PubMed Health⌕ Search

Biomedical subjects

O Grinstead

Publications and source records attributed to O Grinstead.

7 recordsLinked to original sources
PubMed2001

Reducing postrelease risk behavior among HIV seropositive prison inmates: the health promotion program.

The prevalence of AIDS is five times higher among prison inmates than in the general population. Because recidivism is common and many inmates are serving short sentences for parole violation, HIV-seropositive inmates move frequently between prison and their home communities. We designed an eight-session prerelease intervention for HIV seropositive inmates to decrease sexual and drug-related risk behavior and to increase use of community resources after release. The intervention sessions were delivered at the prison by community service providers. We found that a prerelease risk reduction intervention for HIV seropositive inmates was feasible. Descriptive results support the effectiveness of the program in reducing sexual and drug-related behaviors and in increasing use of community resources after release. Compared with men who signed up for the intervention but were unable to attend, men who received the intervention reported more use of community resources and less sexual and drug-related risk behavior in the months following release. We recommend dissemination and continued evaluation of this risk-reduction intervention.

Adult↗
PubMed2000

Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

BACKGROUND: Access to HIV-1 voluntary counselling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings. METHODS: The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters. FINDINGS: HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and $346, respectively, and the cost per DALY saved was $12.77 and $17.78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5.16-27.36 in Kenya, and $6.58-45.03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10.71 in Kenya and $13.39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8.36 in Kenya and $11.74 in Tanzania. INTERPRETATION: HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly.

AIDS Serodiagnosis↗
PubMed1999

Facilitators and barriers to use of the female condom: qualitative interviews with women of diverse ethnicity.

Women in the United States, particularly African-Americans and Hispanics, are at increased risk for HIV. The female condom now offers women a potentially important option for HIV prevention, yet few efforts have been made to increase its use. To elucidate strategies to promote the use of the female condom, we conducted in-depth interviews with 62 women recruited from the four major racial/ethnic groups of the U.S. (African-American, Asian-American, Hispanic, and white). Subject recruitment took place at a family planning clinic in San Francisco during 1996-97. We identified four major types of facilitators and barriers to use of the female condom: mechanical, psychosexual, interpersonal, and situational. Specifically, the mechanical facilitators and barriers included positive and negative aspects of the device, and difficulty with insertion. The psychosexual factors were female empowerment, more options for contraception and disease prevention, discomfort with vaginal insertion, and condom use norms. The interpersonal factors included: enhanced communication, relationship status, partner preferences, and partner objections. Finally, the situations that made women disinclined to use the device were: no access to the female condom when having sex and using other forms of contraceptives. The implications of these findings for HIV prevention and future research are discussed.

Adolescent↗
PubMed1995

Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda.

OBJECTIVE: To describe sexual interaction and HIV-related communication in Rwandan couples and to examine their relationship to HIV testing and condom use. STUDY DESIGN: Cross-sectional survey of a longitudinal cohort. METHODS: In 1988, women recruited for an epidemiological study of HIV, and interested male partners, received confidential HIV testing and counseling. Two years after enrollment, 876 women reporting one steady partner in the past year completed a questionnaire addressing sexual and HIV-related communication, sexual motivation and violence in the partnership. RESULTS: Men control sexual decision making, and coercive sex and violence between partners is not uncommon. HIV-positive women were more likely to report coercive sex and less likely to have discussed their test results with their partner. Women with HIV-positive partners were more likely to report being physically abused. Condom use was more common if the man had been previously tested, and if women reported discussing or negotiating condom use. HIV-negative women with untested or seronegative partners were the least likely to use condoms or to discuss or attempt to negotiate condom use. CONCLUSIONS: Participation of the male partner is crucial for successful HIV risk reduction in couples. HIV testing and counseling of couples has beneficial long term effects on condom use and HIV-related communication. Couple communication is associated with condom use, but only when the discussion is specific (sexually transmitted disease risks and using condoms). Seronegative women with untested partners are at increased risk for HIV as they are the least likely to discuss or attempt to negotiate condom use.

Coercion↗
PubMed1993

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↗
PubMed1993

Evaluating needle exchange: are there negative effects?

OBJECTIVE: We analyzed data on all drug-treatment admissions in San Francisco County over a 4-year period (n = 35,460) to evaluate the potential negative effects of the San Francisco needle-exchange program. METHODS: Admissions in the 2 years preceding implementation of the exchange program (1987-1988) were compared with admissions in the 2 years following implementation (1989-1990). RESULTS: No negative consequences of needle exchange were detected. Specifically, the presence of the exchange program was not associated with (1) increases in injection drug use, (2) increases in needle-sharing behavior, or (3) changing drug-use behavior from non-injection to injection. We also compared high-drug-use neighborhoods with and without local needle-exchange sites. Neighborhoods without needle-exchange sites showed a greater increase in proportion of admissions for injection drug use, and in frequency of injection, over time. CONCLUSIONS: Because of methodological limitations, our findings are preliminary. Longitudinal studies comparing needle-exchange and non-exchange cohorts are needed to further evaluate effects of this intervention.

Adult↗