HIV/AIDS-related attitudes and practices of hospital-based health workers in Kampala, Uganda.

OBJECTIVE: To assess HIV/AIDS-related attitudes and practices of hospital-based health workers in Kampala, Uganda. METHODS: A cross-sectional study was conducted in Mulago Hospital, the main national referral hospital in Uganda. A total of 155 physicians and nurses completed a brief questionnaire on HIV risk perception, attitudes and practices regarding AIDS prevention education, HIV counseling and testing and care of patients with HIV disease. RESULTS: Twenty-nine per cent of health workers reported never having discussed AIDS prevention with patients, 26% had never referred patients for HIV counseling and 31% had never advised patients suspected of HIV infection to be tested. Frequent explanations for not providing AIDS prevention education included time constraints and/or lack of related knowledge or skills. While 29% perceived recapping needles as involving no risk, activities involving casual contact with patients and condom use for protection against HIV infection were associated with a high perceived risk of HIV transmission, particularly among nurses. Physicians and nurses differed in their HIV/AIDS-related attitudes and practices. The physicians had a more positive attitude towards the care of patients with HIV disease. In addition, 80% of physicians compared to 59% of nurses referred patients for HIV counseling. A similar trend was found for advising patients to obtain HIV testing. CONCLUSIONS: Hospital-based health workers are missing important opportunities for AIDS prevention education with their patients. There are gaps in their knowledge about HIV and related infection control practices. Interventions should address their concerns and barriers to HIV prevention practices.

Reducing postrelease risk behavior among HIV seropositive prison inmates: the health promotion program.

The prevalence of AIDS is five times higher among prison inmates than in the general population. Because recidivism is common and many inmates are serving short sentences for parole violation, HIV-seropositive inmates move frequently between prison and their home communities. We designed an eight-session prerelease intervention for HIV seropositive inmates to decrease sexual and drug-related risk behavior and to increase use of community resources after release. The intervention sessions were delivered at the prison by community service providers. We found that a prerelease risk reduction intervention for HIV seropositive inmates was feasible. Descriptive results support the effectiveness of the program in reducing sexual and drug-related behaviors and in increasing use of community resources after release. Compared with men who signed up for the intervention but were unable to attend, men who received the intervention reported more use of community resources and less sexual and drug-related risk behavior in the months following release. We recommend dissemination and continued evaluation of this risk-reduction intervention.

Sources of information for HIV prevention program managers: a national survey.

This study's objective was to find out if HIV prevention program planners seek out science in designing interventions, and if not, where they turn for prevention information. Researchers conducted a survey of 284 program managers of AIDS prevention programs across the United States. Respondents' three most important sources of information were peers and colleagues, departments of public health (DPH) and the centers for Disease Control (CDC). The four least important sources included scientific publications and government reports. We find that most program managers do not turn to research, nor do they perceive it as an important source of information. They turn to each other, their DPH, and the CDC. The authors have made suggestions for researchers, community-based organizations, state DPHs, and the CDC to close the gap between HIV prevention science and prevention practice. We must ensure that our efforts will not be wasted, and we can make a difference in the fight against HIV.

Sex in the New World: an empowerment model for HIV prevention in Latina immigrant women.

In 1996, nearly 60% of U.S. AIDS cases among Latinas were attributed to unprotected sex with men. Economic disadvantage, language barriers, and strong cultural gender norms regarding sex exacerbate the risk for HIV infection among Latina immigrant women. Through a collaboration among scientists and providers, this study was designed to evaluate the impact of a multifaceted empowerment program for Latina immigrant women on HIV risk behaviors. Women (N = 74) were followed for the first 6 months of their participation and attended up to nine distinct types of activities (e.g., information meetings, friendship circles, and workshops). Although the program was not developed to specifically target HIV risk behaviors, women showed significant increases in sexual communication comfort, were less likely to maintain traditional sexual gender norms, and reported changes in decision-making power. Targeting broader sociocultural issues may increase the necessary skills for Latina women to prevent HIV infection from their sexual partners. Successful collaborations between scientists and providers are critical in developing effective, community-relevant interventions.

Collaborative research to prevent HIV among male prison inmates and their female partners.

Despite the need for targeted HIV prevention interventions for prison inmates, institutional and access barriers have impeded development and evaluation of such programs. Over the past 6 years, the authors have developed a unique collaborative relationship to develop and evaluate HIV prevention interventions for prison inmates. The collaboration includes an academic research institution (the Center for AIDS Prevention Studies at the University of California, San Francisco), a community-based organization (Centerforce), and the staff and inmate peer educators inside a state prison. In this ongoing collaboration, the authors have developed and evaluated a series of HIV prevention interventions for prison inmates and for women who visit prison inmates. Results of these studies support the feasibility and effectiveness of HIV prevention programs for inmates and their partners both in prison and in the community. Access and institutional barriers to HIV intervention research in prisons can be overcome through the development of collaborative research partnerships.

Inpatient statin use predicts improved ischemic stroke discharge disposition.

OBJECTIVE: To determine whether statin use is associated with improved discharge disposition after ischemic stroke. METHODS: We used generalized ordinal logistic regression to analyze discharge disposition among 12,689 patients with ischemic stroke over a 7-year period at 17 hospitals in an integrated care delivery system. We also analyzed treatment patterns by hospital to control for the possibility of confounding at the individual patient level. RESULTS: Statin users before and during stroke hospitalization were more likely to have a good discharge outcome (odds ratio [OR] for discharge to home = 1.38, 95% confidence interval [CI] 1.25-1.52, p < 0.001; OR for discharge to home or institution = 2.08, 95% CI 1.72-2.51, p < 0.001). Patients who underwent statin withdrawal were less likely to have a good discharge outcome (OR for discharge to home = 0.77, 95% CI 0.63-0.94, p = 0.012; OR for discharge to home or institution = 0.43, 95% CI 0.33-0.55, p < 0.001). In grouped-treatment analysis, an instrumental variable method using treatment patterns by hospital, higher probability of inpatient statin use predicted a higher likelihood of discharge to home (OR = 2.56, 95% CI 1.71-3.85, p < 0.001). In last prior treatment analysis, a novel instrumental variable method, patients with a higher probability of statin use were more likely to have a good discharge outcome (OR for each better level of ordinal discharge outcome = 1.19, 95% CI 1.09-1.30, p = 0.001). CONCLUSIONS: Statin use is strongly associated with improved discharge disposition after ischemic stroke.

Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score.

BACKGROUND AND PURPOSE: Endovascular treatments are being increasingly used in acute ischemic stroke, and better tools are needed to determine which patients may benefit most from these techniques. We hypothesized that specific chronic diseases can be used, along with age and stroke severity, to predict endovascular stroke treatment outcomes. MATERIALS AND METHODS: Data from 2 single-arm trials of a thrombectomy device, MERCI and Multi MERCI, were pooled for analysis. A predictive score was developed by using the independent contribution of variables in multivariable analysis. RESULTS: HTN, DM, and AFib were found to predict outcomes. These 3 conditions contribute equally to a CDS that predicts outcomes independent of other predictor variables, including age, stroke severity, and vessel recanalization. A 10-level predictive score, the THRIVE score, which incorporates age, stroke severity, and the CDS, was developed. The THRIVE score strongly predicts outcome and mortality at 90 days. CONCLUSIONS: Specific chronic diseases influence poststroke outcomes among patients undergoing endovascular stroke treatment, independent of other predictors of outcome. The THRIVE score reflects the contributions of chronic disease, age, and stroke severity and strongly predicts endovascular stroke treatment outcomes.

Smoking and socioeconomic status in a population-based inner city sample of African-Americans, Latinos and whites.

OBJECTIVE: To examine patterns of cigarette smoking among individuals of different socioeconomic status (SES) and ethnicity. DESIGN: A cross-sectional and longitudinal community-based random household sample. METHODS: Unmarried African-American, Latino and while men and women, aged 20-44 years, living in San Francisco in 1988-9 and in 1989-90, were surveyed regarding prior and current smoking. Evaluation of behaviors was based on responses to an interviewer reading questions related to the variables of interest. SES was primarily based on educational attainment. RESULTS: Overall, 40% of respondents smoked, with an inverse association in univariate analysis between smoking and educational attainment in each gender/ethnic subgroup, except for Latino men. After controlling for other variables, ethnicity and education predicted smoking: with Latinos as referent, whites [odds ratio (OR) = 3.2] and African-Americans (OR = 2.7) were more likely to stroke, and there was a consistent graded inverse association between educational attainment and smoking (P < 0.0001). Of smokers, after controlling for other variables, heavy smokers (> or = 1 pack/day compared with < 1 pack/day) were more likely to be older (P < 0.0001) and white (OR = 7.1) than African-American (OR = 1.8) or Latino (OR = 1.0), and there was trend toward heavy smokers being less educated (P = 0.06). One year later, 1422 (80%) of the original participants were resurveyed. Of 563 baseline smokers, 96 (17%) reported having quit, with African-Americans less likely to quit than whites or Latinos (P < 0.05). Of 859 baseline nonsmokers, 34 (4%) had started to smoke 1 year later. CONCLUSIONS: In a population-based inner city sample, the prevalence of smoking was considerable and there was a strong inverse association between smoking and educational attainment in almost all ethnic and gender subgroups. Further studies are needed to explore the possible reasons for these differences so that culturally sensitive risk factor interventions may be developed and tested.

Data from the National AIDS Behavioral Surveys. I. Sexual risk for human immunodeficiency virus infection among women in high-risk cities.

Data from 3,482 women aged 18-49 living in 23 urban areas of the United States who participated in the 1990-1991 National AIDS Behavioral Surveys show that in the preceding year, approximately 15% engaged in sexual behavior that might expose them to the human immunodeficiency virus (HIV). Risk behaviors include having multiple sexual partners, having a risky main sexual partner or having both multiple partners and a risky main partner. An additional 17% of women with no other risk factor report that they do not know their main partner's HIV risk status. Predictors of risk factors vary by ethnicity, and having multiple partners and having a risky main partner appear to have distinct sets of predictors. Single women are more likely than others to have multiple partners, and among white women, those with more than 12 years of education are more likely to have multiple partners. Among blacks and Hispanics, younger women are more likely than older women to have multiple partners. Among Hispanic women, married respondents and those with more than 12 years of education are more likely than others to have a risky main sexual partner; the latter pattern is reversed among white women, however, with those having less than 12 years of education being more likely to have a risky main sexual partner. In general, women with a risky main partner are the least likely to use condoms consistently.

Data from the National AIDS Behavioral Surveys. II. Multiple sexual partners among Hispanics in high-risk cities.

Data from a random sample of 4,658 heterosexual Hispanics from 23 high-risk cities in the 1990-1991 National AIDS Behavioral Surveys reveal that 11% of Hispanics have had multiple partners in the past year-17% of men and 4% of women. The study shows a higher proportion of multiple sexual partners in the past year among Hispanic men who are unmarried (31%), Cuban (28%), aged 18-29 (25%), better educated (21%), of lower income (23%) and highly acculturated (20%). Among Hispanic women, marital status, age, Hispanic subgroup and level of acculturation are significant predictors of having multiple partners. Among highly acculturated Hispanic men, income, Hispanic subgroup and marital status are significant predictors of having multiple partners; among less acculturated Hispanic men, marital status is the only significant predictor. Only 20% of Hispanics with multiple partners report using a condom regularly with their primary partner, and 29% report regular condom use with their secondary partner. Among men, condom use tends to decrease as the number of partners increases.

Antibody testing and condom use among heterosexual African Americans at risk for HIV infection: the National AIDS Behavioral Surveys.

OBJECTIVES: This study describes predictions of condom use and human immunodeficiency virus (HIV) antibody testing in a population-based sample of African-American heterosexuals who reported HIV risk behavior. METHODS: Data were taken from the National AIDS Behavioral Surveys. RESULTS: Of the African-American respondents, 22% reported some risk for HIV infection; of those, 24% had been tested for HIV. CONCLUSIONS: Prevention messages encouraging HIV testing and condom use have not resulted in high rates of self-protective behavior among African Americans. Future prevention interventions must focus on specific motivations and barriers with regard to engaging in preventive behavior among specific age, gender, and educational-level groups within the population of African Americans at risk for HIV infection.

Data from the National AIDS Behavioral Surveys. III. Multiple sexual partners among blacks in high-risk cities.

The National AIDS Behavioral Surveys collected data between June 1990 and February 1991 on the prevalence of multiple sex partners and condom use among 2, 166 blacks living in cities with a high prevalence of AIDS cases. Almost one-fifth (19%) of respondents report having had two or more partners in the year preceding the survey. More men (30%) than women (10%), and more single (25%) than married or cohabiting adults (8%), report that they have had multiple sexual partners in the previous year. Although respondents are more likely to use condoms with secondary than main sexual partners, substantial proportions of blacks with multiple sex partners used no condoms in the previous year with either their main (47%) or their secondary partners (35%).

PIP: Data from several studies suggest that Black heterosexual men and women in the U.S. are ten times more likely to be diagnosed with AIDS than are White men and women. U.S. National AIDS Behavioral Surveys data collected June 1990 - February 1991 offer insight into the prevalence of multiple sex partners and condom use among Blacks in cities with high prevalence of AIDS cases. The authors present findings from telephone interviews with 2166 self-described Black heterosexuals aged 18-49 years. 63% of the sample was female and 37% was male. 56% had more than 12 years of formal education. 19% of respondents reported having had two or more partners in the year before the survey. Of those reporting having multiple sex partners in the previous year, 30% of men did so compared to 10% of women, along with 25% of single individuals compared to 8% of married or cohabiting adults. Respondents were more likely to use condoms with secondary than main sex partners. More precisely and respectively, 47% and 35% of Blacks with multiple sex partners used no condoms in the previous year with their main and secondary partners. Efforts are therefore urgently needed to increase the prevalence of condom use in the interest of reducing the incidence of HIV infection in such communities.