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Hammack AY, Bickham JN, Gilliard I 3rd, Robinson WT. A Community Health Worker Approach for Ending the HIV Epidemic. Am J Prev Med 2021; 61:S26-31. [PMID: 34686287 DOI: 10.1016/j.amepre.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In the second half of 2019, East Baton Rouge Parish, Louisiana was selected as 1 of the 3 jump-start pilot jurisdictions for the Centers for Disease Control and Prevention-funded Ending the HIV Epidemic in the U.S. Initiative. An innovative community health worker program was among the strategies developed to reduce the number of new HIV infections. In addition to testing for HIV/sexually transmitted infections in nontraditional settings, community health workers provided integrated services, including linkage for people with HIV, pre-exposure prophylaxis navigation, sterile injection supplies and referrals to syringe services programs, and other social services. METHODS The 5-member community health worker team was representative of the populations they intended to reach. They conducted outreach, from October 2019 to December 2020, within areas known to have a high incidence of new HIV infections. RESULTS The community health worker team documented 977 encounters with individuals in their communities. The vast majority of encounters were among Black clients; 9% were among White clients. In total, 48% were among cisgender women, 50% were among cisgender men, and 2% were among transgender women. People who inject drugs represented 7% of the sample. Community health workers conducted rapid testing for HIV (n=320), hepatitis C (n=274), and syphilis (n=280). In addition, they successfully linked 10 people with HIV to HIV medical care and 20 people who inject drugs to a syringe services program and assisted 19 people at risk of HIV infection with pre-exposure prophylaxis initiation. CONCLUSIONS The community health worker team successfully facilitated access to HIV prevention and treatment for priority populations in East Baton Rouge Parish.
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Strickland JC, Marks KR, Bolin BL. The condom purchase task: A hypothetical demand method for evaluating sexual health decision-making. J Exp Anal Behav 2020; 113:435-448. [PMID: 32056222 DOI: 10.1002/jeab.585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Behavioral economic theory has proved useful for understanding the influence of delay and probability on sexual health decision-making. Demand is another principle at the intersection of microeconomics and psychology that has helped advance research relevant to health behaviors. The purpose of the present study was to develop and test a demand measure related to sexual health decision-making and the influence of sexually transmitted infection (STI) risk. Participants (N = 438) recruited using Amazon Mechanical Turk completed a commodity purchase task assessing hypothetical condom demand. Condom demand was evaluated at varied prices for use with hypothetical sexual partners that varied in STI risk. Demand was characterized by prototypic decreases in consumption with increases in cost. Higher partner STI risk was associated with greater intentions for condom-protected sex at no cost and smaller decreases in condom demand with increases in cost. Price sensitivity was also related to individual difference factors relevant to sexual health (e.g., alcohol use severity, lower STI knowledge). This study supports the utility of a condom purchase task for indexing condom valuation and capturing individual difference and contextual risk factors relevant to STI transmission. Future studies may leverage this methodology as a means to study sexual health decision-making.
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Affiliation(s)
- Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Katherine R Marks
- Department of Behavioral Science, University of Kentucky College of Medicine
| | - B Levi Bolin
- Department of Behavioral Science, University of Kentucky College of Medicine
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Sipe TA, Barham TL, Johnson WD, Joseph HA, Tungol-Ashmon ML, O'Leary A. Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review. AIDS Behav 2017; 21:3366-430. [PMID: 29159594 DOI: 10.1007/s10461-017-1965-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC's HIV/AIDS Prevention Research Synthesis Project's database for relevant interventions during 1988-2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.
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Malekinejad M, Parriott A, Blodgett JC, Horvath H, Shrestha RK, Hutchinson AB, Volberding P, Kahn JG. Effectiveness of community-based condom distribution interventions to prevent HIV in the United States: A systematic review and meta-analysis. PLoS One 2017; 12:e0180718. [PMID: 28771484 PMCID: PMC5542551 DOI: 10.1371/journal.pone.0180718] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/20/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite significant public health implications, the extent to which community-based condom distribution interventions (CDI) prevent HIV infection in the United States is not well understood. METHODS We systematically reviewed research evidence applying Cochrane Collaboration methods. We used a comprehensive search strategy to search multiple bibliographic databases for relevant randomized controlled trials (RCTs) and non-RCTs published from 1986-2017. We focused on CDI that made condoms widely available or accessible in community settings. Eligible outcomes were HIV infection (primary), sexually transmitted infections, condom use, and multiple sexual partnership. Two reviewers independently screened citations to assess their eligibility, extracted study data, and assessed risk of bias. We calculated risk ratios (RR) with 95% confidence intervals (CI) and pooled them using random-effects models. We assessed evidence quality using GRADE. RESULTS We reviewed 5,110 unique records. Nine studies (including one RCT) met eligibility criteria. Studies were conducted in 10 US states between 1989 and 2011. All studies were at high risk of bias. Interventions were categorized into three groups: "Ongoing" (unlimited access to condoms), "Ongoing-plus" (unlimited access to condoms, with co-interventions), and "Coupon-based" (coupons redeemed for condoms). No studies reported incident HIV. Ongoing CDI (four non-RCTs) modestly reduced condomless sex (RR 0.88, 95% CI 0.78 to 0.99). Ongoing-plus CDI (two non-RCTs) significantly reduced multiple sexual partnership (RR 0.37, 95% CI 0.16 to 0.87). Of two coupon-based studies, one (non-RCT) showed reduction in condomless sex in female participants (Odds Ratio 0.67, 95% CI 0.47 to 0.96), while the other one (RCT) showed no effect on STI incidence (RR 0.91, 95% CI 0.63 to 1.31). Evidence quality was "very low" for all outcomes. CONCLUSIONS CDI may reduce some risky sexual behaviors, but the evidence for any reduction is limited and of low-quality. Lack of biological outcomes precludes assessing the link between CDI and HIV incidence.
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Affiliation(s)
- Mohsen Malekinejad
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Andrea Parriott
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, CA, United States of America
| | - Janet C. Blodgett
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, CA, United States of America
| | - Hacsi Horvath
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, CA, United States of America
| | - Ram K. Shrestha
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States of America
| | - Angela B. Hutchinson
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States of America
| | - Paul Volberding
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, CA, United States of America
- AIDS Research Institute, University of California, San Francisco, San Francisco, CA, United States of America
| | - James G. Kahn
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
- The Consortium for the Assessment of Prevention Economics (CAPE), University of California, San Francisco, San Francisco, CA, United States of America
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Shrestha RK, Farnham PG, Whitham HK, Sansom SL. Challenges in Estimating Effectiveness of Condom Distribution Campaigns to Prevent HIV Transmission. J Acquir Immune Defic Syndr 2016; 73:e35-8. [PMID: 27400404 PMCID: PMC8559129 DOI: 10.1097/qai.0000000000001124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ram K Shrestha
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Thach SB, Eng E, Thomas JC. Defining and Assessing Organizational Competence in Serving Communities at Risk for Sexually Transmitted Diseases. Health Promot Pract 2016. [DOI: 10.1177/152483990200300217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to develop an assessment tool to help health agencies enhance their capacity to provide sexually transmitted disease (STD) care to communities at risk and close the gap of racial disparities in health. Specifically, the study sought to (a) define the organizational competence of agencies serving communities at risk for STDs, and (b) develop a method to assess an agency’s organizational competence. In a rural Southern county, qualitative action research methods including key informant interviews, observation, and document review were used to assess four health agencies’ competence in responding to the needs of high STD-risk communities. Nine dimensions of organizational competence were identified: community participation, assessment of community needs, ensured access to services, community outreach, cultural competence, interagency collaboration, policy development, resource acquisition, and organizational commitment to serve. A competent organization was conceived as one that (a) is committed to serve, (b) works with communities at risk, (c) understands and appropriately responds to their needs, and (d) advocates on their behalf.
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Affiliation(s)
- Sarah Brill Thach
- Community Health Resource Services, Mountain Area Health Education Center, North Carolina
| | - Eugenia Eng
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina
| | - James C. Thomas
- Department of Epidemiology, School of Public Health, University of North Carolina
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Abstract
This article describes the application and refinement of community-based prevention marketing (CBPM), an example of community-based participatory research that blends social marketing theories and techniques and community organization principles to guide voluntary health behavior change. The Florida Prevention Research Center has worked with a community coalition in Sarasota County, Florida to define locally important health problems and issues and to develop responsive health-promotion interventions. The CBPM framework has evolved as academic and community-based researchers have gained experience applying it. Community boards can use marketing principles to design evidence-based strategies for addressing local public health concerns. Based on 6 years of experience with the “Believe in All Your Possibilities” program, lessons learned that have led to revision and improvement of the CBPM framework are described.
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Fisher HH, Hoyte T, Purcell DW, Van Handel M, Williams W, Krueger A, Dietz P, Stratford D, Heitgerd J, Dunbar E, Wan C, Linley LA, Flores SA. Health Department HIV Prevention Programs That Support the National HIV/AIDS Strategy: The Enhanced Comprehensive HIV Prevention Planning Project, 2010-2013. Public Health Rep 2016; 131:185-94. [PMID: 26843685 DOI: 10.1177/003335491613100126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The Enhanced Comprehensive HIV Prevention Planning project was the first initiative of the Centers for Disease Control and Prevention (CDC) to address the goals of the National HIV/AIDS Strategy (NHAS). Health departments in 12 U.S. cities with a high prevalence of AIDS conducted comprehensive program planning and implemented cost-effective, scalable HIV prevention interventions that targeted high-risk populations. We examined trends in health department HIV prevention programs in these cities during the project. METHODS We analyzed the number of people who received partner services, condoms distributed, and people tested for HIV, as well as funding allocations for selected HIV prevention programs by year and by site from October 2010 through September 2013. We assessed trends in the proportional change in services and allocations during the project period using generalized estimating equations. We also conducted thematic coding of program activities that targeted people living with HIV infection (PLWH). RESULTS We found significant increases in funding allocations for HIV testing and condom distribution. All HIV partner services indicators, condom distribution, and HIV testing of African American and Hispanic/Latino populations significantly increased. HIV tests associated with a new diagnosis increased significantly among those self-identifying as Hispanic/Latino but significantly decreased among African Americans. For programs targeting PLWH, health department activities included implementing new program models, improving local data use, and building local capacity to enhance linkage to HIV medical care, retention in care, and treatment adherence. CONCLUSIONS Overall, these findings indicate that health departments in areas with a high burden of AIDS successfully shifted their HIV prevention resources to scale up important HIV programs and make progress toward NHAS goals.
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Affiliation(s)
- Holly H Fisher
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Tamika Hoyte
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - David W Purcell
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Michelle Van Handel
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | | | - Amy Krueger
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Patricia Dietz
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Dale Stratford
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Janet Heitgerd
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Erica Dunbar
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Choi Wan
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Laurie A Linley
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Stephen A Flores
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
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Abstract
A systematic review was undertaken to determine whether cost is a structural barrier preventing men who have sex with men (MSM) accessing condoms. Studies were examined from a range of countries where condoms have been distributed free to particular populations and also those where condoms were available at a cost to the individual. The study inclusion criteria were: published between January 1990 and September 2014 inclusive; published in any language, discussed cost as a barrier to condom use, discussed cost barriers to MSM accessing condoms and included a measure of outcome. Articles were systematically extracted from MEDLINE, Embase, PyschINFO and Informat using the five search terms; Male Homosexuality, Access, Cost, Cost and Cost analysis, Condoms. Sixty-four articles were initially identified and 11 included in the final review. The included studies used cost-utility analysis, qualitative, cross-sectional, cohort or randomised control trial design. Large-scale free distribution programmes and smaller targeted programmes showed positive correlations in reducing the burden of disease from HIV and other sexually transmitted infections through eliminating the issue of cost. Decreasing the cost of condoms, and providing them for no cost, appears to increase their utilisation amongst MSM and possibly reduce the burden from HIV and other sexually transmitted infections. Inequality and stigma remain important barriers to MSM accessing and using condoms particularly in the developing world.
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Affiliation(s)
- Ashley Ubrihien
- a Northern Sydney Sexual Health Service, Royal North Shore Hospital , St Leonards , NSW , Australia.,b School of Public Health, Sydney Medical School, University of Sydney , Sydney , NSW , Australia
| | - Stephen C Davies
- a Northern Sydney Sexual Health Service, Royal North Shore Hospital , St Leonards , NSW , Australia.,c Sydney Medical School, University of Sydney , Sydney , NSW , Australia
| | - Tim Driscoll
- b School of Public Health, Sydney Medical School, University of Sydney , Sydney , NSW , Australia
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Mustanski B, DuBois LZ, Prescott TL, Ybarra ML. A mixed-methods study of condom use and decision making among adolescent gay and bisexual males. AIDS Behav 2014; 18:1955-69. [PMID: 24906532 DOI: 10.1007/s10461-014-0810-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Young men who have sex with men have the highest rates of new HIV infections in the U.S., but they have been understudied relative to other populations. As a formative step for the development of a text messaging HIV prevention intervention, this mixed methods study aimed to understand how adolescent gay and bisexual males (AGBM) make decisions about condom use and factors that may differ based on age, sexual experience, and rural versus urban residency. Four online, asynchronous focus groups were conducted with 75 14-18 year old AGBM across the U.S. Qualitative analyses uncovered themes related to relationship influences on condom use (e.g. marriage, trust), access issues, and attitudes and experiences that both encouraged as well as discouraged condom use. Mixed methods analyses explored differences between groups in endorsement of themes. For example, younger and sexually experienced participants were more likely to report the cost of condoms was prohibitive and sexually experienced and rural youth were more likely to describe being influenced by emotional aspects of the relationship. These data highlight both opportunities for as well as the importance of tailoring HIV prevention programs for sub-groups of AGBM.
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Abstract
We assessed awareness and use of the "NYC Condom" among persons who use heroin and cocaine in New York City. The NYC Condom distribution program is the largest free condom distribution program in the USA, with over 30 million condoms distributed per year. It includes a condom social marketing program for a specific brand, the NYC Condom with its own packaging and advertising. People who use heroin and cocaine are at relatively high risk for HIV infection and are an important target population for the program. In order to assess awareness of the NYC Condom, structured interviews and blood testing for HIV, HSV-2, and sexually transmitted infections (STI) were conducted among entrants to the Beth Israel Medical Center drug detoxification and methadone treatment programs. Participants were asked about drug use, sexual risk behaviors, and awareness and use of the NYC Condom. Univariate and multivariable regression analyses were conducted to examine the associations between use of NYC Condoms and consistent condom use with primary and casual sexual partners. A total of 970 subjects were recruited between February 2011 and December 2012. Subjects were primarily African-American and Hispanic, with a mean age of 43. Fifty-five percent of subjects reported being sexually active with primary sexual partners, and 25 % reported being sexually active with a casual partner for the 6 months prior to the interview. Sixty-five percent of subjects had heard of the NYC Condom, 48 % of those who had heard of the condom had used it, and 58 % of those who had ever used it were currently using it (in the previous 6 months). In multivariable regression analyses, current use of NYC Condoms was strongly associated with consistent condom use with primary sexual partners (adjusted odds ratio (AOR) = 3.99, 95 % confidence interval (CI) 1.85-8.58) and consistent condom use with casual sexual partners (AOR = 4.48, 95 % CI 1.49-13.42). In terms of market share, 38 % of subjects consistently using condoms with primary partners were using the NYC Condom, and 47 % of those consistently using condoms with casual partners were using the NYC Condom. The NYC Condom is an important tool for reducing sexual transmission of HIV and STI among persons who use drugs in the city. Given the strong relationship between using the NYC Condom and consistent condom use, further efforts to promote the NYC Condom brand would be easily justified.
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Tran BR, Thomas AG, Vaida F, Ditsela M, Phetogo R, Kelapile D, Haubrich R, Chambers C, Shaffer R. An intervention study examining the effects of condom wrapper graphics and scent on condom use in the Botswana Defence Force. AIDS Care 2013; 26:890-8. [PMID: 24266459 DOI: 10.1080/09540121.2013.860420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Free condoms provided by the government are often not used by Botswana Defence Force (BDF) personnel due to a perceived unpleasant scent and unattractive wrapper. Formative work with the BDF found that scented condoms and military-inspired (camouflage) wrapper graphics were appealing to personnel. A non-randomized intervention study was implemented to determine whether condom wrapper graphics and scent improved condom use in the BDF. Four military sites were selected for participation. Two sites in the south received the intervention condom wrapped in a generic wrapper and two sites in the north received the intervention condom wrapped in a military-inspired wrapper; intervention condoms were either scented or unscented. Two hundred and eleven male soldiers who ever had sex, aged 18-30 years, and stationed at one of the selected sites consented to participate. Sexual activity and condom use were measured pre- and post-intervention using sexual behavior diaries. A condom use rate (CUR; frequency of protected sex divided by the total frequency of sex) was computed for each participant. Mean CURs significantly increased over time (85.7% baseline vs. 94.5% post-intervention). Adjusted odds of condom use over time were higher among participants who received the intervention condom packaged in the military wrapper compared with the generic wrapper. Adjusted odds of condom use were also higher for participants who reported using scented vs. unscented condoms. Providing scented condoms and condoms packaged in a military-inspired wrapper may help increase condom use and reduce HIV infection among military personnel.
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Affiliation(s)
- Bonnie Robin Tran
- a Department of Defense HIV/AIDS Prevention Program , Naval Health Research Center , San Diego , CA , USA
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Abstract
OBJECTIVES Despite large public investments in condom distribution programs for HIV prevention among men who have sex with men (MSM), few evaluations have documented the reach of condom distribution programs or whether free condoms distributed to MSM are actually used. Among MSM recruited from social networking and dating websites, we examined the proportion who reported acquiring and using free condoms, and associations between select characteristics and reported acquisition and use of free condoms. METHODS We used baseline data from a prospective, online cohort of U.S. MSM. Participants reported acquiring free condoms in the 12 months before interview and, for those who acquired condoms and had anal intercourse, use of the free condoms they acquired. We used multivariable log binomial regression models to describe factors associated with self-reported acquisition and use of condoms. RESULTS Of the 2,893 men in the analytic sample, 1,701 (59%) reported acquiring free condoms in the past year. Acquisition of free condoms was higher for men who were younger, more educated, recently tested for HIV, and had higher numbers of sex partners. Seventy-three percent of men who acquired free condoms reported using them; use was higher for men who were black, had been recently tested for HIV, and reported greater numbers of sex partners. CONCLUSIONS Most MSM in our online sample reported receiving free condoms, and most who acquired free condoms reported using them. These data suggest that condom distribution programs have reasonable reach and utility as part of a comprehensive package of HIV prevention interventions for U.S. MSM.
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Affiliation(s)
- Christine Khosropour
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
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Affiliation(s)
- Rosemary Thackeray
- a Department of Health Science , Brigham Young University , 229B Richards Building, Provo , UT , 84602 , USA
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Hemmige V, McFadden R, Cook S, Tang H, Schneider JA. HIV prevention interventions to reduce racial disparities in the United States: a systematic review. J Gen Intern Med 2012; 27:1047-67. [PMID: 22798215 DOI: 10.1007/s11606-012-2036-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Racial and ethnic minorities are disproportionately affected by HIV/AIDS in the United States despite advances in prevention methodologies. The goal of this study was to systematically review the past 30 years of HIV prevention interventions addressing racial disparities. We conducted electronic searches of Medline, PsycINFO, CINAHL, and Cochrane Review of Clinical Trials databases, supplemented by manual searches and expert review. Studies published before June 5, 2011 were eligible. Prevention interventions that included over 50% racial/ethnic minority participants or sub-analysis by race/ethnicity, measured condom use only or condom use plus incident sexually transmitted infections or HIV as outcomes, and were affiliated with a health clinic were included in the review. We stratified the included articles by target population and intervention modality. Reviewers independently and systematically extracted all studies using the Downs and Black checklist for quality assessment; authors cross-checked 20% of extractions. Seventy-six studies were included in the final analysis. The mean DB score was 22.44--high compared to previously published means. Most of the studies were randomized controlled trials (87%) and included a majority of African-American participants (83%). No interventions were designed specifically to reduce disparities in HIV acquisition between populations. Additionally, few interventions targeted men who have sex with men or utilized HIV as a primary outcome. Interventions that combined skills training and cultural or interactive engagement of participants were superior to those depending on didactic messaging. The scope of this review was limited by the exclusion of non-clinic based interventions and intermediate risk endpoints. Interactive, skills-based sessions may be effective in preventing HIV acquisition in racial and ethnic minorities, but further research into interventions tailored to specific sub-populations, such as men who have sex with men, is warranted.
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Charania MR, Crepaz N, Guenther-Gray C, Henny K, Liau A, Willis LA, Lyles CM. Efficacy of structural-level condom distribution interventions: a meta-analysis of U.S. and international studies, 1998-2007. AIDS Behav 2011; 15:1283-97. [PMID: 20886277 PMCID: PMC3180557 DOI: 10.1007/s10461-010-9812-y] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This systematic review examines the overall efficacy of U.S. and international-based structural-level condom distribution interventions (SLCDIs) on HIV risk behaviors and STIs and identifies factors associated with intervention efficacy. A comprehensive literature search of studies published from January 1988 through September 2007 yielded 21 relevant studies. Significant intervention effects were found for the following outcomes: condom use, condom acquisition/condom carrying, delayed sexual initiation among youth, and reduced incident STIs. The stratified analyses for condom use indicated that interventions were efficacious for various groups (e.g., youth, adults, males, commercial sex workers, clinic populations, and populations in areas with high STI incidence). Interventions increasing the availability of or accessibility to condoms or including additional individual, small-group or community-level components along with condom distribution were shown to be efficacious in increasing condom use behaviors. This review suggests that SLCDIs provide an efficacious means of HIV/STI prevention.
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Affiliation(s)
- Mahnaz R Charania
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Wei C, Herrick A, Raymond HF, Anglemyer A, Gerbase A, Noar SM. Social marketing interventions to increase HIV/STI testing uptake among men who have sex with men and male-to-female transgender women. Cochrane Database Syst Rev 2011:CD009337. [PMID: 21901734 DOI: 10.1002/14651858.cd009337] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Social marketing interventions have been shown to both promote and change many health-related behaviours and issues. As the HIV epidemic continues to disproportionately affect MSM and transgender women around the world, social marketing interventions have the potential to increase HIV/STI testing uptake among these populations. OBJECTIVES To assess the impact of social marketing interventions on HIV/STI testing uptake among men who have sex with men and transgender women compared to pre-intervention or control group testing uptake in the same population. SEARCH STRATEGY We searched the following electronic databasesfor results from 01 January 1980 to the search date, 14 July 2010: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, LILACS (Latin America and Brazil), PsycINFO, PubMed, Web of Science/Web of Social Science, Chinese National Knowledge Infrastructure (CNKI), and CQ VIP (China). We also searched for conference abstracts in the Aegis archive of HIV/AIDS conference abstracts and the CROI and International AIDS Society websites. In addition to searching electronic databases, we searched the following sources of grey literature: Australasian Digital Theses Program, Canadian Evaluation Society, Eastview: China Conference Proceedings, ProQuest Dissertations and Theses, and World Health Organization Library Information System (WHOLIS). We contacted individual researchers, experts working in the field, and authors of major trials for suggestions of any relevant manuscripts that were in preparation or in press. References of published articles from the databases above were searched for additional, pertinent materials. All languages were included in this search. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials that compared social marketing interventions with a control were included. Interrupted time series and pretest-posttest design studies (controlled or uncontrolled) that compared social marketing interventions with no intervention or a control were also included. Posttest-only studies and studies that combined pre-post data were excluded. Interventions that targeted at general public but did not include MSM or transgender women as a segment or did not have outcome data for an MSM or transgender segment were excluded. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from each included study and assessed study quality. Meta-analyses were conducted to compare pre- and post-intervention and intervention and control group outcomes of HIV and STI testing uptake. Quality of evidence was assessed using the GRADE approach. MAIN RESULTS Three serial, cross-sectional pretest-posttest study designs (one with a control group and two without) were included in the final analysis. Statistical pooling was conducted for two studies and compared to pre-intervention level testing uptake, which showed that multi-media social marketing campaigns had a significant impact on HIV testing uptake (OR=1.58, 95%CI = 1.40 - 1.77). However, the campaigns were not found to be effective in increasing STI testing uptake (OR=0.94, 95%CI = 0.68 - 1.28). Overall, risk of bias was high and quality of evidence was low. None of the studies were conducted in developing countries or included male-to-female transgender women. AUTHORS' CONCLUSIONS This review provided limited evidence that multi-media social marketing campaigns can promote HIV testing among MSM in developed countries. Future evaluations of social marketing interventions for MSM should employ more rigorous study designs. Long-term impact evaluations (changes in HIV or STI incidence over time) are also needed. Implementation research, including detailed process evaluation, is needed to identify elements of social marketing interventions that are most effective in reaching the target population and changing behaviours.
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Affiliation(s)
- Chongyi Wei
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, 15261
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Williams M, Bethea J. Patient awareness of oral cancer health advice in a dental access centre: a mixed methods study. Br Dent J 2011; 210:E9. [PMID: 21436799 DOI: 10.1038/sj.bdj.2011.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In the United Kingdom in 2006, 5,325 persons were diagnosed with oral cancer; and in 2007 it caused around 1,850 deaths. The purpose of this study was to assess the patient awareness, in a dental access centre, of a poster and leaflet campaign providing information about smoking and excess alcohol consumption as risk factors in the development of oral cancer, and to explore dental patients' beliefs and perceptions about these risk factors. METHODS Posters and leaflets providing information about risk factors for oral cancer were displayed in the patient waiting areas of a dental access centre. Data were collected prospectively in relation to the smoking and drinking habits of patients attending the centre. This information was used to categorise patients into one of four groups ranging from low to high consumption. During triage, patients were asked if they had read any of the information about oral cancer that was on display, and patients in the high risk groups were asked to participate in a semi-structured interview that would explore their knowledge about risk factors and their views on the delivery of healthcare messages in relation to oral cancer. RESULTS Data on risk status and exposure to the poster and leaflet campaign were collected for 1,161 patients attending during the study period. More than 50% of these patients were smokers, with 36% in the high or very high tobacco and alcohol use groups. Approximately 40% of patients within each consumption group had read any of the information available. Nine patients agreed to be interviewed and overall knowledge about risk factors for oral cancer, even after reading the information was poor. CONCLUSION Dental access centres attract a significant number of patients with lifestyle habits that make them vulnerable to oral cancer, and as such are well placed to deliver oral health messages to this high risk group. However, the delivery of information through a simple poster and leaflet campaign is likely to have limited impact.
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Burke RC, Wilson J, Kowalski A, Murrill C, Cutler B, Sweeney M, Begier EM. NYC condom use and satisfaction and demand for alternative condom products in New York City sexually transmitted disease clinics. J Urban Health 2011; 88:749-58. [PMID: 21792691 PMCID: PMC3157509 DOI: 10.1007/s11524-011-9597-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In 2007, via a high-profile media campaign, the New York City Department of Health and Mental Hygiene (NYC DOHMH) introduced the "NYC Condom," the first specially packaged condom unique to a municipality. We conducted a survey to measure NYC Condom awareness of and experience with NYC Condoms and demand for alternative male condoms to be distributed by the DOHMH. Trained interviewers administered short, in-person surveys at five DOHMH-operated sexually transmitted disease (STD) clinics in Spring 2008. We systematically sampled eligible patients: NYC residents aged ≥18 years waiting to see a physician. We approached 539; 532 agreed to be screened (98.7% response rate); 462 completed the survey and provided NYC zip codes. Most respondents were male (56%), non-Hispanic black (64%), aged 18-24 years (43%) or 25-44 years (45%), employed (65%), and had a high school degree/general equivalency diploma or less (53%). Of those surveyed, 86% were aware of the NYC Condom, and 81% of those who obtained the condoms used them. NYC Condom users were more likely to have four or more sexual partners in the past 12 months (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.0-3.8), use condoms frequently (AOR = 2.1, 95% CI = 1.3-3.6), and name an alternative condom for distribution (AOR = 2.2, 95% CI = 1.3-3.9). The most frequently requested condom types respondents wanted DOHMH to provide were larger size (28%), ultra thin/extra sensitive (21%), and extra strength (16%). We found high rates of NYC Condom use. NYC Condom users reported more sexual partners than others, suggesting the condom initiative successfully reached higher-risk persons within the STD clinic population. Study results document the condom social marketing campaign's success.
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Affiliation(s)
- Ryan C. Burke
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
- Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, El Paso, TX USA
| | - Juliet Wilson
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Alexis Kowalski
- Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Christopher Murrill
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Blayne Cutler
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Monica Sweeney
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
| | - Elizabeth M. Begier
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY USA
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY USA
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Phillips-Guzman CM, Martinez-Donate AP, Hovell MF, Blumberg EJ, Sipan CL, Rovniak LS, Kelley NJ. Engaging local businesses in HIV prevention efforts: the consumer perspective. Health Promot Pract 2011; 12:620-9. [PMID: 20421409 DOI: 10.1177/1524839909343166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Participation of different community sectors, including the private business sector, is necessary to fight the HIV/AIDS epidemic. Local businesses may be reluctant to participate in HIV prevention because of fear of negative customer reactions and loss of revenue. This study examines the extent to which residents of two communities in San Diego, California, would support HIV prevention initiatives in local businesses. A population-based household survey (N = 200) is conducted in two communities with higher versus lower risk for HIV. The survey includes questions regarding the acceptability of HIV prevention activities, such as condom and brochure distribution in businesses, and history of exposure to HIV prevention activities in local businesses. Most residents agree that (a) business involvement in prevention activities would reduce HIV (92%), (b) free or low-cost condoms available in businesses could prevent the spread of HIV (90.9%) and increase condom accessibility (87%), and (c) they would prefer to shop at businesses that supported HIV prevention versus those that did not (87.4%). These findings suggest that HIV prevention in local businesses would be supported by residents and would be unlikely to adversely affect business profits. This information could be used to design interventions to engage local businesses in HIV-prevention efforts.
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Shams M, Shojaeizadeh D, Majdzadeh R, Rashidian A, Montazeri A. Taxi drivers' views on risky driving behavior in Tehran: a qualitative study using a social marketing approach. Accid Anal Prev 2011; 43:646-651. [PMID: 21376850 DOI: 10.1016/j.aap.2010.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 09/10/2010] [Accepted: 10/12/2010] [Indexed: 05/30/2023]
Abstract
The use of the social marketing approach for public health issues is increasing. This approach uses marketing concepts borrowed from the principles of commercial marketing to promote beneficial health behaviors. In this qualitative study, four focus groups involving 42 participants were used in consumer research to explore taxi drivers' views on the driving situation and the determinants of risky driving behaviors in Tehran, as well as to gather their ideas for developing a social marketing program to reduce risky driving behaviors among taxi drivers in Tehran, Iran. Participants were asked to respond to questions that would guide the development of a marketing mix, or four Ps (product, price, place and promotion). The discussions determined that the program product should involve avoiding risky driving behaviors through increased attention to driving. They pointed out that developing and communicating with a well-designed persuasive message meant to draw their attention to driving could affect their driving behaviors. In addition, participants identified price, place and promotion strategies. They offered suggestions for marketing nonrisky driving to the target audience. The focus group discussions generated important insights into the values and the motivations that affect consumers' decisions to adopt the product. The focus group guided the development of a social marketing program to reduce risky driving behaviors in taxi drivers in Tehran, Iran.
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Affiliation(s)
- Mohsen Shams
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran
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23
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Martínez-Donate AP, Zellner JA, Sañudo F, Fernandez-Cerdeño A, Hovell MF, Sipan CL, Engelberg M, Carrillo H. Hombres Sanos: evaluation of a social marketing campaign for heterosexually identified Latino men who have sex with men and women. Am J Public Health 2010; 100:2532-40. [PMID: 21068423 PMCID: PMC2978169 DOI: 10.2105/ajph.2009.179648] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effectiveness of Hombres Sanos [Healthy Men] a social marketing campaign to increase condom use and HIV testing among heterosexually identified Latino men, especially among heterosexually identified Latino men who have sex with men and women (MSMW). METHODS Hombres Sanos was implemented in northern San Diego County, California, from June 2006 through December 2006. Every other month we conducted cross-sectional surveys with independent samples of heterosexually identified Latino men before (n = 626), during (n = 752), and after (n = 385) the campaign. Respondents were randomly selected from 12 targeted community venues to complete an anonymous, self-administered survey on sexual practices and testing for HIV and other sexually transmitted infections. About 5.6% of respondents (n = 98) were heterosexually identified Latino MSMW. RESULTS The intervention was associated with reduced rates of recent unprotected sex with both females and males among heterosexually identified Latino MSMW. The campaign was also associated with increases in perception of HIV risk, knowledge of testing locations, and condom carrying among heterosexual Latinos. CONCLUSIONS Social marketing represents a promising approach for abating HIV transmission among heterosexually identified Latinos, particularly for heterosexually identified Latino MSMW. Given the scarcity of evidence-based HIV prevention interventions for these populations, this prevention strategy warrants further investigation.
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Affiliation(s)
- Ana P Martínez-Donate
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA.
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Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 2010. [PMID: 20838871 DOI: 10.1007/s10461-010-9804-y.a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.
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Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
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25
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Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 2010; 14:222-38. [PMID: 20838871 DOI: 10.1007/s10461-010-9804-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.
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26
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Muñoz FA, Pollini RA, Zúñiga ML, Strathdee SA, Lozada R, Martínez GA, Valles-Medina AM, Sirotin N, Patterson TL. Condom access: Associations with consistent condom use among female sex workers in two northern border cities of Mexico. AIDS Educ Prev 2010; 22:455-465. [PMID: 20973665 PMCID: PMC3069917 DOI: 10.1521/aeap.2010.22.5.455] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To determine whether condom access is associated with consistent condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, between 2004 and 2006 we administered a questionnaire to 924 FSWs who reported unprotected sex with a client in the past 2 months. Of these women, 43% reported consistent ("often" or "always") condom use, 74% said condoms were available, and 38% reported having access to free condoms. In a logistic regression, factors positively associated with consistent condom use were condom availability (adjusted odds ratio [AOR] = 2.00; 95% confidence interval [CI]: 1.32-3.03), condom affordability (AOR = 1.72; 95% CI: 1.25-2.38) and self-efficacy (AOR = 2.16; 95% CI: 1.54-3.04). Factors inversely associated with consistent condom use included poor financial status (AOR = 0.65; 95% CI: 0.47-0.90), methamphetamine use (AOR = 0.58; 95% CI: 0.40-0.83), alcohol use (AOR = 0.68; 95% CI: 0.49-0.96), and recent injection drug use (AOR = 0.62; 95% CI: 0.39-0.97). While increased condom availability may improve condom use among FSWs in general, interventions to broaden condom use among lower income and drug-using FSWs are critically needed.
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Affiliation(s)
- Fátima A. Muñoz
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Robin A. Pollini
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - María Luisa Zúñiga
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Steffanie A. Strathdee
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | | | - Gustavo A. Martínez
- Community Health & Development of Ciudad Juarez (SADEC) and Mexican Federation of Private Associations (FEMAP), Ciudad Juarez, Chihuahua, Mexico
| | - Ana M. Valles-Medina
- Master in Public Health Program, Autonomous University of Baja California, Tijuana, Mexico
| | - Nicole Sirotin
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Thomas L. Patterson
- Department of Psychiatry University of California, San Diego and MIRECC, VA Medical Center, San Diego, California
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Rovniak LS, Hovell MF, Hofstetter CR, Blumberg EJ, Sipan CL, Batista MF, Martinez-Donate AP, Mulvihill MM, Ayala GX. Engaging community businesses in human immunodeficiency virus prevention: a feasibility study. Am J Health Promot 2010; 24:347-53. [PMID: 20465150 DOI: 10.4278/ajhp.080721-arb-129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the feasibility of engaging community businesses in human immunodeficiency virus (HIV) prevention. DESIGN Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures, both of which were provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-program, and post-program. Customer feedback was obtained through an online survey. SETTING Participants were selected from a San Diego, California neighborhood with a high rate of acquired immune deficiency syndrome. PARTICIPANTS Fifty-one business owners/managers who represented 10 retail categories, and 52 customers. MEASURES Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction, and business owners'/managers' willingness to provide future support for HIV prevention were measured. ANALYSIS Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data. RESULTS The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or who refused to participate (41%; p < .05). Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures (p < .05). More than 90% of customers supported distributing condoms and brochures in businesses, and 96% of business owners/managers described their program experience as positive. CONCLUSION Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested.
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Affiliation(s)
- Liza S Rovniak
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA.
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28
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Bowleg L, Valera P, Teti M, Tschann JM. Silences, gestures, and words: nonverbal and verbal communication about HIV/AIDS and condom use in black heterosexual relationships. Health Commun 2010; 25:80-90. [PMID: 20390673 DOI: 10.1080/10410230903474019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This qualitative study examined how 27 Black men and women, ages 22 to 50 years, in heterosexual relationships communicated verbally and nonverbally about HIV/AIDS and condom use before first time sex. Although most interviewees reported no HIV/AIDS communication, most noted communication about condom use. Verbal condom communication focused typically on requests and declarations, whereas nonverbal communication centered on the presentation of condoms. Women were more likely to communicate about condoms verbally, whereas men were more likely to do so nonverbally. Interviewees who communicated about condom use were more likely than those who did not to report first-time condom use. We discuss these findings and their implications within the context of relationship and sociocultural factors relevant to HIV/AIDS in Black communities.
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Affiliation(s)
- Lisa Bowleg
- Department of Community Health and Prevention, Drexel University
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29
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Burke RC, Wilson J, Bernstein KT, Grosskopf N, Murrill C, Cutler B, Sweeney M, Begier EM. The NYC Condom: use and acceptability of New York City's branded condom. Am J Public Health 2009; 99:2178-80. [PMID: 19834001 DOI: 10.2105/ajph.2008.152298] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We assessed awareness and experience with the NYC Condom via surveys at 7 public events targeting priority condom distribution populations during 2007. Most respondents (76%) were aware of NYC Condoms. Of those that had obtained them, 69% had used them. Most (80%) wanted alternative condoms offered for free: 22% wanted ultra-thin, 18% extra-strength, and 14% larger-size. Six months after the NYC Condom launch, we found high levels of awareness and use. Because many wanted alternative condoms, the Department of Health and Mental Hygiene began distributing the 3 most-requested alternatives.
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Affiliation(s)
- Ryan C Burke
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health & Mental Hygiene, 125 Worth, Room 204, New York, NY 10013, USA
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Noar SM, Palmgreen P, Chabot M, Dobransky N, Zimmerman RS. A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? J Health Commun 2009; 14:15-42. [PMID: 19180369 DOI: 10.1080/10810730802592239] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of the current study was to conduct a 10-year systematic review of HIV/AIDS mass communication campaigns focused on sexual behavior, HIV testing, or both (1998-2007) and to compare the results with the last comprehensive review of such campaigns, conducted by Myhre and Flora (2000). A comprehensive search strategy yielded 38 HIV/AIDS campaign evaluation articles published in peer-reviewed journals, representing 34 distinct campaign efforts conducted in 23 countries. The articles were coded on a variety of campaign design and evaluation dimensions by two independent coders. Results indicated that compared with the previous systematic review (1986-1998 period), campaigns increasingly have employed the following strategies: (1) targeted defined audiences developed through audience segmentation procedures; (2) designed campaign themes around behavior change (rather than knowledge change); (3) used behavioral theories; (4) achieved high message exposure; (5) used stronger research designs for outcome evaluation; and (6) included measures of behavior (or behavioral intentions) in outcome assessments. In addition, an examination of 10 campaign efforts that used more rigorous quasi-experimental designs revealed that the majority (8 of 10) demonstrated effects on behavior change or behavioral intentions. Despite these positive developments, most HIV/AIDS campaigns continue to use weak (i.e., preexperimental) outcome evaluation designs. Implications of these results for improved design, implementation, and evaluation of HIV/AIDS campaign efforts are discussed.
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Affiliation(s)
- Seth M Noar
- Department of Communication, University of Kentucky, Lexington, Kentucky 40506-0042, USA.
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Harrison TR, Morgan SE, Chewning LV. The challenges of social marketing of organ donation: news and entertainment coverage of donation and transplantation. Health Mark Q 2008; 25:33-65. [PMID: 18935879 DOI: 10.1080/07359680802126079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While great strides have been made in persuading the public to become potential organ donors, actual behavior has not yet caught up with the nearly universally favorable attitudes the public expresses toward donation. This paper explores the issue by situating the social marketing of organ donation against a broader backdrop of entertainment and news media coverage of organ donation. Organ donation storylines are featured on broadcast television in medical and legal dramas, soap operas, and other television serials approximately four times per month (not including most cable networks), and feature storylines that promote myths and fears of the organ donation process. National news and other non-fictionalized coverage of organ donation are even more common, with stories appearing over twenty times a month on average. These stories tend to be one-dimensional and highly sensationalized in their coverage. The marketing of organ donation for entertainment essentially creates a counter-campaign to organ donation, with greater resources and reach than social marketers have access to. Understanding the broader environmental context of organ donation messages highlights the issues faced by social marketing campaigns in persuading the public to become potential donors.
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Affiliation(s)
- Tyler R Harrison
- Department of Communication, Purdue University, Beering Hall Room 2114, West Lafayette, IN 47907-2098, USA.
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Bull SS, Posner SF, Ortiz C, Beaty B, Benton K, Lin L, Pals SL, Evans T. POWER for reproductive health: results from a social marketing campaign promoting female and male condoms. J Adolesc Health 2008; 43:71-8. [PMID: 18565440 DOI: 10.1016/j.jadohealth.2007.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 12/10/2007] [Accepted: 12/21/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate effects of a 6-month social marketing campaign on awareness of, attitudes toward and use of female as well as male condoms for 15-25 year-old-women. METHODS Using a time-space sampling methodology, we conducted a cross-sectional survey of 3407 women at pre-campaign in 12 western U.S. neighborhoods on female and male condom awareness, attitudes, and use. Six of the 12 study neighborhoods were randomly selected to receive the POWER social marketing campaign designed to impact condom knowledge, attitudes, and use. The campaign was followed with another cross-sectional survey of 3,003 women in all 12 study neighborhoods on condom knowledge, attitudes, use and awareness of POWER materials. We compared pre-and post-campaign surveys to determine the efficacy of POWER and conducted post hoc analyses on post-campaign data to determine if exposure to POWER was related to higher levels of positive condom attitudes and norms and condom use. RESULTS We found no differences between neighborhoods with and without the POWER campaign with regard to our primary outcomes. To diagnose reasons for this null effect, we examined outcomes post hoc examining the influence of POWER exposure. Post hoc analyses show some evidence that exposure to POWER was associated with condom use. In the context of the nested trial, this raises concerns that post test only evaluations are limited. CONCLUSIONS Establishing the efficacy of a social marketing campaign is challenging. This group randomized trial showed a null effect. Social marketing campaigns may need to have more media channels and saturation before they can show behavioral effects. Using a nested design with randomization at the community level and probability sampling introduces rigor not commonly seen in evaluations of social marketing campaigns.
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Affiliation(s)
- Sheana S Bull
- Colorado Health Outcomes Program, University of Colorado Health Sciences Center, Aurora, Colorado 80045-0508, USA.
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Frieden TR, Bassett MT, Thorpe LE, Farley TA. Public health in New York City, 2002-2007: confronting epidemics of the modern era. Int J Epidemiol 2008; 37:966-77. [PMID: 18540026 DOI: 10.1093/ije/dyn108] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Long after the leading causes of death in the United States shifted from infectious diseases to chronic diseases, many public health agencies have not established effective policies and programmes to prevent current health problems. Starting in 2002, the New York City health department, an agency with a long history of innovation, undertook initiatives to address chronic disease prevention and control, as well as to modernize methods to address persistent health problems. All the initiatives relied on an expansive use of epidemiology; actions to prevent disease were based on policy change to create health-promoting environments as well as engagement with the health care system to improve its focus on prevention. Examples of policy-based initiatives are: a multi-component tobacco control programme that included a tax increase, a comprehensive smoke-free air law, hard-hitting anti-tobacco advertising and cessation services; elimination of trans fats from restaurants and a mandate that restaurants post-calorie information on menu boards. Examples of health care initiatives are public health 'detailing' to primary care providers, creation of a city-wide diabetes registry and development of a public health-oriented electronic health record. The infrastructure needed by local health departments to prevent chronic diseases and other modern health problems includes strong information technology systems, skillful epidemiology, expertise in communications using modern media, policy-making authority and, most importantly, political support.
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Affiliation(s)
- Thomas R Frieden
- New York City Department of Health and Mental Hygiene, New York, NY, USA.
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Abstract
The Canadian "Think Again" social marketing HIV/AIDS prevention campaign, adapted from an American effort, encourages gay men to rethink their assumptions about their partners' HIV statuses and the risks of unsafe sex with them. To improve future efforts, existing HIV/AIDS prevention initiatives require critical reflection. While a formal evaluation of this campaign has been carried out elsewhere, here we use the campaign as a social marketing case study to illustrate its strengths and weaknesses, as a learning tool for other campaigns. After describing the campaign and its key results, we assess how it utilized central tenets of the social marketing process, such as formative research and the marketing mix. We then speak to the importance of theoretical influence in campaign design and the need to account for social-contextual factors in safer sex decision making. We conclude with a summary of the lessons learned from the assessment of this campaign.
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Abstract
PURPOSE This study examines the individual and environmental correlates of home smoking bans among a population-based sample of Mexican-Americans. Design. A telephone survey on tobacco use and home policies was conducted using stratified, random sampling of listed phone numbers. SETTING Surveys were completed by telephone in San Diego, California. SUBJECTS The sample consisted of San Diego adult residents of Mexican descent (N=1103). MEASURES The interview included questions on home rules regarding smoking in the household and a number of potential correlates, based on the Behavioral Ecological Model (BEM). This model emphasizes the influence of family, social, and cultural factors on health behaviors. RESULTS Overall, 90.6% of all respondents reported a ban on smoking in the home. Multivariate analyses indicated that home bans on smoking are more likely among individuals that do not smoke, live with children, are more acculturated to U.S. society, report greater aversion to ETS, and/or report more social pressure against indoor smoking. In contrast, smoking bans are less likely among Mexican Americans who live with smokers. CONCLUSIONS Individual and environmental factors play a protective role by increasing the likelihood of smoking bans in the home of Mexican-descent individuals. These factors should be considered for the design of interventions to sustain and promote the adoption of smoking bans in the home among this and other populations.
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Affiliation(s)
- Ana P Martinez-Donate
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA.
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Scott-Sheldon LAJ, Glasford DE, Marsh KL, Lust SA. Barriers to condom purchasing: Effects of product positioning on reactions to condoms. Soc Sci Med 2006; 63:2755-69. [PMID: 16962220 DOI: 10.1016/j.socscimed.2006.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Indexed: 11/21/2022]
Abstract
Correct and consistent condom use has been promoted as a method to prevent sexually transmitted infections including HIV. Yet research has repeatedly shown that people fail to use condoms consistently. One influence on the pervasive lack of condom use that has received relatively little attention is the context in which consumers are exposed to condoms (i.e., how condoms are displayed in retail settings). In this paper we present two studies explored variations in condom shelf placement and its effects on people's condom attitudes and acquisition. Study 1 explored the shelf placement of condoms in 59 retail outlets in Connecticut, USA and found that condoms were typically located in areas of high visibility (e.g., next to the pharmacy counter) and on shelves adjacent to feminine hygiene and disease treatment products. In Study 2, 120 heterosexual undergraduate students at the University of Connecticut were randomly assigned to evaluate condoms adjacent to sensual, positive, neutral, or negative products and found that overall men reported more positive attitudes and acquired more condoms when exposed to condoms in a sensual context compared to women in the same condition. Among women, condom attitudes were more positive in the context of neutral products; condom acquisition was strongest for women exposed to condoms in the positive aisles. These results suggest a gender-specific approach to condom promotion. Implications of these studies for HIV prevention, public health, and condom marketing strategies are discussed.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Center for Health/HIV Intervention and Prevention, University of Connecticut Storrs, CT, USA.
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Cohen DA, Wu SY, Farley TA. Structural interventions to prevent HIV/sexually transmitted disease: are they cost-effective for women in the southern United States? Sex Transm Dis 2006; 33:S46-9. [PMID: 16794555 DOI: 10.1097/01.olq.0000221015.64056.ee] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Structural interventions are theoretically promising for populations with a low prevalence of HIV, because they can reach large numbers of people to influence their social norms and collective risky behaviors for a relatively low cost per person. Because HIV transmission is continuing to increase among women in the southern United States, interventions to stem this epidemic are particularly warranted. This study explores whether structural interventions may be a cost-effective way to prevent HIV in this population. METHODS We used the cost-effectiveness estimator, "Maximizing the Benefit" to determine the relative cost-effectiveness of 6 structural HIV prevention interventions. "Maximizing the Benefit" is a spreadsheet tool using mathematical models to estimate the cost per HIV infection prevented taking into account the epidemiologic contexts, behavioral change as a result of an intervention, and the costs of intervention. We applied estimates of HIV prevalence related to blacks in the southern United States. RESULTS All the structural interventions were cost-effective compared with average lifetime treatment costs of HIV, but mass media, condom availability, and alcohol taxes theoretically prevented the largest numbers of HIV infections. CONCLUSIONS Although the assumptions used in cost-effectiveness estimates have many limitations, they do allow for a relative comparison of different interventions and help to inform policy decisions related to the allocation of HIV prevention resources. Structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.
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Abstract
This study examines the condom purchasing and use habits of 256 college students in Norway and English-speaking Canada, and develops a structural equation model to explain condom purchase and use. In the model, intention to purchase condoms is influenced by self-efficacy in condom purchasing, as well as by intention to use condoms. Intention to use condoms is influenced by having a positive attitude toward condom usage and by self-efficacy in persuading a partner to use condoms. The implications for health promotion and social marketing campaigns are discussed.
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Tourangeau AE. Commentary by Tourangeau. West J Nurs Res 2005. [DOI: 10.1177/0193945904269004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meekers D, Rahaim S. The importance of socio-economic context for social marketing models for improving reproductive health: evidence from 555 years of program experience. BMC Public Health 2005; 5:10. [PMID: 15676068 PMCID: PMC548279 DOI: 10.1186/1471-2458-5-10] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Accepted: 01/27/2005] [Indexed: 11/13/2022] Open
Abstract
Background Over the past two decades, social marketing programs have become an important element of the national family planning and HIV prevention strategy in several developing countries. As yet, there has not been any comprehensive empirical assessment to determine which of several social marketing models is most effective for a given socio-economic context. Such an assessment is urgently needed to inform the design of future social marketing programs, and to avoid that programs are designed using an ineffective model. Methods This study addresses this issue using a database of annual statistics about reproductive health oriented social marketing programs in over 70 countries. In total, the database covers 555 years of program experience with social marketing programs that distribute and promote the use of oral contraceptives and condoms. Specifically, our analysis assesses to what extent the model used by different reproductive health social marketing programs has varied across different socio-economic contexts. We then use random effects regression to test in which socio-economic context each of the models is most successful at increasing use of socially marketed oral contraceptives and condoms. Results The results show that there has been a tendency to design reproductive health social marketing program with a management structure that matches the local context. However, the evidence also shows that this has not always been the case. While socio-economic context clearly influences the effectiveness of some of the social marketing models, program maturity and the size of the target population appear equally important. Conclusions To maximize the effectiveness of future social marketing programs, it is essential that more effort is devoted to ensuring that such programs are designed using the model or approach that is most suitable for the local context.
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Affiliation(s)
- Dominique Meekers
- Department of International Health and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
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Abstract
OBJECTIVE Communities need to identify cost-effective interventions for HIV prevention to optimize limited resources. METHODS The authors developed a spreadsheet tool using Bernoulli and proportionate change models to estimate the relative cost-effectiveness for 26 HIV prevention interventions including biomedical interventions, structural interventions, and interventions designed to change risk behaviors of individuals. They also conducted sensitivity analyses to assess patterns of the cost-effectiveness across different populations using various assumptions. RESULTS The 2 factors most strongly determining the cost-effectiveness of the different interventions were the HIV prevalence of the population at risk and the cost per person reached. In low-prevalence populations (eg, heterosexuals) the most cost-effective interventions were structural interventions (eg, mass media, condom distribution), whereas in high-prevalence populations (eg, men who have sex with men) individually focused interventions to change risk behavior were also relatively cost-effective. Among the most cost-effective interventions overall were showing videos in STD clinics and raising alcohol taxes. School-based HIV prevention programs appeared to be the least cost-effective. Needle exchange and needle deregulation programs were relatively cost-effective only when injection drug users have a high HIV prevalence. CONCLUSIONS Comparing estimates of the cost-effectiveness of HIV interventions provides insight that can help local communities maximize the impact of their HIV prevention resources.
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Abstract
Women drug users are at significant risk of sexually transmitted HIV; however, interventions aimed at increasing condom use by this population have been relatively ineffective. The authors conducted a series of focus groups with 17 current and former drug-using women to identify (a) reasons for using versus not using condoms, (b) intervention strategies they believed would be most effective at increasing condom use, and (c) previous ineffective intervention strategies. Risk of HIV, sexually transmitted diseases, and pregnancy was the main reason given for using condoms. Many factors were identified that limited condom use, including lack of availability, substance use, and cost. Participants enthusiastically endorsed condom availability and AIDS awareness interventions, and suggested that no intervention was a waste of money. The authors discuss the limitations of the suggested interventions and recommend additional research to evaluate the efficacy of these strategies.
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Affiliation(s)
- Andrea M Fenaughty
- Division of Public Health, Alaska Department of Health and Social Services, 3601 C Street, Ste 540, Anchorage, Alaska, 99503, USA.
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Stirman SW, Crits-Christoph P, DeRubeis RJ. Achieving successful dissemination of empirically supported psychotherapies: A synthesis of dissemination theory. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/clipsy.bph091] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
In the United States, drug users have dramatically reduced drug-related risk behaviors but continue sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. Successful interventions are likely to be those that intervene at multiple levels, yet, historically, sexual interventions for drug users have primarily addressed only personal factors, such as condom use. Sexual risk arises from personal factors (e.g., perceived vulnerability and protective behaviors); interpersonal factors (e.g., relationship type and a partner's risk profile); social factors (e.g., gender roles and sexual mixing patterns among and between networks); and, finally, community-level factors (e.g., access to preventive methods and the prevalence of a sexually transmitted pathogen within a network). For female drug users, multiple sources of risk plus concurrent drug use during sex pose additional prevention challenges that disproportionately elevate their risk of sexually acquired HIV infection. New, multimodal interventions need to be developed and tested to more effectively address the many sources of sexual risk facing female drug users.
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Affiliation(s)
- Mary Latka
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029, USA.
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Abstract
BACKGROUND Infection with herpes simplex virus type 2 (HSV-2) currently affects approximately 22% of adult Americans and increased markedly in prevalence between the late 1970s and early 1990s. Although some estimates of the costs of prevalent disease due to HSV-2 are available, selection of interventions to prevent HSV-2 infection, as well as evaluation of their potential cost-effectiveness, should take into account projected future costs that will result if the epidemic is left unchecked. GOAL The goal was to estimate the future health and economic consequences attributable to the HSV-2 epidemic in the absence of interventions to slow the epidemic. STUDY DESIGN A mathematical model was constructed to project future increases in HSV-2 seroprevalence in the United States. The probability of heterosexual transmission of HSV-2 was estimated from cross-sectional estimates of infection prevalence reported by the National Health and Nutrition Examination Survey (NHANES). Per-infection expected costs were calculated on the basis of data obtained from the published medical literature. RESULTS Without intervention, the prevalence of HSV-2 infection among individuals aged 15 to 39 years was projected to increase to 39% among men and 49% among women by 2025. Annual incidence was projected to increase steadily between 2000 and 2025, from 9 to 26 infections per 1,000 men and from 12 to 32 infections per 1,000 women in this age group. The cost of incident infections in the year 2000 were estimated to be $1.8 billion; the cost of incident infections was predicted to rise to $2.5 billion by 2015 and $2.7 billion by 2025. The projected cumulative cost of incident HSV-2 infections occurring over the next 25 years was estimated to be $61 billion; at a 3% discount rate, this sum has a present value of $43 billion. CONCLUSION The costs of incident HSV-2 infection in the United States are substantial and can be expected to increase as both the incidence and prevalence of this disease increase in the first half of the century. The level of resource allocation for HSV-2 prevention strategies should reflect the economic benefits that would result from control of this epidemic.
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Affiliation(s)
- David N Fisman
- City of Hamilton Social and Public Health Services Department, McMaster University, Hamilton, Ontario, Canada.
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Affiliation(s)
- Cornelis A Rietmeijer
- Denver Public Health Department, University of Colorado Health Sciences Center, 80204, USA.
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Affiliation(s)
| | - Brad L Neiger
- Department of Health Science, Brigham Young University, Provo, Utah
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Bull SS, Cohen J, Ortiz C, Evans T. The POWER campaign for promotion of female and male condoms: audience research and campaign development. Health Commun 2002; 14:475-491. [PMID: 12375772 DOI: 10.1207/s15327027hc1404_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this study, we conducted and content analyzed 12 focus groups with women aged 15-25 living in inner city Denver as a process of audience research to develop a male and female condom promotion campaign. We recruited 89 women from school and community sites in central Denver neighborhoods to discuss their knowledge, attitudes, and practices regarding both male and female condoms, then solicited opinions about how to increase knowledge about and familiarity with female condoms, increase positive attitudes toward both male and female condoms, and how to increase access to and use of both male and female condoms. Opinions on these topics drove the development of a targeted media campaign promoting condom use in this population. We report here on the general findings from focus groups and provide details about the campaign the participants helped to develop.
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Abstract
To explore the conceptualization of risk by primary care physicians about behaviors associated with a relatively low risk of HIV transmission, we performed open-ended telephone interviews with 59 primary care physicians throughout the United States. During the interviews, physicians were asked to respond to a series of clinical vignettes presenting situations where the risk of HIV transmission is relatively low or unknown. We performed a qualitative content analysis of physicians' responses to these clinical vignettes. We found that relatively few information-gathering statements were made in an effort to elicit the patient's perspective regarding risk, and that risk counseling by physicians often followed an 'all or nothing' heuristic that manifested itself as the advice to take maximum precautions under situations of any perceived risk, no matter how small. In addition, HIV testing was often incompletely explained. When combined with the all or nothing heuristic, this created advice that was potentially harmful by using testing as a means to achieve zero risk and forgo protective strategies in settings where patients may potentially be in the HIV negative 'window' phase of infection.
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Affiliation(s)
- Paul Haidet
- General Medicine Section, Houston Veterans Affairs Medical Center, 2002 Holcombe Boulevard (152), Houston, TX, 77030, USA.
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