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.     

When is an HIV infection prevented and when is it merely delayed?

HIV prevention programs are typically evaluated using behavioral outcomes. Mathematical models of HIV transmission can be used to translate these behavioral outcomes into estimates of the number of HIV infections averted. Usually, intervention effectiveness is evaluated over a brief assessment period and an infection is considered to be prevented if it does not occur during this period. This approach may overestimate intervention effectiveness if participants continue to engage in risk behaviors. Conversely, this strategy underestimates the true impact of interventions by assuming that behavioral changes persist only until the end of the intervention assessment period. In this article, the authors (a) suggest a simple framework for distinguishing between HIV infections that are truly prevented and those that are merely delayed, (b) illustrate how these outcomes can be estimated, (c) discuss strategies for extrapolating intervention effects beyond the assessment period, and (d) highlight the implications of these findings for HIV prevention decision making.     

HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.     

Preventing HIV/AIDS Among Trinidad and Tobago Teens Using a Family-Based Program

Summary

This paper describes a family-based HIV/AIDS prevention project currently underway in Trinidad and Tobago—an English speaking twin-island nation in the Caribbean. The project involves a partnership between U.S.-based researchers and a social service agency on the Islands. It describes the development and adaptation of the intervention and reports preliminary outcomes from a pilot intervention (n= 32). Findings indicate high participant retention; statistically significant pre to posttest changes in HIV/AIDS knowledge and awareness; parent/youth discussions at home; condom self-efficacy; and parental monitoring. Findings are discussed within the context of collaborative HIV/AIDS prevention research.     

Comparison of Two Psycho-Educational Interventions Aimed at Preventing HIV and Promoting Sexual Health Among Portuguese Women

This study compares the efficacy of 2 psychoeducational interventions—ACCENT skills-based and didactic information only—to prevent HIV among Portuguese women. At posttest and follow-up, participants in both intervention groups (n = 127) were more knowledgeable about HIV than at baseline. Although both intervention groups showed an increase in self-reported condom use over time, differences were marginally stronger in the ACCENT group. Both intervention groups showed more positive results than the non-intervention control group (n = 33). The study suggests that HIV prevention interventions can produce significant changes when they target a set of knowledge, social, and cognitive variables relevant to sexual behavior change.     

Evaluation of two school-based HIV prevention interventions in the border city of Tijuana, Mexico

This research project examined the individual and combined effectiveness of an HIV prevention workshop and a free condom distribution program in four high schools in Tijuana, Mexico. Adolescents (N = 320) completed baseline measures on sexual practices and theoretical correlates and participated in a two-part study. In Study 1, students were randomly assigned to an HIV prevention workshop or a control condition, with a 3-month follow-up assessment. Results indicate three significant workshop benefits regarding HIV transmission by altering sexual initiation, access to condoms, and traditional beliefs regarding condoms. In Study 2, we set up a condom distribution program at two of the participating schools, and students completed a 6-month follow-up assessment. Results indicate that exposure to the workshop followed by access to the condom distribution program yielded two beneficial results for reducing HIV transmission: moderating sexual initiation and increasing condom acquisition. Access to the condom distribution program alone had no effects on behavioral and psychosocial correlates of HIV transmission. We discuss implications of these results.     

Family-Based HIV Preventive Intervention

Summary

Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youth's exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youth's best hope to grow up and survive multiple dangers in urban neighborhoods (Pequegnat& Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided.     

Entertainment Venue Visiting and Commercial Sex in China

ABSTRACT

Entertainment venues in China play an important role in the sexually transmitted disease (STD)/HIV epidemic. Most previous studies have focused on sex workers working in entertainment venues, but little is known about their clients. This study investigated the perceptions and behavior of the patrons visiting entertainment venues. Qualitative in-depth interviews were conducted with 30 male market vendors who visited entertainment venues at least once in the past 3 months in an eastern city in China. Information about their risky behavior, attitude toward commercial sex, and STD/HIV prevention approaches was collected. Saunas, karaoke bars, and massage centers are the most frequently visited entertainment venues. Seventy-three percent of study participants reported purchasing commercial sex at these entertainment venues. Participants expressed a very liberal attitude toward commercial sex. Seeking commercial sex was perceived as a characteristic of a male's nature. The perceived risks of STD/HIV infection do not deter participants from engaging in commercial sex. Commercial sex clients reported irregular condom use and a number of other misperceptions and improper practices toward preventing STD/HIV infection. Venue-based intervention is urgently needed to target the population. The sex workers themselves could potentially serve as “health educators” to communicate prevention information to their clients and encourage safer sex behavior.     

Improving ascertainment of risk factors for HIV infection: results of a group-randomized evaluation

To allow appropriate allocation of prevention and care funding, HIV/AIDS surveillance data must include risk factor information, currently available for less than 70% of cases reported in the United States. The authors evaluated an intervention consisting of provider training and materials to improve risk factor reporting. Facilities were matched prior to randomization to intervention or control, and generalized linear mixed models were used to test for an intervention effect. Twenty-one percent of cases from intervention facilities and 33.4% from control facilities (p = .09) were reported without any risk factor information. The pre-post difference (20.7% for intervention and 36.0% for control) was not significant among HIV cases (p = .11) nor among AIDS cases (p = .12; 21.3% for intervention and 31.1% for control). The methods the authors' evaluated may need to be combined with other approaches and/or alternative classification schemes to significantly reduce the percentage of cases reported to surveillance without risk factor information.     

Treatment is Prevention

The past 15 years have seen the waning of both cultural analysis and activism dedicated to HIV/AIDS prevention, especially in relation to the enduring epidemic in the United States. However, current mutations in the American HIV prevention landscape, driven by the biomedical promise of a ‘Test and Treat’ strategy, are producing potentially destructive outcomes for vulnerable and dispossessed communities, a situation that demands renewed investment from cultural critics. The aim of this article is to mobilize a specific strand of biopolitical theory (Foucault, Agamben, Esposito) to examine recent federally orchestrated prevention measures dedicated to a scale-up and integration of HIV testing, treatment and ‘linkage to care’, in order to move beyond their reductive approach to the preservation of life and advance a more capacious, politically engaged prevention model rooted in communal rather than individual forms of immunity. Based on my ethnographic fieldwork in Baltimore, MD, I attend to ways in which local HIV prevention initiatives are courting the city's precarious Ballroom community – a kinship system of black queer youth structured around competitive dance and performance – in an attempt to materialize their ‘target population’ for testing purposes. Previously neglected by governmental and medical institutions, members of the Ballroom community now find themselves addressed as responsible sexual citizens who are expected to protect their bodies by getting tested and, if tested positive, start treatment. Yet, this emphasis on the medical rights and responsibilities of HIV positive youth threatens to abandon large groups of youth who have managed to stay uninfected. I conclude by locating this problem in the incongruity between the biological life protected by current ‘Test and Treat’ strategies and the forms of life that allow the Ballroom community to persevere under often dire circumstances, constituting an indigenous resource for an alternative take on HIV prevention     

A systematic review of education for the prevention of HIV/AIDS among older adults

Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.     

Evaluation of two school‐based HIV prevention interventions in the border city of Tijuana,Mexico

This research project examined the individual and combined effectiveness of an HIV prevention workshop and a free condom distribution program in four high schools in Tijuana, Mexico. Adolescents (N = 320) completed baseline measures on sexual practices and theoretical correlates and participated in a two‐part study. In Study I, students were randomly assigned to an HIV prevention workshop or a control condition, with a 3‐month follow‐up assessment. Results indicate three significant workshop benefits regarding HIV transmission by altering sexual initiation, access to condoms, and traditional beliefs regarding condoms. In Study 2, we set up a condom distribution program at two of the participating schools, and students completed a 6‐month follow‐up assessment. Results indicate that exposure to the workshop followed by access to the condom distribution program yielded two beneficial results for reducing HIV transmission: moderating sexual initiation and increasing condom acquisition. Access to the condom distribution program alone had no effects on behavioral and psy‐chosocial correlates of HFV transmission. We discuss implications of these results.     

"MEN I MESS WITH DON'T HAVE ANYTHING TO DO WITH AIDS":

Pivotal in HIV/STD intervention and prevention is how individuals perceive risk. This article discusses how ethnotheory can be used to understand the underpinnings of risk perception from the subject's perspective. Ethnotheory's theoretical and methodological character extends present models used to explain sex-related HIV behaviors and provides insights into risk perception useful for the development of effective intervention strategies. Four detailed ethnographic excerpts from low-income African American and Mexican American men and women illustrate how people form perceptions of risk and how information gained through ethnotheory is useful in the design of culturally relevant interventions.     

Stressful neighborhoods and depression: a prospective study of the impact of neighborhood disorder

Quantitative and qualitative research suggests that urban disadvantaged environments may be highly stressful to their inhabitants. Social disorganization may be deleterious to both physical and mental health. The relationships among perceptions of one's neighborhood, measures of social support and social integration, and level of subsequent depressive symptoms was examined with a community sample of 818 individuals screened for an HIV prevention intervention, most of whom were current or former drug users. After adjusting for baseline levels of depressive symptoms, perceptions of neighborhood characteristics (vandalism, litter or trash, vacant housing, teenagers hanging out, burglary, drug selling, and robbery) predicted depressive symptoms at a 9-month follow-up interview. Measures of social support and social integration, entered as interactions with neighborhood perceptions, did not buffer the effect of neighborhood perceptions. However, CES-D scores at follow-up for frequent church attendees were lower. The data support theories of social disorganization and social stress and suggest the need for structural intervention.     

Probabilistic cost-effectiveness analysis of HIV prevention. Comparing a Bayesian approach with traditional deterministic sensitivity analysis

In cost-effectiveness analysis, the incremental cost-effectiveness ratio is used to measure economic efficiency of a new intervention, relative to an existing one. However, costs and effects are seldom known with certainty. Uncertainty arises from two main sources: uncertainty regarding correct values of intervention-related parameters and uncertainty associated with sampling variation. Recently, attention has focused on Bayesian techniques for quantifying uncertainty. We computed the Bayesian-based 95% credible interval estimates of the incremental cost-effectiveness ratio of several related HIV prevention interventions and compared these results with univariate sensitivity analyses. The conclusions were comparable, even though the probabilistic technique provided additional information.     

HIV Risk and the Freedom to Act Without Thinking: Alcohol Use and Sexual Behavior Among Adolescents on Probation

Through in-depth phenomenological interviews, 18 adolescents currently on probation describe how they make decisions about using alcohol and engaging in sexual behaviors. Two main threads emerge: they value spontaneity in sex and believe that they act spontaneously in regard to both sex and alcohol. At the same time, they describe being highly influenced by parents and peers. The researchers discuss the potential implications of these and other findings for HIV prevention and intervention.     

Sexuality,Morality and Lifestyle: The ABC of HIV Prevention Strategies in Rural Papua New Guinea

This article explores the national program for the prevention of the spread of HIV/AIDS in Papua New Guinea and its intersection with the experiences of a rural community in Western Province. The social marketing of HIV/AIDS awareness and prevention has seen an influx of categories and definitions of people, sexual behaviour and HIV/AIDS that have the potential to create confusion, but also spaces in which rural populations can understand and conceptualise AIDS. In the present paper, the preventative program is examined from the perspective of the Gogodala, whose understandings of sickness and prevention are based on an intimate and interactive relationship with the local environment. In this context, ‘lifestyle’ (ela gi) and the maintenance of certain ‘laws’ is the primary method of sickness prevention. I argue that an exploration of the local dynamic between sexuality, morality and lifestyle is vital to the evaluation of the impact of these awareness and prevention programs and the possibilities for future prevention strategies.     

Temporary Migration and The Spread of STDs/HIV in China: Is There A Link?1

Using data from the literature and a specially designed community‐level survey, this article examines the link between temporary migration and the spread of HIV/STDs in China. The results suggest that temporary migrants not only are overrepresented among people with STD/HIV risk‐taking behaviors, but also account for disproportionately more STD patients and persons infected with HIV. It is imperative that STD and AIDS prevention intervention and education programs in China target temporary migrants. More research is needed that focuses on the underlying mechanisms by which the process of temporary migration renders migrants vulnerable to STD/HIV risk‐taking behaviors.     

Masturbation and Sexual Health

Abstract

In this study we applied research examining the hypothesized benefits of masturbation in dealing with sexual problems to the urgent health crisis posed by the HIV/AIDS pandemic. This is the first study to test the hypothesized relationship between masturbation and HIV risk as predicted by the Sexual Health Model, a sex-positive approach to sexual health developed in response to the need for a more explicit focus on sexuality and relationships in HIV prevention. This is also the first study to examine the relationship between several masturbation variables (i.e., masturbation guilt, lifetime masturbation, and current masturbation) and HIV-related sexual behaviors and attitudes in a sample of African American women (N =239). Data was collected using face-to-face structured interviews as part of the Women's Initiative for Sexual Health (WISH), a randomized, controlled trial of an HIV prevention intervention based on the Sexual Health Model, targeting low income, adult African American women. Contrary to expectations, results showed that participants who reported masturbating were more likely to report having multiple partners, being in a nonmonogamous relationship and engaging in high-risk sexual behaviors. There was no significant relationship between level of masturbation guilt and HIV risk nor between masturbation and consistent condom use or attitudes toward condoms. This study adds to the growing empirical support for associations between sexual health variables and safer sex and argues for a more explicit focus on sexuality in HIV prevention.