The Association of HIV Stigma and HIV/STD Knowledge With Sexual Risk Behaviors Among Adolescent and Adult Men Who Have Sex With Men in Ghana, West Africa.

Ghanaian men who have sex with men (MSM) have a high HIV seroprevalence, but despite a critical need to address this public health concern, research evidence has been extremely limited on influences on sexual risk behavior among MSM in Ghana. To investigate associations between HIV/STD knowledge, HIV stigma, and sexual behaviors in a sample of MSM in Ghana, we conducted a secondary data analysis of cross-sectional survey data from a non-probability sample of Ghanaian MSM (N = 137). Nearly all the men (93%) had more than one current sex partner (M = 5.11, SD = 7.4). Of those reported partners, the average number of current female sexual partners was 1.1 (SD = 2.6). Overall, knowledge levels about HIV and STDs were low, and HIV stigma was high. There was no age-related difference in HIV stigma. Younger MSM (≤25 years) used condoms less often for anal and vaginal sex than did those over 25. Relative frequency of condom use for oral sex was lower in younger men who had higher STD knowledge and also was lower in older men who reported high HIV stigma. Knowledge and stigma were not associated with condom use for anal or vaginal sex in either age group. These descriptive data highlight the need for the development of intervention programs that address HIV/STD prevention knowledge gaps and reduce HIV stigma in Ghanaian communities. Intervention research in Ghana should address age-group-specific HIV prevention needs of MSM youth.

Identifying subgroups of care providers participating in a telehealth educational intervention: hierarchical cluster analysis of evaluation data.

UNLABELLED: Health care providers (HCPs) serving HIV-infected patients, especially in rural and underserved areas, have limited access to continuing medical education. OBJECTIVES: To identify subgroups of HCPs who might benefit from a telehealth training program focusing on HIV/AIDS care based on HCPs' objective for attending the training. METHODS: Hierarchical cluster analysis combined with thematic analysis identified the subgroups. RESULTS: A total of 56 HCPs attended between 1 and 9 of the 12 sessions conducted (mean ≈ 2, standard deviated = 1.6). Subgroups identified included knowledge (HCPs interested in gaining, increasing, or updating their knowledge in HIV care), learn-expert (HCPs interested in learning, obtaining, or providing expert opinion), and observe-apply-network (HCPs interested in observing the training, applying knowledge gained to practice, and networking). No group difference were found in the participants' reaction to the session, change in knowledge following the training, and other important characteristics. CONCLUSION: Methodological contributions of the study are discussed.

Predictors of condom use among peer social networks of men who have sex with men in Ghana, West Africa.

Ghanaian men who have sex with men (MSM) have high rates of HIV infection. A first step in designing culturally relevant prevention interventions for MSM in Ghana is to understand the influence that peer social networks have on their attitudes and behaviors. We aimed to examine whether, in a sample of Ghanaian MSM, mean scores on psychosocial variables theorized to influence HIV/STI risk differed between peer social networks and to examine whether these variables were associated with condom use. We conducted a formative, cross-sectional survey with 22 peer social networks of MSM (n = 137) in Ghana. We assessed basic psychological-needs satisfaction, HIV/STI knowledge, sense of community, HIV and gender non-conformity stigmas, gender equitable norms, sexual behavior and condom use. Data were analyzed using analysis of variance, generalized estimating equations, and Wilcoxon two sample tests. All models were adjusted for age and income, ethnicity, education, housing and community of residence. Mean scores for all psychosocial variables differed significantly by social network. Men who reported experiencing more autonomy support by their healthcare providers had higher odds of condom use for anal (AOR = 3.29, p<0.01), oral (AOR = 5.06, p<0.01) and vaginal (AOR = 1.8, p<0.05) sex. Those with a stronger sense of community also had higher odds of condom use for anal sex (AOR = 1.26, p<0.001). Compared to networks with low prevalence of consistent condom users, networks with higher prevalence of consistent condom users had higher STD and HIV knowledge, had norms that were more supportive of gender equity, and experienced more autonomy support in their healthcare encounters. Healthcare providers and peer social networks can have an important influence on safer-sex behaviors in Ghanaian MSM. More research with Ghanaian MSM is needed that considers knowledge, attitudes, and norms of their social networks in the development and implementation of culturally relevant HIV/STI prevention intervention strategies.

Job-related osteoarthritis of the knee, foot, hand, and cervical spine.

OBJECTIVES: To assess the influence of occupational exposures on risk of site-specific radiographic osteoarthritis (OA) of the knee, hand, foot, and cervical spine. METHODS: Using a cross-sectional design, data collected from men and women aged 40 years and older participating in the Clearwater Osteoarthritis Study were analyzed (n = 3436). Subjects' occupational exposures were queried using the study intake form, including stair climbing, standing on a rigid surface, squatting, and jolting. Physical examinations including radiographs of the knee, hand, foot, and cervical spine were conducted. The Kellgren and Lawrence ordinal scale was used to determine evidence of radiographic OA. RESULTS: Both the unadjusted and adjusted odds ratios (ORs) for men and women indicated that age and body mass index were associated with OA. There were no other significant odds ratios for the cervical spine. Among men, there were significant associations with knee OA for stair climbing and jolting of the legs and with foot OA with stair climbing. Among women, there was a significant association between standing on a rigid surface and knee OA. For hand OA in women, there was a significant association for jolting of the hands. CONCLUSIONS: Although the association with stair climbing was found in other investigations for knee OA, it was also associated with foot OA in this study. In addition, the jolting feature was seen in only one other study for men (knees) and novel for women (hands).

Risk factors for occupational osteoarthritis: a literature review.

Sixteen articles published between 1987 and 2008 regarding work-related activities as risk factors for osteoarthritis of the knee, hand, foot, hip, and cervical spine were chronologically reviewed. Despite challenges (e.g., nonresponse bias, inadequate sample size, and retrospective exposure assessment), the review findings indicated a strong relationship between physical strain experienced while performing physically demanding jobs and the incidence of osteoarthritis. This conclusion informs occupational health nurses' work and design of work policies.