Gay Men's Perspectives on HIV Prevention and Treatment in Berlin,Germany: Lessons for Policy and Prevention

Qualitative data from interviews with gay men in Berlin, Germany were used to identify challenges facing HIV prevention and treatment as well as opportunities to improve them. In 2015, 20 self-identified gay men in Berlin—who had all received HIV prevention services and/or treatment (broadly defined)—participated in 1-on-1 qualitative interviews (30–75 min long). Ages ranged from 24 to 54, 35% self-identified as HIV-positive, and the remainder as HIV-negative. With regard to challenges to HIV prevention, participants highlighted (a) an already high HIV burden among gay men in Berlin and thus a need for doing prevention with positives (test-and-treat, and treatment as prevention); (b) the lack of a universal free condom distribution program; and (c) relaxed attitudes around the seriousness of HIV as a result of HIV treatment optimism. Participants highlighted that although condoms are an effective HIV prevention strategy (and thus certainly an area for focus), HIV prevention campaigns would benefit from updates with regard to embracing a diverse range of biological and behavioral prevention strategies, as well as expanded methods for making access to postexposure prophylaxis and free rapid HIV-antibody testing. This study informs HIV prevention approaches in Berlin, Germany as well as other urban centers where MSM are disproportionally affected by the HIV epidemic.     

Stigma,AIDS, and HIV Prevention in Africa: Reports from Community Organizations Providing Prevention Services

ABSTRACT

The AIDS epidemic in Africa remains a serious health crisis. Nongovernmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services. An important barrier to their HIV prevention efforts is stigma directed at persons living with HIV/AIDS. In order to understand how stigma affects HIV prevention programming, we conducted in-depth qualitative interviews with NGO directors in 29 African countries. Qualitative analytic approaches were used to identify key themes. Substantial discrimination and stigmatization of HIV-positive persons was reported. HIV-positive women were particularly likely to suffer negative social and economic consequences. The stigma associated with HIV interfered with disclosure of HIV status, risk-reduction behaviors, and HIV testing, creating significant barriers to HIV prevention efforts.

Interventions to reduce AIDS-related stigma in Africa are urgently needed. Reducing the burden of stigma is critical to fighting the epidemic in Africa and could play an important role in global HIV reduction.     

Transferring a University-Led HIV/AIDS Prevention Initiative to a Community Agency

Summary

Given the urgent need for HIV/AIDS interventions that will reverse current infection trends among urban minority youth, identifying effective and socially relevant approaches is of primary concern. HIV/AIDS prevention initiatives that are housed in, and led by, communities may address the limits of laboratory-based inquiry for this complex and socially-situated health issue. In this article, we describe the process of moving a researcherled, HIV/AIDS prevention research program—the Collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP)—from a university laboratory to a community mental health agency with the goal of strengthening program access, effectiveness, and sustainability over time. We outline the framework, timeline, and responsibilities involved in moving the program, research, and technology from its original university base to a local community agency. From the challenges faced and lessons learned during this complex transfer process, we hope to enhance understanding of ways in which we can narrow the gap between academic and community leadership of HIV/AIDS prevention research.     

HIV Voluntary Testing among Portuguese Women Attending Family Planning Clinics: Implications for HIV Prevention Education and Testing

ABSTRACT

Objectives: The aim of this article is to analyze the factors associated with HIV testing among 767 sexually active women. Methods: Participants were administered several self-report questionnaires that assessed behavioral and psychosocial measures. Results: Overall, 59.8% of the participants reported ever having tested for HIV. Results show that higher levels of education, being pregnant or having been pregnant, concern about AIDS, AIDS knowledge, self-efficacy in condom negotiation and perception of no risk in partner significantly predicted the likelihood of testing among women. Attending the mass was negatively associated with HIV testing. Conclusions: These findings provide information that can be used in the development of a focused gender sensitive HIV prevention program to increase HIV testing.     

Correlates of Participation in a Family-Based HIV Prevention Program

Abstract

This study examines the relationship between contextual factors and attendance in a family-based HIV prevention program for low-income, urban, African-American women and their children. Participants' motivations to become involved, their concerns about discussing sex-related issues with their children, recruiters' perceptions of respondents' understanding of the program, and environmental stressors were examined. Participants' level of motivation and recruiters' success in improving respondents' understanding of the program were significant correlates of attendance. Stressors experienced by the family and concerns around talking with children about sex were not significantly associated with participation. Recommendations to enhance involvement in family-based HIV prevention programs are made.     

A Model of Heterosexual Adaptive Relationship Functioning in South Africa: Implications for HIV Prevention Interventions

Abstract

Objectives: Couple-based HIV prevention efforts are an important HIV prevention strategy in South Africa but there is a lack of understanding as to what constitutes healthy relationships in South African sociodisadvantaged communities. Methods: To address this, 8 focus group discussions were conducted with 27 men and 23 Black African women living in a large disadvantaged community in Cape Town, South Africa. Results: A model of adaptive relationship functioning is put forth, which involves four primary relationship components that emerged as central to healthy relationships: active relationship building, emotional support/display, communication, and problem-solving. Conclusions: The results of this study can inform couple-based HIV prevention efforts.     

Shattering the Myth of Invulnerability: Exploring the Prevention Needs of Sexual Minority Women Living with HIV/AIDS

Developing effective safer-sex programs for women living with HIV/AIDS (WLH/A) is a national HIV prevention priority. Existing programs focus predominantly on heterosexual women's experiences and ignore the needs of sexual minority women (SMW). Thus, we conducted semi-structured interviews with 16 sexual minority WLH/A to better understand their sexual risk behaviors and corresponding HIV prevention needs. Most of the interviewees were African American (75%) and poor (75%). We used strategies of Grounded Theory to code the interviews for key themes, which included the following: differences between relationships, risk, and protective behaviors in male and female relationships; links between substance abuse and unsafe sex; need for safer-sex or prevention programs to address SMW-specific skills and topics; and the importance of addressing women's resiliency and the social context of women's risk in prevention programs. Conclusions include concrete suggestions to make safer-sex programs more responsive to the needs of SMW.     

Will It Be Silence and Violence or Safety and Prevention for the Next Generation of Gay Youth?

Rates of unprotected anal intercourse and HIV infection are alarmingly high among young gay males. This second wave of infection indicates that traditional models for AIDS education are not working. AIDS educators need to rethink HIV-prevention efforts. Studies consistently find a high level of knowledge about HIV transmission and high levels of commitment to safer sex among gay males, but what accounts for the breakdown between safer sex intentions and practices among them? This article employs social constructionist and queer theoretical assertions that sexuality is socially and culturally produced in complicated and pluralist ways. The analysis examines how risky sexual situations shape young gay males' sexualities by exploring two examples selected to represent, alternatively, models of safer sexual and unsafe sexual trajectories. Implications for HIV prevention practices and policies are discussed.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Motivational Enhancement Counseling Strategies in Delivering a Telephone-Based Brief HIV Prevention Intervention

Motivational enhancement therapy (MET) interventions are being increasingly added to the menu of behavioral interventions for HIV prevention. They present few logistical and psychological barriers for at-risk persons who are ambivalent about transmission risk reduction and appear to offer promise of being transferable to community based organizations and public health programs. We describe the principles of motivational interviewing, a counseling style often used in conjunction with MET, and demonstrate and discuss its application with case examples drawn from a recent pilot trial of a telephone-delivered brief motivational enhancement for HIV risk reduction with men who have sex with men (MSM).     

Potential Roles of Black Churches in HIV/AIDS Prevention

Abstract

This study examines the role of Black churches in AIDS/HIV prevention. This is a pilot survey study design administered to 11 churches represented by 11 ministers and one church member. The analysis is both qualitative and quantitative. The results showed that most of the ministers had spoken with their congregation on HIV/AIDS. A few ministers had previously sponsored or taken part in HIV/AIDS workshops and disseminated HIV/AIDS educational material in the African American community. None of the churches had an established HIV/AIDS prevention program. Most of the ministers were receptive to implementing an HIV/AIDS prevention program, provided that it did not violate the church doctrines. The findings in this study suggest that Black churches represent an important potential resource for HIV/AIDS prevention. For success, the initial strategy should involve the minister in the early planning stage. Future research should focus on expanding the scope of this study and improving communication between the church, community-based organizations, and health professionals.     

HIV conspiracy theory beliefs mediates the connection between HIV testing attitudes and HIV prevention self-efficacy

Abstract

Objective: High rates of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) can be found in states in both the Appalachian and Southeastern regions of the United States. As infection rates increase, it is imperative to understand factors that improve HIV prevention. The current work explored whether HIV conspiracy beliefs influences the link between HIV testing attitudes and perceived prevention ability. Participants: Four samples were collected during Fall 2013 (N?=?373), Spring 2014 (N?=?231), Fall 2014 (N?=?345), and Spring 2015 (N?=?369) at a rural, Southeastern, Appalachian university. Methods: Participants in all samples completed an online survey. Results: Four studies showed that HIV conspiracy theory beliefs mediated the relationship between HIV testing attitudes and HIV prevention self-efficacy. Conclusions: HIV conspiracy theory beliefs at least partially explain the connection between testing attitudes and HIV prevention self-efficacy. Results have implications for the role of HIV testing attitudes, beliefs, and self-efficacy.     

Prevalence of Sexually Transmitted Diseases and Risk Behaviors from the NIMH Collaborative HIV/STD Prevention Trial

ABSTRACT

This cross-sectional study describes the baseline prevalence and correlates of common bacterial and viral sexually transmitted diseases (STDs) and risk behaviors among individuals at high risk for HIV recruited in five low- and middle-income countries. Correlations of risk behaviors and demographic factors with prevalent STDs and the association of STDs with HIV prevalence are examined. Between 2,212 and 5,543 participants were recruited in each of five countries (China, India, Peru, Russia, and Zimbabwe). Standard protocols were used to collect behavioral risk information and biological samples for STD testing. Risk factors for HIV/STD prevalence were evaluated using logistic regression models. STD prevalence was significantly higher for women than men in all countries, and the most prevalent STD was Herpes simplex virus-type 2 (HSV-2). HIV prevalence was generally low (below 5%) except in Zimbabwe (30% among women, 11.7% among men). Prevalence of bacterial STDs was generally low (below 5% for gonorrhea and under 7% for syphilis in all sites), with the exception of syphilis among female sex workers in India. Behavioral and demographic risks for STDs varied widely across the five study sites. Common risks for STDs included female gender, increasing number of recent sex partners, and in some sites, older age, particularly for chronic STDs (i.e., HSV-2 and HIV). Prevalence of HIV was not associated with STDs except in Zimbabwe, which showed a modest correlation between HIV and HSV-2 prevalence (Pearson coefficient = .55). These findings underscore the heterogeneity of global STD and HIV epidemics and suggest that local, focused interventions are needed to achieve significant declines in these infections.     

Motivators and Barriers to Participation of Ethnic Minority Families in a Family-Based HIV Prevention Program

Summary

Involving low-income, ethnic minority families in lengthy HIV prevention programs can be challenging. Understanding the motivators and barriers to involvement may help researchers and practitioners design programs that can be used by populations most at risk for HIV exposure. The present study discusses motivators and barriers to involvement in the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP), using data from a sample of 118 families that participated at varying levels in the twelve sessions of the program. Most participants chose motivators that reflect their perceptions of individual and/or family needs (“CHAMP might help me, mine, and other families”), and of characteristics of the program, such as CHAMP staff were friendly, CHAMP was fun. Among barriers to involvement, respondents expressed concerns about confidentiality, and about being judged by program staff. Respondents also reported experiencing many stressful events in their families (e.g., death and violence in the family) that may have been barriers to their involvement. Knowing these motivators and barriers, researchers and practitioners can enhance involvement in HIV prevention programs.     

Fetishizing the health sciences: Queer theory as an intervention

Queer theory often falls impotent in its palatability across disciplinary lines. I offer a conceptual article that interrogates the dis-ease and divide when considering queer theory in and for the health sciences. In so doing, I look to foster a process of making queer theory more tenable to applied practice—and to make practice in social work, at least, more queer. The exemplar of HIV is deconstructed as a preeminent discourse and health disparity. In the end, it is argued that queer theory may be an essential intervention in the arsenal of the helping professions.     

Changing Directions in HIV Prevention: The Move Toward a Psychosocial Model

ABSTRACT

Although some HIV prevention programs have been successful in helping gay and bisexual men change their sexual behaviors, rates of HIV infection continue to increase. In an attempt to address this problem, social workers need to move beyond traditional HIV prevention approaches to a psychosocial model of HIV prevention. Based on the work of previous researchers, this approach assumes that a combination of individual, psychological, and social factors contribute to risky sex in gay and bisexual men. Because social workers are trained to view problems from a psychosocial framework, they are already in a position to develop programs incorporating the psychosocial model. This article examines the psychosocial model of HIV prevention and the various psychosocial factors that may contribute to high-risk sexual behavior and concludes with examples of prevention research that have already incorporated the model.     

Brief Report: Same-Sex Male Couples’ Characteristics and Attitudes Toward Different HIV Prevention Services,by Dyad HIV Serostatus,in Lima,Peru

Abstract

Few HIV/STI prevention studies have been conducted with same-sex male couples in Lima, Peru. This brief report describes quantitative findings of 42 same-sex male couples’ characteristics and attitudes towards using various HIV prevention services. Couples’ communal coping and preferences for sexual health outcomes varied by their serostatus. Many partners were willing to use pre-exposure prophylaxis, couples HIV testing and counseling, and other couples-based prevention services, if and when they would become available. Partners’ likelihood of using HIV prevention services differed by their dyadic serostatus. These findings lend support for providing couples-based HIV/STI prevention interventions for this population in Lima.     

HIV/AIDS Prevention in the African American Community:

The high rate of AIDS cases among African Americans, especially women, suggests that HIV risk reduction behavior change programs and messages have not been highly successful in preventing HIV transmission among this population. This paper recommends that the situational and environmental context of African Americans' lives, and their responses to HIV/AIDS be addressed and incorporated into HIV prevention programs in an effort to make these programs more relevant to high risk African Americans. A multilevel system intervention approach grounded in an ecosystem perspective which focuses on the community as the primary target level of intervention is proposed to increase the effectiveness of HIV prevention efforts among African Americans.     

HIV/AIDS Prevention: MSM Wants,Desires, and Needs

HIV prevention exhaustion has occurred among MSM, with resurgence of HIV beginning in 2000 a palpable effect. A stratified snowball sample was recruited from MSM social venues including gay bars, parks, and social service agencies in order to develop targets and strategies for future prevention efforts. Three methods of data collection were used: (a) individual interviews (n = 30), (b) focus groups (total n = 64), and (c) demographic survey (n = 94). Study results found support for several education topics, substance abuse intervention, and development of MSM interpersonal skills. The article concludes with a discussion of cultural and contextual strategies to curb rising HIV cases among MSM.