The Impact of Providing Free HIV Self-testing on Sexual Risk Behaviors Among Men who have Sex with Men in Hunan, China: A Randomized Controlled Trial.

HIV self-testing (HIVST) increases testing frequency among men who have sex with men (MSM). However, its impact on sexual risk behaviors is unclear. In a randomized controlled trial conducted in Hunan Province, China, HIV-negative MSM were randomized to receive one of two interventions for one year: (1) facility-based HIV testing, or (2) facility-based HIV testing augmented with free HIVST. From April to June 2018, 230 MSM were enrolled. They self-reported sexual behaviors every 3 months for 12 months. Among 216 MSM with follow-ups (intervention: 110; control: 106), adjusting for potential confounders in Generalized Estimating Equation models, there were no statistically significant differences in consistent condom use with male partners (regular/casual) or female partners, nor on number of male or female sexual partners. Provision of free HIVST kits does not increase risky sex and should be included in comprehensive HIV prevention packages, particularly for sexual minority men in China.

Ethical Decision-making of Health Professionals Caring for People Living with HIV/AIDS in Hunan, China: A Qualitative Study.

Numerous ethical issues surged the moment acquired immunodeficiency syndrome (AIDS) was discovered. As advocates of people living with HIV/AIDS (PLWHA), health professionals encounter many ethical dilemmas in clinical practice. However, it remains unclear how health professionals solve these issues. The descriptive qualitative research was conducted through semi-structured interviews with 22 health professionals from May to August 2018. Three themes emerged from data analyses of the interviews: (1) real ethical dilemma experienced by health professionals, (2) factors influencing ethical judgment, (3) ethical motivations. About two-thirds of participants failed to recall ethical dilemmas experienced in their clinical practice. Emotions, gender, occupation, and difficulty balancing different roles may influence the ethical judgments of health professionals. In the ethical decision-making (EDM) process, most participants took other people's interests into consideration and conformed to law and professional codes of conduct. However, the fear of medical disputes (conflicts with families and others) was experienced by many participants, influencing their ethical behaviors.

Stress and Coping in Nurses Taking Care of People Living with HIV in Hunan, China: A Descriptive Qualitative Study.

BACKGROUND/PURPOSE: Nurses engaged in the care of people living with HIV (PLWH) are commonly exposed to workplace stress. This study aimed to explore the stress experiences and coping strategies among nurses taking care of PLWH in China. METHODS: Nurses were recruited from the AIDS department of a public, general, third-grade class-A hospital, which has the largest HIV care department in the Hunan Province of China. Thirty-three nurses working in the AIDS Department were recruited in this qualitative study. Eight nurses participated in a focus group and 25 nurses underwent in-depth individual interviews aimed at characterizing the nurse's feelings and struggles with stress during caregiving for PLWH. The interviews were audio-recorded, transcribed verbatim, anonymized, and imported into NVivo 8.0 software. The data were coded and subjected to thematic analysis. RESULTS: Concerns about occupational exposure, heavy workload, mental health problems and risk behaviors of patients, and discrimination towards nurses caring for PLWH were the four main sources of stress. The negative impact of stress included problems with emotion regulation, somatic health and sleep, and work performance. Some participants also reported a positive impact of work stress on their mental health. Using personality strengths, problem-solving, help-seeking, concealing and avoiding/suppression were common coping strategies employed by nurses caring for PLWH. CONCLUSION: Our findings help characterize the stress experienced by nurses caring for PLWH in the Chinese cultural context, and may inform specific interventions to help manage stress and promote mental health of nurses.

Reframing the meaning of life and professional values: A theoretical framework of facilitating professional care for terminally ill patients.

Professional values reflect nurses' understanding of how to deliver professional care, which might influence nurses' attitudes and caring behaviors during end-of-life care. However, limited research has been conducted to explore nurses' experiences of professional development during end-of-life care, and theoretical explanations are scarce about how nurses enact their professional values during the caring process. This study explored the social process of professional values involved in end-of-life care in the Chinese cultural context by adopting a constructivist grounded theory approach. Twenty semi-structured in-depth interviews with 15 nurses from three hospitals in southeastern China were conducted. A theoretical framework emerged when focusing on the social process of "reframing the meaning of life and professional values" to facilitate professional care for terminally ill patients. Three main categories were sequentially identified as "recognizing the dilemmas when caring for terminally ill patients," "applying strategies to deal with values conflict," and "reconstructing values." This theoretical framework may be applied as a practical framework for equipping nurses with effective strategies to cultivate professional values, including the provision of adequate end-of-life knowledge, and a supportive workplace environment.

Facilitators and Barriers of HIV Self-Testing Among Chinese Men Who Have Sex With Men: A Qualitative Study.

ABSTRACT: HIV self-testing (HIVST) could increase HIV testing. However, HIVST uptake rate among Chinese men who have sex with men (MSM) is low. We conducted qualitative interviews with 23 MSM, 4 workers from community-based organizations, and 7 officials from both provincial Centers for Disease Control and Prevention and affiliated city-level Centers for Disease Control and Preventions to explore facilitators and barriers of HIVST among Chinese MSM. Eight barriers were identified, including fear of being duped by a fake test, concern for cost, fear of disclosing sexual orientation, limited access, lack of consulting services, biosafety concerns, lack of policy support, and concern for lost opportunities to link men to care. Five facilitators were identified, including convenience, confidentiality, easy operation, partner HIV testing, and peers' influence. Officials and scholars should urgently address structural barriers and provide accessible, affordable, and high-quality HIVST services that are accompanied by counseling to develop culturally appropriate HIVST guidelines.

Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial.

BACKGROUND: The HIV epidemic is rapidly growing among men who have sex with men (MSM) in China, yet HIV testing remains suboptimal. We aimed to determine the impact of HIV self-testing (HIVST) interventions on frequency of HIV testing among Chinese MSM and their sexual partners. METHODS AND FINDINGS: This randomized controlled trial was conducted in 4 cities in Hunan Province, China. Sexually active and HIV-negative MSM were recruited from communities and randomly assigned (1:1) to intervention or control arms. Participants in the control arm had access to site-based HIV testing (SBHT); those in the intervention arm were provided with 2 free finger-prick-based HIVST kits at enrollment and could receive 2 to 4 kits delivered through express mail every 3 months for 1 year in addition to SBHT. They were encouraged to distribute HIVST kits to their sexual partners. The primary outcome was the number of HIV tests taken by MSM participants, and the secondary outcome was the number of HIV tests taken by their sexual partners during 12 months of follow-up. The effect size for the primary and secondary outcomes was evaluated as the standardized mean difference (SMD) in testing frequency between intervention and control arms. Between April 14, 2018, and June 30, 2018, 230 MSM were recruited. Mean age was 29 years; 77% attended college; 75% were single. The analysis population who completed at least one follow-up questionnaire included 110 (93%, 110/118) in the intervention and 106 (95%, 106/112) in the control arm. The average frequency of HIV tests per participant in the intervention arm (3.75) was higher than that in the control arm (1.80; SMD 1.26; 95% CI 0.97-1.55; P < 0.001). This difference was mainly due to the difference in HIVST between the 2 arms (intervention 2.18 versus control 0.41; SMD 1.30; 95% CI 1.01-1.59; P < 0.001), whereas the average frequency of SBHT was comparable (1.57 versus 1.40, SMD 0.14; 95% CI -0.13 to 0.40; P = 0.519). The average frequency of HIV tests among sexual partners of each participant was higher in intervention than control arm (2.65 versus 1.31; SMD 0.64; 95% CI 0.36-0.92; P < 0.001), and this difference was also due to the difference in HIVST between the 2 arms (intervention 1.41 versus control 0.36; SMD 0.75; 95% CI 0.47-1.04; P < 0.001) but not SBHT (1.24 versus 0.96; SMD 0.23; 95% CI -0.05 to 0.50; P = 0.055). Zero-inflated Poisson regression analyses showed that the likelihood of taking HIV testing among intervention participants were 2.1 times greater than that of control participants (adjusted rate ratio [RR] 2.10; 95% CI 1.75-2.53, P < 0.001), and their sexual partners were 1.55 times more likely to take HIV tests in the intervention arm compared with the control arm (1.55, 1.23-1.95, P < 0.001). During the study period, 3 participants in the intervention arm and none in the control arm tested HIV positive, and 8 sexual partners of intervention arm participants also tested positive. No other adverse events were reported. Limitations in this study included the data on number of SBHT were solely based on self-report by the participants, but self-reported number of HIVST in the intervention arm was validated; the number of partner HIV testing was indirectly reported by participants because of difficulties in accessing each of their partners. CONCLUSIONS: In this study, we found that providing free HIVST kits significantly increased testing frequency among Chinese MSM and effectively enlarged HIV testing coverage by enhancing partner HIV testing through distribution of kits within their sexual networks. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1800015584.

Strategies for Effective Collaboration with Middle School Physical Education Teachers: An Application of School-Engaged Research.

BACKGROUND: Increasing the capacity of teachers to deliver physical education (PE) lessons that are high in moderate to vigorous physical activity (PA) is one strategy to increase the amount of exercise students receive during school. However, traditional research approaches have not directly engaged the school community as equitable partners in the intervention design process. The purpose of this article is to describe the process, outputs, and lessons learned from a school-engaged research study, which incorporates the unique needs of schools-in terms of structure, accountability measures, and array of stakeholders into the research process and design. METHODS: This article describes lessons learned from Project SHAPE, a PA intervention that used principles of school-engaged research to guide program planning, recruitment, implementation, and data dissemination. RESULTS: The study team successfully partnered with 16 schools and enrolled 55 teachers and surveyed 4,773 students. CONCLUSIONS: Efforts to improve PE programs can benefit from a school-engaged research approach that directly involves teachers, fosters mutually beneficial relationships, and integrates the schools' perspective in the research process.

"You Only Teach PE and It Doesn't Really Matter": Middle School PE Teachers' Perspectives on Intervention Efforts to Increase Physical Activity.

Physical education (PE) is a frequent site of public health intervention to promote physical activity (PA); however, intervention research frequently overlooks the perspective of PE teachers. The purpose of this qualitative study was to explore teachers' experiences with and perceptions of a PA curriculum intervention. Six findings within three categories were identified and described in detail. In-depth one-on-one semistructured interviews were conducted with nine PE teachers from eight middle schools in Los Angeles. Feeling underappreciated and having a "muddled mission" within PE were driving factors in teacher morale and practice. Teachers had positive experiences with the curriculum, but significant barriers remained and limited the potential for PA during PE classes. PE teachers are pulled in multiple directions and perceive a lack of necessary support systems to achieve student health goals. Interventions aimed at leveraging PE as a site of PA promotion must incorporate the perspectives of PE teachers.

Cognitive Impairment Among Aging People Living With HIV on Antiretroviral Therapy: A Cross-Sectional Study in Hunan, China.

Our cross-sectional study examined the prevalence of cognitive impairment among people living with HIV (PLWH) aged 60 years or older. The sample, composed of 250 PLWH, was recruited from 2 clinics in Hunan, China. Structured questionnaires guided face-to-face interviews, including items addressing demographic characteristics, regimens of antiretroviral therapy, and cognitive status as measured by the Montreal Cognitive Assessment. Findings revealed cognitive function of this population was significantly lower than that of uninfected individuals based on historical comparisons; 87.2% (n = 218) of PLWH in our study had cognitive impairment. Global cognitive function as well as the domains of language and orientation decreased with age. Global cognitive function was associated with sex and education, but not with antiretroviral therapy regimens. These findings support an urgent need to include routine screening for cognitive function in older PLWH and the need to consider the complexity of the evaluation process.

Associations of Partner Support and Acculturation With Physical Activity in Mexican American Women.

INTRODUCTION: Insufficient physical activity (PA) and obesity-related health conditions have reached epidemic proportions worldwide. Mexican American women (MAW) report low leisure time physical activity. Few studies examine activities beyond leisure time. Qualitative research suggests that partner support influence provides a cultural approach relevant to PA among MAW. METHOD: This cross-sectional study used an ecological model to investigate community (the physical environment), interpersonal (partner support, attitudinal familism), and intrapersonal (age, health conditions, acculturation, employment, and body mass index) factors associated with PA among 112 MAW. Community-based participatory research recommendations guided the preparatory phase of the study and the face-to-face interviews. Frequencies and descriptive statistics were computed. Multivariable linear regression analyses were used to examine associations between study variables. RESULTS: Moderate to high PA levels were found based on combined activities performed during leisure time, transportation, household tasks, and occupational duties. Women with greater partner support reported higher PA levels. Although acculturation levels were low among women, those with higher acculturation were found to be more physically active. CONCLUSIONS: Future studies should examine strategies to increase partner support and address acculturation within intervention programs to enhance overall PA among MAW.

Mindfulness-Based Intervention For Nurses In AIDS Care In China: A Pilot Study.

BACKGROUND/PURPOSE: Workplace stress among nurses providing care for people living with human immunodeficiency virus is a serious problem in China that may increase rates of job burnout and affect quality of care. Mindfulness-based intervention has been shown to be effective in relieving stress and burnout in nurses. Therefore, we designed a mixed-method pilot study to evaluate a mindfulness-based intervention for nurses providing care for people living with human immunodeficiency virus. METHODS: Twenty nurses caring for people living with human immunodeficiency virus in the First Hospital of Changsha, China participated in a mindfulness-based intervention for 2 hr sessions weekly for 6 weeks. The Perceived Stress Scale, Maslach Burnout Inventory, Five Facets Mindfulness Questionnaire, State-Trait Anxiety Inventory, and the Beck Depression Inventory were used to collect data before and after the mindfulness-based intervention. Participants were invited to attend an in-depth interview 1 week after the end of the mindfulness-based intervention to give feedback. RESULTS: The quantitative analyses revealed a significant change in Five Facets Mindfulness Questionnaire scores. There were no significant differences between pre- and post-intervention measures of any other variables. Qualitative results showed nurses experienced a decrease in work and daily life pressures; improvements in communications with patients, colleagues and families, with better regulation of negative emotions, and acceptance of other people and attention. CONCLUSION: This study supports the acceptability and potential benefits of the mindfulness-based intervention in helping nurses caring for people living with human immunodeficiency virus to manage stress and emotions, and improve their acceptance of others and attention. A larger study with a randomized controlled trial design is warranted to confirm the effectiveness of this mindfulness-based intervention.

Evaluation of an Intervention to Increase Physical Activity in Low-Income, Urban Middle Schools.

BACKGROUND: Physical education (PE) can provide opportunities to engage in daily moderate-to-vigorous physical activity (MVPA), but MVPA levels in many classes are low. This study examines MVPA during middle school PE lessons before and after receiving the SPARK (Sports, Play, and Active Recreation for Kids) program. METHODS: Sixteen schools were enrolled in the study. PE teachers at eight schools received the intervention. PE lessons at all schools (N = 561) were observed over 2 years. Hierarchical linear regression models examined the effect of the intervention on the amount and consistency of MVPA and sedentary behavior. RESULTS: An average of 13.7% of observed class time was spent in MVPA (approximately 5 minutes of a 60-minute class), compared to 27.5% of time spent sedentary. There was no evidence that the curriculum resulted in increased MVPA or consistent MVPA, or that it decreased sedentary behavior. Findings also suggested that contextual factors may contribute to physical activity levels in PE. CONCLUSIONS: Mixed evaluation findings of the SPARK middle school curriculum demonstrate that an out-of-the-box curriculum does not have the same results in all contexts. Implications for school health are described based upon findings. Further research is needed to identify effective strategies to increase MVPA for adolescents both in and outside of PE.

The Effects of a 2-Year Middle School Physical Education Program on Physical Activity and Its Determinants.

Purpose: This study examines the effects of the middle school SPARK physical education (PE) curriculum on predisposing, enabling, and reinforcing factors for physical activity (PA) as well as self-reported PA in a predominantly low-income, Latinx student population in Los Angeles, CA. Methods: Data were collected from 3763 students of seventh and eighth grades at 2 time points at the 16 middle schools enrolled in the study. Hierarchical logistic regression models were used to assess intervention effects on PA attitudes, PE enjoyment, FitnessGram passing, daily PA, and muscle-strengthening PA, controlling for demographic variables. Results: Although there was no detectable intervention effect on increasing the number of students exercising 60 minutes per day, there was a negative intervention effect detected for muscle-strengthening exercises. A significant positive intervention effect was detected for both PE enjoyment and FitnessGram passing. Deeper analysis of these findings revealed that the positive effect on PE enjoyment occurred only among male students. Conclusion: The SPARK curriculum had mixed effects on students' PA behavior as well as predisposing, enabling, and reinforcing factors for PA. Incorporating student perspectives into the evaluation of intervention efforts to promote PA can facilitate a better understanding of the ways in which these efforts influence PA behaviors and its determinants.

Physical Activity Correlates in Middle School Adolescents: Perceived Benefits and Barriers and Their Determinants.

The purpose of this study was to examine the determinants of benefits and barriers and their relationship with physical activity (PA) among predominantly Latino middle school students. Data were collected in a cross-sectional survey of 4,773 seventh-grade students recruited from a large, urban school district in Los Angeles. Hierarchical logistic regression models were used to assess determinants of benefits and barriers as well as their association with self-reported PA. Differences in benefits and barriers were observed by gender, ethnicity, and body size. Barriers were negatively correlated with all three PA outcomes while benefits were positively associated with exercising at least 60 min daily. A deeper understanding of benefits and barriers can facilitate the development of interventions and collaborative efforts among physical education teachers, school nurses, and administrators to implement comprehensive approaches that encourage students' participation in PA inside and outside of the classroom.

Effectiveness of self-testing kits availability on improving HIV testing frequency for chinese men who have sex with men and their sexual partners: a protocol for a multicenter randomised controlled trial.

INTRODUCTION: HIV epidemic is increasing among men who have sex with men (MSM) in China, yet HIV testing uptake remains low. As an emerging approach, HIV self-testing (HIVST) has the potential to promote HIV testing coverage and frequency in this population. However, evidence of the effectiveness on implementation of HIVST among Chinese MSM and their sexual partners is scarce. METHODS AND ANALYSIS: The randomised controlled trial will be performed in Changsha, Changde, Shaoyang and Yiyang, Hunan province, China, recruiting 184 recent testers (men who had at least one HIV test within the past 2 years) and 26 non-recent testers (men who did not have HIV tests within 2 years or never had an HIV test). Eligible men will be randomly divided 1:1 into two groups: intervention (with free HIVST kits plus site-based HIV testing services) and control (site-based HIV testing services only). Participants in the intervention group will be provided with two free finger-prick-based HIVST kits, and can apply for two to four kits every 3 months for 1 year.Participants in both groups will complete questionnaires via WeChat at five separate times: baseline, third, sixth, ninth and twelfth month. The primary outcome is the mean number of HIV tests for MSM over the 12-month study period. The secondary outcome is the mean number of HIV tests for sexual partners of MSM over the 12-month study period. The tertiary outcomes are the self-reported proportion of consistent condom usage for anal sex, and the numbers of sexual partners during the 12-month study period. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Review Board of Behavioural and Nursing Research in Xiangya School of Nursing of Central South University, China (2018002). Study results will be disseminated through conferences and academic journals. TRIAL REGISTRATION NUMBER: ChiCTR1800015584; Pre-results.

Review: Partner Support and Physical Activity among Mexican American Women.

Objective: Global recommendations on physical activity for noncommunicable disease prevention can be promoted using partner support strategies among women of Mexican descent and other ethnicities. Design/Methods: This systematic review utilized a multifaceted ecological approach by focusing comprehensively on community, individual, and social factors influencing physical activity. PubMed, SAGE Publications, EBSCO, ResearchGate, the Cochrane Library and Google Scholar search engines were used to find research on physical activity, with inclusion criteria of Mexican American women, aged ≥ 18 years, comprising at least 50% of study population sizes. Main Outcome Measures: An initial search of 232 articles with subsequent searches from reference lists led to selection of a mixture of qualitative (3), mixed methods (3), and intervention (1) studies reporting partner support for physical activity as perceived by women. Results: Primarily, studies have conceptualized physical activity as leisure time activities. Few studies have considered multiple ecological factors in examining influences of physical activity among women. Importantly, how women perceive support for physical activity received from partners has been shown to influence their levels of activity. Conclusions: Conceptualization of physical activity restricted only to leisure time eliminates other domains that a broader definition of the term encompasses. Future studies are needed to investigate partner support influences on the overall physical activity of Mexican American women within a larger ecological context. Careful attention to partner support for physical activity engagement can help ameliorate and prevent chronic diseases both nationally and around the world.

Acceptability and Feasibility of a Sexual Health Intervention for Young Adult Black Women.

OBJECTIVE: To assess the acceptability and feasibility of S2S, a newly adapted behavior intervention to address high-risk sexual behavior. DESIGN: Pilot randomized controlled trial. SETTING: The Internet and text messages with no in-person interactions. PARTICIPANTS: Eighty-eight Black women, ages 18 to 24 years, were randomly assigned to the intervention or control groups and self-enrolled in the respective text message program. METHODS: Participants in the intervention group were sent text messages about sexual health, whereas those in the control group were sent text messages about diet and/or exercise. Participants in each group received 24 text messages, including text-only messages, memes, and infopics. Participants in the intervention group also received videos links. All text messages were sent three times per week for 8 weeks. Quantitative methods were used to analyze data from the message and video platform reports. Quantitative and qualitative methods were used to analyze participants' responses to an acceptability and feasibility survey. RESULTS: Overall, the delivery of health promotion text messages was viewed as acceptable and feasible by participants in both groups. Most of the short answer responses from participants were favorable, and responses to the acceptability and feasibility survey yielded a total mean score of 4.01 on a 5-point scale. CONCLUSION: Results from this study support the idea that evidence-based interventions can be adapted for delivery by text message. This delivery modality is acceptable to young adult Black women and may help decrease barriers that would otherwise prevent them from receiving health promotion messages.

Correlates of Social Support and its Association With Physical Activity Among Young Adolescents.

BACKGROUND: A substantial proportion of adolescents, particularly girls and minority youth, fail to meet daily physical activity (PA) recommendations. Social support contributes to adolescent PA, but studies examining this relationship have yielded inconsistent results and rarely focus on diverse, urban populations. AIMS: This study examines the correlates of support for PA from family and friends and its relationship with PA outcomes among young adolescents. METHODS: Data were collected in a cross-sectional survey of 4,773 middle school students. Social support from family and friends was separately measured using the Sallis Support for Exercise Scales. Hierarchical logistic regression models were used to assess correlates of high support and the relationship between support and self-reported PA. RESULTS: Approximately one quarter of students reported being active for at least an hour each day. 31.7% of students reported high family support for PA, while 17.8% reported high friend support. Differences in perceptions of support by gender, ethnicity, and language emerged. Support from family and friends were both consistently strong predictors of all three PA outcomes measured. DISCUSSION: Findings highlight the need for multilevel interventions targeting both psychosocial influences on behavior in addition to addressing the physical environment. Given low rates of friend support for PA, there appears to be an opportunity to increase PA levels through promotion of supportive behaviors among peers. CONCLUSION: Support for PA from family and friends is a key contributor to increased PA among adolescents. Further research is needed to further understand the mechanisms by which these factors influence PA.

Knowledge, Behaviors, and Attitudes About Human Papilloma Virus Among Nursing Students in Izmir, Turkey.

Human papillomavirus (HPV) is transmitted through sexual contact and can cause cervical cancer. The aim of this study was to determine knowledge, behaviors, and attitudes about human papillomavirus (HPV) in nursing students in a baccalaureate program. This study was conducted with a sample of 624 students. Data were collected via questionnaires administered during the first class time. Students' knowledge about HPV was high; 90.5% knew HPV can cause cervical cancer; 94.6% recognized it as a sexually transmitted disease. Although; 87.7% stated a vaccine is available to protect women from HPV, nearly all participants (98.1%) had not received HPV vaccination. Findings show students' level of knowledge about HPV's risk factors and modes of transmission were high. However, this knowledge did not translate into engagement in health related behaviors such as being vaccinated against HPV.