Identifying what rural health workers in Malawi need to become HIV prevention leaders.

Health workers have high potential as HIV prevention leaders, but health system and individual barriers limit their impact. This descriptive qualitative study identified the HIV prevention needs of rural health workers to use as a basis for tailoring an HIV/AIDS risk-reduction intervention. Data included interviews with 9 health administrators, 22 focus groups with 200 health workers, and 12 observations of caregivers in two rural districts. Health system barriers identified included lack of essential supplies, staff shortages, overcrowded facilities, and lack of training. Individual barriers included hopelessness, stigmatizing attitudes, knowledge gaps, and risky personal behaviors. Health workers also expressed willingness to be HIV prevention leaders and role models. Most results agree with previous African studies. Personal risky behaviors and willingness to be HIV prevention leaders have not been previously reported. Results provide insights for developing effective interventions and health policies to address health workers' HIV prevention needs.

Mothers' effectiveness as HIV risk reduction educators for adolescent daughters.

Low-income African American inner city adolescent females continue to be at disproportionately high risk for contracting HIV. Though it has been speculated that mothers' involvement in HIV risk reduction may be helpful in the fight against HIV, very few interventions involve mothers. The Mother/Daughter HIV Risk Reduction intervention (MDRR), an innovative community-based intervention, trains mothers to be their daughters' primary HIV educators. A split-plot repeated measures design was used to test the effectiveness of the MDRR in decreasing daughters' sexual activity over a 2-month period. The mediating variables were daughters' HIV transmission knowledge, self-efficacy and intention to refuse sex. The sample consisted of 262 daughters with a mean age of 12.4 years. The results revealed that mothers were effective in increasing the mediating variables and in reducing their daughters' level of sexual activity. Active involvement of mothers is cost-effective and should be integrated into HIV intervention programs.

Untangling the health disparities of teen pregnancy.

PURPOSE: The purpose of this secondary analysis is to determine whether a developmental maturity model differentially predicts pregnancy for African American, Puerto Rican, and Mexican inner-city teens. DESIGN AND METHODS: This is a secondary analysis of data from a case control study that tested a model of developmental maturity and teen pregnancy with 183 pregnant and never-pregnant pairs of inner-city teens matched on age, ethnicity, and freshman cohort. RESULTS: The models differentially predict pregnancy for the separate ethnic groups, with sexual behaviors being the most important factors regardless of ethnicity. PRACTICE IMPLICATIONS: The health disparities of teen pregnancies may not decrease unless patterns of dating/sexual behaviors are reversed.

Building teen power for sexual health.

Alarming numbers of teens engage in behaviors that place them at risk for pregnancy and sexually transmitted infections (STIs) including AIDS. Intervention studies targeted toward reducing risky sexual behavior and improving school retention and literature about variables that affect risky sexual behavior and school performance were reviewed to develop the Social-Cognitive Model for Sexual Behavior During Adolescence. Interventions that target change in the family and school environments in addition to building the personal capacities of each teen have the potential to be effective. Many environmental factors cannot be altered, but the intervention can help reframe the situation and provide the knowledge, specific skills, role models, and rehearsal that promote change. The 13-week school-based intervention assists students identify how personal strengths and family, school, and neighborhood environmental factors can reinforce health behaviors and choices.

The context of risky behaviors for Latino youth.

BACKGROUND AND SIGNIFICANCE: Alarming numbers of Latino teens continue to engage in behaviors that place them at risk for pregnancy and sexually transmitted infections including HIV. DESIGN: This study includes data from six focus groups with 38 Latinas. The primary purpose of the focus groups was to elicit antecedents to unsafe sex to guide the development of an HIV-prevention intervention for adult Latinas. The data were reanalyzed using the rich content that had been elicited about community teens. FINDINGS: Six major themes were identified surrounding teen issues and concerns. These are (a) the culture of risky behaviors; (b) romance: illusion and reality; (c) parental involvement: a protective factor; (d) HIV: knowledge versus ignorance; (e) HIV among youth: fear, stigma, and anger; and (f) saving our youth. IMPLICATIONS: A multimodal approach is required to help teens adopt healthy life styles, remain in school, and have a positive relationship with their parents.