HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng,South Africa

Married and cohabiting women have been neglected in the promotion of condoms as the most effective prevention method of sexually transmitted infections (STIs) and HIV. As a result, HIV prevalence is increasing in this population group in high HIV prevalence settings. The study assesses the prevalence of and identifies the predictors of consistent use of male condoms among married and cohabiting women, and examines its implications for HIV transmission. The data used were obtained from a cross-sectional survey on sexual and reproductive health conducted among women aged 18–49 years of age in Mahikeng Local Municipality in 2012 using mixed methods. A structured questionnaire and in-depth interview guide were used to collect quantitative data from 568 and qualitative data from 33 married or cohabiting women. The data were analysed using logistic regression and thematic content analysis methods. The results show that only 16.2% of the women consistently used condoms. Women having no and 1–2 surviving children, educated women, women in relationships in which most sexual decisions were jointly made with husbands/partners, women having high risk perceptions of STIs and HIV infection and women who negotiate condom use with and know the HIV status of their husbands/partners were significantly more likely to have consistently used condoms. However, women who perceived that condoms reduce sexual pleasure, feared they would be blamed for infidelity by husbands/partners, trusted that their husbands/partners were faithful and feared condoms could lead to relationship instability used condoms inconsistently. We conclude that the prevalence of consistent use of condoms by married and cohabiting women in the study is low, indicating that promotion of condoms among married or cohabiting women is neglected, which could increase the risk of HIV transmission. Based on our findings, we recommend the review of condom programmes with a view to targeting married or cohabiting couples as an important group for condom promotion and uptake.     

Woman to Woman (W2W): Adapting an HIV risk reduction intervention for older women

Woman to Woman (W2W) is a novel adaptation of the Sisters Informing Sisters about Topics on AIDS (SISTA) HIV prevention program. This article describes the process of adapting and piloting W2W based on recommendations from existing HIV prevention research. Six older women, all of whom had histories of homelessness and the majority of whom identified as African American, enrolled in the study, which piloted the adapted intervention and materials, evaluated the acceptability of the program, and assessed the measures related to the intervention. Participants described satisfaction with the program and had high rates of attendance; observations regarding the measures suggest the need to further develop assessments of HIV knowledge, condom use self-efficacy, and risk behaviors in this context.     

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.     

Knowledge and attitudes about HIV/AIDS among community-living older women: reexamining issues of age and gender

Although older women face unique risks related to HIV/ AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

Knowledge and Attitudes About HIV/AIDS Among Community-Living Older Women: Reexamining Issues of Age and Gender

ABSTRACT

Although older women face unique risks related to HIV/AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

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.     

Marital strategies for regulating exposure to HIV

In a setting where the transmission of HIV occurs primarily through heterosexual contact and where no cure or vaccine is available, behavioral change is imperative for containing the epidemic. Abstinence, faithfulness, and condom use most often receive attention in this regard. In contrast, this article treats marriage as a resource for HIV risk management via mechanisms of positive selection (partner choice) and negative selection (divorce of an adulterous spouse). Retrospective marriage histories and panel data provide the evidence for this study and results indicate that men and women in Malawi increasingly turned to union-based risk-avoidance strategies during the period that the threat of HIV/AIDS materialized. Although both sexes strategize in a similar fashion, men are better equipped than women to deploy these strategies to their advantage. The article concludes with reflections on the long-term and population-level implications of these coping mechanisms.     

Gender roles,HIV risk behaviors,and perceptions of using female condoms among college students

The purpose of this study was to examine relationships between gender roles and HIV risk behavior, and perceptions and acceptance of the female condom among college students (n = 410). It was hypothesized that high hyperfeminine females and high hypermasculine males – those adhering to traditional gender roles – would engage in more HIV risk behaviors, including alcohol and drug use and various sexual practices, than those with lower hyperfemininity and hypermasculinity. It was also hypothesized that higher hyperfeminine females as well as higher hypermasculine males would perceive the female condom more negatively and would be less likely to view the female condom as a viable form of protection in the future. It was also hypothesized that high hyperfeminine females and high hypermasculine males would not accept the female condom as an alternative form of protection. Implications for prevention interventions are discussed.     

Gender comparisons of injection drug use practices in shooting galleries

Previous research studies and anecdotal evidence portray shooting galleries as locales that place injection drug users at great risk for HIV infection, drug use and violence. Collectively, these studies highlight the need to intervene with injectors who frequent shooting galleries. However, few researchers have studied an often-forgotten risk group – women injecting drug users who frequent shooting galleries – and compared their risk behaviors to their male counterparts. To address this gap in the research literature and to evaluate the functionality of the shooting gallery as a setting for HIV prevention, we collected data on risk practices from 201 injectors (101 men and 100 women) who were recruited from eight shooting galleries in Miami, Florida. Results indicate that, compared with men, women injectors engaged in a similar variety and frequency of injection risk behaviors and had more shooting companions. While only minor gender differences were apparent, relatively few injectors – male or female – adhered to current recommendations for needle hygiene practices. Needle hygiene practices existed equally among injectors of both sexes, however very few adhered to current recommendations. Furthermore, contrary to common images of shooting galleries, use of other drugs was infrequently reported, episodes of violence or victimization were uncommon, and sexual contact almost never occurred. Operators of shooting galleries, both men and women, indicated their willingness to participate in HIV prevention efforts. Implications of these findings for HIV intervention indicate that (1) there is a great need to intervene with both men and women IDUs who frequent shooting galleries and that (2) shooting galleries can be an optimal setting for HIV prevention.     

Midlife and older women’s experiences and advice about sex with men,risk behaviors,and HIV prevention education

This article reports on older women’s experiences and advice on condom use, male-female relationships, HIV risk, and prevention education. It reports on findings from five written, open-ended questions with 110 ethnically and economically diverse women, 40–80 years old. Analysis revealed four themes: (a) Gap between condom use advice and condom use behavior; (b) invisibility with age; (c) negative expectations of men; and (d) desire for education that breaks the silence on sex. The article discusses the meaning of the findings as they relate to current knowledge about HIV prevention education and midlife and older women and offers recommendations for research and education.     

Socioeconomic status, sexual behavior, and differential AIDS mortality: evidence from Côte d’Ivoire

Lack of knowledge about differential AIDS mortality seriously hampers the study of the economic impact of AIDS in developing countries. We derive HIV infection risk differentials by age, education, and other microeconomic characteristics using the Ivorian Demographic and Health Survey. Our model is based on econometrically estimated equations using commonly available variables, therefore it can be used whenever such a survey is available but there is no representative information about HIV infection by socioeconomic group. For instance, we found that educated people have a higher risk of HIV infection, because they are more likely to have several sexual partners. However, this effect is partly offset by a higher probability of condom use relative to less educated people. The identification of the socioeconomic characteristics of low and high risk groups seems indispensable to set up adequate AIDS prevention and therapy policies in developing countries.

Theory-Based Policy Development for HIV Prevention in Racial/Ethnic Minority Midlife and Older Women

ABSTRACT

In 2008, there were more than a million persons with HIV/AIDS in the United States. The CDC (2007) estimates that 15% of persons with HIV/AIDS are over age 50. At greater risk are women of color. Most intervention efforts have focused on intrapersonal aspects of an individual and his or her sexual-risk behaviors, with little or no attention directed toward interpersonal and socioenvironmental considerations of risk and prevention. This paper considers the limitations of current national policies relating to HIV prevention in minority populations, especially among midlife and older women of color. In particular, this paper examines risk and prevention policies in light of ecological perspectives, social capital, and dialogical theories.     

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.     

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。     

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.     

Hiv status and union dissolution in Sub-saharan Africa: The case of Rakai,Uganda

Little is known about the impact of HIV infection on the disruption of families through separation, divorce, and widowhood. Using life tables and multinomial logistic regression, this research examined the influence of HIV status on the risk of separation or divorce and widowhood among women in Rakai, Uganda. The multivariate results revealed that dissolution is more common among HIV-infected women and that infected women in HIV-discordant couples are especially likely to face separation or divorce than women in other HIV-status couples. These results highlight women's vulnerability to the social impact of HIV infection and the importance of dyadic studies of the disruption of unions.     

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。     

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