Drug users' willingness to encourage social, sexual, and drug network members to receive an HIV vaccine: a social network analysis.

This study examined feasibility of peer-based promotion of HIV vaccination and dyadic correlates to vaccine encouragement in risk- and non-risk networks of drug users (n = 433) in the US. Data were collected on HIV vaccine attitudes, risk compensation intentions, likelihood of encouraging vaccination, and recent (past 6 months) risk (i.e. involving sex and/or injecting drugs) and non-risk (i.e. involving co-usage of noninjected drugs and/or social support) relationships. Willingness to encourage HIV vaccination was reported in 521 and 555 risk- and non-risk relationships, respectively. However, 37 % expressed hesitancy, typically due to fear of side effects or social concerns. Encouragement was often motivated by perceived HIV risk, though 9 % were motivated by risk compensation intentions. In non-risk partnerships, encouragement was associated with drug co-usage, and in risk relationships, with perceived vaccine acceptability and encouragement by the partner. Network-based HIV vaccine promotion may be a successful strategy, but risk compensation intentions should be explored.

Application of audio computer-assisted self-interviews to collect self-reported health data: an overview.

For assessment of sensitive health behaviors (e.g., sexual behavior, violent behaviors, substance use), research is typically limited to an examination of self-reports of past behavior. Audio computer-assisted self-interviews (ACASI) may enhance the validity of self-report data in research and clinical settings by reducing measurement bias. This paper provides an introduction to ACASI for collection of self-reported health data. The potential benefits and cost-effectiveness of ACASI use in research and clinical settings are reviewed. We then review the theoretical underpinnings that may underlie differential reporting of health behaviors between assessment modalities. Next, we highlight studies that have investigated differences in self-reported health behaviors between assessment modalities. Lastly, we summarize potential applications of ACASI assessments within clinical settings.

Exploring why young African American women do not change condom-use behavior following participation in an STI/HIV prevention intervention.

Human immunodeficiency virus (HIV) interventions can significantly reduce risky sexual behaviors among vulnerable populations. However, not everyone exposed to an intervention will reduce their sexual risk behavior. This qualitative study sought to identify factors associated with young African American females' lack of increase in condom use post-participation in an HIV prevention intervention. Semi-structured interviews were conducted with 50 young African American women (18-23 years; approximately half were mothers) after participating in a demonstrated effective HIV prevention intervention; 24 did not increase condom use post-intervention. Interviews were thematically coded for barriers to condom-use post-intervention. Although nearly all young women reported partner-associated challenges to using condoms, there were relational differences observed among those who changed their condom use versus those who did not. Many 'non-changers' were engaged in non-stable 'on and off' relationships, with high rates of infidelity, often with the father of their child, in which they were fearful of requesting condom use. 'Non-changers' also reported more substance use, feeling incapable of change and not thinking about condom use. Thus, future HIV prevention efforts may benefit from incorporating strategies on how young mothers can maintain a non-sexual relationship with their child's father, as well as elaborating on the intersection of substance use and risky sexual decision-making.

Situational and motivational factors associated with unhealthy alcohol use among Russian women with HIV and hepatitis C Virus co-infection.

Introduction: Alcohol use is prevalent among Russian women with HIV and hepatitis C Virus (HCV) co-infection despite alcohol's known harmful health effects for this population. Identifying factors that facilitate continued unhealthy alcohol use is critical to developing effective alcohol reduction interventions. This study assessed situational and motivational factors associated with unhealthy alcohol use among HIV/HCV co-infected women in clinical care in St. Petersburg, Russia. Methods: Guided by the motivational model for alcohol use, we conducted 30 semi-structured interviews with women living with HIV/HCV co-infection to identify situational and motivational factors associated with unhealthy drinking and barriers and facilitators to abstaining. Interviews were recorded and analyzed using a the-matic analysis approach. Results: Despite awareness of the health risks associated with alcohol use, many women reported heavy episodic drinking, particularly in social situations. A key motive for drinking was coping with negative emotions triggered by stressful situations, such as work- and family-related conflicts. Key situational factors included drinking with family and friends and in social situations. Women who endorsed negative drinking coping motives were the most motivated to stop drinking. Health concerns were also cited as reasons to stop drinking; however, few women reported that their doctors recommended that they abstain. Conclusions: Several situational and motivational facilitators of alcohol use and barriers to alcohol reduction were identified, as well as some opportunities for prevention, among women in care for HIV in Russia. Awareness-raising and training regarding the adverse consequences of alcohol use among persons with HIV/HCV co-infection should include clinicians, patients and relatives.

Exposure to alcohol problems and its association with sexual behaviour and biologically confirmed Trichomonas vaginalis among women living with HIV.

OBJECTIVES: Only a small number of studies have examined the association between alcohol use and risky sexual behaviour among women living with HIV, particularly African-American women. The present study examined the association between alcohol problems, sexual behaviour and biologically confirmed sexually transmitted infections (STI) among a sample of predominantly African-American women living with HIV. METHODS: A sample of 366 women living with HIV between the ages of 18 and 50 years participated in the study. The majority of women were African-American (84.2%). Participants completed a face-to-face interview assessing sociodemographics, sexual behaviour, other substance use and alcohol problems using the CAGE (Cut down, Annoyed, Guilty, Eye opener), a screening measure for alcohol abuse. Participants also provided self-collected vaginal swab specimens that were assayed for STI. RESULTS: The prevalence of high scores on the CAGE was 54.5% and 15% of women tested positive for Trichomonas vaginalis. Multivariate logistic regression analyses, with age and other substance use as covariates, indicated that women who scored higher on the CAGE, relative to those who scored lower, were more likely to test positive for T vaginalis, have sex with their spouse or steady partner when only they had been drinking and have sex with their spouse or steady partner when they had both been drinking. CONCLUSIONS: These findings suggest that alcohol assessment should be included in regular healthcare maintenance among women living with HIV. Intervention programmes should be tailored to address alcohol use/abuse among African-American women living with HIV.

Prevalence and incidence of human papillomavirus infection in women in the USA: a systematic review.

A systematic review of studies published in the last decade was conducted to summarize data on the epidemiology of human papillomavirus (HPV) in the USA. A structured protocol was used to screen studies for review. Studies had to meet the following criteria: (1) the study was conducted in the USA, (2) the study population was predominantly adolescent women, (3) the description of the study's methodological and statistical methods is provided, and (4) the prevalence and/or incidence of HPV were clearly stated. The prevalence of HPV reported in the assessed studies ranged from 14% to more than 90%. The highest prevalence of HPV was identified among women attending sexually transmitted diseases (STD) clinics and college students, identifying them as target populations for prevention interventions. Conversely, the lowest HPV prevalence was among women in the general population. The review also revealed that HPV prevalence in African Americans is understudied, and the results of a few studies in this area are inconclusive.

HIV-related risk behaviors among psychiatrically hospitalized adolescents and school-based adolescents.

The authors compared the responses of 76 adolescents on an inpatient psychiatric service with those of 802 school-based adolescents in the same city regarding HIV risk behaviors. The psychiatrically hospitalized adolescents reported a significantly higher rate of sexual and drug-related behaviors that involve a risk for contracting sexually transmitted disease, including HIV-related illnesses.

Correlates of hepatitis B vaccination in a high-risk population: an Internet sample.

PURPOSE: We sought to identify factors associated with hepatitis B virus vaccination, including knowledge and attitudes about hepatitis vaccination, and sexual and nonsexual risk behaviors among at-risk homosexual and bisexual men. SUBJECTS AND METHODS: Internet electronic communications were used to collect data from homosexual and bisexual men from the United States, using a 31-item online questionnaire accessible for 1 month. RESULTS: The mean (+/- SD) age of the 336 respondents was 38 +/- 11 years. Nearly 42% (142) reported at least one dose of vaccine; the remainder were completely unvaccinated. About 21% (n = 71) reported having no information about hepatitis. Approximately 72% (242) of respondents reported never using condoms during oral intercourse, and 26% (n = 87) reported using condoms during less than half of their episodes of anal intercourse. In multivariate analysis, variables associated with vaccination were younger age (odds ratio [OR] 0.7 per 10-year increase in age; 95% confidence interval [CI] 0.59 to 0.84, P = 0.002), high level of knowledge about the vaccine (OR 1.4; 95% CI: 1.03 to 1.83, P = 0.007), communication with a health-care provider about hepatitis (OR 1.98; 95% CI 1.31 to 2.98, P = 0.006), and professional training that included hepatitis education (OR 2.77; 95% CI 1.7 to 4.5, P = 0.001). CONCLUSIONS: Our findings underscore the need for health care providers to emphasize vaccine efficacy and safety, and to encourage high-risk patients to receive vaccination, particularly among men at high risk based on sexual and drug use behaviors.

Determinants of condom use among junior high school students in a minority, inner-city school district.

Condoms reduce the risk of human immunodeficiency virus (HIV) transmission; however, their use among adolescents has been inconsistent. Little is known about factors which motivate consistent condom use, particularly among younger adolescents. In a study designed to identify such factors, 1899 inner-city junior high school students were surveyed. In June 1988, students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, and behaviors. Among sexually active students (N = 403), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on frequency of condom use. Respondents who believe condoms are effective in preventing HIV transmission were 2.2 times more likely to report using condoms consistently during sexual intercourse; those with low perceived costs associated with condom use were 1.9 times more likely to be consistent users. Number of lifetime sexual partners was inversely related to frequency of condom use. Respondents with a history of three or more sex partners were half as likely to use condoms consistently. Factors not associated with consistent condom use include age, age at sexual debut, ethnicity, HIV knowledge, perceived efficacy to avoid HIV infection, and alcohol and drug use. School- and community-based HIV prevention programs will have to go beyond the didactic transfer of factual information and include more interactive teaching strategies to improve adolescents' attitudes toward condoms are self-efficacy to increase condom use and to counter negative peer influences and adolescents' perceptions of invulnerability. Physicians are an underutilized source of HIV prevention information. They have an important role in counseling adolescents about effective HIV-prevention methods and dispelling misperceptions which hinder consistent condom use.

African-American adolescents residing in high-risk urban environments do use condoms: correlates and predictors of condom use among adolescents in public housing developments.

OBJECTIVE: African-American adolescents living in high-risk inner-city environments have been disproportionately affected by the epidemics of human immunodeficiency virus (HIV) and other sexually transmitted diseases. Understanding the factors that influence the use of condoms by adolescents is critical for developing effective behavioral interventions. The present study examined the demographic, psychosocial, and behavioral correlates of condom use among African-American adolescents residing in public housing developments in an HIV epicenter (San Francisco) and prospectively evaluated the stability of these significant cross-sectional variables to predict consistent condom use. DESIGN: A prospective study. SETTING: Two public housing developments in San Francisco. PARTICIPANTS: African-American adolescents and young adults between 12 and 21 years of age were recruited though street outreach and completed a theoretically derived research interview assessing HIV-related knowledge, attitudes, and behaviors. After a 6-month period, adolescents completed a follow-up interview similar to the baseline measure. Among adolescents reporting sexual activity in the 6 months before completing the baseline interview (n = 116), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on consistent condom use. RESULTS: Adolescents who had high assertive self-efficacy to demand condom use (adjusted odds ratio [OR], 11), perceived peer norms as supporting condom use (OR, 4.2), had greater impulse control (OR, 3.7), were male (OR, 4.7), and were younger (OR, 2.9) were more likely to report consistent condom use. Frequency of sexual intercourse was inversely related to condom use; adolescents with higher numbers of sexual episodes were less likely to use condoms consistently. Prospective analyses identified the baseline level of condom use as the best predictor of condom use at the 6-month follow-up. Adolescents who were consistent condom users at baseline were 7.4 times as likely to be consistent condom users during the follow-up period. Of those adolescents changing their frequency of condom use during the follow-up interval, significantly more engaged in risky behavior; 33.3% changed from consistent to inconsistent condom use, whereas 20.6% changed from inconsistent to consistent use (OR, 1.6). CONCLUSIONS: The findings suggest that HIV prevention programs need to be implemented early, before high-risk behaviors are established and may be more difficult to modify.

Correlates of unprotected vaginal sex among African American female adolescents: importance of relationship dynamics.

OBJECTIVE: To determine the associations between the frequency of unprotected vaginal sex (UVS) and female adolescents' perceptions, particularly their perceptions of relationship dynamics. DESIGN: Cross-sectional study of 522 African American female adolescents enrolled in a sexually transmitted disease (STD) and human immunodeficiency virus prevention intervention trial. SETTING AND PARTICIPANTS: A volunteer sample of adolescents recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and STDs; 28% tested positive for STDs as assessed by DNA amplification or culture. MAIN OUTCOME MEASURE: Frequency of UVS assessed by interview using a 6-month recall period. RESULTS: Among adolescents having steady relationships, those spending more time with their boyfriends and having longer relationships reported a significantly greater frequency of UVS. Other significant correlates included perception of more girlfriends using condoms, no history of STDs, stronger normative beliefs favoring male decision making in relationships, greater pregnancy worry, and greater perceived invulnerability to STDs. For adolescents reporting casual relationships, personal barriers to condom use, no history of STDs, and reporting that their boyfriends typically decide when to have sex were associated with more frequent UVS. CONCLUSIONS: Adolescents' perceptions, particularly their perceptions of relationship dynamics, played an integral role in explaining female adolescents' frequency of UVS with both steady and casual partners. Female adolescents in steady relationships differ from those in casual relationships relative to their prevention needs. These findings have implications for clinic- or community-based STD and human immunodeficiency virus prevention programs.

Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls.

OBJECTIVE: To ascertain the acceptability of testing and prevalence of 3 readily treatable sexually transmitted diseases (STDs) (infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis) with the use of patient-obtained vaginal swabs. STUDY DESIGN: Study participants at each initial session were asked to provide self-obtained vaginal swabs for ligase chain reaction testing to detect N gonorrhoeae and C trachomatis, and for culture of T vaginalis. SETTING: Behavioral intervention sessions with African American adolescent girls in a nonclinical program to reduce risk of STDs, human immunodeficiency virus infection, and pregnancy. RESULTS: All study participants were offered their choice of STD screening in the context of a traditional pelvic examination or using self-obtained vaginal swabs. All eligible participants chose self-administered vaginal swabs. Of the 512 participants examined at their initial study visit, 28.7% were found to be infected with 1 or more treatable STDs (5.3% with N gonorrhoeae, 17.8% with C trachomatis, and 12.9% with T vaginalis). CONCLUSIONS: With the use of newer detection systems, STDs can be readily detected in nonclinical settings with the use of self-obtained vaginal swabs, providing new opportunities for efforts to control STDs.

Child sexual abuse of Asians compared with other populations.

This retrospective chart review study of a child sexual abuse clinic compared a consecutive sample of substantiated sexual abuse cases of Asian victims with random samples of black, white, and Hispanic victims. The findings suggest that there are clinically relevant differences between Asians and the other three populations. Asian victims showed a distinct demographic profile, suffered less physically invasive forms of abuse, were more likely to express suicidality, less likely to display anger and sexual acting out, and had less supportive primary caretakers than non-Asians. Awareness of such ethnic differences will help clinicians better evaluate and treat minority victims.

An AIDS education and prevention program for hospitalized adolescents.

This paper describes the development of a human immunodeficiency virus Prevention Program for a University-based adolescent psychiatric unit. The intervention spans 8 days with components in school, activity therapies, and a specific group that teaches sexual education. Important aspects that have contributed to the success of this intervention include its integration into a general sex education program, the utilization of the psychiatric milieu for promotion of the intervention, the participation of a person with acquired immune deficiency syndrome (AIDS) in the educational process, "high tech" components, such as attractive well-designed videos, and assessment and evaluation. The importance of AIDS education for psychiatrically hospitalized adolescents will be further elaborated.

Prevalence and correlates of cutting behavior: risk for HIV transmission.

The prevalence of cutting behavior among a population of 76 psychiatrically hospitalized adolescents was found to be 61.2%. The frequency ranged from a single occasion to over 50 instances, with a mean of 9.9 occasions. Increased self-mutilation was not found to be associated with gender, age, ethnicity, or primary psychiatric diagnosis. A significant association was identified between adolescents who report forced sex and those who report cutting behavior. Approximately 26.7% of those reporting this behavior also report sharing cutting implements with other adolescents. This article raises concern about this behavior as it relates to the transmission of human immunodeficiency virus and makes recommendations for clinicians treating this population.

Adolescents with psychiatric disorders and the risk of HIV.

OBJECTIVE: To review literature relevant to human immunodeficiency virus (HIV)-associated risk behaviors among adolescents with psychiatric disorders and psychological influences on risk behaviors. METHOD: This report is based on review of 66 articles, which comprise all of the relevant literature in the English language. RESULTS: Although the seroprevalence of HIV in adolescents with psychiatric disorders is unknown, studies indicate that adolescents with psychiatric disorders are at greater risk than their peers because of increased rates of unsafe sexual practices, impulsivity, self-destructive attitudes, cognitive immaturity, high rates of substance use, self-cutting behavior, and the sequelae of sexual abuse. CONCLUSION: Directions are proposed for the design of developmentally appropriate, clinically oriented HIV prevention interventions based on the relationships between psychological dysfunction, social stressors, and HIV risk behaviors.

The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior.

OBJECTIVE: The present study examines psychosocial and behavioral influences, particularly drug and alcohol use, as correlates of inconsistent condom use and having multiple sexual partners during the past months among African-American women. METHODS: The cross-sectional study, conducted between May and June 1996, recruited a convenience sample of 180 African-American women in Birmingham, Alabama. Women completed a face-to-face interview that assessed alcohol and drug use, sexual behaviors, depression, condom use, and negotiation skills. RESULTS: The majority of women, 51.6% (n = 93), had used either alcohol or drugs during the previous month. Many women, 31.1%, consumed alcohol, 18.3% used marijuana, and 8.3% had smoked crack within the past month. Nearly 42.7% of women used condoms inconsistently in the past month and 13.3% of women had multiple sexual partners within the past month. A logistic regression model predicting inconsistent condom use indicated that women were less likely to use condoms if they consumed alcohol between 20 and 30 days of the month (OR = 2.8, 90% CI = 1.3-5.9) and if they had not negotiated condom use (OR = 32.4, 90% CI = 7.9-131.6). The logistic regression model predicting multiple sexual partners indicated that women were more likely to have multiple sexual partners if they had smoked crack in the past month (OR = 5.3, 90% CI = 1.6-18.2). CONCLUSION: HIV sexual risk-reduction interventions for African-American women need to address the overlapping epidemics of drugs, alcohol, and STDs. Additionally, HIV sexual risk reduction efforts should be incorporated into existing drug and alcohol treatment programs and STD clinics.

Child sexual abuse, HIV sexual risk, and gender relations of African-American women.

INTRODUCTION: A cross-sectional study was conducted to examine the association between childhood abuse, HIV-related sexual risks, and gender relations among African-American women. METHODS: The sample 165 African-American women, 18-29 years of age, were recruited by street outreach from a lower socioeconomic community in San Francisco, CA. A face-to-face interview was administered to assess HIV/STD-sexual risk practices, alcohol use, physical abuse, affective health, and relationship commitment. Childhood sexual abuse was defined as experiencing forced sex prior to age 16. RESULTS: The prevalence of childhood sexual abuse in this sample was 13.3%. Compared to women who were not abused during childhood, women who reported a history of childhood sexual abuse were 1.5 times more likely to have had an abortion, 1.4 times more likely to report having an STD, 2.4 times as likely to report having greater than two lifetime STDs, 3.8 times as likely to have a history of anal sex, 2.6 times as likely to worry about acquiring HIV, 3.9 times more likely to believe their partner did not care for them, twice as likely to doubt the longevity of their relationship, 5.1 times as likely to have a partner who had been physically abusive within the previous 3 months, 2.6 times as likely to have a partner who was physically abusive when asked to use condoms, and 1.5 times as likely to consume three or more glasses of alcohol at one time. CONCLUSIONS: Awareness of a women's history of child sexual abuse can assist in making appropriate medical and social referrals and can lead to the development of more tailored HIV prevention programs for African-American women.

HIV sexual risk reduction interventions for women: a review.

AIDS has emerged as a serious public health threat for women. Reducing the risk for HIV infection among sexually active women requires the adoption of preventive strategies that effectively inhibit viral transmission. However, there is a paucity of published literature describing interventions targeted toward women and even fewer published reports evaluating their effectiveness. We conducted a search of HIV prevention interventions for women using the MEDLINE, ERIC and PSYCHLIT on-line computer database for the years January 1984-May 1995 to assess the effectiveness of interventions in increasing condom use during sexual intercourse. Interventions efficacious at increasing condom use applied a social psychological model of behavior to guide the development and implementation of the intervention, used randomized controlled designs to evaluate program efficacy, emphasized gender-related influences, were peer-led, and used multiple intervention sessions. While these findings are promising, methodologic limitations preclude any definitive assessment of programmatic efficacy. One challenge for future studies is to corroborate and extend these findings using rigorous methodologic research designs to evaluate programmatic efficacy, in particular, longer follow-up to assess stability of treatment effects over time. Another challenge is to understand the implications of previous research for the development of more gender-relevant interventions. The urgency of the HIV epidemic demands that the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Medical Subject Headings (MeSH): women, HIV/AIDS, interventions, prevention.

PIP: AIDS has emerged as a serious public health threat for women. Reducing the risk for HIV infection among sexually active women requires the adoption of preventive strategies that effectively inhibit viral transmission. However, there is a paucity of published literature describing interventions targeted toward women and even fewer published reports evaluating their effectiveness. The authors conducted a search of HIV prevention interventions for women using the MEDLINE, ERIC, and PSYCHLIT on-line computer databases for the period of January 1984 to May 1995 to assess the effectiveness of interventions in increasing condom use during sexual intercourse. Interventions efficacious at increasing condom use applied a social psychological model of behavior to guide the development and implementation of the intervention, used randomized controlled designs to evaluate program efficacy, emphasized gender-related influences, were peer-led, and used multiple intervention sessions. While these findings are promising, methodologic limitations preclude any definitive assessment of programmatic efficacy. One challenge for future studies is to corroborate and extend these findings using rigorous methodologic research designs to evaluate programmatic efficacy, in particular, longer follow-up to assess stability of treatment effects over time. Another challenge is to understand the implications of previous research for the development of more gender-relevant interventions. The urgency of the HIV epidemic demands that the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority.

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters.

OBJECTIVE: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. METHODS: A cross-sectional study was conducted among 203 women seeking refuge in battered women's shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. RESULTS: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. CONCLUSIONS: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.