Rapid vs. standard HIV testing in bathhouses: what is gained and lost?

Previous research demonstrates that standard voluntary counseling and testing (VCT) in bathhouses is feasible, and is an effective means for identifying new HIV cases and producing short term change in risk and precautionary behaviors. Less is known about whether the promise shown in standard VCT will be maintained as rapid testing is disseminated into outreach settings such as bathhouses. This study aimed to compare the risk and demographic profiles of men presenting for rapid vs. standard VCT in a bathhouse setting, and to explore the effectiveness of rapid VCT in identifying new infections and changing risk and precautionary behaviors. Bathhouse-based VCT was conducted over the course of two years--in the first year, 492 men participated in standard testing, and in the following year 528 men from the same venue participated in rapid testing. Similar percentages of men were found to be positive using rapid and standard testing (2.5% and 3.7%, respectively), although rapid testing delivered results to more individuals than standard testing (97% vs. 71%). Convenience samples of 133 of the standard testers and 161 of the rapid testers were obtained and assessed at two points: immediately prior to and 3 months after testing. The risk and demographic profiles of men participating in standard vs. rapid testing were similar, suggesting that rapid testing is as feasible an approach as standard testing for attracting men with recent histories of HIV-related risk behavior. In the 3 months following rapid VCT, some risk and precautionary behaviors were changed compared to pre-VCT, but effects were smaller than in the previous study of standard VCT.

The efficacy of female condom skills training in HIV risk reduction among women: a randomized controlled trial.

OBJECTIVES: We evaluated the efficacy of skills training designed to increase female condom use among women. METHODS: We conducted a randomized controlled trial of 409 women, recruited from family planning clinics in northern California, who were randomly assigned to the experimental 4-session female condom skills training intervention or the comparison 4-session women's general health promotion intervention. Participants received condom use instructions at baseline and male and female condoms during the study. They completed audio computer-assisted self-interviews at baseline and at 3 and 6 months. RESULTS: At 3 and 6 months, women in the experimental group were more likely than those in the comparison group to have used the female condom at least once in the prior 3 months. The increase in the percentage of sexual acts protected by female condoms from baseline to the 6-month follow-up was greater for the experimental group. The percentage of sexual acts during which any condom was employed was higher in the experimental group at 6 months. There were no group differences in male condom use. CONCLUSIONS: Outcomes suggest that skills training can increase female condom use and protected sexual acts without reducing male condom use among women.

Bringing it home: design and implementation of an HIV/STD intervention for women visiting incarcerated men.

Incarceration has been identified as a key variable to be addressed in halting the HIV epidemic among African Americans. Our research team has been conducting and evaluating HIV prevention interventions for prisoners and their families since the early 1990s, including interventions specifically tailored to the needs of women with incarcerated partners. This article describes the development and implementation of a multicomponent HIV prevention intervention for women with incarcerated partners, and presents qualitative data from women who participated as peer educators in this intervention. Women with incarcerated partners reported low rates of condom use and HIV testing combined with a lack of information about prison-related HIV risks. We found that peer education is a feasible intervention to reach women with incarcerated partners and that flexibility and inclusiveness are important factors in designing intervention programs for this population.

Building stakeholder partnerships for an on-site HIV testing programme.

Because of the large number of individuals at risk for HIV infection who visit gay saunas and sex clubs, these venues are useful settings in which to offer HIV outreach programmes for voluntary counselling and testing (VCT). Nevertheless, establishing a successful VCT programme in such a setting can be a daunting challenge, in large part because there are many barriers to managing the various components likely to be involved. Using qualitative data from a process evaluation of a new VCT programme at a gay sauna in California, USA, we describe how the various stakeholders overcame barriers of disparate interests and responsibilities to work together to successfully facilitate a regular and frequent on-site VCT programme that was fully utilized by patrons.

Making sure research is used: community-generated recommendations for disseminating research.

Academic research, no matter how innovative, will never make a difference in the lives of people unless it is disseminated in an appropriate and timely manner to providers and organizations serving the public. Yet many researchers are not trained, rewarded, or supported to disseminate research findings. The Community Advisory Board (CAB) of the University of California, San Francisco, Center for AIDS Prevention Studies (CAPS) developed a set guidelines to support researchers' intentions to disseminate their findings through nontraditional venues. These guidelines are unique because community members, many of whom have struggled with accessing research in a timely way, generated them. In addition to developing the guidelines, the CAB also conceived and implemented a dissemination strategy for the guidelines. The purpose of this article is to present specific guidelines for disseminating research developed by the CAPS CAB.

Responsibility for HIV prevention: patterns of attribution among HIV-seropositive gay and bisexual men.

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.

Bathhouse-based voluntary counseling and testing is feasible and shows preliminary evidence of effectiveness.

The goal of this study was to provide evidence for the feasibility and effectiveness of conducting voluntary counseling and testing (VCT) for HIV in a bathhouse setting. Four hundred ninety-two men participated in bathhouse-based VCT offered at a single venue over a 13-month period. A convenience sample of 133 of these testers was assessed at 2 points: immediately before and 3 months after testing. Thirty-eight percent of men in the sample reported unprotected anal intercourse (UAI) with 1 of their 2 most recent partners in the 3 months before testing, and 48% of those men had not otherwise been tested for HIV in the previous 12 months. Results showed that in the months after VCT, men were less likely to engage in UAI, decreased their frequency of engaging in sex while drunk or high, and were more likely to communicate about HIV with their sexual partners. Bathhouse-based VCT seems to be a feasible approach for reaching significant numbers of men at risk for HIV and shows preliminary evidence of effectiveness in changing some specific HIV-related risk and precautionary behaviors.

Uncovering implicit theories of HIV prevention providers: it takes a community.

The Implicit Theories Project was a formative research study about what HIV prevention providers believe promotes risk behavior and facilitates behavior change. The study focused on providers who worked directly with clients to uncover providers' implicit theories. We conducted this work across several communities and targeted "risk groups" to uncover any commonalties among these various groupings. We conducted 20 in-depth interviews with HIV prevention providers from five community-based organizations (CBOs) in the San Francisco Bay Area. Although we focused on widely diverse populations, there was a tremendous amount of overlap in what they believed was at the core of behavior change. We also found that their theories of change were based on acknowledging larger structural factors and providing a sense of community. Identifying providers' implicit theories is useful to CBOs and researchers in helping to clarify circumstances that encourage HIV-related risk behaviors among at-risk populations and to inform program development and more formal evaluation efforts.

Unprotected sex with multiple partners: implications for HIV prevention among young men with a history of incarceration.

OBJECTIVES: The objectives of this study were to describe preincarceration risk behaviors of young men and identify correlates of unprotected sex with multiple partners during the 3 months before incarceration. STUDY: Data on preincarceration risk behaviors were obtained from 550 men, aged 18 to 29 years, in state prisons in California, Mississippi, Rhode Island, and Wisconsin. Correlates of unprotected sex with multiple partners were determined by logistic regression. RESULTS: Of 550 participants, 71% had multiple sex partners, 65.1% had sex with a partner they perceived as risky, and 45.3% engaged in unprotected sex with multiple partners. Men who drank heavily (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.11-2.54) or who had a risky partner (OR, 3.90; 95% CI, 2.60-5.85) were more likely to report unprotected sex with multiple partners. Men who attended religious gatherings (OR, 0.66; 95% CI, 0.46-0.96) or lived in stable housing (OR, 0.69; 95% CI, 0.48-1.00) were less likely to report unprotected sex with multiple partners. CONCLUSIONS: Most participants engaged in behaviors that could result in a sexually transmitted disease, including HIV. Prevention programs should address the relationship between heavy alcohol use and risky sexual behavior. Discharge planning should address housing needs. Faith-based community organizations may play an important role for some young men in their transition to the community.

HIV, STD, and hepatitis risk to primary female partners of men being released from prison.

Incarcerated men in the US are at increased risk for HIV, STDs and hepatitis, and many men leaving prison have unprotected sex with a primary female partner immediately following release from prison. This paper addresses risk to the primary female partners of men being released from prison (N = 106) by examining the prevalence of men's concurrent unprotected sex with other partners or needle sharing prior to and following release from prison (concurrent risk). Rates of concurrent risk were 46% prior to incarceration, 18% one month post release, and 24% three months post release. Multivariate analysis showed concurrent risk was significantly associated with having a female partner who had one or more HIV/STD risk factors and having a history of injection drug use. Findings demonstrate need for prevention programs for incarcerated men and their female partners.

"You cannot do nothing in this damn place": sex and intimacy among couples with an incarcerated male partner.

In an effort to deepen our understanding of how circumstances of forced separation and the interdiction of physical contact affect women's sexual behavior, we investigated the development and maintenance of heterosexual couples' intimacy when the male partner is incarcerated. As HIV-prevention scientists who work with women visiting men at a California state prison, we recognize that correctional control extends to these women's bodies, both when they are within the facility's walls visiting their mates and when they are at home striving to remain connected to absent men. This paper analyzes the impact of a peculiar public "place", a penitentiary, on couples' romantic and sexual interactions, drawing out the implications of imprisonment for relationship decision making, sexual health, and HIV risk. Using qualitative interviews with 20 women who visit their incarcerated partners and 13 correctional officers who interact with prison visitors, we examined how institutional constraints such as the regulation of women's apparel, the prohibition of physical contact, and the lack of forums for privacy result in couples forging alternative "spaces" in which their relationships occur. We describe how romantic scripts, the build-up of sexual tension during the incarceration period, and conditions of parole promote unprotected sexual intercourse and other HIV/STD risk behavior following release from prison.

Patterns and predictors of female condom use among ethnically diverse women attending family planning clinics.

BACKGROUND: The female condom is a viable option for women to protect themselves from HIV infection and other sexually transmitted diseases. GOAL: The goal was to examine the level of female condom use and factors associated with frequency of use among US women living in San Francisco and Oakland, California. STUDY DESIGN: Of 238 women recruited from family planning clinics from July 1998 to April 1999, 206 were interviewed at both baseline and 3-month follow-up (a 92% retention rate). RESULTS: We observed a significant increase in vaginal sexual acts protected by the female condom during the study but no reduction in male condom use. Overall, 82% of women reported using a female condom at least once, but the proportion of sexual acts protected by the female condom was only 17%. Multivariate analyses showed that female condom use was associated with suggesting female condom use to one's partner, less concern about device appearance, and a partner's positive attitude about the female condom. CONCLUSION: Our data indicate that female condom use supplements male condom use and leads to an increase in protected sex. The results also suggest that attitudinal and communication factors can increase female condom use.

HIV and STD testing in prisons: perspectives of in-prison service providers.

Because individuals at risk for HIV and STDs are concentrated in prisons and jails, incarceration is an opportunity to provide HIV and STD testing. We interviewed 72 service providers working in U.S. prisons in four states about their experiences with and perceptions regarding HIV and STD testing in prison. Providers' job duties represented administration, education, security, counseling, and medical care. Providers' knowledge of prison procedures and programs related to HIV and STD testing was narrowly limited to their specific job duties, resulting in many missed opportunities for prevention counseling and referral. Suggestions include increasing health care and counseling staff so posttest counseling can be provided for those with negative as well as positive test results, providing additional prevention programs for incarcerated persons, improving staff training about HIV and STD testing, and improving communication among in-prison providers as well as between corrections and public health staff.

HIV infection and pregnancy status among adults attending voluntary counseling and testing in 2 developing countries.

OBJECTIVES: This study investigated the impact of HIV voluntary counseling and testing (VCT) on reproduction planning among 1634 adults in 2 sub-Saharan countries. METHODS: Data were obtained from a multisite randomized controlled trial. RESULTS: At 6 months post-VCT, the women more likely to be pregnant were younger (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.0, 6.5), not using contraceptives (OR = 0.1; 95% CI = 0.1, 0.3), and HIV infected (OR = 3.0; 95% CI = 1.3, 7.0). An interaction emerged linking pregnancy intention at baseline and HIV serostatus with pregnancy at follow-up (OR = 0.1; 95% CI =.0, 0.4) Partner pregnancy rates did not differ by HIV serostatus among men. CONCLUSIONS: HIV diagnosis may influence reproduction planning for women but not for men.