HIV-Risk Related Attitudes and Behaviors Among Older Impoverished Women Living in Puerto Rico.

HIV has increasingly impacted older adults regarding sero-prevalence and sero-incidence as long-term survivors of HIV/AIDS are living longer. This study examines the relationship between age and HIV-related attitudes and risk behaviors among female public housing residents in Puerto Rico. Using a self-administered survey instrument, 1,138 female public housing residents were surveyed between April and August 2006. Bivariate results showed that older women (aged 50+ years) were significantly less likely to report HIV testing and to discuss safer sex with their most recent "steady" sex partner than women under the age of 50 years. Older women were also more likely to express anxiety associated with condoms and more barriers to using condoms. The older versus younger groups did not significantly differ regarding condom use, which was extremely low across the groups. In the past three and 12 months, older women were less likely than younger women to report having (a) multiple sex partners and; (b) oral and anal sex with their most recent steady sex partner; (c) oral sex with their most recent non-steady sex partner and, (d) engaging in sexual activity in the previous three and 12 months. Age-specific messages concerning their increased risk of HIV among other interventions would likely curtail the increase in the number of new HIV cases being reported among members of this sub-population.

Condom-use patterns among women who live in public housing developments in Ponce, Puerto Rico.

Abstract:Background. Understanding condom-use patterns and the reasons that women have for choosing not to use condoms with their sexual partners, (both steady and non-steady), is important to the development and implementation of targeted, culturally appropriate interventions that can promote condom use in low-income and impoverished women. Methods. A total of 386 women from four public housing developments in Ponce, Puerto Rico, underwent HIV/STI testing and completed a self-administered questionnaire. Data were collected from August 2008 to October 2010. Results. Reported levels of condom use were low with both steady and non-steady sexual partners. Reasons given for not using condoms with both partner types included the respondent claiming to know her partner well, a general dislike for condoms, not having condoms available, and perceiving no need for them. Conclusions. These findings provide a foundation on which to build an intervention to promote condom use among impoverished women who live in public housing in Puerto Rico in addition to other disadvantaged or impoverished women. It is imperative that health practitioners consider the reasons that these women have for not using condoms in order to inform the development and implementation of effective HIV-prevention interventions.

HIV-Testing Practices and a History of Substance Use among Women Living in Public Housing in Puerto Rico.

The objective of this study was to examine the relationship between HIV testing practices and history of substance use among a large sample of women living in public housing in Puerto Rico and the relationships among HIV testing and history of substance abuse. A total of 1138 women were surveyed between April and August 2006 using a self-administered survey instrument. A total of 82% of the women in the sample group reported a history of HIV testing. Logistic regression analysis revealed that those with a history of alcohol use, marijuana use, and other illicit drug use were more likely to report a history of HIV testing (P < .05). These findings suggest the possibility that women who engage in riskier behaviors may be aware of these risks and therefore make more of an effort to determine their status. Future studies should, however, further examine the risks among women from subpopulations who may be at high risk for HIV.

The viability of outercourse for HIV prevention within the Puerto Rican context.

BACKGROUND: As the number of HIV/AIDS cases continues to increase in Puerto Rico, outercourse, or non-penetrative sexual activities, may be one alternative for healthy sexual living for persons living with or at risk for HIV/AIDS. METHODS: Between April and August 2006, we surveyed 1138 women living in low-income housing in Ponce, PR on their attitudes toward and participation in outercourse activities. RESULTS: The majority of the sample were aged >25 years (80.2%), with a mean sample age of 36.77 (SD = 12.31). Approximately one half (49.8%) of the women in the sample were legally married or involved in a common-law relationship. Mutual masturbation and the use of sex toys were viewed as "real sex" by only 33% and 16%, respectively, of the women surveyed. A slight majority had at least a high school education (57.5%). Of those with a steady sex partner in the previous 12 months, 47% engaged in mutual masturbation, and 17% used sex toys. Of those with a non-steady sex partner in the previous 12 months, 41% engaged in mutual masturbation, and 14% used sex toys. Logistic regressions indicated that persons who perceived mutual masturbation and the use of sex toys as real sex were more likely than those who did not perceive them to be so to engage in either or both behaviors with their most recent steady sex partner (OR = 4.5, CI =3.3-6.2 and OR=18.11, CI = 11.5-28.6, respectively); the same relationship emerged with their most recent non-steady sex partner (OR = 4.0, CI = 1.9-8.3 and OR = 15.9, CI = 5.3-47.4). CONCLUSIONS: The levels of participation in outercourse were low across the sample; also low was the perception of outercourse as being real sex. Outercourse appears to be, primarily, a precursor to penetrative sex, especially with steady sex partners. If culturally sensitive prevention messages were to promote outercourse as real sex and as an ultimate sexual goal, couples might be able to maintain an intimate, yet safe, sexual relationship. Outercourse should not be promoted as the only option for safer sex relationships but instead in the context of a comprehensive prevention message, which would also include protected sexual intercourse for those who choose to engage in penetrative activities.

The effect of sympathy on discriminatory attitudes toward persons living with HIV/AIDS in Puerto Rico: a hierarchical analysis of women living in public housing.

As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Puerto Rico, it becomes increasingly important to address the issues of stigma and other discriminatory attitudes. Therefore, the objective of the present study is to examine the attitudes toward PLWHA of a large sample of women living in public housing in Puerto Rico, including sympathy and support for PLWHA in the workplace and in school. A total of 1138 women completed a self-administered 218-item survey made up of questions that measured HIV-related knowledge, attitudes and behaviors. Levels of sympathy varied depending upon the target group, with HIV-infected drug users receiving the least sympathy. Most women reported that HIV-positive teachers should be allowed to teach and that HIV-positive children should be allowed to attend school. However, a significantly lower percentage reported that HIV-infected nurses should be allowed to continue working. Women who were more sympathetic toward PLWHA were more tolerant of PLWHA in the workplace and school, while those with inaccurate knowledge concerning HIV transmission were less tolerant. Also, those who knew a PLWHA were more tolerant. Levels of discriminatory attitudes in Puerto Rico are high and warrant both individual- and societal-level interventions.

HIV testing practices among women living in public housing in Puerto Rico.

OBJECTIVE: The objective of our study was to examine HIV testing practices among a large sample of women living in public housing in Puerto Rico and the relationships among HIV testing, sociodemographic variables, and HIV-related behaviors. METHODS: A total of 1138 women were surveyed between April and August 2006 using a self-administered survey instrument. RESULTS: Eighty-two percent of the women in the sample group reported a history of HIV testing. Hierarchical logistic regression analyses revealed that those adults who were at least 25 years of age and those who perceived some risk of HIV were more likely to report previous HIV testing. Also, those who had attended an HIV/AIDS education workshop or discussion and those who reported knowing persons living with HIV/AIDS were more likely to report previous testing. CONCLUSIONS: A large percentage of the women in our study have been tested for HIV; it is imperative, however, that appropriate HIV education and prevention messages be given to them when they receive their results. Client-initiated HIV testing to learn HIV status provided through counseling and testing remains critical to the effectiveness of HIV prevention. It is unwise to underestimate the importance of being tested. One of the first steps in self-protection from HIV is to be informed of one's HIV status, which allows one to make appropriate and responsible sexual decisions. Future success in decreasing the number of new infections among women will result from targeting women who may be at high risk, although not because of sex work or drug use. Increasing knowledge of HIV serostatus and the implications of these results, especially among those who are infected, can serve as a gateway to sustained behavioral risk reduction intervention, as well as to care and treatment. Considering the fact that both the actual and estimated numbers of HIV/AIDS cases among women in Puerto Rico continue to increase, it is clear that effective, targeted, and aggressive strategies are urgently needed to prevent both primary and secondary HIV transmission.

Trends in HIV risk perception, condom use and sexual history among Jamaican youth, 1996-2004.

As the number of HIV/AIDS cases continues to increase among youth, aged 15-24 years, it becomes critically important to identify the factors that are contributing to this increase. Trends in perceived risk and risk behaviours were examined among youth by sex and age in an attempt to address this concern. National-level cross-sectional data across three time periods (1996, 2000, 2004) gathered from youths, aged 15-24 years in Jamaica for six outcomes were examined (perceived risk, ever had sex, initiation of sex before age 14, multiple sexual partnerships, condom use at last sex with regular and non-regular partners). Trend analyses were employed for each outcome for the total sample and separately by sex and age. A significant positive increase in condom use emerged; males reported higher levels of condom use at last sex with most recent regular partner (55.7% in 1996, 67.9% in 2004, p < 0.01). Condom use by females with regular and non-regular partners did not increase. There was no significant change in the percent of youths reporting multiple partnerships, the percent initiating sex or age at first sex. Youths did perceive themselves to be at greater risk for HIV in 2004 than in 1996 (40.0% vs. 17.6%, p < 0.001). These analyses revealed inadequate protective behaviour adoption by Jamaican youths. Prevention programs targeting youths need to be expanded significantly, be culturally relevant, and also address social vulnerability.

Chronic morphine exposure causes pronounced virus replication in cerebral compartment and accelerated onset of AIDS in SIV/SHIV-infected Indian rhesus macaques.

Six morphine-exposed and 3 control male Indian rhesus macaques were intravenously inoculated with mixture of SHIV(KU), SHIV(89.6)P and SIV/17E-Fr. These animals were followed for a period of 56 weeks in order to determine CD4 and CD8 profile, viral loads in plasma and cerebrospinal fluid (CSF), relative distribution of 3 pathogenic viruses in blood and brain, binding as well neutralizing antibody levels and cellular immune responses. Both morphine-exposed and control macaques showed a precipitous loss of CD4+ T cells; control animals, however, showed a greater tendency to recover these cells than did their morphine-exposed counterparts. The plasma and CSF viral loads were significantly higher in morphine-exposed group than those in the control group. Four morphine-exposed animals succumbed to SIV/SHIV-induced AIDS at week 18, 19, 20 and 51; post-infection with neurological disorders was found in 3 of the 4 animals. At the end of the 56-week observation period, 2 morphine-exposed and 3 control animals were still alive. All 3 viruses replicated in the blood of both morphine-exposed and control macaques, but the cerebral compartment showed a selection phenomenon; only SIV/17E-Fr and SHIV(KU) successfully crossed the blood brain barrier (BBB). The morphine-exposed macaques further favored viral migration through the blood brain barrier (BBB). SIV/17E-Fr crossed the BBB within 2 weeks in both morphine-exposed and control macaques, whereas SHIV(KU) crossed the BBB more rapidly in morphine-exposed than in control macaques. Three morphine-exposed macaques (euthanized at weeks 18, 19 and 20) did not develop cellular or humoral immune responses, whereas the other 3 morphine-exposed and 3 control macaques developed both cellular and humoral immune responses.

Sexual stigma and sympathy: attitudes toward persons living with HIV in Jamaica.

As the number of persons living with HIV continues to increase in Jamaica, attitudes and values become more important. This study aimed to examine the attitudes of university students in Jamaica toward persons living with HIV, including homosexual men, heterosexual men, women sex workers, other women, and children. One thousand two hundred and fifty-two students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge, attitudinal and behavioural items. Less than half of students reported sympathetic attitudes toward homosexual men or women sex workers living with HIV while a majority reported generally sympathetic attitudes toward heterosexual men and non-sex worker women living with the disease. Predictors of sympathy varied by target group. Male students were significantly less likely to report sympathy for homosexual men than for any other group. Spirituality was associated with sympathy for homosexual men and women sex workers, but not for the remaining two groups. Findings suggest that levels of negative attitudes are high in Jamaica and warrant attention to both individual and societal-level actions and interventions. In addition, messages and interventions must be targeted, recognizing both the differences in level of sympathy expressed toward different groups and predictors of sympathy across the groups.

Prevalence and correlates of HIV testing: an analysis of university students in Jamaica.

BACKGROUND: Prevention programs often promote HIV testing as one possible strategy of combating the spread of the disease. OBJECTIVE: To examine levels of HIV testing practices among a large sample of university students and the relationship among HIV testing, sociodemographic variables, and HIV-related behaviors. METHODS: A total of 1252 students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge and attitudinal and behavioral items. RESULTS: Hierarchical logistic regression analyses revealed that youths, married persons, persons who had attended an HIV education forum, and those who knew someone with HIV/AIDS were more likely to report a previous HIV test. However, HIV testing was not associated with condom use or number of sex partners. CONCLUSION: The lack of significant findings between testing and risky sexual behaviors should not negate the importance of HIV testing. Being informed regarding personal HIV serostatus is one of the first steps in self-protection. Effective messages and programs need to be developed and implemented in Jamaica to promote HIV testing and help persons to adequately assess their level of risk with respect to contracting HIV.

Prevalence and Correlates of HIV Testing: An Analysis of University Students in Jamaica.

BACKGROUND: Prevention programs often promote HIV testing as one possible strategy of combating the spread of the disease. OBJECTIVE: To examine levels of HIV testing practices among a large sample of university students and the relationship among HIV testing, sociodemographic variables, and HIV-related behaviors. METHODS: A total of 1252 students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge and attitudinal and behavioral items. RESULTS: Hierarchical logistic regression analyses revealed that youths, married persons, persons who had attended an HIV education forum, and those who knew someone with HIV/AIDS were more likely to report a previous HIV test. However, HIV testing was not associated with condom use or number of sex partners. CONCLUSION: The lack of significant findings between testing and risky sexual behaviors should not negate the importance of HIV testing. Being informed regarding personal HIV serostatus is one of the first steps in self-protection. Effective messages and programs need to be developed and implemented in Jamaica to promote HIV testing and help persons to adequately assess their level of risk with respect to contracting HIV.

Discriminatory attitudes toward persons living with HIV/AIDS in Jamaica: a hierarchical analysis of university students.

BACKGROUND: As the number of persons living with HIV/AIDS (PLWHAs) continues to increase in Jamaica, concerns of discriminatory attitudes become more important. OBJECTIVE: To examine the attitudes of university students in Jamaica toward PLWHAs, including sympathy and support for PLWHAs in the workplace and in school. METHODS: The authors conducted a survey of 1,252 students between June 2001 and February 2002 using a 193-item questionnaire that measured HIV-related knowledge, attitudes, and behaviors. RESULTS: Less than half of the students who were surveyed reported sympathetic attitudes toward either homosexual males or female prostitutes living with HIV/AIDS (41 percent and 44 percent, respectively), while a majority reported sympathetic attitudes toward heterosexual males and non-prostitute females living with the disease (67 percent and 81 percent). Most students reported that HIV-positive teachers should be allowed to teach, and that HIV-positive children should be allowed to attend school (80 percent and 62 percent). Only a minority (36 percent) reported that HIV-positive nurses should be allowed to work. Students who were more sympathetic toward PLWHAs were more tolerant of PLWHAs in the workplace and in school, while those with inaccurate knowledge concerning HIV transmission risk were less tolerant. CONCLUSION: Levels of discriminatory attitudes are high in Jamaica and warrant the attention of both individual- and societal-level interventions.

Prevalence and determinants of sexually transmitted diseases: an analysis of young Jamaican males.

BACKGROUND: Jamaican adolescents have high rates of sexually transmitted diseases (STDs). GOALS: Since the sexual behaviors that put an individual at risk for HIV are the same as for other STDs, the prevalence and determinants of STD symptoms among a sample of young Jamaican males were examined. STUDY DESIGN: As part of the 1997 Reproductive Health Survey, male adolescents and young adults in Jamaica were surveyed about symptoms of STDs and related sex behaviors. RESULTS: Overall, 9% of the sample reported symptoms of STDs in the year before the interview. Rates of high-risk sexual behaviors were high. Logistic regression analyses indicated that being older and having multiple sex partners were associated with having symptoms of STDs. CONCLUSIONS: Prevention programs should recognize that various factors can increase the risk of contracting and transmitting STDs, including HIV. Interventions should be targeted to those with high-risk behaviors that are conducive to continued participation in high-risk sexual behaviors.