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Sexual risk reduction behaviors among young heterosexual adults.

Although young, sexually-active heterosexuals have always been at risk for contracting sexually transmitted diseases, the recent appearance of Acquired Immunodeficiency Syndrome (AIDS) has increased the possible peril of sexual experimentation. Currently, behaviors to reduce the risk of contracting AIDS are being widely advocated. The present study examines predictors of self-reported risk reduction behaviors in a sample of 188 young, sexually-active heterosexuals. Three factors (perceptions of personal vulnerability, sexual behaviour history, and homophobia) were hypothesized to predict levels of worry about contracting a sexually transmitted disease. Worry, in turn, was hypothesized to predict behavior change. Structural equation modeling provided support for these predictions, but found somewhat different patterns for women and men. For both sexes, higher levels of worry were a significant predictor of risk reduction behavior implementation. For women only, more extensive sexual behavior histories significantly predicted levels of worry. In contrast, for men only, perceptions of personal vulnerability and homophobia were significant predictors of worry. Results suggest that gender plays an important role in understanding cognitive predictors of sexual risk reduction behaviors.

Acquired Immunodeficiency Syndrome

Psychosocial predictors of gay men's AIDS risk-reduction behavior.

Used psychosocial variables derived from the health belief model (Rosenstock, 1974), Bandura's (1986) self-efficacy framework, and protection motivation theory (Rogers, 1984) to predict self-reported AIDS risk-reduction behaviors in a sample of 389 homosexual men who participated in the Multicenter AIDS Cohort Study in Los Angeles and who knew their HIV antibody status. Hierarchical multiple regression analyses showed that self-efficacy, perceived risk, response efficacy, and prior sexual behavior accounted for approximately 70% of the variance in the total number of sexual partners and the number of anonymous partners over a 6-month interval, controlling for demographic variables, HIV antibody status, and presence of a primary partner. A logistic regression analysis showed that barriers to change predicted increased unprotected anal receptive intercourse over a 6-month interval, controlling for prior behavior. The relation of health beliefs to risk-reduction behavior was substantially different for HIV-seropositive men without primary partners than for other groups of gay men. Implications for interventions are discussed.

Acquired Immunodeficiency Syndrome

HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis.

BACKGROUND AND PURPOSE: Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population. METHODS: We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities. RESULTS: In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time. CONCLUSIONS: Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection.

Community Participation

Osteoporosis risk assessment of mature working women: primary and secondary prevention strategies.

1. Occupational health nurses have a prime opportunity to promote a healthy and stable population of working women through teaching osteoporosis risk reduction behaviors and conducting periodic osteoporosis risk assessments. 2. Health teaching about osteoporosis prevention is needed to foster health promotion and risk reduction behaviors among pre-, peri-, and postmenopausal women to lessen the incidence of fractures and secondary consequences. 3. By incorporating primary and secondary prevention strategies into occupational health nursing practice, great strides can be made in guiding women to initiate osteoporosis prevention behaviors to promote a more healthy and less restrictive lifestyle in later years.

Female

Relapse from safer sex: the next challenge for AIDS prevention efforts.

Prevention campaigns to reduce sexual transmission of human immunodeficiency virus (HIV) typically emphasize the initial adoption of safer sex techniques. We present data from a 5-year prospective study to show that the vast majority of resident gay men in San Francisco have made these initial risk reductions. Rather, relapse from safer sex techniques is now the predominant predominant kind of high-risk sex, accounting for approximately two thirds of all prevalent high-risk sex in the 1988 wave of data collection. Predictors of relapse from safer sex are identified, and these are discussed in terms of their implications for preventing relapse from the exclusive practice of safe sex. In communities that have already manifested widespread behavioral risk reductions and in which HIV infection is highly prevalent, finding ways to prevent relapse of behavioral risk reductions will be the next important challenge in the fight against acquired immune deficiency syndrome.

Acquired Immunodeficiency Syndrome

Caring for women at risk of HIV infection.

HIV infection and AIDS are having a major and growing impact on women's lives. In addition to the usually described risk behaviors, many other medical or behavioral factors should prompt physicians to offer HIV counseling and testing. These include unusual or difficult-to-treat gynecologic conditions, unexplained vague systemic symptoms, and most sexually transmitted diseases. Use of alcohol and crack cocaine can be associated with a higher risk of HIV infection because of decreased risk reduction behaviors. The authors discuss the barriers to risk reduction among women deriving from their unequal social roles in relation to men and provide specific and detailed guidelines for counseling and educating women about HIV infection.

AIDS Serodiagnosis

The attitude-practice gap revisited: risk reduction beliefs and behaviors among owners of residential swimming pools.

Complete pool fencing and effective bystander resuscitation are both believed to reduce the risk of childhood drowning. The relationship between support for, and prevalence of, a complete pool barrier and current cardiopulmonary resuscitation certification was investigated among an equal probability sample of 795 owners of residential swimming pools in Sacramento County, California. Only 50% (95% confidence interval [CI] 44%, 56%) of respondents who favored a cardiopulmonary resuscitation certification requirement for pool owners represented a household with any members so certified. Only 35% (95% CI 26%, 44%) of respondents who endorsed a complete barrier requirement for all pools had a fence surrounding their own pool. Support for a cardiopulmonary resuscitation requirement was associated with a modestly higher prevalence of current cardiopulmonary resuscitation certification (46% vs 33%, difference = 13%, 95% CI for difference 2%, 24%). Endorsement of a pool barrier requirement was associated with a substantially higher prevalence of complete pool fencing (35% vs 7%, difference = 28%, 95% CI for difference 19%, 37%). The proportion of the pool-owning population endorsing these risk reduction behaviors is much larger than the proportion actually adopting them. The results suggest that an effective pool drowning-prevention program will rely primarily on legislative approaches, with health education serving as a useful adjunct.

Attitude

Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public school sample in San Francisco.

Data collected from incarcerated youth (n = 113) and a public school sample (n = 802) demonstrate that both adolescent groups have a high level of AIDS knowledge. Incarcerated youth are less aware of HIV risk-reduction behaviors and report markedly higher rates of HIV risk behaviors. Incarcerated youth are at substantially increased risk of HIV infection relative to their school-based counterparts and should be a primary target of HIV prevention programs.

Acquired Immunodeficiency Syndrome

Drug use and AIDS risks in a soup kitchen population.

Untreated substance users remain beyond the reach of most acquired immune deficiency syndrome (AIDS) prevention efforts. In an effort to describe the risk behavior and attitudes of this population, the authors conducted interviews with 148 drug users in an urban soup kitchen. The study focused on subjects' risk-taking and risk-reduction behavior related to injection drug use, perceived changes in risk behavior, perceived risk for contracting AIDS, and socioeconomic and attitudinal correlates of injecting and sharing needles. Study findings underscore the need for community-based AIDS prevention strategies to intervene with high-risk populations beyond the reach of drug treatment and AIDS prevention programs.

AIDS Serodiagnosis

Psychological and behavioral impact among intravenous drug users of learning HIV test results.

In 1984 as part of a New York City study to examine the prevalence of HIV infection in a substance-abusing population and to test the validity of HIV screening kits, 94 patients at the New York VAMC were tested. Results were made available to 50 (35 seronegative, 15 seropositive) patients in January 1986. Psychological and behavioral impact of learning test results was assessed using standardized psychiatric rating scales. A comparison group of 31 nontested subjects were also evaluated. Ratings were done preresults, approximately 1-2 weeks after results, and 8-10 weeks after informing patients of their HIV status. No major stress reactions were observed. Seropositives experienced a higher level of anxiety 1-2 weeks after learning results but anxiety generally diminished; they made significant behavior changes which were maintained. Seronegatives experienced relief and maintained IV drug risk reduction behavior. Anxiety about contracting AIDS increased in nontested subjects as the study progressed.

AIDS Serodiagnosis

University students and AIDS: knowledge, attitudes and behavioral adjustment.

This study addresses the relations between AIDS-related knowledge, attitudes, and behavior change among university students. A questionnaire covering such issues and personal background variables was administered to 750 students at the University of Zagreb. Over-all, 62.7% of the knowledge items were answered correctly, while functional, self-protective aspects of knowledge proved to be much better than general knowledge. On the average, attitudinal responses were moderately liberal. Both self-reported change in risk-reduction behavior and personal concern due to the appearance of AIDS were very small. Correlations of risk-reducing behavior with permissive (.15) and restrictive (.14) attitude orientations and with general and functional knowledge (.08) were modest. The level of personal concern correlated neither with permissive attitudes nor with functional knowledge, while it correlated negatively with restrictive attitudes (-.20) and with general knowledge (-.08). Substantial association was only established between functional knowledge and permissive (.51) and restrictive attitude orientations (-.23). It is concluded that, in addition to knowledge and attitudes, a number of factors which restrain desired behavioral adjustment should be considered in anti-AIDS campaigns, such as perceived level of exposure to HIV in a particular environment, young age-specific illusion of invulnerability, peer norms, and others.

Acquired Immunodeficiency Syndrome

Prior episode of sexually transmitted disease and subsequent sexual risk-reduction practices. A need for improved risk-reduction interventions.

Persons with a history of a sexual transmitted disease (STD) are at increased risk for infection with human immunodeficiency virus (HIV). The extent to which women with a previous history of a STD report currently practicing protective behaviors against STD transmission is examined. Specifically, whether having experienced one or more previous episodes of an STD was related to current STD/HIV preventive practices was studied. Of the study group, 36% had at least one prior STD episode. Results of bivariate analysis show no relationship between previous STDs and current STD/HIV preventive practices: 47% of women with no previous STD episode, 64% of women with 1 previous episode, and 46% of women with 2 or more previous STD episodes reported currently practicing moderate to high levels of STD/HIV prevention methods. To adjust for potentially confounding variables, logistic regression analyses were also performed. The logistic regression model included age, alcohol use with sex, drug use with sex, marital status, and perceived risk of becoming infected with an STD in the next year. Results from the logistic regression analyses also showed no relationship between prior STD episode and current level of preventive practices against STD/HIV. Variables found to be significantly associated with level of STD/HIV preventive practices were marital status, age, and drug use with sex. These findings suggest that greater advantage should be taken of the opportunities presented when women are diagnosed with an STD to teach individuals at risk of acquiring STDs or HIV to practice risk-reduction behaviors.

Adolescent

Knowledge about and behaviors affecting the spread of AIDS: a street survey of intravenous drug users and their associates in New York City.

An informal survey of knowledge about and behaviors relevant to the spread of AIDS was conducted on the street in New York City during October 1986. The sample (n = 204) includes IV drug users (60%) and others (40%). The informal nature of the interview suggests that respondents gave "salient" answers rather than the complete answers that would be expected in a formal interview situation. A smaller proportion of respondents reported salient knowledge about drug-related transmission of AIDS than had been found in other populations, using formal interview methods. A close association was found between any accurate knowledge about spread of AIDS and likelihood of practicing one or more risk reduction behaviors. New users (persons who had been using drugs for only 1 or 2 years) were significantly less likely than others to have salient knowledge about AIDS transmission and also less likely to practice risk reduction measures.

Acquired Immunodeficiency Syndrome

Longitudinal sexual behavior changes in injecting drug users.

OBJECTIVE: To determine whether injection drug users (IDU) maintained sexual behavior risk reduction over an 18-month period that had been noted previously over a 4-month period. DESIGN: A repeated measures design was utilized with IDU assessed initially at study enrollment and again 18 months later. METHODS: Sexual behaviors of a group of 220 IDU (148 men and 72 women) were assessed by a structured interview at the start of an AIDS prevention project and again 18 months later. RESULTS: Having multiple sex partners during the 12 months before initial assessment was reported by 42.6% of the men and 35.7% of the women. Significantly fewer had multiple sex partners during the 10 months before follow-up assessment (men, 20.9%; women, 14.3%). Condom use for vaginal intercourse increased from a mean of 11.9% initially to 27.8% at follow-up for men. The increase in condom use was greater for those with multiple sex partners. Women did not report significant increases in condom use. Continued involvement in unsafe sexual behaviors was associated with exchanging sex for money or drugs, using drugs to help meet sexual needs, alcohol use and drug use. CONCLUSIONS: Risk reductions noted previously were maintained over 18 months for the majority of the sample. Drug-use treatment and interventions that closely examine the interplay between drug use and sexuality for individual IDU are recommended as strategies to further reduce the sexual risk of HIV transmission among IDU.

Adult

Strategies for AIDS prevention: leadership training and peer counseling for high-risk African-American women in the drug user community.

A culturally congruent training program to promote HIV risk-reduction behaviors was implemented in a convenient sample of 9 African-American women in an urban methadone treatment program. At each of eight peer counseling and leadership training (PCLT) program sessions, the transmission and prevention of AIDS were discussed while emphasizing enhancement of participants' self-esteem, confidence, and control over high-risk behaviors. The results indicate that support of the women helped develop their sense of purpose and self-worth, reduced sexual and drug use practices associated with risk for HIV and AIDS infection, and promoted assumption of leadership roles and dissemination of accurate AIDS-related information in their communities. It was apparent that knowledge alone does not change behavior if it conflicts with established norms, values, beliefs, and life-styles and that individuals who have a sense of personal control are more willing to explore alternative lower-risk behaviors.

Acquired Immunodeficiency Syndrome

New Jersey high school students' knowledge, attitudes, and behavior regarding AIDS.

In 1988 a questionnaire was administered to 1,793 urban and suburban New Jersey high school students to survey their knowledge, attitudes, and behavior related to the acquisition of acquired immunodeficiency syndrome (AIDS). Knowledge about the disease was high, but exaggeration of risk from social contacts was common. Although fear was associated with misperceptions, it was not always dispelled by knowledge. Nearly half (49%) of all participants reported having used condoms, indicating that condom use is somewhat familiar and acceptable to them. Over 80% thought that condoms offer some protection against AIDS. However, knowledge did not always result in recognition or practice of risk-reduction behaviors. Student suggestions for slowing the spread of AIDS stressed personal responsibility and education. Follow-up assemblies that used survey results to address gaps in knowledge appeared necessary to counter misperceptions that might have arisen from the survey.

Acquired Immunodeficiency Syndrome

Risk reduction in sexual behavior: a condom giveaway program in a drug abuse treatment clinic.

Just before and 4 months after initiation of a condom giveaway program, a questionnaire regarding sexual behavior and condom acquisition was administered to 103 men attending an outpatient drug abuse treatment clinic. Jars filled with a variety of condoms were placed in every clinic room. Condom taking varied as a function of room. Sixty percent of the subjects reported taking condoms. At follow-up, clients reported increases in condom possession and in use of condoms for vaginal intercourse.

Acquired Immunodeficiency Syndrome