HIV/AIDS in Latin America and the Caribbean: an update.
Explore the source record for details and available documents.
Acquired Immunodeficiency Syndrome↗
Biomedical subjects
N Hearst
Publications and source records attributed to N Hearst.
Evaluation of an HIV risk reduction intervention among African-American homosexual and bisexual men.
OBJECTIVE: To provide the first data which evaluates an HIV risk reduction intervention designed to reduce HIV high-risk sexual behavior in African-American homosexual and bisexual men. SUBJECTS: Participants (n = 318) were recruited from bars, bathhouses, and erotic bookstores, and through homosexual African-American organizations, street out-reach, media advertisements, and personal referrals of individuals aware of the study. METHODS: Participants were randomized into a single or triple session experimental group or a wait-list control group. Both experimental interventions included AIDS risk education, cognitive-behavioral self-management training, assertion training, and attempts to develop self-identity and social support. Data collection involved assessments of self-reported changes in sexual behavior at 12- and 18-month follow-up. RESULTS: Participants in the triple session intervention greatly reduced their frequency of unprotected anal intercourse (from 46 to 20%) at the 12-month follow-up evaluation and (from 45% to 20%) at the 18-month follow-up evaluation. However, levels of risky behavior for the control group remained constant (from 26 to 23% and from 24 to 18%) at 12- and 18-month follow-up evaluations, respectively. In addition, levels of risky behavior for the single session intervention decreased only slightly (from 47 to 38% and from 50 to 38%) at the 12- and 18-month follow-up evaluations, respectively. CONCLUSIONS: Results were interpreted to demonstrate the superiority of a triple session over a single session intervention in reducing risky sexual behavior in this cohort.
Adult↗
HIV infection and risk behaviors among male port workers in Santos, Brazil.
OBJECTIVES: This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working-class population of Santos, Brazil. METHODS: Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. RESULTS: Although the rate of HIV infection among these men- the working-class male population of Santos-remains low (1.1%), self-reported behavioral risks for HIV infection are common. CONCLUSIONS: There is still time to prevent a widespread outbreak of HIV infection among the hetero-sexual population of Santos and of the transportation corridors emanating from that city.
Adult↗
Epidemiology of HIV infection among long distance truck drivers in Kenya.
A total number of two hundred eighty three long distance truck drivers and their assistants (loaders) who ferry goods between Kenya and Zaire were included in a cross-sectional study between September 1991 and April 1992. Twenty six percent of the study subjects were seropositive for HIV-1 and none were HIV-2 seropositive. Countries of birth and residence were significantly associated with HIV infection (X2 = 23.6, P = 0.0006). Significant associations were also found between HIV seropositivity and level of education from secondary school and above (OR = 3.4, 95% C.I. = 1.01-11.55); being circumcised was more protective, (OR = 0.38; 95% C.I. = 0.19-0.76), history of many years of driving (X2 = 9.3, p = 0.0254) and income (OR = 11.13, 95% C.I. = 1.35-91.95). When a stepwise multiple logistic regression model was fitted to all the variables observed to be significant in the univariate analysis, the following risk factors attained statistical significance: lack of circumcision (OR = 3.75); income greater than Ksh. 2000 (OR = 7.24); being employed in long distance driving more than 11 years (OR = 3.98); and secondary school education and above (OR = 4.06, 95% C.I. = 1.18-13.98). Reference for all the above Odds Ratios was 1.
Adult↗
Family practice bashing as perceived by students at a university medical center.
BACKGROUND AND OBJECTIVES: Medical schools are being asked to produce more family physicians, but it is not always clear how this can be accomplished. Previous research has focused on students' characteristics and attitudes that predict specialty choice but has paid less attention to feedback they receive in the academic medical center environment. METHODS: In early 1993, a self-administered questionnaire was mailed to 160 students from all classes of the University of California, San Francisco Medical School who had previously shown interest in family practice. Data are shown for the 138 respondents. RESULTS: Most students from all years had received positive feedback about their interest in family practice, usually from family physicians. By the fourth year, 95% of students had received negative feedback, usually from physicians in other specialties. Many students gave poignant examples of pejorative comments about family practice by faculty and house staff. Negative feedback seemed strongest at the time students were making decisions about residency. By the fourth year, only 39% of these previously interested students chose family practice. CONCLUSION: Serious efforts to encourage students to enter family practice must address the problem of negative feedback from other specialties. To promote positive feedback, contact with family physicians should be increased, especially in the third and fourth years.
Academic Medical Centers↗
Help-seeking for AIDS high-risk sexual behavior among gay and bisexual African-American men.
Help-seeking for AIDS high-risk sexual behavior and its association with HIV status were examined among 318 gay and bisexual men in the San Francisco Bay Area who participated in the African American Men's Health Project, a longitudinal survey of gay and bisexual African-American men. A third (36%) of the sample reported seeking help regarding their concerns about HIV high-risk sexual behavior. Peers and professionals were the most widely sought sources of help and the sources perceived to be the most helpful. Men (39%) who had received the HIV antibody test and who were HIV seropositive were more likely to seek help than men who were HIV seronegative or did not know their HIV status (25%). Furthermore, gay men who were HIV seropositive or who knew their serostatus were more likely to seek help from professionals and peers. Explanations for the differences in help-seeking by HIV-seropositive men are discussed with implications for the development of social support for HIV risk reduction among gay and bisexual African-American men.
Acquired Immunodeficiency Syndrome↗
Collaborative AIDS prevention research in the developing world: the CAPS experience.
BACKGROUND: Prevention through behavior change is the only way to control the spread of HIV infection in the developing world. Success in prevention requires consistent and persistent intervention over time, a clear understanding of the realities of target populations and involvement of members of these populations in prevention efforts. Applied local research is urgently needed, especially in the developing world, to design interventions that meet these criteria and to test their effectiveness. CENTER FOR AIDS PREVENTION STUDIES (CAPS) MODEL OF INTERNATIONAL COLLABORATIVE RESEARCH: Each year, eight to 10 scientists from developing countries visit CAPS in San Francisco for 10 weeks of intensive learning and collaboration. The main emphasis is on designing a protocol for a research project related to AIDS prevention in the visiting scientist's home country. CAPS provides pilot study funding and technical assistance to implement the project. RESULTS: The quality of the resulting collaborative research is represented by the articles published in this volume and by the many alumni of the program who have undertaken additional research projects and/or assumed leadership positions in AIDS control efforts in their countries.
Acquired Immunodeficiency Syndrome↗
Female partners of AIDS patients in Uganda: reported knowledge, perceptions and plans.
OBJECTIVE: To assess reported knowledge of a partner's AIDS diagnosis, perceived risk of HIV infection, need for HIV testing and future support plans among women partners of male Ugandan AIDS patients. SUBJECTS AND METHODS: A cross-sectional descriptive survey was conducted at New Mulago Hospital, Kampala, Uganda. The subjects were women partners of consecutive male AIDS patients admitted to medical wards. RESULTS: Only 12% reported their partner's AIDS diagnosis; women who reported knowing were less likely to be financially dependent on the partner. Most women (76%) reported being at risk of HIV; in general, these women were older, in a newer relationship, had less children and were in customary rather than civil or cohabiting marriages. More than half (56%) of the women reported a need for HIV testing, though few (5%) had been tested. Those who stated the need for HIV testing were in a newer relationship, had less children and were more financially independent of their husbands; women in a cohabiting type marriage were less likely to report their need for testing than those in a civil or customary marriage. About half (56%) reported plans for future support if their husbands did not recover; these women were more likely to be in an older relationship and to have more children. CONCLUSIONS: Most women partners of AIDS patients in New Mulago Hospital reported no knowledge of their husbands' diagnosis. Over half perceived a need to be tested but very few reported having been tested, and only half reported having planned for the future of their families. Interventions are urgently needed to address barriers to knowledge and to acknowledgement of a partner's AIDS diagnosis, to HIV testing and to planning for the future.
AIDS Serodiagnosis↗
Socioeconomic status and risk of HIV-1, syphilis and hepatitis B infection among sex workers in São Paulo State, Brazil. Instituto Adolfo Lutz Study Group.
OBJECTIVES: To determine how HIV risk behavior and the prevalences of sexually transmitted diseases vary according to socioeconomic status and city among sex workers in São Paulo State, Brazil. SUBJECTS AND METHODS: A cross-sectional study of 600 female sex workers (100 of a higher socioeconomic status and 100 of a lower socioeconomic status in each city) was conducted in the cities of São Paulo, Campinas and Santos. HIV risk behavior was assessed by questionnaire; serological tests were administered to assess prior exposure to HIV-1, syphilis and hepatitis B. RESULTS: Only statistically significant (P < 0.05) findings are reported here. Compared to those with a higher socioeconomic status, sex workers with a lower socioeconomic status worked longer hours each day (9.6 versus 7.9), had more clients per day (5.4 versus 2.6) and had fewer episodes of intercourse per client per encounter (1.1 versus 1.4). Levels of condom use for vaginal, anal and oral sex were significantly higher in Santos than in São Paulo or Campinas. Twenty-three per cent of the women said they feared violence if they insisted that their clients wear condoms; 74% voiced similar fears regarding their non-client sexual partners. Overall, 11% of sex workers were positive for exposure to HIV-1, 45% for syphilis and 39% for hepatitis B. Those with a lower socioeconomic status were more likely than those with a higher socioeconomic status to be infected with HIV-1 (17 versus 4%), syphilis (66 versus 24%) and hepatitis B (52 versus 26%), but there were no differences in prevalence rates by city. CONCLUSIONS: These data demonstrate substantial heterogeneity in HIV risk behavior and the prevalence of HIV-1 and other sexually transmitted diseases among sex workers in São Paulo State, many of which were related to differences in socioeconomic status. Interventions to prevent HIV transmission among sex workers must be tailored to the local environment and, in particular, to the socioeconomic status of these workers.
Adolescent↗
AIDS risk-taking behavior during carnival in São Paulo, Brazil.
OBJECTIVE: The Brazilian Carnival is thought to be a time when the risk of HIV infection is likely to be high. We therefore compared the risk during Carnival to risk in the past month among male samba school participants in São Paulo, Brazil. SUBJECTS AND METHODS: A cross-sectional study was conducted among 380 male samba school drummers randomly sampled during rehearsal for the 1993 Carnival in São Paulo by means of a 20-min interviewer-administered questionnaire. The main outcome variable was condom use with non-steady partners. RESULTS: The sexual behavior of 36.1% of subjects risked HIV infection, but only 9.7% of all subjects were at risk only during Carnival. Subjects with a sexual risk of HIV differed from those without risk in substance use, attitudes towards condoms and expectations about Carnival; those who were at risk only during Carnival did not differ from those who were at risk at other times. About half of the subjects had been given free condoms during Carnival, although few of the men at risk had actually used them. CONCLUSIONS: Though more than a third of the drummers were at risk of HIV infection, only a small per cent were at risk only during Carnival. The level of sexual risk of HIV infection is probably better explained by factors in the men's daily lives, rather than through information on risks taken during Carnival. These results raise questions concerning the efficacy of universal condom distribution during Carnival, since about half of the men were given condoms but few of those at risk actually used them. A targeted distribution of condoms to populations with a high demonstrated risk may be more effective in preventing new HIV infection.
Acquired Immunodeficiency Syndrome↗
Adolescent sexuality in Saint Petersburg, Russia.
OBJECTIVES: To describe adolescent knowledge, attitudes and behavior relevant to sexuality and the prevention of AIDS in Saint Petersburg, Russia. SUBJECTS AND METHODS: A cross-sectional descriptive study was designed, taking a random sample of 10th grade students at 14 Saint Petersburg grade schools, which were stratified by socio-economic district. A total of 185 female and 185 male students completed a self-administered 46-item questionnaire, with a response rate of 94%. RESULTS: From the questionnaires, 20% of females and 31% of males reported having had sexual intercourse and 25% of females and 12% of males reported being sexually abused. These adolescents displayed much misinformation about sexual matters and AIDS prevention. Only 25% of the females and 34% of the males believed that condoms should be used just once, and 38% of each sex believed that if washed, they could be used multiple times. Many respondents, especially males, rated their knowledge about sexual matters as high or adequate. Support for sex education was strong, especially among females, and respondents generally saw sex education as improving sexual pleasure. Most information sources about sexual activity were either not considered very credible, or not adequately accessible. CONCLUSIONS: Substantial reported rates of sexual abuse, sexual experience and much misinformation and unwarranted attitudes toward condoms, safer sexual practices and HIV/AIDS suggest the need for vigorous sex education programs for Russian youth. The early and sustained education of girls is especially important. Sex education should be introduced at an early age so that children can be taught how to reduce the risks of sexual abuse, HIV infection and other sexually transmitted diseases, and to improve their sexual experiences as responsible adults.
Acquired Immunodeficiency Syndrome↗
'Dry sex' and HIV infection among women attending a sexually transmitted diseases clinic in Lusaka, Zambia.
OBJECTIVES: To describe 'dry sex' practices intended to decrease vaginal secretions and to determine whether these practices are related to HIV infection. SUBJECTS AND METHODS: A cross-sectional study was conducted in a sexually transmitted diseases clinic in a teaching hospital in Lusaka, Zambia. The subjects comprised 329 women aged 15-50 years presenting consecutively for an initial evaluation of sexually transmitted disease symptoms. Dry sex practices were assessed by questionnaire, and serological testing for HIV antibodies was performed. RESULTS: Fifty percent of women had engaged in at least one dry sex practice. The most common practices were drinking 'porridge' (a liquid or suspension believed to cause drying of the vagina; 28%), removing vaginal secretions with a cloth (22%) and placing leaves in the vagina (11%). The most frequent reasons given for drinking porridge were to increase the partner's sexual enjoyment and to tighten the vagina, while cleaning the vagina was mentioned often by those using cloth or leaves. Swelling or peeling of the vagina was reported by approximately 10% of women using cloth or leaves. Overall, the HIV seroprevalence in the sample was 58%. In bivariate analysis, no practice was statistically significantly associated with HIV infection. Multiple logistic regression had little impact on these findings. CONCLUSIONS: Although a variety of practices with potential relevance to HIV transmission were reported, there was no evidence in this study population of a strong relationship between these practices and HIV infection. Women should be counseled about the potential risks of these practices, but prevention efforts should continue to emphasize measures of known effectiveness, particularly limiting the numbers of sexual partners, consistently using condoms and obtaining appropriate treatment for sexually transmitted diseases.
Adolescent↗
Results of a model AIDS prevention program for high school students in the Philippines.
OBJECTIVES: To describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors. SUBJECTS AND METHODS: A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in four demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. INTERVENTION: An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists and health educators. The teacher-led AIDS program was designed to provide students with accurate information about AIDS, particularly in dispelling misconceptions about casual contagion, to foster positive attitudes towards people with AIDS and to develop skills aimed at clarifying values and assessing intended behavior. RESULTS: At baseline, 11% of students (20% of males and 4% of females) reported ever having had sexual intercourse (mean age 14 years). Among these, condom use was low (24%). After implementation of the AIDS prevention program, statistically significant effects favoring the intervention group were observed in knowledge and attitudes towards people with AIDS. While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. CONCLUSIONS: A sizable number of Filipino high school students are sexually active but condom use is low. School-based AIDS prevention programs can be developed and implemented in developing countries with the assistance of school personnel to address sexual issues. Our program was successful in increasing AIDS-related knowledge and improving attitudes towards people with AIDS. Supplementation with other preventive activities may be needed to achieve lasting changes in students' risk-taking behavior.
Acquired Immunodeficiency Syndrome↗
Rifabutin prophylaxis against Mycobacterium avium complex infection.
Explore the source record for details and available documents.
AIDS-Related Opportunistic Infections↗
Ethical, behavioral, and social aspects of HIV vaccine trials in developing countries.
ISSUE: Several investigators are preparing to conduct efficacy trials of human immunodeficiency virus (HIV) vaccines in the developing world. Failure to adequately address the unique ethical, behavioral, and social issues that surround vaccine testing in that setting will jeopardize the success of these trials and future acquired immunodeficiency syndrome (AIDS) research in the host nation. DESCRIPTION OF THE PROJECT: Twelve investigators from Africa, Asia, North America, and South America reviewed previous experience with HIV trials in developing countries and explored potential solutions to these issues. CONCLUSIONS: Host country scientists, government officials, and media must be actively involved in all aspects of the trials. Minimum prerequisites for conducting the trial include the following: (1) researching vaccines active against developing world HIV isolates; (2) establishing and maintaining an adequate technological infrastructure; (3) assessing the feasibility of recruitment in countries where the existence of HIV may be denied; (4) designing methods to obtain informed consent from each individual subject, rather than exclusively from family members or community elders; (5) creating locally appropriate instruments to measure risk behavior; (6) identifying a behavioral intervention for placebo and treatment groups; (7) making available laboratory methods to distinguish between natural HIV infection and vaccine-induced seropositivity; and (8) guaranteeing that an effective vaccine is available free of charge to the placebo group and at affordable prices to other host country residents.
AIDS Vaccines↗
Evaluating a school-based intervention for STD/AIDS prevention in Peru.
PURPOSE: In a context of increasing HIV/STD risks among adolescents in Latin America, new conceptions of sequential "sex education" are needed. However, older adolescents must be reached through shorter programs. A quasi-experimental study was conducted to evaluate the impact of a short school-based STD/AIDS prevention program on knowledge, attitudes, and intended behavior among secondary students in Lima. METHODS: Aimed at empowering adolescents regarding their sexuality, improving knowledge and attitudes, and developing skills and prevention-oriented behavioral intentions, the program consisted of seven weekly two-hour sessions. Cost exclusive of research expenses was $3 per student reached. RESULTS: 1213 students from 14 schools participated in either the intervention or control groups. Significant changes in knowledge on sexuality and AIDS, erotophilia, acceptance of contraception, machismo, and discrimination against persons with HIV/AIDS were found in the intervention group, as compared to the control group. Self-efficacy and prevention-oriented behavioral intentions were significantly better in the intervention group. CONCLUSIONS: Owing to its effectiveness, acceptability, and low cost, this program may become useful in reaching adolescents unable to participate in longer-term sex education programs in Peru and elsewhere.
Acquired Immunodeficiency Syndrome↗
HIV antibody testing among those at risk for infection. The National AIDS Behavioral Surveys.
OBJECTIVE: To determine the prevalence of testing for human immunodeficiency virus (HIV) antibody among adults with various risk factors for infection, particularly those residing in large metropolitan areas where the bulk of cases of acquired immunodeficiency syndrome (AIDS) have occurred. DESIGN: A nationwide, population-based telephone survey eliciting testing, sexual, and injection drug use histories. PARTICIPANTS: A total of 2673 randomly chosen US residents and 8263 randomly chosen residents of 23 metropolitan areas containing 64% of reported cases of AIDS. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Testing for HIV antibody. MAIN RESULTS: Overall, rates of individuals ever tested were only slightly higher in the urban areas (23%) than in the nation as a whole (21%). Testing frequencies were low among all risk groups (less than 40%), except men engaging in same-sex sexual activity (60%) and male and female injection drug users (46% and 73%, respectively). The low rate of testing (35%) among the largest risk group, heterosexual men and women engaging in unprotected sexual intercourse with multiple partners, was particularly worrisome. CONCLUSIONS: To encourage antibody testing among the many at risk for infection who have not yet been tested, promotional campaigns should explain the universal susceptibility to infection among those at risk, and the availability of prophylactic medical therapies and social support services to persons who are HIV-seropositive. As there were comparable levels of risk-taking behavior among subjects in both samples, these campaigns must be designed to reach all segments of the population.
AIDS Serodiagnosis↗
Self-reported sexually transmitted diseases among family planning clients: ethnic differences in sexual risk behavior and HIV risk reduction.
The relationship between sexually transmitted diseases (STDs) and risk for human immunodeficiency virus (HIV) has been established. Little is known, however, about the relationship between being infected with an STD and initiating HIV risk-reduction behavior. We interviewed 267 young women who were family planning clients of the San Francisco Bay-Area Planned Parenthood clinics, of whom 40% were white, 37% African American, and 23% women of other ethnic origins. Fifty-three percent of the women surveyed reported having been diagnosed with an STD, and 22% reported two or more episodes of infection. African-American women who reported lower educational attainment and being unemployed were more likely to report having been infected with an STD than were women from other ethnic and demographic groups. Ethnic differences were also found in the prevalence of the risk behaviors associated with the self-reported STDs and in the relationship between reporting a history of STD and practicing HIV risk-reduction behavior. Women who reported an STD were significantly more likely to report having a nonmonogamous primary partner. Risk-reduction behaviors associated with a personal history of STD included being less likely to report having asked a sexual partner about his number of previous partners and being more likely to have been tested for antibodies to HIV. Results from this survey suggest that these family planning clients report a frequent history of STDs and that while some have attempted to reduce their risk, these efforts are inadequate. These data underscore a need for ethnically relevant HIV risk-reduction interventions for this population.
Adolescent↗