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Thoma BC, Huebner DM, Rullo JE. Unseen risks: HIV-related risk behaviors among ethnically diverse sexual minority adolescent females. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:535-41. [PMID: 24245599 DOI: 10.1521/aeap.2013.25.6.535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
High rates of HIV-related sexual risk behaviors among lesbian and bisexual female adolescents have been documented. However, previous research has not adequately described racial/ethnic subgroup differences in risk behaviors within this population. We examined HIV-related sexual risk behaviors among an ethnically diverse sample of sexual minority girls (N = 244). Compared to their White peers, girls who identified their race/ethnicity as mixed had more than four times the odds of reporting both unprotected vaginal sex with a male and multiple male sex partners. All subgroups exhibited risk behaviors, indicating that sexual minority girls must be included in HIV-prevention efforts targeting adolescent females.
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Dolcini MM, Catania JA, Harper GW, Watson SE, Ellen JM, Towner SL. Norms governing urban African American adolescents' sexual and substance-using behavior. J Adolesc 2012; 36:31-43. [PMID: 23072891 DOI: 10.1016/j.adolescence.2012.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 08/25/2012] [Accepted: 09/02/2012] [Indexed: 11/30/2022]
Abstract
Using a probability-based neighborhood sample of urban African American youth and a sample of their close friends (N = 202), we conducted a one-year longitudinal study to examine key questions regarding sexual and drug using norms. The results provide validation of social norms governing sexual behavior, condom use, and substance use among friendship groups. These norms had strong to moderate homogeneity; and both normative strength and homogeneity were relatively stable over a one-year period independent of changes in group membership. The data further suggest that sex and substance using norms may operate as a normative set. Similar to studies of adults, we identified three distinct "norm-based" social strata in our sample. Together, our findings suggest that the norms investigated are valid targets for health promotion efforts, and such efforts may benefit from tailoring programs to the normative sets that make up the different social strata in a given adolescent community.
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Affiliation(s)
- M Margaret Dolcini
- Oregon State University, College of Public Health and Human Sciences, Hallie E. Ford Center for Healthy Children and Families, 2631 SW Campus Way, Corvallis, OR 97331, USA.
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Seth P, Lang DL, Diclemente RJ, Braxton ND, Crosby RA, Brown LK, Hadley W, Donenberg GR. Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment. Sex Health 2012; 9:240-6. [PMID: 22697141 DOI: 10.1071/sh10098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 07/19/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. METHODS Three hundred and seventy nine sexually active adolescents, aged 13-18 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. RESULTS After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)=3.2, P=0.0001), obtain their HIV test results (AOR=2.9, P=0.03), refuse sex out of fear for STI acquisition (AOR=1.7, P=0.04), or avoid a situation that might lead to sex (AOR=2.4, P=0.001), and were less likely to have a casual sex partner (AOR=0.40, P=0.002). Additionally, females were more likely to report inconsistent condom use (AOR=2.60, P=0.001) and have a STI (AOR=9.1, P=0.0001) than their male counterparts. CONCLUSIONS Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.
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Affiliation(s)
- Puja Seth
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA 30322, USA.
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Robertson AA, Robertson AR, St Lawrence J, Morse DT, Baird-Thomas C, Liew H, Gresham K. The Healthy Teen Girls project: comparison of health education and STD risk reduction intervention for incarcerated adolescent females. HEALTH EDUCATION & BEHAVIOR 2011; 38:241-50. [PMID: 21393623 DOI: 10.1177/1090198110372332] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescent girls incarcerated in a state reformatory (N = 246) were recruited and assigned to an 18-session health education program or a time-equivalent HIV prevention program. Cohorts were assigned to conditions using a randomized block design separated by a washout period to reduce contamination. Post intervention, girls in the HIV risk reduction program demonstrated the acquisition of risk-reduction behavioral skills and improved condom application skill. At a follow-up assessment approximately 9 months after release from the correctional facility, girls in both conditions reported fewer unprotected sexual intercourse occasions and less sex while under the influence of alcohol or other drugs.
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Associations Between Adolescents' Sexual Risk Behavior and Scores on Six Psychometric Scales. ACTA ACUST UNITED AC 2009. [DOI: 10.1300/j129v04n01_04] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bauermeister JA, Zimmerman M, Xue Y, Gee GC, Caldwell CH. Working, sex partner age differences, and sexual behavior among African American youth. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:802-13. [PMID: 18574686 PMCID: PMC2745502 DOI: 10.1007/s10508-008-9376-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 01/18/2008] [Accepted: 01/18/2008] [Indexed: 05/21/2023]
Abstract
Participation in the workplace has been proposed as a potential structural-level HIV/STI prevention strategy for youth. Only a few cross-sectional studies have explored the effect of work during adolescence and young adulthood on sexual behavior and their results have been mixed. This study builds on this literature by exploring whether work influences youths' sexual behavior in a cohort of African American youth (N = 562; 45% males; M = 14.5 years, SD = 0.6) followed from adolescence to young adulthood (ages 13-25 years). Using growth curve modeling, we tested whether working was associated with older sex partners. Then, we explored the association between sex partner age differences and sexual behaviors (i.e., number of sex partners, condom use, and frequency of sexual intercourse). Finally, we tested whether the relationship between sex partner age differences and sexual behaviors was confounded by working. Working greater number of hours was not significantly associated with having older sex partners. Sex partner age differences was associated with number of partners, condom use, and higher sex frequency. These associations were larger for females. Working was associated with higher sex frequency, after accounting for age differences. We discuss the implications of these findings for future research and program planning, particularly in the context of youth development programs.
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Affiliation(s)
- José A Bauermeister
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA.
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Haglund K. Reducing sexual risk with practice of periodic secondary abstinence. J Obstet Gynecol Neonatal Nurs 2009; 37:647-56. [PMID: 19012715 DOI: 10.1111/j.1552-6909.2008.00289.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Test a novel intervention to help sexually experienced girls increase abstinence behaviors and attitudes. DESIGN A quasi-experimental repeated measures design using qualitative and quantitative data. SETTING Two alternative public schools. PARTICIPANTS Thirty-three females whose mean age was 16 and who were 79% African American participated. Most (79%) had experienced a pregnancy. INTERVENTION A 6 session, weekly, interactive intervention was delivered. Data were collected at baseline, last session, and at 5 and 7 month follow-ups. MAIN OUTCOME MEASURES Measured outcomes related to abstinence included participants' reasons, behaviors, stages of change, and attitudes. RESULTS The most common reason for abstinence was not wanting to have sex. At each postintervention data collection point, most participants (greater than or equal to 74%) reported that they had purposefully avoided sex. Duration of consecutive days of abstinence increased although only significantly at 5 month follow-up. Abstinence behaviors increased with the largest change from first to last session. Stage of change advanced from preparation to action by 7 month follow-up. Attitudes toward abstinence became more favorable. CONCLUSION Effective sexual risk reduction interventions are critically needed to promote safety. Nurses may assist young women to decrease their sexual risks by teaching them to practice periodic abstinence.
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Affiliation(s)
- Kristin Haglund
- Marquette University, College of Nursing, Milwaukee, WI 53201-1881, USA.
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Salazar LF, Crosby RA, Diclemente RJ, Wingood GM, Rose E, McDermott-Sales J, Caliendo AM. African-American female adolescents who engage in oral, vaginal and anal sex: "doing it all" as a significant marker for risk of sexually transmitted infection. AIDS Behav 2009; 13:85-93. [PMID: 18369721 DOI: 10.1007/s10461-008-9381-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 03/12/2008] [Indexed: 11/25/2022]
Abstract
African-American female adolescents who engaged in vaginal sex only (N = 272) were compared to adolescents who engaged in two types (vaginal plus oral or anal; N = 295) and three types (vaginal, oral and anal; N = 144) on a constellation of other sexual risk behaviors (SRBs) and on sexually transmitted infections (STIs). Adjusted contrasts among groups revealed that adolescents who engaged in two and in three types of sex as compared to those who engaged in vaginal sex only were more likely to engage in six of the seven SRBs, but were just as likely to have a STI. One SRB, having >/= 4 lifetime sex partners, was in turn associated with STI. Two-way interactions indicated that having a casual sex partner and having multiple sex partners in the last 60 days increased the likelihood of STI, but only for adolescents who engaged in all three types.
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Affiliation(s)
- Laura F Salazar
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1520 Clifton Rd, Suite 214, Atlanta, GA, 30322, USA.
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Sales JM, Spitalnick J, Milhausen RR, Wingood GM, DiClemente RJ, Salazar LF, Crosby RA. Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females. HEALTH EDUCATION RESEARCH 2009; 24:140-52. [PMID: 18353760 PMCID: PMC2721668 DOI: 10.1093/her/cyn006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 12/28/2007] [Indexed: 05/16/2023]
Abstract
This study examined the psychometric properties of a new scale to measure adolescents' worry regarding outcomes of risky sexual behavior (i.e. sexually transmitted infections, including HIV [STI/HIV], and unintended pregnancy). The 10-item worry about sexual outcomes (WASO) scale, resulting in two subscales STI/HIV worry and pregnancy worry, was administered to a sample of 522 African-American female adolescents ranging in age from 14 to 18, residing in the southeast United States and participating in a sexual risk reduction intervention. The WASO demonstrated internal consistency across multiple administrations and yielded satisfactory construct validity. Worry was found to negatively correlate with sexual communication self-efficacy (with a new male partner and a steady male partner), frequency of sexual communication with male partner, attitudes about condom use and social support; worry was positively correlated with perceived barriers to condom use, condom negotiation, locus of control and depression. Overall, the results indicate that the WASO is a reliable and valid measure of assessing adolescents' worry about STIs, HIV and pregnancy. The WASO represents a brief self-administered instrument that can be easily integrated into sexual risk reduction assessments and interventions. Future studies employing the WASO might consider testing it with more diverse samples in terms of gender, race/ethnicity, age and sexual orientation.
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Affiliation(s)
- Jessica M Sales
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Malow RM, Kershaw T, Sipsma H, Rosenberg R, Dévieux JG. HIV preventive interventions for adolescents: a look back and ahead. Curr HIV/AIDS Rep 2008; 4:173-80. [PMID: 18366948 DOI: 10.1007/s11904-007-0025-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV and sexual risk continue to be central threats to the health and well-being of adolescents in the United States and abroad. Great strides have been made in creating interventions that reduce contracting and transmitting the deadly virus among adolescents. Numerous interventions have been designed and evaluated, with many having positive results in reducing adolescents' HIV risk behavior. However, the complexity of adolescents as well as limited effects on many sexual risk outcomes indicate that much more work needs to be done. This article provides a review of the literature on interventions among adolescents, summarizing why adolescents provide a unique challenge for HIV prevention, the intervention approaches that have been taken, and the challenges and recommendations for the future as the field confronts the neurobiologic dimension of risk.
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Affiliation(s)
- Robert M Malow
- Biscayne Bay Campus, CI-Suite 260, Florida International University, Miami, FL 33181-3600, USA.
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Townsend TG. Protecting Our Daughters: Intersection of Race, Class and Gender in African American Mothers’ Socialization of Their Daughters’ Heterosexuality. SEX ROLES 2008. [DOI: 10.1007/s11199-008-9409-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salazar LF, Crosby RA, Diclemente RJ, Wingood GM, Rose E, Sales JM, Caliendo AM. Personal, relational, and peer-level risk factors for laboratory confirmed STD prevalence among low-income African American adolescent females. Sex Transm Dis 2008; 34:761-6. [PMID: 17507835 DOI: 10.1097/01.olq.0000264496.94135.ac] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify risk factors for laboratory confirmed sexually transmitted disease (STD) prevalence among low-income African American adolescent females living in a high-risk urban area of the Southern United States. METHODS Participants were 715 African American adolescent females recruited from urban clinics. Data collection occurred from 2002 to 2004 and included an audio-computer assisted self-interview lasting about 60 minutes and a self-collected vaginal swab for NAAT to detect Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Ten personal-level risk factors were assessed as well as 8 risk factors involving either peer or relational factors. RESULTS Adolescents (28.8%) tested positive for at least 1 STD. Six personal-level and 4 social-level measures achieved a bivariate screening level of significance. In the multivariate model, only 3 measures achieved significance: gang involvement, social support from peers, and fear of condom use negotiation. Compared to those who had never belonged to a gang, those who had were about 4.2 times more likely (95% CI = 2.16-9.44) to test positive. Adolescents' who had higher levels of fear pertaining to condom use negotiation were more likely to test positive as were adolescents who perceived higher levels of social support from their peers. CONCLUSIONS This finding suggests and supports the utility of designing interventions for high-risk African American adolescent females that incorporate objectives to modify the significant social influences related to STD acquisition.
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Affiliation(s)
- Laura F Salazar
- Rollins School of Public Health, Department of Behavioral Science and Health Education, Emory University, Atlanta, Georgia 30322, USA.
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Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med 2008. [PMID: 17688395 DOI: 10.1080/08836610701495268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence. PURPOSE We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM. METHODS An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk. RESULTS The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors. CONCLUSIONS These data suggest the existence of cooccurring epidemics, or "syndemic," of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.
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Affiliation(s)
- Brian Mustanski
- Institute for Juvenile Research at the University of Illinois at Chicago, Department of Psychiatry, and Children's Memorial Hospital, IL 60608, USA.
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Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Ann Behav Med 2007; 34:37-45. [PMID: 17688395 PMCID: PMC2219199 DOI: 10.1007/bf02879919] [Citation(s) in RCA: 343] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence. PURPOSE We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM. METHODS An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk. RESULTS The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors. CONCLUSIONS These data suggest the existence of cooccurring epidemics, or "syndemic," of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.
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Affiliation(s)
- Brian Mustanski
- Institute for Juvenile Research at the University of Illinois at Chicago, Department of Psychiatry, and Children's Memorial Hospital, IL 60608, USA.
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Olsen ML, Cwiak CA, Koudelka C, Jensen JT. Desired qualities and hypothetical contextual use of vaginal microbicides in a diverse sample of US women. Contraception 2007; 76:314-8. [PMID: 17900444 DOI: 10.1016/j.contraception.2007.05.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 05/20/2007] [Accepted: 05/23/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vaginal microbicides represent an important emerging class of antiinfectives. To guide research and development, we conducted a survey to determine interest in desired qualities of and intended use of microbicides within the current milieu of contraceptive options. STUDY DESIGN Women completed an anonymous survey while waiting for health care clinic appointments in Portland, OR, and Atlanta, GA, and in one public area (Atlanta). RESULTS Four hundred one women completed the survey. Subjects had a mean age of 25.6 (SD=7.4), parity of 1.5 (SD=1.6) and 47.7% were non-Caucasian. Respondents showed moderate interest in noncontraceptive anti-HIV gel-based microbicides (mean, 53.8; SD, 39.6; n=362) and significantly stronger interest in contraceptive anti-HIV microbicides (mean, 89.4 mm; SD, 20.7; n=363; p<.001). The qualities of HIV, pregnancy and sexually transmitted infection (STI) prevention were the highest priorities of the largest percentage (40%) of respondents. Half (49.6%) of respondents reported they would use another form of protection in conjunction with a contraceptive anti-HIV microbicide. CONCLUSIONS A diverse sample of women reported substantial interest in vaginal microbicides capable of preventing HIV and pregnancy, and a smaller high-risk subgroup was interested in noncontraceptive anti-HIV microbicides. Most women would prefer a product capable of preventing HIV, pregnancy and STIs. Almost half of respondents would use vaginal microbicides as part of a dual method.
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Affiliation(s)
- Molly Lalor Olsen
- School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
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Crosby RA, DiClemente RJ, Wingood GM, Salazar LF, Rose E, Sales JM. The protective value of school enrolment against sexually transmitted disease: a study of high-risk African American adolescent females. Sex Transm Infect 2007; 83:223-7. [PMID: 17569721 PMCID: PMC2659109 DOI: 10.1136/sti.2006.022590] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify whether school enrolment is protective against laboratory-confirmed diagnosis of sexually transmitted diseases (STDs) and against a spectrum of sexual risk factors. METHODS A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included an audio-computer-assisted self-interview lasting about 60 min and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. RESULTS In total, 65% were enrolled in school. After adjusting for age and whether adolescents resided with a family member, those not enrolled were twice as likely to test positive for one of the three STDs compared with those enrolled (adjusted OR2; 95% CI 1.38 to 2.91). Similarly, school enrolment was protective against risk factors contributing to STD acquisition. The measures of sexual risk behaviour of 8 of 10, retained significance after adjusting for the covariates, and 2 of the 3 psychosocial mediators retained significance. CONCLUSION This study provides initial evidence suggesting that keeping high-risk African-American adolescent females in school (including forms of school that occur after high-school graduation) may be important from a public health standpoint.
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Crosby RA, DiClemente RJ, Wingood GM, Salazar LF, Rose E, Sales JM, Caliendo AM. Oral contraceptive use may not preclude condom use: a study of non-pregnant African-American adolescent females. Sex Transm Infect 2007; 83:216-8. [PMID: 17569720 PMCID: PMC2659095 DOI: 10.1136/sti.2006.022442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the association between oral contraceptive and condom use, and laboratory-confirmed sexually transmitted infection (STI) among African-American adolescent females at a high risk of STI acquisition. METHODS A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included (a) an audio-computer-assisted self-interview and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. RESULTS The age-adjusted odds ratio (AOR) indicated a modest protective effect of oral contraceptive use against unprotected vaginal sex (UVS) using a 60-day recall period (AOR = 0.66; 95% CI 0.43 to 0.99). The age-adjusted difference in mean frequency of UVS in the past 60 days was non-significant (p = 0.23) as was condom use at last sex (p = 0.34). The age-AOR relative to STI prevalence also showed a protective effect (AOR = 0.60; 95% CI 0.36 to 0.98) for those using oral contraceptives. CONCLUSION The findings suggest that the use of oral contraceptives may not preclude safer sex practices for the prevention of STIs among high-risk African-American adolescent females.
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Affiliation(s)
- Richard A Crosby
- Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, KY 40506-0003, USA.
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Sales JM, Milhausen RR, Wingood GM, Diclemente RJ, Salazar LF, Crosby RA. Validation of a Parent-Adolescent Communication Scale for Use in STD/HIV Prevention Interventions. HEALTH EDUCATION & BEHAVIOR 2007; 35:332-45. [PMID: 17200099 DOI: 10.1177/1090198106293524] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study reports on the validation of a scale to assess adolescent girls' frequency of sexual communication with their parents. The Parent-Adolescent Communication Scale (PACS) was administered to 522 African American female adolescents ranging in age from 14 to 18. The PACS demonstrated satisfactory internal consistency (across multiple administrations) and acceptable test-retest reliability over a 12-month follow-up period. Concurrently, scores on the PACS were correlated with frequency of sexual communication with partner, sexual communication self-efficacy (boyfriend), perceived parental knowledge, family support, depression, and condom use with steady male sex partners. Prospectively, baseline PACS scores were correlated with frequency of sexual communication with partner and condom use. The present investigation indicates that the PACS is a reliable and valid measure of frequency of sexual communication between female adolescents and their parents. Utility of the PACS for researchers and practitioners is discussed.
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Affiliation(s)
- Jessica McDermott Sales
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, USA.
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Abstract
Adolescents comprise a growing proportion of people diagnosed with HIV or AIDS. Navigating adolescence while infected with HIV presents specific challenges not only to the youth but to their families and caregivers. As children enter their teen years, they have medical, physiologic, and psychosocial issues that differ greatly from both younger children and young adults. These issues include the limited number of medications available, mental illness (especially depression), and psychosocial issues such as distorted body image, sexual awareness, and problems with family and peer relations. Many of these issues are heightened in this population and can be important factors that can influence adherence. Awareness of these issues is important for health care providers, for if they understand not just the illness itself, but the psychosocial issues of the patient they are treating, the clinician can optimize treatments and adherence, and help these young persons successfully transition into adulthood.
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Affiliation(s)
- Patricia DeLaMora
- Weill Cornell Medical College, Department of Pediatrics, Division of Infectious Diseases, 1300 York Avenue, Box 296, New York, NY 10021, USA.
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Purswani MU, Hagmann S, Bakshi SS, Matias AR, Nubel CA, Neugebauer R, Dunne JM, Kairam R. A blinded survey of the seroprevalence of HIV-1 infection in an inner-city adolescent and young adult population attending a community hospital in the United States. J Adolesc Health 2007; 40:182-4. [PMID: 17259063 DOI: 10.1016/j.jadohealth.2006.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 09/05/2006] [Accepted: 09/07/2006] [Indexed: 11/21/2022]
Abstract
The seroprevalence of HIV-1 infection in youth aged 12-24 years attending a Bronx community hospital was studied by blinded testing of unused sera. A crude prevalence of 0.98% (95% CI 0.08-1.88%) was observed, higher than rates in United States national HIV surveys, underscoring the need for enhanced screening and preventive services.
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Affiliation(s)
- Murli U Purswani
- Department of Pediatrics, Infectious Diseases Division, Bronx-Lebanon Hospital Center, Bronx, New York 10457, USA.
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Butler TH, Miller KS, Holtgrave DR, Forehand R, Long N. Stages of sexual readiness and six-month stage progression among African American pre-teens. JOURNAL OF SEX RESEARCH 2006; 43:378-86. [PMID: 17599259 DOI: 10.1080/00224490609552337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We examined the range of sexual intentions and behaviors preceding sexual initiation among 211 African-American pre-teens assigned to the control arm of a longitudinal community-based intervention trial. Stage of sexual readiness was assessed using the stage of change construct from the Transtheoretical Model, and patterns of stage movement during a 6-month period were examined. Overall, 90% of participants were in precontemplation at baseline, with the proportion of participants in this stage declining with each year of age. There was substantial stability in stage of sexual readiness during the 6-month period (87% stable). While definitive conclusions regarding exact patterns of movement are not yet possible, stage movement does not appear to be linear for all pre-teens, and there is evidence of both stage progression and regression. We present emerging patterns of stage movement, which suggest potential variation by age, gender, and baseline stage, and discuss potential implications.
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Affiliation(s)
- Terry H Butler
- National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail stop E-07, Atlanta, GA 30333, USA.
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Wingood GM, DiClemente RJ, Harrington KF, Lang DL, Davies SL, Hook EW, Oh MK, Hardin JW. Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence. Am J Public Health 2006; 96:1085-90. [PMID: 16670238 PMCID: PMC1470614 DOI: 10.2105/ajph.2004.053595] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. METHODS In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. RESULTS Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. CONCLUSIONS Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.
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Affiliation(s)
- Gina M Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, the Emory Center for AIDS Research, Emory University, Atlanta, GA, USA.
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McNaghten AD, Neal JJ, Li J, Fleming PL. Epidemiologic profile of HIV and AIDS among American Indians/Alaska Natives in the USA through 2000. ETHNICITY & HEALTH 2005; 10:57-71. [PMID: 15841587 DOI: 10.1080/1355785052000323038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To describe HIV and AIDS among American Indians/Alaska Natives (AI/ AN) in the USA through 2000. DESIGN An epidemiologic profile was constructed using HIV/AIDS surveillance, sexually transmitted disease (STD), and seroprevalence data. RESULTS Although AIDS among AI/AN represents < 1% of cumulative AIDS cases in the USA, in 2000 the AIDS incidence rate (cases per 100,000 population) for AI/AN (11.9) was higher than that for whites (7.3). AI/AN had high rates of chlamydia, gonorrhea, and syphilis from 1996 through 2000; among all females, AI/AN females had the second highest rates of chlamydia, gonorrhea, and syphilis reported during this time period. Of all AIDS cases among AI/AN, 70% were reported by 10 states. CONCLUSIONS These data demonstrate that the impact of STDs and the potential for an impact of HIV/AIDS among AI/AN are greater than indicated by the relatively small number of AIDS cases in this population. Additional mechanisms are needed to fill gaps in the available data. Coordination among the complex network of healthcare providers, tribes, and federal, state, and local health agencies is needed to improve delivery of information about HIV/AIDS to AI/AN and to ensure access to HIV prevention and treatment programs for AI/AN.
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Affiliation(s)
- A D McNaghten
- Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-46, Atlanta, GA 30333, USA.
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Newbern EC, Miller WC, Schoenbach VJ, Kaufman JS. Family socioeconomic status and self-reported sexually transmitted diseases among black and white american adolescents. Sex Transm Dis 2004; 31:533-41. [PMID: 15480114 DOI: 10.1097/01.olq.0000137898.17919.35] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess associations between socioeconomic status (SES) and adolescent sexually transmitted diseases (STDs) stratified by race and gender. STUDY In cross-sectional analyses of the National Longitudinal Study of Adolescent Health Wave One (1995), unadjusted and adjusted associations between 4 family SES indicators and STD reports for black and white 7th through 12th graders were examined. RESULTS Lower maternal education and nonprofessional maternal occupations were associated with higher STD reports in all groups except white females. Generally, STD reports were higher for adolescents not living in 2-parent homes, and lower income was only associated for black males. CONCLUSION Overall, SES is only a weak to moderate marker for adolescent STD risks. The relationship of SES and STDs varies by the SES measure used and differs across race-gender groups. Other individual factors such as risk behaviors or community factors such as income inequality could play a more critical role for adolescent STDs than family SES.
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Affiliation(s)
- Elizabeth Claire Newbern
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA
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Lederman RP, Mian TS. The parent-adolescent relationship education (PARE) program: a curriculum for prevention of STDs and pregnancy in middle school youth. Behav Med 2004; 29:33-41. [PMID: 14977246 DOI: 10.1080/08964280309596173] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Parent-Adolescent Relationship Education (PARE) Program, designed for parents and middle school students, focuses on strengthening family communication about sexual issues and behaviors to help prevent teen pregnancy, human immunodeficiency virus (HIV), and other sexually transmitted diseases (STDs). The program includes content about reproduction, STDs and Acquired Immune Deficiency Syndrome (AIDS), contraception, sex risks, and safe-sex behaviors. The course uses social learning and cognitive behavioral concepts to enhance decision-making, refusal, and resistance skills. A randomized treatment or control group design is used to assign parent-child dyads to an experimental education group (social learning) or an attention-control group (traditional didactic teaching). Three post-program maintenance or booster sessions are held at 6-month intervals and at times prior to peak teen conception periods to reinforce the knowledge and skills learned. Pre- and posttests for parents and students assess group differences in parental involvement and communication, contraception, sex attitudes and intentions, sex behaviors (initiation of sexual intercourse, frequency, number of partners, contraceptive practices, refusal skills), and the incidence of pregnancy.
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Affiliation(s)
- Regina P Lederman
- School of Nursing, Department of Community Health and Preventive Medicine, Division of Sociomedical Sciences, at the University of Texas at Galveston, USA
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Teplin LA, Mericle AA, McClelland GM, Abram KM. HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy. Am J Public Health 2003; 93:906-12. [PMID: 12773351 PMCID: PMC1447866 DOI: 10.2105/ajph.93.6.906] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2002] [Indexed: 11/04/2022]
Affiliation(s)
- Linda A Teplin
- Psycho-Legal Studies Program, The Feinberg School of Medicine, Dept of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL 60611, USA.
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Sateren WB, Renzullo PO, Carr JK, Birx DL, McNeil JG. HIV-1 infection among civilian applicants for US military service, 1985 to 2000: epidemiology and geography. J Acquir Immune Defic Syndr 2003; 32:215-22. [PMID: 12571533 DOI: 10.1097/00126334-200302010-00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examined demographic and geographic correlates of HIV-1 prevalence among civilian applicants for US military service. METHODS HIV-1 test results and demographic and geographic data were available for 5.3 million applicants. RESULTS Between October 1985 and December 2000, a total of 5,340,694 individuals applied to join one of the armed service branches of the US military. Overall, HIV-1 prevalence was 0.80 per 1000 applicants (95% CI: 0.78-0.82), with 4276 applicants testing positive for HIV-1 infection. Prevalence declined over the 16-year period from a high of 2.89 per 1000 applicants in 1985 to 0.36 per 1000 applicants in 2000. The majority of applicants (82.7%) were male, and the majority of HIV-1 cases (89.4%) occurred in men. HIV-1 prevalence was higher among African Americans (2.47/1000) and Hispanics (0.90/1000) than among white applicants (0.36/1000). HIV-1 prevalence was lowest in the West North Central region of the United States (0.33/1000) and highest in the Middle Atlantic region (1.61/1000) and Puerto Rico (3.56/1000). CONCLUSIONS Civilian applicants for US military service comprise a unique cohort for following trends in the evolving HIV-1 epidemic.
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Affiliation(s)
- Warren B Sateren
- Division of Retrovirology, Walter Reed Army Institute of Research, U.S. Military HIV Research Program, 1 Taft Court, Suite 250, Rockville, MD 20850, USA.
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Crosby R, DiClemente RJ, Wingood GM, Harrington K, Davies SL, Hook EW, Oh MK. Predictors of infection with Trichomonas vaginalis: a prospective study of low income African-American adolescent females. Sex Transm Infect 2002; 78:360-4. [PMID: 12407241 PMCID: PMC1744539 DOI: 10.1136/sti.78.5.360] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify psychosocial predictors of Trichomonas vaginalis infection among low income African-American adolescent females living in a high risk urban area of the United States. METHODS Baseline plus 6 and 12 month follow up data collected as part of an HIV prevention intervention trial were utilised. The baseline sample consisted of 522 African-American females, 14-18 years of age. Recruitment sites were located in low income neighbourhoods of Birmingham, Alabama, characterised by high rates of unemployment, substance abuse, violence, teenage pregnancy, and sexually transmitted infections. Self administered vaginal swab specimens were cultured for T vaginalis. Baseline measures collected as part of a self administered survey and face to face interviews were used to predict subsequent infection with T vaginalis at any of the three assessment periods conducted over the span of 1 year. RESULTS At baseline, 12.9% were diagnosed with T vaginalis. At the 6 and 12 month follow ups, T vaginalis was diagnosed in 8.9% and 10.2%, respectively. The strongest multivariate predictor of T vaginalis infection was biologically confirmed marijuana use; those using marijuana were more than six times as likely to test positive for T vaginalis (adjusted odds ratio (AOR) = 6.2, p = 0.0003). Other multivariate predictors were reporting that typical sex partners were at least 5 years older (AOR = 2.6; p = 0.005), reporting sex with non-steady partners (AOR = 1.9; p = 0.02), and history of delinquency (AOR = 1.3; p = 0.02). The odds of testing positive increased by 31% for every one unit increase on a six item scale measure of delinquency. CONCLUSIONS Infection with T vaginalis was common and significant multivariate predictors comprised a constellation of problem behaviours, each of which are potentially amenable to behavioural intervention.
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Affiliation(s)
- R Crosby
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education and Emory Center for AIDS Research, Atlanta, GA 30322, USA.
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McClelland GM, Teplin LA, Abram KM, Jacobs N. HIV and AIDS risk behaviors among female jail detainees: implications for public health policy. Am J Public Health 2002; 92:818-25. [PMID: 11988453 PMCID: PMC1447167 DOI: 10.2105/ajph.92.5.818] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.
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Affiliation(s)
- Gary Michael McClelland
- Psycho-Legal Studies Program, Northwestern University Medical School, Chicago, Ill 60611-3078, USA.
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St Lawrence JS, Wilson TE, Eldridge GD, Brasfield TL, O'Bannon RE. Community-based interventions to reduce low income, African American women's risk of sexually transmitted diseases: a randomized controlled trial of three theoretical models. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2001; 29:937-964. [PMID: 11800513 DOI: 10.1023/a:1012919700096] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.
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Mertz KJ, Ransom RL, St Louis ME, Groseclose SL, Hadgu A, Levine WC, Hayman C. Prevalence of genital chlamydial infection in young women entering a national job training program, 1990-1997. Am J Public Health 2001; 91:1287-90. [PMID: 11499120 PMCID: PMC1446762 DOI: 10.2105/ajph.91.8.1287] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2000] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This analysis describes trends in the prevalence of genital chlamydial infection in economically disadvantaged young women entering a national job training program. METHODS We examined chlamydia test data for May 1990 through June 1997 for women aged 16 to 24 years who enrolled in the program. The significance of trends was evaluated with the chi 2 test for trend. RESULTS Prevalence of chlamydial infection declined 32.9%, from 14.9% in 1990 to 10.0% in 1997 (P < .001). Prevalence decreased significantly in all age groups, racial/ethnic groups, and geographic regions. CONCLUSIONS The decrease in prevalence of chlamydial infection suggests that prevention activities have reached disadvantaged women across the United States; however, prevalence of chlamydial infection remains high, and enhanced prevention efforts in disadvantaged communities are urgently needed.
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Affiliation(s)
- K J Mertz
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga., USA
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Karon JM, Fleming PL, Steketee RW, De Cock KM. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001; 91:1060-8. [PMID: 11441732 PMCID: PMC1446722 DOI: 10.2105/ajph.91.7.1060] [Citation(s) in RCA: 330] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The current status of and changes in the HIV epidemic in the United States are described. METHODS Surveillance data were used to evaluate time trends in AIDS diagnoses and deaths. Estimates of HIV incidence were derived from studies done during the 1990s; time trends in recent HIV incidence were inferred from HIV diagnoses and seroprevalence rates among young persons. RESULTS Numbers of deaths and AIDS diagnoses decreased dramatically during 1996 and 1997 but stabilized or declined only slightly during 1998 and 1999. Proportional decreases were smallest among African American women, women in the South, and persons infected through heterosexual contact, HIV incidence has been roughly constant since 1992 in most populations with time trend data, remains highest among men who have sex with men and injection drug users, and typically is higher among African Americans than other racial/ethnic groups. CONCLUSIONS The epidemic increasingly affects women minorities, persons infected through heterosexual contact, and the poor. Renewed interest and investment in HIV and AIDS surveillance and surveillance of behaviors associated with HIV transmission are essential to direct resources for prevention to populations with greatest need and to evaluate intervention programs.
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Affiliation(s)
- J M Karon
- National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Ga., USA.
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Catania JA, Canchola J, Binson D, Dolcini MM, Paul JP, Fisher L, Choi KH, Pollack L, Chang J, Yarber WL, Heiman JR, Coates T. National trends in condom use among at-risk heterosexuals in the united states. J Acquir Immune Defic Syndr 2001; 27:176-82. [PMID: 11404540 DOI: 10.1097/00126334-200106010-00013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Based on national level surveys, we examined data relevant to the United States' overall effort to prevent the spread of HIV among heterosexual adults. We examined changes in condom use among at-risk heterosexuals over the past decade. The observed increases over time in condom use across all heterosexual at-risk population segments are consistent with the observed (declines) trends in HIV and syphilis in the 1990s. These results and findings from prior studies suggest that U.S. efforts to facilitate condom use and contain HIV and related sexually transmitted disease (STD)-cofactors among adult at risk heterosexuals was succeeding over most of the 1990s. The absence of national level behavioral trend data after 1996, and the ambiguities of HIV spread suggest some caution in projecting trends into this century. National and local efforts need to be directed at sustaining behavioral change and conducting more rigorous studies on population trends in HIV/STD-related behaviors/pathogens.
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Affiliation(s)
- J A Catania
- Health Survey Research Unit/Center for AIDS Prevention Studies/Department of Medicine, University of California San Francisco, 74 New Montgomery, San Francisco, CA 94105, USA.
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DiClemente RJ, Wingood GM, Crosby R, Sionean C, Cobb BK, Harrington K, Davies S, Hook EW, Oh MK. Parental monitoring: association with adolescents' risk behaviors. Pediatrics 2001; 107:1363-8. [PMID: 11389258 DOI: 10.1542/peds.107.6.1363] [Citation(s) in RCA: 320] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Contemporary threats to adolescents' health are primarily the consequence of risk behaviors and their related adverse outcomes. Identifying factors associated with adolescents' risk behaviors is critical for developing effective prevention strategies. A number of risk factors have been identified, including familial environment; however, few studies have examined the impact of parental monitoring. OBJECTIVE To examine the influence of less perceived parental monitoring on a spectrum of adolescent health-compromising behaviors and outcomes. Design. Survey. SETTING A family medicine clinic. Participants. To assess eligibility, recruiters screened a sample of 1130 teens residing in low-income neighborhoods. Adolescents were eligible if they were black females, between the ages of 14 and 18 years, sexually active in the previous 6 months, and provided written informed consent. Most teens (n = 609) were eligible, with 522 (85.7%) agreeing to participate. MAIN OUTCOME MEASURES Variables in 6 domains were assessed, including: sexually transmitted diseases, sexual behaviors, marijuana use, alcohol use, antisocial behavior, and violence. RESULTS In logistic regression analyses, controlling for observed covariates, adolescents perceiving less parental monitoring were more likely to test positive for a sexually transmitted disease (odds ratio [OR]: 1.7), report not using a condom at last sexual intercourse (OR: 1.7), have multiple sexual partners in the past 6 months (OR: 2.0), have risky sex partners (OR: 1.5), have a new sex partner in the past 30 days (OR: 3.0), and not use any contraception during the last sexual intercourse episode (OR: 1.9). Furthermore, adolescents perceiving less parental monitoring were more likely to have a history of marijuana use and use marijuana more often in the past 30 days (OR: 2.3 and OR: 2.5, respectively); a history of alcohol use and greater alcohol consumption in the past 30 days (OR: 1.4 and OR: 1.9, respectively); have a history of arrest (OR: 2.1); and there was a trend toward having engaged in fights in the past 6 months (OR: 1.4). CONCLUSIONS The findings demonstrate a consistent pattern of health risk behaviors and adverse biological outcomes associated with less perceived parental monitoring. Additional research needs to focus on developing theoretical models that help explain the influence of familial environment on adolescent health and develop and evaluate interventions to promote the health of adolescents.
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Affiliation(s)
- R J DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia, USA.
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A Continuum of Care Model for Adolescents Living with HIV: Larkin Street Youth Center. ACTA ACUST UNITED AC 2001. [DOI: 10.1300/j023v16n01_06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Behrman AJ. Priorities in HIV prevention. Science 2001; 291:45-6. [PMID: 11192004 DOI: 10.1126/science.10.1126/science.291.5501.45b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Mofenson LM. Technical report: perinatal human immunodeficiency virus testing and prevention of transmission. Committee on Pediatric Aids. Pediatrics 2000; 106:E88. [PMID: 11099631 DOI: 10.1542/peds.106.6.e88] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In 1994, the US Public Health Service published guidelines for the use of zidovudine to decrease the risk of perinatal transmission of human immunodeficiency virus (HIV). In 1995, the American Academy of Pediatrics and the US Public Health Service recommended documented, routine HIV education and testing with consent for all pregnant women in the United States. Widespread incorporation of these guidelines into clinical practice has resulted in a dramatic decrease in the rate of perinatal HIV transmission and has contributed to more than a 75% decrease in reported cases of pediatric acquired immunodeficiency syndrome (AIDS) since 1992. Substantial advances have been made in the treatment and monitoring of HIV infection; combination antiretroviral regimens that maximally suppress virus replication are now available. These regimens are recommended for pregnant and nonpregnant individuals who require treatment. Risk factors associated with perinatal HIV transmission are now better understood, and recent results from trials to decrease the rate of mother-to-child HIV transmission have contributed new strategies with established efficacy. However, perinatal HIV transmission still occurs; the Centers for Disease Control and Prevention estimates that 300 to 400 infected infants are born annually. Full implementation of recommendations for universal, routine prenatal HIV testing and evaluation of missed prevention opportunities will be critical to further decrease the incidence of pediatric HIV infection in the United States. This technical report summarizes recent advances in the prevention of perinatal transmission of HIV relevant to screening of pregnant women and their infants.
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Somlai AM, Kelly JA, Heckman TG, Hackl K, Runge L, Wright C. Life optimism, substance use, and AIDS-specific attitudes associated with HIV risk behavior among disadvantaged innercity women. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2000; 9:1101-11. [PMID: 11153106 DOI: 10.1089/152460900446018] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The development of more effective human immunodeficiency virus (HIV) prevention programs for disadvantaged women requires identification of factors associated with risk. In the present study, 158 women - all of whom met criteria indicative of HIV risk - were recruited in innercity primary healthcare clinics and administered measurements that assessed variables in three domains believed pertinent to HIV sexual risk behavior: (1) substance use in the past 3 months, (2) acquired immunodeficiency syndrome (AIDS)-specific cognitive and attitudinal factors, including AIDS risk knowledge, condom attitudes, perceived risk for AIDS, behavior change intentions, and perceived self-efficacy, and (3) life context variables, including self-esteem, fatalism, personal optimism toward the future, and current life satisfaction. When women were categorized into highest and lower groups based on their recent risk behavior, AIDS-specific cognitive and attitudinal factors, as expected, differentiated the groups. However, women at highest risk for HIV also most often used a variety of substances and scored lower in self-esteem, held views more characterized by personal fatalism and low optimism concerning the future, and had greater life dissatisfaction than women at lower risk. HIV prevention programs for disadvantaged women require attention not only to AIDS-specific knowledge, attitudes, and skills development but also to broader issues of life context that, if unaddressed, may limit women's ability and motivation to reduce risk for HIV/AIDS.
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Affiliation(s)
- A M Somlai
- Center for AIDS Intervention Research (CAIR) and Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Economic Evaluation of HIV Risk Reduction Intervention in African-American Male Adolescents. J Acquir Immune Defic Syndr 2000. [DOI: 10.1097/00126334-200010010-00011] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pinkerton SD, Holtgrave DR, Jemmott JB. Economic evaluation of HIV risk reduction intervention in African-American male adolescents. J Acquir Immune Defic Syndr 2000; 25:164-72. [PMID: 11103047 DOI: 10.1097/00042560-200010010-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of a cognitive-behavioral HIV risk reduction intervention for African-American male adolescents that has previously been shown to be effective at reducing sexual risk taking. METHODS Standard techniques of cost-utility analysis were employed. A societal perspective and a 3% discount rate were used in the main analysis. Program costs were ascertained retrospectively. A mathematical model of HIV transmission was used to translate observed changes in sexual behavior into an estimate of the number of HIV infections the intervention averted. Intervention effects were assumed to last for 1 year. For each infection averted, the corresponding savings in future HIV-related medical care costs and quality-adjusted life years (QALYs) were estimated. The overall net cost per QALY saved (cost-utility ratio) was then calculated. Sensitivity analyses were performed to assess the robustness of the main results. RESULTS The cost-utility ratio was approximately $57,000 U.S. per QALY saved when training costs were included, and $41,000 U.S. per QALY saved when they were excluded. The intervention appeared substantially more cost-effective when the analysis was restricted to the subgroup of participants who reported being sexually active at baseline. Assumptions about the prevalence of HIV infection and the duration of intervention effectiveness also greatly affected the cost-utility ratio. CONCLUSIONS The HIV prevention intervention was moderately cost-effective in comparison with other health care programs. Selectively implementing the intervention in high-HIV prevalence communities and with sexually active youth can enhance cost-effectiveness.
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Affiliation(s)
- S D Pinkerton
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA.
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Page-Shafer K, Kim A, Norton P, Rugg D, Heitgerd J, Katz MH, McFarland W. Evaluating national HIV prevention indicators: a case study in San Francisco. AIDS 2000; 14:2015-26. [PMID: 10997407 DOI: 10.1097/00002030-200009080-00018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To field-test the availability, interpretability, and programmatic usefulness of 37 proposed national HIV prevention indicators (HPI) intended to evaluate community-level impact of HIV prevention efforts in San Francisco. METHODS HPI were defined for four populations (high risk heterosexuals, injecting drug users, men who have sex with men, and childbearing women) and for four domains (biological, behavioral, service, and socio-political). HPI were obtained from existing data sources only. Trends in HPI were examined from 1990 to 1997. RESULTS Existing data provided 29 (78%) of the 37 proposed HPI; eight HPI were not available because California does not have HIV case reporting. Interpretation was limited for several HPI due to small sample size, inconsistencies in data collection, or lack of contextual information. Data providing behavioral HPI were scarce. HPI were consistent with historical patterns of HIV transmission in San Francisco but also highlighted new and worrisome trends. Notably, HPI identified recent increases in risk for HIV transmission among men who have sex with men. CONCLUSIONS Despite limitations, the proposed national HPI provided evidence of the aggregate effectiveness of prevention efforts in San Francisco. Supplemental or local HPI are needed to fill data gaps, add context, and increase the scope and programmatic usefulness of the national HPI.
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Affiliation(s)
- K Page-Shafer
- San Francisco Department of Public Health and the University of California, 94102-6033, USA
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Rugg DL, Heitgerd JL, Cotton DA, Broyles S, Freeman A, Lopez-Gomez AM, Cotten-Oldenburg NU, Page-Shafer K. CDC HIV prevention indicators: monitoring and evaluating HIV prevention in the USA. AIDS 2000; 14:2003-13. [PMID: 10997406 DOI: 10.1097/00002030-200009080-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study selected and field tested indicators to track changes in HIV prevention effectiveness in the USA. METHODS During 1996-1999, the Centers for Disease Control and Prevention held two 2 day expert consultations with more than 80 national, state and local experts. A consensus-driven, evidence-based approach was used to select 70 indicators, which had to be derived from existing data, available in more than 25 states, and meaningful to state health officials in monitoring HIV. A literature review was performed for each indicator to determine general relevance, validity, and reliability. Two field tests in five US sites determined accessibility, feasibility, and usefulness. RESULTS The final 37 core indicators represent four categories: biological, behavioral, services, and socio-political. Specific indicators reflect the epidemic and associated risk factors for men who have sex with men, injection drug users, heterosexuals at high risk, and childbearing women. CONCLUSIONS Despite limitations, the indicators sparked the regular, proactive integration and review of monitoring data, facilitating a more effective use of data in HIV prevention community planning.
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Affiliation(s)
- D L Rugg
- Global AIDS Activity/LIFE Initiative, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Smith DK, Gwinn M, Selik RM, Miller KS, Dean-Gaitor H, Ma'at PI, De Cock KM, Gayle HD. HIV/AIDS among African Americans: progress or progression? AIDS 2000; 14:1237-48. [PMID: 10894289 DOI: 10.1097/00002030-200006160-00022] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To review data on the extent of HIV infection and associated risk behaviors, the occurrence of AIDS, and HIV-related mortality in African Americans and to suggest what can be done to reduce HIV exposure and infection in this population. DESIGN/METHODS Review of epidemiologic, published, multisite data on HIV infection in, and related behaviors of, African Americans. RESULTS On every epidemiologic measure in common use, African Americans, compared with the four other federally recognized racial/ethnic groups, have the most severe epidemic. The trend data show continuing growth in the African American epidemic despite the availability of effective behavioral interventions and biomedical treatments. Few published intervention studies with African American populations have been adequately evaluated; nor have they focused proportionately on men who have sex with men, a group in the African American community with continuing high rates of infection. CONCLUSIONS Rates of HIV transmission and disease among African Americans are high, disproportionate, and are not declining as significantly in response to effective interventions as they are among whites. Attention is urgently needed to increase our understanding of risk behaviors, social networks, and specific factors in the African American community that can be altered to reduce HIV infection. Macroenvironmental factors--poverty, social class, racism--need to be studied to suggest possible intervention components to reduce rates of HIV transmission and to increase the use of therapies that are more effectively slowing disease progression and lowering death rates among whites.
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Affiliation(s)
- D K Smith
- Centers for Disease Control and Prevention, Surveillance and Epidemiology, Atlanta, GA 30333, USA
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Ruiz JD, Molitor F, McFarland W, Klausner J, Lemp G, Page-Shafer K, Parikh-Patel A, Morrow S, Sun RK. Prevalence of HIV infection, sexually transmitted diseases, and hepatitis and related risk behavior in young women living in low-income neighborhoods of northern California. West J Med 2000; 172:368-73. [PMID: 10854379 PMCID: PMC1070918 DOI: 10.1136/ewjm.172.6.368] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the prevalence of human immunodeficiency virus (HIV) infection, sexually transmitted diseases, and hepatitis and the associated sexual and drug-using behavior among women residing in low-income neighborhoods in 5 northern California counties. METHODS From April 4, 1996, to January 6, 1998, women aged 18 to 29 years were recruited door-to-door from randomly selected street blocks within 1990 census block groups below the 10th percentile for median household income for each county. RESULTS Of 24,223 dwellings enumerated, contact was made with residents from 19,546 (80.7%). Within contacted dwellings, 3,560 eligible women were identified and 2,545 enrolled (71.5%). Weighted estimates for disease prevalence were HIV infection, 0.3% (95% confidence interval, 0.1%-0.4%); syphilis, 0.7% (0.3%-1.1%); gonorrhea, 0.8% (0.3%-1.3%); chlamydia, 3.3% (2.4%-4.8%); herpes simplex virus, type 1, 73.7% (71.6%-76.9%); herpes simplex virus, type 2, 34.4% (29.9%-39.0%); hepatitis A, 33.5% (28.3%-38.7%); chronic hepatitis B, 0.8% (0.3%-1.2%); and hepatitis C, 2.5% (1.4%-3. 6%). Condom use at last sexual intercourse with a new partner was reported by 44.0% (33.9%-54.1%). Injection drug use in the last 6 months was reported by 1.8% (1.0%-2.7%). CONCLUSIONS The Young Women's Survey provided population-based estimates of the prevalence of 8 infectious diseases and related risk behavior within a population for whom data are often difficult to collect. Population-based data are needed for appropriate targeting and planning of primary and secondary disease prevention.
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Affiliation(s)
- J D Ruiz
- California Department of Health Services Office of AIDS HIV/AIDS Epidemiology Branch, Sacramento, CA 94234-7320, USA.
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Rotheram-Borus MJ, O'Keefe Z, Kracker R, Foo HH. Prevention of HIV among adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2000; 1:15-30. [PMID: 11507791 DOI: 10.1023/a:1010071932238] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Adolescents are at risk for HIV primarily through their sexual behavior. A comprehensive prevention strategy includes a national HIV campaign based on social marketing principles; targeted social marketing, intensive skill building, and sexually transmitted disease control programs for youth at high risk; programs targeting institutions (e.g., school health clinics), providers, and parents; and interventions to identify and reduce risk acts among seropositive youth. The U.S. focus for HIV prevention has been single-session educational classes (an ineffective strategy) or intensive multi-session, small-group interventions for youth at high risk (demonstrated to increase condom use by about 30%). There is a need to expand the range, modalities, and dissemination of HIV prevention programs nationally, to recognize (especially by policymakers) limitations of abstinence programs, and to increase early detection of HIV among youth.
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Affiliation(s)
- M J Rotheram-Borus
- Department of Psychiatry, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA
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