The encounter with family violence and risky sexual activity among young adolescent females

In this article, we analyze the relationship between family violence and risky sexual activity for female adolescents (age 14 to 17). We examine two forms of family violence: experience (receiving physical abuse from a parent or parent-figure) and exposure (witnessing interparental physical violence). We hypothesize that either form of violence will predict greater odds of engaging in risky sexual behavior. We define risky sexual activity as any of the following: having multiple partners within the last 12 months or having sex with partners who are themselves engaging in risky behavior (e.g., having multiple partners of either sex, injecting unprescribed drugs, sharing unprescribed needles for injecting drugs). We analyzed data from 710 respondents taken from the National Survey of Family Growth, Cycle V, living with at least one biological parent. Results showed that experiencing violence from a parent greatly increased the likelihood of risky sex, even when controlling for the experience of forced sex, age, mother's age at first birth, race, socioeconomic status, and religiosity. Female adolescents who had experienced forced sex, those who were older (especially 17-year-olds), non-Hispanic Blacks (but not Hispanics), those living in a family with low educational attainment (less than a high school diploma), and those for whom religion was not or only somewhat personally important were more likely to report risky sex compared to others. These effects were not modified by whether the respondents lived in single- or two-parent families. An interaction between the two forms of physical violence suggests that either form is sufficient to increase significantly the odds of risky sex; an analysis in which respondents were differentiated by their experience of either form of violence showed a strong effect of experience on risky sex, net of the control variables.     

A model-based evaluation of a cultural mediator outreach program for HIV+ Ethiopian immigrants in Israel

This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study's approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.     

Reducing HIV/AIDS high-risk behavior among injection drug users: peers vs. education

This study examines the effects of peer groups and education on risk behavior for HIV among injection drug users (IDUs). The sample consisted of 682 participants in the Eastern Connecticut Health Outreach project, which compares traditional and peer-driven outreach interventions for IDUs. Participants are educated about safer injecting, subsequently administered a risk-reduction knowledge test, and given an extensive interview. Logistic regression shows that education alone is not a significant factor in reducing risky behavior in IDUs among the behaviors studied. A significant interaction was found between peer support for safer use and personal saliency of peer attitudes for both syringe and water sharing. Neither peer attitudes nor education affected cooker sharing. These results suggest that while education may be an important component in any intervention, it is not alone sufficient to reduce risky behavior. Our findings suggest that peer-directed interventions may be useful in reducing some forms of risk behavior among IDUs.     

Evaluating strategies to avoid AIDS: Number of partners vs. use of condoms

A probability model based on the best estimates we have today for prevalence and infectivity of Human Immunodeficiency Virus (HIV) has been developed. The model is used to compare the two most widely publicized risk reduction strategies: (1) Reducing the number of partners and (2) Using condoms. The results indicate that under almost all conditions of prevalence and infectivity, consistent and careful condom use is a far more effective method of reducing the risk of HIV infection. The analysis is applied to both high and low prevalence groups. In order to test more rigorously the conclusions, infectivity rates ten times higher than now estimated are examined, and infectivity is estimated on a per partner, as well as a per sexual act basis. Epidemic growth of prevalence is estimated to further check our findings. None of these conditions alters our basic conclusion. It is suggested that there is reluctance to publicize such findings about AIDS because they may be used to support having multiple sexual partners. Nevertheless, it is assumed to be more important to protect ourselves from infection than to sustain norms opposed to multiple sexual partners. Thus, our results may prove extremely useful to those who give advice to people concerning risk reduction strategies.     

The Relationship Among Population Size,Requests for Bareback Sex,and HIV Serostatus in Men Who Have Sex With Men Using the Internet to Meet Sexual Partners

Recent research has indicated the use of the Internet to meet sexual partners among men who have sex with men (MSM) is increasing. This medium also serves as a major source for social and sexual networking among MSM who live in more rural areas. In addition, data suggest the use of the Internet to initiate sexual relationships among this population may increase the risk of transmission of sexually transmitted infections, including HIV. The purpose of this study was to examine differences between self-reported HIV serostatus and requests for condomless bareback (BB) sex among a sample of Florida MSM (n = 483) using a popular Internet sexual networking site to meet sexual partners. Specifically, these variables were assessed in relation to population size among the site's seven geographic regions within the state. Findings indicated an overall statistically significant relationship among requests for BB sex and self-reported HIV serostatus. However, there was not a significant relationship among these variables and geographic region. Thus, although previous data have emphasized the importance of different HIV prevention strategies among rural versus urban MSM, there may not be major differences in HIV serostatus and requests for unsafe sexual practices among these men who use the Internet to meet sexual partners in comparison to MSM in more populated areas.     

Gauging the Acceptability of HIV Vaccines: An Exploratory Study Examining Knowledge,Attitudes, and Beliefs Among Injecting Drug Users in Viet Nam

ABSTRACT

In contrast to other countries in Southeast Asia, the HIV/ AIDS epidemic is in the initial stages in Viet Nam, although the rates have increased notably since 1997. This study examined attitudes towards the use of an HIV vaccine (when one becomes available) as a means for preventing the disease. Since injecting drug users are the great majority of those affected by the HIV/AIDS epidemic in Viet Nam, two focus groups (n = 18) were conducted among this population to identify potential barriers and incentives for HIV vaccination. Most were willing to be vaccinated if an HIV vaccine were available. Although there were some concerns about side effects, financial costs, and stigmatization, the benefits were seen to outweigh the risks. The findings may help governments better understand the potential demand for this type of vaccine and design social marketing campaigns for post-trial HIV vaccine dissemination in order to maximize potential uptake of an HIV vaccine.     

Women in India: The Context and Impact of HIV/AIDS

ABSTRACT

The response to the HIV/AIDS epidemic on the Indian subcontinent has been hampered by several factors, including societal stigma, lack of educational resources, lack of economic opportunities, and the competing priorities for a nation just growing and developing an infrastructure for education, industry, and health. In particular, Indian women are silent victims in this epidemic because they do not readily have a respected voice in decision making and priority setting for the government. The epidemic is increasingly affecting and infecting Indian women (e.g., female commercial sex workers, married women, and pregnant women). The status of Indian women has placed them at extreme disadvantage because India is a country with socially progressive laws but has been slow to change its social norms. The reported HIV prevalence is low although many researchers agree a large amount of underreporting occurs. For India to address this emerging epidemic among women appropriately, it should focus on three intervention areas: (1) short-term solutions such as treatment options for those already infected with HIV to prevent further infection to sexual partners and children; (2) intermediate solutions such as education for those who are uninfected but engaging in behaviors that may put them at risk, such as injection drug use, engaging in commercial sex work, engaging in extramarital sexual relations, and having sexual partners who are not monogamous; and 3) long-term solutions such as addressing the root causes of inequality (e.g., disparities in education and employment and unwillingness to change social norms).     

Among Brothers and Strangers: Identities in Displacement in Iraq

Through analysis of primary qualitative data collected in Nineveh, Kirkuk, and Sulaimaniya Governorates in Iraq, this article seeks to explore the rapidly shifting and fragmenting identity dynamics at play in the emerging aftermath of ISIS and the impact that this conflict – and previous legacies of violence and repression – has had on relationships within and between groups, and between groups and the state. Communities increasingly position themselves against one another in relation to vindication of rights and protection. This zero‐sum stance comes from a history of mismanagement of communities and their respective grievances by the state and international partners. Formal acknowledgement of suffering across groups by the state may serve as a first step to break this cycle of negation toward one of inclusion, in the midst of mass displacement and emerging population returns.     

Base rates revisited: Assessment strategies for HIV/AIDS

The efficiency of a diagnostic test is largely determined by the base rate, or prevalence, of disease in the population under study, with the consequence that low prevalence diseases are often difficult to detect. However, a review of clinical decision‐making, from a Bayesian standpoint, indicates that even relatively inefficient measures may be effective when combined in appropriate ways, and when the costs and benefits of detection versus non‐detection are considered. In the case of HIV/AIDS, a number of factors, including low prevalence population characteristics, the tendency to distort critical information, and the horrendous consequences of this disease, severely complicate the decision‐making task. The present paper reevaluates the problem of prediction as it relates to HIV/AIDS by examining the use of multiple tests, the relevance of Bayesian utility theory, and the significance of both immediate and projected costs and benefits.     

DRUG POLICY IN THE TIME OF AIDS:

In 1985, the National Institute on Drug Abuse (NIDA) funded an ethnographic research project in San Francisco to study the needle sharing behavior of injection drug users (IDUs). The goal of the research was to develop a strategy to slow the spread of HIV among this hidden and hard to reach population of drug users and their sexual partners. This small-scale project grew into a model intervention in which bleach, condoms, and street-based education by outreach workers were employed to inform IDUs of the risk of AIDS and of methods for protecting themselves. The "reach and teach bleach" model was adopted by NIDA and implemented in a number of American cities. This study describes the development of the model intervention, the adoption of the model by NIDA as part of its National AIDS Demonstration Research (NADR) project, and the political circumstances under which the city of San Francisco applied for the NADR grant. Drawing on Social Worlds/Arena theory, and based on extensive interviews and participant observation, a sociohistorical analysis examines the initial development, implementation, and disintegration of the model outreach project and the impact of the program on drug policy in the city of San Francisco.     

Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment

Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index–Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.     

Longitudinal Event-Level Analysis of Gay and Bisexual Men’s Anal Sex Versatility: Behavior,Roles, and Substance Use

Gay and bisexual Men Who Have Sex with Men (GBM) are sexually unique in that they can practice penile-anal sex versatility, i.e. engage in insertive and receptive anal sex. Individual-level versatility is extensively researched both as a sexual behavior linked to HIV/STI transmission, and as a GBM identity that can change over time. However, there is a dearth of research on event-level versatility (ELV), defined as taking the receptive and insertive role in the same sexual encounter. We analyzed event-level data from 644 GBM in the Momentum Health Study from February 2012-February 2017 to identify factors associated with ELV prevalence, the relationship between ELV and anal sex role preference, and sero-adaptive and sexualized drug use strategies. Univariate analysis revealed ELV prevalence rates between 15% and 20%. A multivariate generalized linear mixed model indicated ELV significantly (p < .05) associated with versatile role preference and condomless sex. However, the majority of ELV came from GBM reporting insertive or receptive role preferences, and there was significantly higher condom use among sero-discordant partners, indicating sero-adaptation. Multivariate log-linear modeling identified multiple polysubstance combinations significantly associated with ELV. Results provide insights into GBM sexual behavior and constitute empirical data useful for future HIV/STI transmission pattern modeling.     

School dropout and injecting drug use in a national sample of white non-Hispanic American adults

In this study we sought to extend our previous finding of an association between school dropout and injecting drug use (IDU) among African Americans by testing the association in a sample of White non-Hispanic Americans. A nationally representative sample of White non-Hispanic Americans age eighteen years and older was drawn from public use data files of the 1995-1996 National Household Surveys on Drug Abuse (NHSDA). Adults with a self-report history of IDU were identified, and were matched to non-IDU adults in the same neighborhoods of residence. Conditional logistic regression was used to estimate the association between dropping out of high school and the occurrence of IDU. White non-Hispanic American high school dropouts were more likely than high school graduates to have injected a drug at least once. The findings of this research on non-Hispanic Whites are generally consistent with our earlier evidence on the association between educational status and a history of IDU among African-American adults. School dropout prevention programs may merit attention in an overall strategy of preventing injecting drug use and HIV/AIDS.     

ANATOMY OF A DRIVE-BY:

This is an ethnographic study of a shooting that was labeled a drive-by and that resulted in the death of a fifteen-year-old boy. This homicide is seen as an unexpected event that in turn is used as an investigative tool to enhance data collected through observation and in-depth interview methods. I suggest that behaviors revealed by unexpected events can form the basis for theoretical and methodological concepts useful for the study of minority injecting drug users and other hidden populations at high risk to HIV infection and substance abuse.     

Hidden dangers among circuit parties—A systematic review of HIV prevalence,sexual behaviors and drug abuse during the biggest gay events

ABSTRACT

Circuit parties (CP) are extended celebrations, lasting from a day to a week, primarily attended by gay and bisexual men in their thirties and forties. The increasing popularity of circuit parties may play a significant role in the epidemiology of HIV and other sexually transmitted diseases. We performed a systematic literature search in MEDLINE, without any temporal limit, using the term “circuit party”. Only articles reporting cross-sectional studies were analyzed. Ten articles, published in the period from 2001 to 2015 were included in our systematic review and reported data on samples ranging from 173 to 13,883 gay/bisexual men. The HIV prevalence among men who attended the CPs was very high, ranging from 6% to 40.8%. Sexual risk behaviors (e.g. unsafe sex or multiple partners) and drug use were particularly frequent. It wo'uld be useful to promote efficient strategies with the cooperation of party planners, catching the participants before nightlife activities in order to prevent HIV transmission and the use of recreational drugs.     

The impact of touch‐tone data entry on reports of HIV and STD risk behaviors in telephone interviews

Respondents’ concerns about privacy can decrease reporting of HIV and STD risk behaviors in general population telephone surveys. The purpose of this paper is to describe the results of an experimental study evaluating whether one method for increasing privacy, touch‐tone data entry (TTDE), is effective in increasing estimates of sexual behaviors from a population‐based survey. We conducted a random‐digit‐dial telephone survey of adults in New Jersey (n = 405), with half the respondents using TTDE for answering sexual behavior questions. TTDE led to increased reports of same‐sex sexual behavior, certain HIV and STD risk factors, and concern about one's risk for HIV and STD transmission. TTDE also narrowed the difference between men's and women's reports of the number of different sexual partners over the past 10 years. The feasibility and limitations of TTDE are discussed, along with possible alternative interpretations that consider the impact of TTDE on the dynamics of the interaction between the respondent and the interviewer.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.     

The Game of Contacts: Estimating the Social Visibility of Groups

Estimating the sizes of hard-to-count populations is a challenging and important problem that occurs frequently in social science, public health, and public policy. This problem is particularly pressing in HIV/AIDS research because estimates of the sizes of the most at-risk populations-illicit drug users, men who have sex with men, and sex workers-are needed for designing, evaluating, and funding programs to curb the spread of the disease. A promising new approach in this area is the network scale-up method, which uses information about the personal networks of respondents to make population size estimates. However, if the target population has low social visibility, as is likely to be the case in HIV/AIDS research, scale-up estimates will be too low. In this paper we develop a game-like activity that we call the game of contacts in order to estimate the social visibility of groups, and report results from a study of heavy drug users in Curitiba, Brazil (n = 294). The game produced estimates of social visibility that were consistent with qualitative expectations but of surprising magnitude. Further, a number of checks suggest that the data are high-quality. While motivated by the specific problem of population size estimation, our method could be used by researchers more broadly and adds to long-standing efforts to combine the richness of social network analysis with the power and scale of sample surveys.     

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.     

The impact of touch-tone data entry on reports of HIV and STD risk behaviors in telephone interviews

Respondents concerns about privacy can decrease reporting of HIV and STD risk behaviors in general population telephone surveys. The purpose of this paper is to describe the results of an experimental study evaluating whether one method for increasing privacy, touch-tone data entry (TTDE), is effective in increasing estimates of sexual behaviors from a population-based survey. We conducted a random-digit-dial telephone survey of adults in New Jersey (n = 405), with half the respondents using TTDE for answering sexual behavior questions. TTDE led to increased reports of same-sex sexual behavior, certain HIV and STD risk factors, and concern about one s risk for HIV and STD transmission. TTDE also narrowed the difference between men s and women s reports of the number of different sexual partners over the past 10 years. The feasibility and limitations of TTDE are discussed, as well as possible alternative interpretations that consider the impact of TTDE on the dynamics of the interaction between the respondent and the interviewer.