From the Centers for Disease Control. HIV prevention in US correctional system, 1991.
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Adolescent↗
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Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases.
Understanding the role of other sexually transmitted diseases (STDs) in the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in alterations of natural history, diagnosis, or response to therapy of STDs is critical to the development of optimal strategies for HIV control. One hundred sixty-three studies on the interrelationships between HIV infection and other STDs were examined. Of 75 studies on the role of STDs in HIV transmission, the 15 analyses of examination or laboratory evidence of STDs adjusted for sexual behavior showed that both ulcerative and nonulcerative STDs increase the risk of HIV transmission approximately 3- to 5-fold. Due to limited data, the role of STDs in progression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcers). If coinfection with HIV prolongs or augments the infectiousness of individuals with STDs, and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another. This "epidemiological synergy" may be responsible for the explosive growth of the HIV pandemic in some populations. Effective STD control programs will be essential to HIV prevention in these communities.
Acquired Immunodeficiency Syndrome↗
Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities.
OBJECTIVES: It is critical to extend community-level acquired immunodeficiency syndrome (AIDS) prevention efforts beyond education alone and to develop models that better encourage behavioral changes. Gay men in small cities are vulnerable to human immunodeficiency virus (HIV) infection due to continued high rates of risk behavior. This research introduced an intervention that trained popular people to serve as behavioral change endorsers to peers sequentially across three different cities. METHODS: Populationwide surveys were conducted of all men patronizing gay clubs in each city to establish risk behavior base rates. After a small cadre of popular "trendsetters" were identified, they received training in approaches for peer education and then contracted to communicate risk reduction recommendations and endorsements to friends. Surveys were repeated at regular intervals in all cities, with the same intervention introduced in lagged fashion across each community. RESULTS: Intervention consistently produced systematic reductions in the population's high-risk behavior (unprotected anal intercourse) of 15% to 29% from baseline levels, with the same pattern of effects sequentially replicated in all three cities. CONCLUSIONS: This constitutes the first controlled, multiple-city test of an HIV prevention model targeting communities. The results support the utility of norm-changing approaches to reduce HIV risk behavior.
Acquired Immunodeficiency Syndrome↗
"Everybody thinks that it won't happen to them": A mixed-methods study of HIV prevention strategies among people experiencing homelessness who use drugs.
BACKGROUND: HIV disproportionately affects people experiencing homelessness, particularly those who use drugs. Although effective prevention strategies exist, uptake remains suboptimal in high-risk populations. Limited research has examined how this population engages with HIV prevention strategies and the contextual factors shaping behaviors. METHODS: We conducted a mixed-methods study of adults (≥18 years) experiencing homelessness with recent drug use, recruited from three Boston sites (Feb 2024-Jan 2025). Participants completed a survey assessing HIV prevention strategy uptake. A subsample completed in-depth interviews on factors influencing behavior. Guided by the Theoretical Domains Framework, we coded qualitative data and identified themes to help contextualize uptake. RESULTS: Among 196 participants, mean age was 48; 61% identified as male and 44% as non-Hispanic White. Forty-two percent reported condomless sex, and among those who had ever injected drugs (n = 123), 24% reported syringe sharing in the prior three months. Only 9% reported current PrEP use, and 12% had ever used HIV self-tests. Qualitative findings highlighted perceived control as a key facilitator, while low perceived HIV risk hindered uptake across strategies. Additional barriers varied by strategy and included partner dynamics and substance use affecting condom use, structural constraints affecting syringe use, and knowledge, stigma, and cost concerns affecting PrEP and self-testing. CONCLUSION: In this cohort of people experiencing homelessness who use drugs, HIV prevention strategy uptake was suboptimal, with particularly low PrEP and HIV self-testing use. Qualitative findings suggest that interventions to promote HIV prevention strategy uptake in this population should leverage perceived control, address perceived risk, and target strategy-specific interpersonal and structural barriers.
Humans↗
Toward a comprehensive HIV prevention program for the CDC and the nation.
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Behavior Control↗
Changes in sexual behavior among women in studies evaluating the dapivirine vaginal ring for HIV prevention.
BACKGROUND: Access to novel HIV prevention technologies often raise concerns of risk compensation. This analysis examined changes in the sexual behaviors of MTN 020/ASPIRE participants, a placebo controlled randomized control trial, who subsequently enrolled in MTN-025/HOPE, an open-label extension using the dapivirine vaginal ring. METHODS: Both studies enrolled healthy, sexually active, HIV-negative women from Malawi, South Africa, Uganda and Zimbabwe. Longitudinal data on participants' sexual behaviors, specifically sex with a nonprimary partner (past 3 months), and use of male or female condoms at the last vaginal sex act were compared between ASPIRE and HOPE. Conditional and mixed ordinal logistic regression models evaluated associations between study and sexual behaviors at enrollment, and quarterly over the first 12 months. RESULTS: Of the 2629 individuals enrolled in ASPIRE, 1456 (55%) participated in HOPE. At enrollment, the proportion of participants who reported sex with a nonprimary partner and condom use at last vaginal sex act did not differ by study. Across all quarterly follow-up visits, sex with a nonprimary partner was more common in HOPE (13.9-18.7%) than ASPIRE (10.7-12.6%); adjusted OR 1.47, 95% CI 1.24-1.75, P < 0.001. There was no difference in condom use at the last vaginal act across all quarterly follow-up visits between ASPIRE (36.5-42.7%) and HOPE (43.6-46.7%); adjusted OR 1.05, 95% CI 0.94-1.18. CONCLUSION: More women reported sex with nonprimary partners in HOPE, with little change in condom use over time between the two studies. Understanding behavior changes during PrEP use allows for tailored, holistic reproductive health programming.
Humans↗
Self-control and ego identity development as predictors of unprotected sex in late adolescent males.
Male college students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, moral development, personality factors and behaviors. Bivariate analyses were used to identify factors associated with high-risk sexual intercourse. Significant demographic psychosocial and behavioral predictors were entered into a logistic regression analysis to evaluate the independent influence of each predictor on unprotected sexual intercourse. Behavioral factors were the most powerful predictors of unprotected sexual intercourse. Adolescents reporting multiple sex partners, drinking and picking-up sex partners were significantly more likely to engage in sex without condoms. Examining psychosocial factors alone, it was found that adolescents who had low scores for ego-development (goal-directedness) and self-control were significantly more likely to engage in sex without condoms. Identification of two personality constructs as underlying predictors of high-risk behavior, while potentially important for the development of effective HIV prevention programs, needs corroboration to further define the interrelationships between these factors and other psychosocial constructs.
Adolescent↗
AIDS Community Demonstration Projects: implementation of volunteer networks for HIV-prevention programs--selected sites, 1991-1992.
States and cities have effectively used community-level intervention projects to reduce cigarette smoking and other risk behaviors associated with chronic disease (1-3); similar strategies have been introduced to prevent human immunodeficiency virus (HIV) infection in men who have sex with men and who identify themselves as homosexual or bisexual (4,5). Many of these projects used community volunteers to deliver interventions (2,4,5). An important concern for community-level intervention projects that rely on volunteers is the need to address the recruitment and retention of these volunteers. CDC AIDS Community Demonstration Projects have developed and maintained volunteer networks among hard-to-reach populations for HIV prevention. This report summarizes methods used by demonstration projects in five cities to develop and maintain volunteer networks during 1991-1992.
Acquired Immunodeficiency Syndrome↗
HIV prevention and the two faces of partner notification.
In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made.
Confidentiality↗
Taming demons: the reduction of harm resulting from use of illicit drugs.
Restricting availability is the major response to illicit drugs in most Western countries including Australia. Prohibition may reduce harm when the drug in question is in low demand, controls are difficult to subvert, and when similar drugs are less toxic or unavailable. However, the health, social and economic costs of supply reduction are substantial and increasing for both injecting drug users and the general community. Population adjusted mortality of heroin users has doubled in Australia in the last decade. The possible impact of supply reduction policy on the spread of HIV infection among IDUs is an important but largely neglected consideration. The effectiveness of supply restriction policy in decreasing the availability of drugs or in reducing drug-related harm is unlikely to be increased significantly by more vigorous implementation of supply reduction or adoption of new technology. Conversely, on the basis of existing data, greater availability of HIV prevention measures attractive to the target population (including especially drug treatment such as methadone maintenance) is likely to be effective and cost-effective. The costs and benefits of innovative methods of providing currently illicit drugs to those who are determined to use them requires careful evaluation and comparison with existing policies. Policy on illicit drugs in most countries including Australia is still dominated by concern about drug use rather than focused on the need to reduce drug-related problems which is the agreed aim of national drug policy.
Australia↗
Family/media approach to HIV prevention: results with a home-based, parent-teen video program.
We describe the first study with a home-based HIV prevention video program for parents and young teenagers. The objectives of the program are to inform parents and teenagers about the causes and prevention of HIV infection and other sexually transmitted diseases, to increase family problem-solving skills, and to increase teen problem-solving and assertiveness skills. The objectives pertain to the goals of increasing skills needed to help teenagers avoid or manage high-risk behaviors and situations. Forty-five families with at least one 12- to 14-year-old were randomly assigned to either experimental (receive video program) or control (no video) conditions in a pretest-posttest design. After 6 months (Follow-Up 1), the experimental and control families were reassessed. The control families next received the video program, and the control families were assessed again (Follow-Up 2). The results indicate increases in parent and teen knowledge and skills only with video viewing. Approaches to improving the video program, particularly with teenagers, are discussed.
Acquired Immunodeficiency Syndrome↗
Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective.
Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.
Adolescent↗
Sexual behavior patterns of gay university men: implications for preventing HIV infection.
Gay male university students less than 25 years old were studied to determine whether they had changed their sexual activity patterns to reduce the risk of HIV infection. Most had not established sexual behavior patterns typical of the older gay men who had been studied in earlier research. Although most of the participants surveyed were concerned about HIV infection, some did engage in risky sexual behavior. The risk-reduction strategies most often used were having fewer sexual partners and being more selective in choosing partners. Future HIV-prevention interventions must be designed to address the needs of this generation of gay men.
Adult↗
Brief Report: Beyond Testing: Exploring the Psychosocial Impact of HIV Self-Testing Among Ugandan Gender-Diverse Sex Workers.
BACKGROUND: The psychosocial effect of HIV self-testing (HIVST) on sex workers' self-esteem, depression, alcohol misuse, perceived sex work stigma, and empowerment remains poorly characterized. We hypothesized that HIVST would reduce sex work stigma and improve these psychosocial outcomes by enabling private, autonomous testing and reducing exposure to stigmatizing healthcare encounters. SETTING: Kampala, Uganda. METHODS: We conducted a secondary analysis of the Empower study (NCT03426670), an open-label randomized trial in which 117 cisgender female, transgender female, and cisgender male sex workers were assigned 1:1 to monthly HIVST plus quarterly clinic-based testing, or to quarterly clinic-based testing alone, and followed for 12 months. Self-esteem (Rosenberg Self-Esteem Scale), depressive symptoms (PHQ-2), alcohol misuse (RAPS4), perceived sex work stigma (adapted Female Sex Worker Stigma Scale), and empowerment were assessed quarterly. Mixed-effects regression models, adjusted for baseline values, evaluated intervention effects. RESULTS: Data from 117 participants were analyzed, including 7 early disenrollments. Over 12 months, HIVST participants reported significantly lower perceived sex work stigma than standard of care participants (β = -0.38, P = 0.04; monthly reduction P = 0.003), although the rate of decline did not differ significantly between arms (interaction P = 0.08). Self-esteem and depressive symptoms improved in both arms, with no between-arm differences (interaction P = 0.41 and 0.32). Alcohol misuse and empowerment showed no significant arm differences. CONCLUSION: HIVST may reduce sex work stigma without adverse psychosocial effects, supporting its integration into combination HIV prevention for gender-diverse sex workers in sub-Saharan Africa.
Humans↗
HIV prevalence and risk behavior among injecting drug users who participate in "low-threshold" methadone programs in Amsterdam.
INTRODUCTION: After the onset of the HIV epidemic, the hope arose that the "harm reduction" approach of the Amsterdam "low-threshold" methadone programs would have a function in controlling the spread of HIV among injecting drug users (IDUs). METHODS: To find evidence for this assumption, 386 IDUs participating in an HIV study between 1985 and 1989 were studied. Long-term regular participants in low-threshold methadone programs were compared with short-term and/or irregular participants. RESULTS: Controlling for possible confounders, long-term regular participants had a slightly increased but not statistically significant risk of being HIV infected. With regard to current drug use, they injected daily and shared needles as often as did short-term and/or irregular participants. CONCLUSIONS: The results suggest that the Amsterdam low-threshold methadone programs fail to diminish HIV risk behavior. If these programs want to have a positive effect on the spread of HIV, expansion of existing HIV prevention efforts, an increase in the daily methadone dose level, and measures to enforce regular attendance may be required.
Adolescent↗
HIV counseling and testing services from public and private providers--United States, 1990.
Human immunodeficiency virus (HIV) counseling and testing (CT) services are key elements of the national HIV-prevention strategy (1,2). Although the number and characteristics of persons receiving CT through publicly funded programs are monitored by CDC's CT data system (3), this system does not provide information about persons tested for HIV antibody by physicians in the private sector, hospitals, and other nonpublicly funded sources. This report summarizes data from CDC's 1990 National Health Interview Survey (NHIS) AIDS Supplement (4) regarding CT received from public and private providers.
Adolescent↗
Publicly funded HIV counseling and testing--United States, 1991.
Human immunodeficiency virus (HIV) counseling and testing (CT) services provided by health departments are a major component of the national HIV-prevention program. The purpose of HIV CT is to 1) reinforce perception of risk by those who are unaware or uninformed, 2) help uninfected persons initiate and sustain behavior changes that reduce their risk for becoming infected, and 3) identify HIV-infected persons who can be referred for early medical care and counseled to practice safer behaviors. The use of publicly funded HIV CT has steadily increased; in 1991, nearly 2,091,000 HIV-antibody tests were performed, compared with approximately 79,000 tests in 1985. CT services are provided by health departments in 65 HIV-prevention project areas including the 50 states, the District of Columbia, six cities, and eight territories. Each calendar quarter, the programs report to CDC data regarding the number of pretest counseling sessions. HIV-antibody tests, positive tests, and posttest counseling sessions. Information is also provided on self-reported risk category, age group, sex, and race/ethnicity. This report summarizes data reported for 1991.(ABSTRACT TRUNCATED AT 250 WORDS)
AIDS Serodiagnosis↗
Unannounced simulated patients' observations of physician STD/HIV prevention practices.
Studies describing sexually transmitted disease (STD) and human immunodeficiency virus (HIV) prevention practices of primary care physicians have relied on physician or patient reports. This study describes physician STD/HIV prevention practices as observed by unannounced simulated patient evaluators (SPEs). SPEs visited sixty-five primary care physicians. Each SPE portrayed a sexually active female, new to the area, requesting a consultation on STD prevention. One-third of the physicians in the study asked no risk questions, and over 80% failed to ask the SPE specifically about her sexual practices. Most physicians discussed the risks of STDs and HIV and covered basic recommendations (use condoms and know partners better); however, few physicians provided any individualized information or advice about safer sexual practices and the specifics of condom use, such as how to use them or what kind to use. These observations support the low rates of STD/HIV prevention indicated in physicians' self-report and further identify specific deficiencies in the thoroughness of their risk assessment and preventive counseling practices.
Adult↗