Condom Failure Among HIV-Negative Men in Serodiscordant Relationships in Australia, Brazil, and Thailand.

Condoms continue to be used by many gay, bisexual, and other men who have sex with men (GBM) to reduce the risk of HIV transmission. However this is impacted by condom failure events, defined here as condom breakage and slippage. In a prospective, observational cohort study of 343 HIV serodiscordant male couples recruited through high HIV caseload clinics and hospitals between 2012 and 2016 in Australia, Brazil, and Thailand, condom failure rates and associated factors were analysed, including with the study partner versus other sexual partners. There were 717 reported instances of condom failure from an estimated total of 25,831 sex acts with condoms, from over 588.4 participant years of follow up. Of the HIV-negative partners (n = 343) in the study, more than a third (n = 117, 36.7%) reported at least one instance of condom failure with any partner type during study follow-up. Condom failure with their study partner was reported by 91/343 (26.5%) HIV-negative partners, compared with 43/343 (12.5%) who reported condom failure with other partners. In total, there were 86 events where the HIV-negative partner experienced ano-receptive condom failure with ejaculation, representing 12.0% of all failure events. In multivariable analysis, compared to Australia, HIV-negative men in Brazil reported a higher incidence risk rate of condom failure (IRR = 1.64, 95%CI 1.01-2.68, p = 0.046) and HIV-negative men who reported anal sex with other partners reported an increased risk of condom failure compared with men who only had sex with their study partner (IRR = 1.89, 95%CI 1.08-3.33, p = 0.025). Although at least one event of condom failure was reported by a significant proportion of participants, overall condom failure events represented a small proportion of the total condom protected sex acts.

Início da atividade sexual e sexo protegido em adolescentes / Comienzo de la actividad sexual y sexo protegido en adolescentes / Initiation of sexual activity and protected sex in adolescents

Resumo Objetivos Identificar a prevalência do início da atividade sexual em adolescentes e a prática de sexo seguro entre os mesmos. Método Estudo transversal realizado com 499 adolescentes, em Pouso Alegre, Minas Gerais, de fevereiro a abril de 2017, por meio de um questionário autoaplicado e semiestruturado, contemplando iniciação, práticas sexuais, conhecimento sobre contracepção, prevenção de infecções sexualmente transmissíveis e participação em atividades educativas sobre o tema. Os dados foram analisados por estatística descritiva, as diferenças estatísticas avaliadas pelo teste X2 de Pearson. Resultados A prevalência da atividade sexual foi 47,3%, com idade média da sexarca de 14,1 anos, e tendência de iniciação sexual precoce no sexo masculino. Um terço das primeiras relações sexuais foram desprotegidas (33,9%). As participantes do sexo feminino apresentavam maior conhecimento a respeito de contracepção e prevenção de doenças, menor adesão ao uso de preservativos e maior utilização de contraceptivos orais e de emergência. Conclusão e implicações para a prática O estudo mostrou início precoce de vida sexual entre adolescentes, e um terço das relações sexuais sem proteção. Há necessidade de ações de saúde e educação que garantam a aquisição de conhecimento e acesso a métodos contraceptivos.

Resumen Objetivos Identificar la prevalencia de la actividad sexual en adolescentes y la práctica de sexo seguro entre ellos. Método Estudio transversal realizado con 499 adolescentes, de febrero a abril de 2017, por medio de un cuestionario autoadministrado y semiestructurado, que abarca la iniciación sexual y las prácticas, conocimiento sobre métodos anticonceptivos, prevención de infecciones de transmisión sexual y participación en actividades educativas sobre el tema. Los datos se analizaron mediante estadística descriptiva y las diferencias estadísticas se evaluaron mediante la prueba X2 de Pearson. Resultados La prevalencia de la actividad sexual fue del 47,3%, con una edad promedio de la primera relación sexual de 14,1 años y una tendencia a la iniciación sexual temprana entre los participantes masculinos. Un tercio de las primeras relaciones sexuales fueron desprotegidas (33,9%). Las mujeres participantes tenían mayor conocimiento sobre los métodos anticonceptivos y prevención de enfermedades, menos adherencia al uso del condón y mayor uso de anticonceptivos orales y de emergencia. Conclusión e implicaciones para la práctica El estudio mostró un inicio temprano de la vida sexual entre un grupo de adolescentes y un tercio de las relaciones sexuales sin protección. Se advierte la necesidad de llevar a cabo acciones en materia de salud y educación que garanticen la adquisición de conocimiento y el acceso a métodos anticonceptivos.

Abstract Objective Identify the prevalence of sexual activity initiation in adolescents and the practice of safe sex among them. Method A cross-sectional study carried out with 499 adolescents in Porto Alegre, Minas Gerais, from February to April 2017, using a self-administered and semi-structured questionnaire, covering sexual initiation and practices, knowledge about contraceptive methods, prevention of sexually transmitted infections and participation in educational activities on the theme. The data were analyzed using descriptive statistics and the statistical differences were assessed using Pearson's X2 test. Results The prevalence of sexual activity was 47.3%, with a mean age of 14.1 years old at first sexual intercourse, and a tendency for early sexual initiation in the male gender. One third of the first sexual intercourses were unprotected (33.9%). Female participants had greater knowledge about contraceptive methods and disease prevention, lower adherence to condom use and greater use of oral and emergency contraceptives. Conclusion and implications for the practice The study showed an early initiation of sexual life among adolescents, and one third of unprotected sexual intercourses. There is a need for health and education actions that guarantee the acquisition of knowledge and access to contraceptive methods.

Condom Use Errors and Problems in a Sample of Young Colombian Adults.

Condom effectiveness can be reduced by a number of problems and errors that take place during use. The purpose of the present study was to translate and adapt the Condom Use Errors and Problems Survey (CUES) into Spanish and to use it for testing the prevalence of these issues in a sample of young Colombian adults. A total of 775 people (414 women and 361 men) between 18 and 26 years of age participated in the study. Participants completed the following questionnaires online: Condom Use Errors and Problems Survey, Sexual Opinion Survey, Sexual Assertiveness Scale, Multidimensional Condom Attitudes Scale, a sociodemographic and sexual history questionnaire, plus two questions concerning condom-associated erectile problems. Results showed significant differences in the prevalence of condom use errors/problems associated with gender, sexual orientation, and whether the participant had a stable sexual partner. The occurrence of problems/errors ranged from 9.4% to 69.5%. Except for certain specific practices, observations were similar to those of studies performed in North America. Results indicate that the present linguistic adaptation of the CUES for its use in Colombian Spanish-speaking populations is an effective instrument to assess problems and errors associated with the use of male condoms.

Hazardous Alcohol Consumption Moderates the Relationship Between Safer Sex Maintenance Strategies and Condomless Sex With Clients Among Female Sex Workers in Mexico.

Understanding the relationship between cognitive and behavioral processes and long-term behavior change is critical to developing behavior change maintenance interventions. We examined the relationship between cognitive and behavioral safer sex maintenance strategies and condomless vaginal/anal sex with clients among female sex workers (FSWs) in Mexico. We hypothesized a moderating effect of hazardous alcohol use, such that the relationship between the use of safer sex maintenance strategies and condomless sex would be weaker among FSWs who meet criteria for hazardous alcohol consumption. Data were gathered from 602 FSWs enrolled in a sexual risk reduction intervention with a text messaging maintenance component. Seven cognitive and behavioral strategies purported to be critical in sustaining long-term behavior change were measured (e.g., maintenance self-efficacy). The relationship between FSWs' use of safer sex maintenance strategies and condomless vaginal/anal sex with clients was moderated by hazardous alcohol consumption. The association was weaker among FSWs who met criteria for hazardous alcohol consumption. Among FSWs who met criteria for hazardous alcohol consumption, maintenance self-efficacy was associated with fewer condomless sex acts with clients (b = -0.35, p < .001). Among FSWs who did not meet criteria for hazardous alcohol consumption, recovery self-efficacy (b = -0.21, p < .05) and self-monitoring (b = -0.34, p < .001) were associated with fewer acts of condomless sex. Results indicate the importance of examining the multidimensional nature of safer sex maintenance strategies and of exploring subgroup differences in their associations with behavioral outcomes. Interventions that address safer sex maintenance strategies in the context of alcohol treatment should be developed for this subgroup of FSWs.

Correlates of concurrent partnerships and patterns of condom use among men who have sex with men and transgender women in Peru.

BACKGROUND: In Peru, there is an ongoing high-incidence HIV epidemic among men who have sex with men (MSM) and transgender women (TW). Sexual concurrency, or having sex with a partner in between two acts of sex with another partner, may be a key factor in onward HIV transmission. In this study, we quantify concurrency, evaluate factors associated with concurrency, and assess condom use with concurrent partners among MSM and TW in Peru. METHODS: We conducted a secondary analysis of data from the 2011 Peruvian Biobehavioral Survey. Pearson's Chi-squared test was used to identify individual-level characteristics associated with concurrency. We estimated the association between participant characteristics, concurrent partnerships, partnership type (stable vs. non-stable), and CLAI within the context of concurrent partnerships using multivariate and repeated-measure Poisson regression. RESULTS: 3-month cumulative prevalence of concurrency was higher among TW compared to MSM (30.7% vs 25.2%, p = 0.014). Among those with concurrent stable and non-stable partners, 45% used condoms with both partners (95% CI: 40%-50%) and 30% preferentially had CLAI with the stable partner only (95%CI: 26%-35%). Factors associated with CLAI within the context of concurrent partnerships varied between MSM and TW. CONCLUSIONS: Although concurrency is common among TW and MSM in Peru, patterns of concurrency and differential condom use may vary between TW and MSM. Future research may explore differential condom use with stable and non-stable partners to better understand behavioral factors that may alter vulnerability to HIV in TW compared to MSM.

Health Education Training Embedded in a Microfinance Platform Associated with Safer Sexual Behavior in Haitian Women.

Sexual health education interventions have generally yielded modest impact, but may be more successful when integrated into programs designed to alleviate poverty and empower women. Between December 2017 and February 2018, we interviewed 304 Haitian female microfinance clients, 75 of whom had received health education training delivered within their regular meetings. Participants reported six key sexual health outcomes. We used log-binomial models to estimate the association between health education training and each outcome, and tested for interaction by age and literacy status. Women with health education training reported more condom use with unfaithful partners [PR (95% CI) 1.78 (1.04, 3.02)], more HIV testing [PR (95% CI) 1.56 (1.28, 1.90)], and fewer STI symptoms [PR (95% CI) 0.37 (0.19, 0.73)], compared to women with no training. Some of the associations were stronger among older women [e.g. HIV testing: PR (95% CI) 2.09 (1.49, 2.82)] and illiterate women [e.g. condom use: PR (95% CI) 3.46 (1.05, 11.38)]. These findings add to the growing body of evidence demonstrating the potential to use microfinance programs as platforms for health education delivery, and provide the first evidence for the association in Haiti.

Social cohesion, condom use, and sexually transmitted infections among female sex workers living with HIV in the Dominican Republic.

This cross-sectional study examines the relationship between social cohesion with consistent condom use (CCU) and sexually transmitted infections (STIs) among the Abriendo Puertas (Opening Doors) cohort of female sex workers (FSWs) living with human immunodeficiency virus (HIV) in the Dominican Republic (n = 228). Using data from the follow-up survey of the cohort, we conducted multivariate logistic regression to explore these dynamics. Social cohesion was significantly associated with CCU between FSWs living with HIV and their clients in the last month (adjusted odds ratio [AOR] = 1.65, 95% confidence interval [CI]: 1.11-2.45) and STI prevalence among FSWs (AOR: 3.76, CI: 1.159-12.162). Social cohesion was not associated with CCU between FSWs living with HIV and their steady partners. However, both illicit drug use in the past six months (AOR = 0.11, CI: 0.023-0.57) and pregnancy intentions (AOR = 0.11; CI: 0.02-0.42) were significantly associated with CCU with steady partners. Findings highlight the differential role of social cohesion on condom use outcomes between FSWs living with HIV and their paying clients versus steady partners. Research on the pathways via which cohesion influences condom use among sex workers and their clients is merited, as is research regarding the role of drug use and pregnancy intentions on condom use with steady partners.

Predicting Condom Use among Undergraduate Students Based on the Theory of Planned Behaviour, Coquimbo, Chile, 2016.

Background: Sexually transmitted infections and pregnancy in adolescents are acknowledged public health problems in many countries. Although it is known that the proper use of condoms allows avoiding these health problems, their use in Chile is still limited, for unknown reasons. Objective: Based on planned behavioural theory, the aim was to validate a behaviour model regarding condom use by measuring the influence of the variables that predict this use among Chilean university students. Methods: A cross-sectional descriptive study was carried out in October 2016 among 151 Chilean university students belonging to the health and engineering areas. The information was collected through a self-administered survey. The sample was divided into two groups: stable and not stable relationships. Partial least squares (PLS) regression was used for the analysis. Results: It was possible to explain the condom use of the students by 57%. The attitude was the main variable related to the intention of using condoms, together with the perceived behavioural control. Additionally, there are statistically significant differences in the variables that predict condom use among students with stable relations compared to those without a stable relationship. Conclusions: The planned behavioural theory is useful for predicting condom use behaviour when students have a stable partner.

HIV Stigma Mediates the Association Between Social Cohesion and Consistent Condom Use Among Female Sex Workers Living with HIV in the Dominican Republic.

Evidence indicates that social cohesion is a successful strategy to improve consistent condom use (CCU) among female sex workers. However, the individual and layered or combined effect that various types of overlapping stigmas may have on CCU between female sex workers living with HIV and their clients and steady partners has not been analyzed. Drawing on the Abriendo Puertas cohort of female sex workers living with HIV in the Dominican Republic, we used structural equation modeling to test the hypothesis that both HIV stigma and sex work stigma mediate the association between social cohesion and CCU and that they have a layered effect. The results indicated that HIV stigma mediated the association between social cohesion and CCU with clients and partners, while sex work-related stigma did not. There was no evidence of a layered HIV stigma and sex work stigma effect, which may be due to methodological limitations to handle highly correlated latent variables. Findings highlight the need to address internalized HIV stigma within the context of community-based approaches to enhance their HIV prevention impact. This will help to reduce the risk of HIV re-infection with a new distinct HIV viral strain, STI infection, and onward HIV transmission among female sex workers living with HIV.

Concurrence and selection of sexual partners as predictors of condom use among Mexican indigenous migrant workers.

OBJECTIVE: To identify if the selection of mixed sexual partners and the existence of concurrent partners are predictors of condom use in indigenous migrant agricultural workers from Colima, Mexico. METHODS: Analytical cross-sectional study using an egocentric sexual network approach. Community interviewers applied a structured questionnaire to 192 indigenous migrant workers in a sugarcane agro-industrial context. Data were analyzed with binary logistic regression; odds ratios (OR) and 95% confidence intervals (CI 95%) were estimated. RESULTS: In the logistic regression model, adjusted odds (OR; 95% CI) of steady condom use were lower within partnerships of the same indigenous ethnicity compared to other partnerships (0.30; 0.17-0.53), partnerships that were concurrent to other partnerships (0.27; 0.15-0.50), and partnerships that used illegal drugs during sex to other partnerships (0.23; 0.11-0.49). Those variables were actually associated with increased risk of unprotected sex (occasionally or never using condoms), and therefore exposures were unprotected. CONCLUSION: Sexual partners of the same ethnicity, concurrent partnerships and partnerships that use illegal drugs favor the low frequency of constant condom use and, in turn, the vulnerability to STIs and HIV transmission in indigenous migrant agricultural workers.

HIV Prevalence, Knowledge, Attitudes, and Practices Among Polydrug Users in Brazil: A Biological Survey Using Respondent Driven Sampling.

Brazil has a concentrated HIV epidemic among key populations. In 2009, the Ministry of Health conducted a survey in 10 Brazilian cities aiming to estimate HIV prevalence, knowledge, and associated risk behaviors of polysubstance users (PSU). Using Respondent Driven Sampling (RDS), 3449 PSU were recruited, answered an Audio-Computer Self Assisted Interview (ACASI) and were tested for HIV and syphilis. Analyses were weighted by individual's social network size generated on RDSAT. Pooled HIV prevalence was 5.8% but varied across cities. Most PSU were male, non-white, without income, unemployed, with low levels of education. Overall, 12.0% used injectable drugs, 48.7% had sex with occasional partners and 46.4% engaged in commercial sex. A majority received free condoms (71.4%) but 76.7% exhibited inconsistent condom use. Findings can support policies aiming to improve health care and preventive interventions tailored to this population that remains at high risk of acquiring and transmitting HIV/STI in multiple scenarios.

Punto Seguro: A Randomized Controlled Pilot Using Conditional Economic Incentives to Reduce Sexually Transmitted Infection Risks in Mexico.

Randomized controlled pilot evaluated effect of conditional economic incentives (CEIs) on number of sex partners, condom use, and incident sexually transmitted infections (STIs) among male sex workers in Mexico City. Incentives were contingent on testing free of new curable STIs and/or clinic attendance. We assessed outcomes for n = 227 participants at 6 and 12 months (during active phase with incentives), and then at 18 months (with incentives removed). We used intention-to-treat and inverse probability weighting for the analysis. During active phase, CEIs increased clinic visits (10-13 percentage points) and increased condom use (10-15 percentage points) for CEI groups relative to controls. The effect on condom use was not sustained once CEIs were removed. CEIs did not have an effect on number of partners or incident STIs. Conditional incentives for male sex workers can increase linkage to care and retention and reduce some HIV/STI risks such as condomless sex, while incentives are in place.

Knowledge about the human immunodeficiency syndrome among elders in a unit for the care of the elderly. / Conhecimento sobre síndrome da imunodeficiência humana de idosos de uma unidade de atenção ao idoso.

OBJECTIVE: To analyze the knowledge of elders regarding HIV/AIDS. METHODS: Descriptive, cross-sectional, quantitative study, with 457 elders from the Unit for the Care of Elders in Uberaba - Minas Gerais, lasting 3 months. The instruments used were the Mental State Mini-exam and a questionnaire on the human immunodeficiency virus for elders, together with frequency measures for their analysis. RESULTS: Most participants were female (74%), between 60 and 69 y/o (51%). The question with the most correct answers was about syringe/needle transmission (96.2%) and the ones with the least (45.3% and 49.6%, respectively) were regarding AIDS transmission through mosquito bites and whether a person with the human immunodeficiency virus always presents symptoms (49.6%). 88.2% of participants never use condoms. CONCLUSION: The general level of knowledge can be considered good, responding to our goal. However, gaps in knowledge were identified due to the lack of campaigns aimed exclusively at such public, as well as to the lack of awareness of professionals.

High Frequency of Illegal Drug Use Influences Condom Use Among Female Transgender Sex Workers in Argentina: Impact on HIV and Syphilis Infections.

The high prevalence of HIV and syphilis found among female transgender sex workers (FTSWs) in Argentina calls for the study of factors leading to negative health consequences. Given the particular characteristics observed in this population (high marginalization, school dropout, and low adherence to healthcare services), we explored the association of several socio-demographic characteristics with syphilis and HIV infections, and the determinants of condom use. This study revealed that FTSWs from Argentina were exposed to several risk factors decreasing thus their ability to negotiate condom use and leading to increased risk for transmission of HIV and other sexually transmitted infections (STIs). Strategies to reduce HIV and syphilis in this population should consider interventions aimed at decreasing violence and substance use which appear to be the most important determinants. Results of this study will contribute to the global information among FTSWs.

HIV Risk Behaviors and Correlates of Inconsistent Condom Use Among Substance Using Migrants at the Mexico/Guatemala Border.

This study assessed correlates of inconsistent condom use with casual partners and the prevalence of sexual risk behaviors and STIs in the Mexico/Guatemala border region using a sample of 392 migrants (303 men, 85 women) who reported current substance use or problem drinking. We ran separate univariate logistic regression models for men and women, and multivariate logistic regression models for men only. Prevalence of syphilis was 1.2% among women and 2.3% among men; HIV prevalence was 2.4% among women and 1.3% among men. Inconsistent condom use with casual partners was higher in women with greater education and lower among women who sold sex. In men, less access to free condoms, drug use with sexual partners, and drug use before sex were independently associated with inconsistent condom use with casual partners. Sexual and substance use risk behaviors were common, and HIV/STI prevention efforts should target both genders and expand beyond most-at risk populations.

Behavioral interventions to promote condom use among women living with HIV: a systematic review update.

Behavioral interventions have been essential components of HIV prevention approaches, especially those aimed to promote safe sexual practices. We conducted a comprehensive literature search without language restrictions between 1980 and July 2014 to identify randomized controlled trials or controlled studies investigating behavioral interventions which: included women living with HIV; focused on condom use promotion; presented/analyzed outcomes by gender; used a 3-month follow-up or more; and considered at least one HIV-related behavioral or biological outcome. Eight studies comprising a total of 1,355 women living with HIV were included in the meta-analyses, and 13 studies were qualitatively described. When compared to standard care or minimal support intervention, behavioral interventions did not demonstrate an effect on increasing consistent condom use at the 3-month follow-up (RR = 0.92; 95%CI: 0.73, 1.16; p = 0.48), 6-month follow-up (RR = 1.13; 95%CI: 0.96, 1.34; p = 0.15), and 12-month follow-up (RR = 0.91; 95%CI: 0.77, 1.08; p = 0.30). Behavioral interventions also failed to reach positive effect in reduction of unprotected sexual intercourse at 6-months (MD = -1.80; 95%CI: -4.21, 0.62; p = 0.14) and 12-months follow-up (MD = -1.39; 95%CI: -2.29, 0.21; p = 0.09). These findings should be interpreted with caution since they are based on a few small trials. New researches are needed to assess the potential gains from a combination of interventions that promote safe sexual behavior with a harm reduction and gender approach, particularly in developing countries where HIV infection rates remain high.

Meanings of HIV/AIDS prevention and sexuality for young Catholics. / Significados a respeito da prevenção ao HIV/aids e da sexualidade para jovens católicos.

OBJECTIVE To analyze the the social representations of young Catholics about HIV/AIDS prevention and sexuality. METHOD Mixed study, based on the theory of social representations, held in 2015 with 84 young Catholics participating in the group "World Youth Day" on Facebook. The data were collected through the technique of free association of words and in-depth interview. For the information analysis, the software Tri-Deux-Mots and Alceste were used. RESULTS Sexuality is processed in the representational field of young people as being associated with the sexual practice. In turn, the prevention of HIV, a phenomenon represented as intrinsic to sexuality, occurs through the use of condoms or fidelity within marriage. CONCLUSION Young Catholics represent the prevention of HIV/AIDS as a transverse phenomenon to sexuality, whose sexual practices are anchored both in hegemonic and progressive discourses.

Behavioral interventions to promote condom use among women living with HIV: a systematic review update / Intervenções comportamentais para promover o uso de preservativo entre mulheres vivendo com HIV: atualização de uma revisão sistemática / Intervenciones conductuales para promover el uso del condón entre las mujeres que viven con el VIH: actualización de una revisión sistemática

Abstract: Behavioral interventions have been essential components of HIV prevention approaches, especially those aimed to promote safe sexual practices. We conducted a comprehensive literature search without language restrictions between 1980 and July 2014 to identify randomized controlled trials or controlled studies investigating behavioral interventions which: included women living with HIV; focused on condom use promotion; presented/analyzed outcomes by gender; used a 3-month follow-up or more; and considered at least one HIV-related behavioral or biological outcome. Eight studies comprising a total of 1,355 women living with HIV were included in the meta-analyses, and 13 studies were qualitatively described. When compared to standard care or minimal support intervention, behavioral interventions did not demonstrate an effect on increasing consistent condom use at the 3-month follow-up (RR = 0.92; 95%CI: 0.73, 1.16; p = 0.48), 6-month follow-up (RR = 1.13; 95%CI: 0.96, 1.34; p = 0.15), and 12-month follow-up (RR = 0.91; 95%CI: 0.77, 1.08; p = 0.30). Behavioral interventions also failed to reach positive effect in reduction of unprotected sexual intercourse at 6-months (MD = -1.80; 95%CI: -4.21, 0.62; p = 0.14) and 12-months follow-up (MD = -1.39; 95%CI: -2.29, 0.21; p = 0.09). These findings should be interpreted with caution since they are based on a few small trials. New researches are needed to assess the potential gains from a combination of interventions that promote safe sexual behavior with a harm reduction and gender approach, particularly in developing countries where HIV infection rates remain high.

Resumo: As intervenções comportamentais têm sido componentes essenciais das abordagens de prevenção do HIV, especialmente daquelas que visam promover práticas sexuais seguras. Realizamos uma pesquisa bibliográfica abrangente sem restrições de linguagem entre 1980 e julho de 2014, visando identificar ensaios randomizados e não randomizados que investigassem intervenções comportamentais que: incluíssem mulheres vivendo com HIV; focassem na promoção do uso de preservativo; apresentassem ou analizassem resultados por gênero; realizasse acompanhamento por três meses ou mais; e considerasse pelo menos um resultado comportamental ou biológico relacionado ao HIV. Oito estudos com um total de 1.355 mulheres vivendo com HIV foram incluídos nas meta-análises e 13 estudos foram qualitativamente descritos. Quando comparadas com o tratamento padrão ou intervenção mínima de apoio, as intervenções comportamentais não demonstraram efeito no aumento do uso do preservativo no seguimento de 3 meses (RR = 0,92; IC95%: 0,73, 1,16; p = 0,48), no seguimento de 6 meses (RR = 1,13; IC95%: 0,96, 1,34; p = 0,15), e no seguimento de 12 meses (RR = 0,91; IC95%: 0,77, 1,08; p = 0,30). Intervenções comportamentais também não demonstraram efeito positivo na redução de relações sexuais desprotegidas aos 6 meses (MD = -1,80; IC95%: -4,21, 0,62; p = 0,14) e aos 12 meses de seguimento (MD = -1,39; IC95%: -2,29, 0,21; p = 0,09). Estes resultados devem ser interpretados com cautela, uma vez que se baseiam em poucos estudos. São necessárias novas pesquisas para avaliar os potenciais ganhos de uma combinação de intervenções que promovam comportamentos sexuais seguros, com uma abordagem de gênero e de redução de danos, particularmente em países em desenvolvimento onde as taxas de infecção pelo HIV permanecem altas.

Resumen: Las intervenciones comportamentales han sido componentes esenciales de los enfoques de prevención del VIH, especialmente de aquellos que tienen por objetivo promover prácticas sexuales seguras. Realizamos una investigación bibliográfica amplia, sin restricciones de lengua, entre 1980 y julio de 2014, teniendo por objetivo identificar ensayos randomizados controlados o estudios controlados que investigaran intervenciones comportamentales que: incluyeran a mujeres viviendo con VIH; se enfocaran en la promoción del uso de preservativo; presentaran o analizaran resultados por género; realizara un seguimiento durante tres meses o más; y considerara -por lo menos- un resultado comportamental o biológico relacionado con el VIH. Ocho estudios con un total de 1.355 mujeres viviendo con VIH se incluyeron en los metaanálisis y 13 estudios fueron cualitativamente descritos. Cuando se comparan con el tratamiento patrón o intervención mínima de apoyo, las intervenciones comportamentales no demostraron un efecto en el aumento del uso del preservativo en el seguimiento de 3 meses (RR = 0,92; IC95%: 0,73, 1,16; p = 0,48), en el seguimiento de 6 meses (RR = 1,13; IC95%: 0,96, 1,34; p = 0,15), y en el seguimiento de 12 meses (RR = 0,91; IC95%: 0,77, 1,08; p = 0,30). Las intervenciones comportamentales tampoco demostraron un efecto positivo en la reducción de relaciones sexuales desprotegidas a los 6 meses (MD = -1,80; IC95%: -4,21, 0,62; p = 0,14) y a los 12 meses de seguimiento (MD = -1,39; IC95%: -2,29, 0,21; p = 0,09). Estos resultados deben ser interpretados con cautela, ya que se basan en pocos ensayos. Es necesaria una nueva investigación para evaluar las potenciales ganancias de una combinación de intervenciones que promuevan comportamientos sexuales seguros, con un enfoque de género y de reducción de daños, particularmente en países en desarrollo, donde las tasas de infección por el VIH permanecen altas.

Significados a respeito da prevenção ao HIV/aids e da sexualidade para jovens católicos / Representaciones sociales de los jóvenes católicos sobre el VIH/SIDA y sexualidade / Meanings of HIV/AIDS prevention and sexuality for young Catholics

Resumo OBJETIVO Analisar as representações sociais de jovens católicos(as) quanto à prevenção ao HIV/AIDS e à sexualidade. MÉTODO Estudo misto, com base na teoria das representações sociais, realizado em 2015 com 84 jovens católicos participantes do grupo "Jornada Mundial da Juventude" no Facebook. Os dados foram coletados através da técnica de associação livre de palavras e entrevista em profundidade. Para análise das informações, foram usados os softwares Tri-Deux-Mots e Alceste. RESULTADOS A sexualidade é processada no campo representacional dos(as) jovens como sendo associada à prática sexual. Por sua vez, a prevenção ao HIV, fenômeno representado como intrínseco à sexualidade, ocorre com o uso de preservativos ou com a fidelidade dentro do matrimônio. CONCLUSÃO Jovens católicos representam a prevenção ao HIV/AIDS como fenômeno transversal à sexualidade, cujas práticas sexuais estão ancoradas tanto nos discursos hegemônicos quanto nos progressistas.

Resumen OBJETIVO Analizar las representaciones sociales de los(as) jóvenes católicos(as) sobre la prevención del VIH/SIDA y la sexualidad. MÉTODO Estudio mixto, basado en la teoría de las representaciones sociales, llevado a cabo en 2015 con 84 jóvenes participantes del grupo de católicos "Jornada Mundial de la Juventud" en Facebook. Los datos fueron recolectados a través de la técnica de la asociación libre de palabras y la entrevista en profundidad. Para el análisis de la información se utilizó el software Tri-Deux-Palabras y Alceste. RESULTADOS La sexualidad es procesada en el campo representacional de los(as) jóvenes como siendo asociada con la práctica sexual. A su vez, la prevención del VIH, fenómeno representado como intrínseco a la sexualidad, se produce con el uso de preservativos o con la fidelidad dentro del matrimonio. CONCLUSIÓN Jóvenes católicos(as) representan la prevención del VIH/SIDA como fenómeno transversal a la sexualidad, cuyas prácticas sexuales están ancladas tanto en los discursos hegemónicos como en los progresistas.

Abstract OBJECTIVE To analyze the the social representations of young Catholics about HIV/AIDS prevention and sexuality. METHOD Mixed study, based on the theory of social representations, held in 2015 with 84 young Catholics participating in the group "World Youth Day" on Facebook. The data were collected through the technique of free association of words and in-depth interview. For the information analysis, the software Tri-Deux-Mots and Alceste were used. RESULTS Sexuality is processed in the representational field of young people as being associated with the sexual practice. In turn, the prevention of HIV, a phenomenon represented as intrinsic to sexuality, occurs through the use of condoms or fidelity within marriage. CONCLUSION Young Catholics represent the prevention of HIV/AIDS as a transverse phenomenon to sexuality, whose sexual practices are anchored both in hegemonic and progressive discourses.

Abriendo Puertas: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic.

Female sex workers (FSW) are disproportionately affected by HIV. Yet, few interventions address the needs of FSW living with HIV. We developed a multi-level intervention, Abriendo Puertas (Opening Doors), and assessed its feasibility and effectiveness among a cohort of 250 FSW living with HIV in the Dominican Republic. We conducted socio-behavioral surveys and sexually transmitted infection and viral load testing at baseline and 10-month follow-up. We assessed changes in protected sex and adherence to antiretroviral therapy (ART) with logistic regression using generalized estimating equations. Significant pre-post intervention changes were documented for adherence (72-89 %; p < 0.001) and protected sex (71-81 %; p < 0.002). Higher intervention exposure was significantly associated with changes in adherence (AOR 2.42; 95 % CI 1.23-4.51) and protected sex (AOR 1.76; 95 % CI 1.09-2.84). Illicit drug use was negatively associated with both ART adherence and protected sex. Abriendo Puertas is feasible and effective in improving behavioral HIV outcomes in FSW living with HIV.