality due to stigma towards homosexuality/bisexuality. Despite these challenges, participants indicated that African American women have a strong sense of pride that can positively impact behaviors in relationships. Conclusion The findings of this study support that social and contextual factor
Weine, Stevan M.; Kashuba, Adrianna B.
To inform the development of multilevel strategies for addressing HIV risk among labor migrants, 97 articles from the health and social science literatures were systematically reviewed. The study locations were Africa (23 %), the Americas (26 %), Europe (7 %), South East Asia (21 %), and Western Pacific (24 %). Among the studies meeting inclusion criteria, HIV risk was associated with multilevel determinants at the levels of policy, sociocultural context, health and mental health, and sexual practices. The policy determinants most often associated with HIV risk were: prolonged and/or frequent absence, financial status, and difficult working and housing conditions. The sociocultural context determinants most often associated with HIV risk were: cultural norms, family separation, and low social support. The health and mental health factors most often associated with HIV risk were: substance use, other STIs, mental health problems, no HIV testing, and needle use. The sexual practices most often associated with increased HIV risk were: limited condom use, multiple partnering, clients of sex workers, low HIV knowledge, and low perceived HIV risk. Magnitude of effects through multivariate statistics were demonstrated more for health and mental health and sexual practices, than for policy or sociocultural context. The consistency of these findings across multiple diverse global labor migration sites underlines the need for multilevel intervention strategies. However, to better inform the development, implementation, and evaluation of multilevel interventions, additional research is needed that overcomes prior methodological limitations and focuses on building new contextually tailored interventions and policies. PMID:22481273
Cristian Rangel, J; Adam, Barry D
Drawing on the sociology of morality, this article analyses the social contexts, discourses and ethno-methods of everyday life that shape real-world decisions of gay men around HIV prevention. Through an analysis of the predominant narratives in an online public forum created for an HIV prevention campaign, this article explores the ways in which homosexually active men engage in everyday moral reasoning and challenge a neoliberal moral order of risk and responsibility. The article concludes that gay and bisexual men engage in forms of practical morality with their sexual partners and imagine larger communities of interest, love, companionship and pleasure. At the same time, they draw heavily from discourses on individual and rational responsibility, as well as narratives of romance and community, that shape forms of moral selfhood. Risk management techniques that are grounded in notions of rational choice and that are insensitive to the emotional worlds that these men inhabit create situations of risk avoidance but also inadvertently open them to new forms of vulnerability.
Alary, M; Castel, J
The surveillance of AIDS (acquired immune deficiency syndrome) through case reporting only reflects the epidemiologic features of HIV (human immunodeficiency virus) transmission a few years earlier and not the prevalence of HIV seropositivity. HIV infection is not a notifiable condition in Quebec. We were asked by the ministère de la Santé et des Services sociaux du Québec to perform a pilot project for the surveillance of HIV seropositivity using a network of sentinel physicians. From May 15, 1988, to Sept. 30, 1989, physicians from four collaborating centres collected data on the serologic status, demographic characteristics and risk factors for 4209 patients who underwent HIV antibody testing. Of the 3899 subjects included in the study 7.9% were HIV positive. Through logistic regression analysis the following variables were found to be significantly associated with HIV seropositivity: presence of HIV-related symptoms (prevalence odds ratio [POR] 36.5), origin from an endemic area (POR 9.1), homosexuality or bisexuality (POR 8.4), intravenous drug use (POR 4.2), male sex (POR 2.8), previous HIV antibody testing (POR 2.5) and previous sexually transmitted disease (POR 1.8). Over the study period we found a large increase in HIV seroprevalence among intravenous drug users (4.2% in 1988 to 19.0% in 1989) (p = 0.02). This increase might reflect a recent change in the epidemiologic pattern of HIV transmission in Quebec. Surveillance of HIV seropositivity through a network of sentinel physicians may be a reasonable alternative to mandatory reporting. PMID:2357678
Platt, Lucy; Jolley, Emma; Rhodes, Tim; Hope, Vivian; Latypov, Alisher; Reynolds, Lucy; Wilson, David
Objectives We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual-level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs. Design A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005. ‘Best’ estimates of HIV prevalence were calculated from the systematic review to provide national level estimates of HIV. Associations between HIV prevalence and selected structural-level indicators were assessed using linear regression models. Studies reviewed Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs. Results HIV in Europe remains low among FSWs who do not inject drugs (<1%), but STIs are high, particularly syphilis in the East and gonorrhoea. FSWs experience high levels of violence and structural risk factors associated with HIV, including lack of access to services and working on the street. Linear regression models showed HIV among FSWs to link with injecting drug use and imprisonment. Conclusions Findings show that HIV prevention interventions should be nested inside strategies that address the social welfare of sex workers, highlighting in turn the need to target the social determinants of health and inequality, including regarding access to services, experience of violence and migration. Future epidemiological and intervention studies of HIV among vulnerable populations need to better
Woody, George E; Krupitsky, Evgeny; Zvartau, Edwin
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
Weiss, Helen A.; Vandepitte, Judith; Bukenya, Justine N.; Mayanja, Yunia; Nakubulwa, Susan; Kamali, Anatoli; Seeley, Janet; Grosskurth, Heiner
The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa. PMID:26805868
Valera, Pamela; Chang, Yvonne; Lian, Zi
HIV prevalence in correctional populations is approximately five times that of the general adult population. This systematic review examines the broad question of HIV prevention and interventions to reduce inmate HIV-related risk behaviors in U.S. federal and state prisons. We conducted a systematic review of multiple databases and Google Scholar to identify behavioral, biomedical, social, and policy studies related to HIV among U.S. prison populations from 1980-2014. Studies were excluded if they did not focus on HIV, prison inmates, if they were conducted outside of the U.S., if they involved juvenile offenders, or if they included post-release outcomes. Twenty-seven articles met the study criteria. Evidence suggests that research related to the HIV care continuum, risk behaviors, gender, prevention (e.g., peer education), and policy are key topics to enhance HIV prevention interventions in the criminal justice system. This review provides a prison-specific overview of HIV in U.S. correctional populations and highlight effective interventions, including inmate peer education. There is an urgent need to continue to implement HIV prevention interventions across all prisons and improve the quality of life among those at heightened risk of HIV infection.
This qualitative study of travel-related risk behaviours of Slovene injection drug users was based on interviews with individuals enrolled in drug addiction treatment programmes run by three regional centres for prevention and treatment of drug addiction. The primary objective of the study was to analyse behaviour patterns and practices of injection drug users during travel. Methods Travel-related problems of Slovene injection drug users were identified on the basis of data obtained by 25 in-depth interviews. A semi-structured questionnaire with 13 open-ended questions was developed after a preliminary study and review of the literature, and on the basis of experience with the treatment of drug addiction in Slovenia. Results The sample comprised 25 individuals, 18 men and seven women, aged 25 to 53 years. The interviews were 10 to 30 minutes long. The results obtained were presented as identified risk behaviours. Five categories were generated, providing information on the following topics: procurement of illicit drugs, criminal acts/environment, HIV and hepatitis B and C infections, storage and transport of substitution medication and pre-travel health protection. The first three categories comprise the injection drug users' risk behaviours that are most frequently explored in the literature. The other two categories - storage and transport of medication across the border and pre-travel health protection - reflect national specificities and the effectiveness of substitution treatment programmes. The majority of participants denied having shared needles and other injecting equipment when travelling. Participants who had no doctor's certificate had recourse to various forms of risk behaviour, finding a number of ways to hide the medication at the border. Conclusion This qualitative study provides insight into potential travel-related risk behaviour of injection drug users from two Slovene regions - central and coastal. The potential value of this qualitative study
Logan, Jennifer L.; Frye, Alison; Pursell, Haley O.; Anderson-Nathe, Michael; Scholl, Juliana E.
Objectives Homeless young adults are exposed to multiple risk factors for HIV infection. We identified HIV risk behaviors and their correlates among homeless young adults in Portland, Oregon. Methods We conducted a community-based, cross-sectional survey of HIV risk behaviors among homeless young adults aged 18–25 years in 2010. Participants completed three study components: (1) an interviewer-administered survey of HIV risk behaviors; (2) a brief, client-centered HIV risk-based counseling session; and (3) rapid HIV testing. Results Among 208 participants, 45.8% identified as racial/ethnic minority groups, 63.8% were male, and 35.7% self-identified as nonheterosexual. Six participants, all from sexual minority groups, had positive HIV screening results (two newly identified, four previously known) for a seropositivity rate of 2.9%. Female sex, belonging to a sexual minority group, frequent traveling between cities, depression, and alcohol use to intoxication were significantly associated with unprotected sex in univariate analysis. Female sex and high perceived risk of HIV were significantly associated with unprotected sex in multivariate analysis. Conclusions Our findings support the need for enhanced HIV prevention interventions for homeless young adults. PMID:23633730
Mettey, A; Crosby, R; DiClemente, R; Holtgrave, D
Methods: A cross sectional survey of men attending a sex resort was conducted. Of 164 men asked to participate, 91% completed a self administered questionnaire. The questionnaire assessed demographic variables and (using a 3 month recall period) men's HIV associated sexual risk behaviours. Potential confounding variables were assessed and controlled, as needed, by multivariate analysis. Results: Men currently resided in 14 states. One sixth reported being HIV positive. 57% of the men reported using the internet to seek sex. Differences in critical behaviours (unprotected anal sex and number of partners) were not found. However, compared to those not seeking sex by internet, men using the internet to meet sex partners were more likely to report fisting (adjusted odds ratio = 3.3, p = 0.04), having group sex (prevalence ratio (PR) = 1.2, p = 0.0001), using poppers during sex (PR = 1.94, p = 0.0001), and using ecstasy during sex (PR = 2.7, p = 0.04). Internet sex seeking men were also significantly more likely to report meeting sex partners in bathhouses (PR = 2.2, p = 0.0001), bars (PR = 1.5, p = 0.001), parks (PR = 3.2, p = 0.006), and circuit parties (PR = 8.9, p = 0.007). Conclusion: Among MSM attending a sex resort, those using the internet to seek sex partners may have modestly elevated risks for acquiring or transmitting sexually transmitted infections. Subsequent studies should investigate the utility of using the internet as forum for promoting safer sex behaviours among high risk MSM. PMID:14663122
Pinedo, Miguel; Burgos, José Luis; Ojeda, Victoria D.
Mexican migrants who are deported from the US may be at elevated risk for HIV infection. Deportations of Mexican migrants by the US have reached record numbers. We critically reviewed existing literature to assess how social and structural conditions in post-deportation settings can influence Mexican deported migrants' HIV risk. We also identify critical research gaps and make research recommendations. PMID:24583278
Corneille, Maya A.; Zyzniewski, Linda E.; Belgrave, Faye Z.
Though HIV prevention efforts have focused on young adult women, women of all ages may engage in HIV risk behaviors and experience barriers to condom use. This article examines the effect of age on sexual risk and protective attitudes and behaviors among African American women. Unmarried heterosexual African American women between the ages of 18…
Moyer, Matthew B.; Silvestre, Anthony J.; Lombardi, Emilia L.; Taylor, Christopher A.
Concerned about reports of a 15% decline in HIV testing among high-risk youth in an earlier study in Pittsburgh, this study was initiated to explore reasons why young people are not getting tested for HIV, while gathering data on their respective level of risk taking behaviors. A total of 580 surveys were collected from youth aged between 14 and…
Pinedo, Miguel; Burgos, José Luis; Ojeda, Victoria D
Mexican migrants who are deported from the US may be at elevated risk for HIV infection. Deportations of Mexican migrants by the US have reached record numbers. We critically reviewed existing literature to assess how social and structural conditions in post-deportation settings can influence Mexican deported migrants' HIV risk. We also identify critical research gaps and make research recommendations.
Elkington, Katherine; Teplin, Linda A.; Mericle, Amy A.; Welty, Leah J.; Romero, Erin G.; Abram, Karen M.
The effect of psychiatric disorders on human immunodeficiency virus/sexually transmitted infection (HIV/STI) risk behaviors in juvenile justice youths is examined. Prevalence, persistence and prediction are addressed among four mutually exclusive diagnostic groups and results show a high prevalence rate of many HIV/STI sexual risk behaviors that…
Fergus, Stevenson; Lewis, Megan A.; Darbes, Lynae A.; Butterfield, Rita M.
This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of…
Wyatt, Gail E.; Gomez, Cynthia A.; Hamilton, Alison B.; Valencia-Garcia, Dellanira; Gant, Larry M.; Graham, Charles E.
This article articulates a contextualized understanding of gender and ethnicity as interacting social determinants of HIV risk and acquisition, with special focus on African Americans and Hispanics/Latinos--2 ethnic groups currently at most risk for HIV/AIDS acquisition in the United States. First, sex and gender are defined. Second, a conceptual…
Stewart, Angela J.; Theodore-Oklota, Christina; Hadley, Wendy; Brown, Larry K.; Donenberg, Geri; DiClemente, Ralph
This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, "M" age = 14.9 years) who received mental…
Roberts, Kathleen Johnston; Newman, Peter A.; Duan, Naihua; Rudy, Ellen T.
HIV vaccines offer the best long-term hope of controlling the AIDS pandemic. We explored HIV vaccine knowledge and beliefs among communities at elevated risk for HIV/AIDS. Participants (N=99; median age=33 years; 48% female; 22% African-American; 44% Latino; 28% white; 6% other) were recruited from seven high-risk venues in Los Angeles, California, using purposive, venue-based sampling. Results from nine focus groups revealed: 1) mixed beliefs and conspiracy theories about the existence of HIV vaccines; 2) hopefulness and doubts about future HIV vaccine availability; 3) lack of information about HIV vaccines; and 4) confusion about vaccines and how they work. Tailored HIV vaccine education that addresses the current status of HIV vaccine development and key vaccine concepts is warranted among communities at risk. Ongoing dialogue among researchers, public health practitioners and communities at risk may provide a vital opportunity to dispel misinformation and rumors and to cultivate trust, which may facilitate HIV vaccine trial participation and uptake of future HIV vaccines. PMID:16396058
Wall, Kristin M.; Kilembe, William; Vwalika, Bellington; Ravindhran, Preeti; Khu, Naw Htee; Brill, Ilene; Chomba, Elwyn; Johnson, Brent A.; Haddad, Lisa B.; Tichacek, Amanda; Allen, Susan
Background. Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting. Methods. Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M−F+) was evaluated. Results. Among 1601 M−F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5–6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI, .4–1.2), oral contraceptive pill (aHR, 0.8; 95% CI, .3–2.1), nor implant (aHR, 0.8; 95% CI, .5–1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions. Conclusions. Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples. PMID:27462093
Li, Jing; Chen, Xiang-Sheng; Merli, M. Giovanna; Weir, Sharon S.; Henderson, Gail E.
Background Female sex workers (FSWs) have become one of the key populations for HIV/STI control in China. Categorization of FSWs can help prioritize HIV/STI intervention efforts. We examined two possible categorizations of FSWs and the relationship with syphilis infection risk in Liuzhou City, China. Methods From October 2009 to February 2010, a total of 583 FSWs recruited by respondent-driven sampling in a cross-sectional survey were tested for syphilis and interviewed to collect socio-demographic and behavioural information. Respondents were categorized based on transaction price for vaginal sex and type of sex work location. The relationship between the two categorizations and syphilis infection risk was assessed using univariate and multivariate logistic regression analysis. Results The prevalence rates of lifetime and active syphilis infection were 8.6% and 4.1% respectively. Lifetime and active syphilis prevalence were higher among FSWs in the lowest price category (52.7% and 25.4% respectively) and those working in streets (69.7% and 39.8% respectively) or through telephone (46.3% and 17.0% respectively). Multivariate analysis showed that lifetime syphilis prevalence was significantly higher among street-(Adjusted odds ratio AOR 38.7, 95% CI 10.7-139.9) and telephone-based FSWs (AOR 10.8, 95% CI 3.3-35.1), and that active syphilis prevalence was significantly higher among street-based FSWs (AOR 15.2, 95% CI 3.7-62.1) after adjusting for demographic and behavioural factors. Conclusions Categorization based on sex work location was more closely related to the risk of syphilis infection than the price classification. Street- and telephone-based FSWs had significantly higher risk of syphilis infection. Focused interventions among these particular high-risk FSWs subgroups are warranted. PMID:22337106
Fowler, Mary G; Qin, Min; Fiscus, Susan A; Currier, Judith S; Flynn, Patricia M; Chipato, Tsungai; McIntyre, James; Gnanashanmugam, Devasena; Siberry, George K; Coletti, Anne S; Taha, Taha E; Klingman, Karin L; Martinson, Francis E; Owor, Maxensia; Violari, Avy; Moodley, Dhayendre; Theron, Gerhard B; Bhosale, Ramesh; Bobat, Raziya; Chi, Benjamin H; Strehlau, Renate; Mlay, Pendo; Loftis, Amy J; Browning, Renee; Fenton, Terence; Purdue, Lynette; Basar, Michael; Shapiro, David E; Mofenson, Lynne M
Background Randomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking. Methods We randomly assigned HIV-infected women at 14 or more weeks of gestation with CD4 counts of at least 350 cells per cubic millimeter to zidovudine and single-dose nevirapine plus a 1-to-2-week postpartum "tail" of tenofovir and emtricitabine (zidovudine alone); zidovudine, lamivudine, and lopinavir-ritonavir (zidovudine-based ART); or tenofovir, emtricitabine, and lopinavir-ritonavir (tenofovir-based ART). The primary outcomes were HIV transmission at 1 week of age in the infant and maternal and infant safety. Results The median CD4 count was 530 cells per cubic millimeter among 3490 primarily black African HIV-infected women enrolled at a median of 26 weeks of gestation (interquartile range, 21 to 30). The rate of transmission was significantly lower with ART than with zidovudine alone (0.5% in the combined ART groups vs. 1.8%; difference, -1.3 percentage points; repeated confidence interval, -2.1 to -0.4). However, the rate of maternal grade 2 to 4 adverse events was significantly higher with zidovudine-based ART than with zidovudine alone (21.1% vs. 17.3%, P=0.008), and the rate of grade 2 to 4 abnormal blood chemical values was higher with tenofovir-based ART than with zidovudine alone (2.9% vs. 0.8%, P=0.03). Adverse events did not differ significantly between the ART groups (P>0.99). A birth weight of less than 2500 g was more frequent with zidovudine-based ART than with zidovudine alone (23.0% vs. 12.0%, P<0.001) and was more frequent with tenofovir-based ART than with zidovudine alone (16.9% vs. 8.9%, P=0.004); preterm delivery before 37 weeks was more frequent with zidovudine-based ART than with zidovudine alone (20.5% vs. 13.1%, P<0.001). Tenofovir-based ART was associated
Liao, C-M; You, S-H; Cheng, Y-H
Influenza poses a significant public health burden worldwide. Understanding how and to what extent people would change their behaviour in response to influenza outbreaks is critical for formulating public health policies. We incorporated the information-theoretic framework into a behaviour-influenza (BI) transmission dynamics system in order to understand the effects of individual behavioural change on influenza epidemics. We showed that information transmission of risk perception played a crucial role in the spread of health-seeking behaviour throughout influenza epidemics. Here a network BI model provides a new approach for understanding the risk perception spread and human behavioural change during disease outbreaks. Our study allows simultaneous consideration of epidemiological, psychological, and social factors as predictors of individual perception rates in behaviour-disease transmission systems. We suggest that a monitoring system with precise information on risk perception should be constructed to effectively promote health behaviours in preparation for emerging disease outbreaks.
Svedhem, Veronica; Marrone, Gaetano; Andersson, Örjan; Azimi, Farshad; Blaxhult, Anders; Sönnerborg, Anders
Objectives One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis. Methods A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient’s neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed. Results The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2–0.8); Sub-Saharan Africa (SSA): 0.3 (0.2–0.6); other: 0.5 (0.2–1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1–1.0); SSA (0.4 (0.2–0.8)). The latter was also lower for men who have sex with men (0.5 (0.2–1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05. Conclusions Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV. PMID:27603207
Langa, Judite; Sousa, César; Sidat, Mohsin; Kroeger, Karen; McLellan-Lemal, Eleanor; Belani, Hrishikesh; Patel, Shama; Shodell, Daniel; Shodell, Michael; Benech, Irene; Needle, Richard
HIV risk perceptions and behaviors of 236 commercial sex workers from three major Mozambican urban centers were studied using the International Rapid Assessment, Response and Evaluation (I-RARE) methodology. All were offered HIV testing and, in Maputo, syphilis testing was offered as well. Sixty-three of the 236 opted for HIV testing, with 30 (48%) testing positive for HIV. In Maputo, all 30 receiving HIV tests also had syphilis testing, with 6 (20%) found to be positive. Results include interview excerpts and qualitative results using I-RARE methodology and AnSWR-assisted analyses of the interviews and focus group sessions. PMID:24736653
Lee, Lisa M; McKenna, Matthew T; Janssen, Robert S
Risk behavior information is essential for allocating resources and developing effective HIV prevention strategies. Over time, transmission risk information on HIV/AIDS cases has been less likely to be reported to the national surveillance system. The Centers for Disease Control and Prevention (CDC) invited approximately 30 experts in HIV/AIDS and behavioral research from state and local health departments, academia, community-based organizations, and the CDC to participate in a consultation in December 2001 to generate ideas on how best to deal with the lack of risk data. The group was charged with providing recommendations on methods for classifying and reporting risk information and for identifying methods and sources for improving ascertainment of transmission risk behaviors for individuals infected with HIV. This report describes the recommendations and the effects of implementing such recommended procedures on the national HIV/AIDS surveillance database.
Lee, Lisa M.; McKenna, Matthew T.; Janssen, Robert S.
Risk behavior information is essential for allocating resources and developing effective HIV prevention strategies. Over time, transmission risk information on HIV/AIDS cases has been less likely to be reported to the national surveillance system. The Centers for Disease Control and Prevention (CDC) invited approximately 30 experts in HIV/AIDS and behavioral research from state and local health departments, academia, community-based organizations, and the CDC to participate in a consultation in December 2001 to generate ideas on how best to deal with the lack of risk data. The group was charged with providing recommendations on methods for classifying and reporting risk information and for identifying methods and sources for improving ascertainment of transmission risk behaviors for individuals infected with HIV. This report describes the recommendations and the effects of implementing such recommended procedures on the national HIV/AIDS surveillance database. PMID:12941852
Phillips, Karran A; Epstein, David H; Mezghanni, Mustapha; Vahabzadeh, Massoud; Reamer, David; Agage, Daniel; Preston, Kenzie L
We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability "as is" in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all P < 0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.
Ma, Ping; Wei, Ye; Xia, Hongli; Jiang, Wenjie; Yang, Changqing; Meng, Xiaojun; Peng, Peng; Yang, Yue; Jiang, Liying; Chu, Minjie; Zhuang, Xun
To investigate the factors associated with sexually transmitted infection and Human Immunodeficiency Virus (STI-HIV) co-infection among men who have sex with men (MSM). A total of 357 HIV-infected participants (84 STI-HIV co-infection and 273 HIV infections only) were recruited from Jiangsu, China. Logistic regression analyses were used to estimate the related factors associated with STI-HIV co-infection. Marginal structural models were adopted to estimate the effect of transmission drug resistance (TDR) on STI-HIV co-infection. For all participants, logistic regression analyses revealed that those who diagnosed with HIV-1 for longer duration (≥1.8 years) were significantly associated with reduced STI-HIV co-infection risk (OR = 0.55, 95%CI: 0.32–0.96, P = 0.036). In further stratification analysis by antiretroviral therapy (ART), individuals with longer duration showed consistent significant associations with STI-HIV co-infection risk (OR = 0.46, 95%CI: 0.26–0.83, P = 0.010) among MSM with ART-naïve status. In addition, significant reduced risk for STI-HIV co-infection (OR = 0.98, 95%CI: 0.96–0.99, P = 0.010) were observed in younger (under the average age of 31.03) MSM of the same group. Interestingly, we also found TDR was significantly associated with an increased risk of STI-HIV co-infection risk (OR = 3.84, 95%CI: 1.05–14.03, P = 0.042) in ART-naïve group. Our study highlights a pattern of STI-HIV co-infection among MSM in China and indicates that targeted interventions aimed at encouraging TDR monitoring in MSM with early HIV infection are warranted. PMID:28158317
Jackson, Caroline A; Henderson, Marion; Frank, John W; Haw, Sally J
The observed clustering, and shared underlying determinants, of risk behaviours in young people has led to the proposition that interventions should take a broader approach to risk behaviour prevention. In this review we synthesized the evidence on 'what works' to prevent multiple risk behaviour (focusing on tobacco, alcohol and illicit drug use and sexual risk behaviour) for policy-makers, practitioners and academics. We aimed to identify promising intervention programmes and to give a narrative overview of the wider influences on risk behaviour, in order to help inform future intervention strategies and policies. The most promising programme approaches for reducing multiple risk behaviour simultaneously address multiple domains of risk and protective factors predictive of risk behaviour. These programmes seek to increase resilience and promote positive parental/family influences and/or healthy school environments supportive of positive social and emotional development. However, wider influences on risk behaviour, such as culture, media and social climate also need to be addressed through broader social policy change. Furthermore, the importance of positive experiences during transition periods of the child-youth-adult phase of the life course should be appropriately addressed within intervention programmes and broader policy change, to reduce marginalization, social exclusion and the vulnerability of young people during transition periods.
Jacobson, Jerry O; Sánchez-Gómez, Amaya; Montoya, Orlando; Soria, Efrain; Tarupi, Wilmer; Chiriboga Urquizo, Marcelo; Champutiz Ortiz, Eliana; Miranda, Sonia Morales; Tobar, Rodrigo; Gómez, Bertha; Riera, Celia
This study characterized the HIV epidemic among men who have sex with men (MSM) in Quito, Ecuador and contrasted risk patterns with other STI's. 416 MSM ages 15 years and older were recruited using respondent-driven sampling in 2010-2011. Biological testing and a self-interview survey assessed HIV and STI infections and risk behaviors. Analysis incorporated recruiter-level variables and clustering adjustments to control for recruitment patterns. We identify high levels of HIV (11 %), HSV-2 (14 %) and active syphilis (5.5 %) infections, low levels of lifetime HIV testing (57 %), limited knowledge of HIV and STI's (<48 %) and limited consistent condom use independent of partner type (<40 %). Sex work was associated with all infections while associations with residential location, how casual partners are met and other variables, varied. Scale-up of behavioral prevention and HIV testing is urgently needed. Interventions should target male sex workers and exploit differential patterns of HIV-STI risk to stay ahead of the epidemic.
Fisher, Colleen M.
Young sexual minority males are among those at highest risk for HIV infection, yet we know relatively little about the impact of sexual identity development on HIV risk. This study used cross-sectional data to investigate factors associated with HIV-related sexual risk among a sample of sexual minority males (n = 156), ages 14 to 21 years, using…
Camlin, Carol S; Kwena, Zachary A; Dworkin, Shari L; Cohen, Craig R; Bukusi, Elizabeth A
Migration and HIV research in sub-Saharan Africa has focused on HIV risks to male migrants, yet women's levels of participation in internal migration have met or exceeded those of men in the region. Moreover, studies that have examined HIV risks to female migrants found higher risk behavior and HIV prevalence among migrant compared to non-migrant women. However, little is known about the pathways through which participation in migration leads to higher risk behavior in women. This study aimed to characterize the contexts and processes that may facilitate HIV acquisition and transmission among migrant women in the Kisumu area of Nyanza Province, Kenya. We used qualitative methods, including 6 months of participant observation in women's common migration destinations and in-depth semi-structured interviews conducted with 15 male and 40 female migrants selected from these destinations. Gendered aspects of the migration process may be linked to the high risks of HIV observed in female migrants - in the circumstances that trigger migration, livelihood strategies available to female migrants, and social features of migration destinations. Migrations were often precipitated by household shocks due to changes in marital status (as when widowhood resulted in disinheritance) and gender-based violence. Many migrants engaged in transactional sex, of varying regularity, from clandestine to overt, to supplement earnings from informal sector trading. Migrant women are at high risk of HIV transmission and acquisition: the circumstances that drove migration may have also increased HIV infection risk at origin; and social contexts in destinations facilitate having multiple sexual partners and engaging in transactional sex. We propose a model for understanding the pathways through which migration contributes to HIV risks in women in high HIV prevalence areas in Africa, highlighting potential opportunities for primary and secondary HIV prevention at origins and destinations, and at
Lotfi, Razieh; Ramezani Tehrani, Fahimeh; Salehifar, Delara; Dworkin, Shari L
Sexual transmission of HIV/AIDS is increasing in Iran and is the main route of infection among women. In order to foster the development of future HIV prevention interventions for women, researchers need to understand the factors that influence sexual risk reduction behaviors in this group. The aim of this study was to explore the predictors of condom use among women at risk of HIV and develop a model of condom use in a sample of women at risk of HIV. We cross-sectionally examined predictors of condom use among 200 women at risk of HIV. Women were recruited from drop-in centers and voluntary counseling and testing centers in Tehran. Condom use among women at risk of HIV was examined using path analysis, and fit indices showed a good fit for the model. Condom use self-efficacy, social support, and less stereotypic gender roles influenced sexually protective behaviors of women at risk of HIV. Our results can provide a basis for future gender-specific intervention programs among women at risk of HIV. Researchers, practitioners, and organizations that play a central role in protecting the health of this population can make use of these results for the benefit of sexual and reproductive health programs.
Cianelli, Rosina; Villegas, Natalia; Lawson, Sarah; Ferrer, Lilian; Kaelber, Lorena; Peragallo, Nilda; Yaya, Alexandra
Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal-postmenopausal-related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention.
Cianelli, Rosina; Villegas, Natalia; Lawson, Sarah; Ferrer, Lilian; Kaelber, Lorena; Peragallo, Nilda; Yaya, Alexandra
Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, FL, with 50 participants. Focus group discussions centered around 8 major themes: intimate partner violence (IPV), perimenopausal-postmenopausal related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention. PMID:23790277
China's transition from an injection drug-driven HIV epidemic to one primarily transmitted through sexual contact has triggered concern over the potential for HIV to move into the non-drug-injecting population. Much discussion has focused on the migrant men of China's vast 'floating population' who are considered a high-risk group. As a result, many men who frequently engage in high-risk behaviour but are not included in this especially vulnerable group are evading HIV prevention messages. This paper highlights the socio-cultural and politico-economic factors that motivate many of China's wealthy businessmen and government officials, sometimes referred to as 'mobile men with money', to engage in such behaviour. Examination of the activities related to the work of these men reveals a situation where the confluence of a market-oriented economy operating within a socialist-style political system under the influence of traditional networking practices has engendered a unique mode of patron-clientelism that brings them together over shared social rituals including feasting, drinking and female-centered entertainment that is often coupled with sexual services. As a result, consideration of the socio-cultural factors influencing these men's sexual practices is important for responding to the newly emerging stage of China's HIV epidemic.
Haddad, Lisa B; Polis, Chelsea B; Sheth, Anandi N; Brown, Jennifer; Kourtis, Athena P; King, Caroline; Chakraborty, Rana; Ofotokun, Igho
Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman's risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms.
Campbell, C; Williams, B
While migrant labour is believed to play an important role in the dynamics of HIV-transmission in many of the countries of southern Africa, little has been written about the way in which HIV/AIDS has been dealt with in the industrial settings in which many migrant workers are employed. This paper takes the gold mining industry in the countries of the Southern African Development Community (SADC) as a case study. While many mines made substantial efforts to establish HIV-prevention programmes relatively early on in the epidemic, these appear to have had little impact. The paper analyses the response of key players in the mining industry, in the interests of highlighting the limitations of the way in which both managements and trade unions have responded to HIV. It will be argued that the energy that has been devoted either to biomedical or behavioural prevention programmes or to human rights issues has served to obscure the social and developmental dimensions of HIV-transmission. This argument is supported by means of a case study which seeks to highlight the complexity of the dynamics of disease transmission in this context, a complexity which is not reflected in individualistic responses. An account is given of a new intervention which seeks to develop a more integrated approach to HIV management in an industrial setting.
Desmond, Nicola; Allen, Caroline F; Clift, Simon; Justine, Butolwa; Mzugu, Joseph; Plummer, Mary L; Watson-Jones, Deborah; Ross, David A
Mining communities with migrant populations are high-risk locations for human immunodeficiency virus (HIV)/sexually transmitted infection transmission in Sub-Saharan Africa. Interventions presupposing certain groups to be at high risk, such as those working exclusively as commercial sex workers, may divert attention from other high-risk groups. Qualitative research was conducted in a small town adjacent to a large-scale commercial gold mine in north-western Tanzania. Objectives were to identify populations at high risk of HIV and suggest suitable behavioural interventions by gaining an understanding of sexual behaviour patterns in the town. Rapid assessment procedures were employed comprising participant observation, informal questioning and in-depth interviews. Epidemiological categories of "core", "bridging" and "general" populations may not be adequate to the understanding of risk. Many types of women were found to receive payment for sex, distinguished by permanency of residence, age, relationship status, accommodation and income-earning activity. Paying for sex and having multiple partners was common among most men. The town was a high-risk environment as a result of the economic opportunities available there (in contrast to the poverty of surrounding areas), which were often accessed by offering sex in exchange for money or gifts. In this environment, the potential for spread of HIV infection between sub-populations was high and identification of distinct high- and low-risk groups not possible. However, the methodology enabled the identification of different social circumstances of risk, such as residential arrangements, employment status and venues for recreation, associated with different types of people. Targeted interventions may be oriented to specific circumstances in order to address risk practices in a culturally appropriate manner. It is useful to think of risk environments rather than attributing risk to types of people, and to target interventions
Marquis, Grace S; Lartey, Anna; Perez-Escamilla, Rafael; Mazur, Robert E; Brakohiapa, Lucy; Birks, Katherine A
Exclusive breast-feeding (EBF) for 6 months supports optimal infant growth, health and development. This paper examined whether maternal HIV status was associated with EBF and other infant feeding practices. Pregnant women were enrolled after HIV counselling, and their babies were followed up for up to 1 year. Data on household socio-economics and demographics, maternal characteristics and infants' daily diet were available for 482 infants and their mothers (150 HIV-positive (HIV-P), 170 HIV-negative (HIV-N) and 162 HIV-unknown (HIV-U)). Survival analyses estimated median EBF duration and time to introduction of liquids and foods; hazards ratios (HR) used data from 1-365 and 1-183 d, adjusting for covariates. Logistic regression estimated the probability of EBF for 6 months. Being HIV-P was associated with a shorter EBF duration (139 d) compared with HIV-N (163 d) and HIV-U (165 d) (P=0·004). Compared with HIV-N, being HIV-P was associated with about a 40 % higher risk of stopping EBF at any time point (HR 1·39; 95 % CI 1·06, 1·84; P=0·018) and less than half as likely to complete 6 months of EBF (adjusted OR 0·42; 95 % CI 0·22, 0·81; P=0·01). Being HIV-P tended to be or was associated with a higher risk of introducing non-milk liquids (HR 1·34; 95 % CI 0·98, 1·83; P=0·068), animal milks (HR 2·37; 95 % CI 1·32, 4·24; P=0·004) and solids (HR 1·56; 95 % CI 1·10, 2·22; P=0·011) during the first 6 months. Weight-for-age Z-score was associated with EBF and introducing formula. Different factors (ethnicity, food insecurity, HIV testing strategy) were associated with the various feeding behaviours, suggesting that diverse interventions are needed to promote optimal infant feeding.
Wenzel, Suzanne L.; Rhoades, Harmony; Tucker, Joan S.; Golinelli, Daniela; Kennedy, David P.; Zhou, Annie; Ewing, Brett
HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV…
Mellins, Claude A.; Dolezal, Curtis; Brackis-Cott, Elizabeth; Nicholson, Ouzama; Warne, Patricia; Meyer-Bahlburg, Heino F. L.
HIV-negative, inner-city adolescents with HIV-infected parents are considered to be at high risk for acquiring HIV themselves. Using a modified theory of health behavior, this study examined the effects of maternal HIV infection and psychosocial variables on the onset of sexual and drug risk behavior in 144 HIV-negative adolescents with and…
Conners, Erin E.; West, Brooke S.; Roth, Alexis M.; Meckel-Parker, Kristen G.; Kwan, Mei-Po; Magis-Rodriguez, Carlos; Staines-Orozco, Hugo; Clapp, John D.; Brouwer, Kimberly C.
Increasingly, ‘place’, including physical and geographical characteristics as well as social meanings, is recognized as an important factor driving individual and community health risks. This is especially true among marginalized populations in low and middle income countries (LMIC), whose environments may also be more difficult to study using traditional methods. In the NIH-funded longitudinal study Mapa de Salud, we employed a novel approach to exploring the risk environment of female sex workers (FSWs) in two Mexico/U.S. border cities, Tijuana and Ciudad Juárez. In this paper we describe the development, implementation, and feasibility of a mix of quantitative and qualitative tools used to capture the HIV risk environments of FSWs in an LMIC setting. The methods were: 1) Participatory mapping; 2) Quantitative interviews; 3) Sex work venue field observation; 4) Time-location-activity diaries; 5) In-depth interviews about daily activity spaces. We found that the mixed-methodology outlined was both feasible to implement and acceptable to participants. These methods can generate geospatial data to assess the role of the environment on drug and sexual risk behaviors among high risk populations. Additionally, the adaptation of existing methods for marginalized populations in resource constrained contexts provides new opportunities for informing public health interventions. PMID:27191846
Conners, Erin E; West, Brooke S; Roth, Alexis M; Meckel-Parker, Kristen G; Kwan, Mei-Po; Magis-Rodriguez, Carlos; Staines-Orozco, Hugo; Clapp, John D; Brouwer, Kimberly C
Increasingly, 'place', including physical and geographical characteristics as well as social meanings, is recognized as an important factor driving individual and community health risks. This is especially true among marginalized populations in low and middle income countries (LMIC), whose environments may also be more difficult to study using traditional methods. In the NIH-funded longitudinal study Mapa de Salud, we employed a novel approach to exploring the risk environment of female sex workers (FSWs) in two Mexico/U.S. border cities, Tijuana and Ciudad Juárez. In this paper we describe the development, implementation, and feasibility of a mix of quantitative and qualitative tools used to capture the HIV risk environments of FSWs in an LMIC setting. The methods were: 1) Participatory mapping; 2) Quantitative interviews; 3) Sex work venue field observation; 4) Time-location-activity diaries; 5) In-depth interviews about daily activity spaces. We found that the mixed-methodology outlined was both feasible to implement and acceptable to participants. These methods can generate geospatial data to assess the role of the environment on drug and sexual risk behaviors among high risk populations. Additionally, the adaptation of existing methods for marginalized populations in resource constrained contexts provides new opportunities for informing public health interventions.
Deschesnes, Marthe; Fines, Phillipe; Demers, Stephanie
Purpose: To date, studies pertaining to possible links between body modification and risk-taking behaviours have been conducted mainly among targeted groups. The objective of this study is to examine the influence of a number of risk-taking behaviours on the probability of being pierced or tattooed among a general adolescent population. Methods:…
Operario, Don; Kuo, Caroline C.; Sosa-Rubí, Sandra G.; Gálarraga, Omar
Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PMID:24001243
Balaji, Alexandra B; Bowles, Kristina E; Hess, Kristen L; Smith, Justin C; Paz-Bailey, Gabriela
MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.
Tully, Stephen; Cojocaru, Monica; Bauch, Chris T
There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms.
Loue, Sana; Sajatovic, Martha; Mendez, Nancy
Latinos, and Puerto Ricans in particular, have been disproportionately impacted by HIV/AIDS. Severe mental illness (SMI) is associated with an increase in HIV risk. Relatively little research has focused on the role of SMI among Puerto Rican injection drug users (IDUs) and non-IDUs in susceptibility to and transmission of HIV and there are few published reports on HIV risk among Latina SMI. We conducted a longitudinal mixed methods study with 53 Puerto Rican women with schizophrenia, bipolar disorder, or major depression to examine the cultural context of HIV risk and HIV knowledge, beliefs, and behaviors among a larger study with Puerto Rican and Mexican women with serious mental illness (SMI). There was a high prevalence of past and current substance use and a high prevalence of substance use-associated HIV risk behaviors, such as unprotected sexual relations with an IDU. The violence associated with substance use frequently increased participants' HIV risk. Choice of substance of abuse depended on cost, availability, and use within the individual participant's network. Participants attributed their substance use to the need to relieve symptoms associated with their mental illness, ameliorate unpleasant feelings, and deaden emotional pain. HIV prevention interventions for poorer Puerto Rican women with SMI must target the individuals themselves and others within their networks if the women are to be supported in their efforts to reduce substance use-related risk. The content of any intervention must address past and current trauma and its relationship to substance use and HIV risk, as well as strategies to prevent HIV transmission.
Gisselquist, David; Potterat, John J; Brody, Stuart
Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV-infected children, but also to prevent transmission of HIV to other children and health care workers through contaminated medical procedures and needlestick accidents. HIV-infected children aged to 1 year typically have high viral loads, making them dangerous reservoirs for iatrogenic transmission. Most vertically infected children experience HIV-related symptoms early, though many survive beyond 5 years. This leads to high HIV prevalence among inpatient and outpatient children. In nine African studies, HIV prevalence in inpatient children ranged from 8.2% to 63%, roughly 1-3 times the prevalence in antenatal women. Investigations of large iatrogenic outbreaks in Russia, Romania, and Libya demonstrate efficient HIV transmission through paediatric health care. Unexplained HIV infections in African children are not rare-studies published through 2003 have recorded more than 300 HIV-infected children with HIV-negative mothers. In addition, several studies have reported much higher HIV prevalence in children 5-14 years old than could be expected from mother-to-child transmission alone. Research is required to determine the extent of iatrogenic HIV infection among African children as well as to identify high-risk procedures and settings. Such research can motivate and direct prevention efforts.
Background A thorough understanding of the contexts of sexual behaviour of the people who are vulnerable to HIV infection is an important component in the battle against AIDS epidemic. We conducted a qualitative study to investigate perceptions, attitudes and practices of sexually active people in three districts of northern Tanzania with the view of collecting data to inform the formulation of appropriate complementary interventions against HIV and AIDS in the study communities. Methods We conducted 96 semi-structured interviews and 48 focus group discussions with sexually active participants (18-60 years of age) who were selected purposively in two fishing and one non-fishing communities. Results The study revealed a number of socio-economic and cultural factors which act as structural drivers of HIV epidemic. Mobility and migration were mentioned to be associated with the risk of HIV acquisition and transmission. Sexual promiscuous behaviour was common in all study communities. Chomolea, (a quick transactional sex) was reported to exist in fishing communities, whereas extramarital sex in the bush was reported in non-fishing community which was predominantly Christian and polygamous. Traditional practices such as Kusomboka (death cleansing through unprotected sex) was reported to exist. Other risky sexual behaviour and traditional practices together with their socio-economic and cultural contexts are presented in details and discussed. Knowledge of condom was low as some people mistook them for balloons to play with and as decorations for their living rooms. Acute scarcity of condoms in some remote areas such as vizingani (fishing islands) push some people to make their own condoms locally known as kondomu za pepsi using polythene bags. Conclusions HIV prevention efforts can succeed by addressing sexual behaviour and its socio-economic and cultural contexts. More innovative, interdisciplinary and productive structural approaches to HIV prevention need to be
Thuo, Daniel Njane; Nyaga, Veronica K.; Bururia, David N.; Barchok, Hilary K.
Education plays an important role in curbing the spread of HIV and AIDS among the youth. However, there is little known how teachers' motivation in teaching HIV/AIDS education affects students' knowledge and attitudes towards sexual behaviour. The purpose of the study was to determine the relationship between teachers' level of motivation in…
Qiao, Shan; Li, Xiaoming; Stanton, Bonita
Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction.
Abraham, C; Sheeran, P
Studies applying social cognitive frameworks such as the health belief model and the theory of reasoned action to HIV-prevention are reviewed. These models suggest that appropriate beliefs, attitudes, social norms, intentions and perceived self-efficacy are sufficient psychological conditions for safer sexual behaviour. Limitations inherent in these accounts are identified and additional factors which need to be incorporated in psychological models and health education programmes are highlighted. These include, the motivational complexity of sexual behaviour, the emotional and arousal states in which it is enacted, the difficulties of planning what is regarded as spontaneous interaction and contextual factors which can undermine HIV-preventive intentions. Health education interventions aimed at individual, group and community levels are examined in light of this theoretical review and action-focused, empowering interventions grounded in youth culture are recommended.
Loeliger, Kelsey B; Biggs, Mary L; Young, Rebekah; Seal, David W; Beckwith, Curt G; Kuo, Irene; Gordon, Michael S; Altice, Frederick L; Ouellet, Lawrence J; Cunningham, William E; Young, Jeremy D; Springer, Sandra A
The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.
Malow, Robert M; McMahon, Robert C; Dévieux, Jessy; Rosenberg, Rhonda; Frankel, Anne; Bryant, Vaughn; Lerner, Brenda; Miguez, Maria Jose
Among severely mentally ill (SMI) substance abusers, HIV rates are elevated and