The spread of HIV into the general population of the USA: A simulation

The spread of HIV from injection drug users and male homosexuals into the general US population is simulated, using survey data on sexual behavior. We estimate that approximately 150,000 persons are currently infected with HIV through heterosexual transmission, the majority of whom are female partners of drug-using or bisexual men. The estimated number of AIDS cases generated by the model is close to the CDC statistics for males, but much higher for females. We conclude that prevention efforts should be targeted towards these high risk groups rather than the general population.Abbreviations IDU injection drug users - NORC National Opinion Research Center; Chicago - STD sexually-transmitted disease     

AIDS in China

Although 10,676 people were officially reported to be infected with HIV on China's mainland by the end of June 1998, experts estimate that more than 300,000 Chinese are actually infected with HIV in China. They also believe HIV continues to spread in alarming fashion. Two thirds of reported HIV infection cases live in rural China, and nearly one third of the 301 people diagnosed as having AIDS have died. About 10% of all HIV infections occurred among teenagers under age 19 years old, with most infected through IV drug use. 60% of teens who responded to a survey in 1997 did not possess correct basic knowledge about AIDS, and 21% did not know how to protect themselves from contracting HIV.     

Modelling the spread of HIV/AIDS in China: the role of sexual transmission

The study presented here is an exploration of the implications of patterns of sexual behaviour for the spread of HIV in China, using a bio-behavioural macrosimulation model. To reflect the uncertainty surrounding key parameters, analyses of varied scenarios are used to show a range of possible outcomes consistent with variations in selected biological and behavioural inputs. The latter are estimated from a nationwide survey of sexual behaviour recently conducted in China, a country with an emerging HIV/AIDS epidemic, where it is feared that HIV/AIDS will spread to the general population via heterosexual transmission. The results highlight the primacy of the levels and distribution of sexual activity in the population. They offer some guidelines for understanding and interpreting the potential implications of current and prospective changes in sexual behaviour for the spread of HIV/AIDS in the world's largest population, and also highlight the need to collect better data on sexual behaviour for the estimation of key model inputs.     

Are young people in the Philippines taking chances with HIV / AIDS?

The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.     

流动人口行为特征及其空间过程与HIV/AIDS扩散

流动人口的行为特征及其空间过程是HIV/AIDS扩散的重要因素之一,其行为特征的高危性和流动性使流动人口成为HIV/AIDS的易感人群,在其流动的空间过程中与不同类型人口的相互接触,当发生与HIV/AIDS人群的高危行为时,一方面容易使自己感染HIV;另一方面,流动人口成为HIV携带者后与其他人发生高危行为则会成为HIV的传染源之一,其结果是导致了HIV/AIDS在感染者数量和感染空间上的扩散。因而,针对流动人口高危行为特征及其空间过程提出防控HIV/AIDS扩散的对策是可行的。     

中国老年艾滋病的流行状况分析

艾滋病在中国的迅速流行已是不争的事实,但是人们普遍认为“艾滋病是年轻人的病”。调查资料显示,50岁及以上的老年艾滋病病毒感染者报告人数已达到全国感染者的1/10,并呈快速增长趋势。老年感染人群的主要感染渠道以既往有偿献血感染为主。老年艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人增多无论对家庭还是对社会均产生严重的后果,在艾滋病预防和控制战役中,老年是一个不可忽略的人群,应引起高度重视。     

A gender comparison of HIV and drug use across the rural-urban continuum

Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has led to significant gaps in researchers' understanding of how and to what extent women may differ in their drug-using and HIV risk behaviors compared to their better-studied male counterparts. This study, derived from a sample of 3,555 out-of-treatment drug users residing in three South Florida urban and rural communities, attempts to compare the drug usage and needle and sexual risk behaviors of male and female drug users that put them at risk for HIV infection. The overall seropositivity rate for women drug users was 26.5% compared to 19.5% for their male counterparts. Results of multivariate analyses indicate that females compared to males were 1.4 times more likely to be HIV seropositive. Risk behaviors associated with this elevated seropositivity include living arrangements, homeless status, drug use, sexual trading behaviors, and history of STDs. Furthermore, there was a strong linear relationship between drug use type and HIV seroprevalence among women drug users. Compared to those who were neither crack smokers nor injectors of illicit drugs, those who were crack smokers only were 2 times more likely to be HIV seropositive, while those who were both crack smokers and injectors were 5 times more likely to be HIV seropositive, and those who were injectors only were 6 times more likely to be HIV seropositive. These findings indicate that among women, drug abuse and its associated risk behaviors, increase the vulnerability of this population for HIV and thus render them an extremely important priority population on which to focus HIV prevention and public health efforts and programs.     

吸毒人群对艾滋病防治的接纳现状与影响因素

近年来我国已经把吸毒人群作为艾滋病防治的重要干预对象之一,然而现状不容乐观,吸毒人群传播艾滋病的风险远未得到有效控制。探讨影响吸毒人群对艾滋病防治措施的认同和接纳的因素,以便为完善艾滋病防治措施提供新的思路。研究表明,吸毒人群的认知水平、社会支持、政策保障、人生态度等因素对其接纳艾滋病防治措施有影响。只有将吸毒人群视为弱势群体予以增权和关爱,以"合作"的社会政策导向和"平等"的社会工作价值介入,从其需求入手开展务实多样的防治措施,才有可能真正改变吸毒人群的观念与行为,从而获得艾滋病防治的良效。     

Sero‐Discordant Couples in Five African Countries: Implications for Prevention Strategies

Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys, which include results from HIV tests, allow the study of HIV infection at the level of the cohabiting couple. This article exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two findings about the dynamics of the HIV/AIDS epidemic that have important implications for policy. First, at least two‐thirds of the infected couples are sero‐discordant, that is, only one of the two partners is infected. This implies scope for prevention efforts among infected couples. Second, among 30–40 percent of the infected couples only the woman is infected. This is at odds with levels of self‐reported extramarital sex by women and with the common perception that unfaithful men are the main link between high‐risk groups and the general population. These findings are confirmed by tests of robustness. These results indicate that extramarital sexual activity among women in union is a substantial source of vulnerability to HIV that should be, as much as male extramarital activity, targeted by prevention efforts.     

A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men

Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large "circuit" parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphetamine use by gay men.     

HIV diffusion patterns and mobility: Gender differences among drug users

Researchers have recently expanded the scope of study of transmission patterns of AIDS to incorporate spatial and geographical questions. United States diffusion patterns of this disease appear to indicate that it may emanate from urban area epicenters to areas of low and moderate prevalence. The travel patterns of injecting drug users (IDUs) and the extent to which they engage in high risk drug and sexual activities was examined as an explanation of diffusion of the HIV virus from one community to another. The study population of 49,621 was comprised of subjects recruited from approximately 60 sites nationwide from 1988–1991. While the data are limited in some ways, they partially support a diffusion explanation of HIV transmission for males and females. The analysis demonstrates that low prevalence cities were significantly more likely to have been the destinations of both men and women who engaged in high risk drug and sexual activities. In addition, HIV seropositive drug users who engaged in high risk drug and sexual behaviors in destination cities were more likely than seronegatives to travel to high or low seroprevalence areas than to moderate prevalence areas. The findings suggest a need for effective HIV prevention educational messages about the risks of traveling and participating in high risk activities.     

Gender differences in substance use and initiation of sexual activity

Even though widespread efforts have focused on educating young adults about HIV and AIDS, many individuals continue to engage in behaviors that place them at risk. These behaviors include frequent experimentation with alcohol and other drugs prior to sex, engaging in sexual activity with different partners, and inconsistent safe sex practices (Butcher et al. 1991). The combination of these risky behaviors causes increased concern about the spread of HIV among those of college age. This study focused on two behaviors by examining the relationship between substance use during adolescence and early initiation of sexual activity in a sample of 950 subjects aged 19–21 in a mid-sized southern city. Results indicate that early use of alcohol and marijuana relates to earlier initiation of sexual activity and subsequent risky sexual behavior among young adults. Also, gender differences were observed for frequent users of marijuana and alcohol with males engaging in riskier sexual practices. Recommendations for interventions are made.     

Environmental Change,Risky Sexual Behavior,and the HIV/AIDS Pandemic: Linkages Through Livelihoods in Rural Haiti

Local natural resources are central to rural livelihoods across much of the developing world. Such “natural capital” represents one of several types of assets available to households as they craft livelihood strategies. In order to explore the potential for environmental scarcity and change to contribute to perpetuation of the HIV/AIDS pandemic, we examine the association between declining natural capital and engaging in risky sexual behaviors, as potentially another livelihood strategy. Such an association has been demonstrated in Kenya and Tanzania, through the fish-for-sex trade. To explore the possibility of this connection within rural Haitian livelihoods we use Demographic and Health Survey data, with a focus on rural women, combined with vegetation measures generated from satellite imagery. We find that lack of condom use in recent sexual encounters is associated with local environmental scarcity—controlling for respondent age, education, religion and knowledge of AIDS preventive measures. The results suggest that explicit consideration of the environmental dimensions of HIV/AIDS may be of relevance in scholarship examining factors shaping the pandemic.     

The United Nations on the Demographic Impact of the AIDS Epidemic

A report prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting “a grim picture with glimmers of hope”—the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135‐page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst‐affected area, sub‐Saharan Africa, is reproduced below. (Figures shown have been renumbered.)     

Internalized Homophobia,HIV Knowledge,and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACT

There exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.     

Sexuality and HIV/AIDS: An Exploration of Older Heterosexual Women's Knowledge Levels

Sexuality research tends to ignore older populations, and little is known about older women's sexual health knowledge. To fill this research gap, 186 Canadian heterosexual women 50 years and older were surveyed about their knowledge regarding sexuality and HIV/AIDS. Respondents had moderate levels of overall knowledge of sexual health and aging, correctly answering, on average, 60% of the 35 questions. They had lower levels of HIV/AIDS knowledge, correctly answering just over 50% of the 25 questions. Results indicate the need for social awareness and education in this group regarding both general sexual health later in life and HIV/AIDS.     

Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth

Sex researchers and mental health clinicians have long recognized that the stigma surrounding homosexuality plays an important role in shaping the social psychological adjustment of gay, lesbian, and bisexual (g/l/b) people. In recent years, researchers have suggested that sexual identity- related distress may influence the physical health status of g/l/b people, primarily because of the ways these self-related feelings and beliefs impact patterns of health-related behavior. This study examines the influence of sexual identity distress and social support on g/l/b youth's drug and alcohol use, psychological distress, and risky sexual behavior. The data come from a services research demonstration program conducted at the Indiana Youth Group, Inc., a g/l/b youth development agency based in Indianapolis, Indiana. Results indicate that sexual identity distress is strongly associated with psychological distress, less frequent use of alcohol, and using fewer types of illegal drugs. Being out to more people in one's support network, however, attenuates the severity of youth's sexual identity-related distress. Youth who report more support ties to g/l/b people indicate engaging in more frequent risky sexual behavior. The implications of these findings for theories of g/l/b youth's sexual identity development are discussed.     

The politics of invisibility: homophobia and low-income HIV-positive women who have sex with women

HIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' perceptions of available support networks and patterns of disclosure in order to raise awareness of their struggle against HIV and homophobia and to assist in empowering the low-income HIV-positive WSW community.     

Risk-Taking Behaviors of Gay and Bisexual Men in New York City Post 9/11

Until now, the reactions of gay and bisexual populations have been largely overlooked in response to terror and disaster. This study assesses risk-taking behaviors in gay and bisexual men two weeks before and after the 9/11 attacks in Manhattan. For the purposes of this study, risk-taking behaviors include drug use and unprotected anal sex. These behaviors and associated desires were examined in relation to race/ethnicity, age, geographic location, and HIV status, within and across time. The results of this study demonstrate that HIV status may be a pivotal demographic feature in understanding risk-taking behaviors post disaster. No changes in drug use were reported pre and post 9/11. However, there was an increase in risky sexual behaviors in relation to serostatus, with HIV-positive men reporting a higher number of sexual partners post 9/11. In contrast, the number of sexual partners remained constant in HIV-negative men. There was also an interaction effect, demonstrating that HIV-positive men were more likely than HIV-negative men to act on their desire for sex. Thus, as a population already faced with the prospect of death, HIV-positive men may be a population more vulnerable in the face of terror and disaster.