Levels and Predictors of Sexual HIV Risk in Social Networks of Men who Have Sex with Men in the Midwest.

Past studies have primarily focused on individual-level factors influencing the HIV risk practices of gay or bisexual men. The role of one's social network has been less explored. This study identified 75 indexes in venues frequented by men who have sex with men and then recruited all willing persons named as members of each index's egocentric social network. Two hundred fifty-five unique network members completed assessments of risk-related characteristics and also sociometric measures that were used to identify the influence leader of each network. White and African American networks were composed primarily of men of the same race. Over 70% of men reported recent casual sexual partners. About one fourth of men engaged in unprotected anal intercourse (UAI) with a casual partner or with multiple partners in the past 3 months. The social network to which a man belonged, weaker risk reduction intentions, and greater substance use independently predicted a range of high-risk sexual behaviors. There were modest but significant correlations between the risk-related characteristics of network members and network leaders. Social network-level approaches are feasible for reaching hidden subgroups of MSM at high risk for contracting HIV.

Reactions of heterosexual African American men to women's condom negotiation strategies.

This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a "steady partner." After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the "least willing to use" subgroup was highest in anger-rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.

Condom use negotiation in heterosexual African American adults: responses to types of social power-based strategies.

This study examined gender differences and preferences in the use of and response to six different styles of condom use negotiation with a hypothetical sexual partner of the opposite gender. Participants were 51 heterosexually active African American adults attending an inner-city community center. Participants completed a semistructured qualitative interview in which they were presented with six negotiation strategies based on Raven's 1992 Power/Interaction Model of Interpersonal Influence. Results showed that female participants responded best to referent, reward, and legitimate strategies, and worst to informational tactics. Male participants responded best to reward strategies, and worst to coercion to use condoms. Further, responses given by a subset of participants indicated that use of negotiation tactics involving coercion to use condoms may result in negative or angry reactions. Response to strategies may vary with the value of the relationship as viewed by the target of negotiation. Implications for HIV prevention efforts are discussed.

HIV prevention programs of nongovernmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project.

OBJECTIVE: The objective of this paper is to describe HIV prevention programs conducted by nongovernmental organizations (NGO) that are meeting this challenge. METHODS: One NGO undertaking HIV prevention programs was evaluated in each of the 23 countries participating in the Global AIDS Intervention Network (GAIN) Project throughout Latin America and the Caribbean. A two-stage selection process was used: (1) a search in databases and other information sources; (2) identification of NGOs that were best established and most actively engaged in HIV prevention activity. Executive directors were questioned about staffing, budget issues, populations served and barriers faced by these entities. RESULTS: The 23 NGOs conducted 58 direct-service programs and had been conducting HIV prevention activities for a mean of 8 years (SD=4.45; range 1-18 years). Average annual program budget was US $205,393 (range: US $10,000 to US $1,440,000). The NGOs reported a mean of 4.5 full-time employees (range 0-15, SD=4.7). Many relied on volunteers (median=10, mean=51, range 0-700, SD=150) to conduct HIV prevention activities. The NGOs provided prevention services for the general community (82.6%), children and adolescents (34.8%) and men who have sex with men (30.4%). Activities conducted by NGOs included train-the-trainer activities (43.5%) and face-to-face prevention activities (34.8%). Obstacles cited included lack of funding (60.9%) and HIV-related stigma and discrimination (56.5%). CONCLUSION: The strategies used by NGOs to overcome barriers to prevention are a testament to their ingenuity and commitment, and serve as examples for NGOs in other world regions.

HIV prevention programs of non-governmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project

Objective: The objective of this paper is to describe HIV prevention programs conducted by nongovernmental organizations (NGO) that are meeting this challenge. Methods: One NGO undertaking HIV prevention program was evaluated in each of the 23 countries participating in the Global AIDS Intervention Network (GAIN) Project throughout Latin America and the Caribbean. A two-stage selection process was used: (1) a search in databases and other information sources; (2) identification of NGOs that were best established and most acrively engaged in HIV prevention activity. Executive directors were questioned about staffing, budget issues, populations served and barriers faced by these entities. Results: The 23 NGOs conducted 58 direct-service programs and had been conducting HIV prevention activities for a mean of 8 years (SD = 4.45;range 1-18 years). Average annual program budget was US$ 205,393 (range: US$ 10,000 to US$ 1,440,000). The NGOs reported a mean of 4.5 full-time employees (range 0-15, SD = 4.7). Many relied on volunteers (median = 10, mean = 51, range 0-700, SD = 150) to conduct HIV prevention activities. The NGOs provided prevention services for the general community (82.6 percent), children and adolescents (34.8 percent) and men who have sex with men (30.4 percent). Activities conducted by NGOs included train-the-trainer activities (43.5 percent) and face-to-face prevention activities (34.8 percent). Obstacles cited included lack of funding (60.9 percent) and HIV-related stigma and discrimination (56.5 percent). Conclusions: The strategies used by NGOs to overcome barriers to prevention are a testament to their ingenuity and commitment, and serve as examples for NGOs in other world regions. (AU)

Distance communication transfer of HIV prevention interventions to service providers.

Most acquired immunodeficiency syndrome (AIDS) service providers are in countries with little access to scientific developments relevant to their programs. It is critical to transfer advances from the scientific arena to service providers on a global scale. Human immunodeficiency virus (HIV) prevention organizations in 78 countries were randomized to receive either a control condition or a technology transfer condition with an interactive distance learning computer training curriculum and individualized distance consultation. Of 42 nongovernmental organizations in the technology transfer condition, 29 adopted the science-based program in their communities or trained other agencies to also use it. Advanced communication technologies can create a cost-effective infrastructure to disseminate new intervention models to service providers worldwide.

HIV prevention in Africa: programs and populations served by non-governmental organizations.

The AIDS epidemic in Africa remains an urgent health crisis. Non-governmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services and assistance to persons living with AIDS. African NGOs are conducting numerous HIV prevention programs with several at-risk populations, yet their efforts have only rarely been systematically documented. To address this gap in the literature, the authors surveyed one NGO in each of 29 African countries regarding their HIV prevention activities and populations served. This report provides details concerning HIV prevention activities across the continent and describes in detail innovative programs from Togo and South Africa. NGOs in the present sample operate with modest budgets and small staff sizes, yet conduct programs that reach large segments of their communities. NGOs were most likely to report community-level interventions such as peer-education or community outreach. Faced with an epidemic where the main transmission occurs via heterosexual activity, African NGOs were most likely to direct their attention to the general public and to youth. NGOs in Africa are struggling to implement sustainable, cost-effective programs with few resources. Strengthening the infrastructure and capacity of these key agencies is crucial to fighting the AIDS epidemic in Africa.