Fidelity, mutual respect best shields against AIDS.
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Researchers at the University of Washington have created and studied a computer-assisted, client-centered, prevention and education program that they hope will encourage risk-reduction behaviors and HIV testing, all on a more affordable basis.
Reducing transmission of human immunodeficiency virus (HIV) in the United States requires new strategies, including emphasis on prevention of transmission by HIV-infected persons. Through ongoing attention to prevention, risky sexual and needle-sharing behaviors among persons with HIV infection can be reduced and transmission of HIV infection prevented. Medical care providers can substantially affect HIV transmission by screening their HIV-infected patients for risk behaviors; communicating prevention messages; discussing sexual and drug-use behavior; positively reinforcing changes to safer behavior; referring patients for services such as substance abuse treatment; facilitating partner notification, counseling, and testing; and identifying and treating other sexually transmitted diseases (STDs). To help incorporate HIV prevention into the medical care of HIV-infected persons, CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America developed these recommendations. The recommendations are general and apply to incorporating HIV prevention into the medical care of all HIV-infected adolescents and adults, regardless of age, sex, or race/ethnicity. They are intended for all persons who provide medical care to HIV-infected persons (e.g., physicians, nurse practitioners, nurses, physician assistants); they might also be useful to those who deliver prevention messages (e.g., case managers, social workers, health educators). The recommendations were developed by using an evidence-based approach. For each recommendation, the strength of the recommendation, the quality of available evidence supporting the recommendation, and the outcome for which the recommendation is rated are provided. The recommendations are categorized into three major components: screening for HIV transmission risk behaviors and STDs, providing brief behavioral risk-reduction interventions in the office setting and referring selected patients for additional prevention interventions and other related services, and facilitating notification and counseling of sex and needle-sharing partners of infected persons.
OBJECTIVE: To identify social, behavioral and epidemiologic factors associated with HIV infection among HIV-infected and HIV-uninfected black women residing in North Carolina. DESIGN: A case-control study conducted in August 2004 in North Carolina. METHODS: Cases were 18-40-year-old women with HIV infections diagnosed from 2003-2004. Controls were 18-40-yearold, HIV-negative heterosexually active women recruited from HIV testing sites. Five focus group discussions were also conducted with women not participating in the case-control study. RESULTS: Multivariate analyses of 31 cases and 101 controls showed that HIV-positive women were more likely to receive public assistance [adjusted odds ratio (aOR) 7.3; 95% confidence interval (CI) 2.1, 26.0], to report a history of genital herpes infection (aOR 10.6; 95% CI 2.4, 47.2), and were less likely to have discussed a variety of sexual and behavioral issues relevant to risk of HIV infection with their male partners (aOR 0.6; 95% CI 0.4, 0.8). Focus group participants indicated that financial and social demands created competing challenges for making HIV prevention a priority. CONCLUSIONS: Inadequate communication between black women and their sexual partners may create barriers to sexual and behavioral risk reduction. A multidimensional approach that addresses both biological factors such as herpes infection and socioeconomic factors may be needed to reduce HIV transmission in this population.
This investigation tested the ability of the Health Belief Model (HBM), dimensions of self-efficacy, various behavioral variables (i.e., number of sex partners in the past 12 months, frequency of drunkenness during sexual intercourse, and number of diagnosed sexually transmitted diseases), and demographic measures to distinguish between three condom user groups (i.e., nonusers, sporadic users, and consistent users). The usable sample consisted of 366 college students, ages 18 to 24. The study operationalized the following HBM components: perceived susceptibility, perceived benefits, and perceived barriers. The multidimensional Condom Use Self-Efficacy Scale (CUSES) was also used in this investigation. Results from a discriminant analysis indicated that sporadic users were best distinguished from both consistent and nonusers by number of sex partners in the past year, frequency of drunkenness during sexual intercourse, perceived susceptibility to HIV/AIDS and other STDs, and a self-efficacy factor labeled Assertive. The sporadic users had significantly more sex partners, were drunk more often when engaging in sexual intercourse, perceived themselves as more susceptible to HIV/AIDS and other STDs, and were less confident in their ability to discuss and insist on condom use with a partner. It was also discovered that each condom user group was best defined by different subsets of discriminating variables. Implications of these findings for campus-based prevention programs and future research are discussed.
The proportion of people with AIDS is increasing rapidly in Zimbabwe. Several strategies have been adopted to check the further spread of the disease. This paper discusses the behaviour patterns which may predispose to HIV infection and possible intervention strategies that may be taken in the City of Harare. Over a third (33.9 pc, n = 1,526) of the married respondents reported that they were living separately from their spouses. There was a high proportion (76.6 pc, n = 564) of single respondents who admitted to engaging in premarital sex. Fifteen pc of total respondents were engaging in casual sex. The proportion of single respondents (31.2 pc) engaging in casual sex was higher than among the married (11.1 pc). More single respondents (10.9 pc) had been paid for sex than the married (4.1 pc) whilst the proportion that had been paid for sex was similar for the single (21.2 pc) and the married (22.9 pc). The median age for starting sex was 17 years (range = three to 26) for the single and 18 years (range = four to 35) for the married respondents. Sixteen pc stated that they had an STD in 1989. Condom usage was low with only 9.2 pc always using a condom. Forty eight pc of the married respondents who have engaged in casual sexual relationships never use condoms. The main source of information on AIDS/HIV was the radio (74 pc). Most parents (66 pc) had not talked about AIDS to their children.
In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.
In Thailand the incidence of HIV/AIDS, other sexually transmitted diseases, and unwanted pregnancies highlights the vulnerability of young people who have moved from rural to urban areas as migrant workers. Possible ways of diminishing the risks are discussed below.
In this paper we examine risk behavior, exposure to street outreach, and condom use in samples of injecting drug users (IDUs) and high-risk youth. We used systematic sampling methods to produce representative samples of injecting drug users IDUs (five sites) and high-risk youth (three sites). The populations surveyed engaged in high levels of sexual risk behavior: 20% to 46% reported two or more sex partners in the last month. The majority (62% to 97%) knew someone infected with HIV. Condom use rates approached national health promotion goals for nonsteady partners but not for steady or main partners. Having a condom at time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents have been in contact with street outreach programs and many acknowledged some personal risk for HIV infection. However, most of the injecting drug users and high-risk youth interviewed (and their sex partners) were still at risk through unprotected sex.
Outreach has a long history in health and social service programs as an important method for reaching at-risk persons within their communities. One method of "outreach" is based on the recruitment of networks of community members (or "networkers") to deliver HIV prevention messages and materials in the context of their social networks and everyday lives. This paper documents the experiences of the AIDS Community Demonstration Projects in recruiting networkers to deliver HIV prevention interventions to high-risk populations, including injecting drug users not in treatment; female sex partners of injecting drug users; female sex traders; men who have sex with men but do not self-identify as gay; and youth in high-risk situations. The authors interviewed project staff and reviewed project records of the implementation of community networks in five cities. Across cities, the projects successfully recruited persons into one or more community networks to distribute small media materials, condoms, and bleach kits, and encourage risk-reduction behaviors among community members. Networkers' continuing participation was enlisted through a variety of monetary and nonmonetary incentives. While continuous recruitment of networkers was necessary due to attrition, most interventions reported maintaining a core group of networkers. In addition, the projects appeared to serve as a starting point for some networkers to become more active in other community events and issues.
A survey of 265 college students was conducted to determine HIV-related knowledge, attitudes, behavior, and perceived self-efficacy with regard to engaging in HIV-protective behaviors. A self-administered 52-item survey was completed by 265 college students (60% response rate). Resident advisors in college dormitories distributed the survey, returned anonymously. Data were analyzed using SPSS to identify differential responses by gender. Although HIV knowledge was high, perceived self-efficacy differed significantly by gender, with men describing themselves as less able to insist upon condom use (P < .00001). Men were also significantly more likely to report using drugs or alcohol in situations likely to lead to a sexual encounter (P < .001) and to having lower self-efficacy in relation to HIV protection than women in such situations (P < .02). Men were also significantly more likely to believe that monogamy obviates the need to use condoms (P < .01). A substantial number of men (13) and women (14.6) say they do not use condoms because they are protected from unwanted pregnancy by pill. Gender-specific HIV education and skills-building programs may improve the success of AIDS prevention efforts by confronting and addressing gender differences. The reliance on hormonal methods of birth control alone may be a barrier to condom use for both male and female adolescents and young adults. Medical Subject Headings (MeSH): AIDS; HIV; knowledge, attitudes, and practice; gender; condoms; birth control; family planning; teenage pregnancy.
Strategies for preventing transmission of human immunodeficiency virus (HIV) include ensuring that individuals have adequate knowledge of how HIV infection can be prevented and encouraging behaviours that decrease risk of HIV infection. In addition, there is evidence that early and appropriate management of other sexually transmitted disease is effective in reducing HIV transmission. Programmes and projects promoting prevention of HIV transmission should be evaluated periodically for their effectiveness. Between March and September 1995, ten prevention indicators developed by the WHO Global Programme on AIDS were used to establish a baseline measure for evaluating the effectiveness of the Ethiopian AIDS control programme. The indicators were measured using a structured population survey, through record review and key informants, structured observation and interview in health care facilities, and through a serosurvey among antenatal clinic attenders. The following results were found: promoting knowledge of preventive practices was successful; a relatively high proportion of young male adults had sexual risk behaviour; poor condom availability outside Addis Ababa, the capital; and very weak STD case management. The prevalence of syphilis and HIV were 8.8% and 13.6%, respectively, among pregnant women aged 15-49 years. These results should serve as a baseline for repeat surveys to assess the effectiveness of HIV prevention programmes in Ethiopia.
Sexual behaviors of long-distance truck drivers in Thailand were investigated to define patterns and determinants critical to the transmission of HIV. This article reports on commercial, spousal, and other sexual partners and on condom use among 327 drivers interviewed in 1992. Forty-eight percent reported a commercial sex worker (CSW) as their first partner and 87% had contact with a CSW at some time. Median lifetime number of all partners was 29. In the 6 months prior to interview, 35% had two or more partners. Among the currently married, 23% had CSW contact within the past 6 months; 13% had contact with a nonmarital, noncommercial partner; and about 8% reported marital as well as both CSW and noncommercial relationships in the same time period. Over half the unmarried reported sexual relations in the 6 months; 25% reported contacts with both CSW and noncommercial partners. About 40% of subjects visiting CSWs used condoms inconsistently or not at all. Drivers were knowledgeable about AIDS and prevention measures, with some important misconceptions, but self-assessment of risk of HIV showed a negligible sense of their personal vulnerability.
Appropriate and effective communication is central to the success of interventions to reduce the risk of HIV infection. This paper reviews what has been learned about the nature of communication in the behavior change process. It examines the contexts in which communication occurs, as well as the contribution of communication theory, social marketing theory, and structural intervention theory to intervention development. Guidance is offered on the most appropriate ways in which to communicate with different groups and audiences, and future priorities for research and intervention are identified.
The purpose of this paper was to provide a framework for discussion in the working group on HIV Counseling for Behavior Change at the Third USAID HIV/AIDS Prevention Conference. The paper begins with a section defining HIV counseling and describing different types of HIV counseling. Next, points of consensus and controversy regarding the conduct and evaluation of HIV counseling are discussed. This is followed by a section outlining findings to date on the effectiveness of HIV counseling, and a discussion of methodological issues in evaluating counseling outcomes. Finally, the paper includes a list of key issues for further research.