Emotional intimacy predicts condom use: findings in a group at high sexually transmitted disease risk.

Previous studies have reported an inverse relationship between condom use and emotional intimacy. The aim of this study was to determine the relationship between condom use and emotional intimacy. The study was a gonorrhoea case-comparison study with the samples being drawn from public health clinics (cases) and select bars/nightclubs (places) of Houston, TX (n = 215). Data were collected by questionnaires administered on a laptop computer. The majority of respondents were African-American (97.7%), women (69.3%) and had either high school or GED education (72.6%). Condom use with the last sexual partner was analysed along with intimacy with that partner assessed on a 3-point scale. Analysis showed that higher intimacy was related to greater condom use which was significant in men but not in women. In conclusion, these data were opposite to those of previous studies, which showed an inverse relationship between condom use and emotional intimacy. We hypothesize that in a high-risk environment, people exert more effort in protecting those they feel closer to. These data suggest a need to further explore the complex relationship between emotional intimacy and condom use.

How to contain generalized HIV epidemics? A plea for better evidence to displace speculation.

In the worst generalized HIV epidemics in East and Southern Africa, from one-quarter to three-quarters of women aged 15 years can expect to be living with HIV or to have died with AIDS by age 40 years. This disaster continues in the face of massive HIV prevention programmes based on current inexact knowledge of HIV transmission pathways and risks. To stop this disaster, both the public and public health experts need better information about the specific factors that allow HIV to propagate so extensively in countries with generalized epidemics. This knowledge could be acquired by tracing HIV infections to their source - especially tracing HIV infections in women of all ages, and tracing unexplained HIV infections in children with HIV-negative mothers.

A study on HIV and hepatitis C virus among commercial sex workers in Tallinn.

INTRODUCTION: Estonia is confronted by a dramatic expansion of the initially injection drug use-driven HIV epidemic. Little is known about HIV occurrence in population groups at high risk other than injection drug users. OBJECTIVE: To obtain data on the prevalence of HIV and hepatitis C virus (HCV) among female sex workers (FSW) in Tallinn. DESIGN: An unlinked, anonymous, cross-sectional survey of FSW recruited in Tallinn from October 2005 to May 2006. METHODS: 227 FSW were recruited for the survey and biological sample collection (HIV, HCV antibodies detection) using a combination of time-location, community and respondent-driven sampling. RESULTS: Among 227 women the HIV and HCV prevalences were 7.6% (95% CI 4.6% to 12.5%) and 7.9% (95% CI 4.5% to 12.6%), respectively. HIV prevalence was higher among FSW working in the street (odds ratio (OR) 6.4; 95% CI 1.1 to 35.6) and at the brothels and apartments supervised by the organised sex industry (OR 5.0; 95% CI 1.3 to 18.4). The duration of sex work was negatively associated with HIV prevalence (OR 0.78; 95% CI 0.63 to 0.97). CONCLUSIONS: Prevention needs of FSW in this area include increasing rates of HIV testing and putting in place effective programmes that can help extend HIV prevention behaviours across a range of sexual and drug use risk behaviours.

Process, efficacy and sample demographics of three approaches to behavioural surveillance for gonorrhoea: case interviews, place surveys, and network studies.

We investigated the process and time required to collect 450 interviews in a project to determine the most efficacious behavioural surveillance approaches to detect changes in gonorrhoea prevalence. In total, 150 respondents were recruited in each method. For each of place surveys (bars), gonorrhoea case interviews, and network studies based on seeds from the case and place interviews, we determined the recruitment rate and process. Urine testing for gonorrhoea and chlamydia took place in the place interviews. We present data from Houston, Texas that illustrate the sample characteristics, recruitment rates, and, where appropriate, infection rates. Data indicate that there was high uptake and a rapid recruitment rate from the place surveys, an intermediate rate from the network studies, and that the gonorrhoea case interviews were the most inefficient accrual method for behavioural surveillance. Sample characteristics and biases in each method are described, and conclusions drawn for the relative efficacy of each method for gonorrhoea behavioural surveillance.

Sex work, drug use, HIV infection, and spread of sexually transmitted infections in Moscow, Russian Federation.

Rates of HIV-1 infection are growing rapidly, and the epidemic of sexually transmitted infections is continuing at an alarming rate, in the Russian Federation. We did a cross-sectional study of sexually transmitted infections, HIV infection, and drug use in street youth at a juvenile detention facility, adults at homeless detention centres, and women and men at a remand centre in Moscow. 160 (79%) women at the remand centre were sex workers. 91 (51%) homeless women had syphilis. At least one bacterial sexually transmitted infection was present in 97 (58%) female juvenile detainees, 120 (64%) women at the remand centre, and 133 (75%) homeless women. HIV seroprevalence was high in women at the remand centre (n=7 [4%]), adolescent male detainees (5 [3%]), and homeless women (4 [2%]). In view of the interaction between sexually transmitted infections and HIV infection, these findings of high prevalence of sexually transmitted infections show that these disenfranchised populations have the potential to make a disproportionately high contribution to the explosive growth of the HIV epidemic unless interventions targeting these groups are implemented in the Russian Federation.

Factors associated with HIV prevalence in a pre-partum cohort of Zambian women.

An ongoing study of mother-to-child human herpes virus-8 (HHV-8) transmission in Zambian women (n = 3160) allowed us to examine the association of medical injections with HIV serostatus while simultaneously accounting for other factors known to be correlated with HIV prevalence. Multi-method data collection included structured interviews, medical record abstraction, clinical examinations, and biological measures. Medically administered intramuscular or intravenous injections in the past five years (but not blood transfusions) were overwhelmingly correlated with HIV prevalence, exceeding the contribution of sexual behaviours in a multivariable logistic regression. Statistically significant associations with HIV also were found for some demographic variables, sexual behaviours, alcohol use, and sexually transmitted diseases (STD). The results confirmed that iatrogenic needle exposure, sexual behaviour, demographic factors, substance use, and STD history are all implicated in Zambian women's HIV+ status. However, the disproportionate association of medical injection history with HIV highlights the need to investigate further and prospectively the role of health-care injection in sub-Saharan Africa's HIV epidemic.

Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection.

Whereas some people appear to cope after learning that they have human immunodeficiency virus (HIV) infection, others experience depression and suicidal ideation. In this study, 142 persons with HIV infection were administered the Center for Epidemiological Studies Depression Scale (CES-D). High levels of depression were predicted by lower perceived social support, attributions that health was influenced more by chance, high-risk sexual behavior practices, and greater number of HIV illness symptoms and greater duration of time knowing of one's own positive serostatus. Ongoing high-risk sexual behavior practices were predicted by higher levels of recreational drug use and of depression. These findings highlight the need for improved mental health services for persons with HIV conditions.

African-American adolescents' knowledge, health-related attitudes, sexual behavior, and contraceptive decisions: implications for the prevention of adolescent HIV infection.

African-American adolescents (N = 195) completed measures of knowledge related to acquired immunodeficiency syndrome (AIDS), attitudes toward condoms, health locus of control, vulnerability to human immunodeficiency virus (HIV) infection, peer sexual norms, personal sexual behavior for the past 6 months, and contraceptive preferences. Hotelling's T2 tests revealed that girls were more knowledgeable about AIDS, reported fewer sexual partners, held more positive attitudes toward precautionary sexual behavior, and perceived themselves to have greater self-control than boys. Five variables accounted for 44% of the variance in condom use: condom use from the 1st intercourse occasion, earlier grade in school, lower belief in an external locus of control, and higher scores on the Effect on Sexual Experience and Self-Control subscales of the Condom Attitude Scale. Implications for the content, format, and timing of HIV prevention with African-American adolescents are discussed.

PIP: Samples of adolescents in the US which suggest that HIV seroprevalence is climbing affirm the at-risk status of youths for HIV infection. Minority and disadvantaged youths are at even greater overall risk within the general national population of youths. Adolescent HIV infection probably accounts for thousands of current AIDS cases and 75,000 adolescents are estimated to already be infected with HIV. Despite the fact that more than half of all adolescents in the US are sexually active. they accept condoms less than adults. Reported rates of sexual activity among minority adolescents are as high as 80%, with African-American youths being disproportionately represented among AIDS and HIV cases diagnoses in youths. To gain some insight into this community, 195 African-Americans of mean age 15.3 years and average grade in school 9.6 were recruited in the southeast US from a public health service-funded clinic, community-based teen centers and after school programs, and the waiting room of a family service agency to complete measures of knowledge reacted to AIDS, attitudes toward condoms, health locus of control, vulnerability to HIV infection, peer sexual norms, personal sexual behavior over the previous 6 months and contraceptive preferences. 82% of the sample received Medicaid; 70% reported being sexually active and first intercourse occurred at the average ate of 11.7 years. Girls were found to be more knowledgeable about AIDS, reported fewer sexual partners, held more positive attitudes toward precautionary sexual behavior, and perceived themselves to have greater self-control than boys. The following variables accounted for 44% of the variance in condom use: condom use from the first intercourse occasion, earlier grade in school, lower belief in an external locus of control, and higher scores on the Effect on Sexual Experience and Self-Control subscales of the Condom Attitude Scale. Implications for the content, format, and timing of HIV prevention among these adolescents are discussed.

Predictors of vulnerability to AIDS risk behavior relapse.

Sixty-eight gay men who earlier attended AIDS prevention sessions were longitudinally followed for 16 months and categorized as successful or unsuccessful in change maintenance. Psychological and behavioral data obtained prior to entry in the prevention program were used as variables to predict long-term change. Resumption of high-risk sexual practices was associated with younger age, earlier history of frequent unprotected receptive anal intercourse with multiple partners, greater number of past sex partners, reinforcement value levels of high-risk practices and condom use, intoxication preceding sex, lower scores on a depression measure, greater belief that HIV infection is largely determined by external factors such as chance or luck, and homosexuality "outness." Discriminant analysis revealed that 86% of Ss could be classified as relapsers or change-maintainers on the basis of these variables. Prevention implications are discussed.

PIP: The longitudinal research study of 68 gay men from a Southern town in 1987 was able to successfully identify 86% of those who were likely to relapse in unprotected anal intercourse. The men were followed 16 months after receiving 12 AID's health risk reduction sessions. The mean age of the population was 32.7 years; 945 were white and 6% African-Americans or Hispanics. Multivariate discriminant analysis was used to identify the relative magnitude of each predictor variables contribution (minimum coefficient of + or - .30). Predictor variables included demographic data and sexual risk behaviors which the subject ranked by the degrees of pleasure on a 4 point scale. Also included were the role of intoxication in sexual behavior, the Beck Depression Inventory, the State Trait Anxiety Inventory, the Health Locus of Control Scale (HLOC), and the AID's Risk Behavior Knowledge Scale. Role plays involving each subject were rated by 2 judges on the overall skill in resisting coercive sexual pressures. After 16 months, 41 reported no occurrence of unprotected anal sex during the preceding 16 months and 27 reported some occurrence, of which the mean frequency was 5.9 occurrences in the preceding 4 months. The relapse population tended to be younger and more out about their homosexuality. The number of sexual partners, use of intoxicants with sex, and frequency of unprotected receptive anal intercourse were the strongest predictors. These predictors were the same for the relapsed men before the risk reduction sessions. These relapsed men also reported lower depression levels and higher scores on HLOC. Similar to cigarette smoking, resuming risk behavior was related to the strength, frequency, and reinforcement value level of past behavior. Outness may be related to frequency of sexual contact and HLOC to beliefs that luck, fate, or other determine risk. Serostatus data was not collected. The limitation of this study was that situational dimensions such as the environment, cognitive, affective, and interpersonal patterns were relevant but not included. Identification of such factors is a needed future research objective.

Behavioral intervention to reduce AIDS risk activities.

Behavior change can curtail the spread of acquired immune deficiency syndrome (AIDS). In this study, 104 gay men with a history of frequent AIDS high-risk behavior completed self-report, self-monitoring, and behavioral measures related to AIDS risk. The sample was randomly divided into experimental and waiting-list control groups. The experimental intervention provided AIDS risk education, cognitive-behavioral self-management training, sexual assertion training, and attention to the development of steady and self-affirming social supports. Experimental group participants greatly reduced their frequency of high-risk sexual practices and increased behavioral skills for refusing sexual coercions, AIDS risk knowledge, and adoption of "safer sex" practices. Change was maintained at the 8-month follow-up.

Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents.

Substance-dependent adolescents (N = 34) in a residential drug treatment facility received either a 6-session behavior skills training HIV-risk reduction intervention or standard HIV education. After the intervention, adolescents who received behavior skills training exhibited increased knowledge about HIV-AIDS, more favorable attitudes toward prevention and condom use, more internal locus of control, increased self-efficacy, increased recognition of HIV risk and decreases in high-risk sexual activity. Self-report data were corroborated by records for the treatment of sexually transmitted diseases. The results from this pilot demonstration effort suggest that skills training based on cognitive-behavioral principles may be effective in lowering high-risk adolescents' vulnerability to HIV infection and warrant evaluation in a controlled comparison with a larger sample.

HIV risk reduction for incarcerated women: a comparison of brief interventions based on two theoretical models.

Although female inmates are seropositive at rates that exceed those of male inmates, few studies, have evaluated HIV risk reduction interventions for incarcerated women. This demonstration project compared an intervention based on social cognitive theory against a comparison condition based on the theory of gender and power. Incarcerated women (N = 90) were assessed at baseline, postintervention, and again 6 months later. Both interventions produced increased self efficacy, self-esteem, Attitudes Toward Prevention Scale scores, AIDS knowledge, communication skill, and condom application skills that maintained through the 6-month follow-up period. Participants in the intervention based on social cognitive theory showed greater improvement in condom application skills, and women in the program based on the theory of gender and power evidenced greater commitment to change. The results suggests brief interventions in prison settings are feasible and beneficial. However, it is not yet known whether the changes will generalize into the natural environment after the women's release into the community.

Cognitive-behavioral intervention to reduce African American adolescents' risk for HIV infection.

Two hundred forty-six African American adolescents were randomly assigned to an educational program or an 8-week intervention that combined education with behavior skills training including correct condom use, sexual assertion, refusal, information provision, self-management, problem solving, and risk recognition. Skill-trained participants (a) reduced unprotected intercourse, (b) increased condom-protected intercourse, and (c) displayed increased behavioral skills to a greater extent than participants who received information alone. The patterns of change differed by gender. Risk reduction was maintained 1 year later for skill-trained youths. It was found that 31.1% of youths in the education program who were abstinent at baseline had initiated sexual activity 1 year later, whereas only 11.5% of skills training participants were sexually active. The results indicate that youths who were equipped with information and specific skills lowered their risk to a greater degree, maintained risk reduction changes better, and deferred the onset of sexual activity to a greater extent than youths who received information alone.

Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior.

Men (N = 526) who patronized gay bars in three cities completed measures of sexual behavior covering the previous 3 months and psychological measures theoretically pertinent to AIDS risk. Thirty-seven percent of the sample reported engaging in unprotected anal intercourse, the behavior most strongly associated with transmission of human immunodeficiency virus (HIV) infection. Perceived peer norms concerning the acceptability of safer sex practices, AIDS health locus of control scores, risk behavior knowledge, age, and accuracy of personal risk estimation, but not personal HIV serostatus knowledge, were associated with high-risk and precaution-taking behavior.

HIV risk behavior among homeless adults.

Very little information is available regarding HIV risk behavior among homeless adults despite increasing evidence that HIV infection disproportionately affects inner-city residents and disadvantaged populations. In the present study, adults (N = 94) entering a storefront medical clinic for the homeless completed an AIDS risk survey. The results suggest that homeless adults are engaging in sexual and substance-use behaviors that place them at high risk for HIV infection. Sixty-nine percent of the present sample was at risk for HIV infection from either 1) unprotected intercourse with multiple partners, 2) intravenous drug use (IVDU), 3) sex with an IVDU partner, or 4) exchanging unprotected sex for money or drugs. Many persons within the sample evidenced multiple risk factors: 45% reported at least two of the risk factors described above and 26% reported three or more risk factors. The results suggest there is an urgent need to develop and evaluate AIDS-prevention strategies for homeless adults.

Reliability of retrospective assessments of sexual HIV risk behavior: a comparison of biweekly, three-month, and twelve-month self-reports.

A review of 30 AIDS behavioral research studies revealed that almost half employed retrospective sexual activity assessment periods of 12 months or longer. The present study examined the correspondence between retrospective reports of sexual activity for 3 overlapping time-frames (past 2 weeks, past 3 months, and past 12 months) for 61 gay men. Adjusted for equivalent 12-month intervals, the reported mean frequencies of sexual practices were considerably higher for shorter recall periods than for longer recall periods, a discrepancy greater than would be expected by normal activity fluctuation. The study also found that behavior reported across shorter retrospective time-frames was more consistent, while reliability for frequently occurring and unsafe sexual activities decreased as the recall period lengthened. Studies utilizing recall periods of 12 months or more may produce data of questionable reliability.

Predictors of African American adolescents' condom use and HIV risk behavior.

This study evaluated predictors of risky and safer behavior in a sample of low-income African American adolescents, assessed their perceptions of the risk associated with their sexual behavior, and examined differences between adolescents who used condoms consistently, inconsistently, or engaged only in unprotected intercourse. African American adolescents (N = 312) completed measures related to AIDS knowledge, frequency of condom use, attitudes toward condoms, and sexual behavior over the preceding 2 months. Multiple regression analyses for the sexually active youths (N = 114) revealed that lower self-efficacy, higher perceived risk, and male gender were associated with high-risk behavior. Positive attitudes toward condoms and younger age had the strongest association with condom use. Consistent condom users were more knowledgeable and held more positive attitudes toward condoms, and nonusers were older. Regardless of their behavior, the adolescents generally did not perceive themselves to be a risk for HIV infection. The findings suggest that precautionary practices (condom use) and high-risk behavior (unprotected sex with multiple partners) may have different correlates. In addition, the data indicate that theoretical models developed with homosexual male populations may also be generalizable to African American adolescents' sexual behavior.

PIP: To facilitate identification of factors that place low-income African American adolescents at increased risk of human immunodeficiency virus (HIV), interviews were conducted with 312 youth 12-19 years of age attending a Public Health Service-funded clinic in Mississippi. The analysis was restricted to the 114 sexually active youth in this sample. The full variable set included age, gender, acquired immunodeficiency syndrome (AIDS) knowledge, condom attitude, perceived risk of AIDS, self-efficacy, social provision, church attendance, AIDS Risk Index, and Condom Use Index. Correlations between these variables were small to moderate (0.0 to -0.48). Separate regression analyses revealed significant relationships between the full variable set and the AIDS Risk Index (p 0.0001) and the Condom Use Index (p 0.02). Half of the teens reported unprotected intercourse in the preceding 2 months, yet most perceived themselves at low risk for AIDS. Multivariate analyses of variance revealed that variables most predictive of unprotected sex with multiple partners differed from those associated with condom use. Males who reported lower self-efficacy in avoiding AIDS and perceived themselves at greater risk were most likely to engage in high-risk behaviors. Consistent condom users were younger than intermittent and non-users and had more positive attitudes about condoms and higher AIDS knowledge scores. Interventions aimed at Black teens may need to expand beyond condom promotion to include broader media and community-based educational programs.

A skills-training group intervention model to assist persons in reducing risk behaviors for HIV infection.

Fifteen gay men with a history of recent high-risk sexual activities attended seven group sessions that provided risk education, training in self-management skills pertinent to risk reduction, sexual assertiveness training, and problem solving with respect to health consciousness, social supports, and efficacy of risk-reduction change. Before and after intervention, subjects completed measures of AIDS risk knowledge, sexual practices occurring over 4-month retrospective periods, and self-monitored records of ongoing sexual activities and participated in role plays assessing behavioral assertiveness skill for resisting high-risk coercions. Eight-month follow-up data were also collected. Subjects exhibited substantial and well-maintained change following intervention in behaviors relevant to HIV infection risk, including frequency of unprotected anal intercourse (which decreased to near-zero levels), condom use (which increased to almost 90% of intercourse occasions), and in an index that reflects the multiplicative function of risk behaviors frequency by the number of partners with whom high-risk behaviors occurs. This demonstration provides further evidence that skills-training approaches can assist individuals in implementing behavior changes to reduce risk for AIDS and identifies a model relevant to counseling efforts in AIDS prevention programs, HIV counseling and testing programs, drug abuse and STD clinics, and other applied settings.

Evaluation of the HIV risk reduction intervention for women entering inpatient substance abuse treatment.

OBJECTIVES: Interventions to lower HIV risk behavior among drug users have concentrated on reduction of high risk injection practices. Less attention has been directed to non-injecting drug users and drug-involved women. Female non-injecting drug users (e.g., women who abuse alcohol or crack cocaine) are also at substantial risk for sexual transmission of HIV due to multiple partners, partners who self-inject and share needles, exchange of sex for drugs, coerced sex, high rates of sexually transmitted diseases, and low rates of condom use. This study compared the effectiveness of an educational intervention (EC) against the behavior skills training intervention (BST) in reducing sexual risk behavior among women (N = 117) court-ordered into inpatient drug treatment. METHODS: Participants were assessed at baseline, post intervention, and 2 months after discharge from the drug treatment facility. RESULTS: Women in both conditions reported high rates of sexual risk behavior prior to the intervention. Women in both conditions had more positive attitudes toward HIV prevention and reported greater partner agreement with condom use at the post intervention assessment. However, these changes were not maintained at follow-up for women in the EC condition, whereas women in BST continued to show improvement post discharge. Women in the BST condition showed marked, while women in EC showed little improvement in communication skills and no improvement in condom application skill. At follow-up, women in both conditions had reduced drug use and drug-related high risk sex activities. BST women had increased their condom use while women in EC evidenced a decrease. Condom use increased from 35.7% to 49.5% of vaginal intercourse occasions for BST women and decreased from 28.8% to 15.8% for women in EC. CONCLUSIONS: Results suggest a brief skills training intervention embedded in drug treatment programs can reduce sexual risk for HIV-infection after discharge.

Cognitive-behavioral group intervention to assist substance-dependent adolescents in lowering HIV infection risk.

Substance dependent adolescents (N = 19), court referred into a residential drug treatment facility received a five-session HIV risk-reduction intervention that provided risk education, social competency skills (sexual assertion, partner negotiation, and communication skills), technical skills (condom use), and problem-solving training. Before and after the intervention, subjects completed measures of AIDS risk knowledge, health locus of control, social support, attitudes toward HIV prevention, attitudes toward condoms, self-efficacy, and perceptions of risk in addition to role-play assessments of behavioral skill resisting high-risk coercions. Postintervention, subjects exhibited increased knowledge about HIV/AIDS, more favorable attitudes toward prevention, greater internal and lower external locus of control scores, more favorable attitudes toward condom use, increased self-efficacy, and greater recognition of HIV vulnerability. Following intervention, the percentage of participants reporting sexual activity in high-risk contexts decreased, substantiating the intervention's effectiveness. Self-report data were corroborated by sexually transmitted disease treatment records. This uncontrolled demonstration effort suggests that skills training based on cognitive-behavioral principles may be a promising intervention strategy to lower vulnerable adolescents' risk of HIV infection.