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PubMed1993

Two reasonable people: joint decisionmaking in contraceptive choice and use.

The authors discuss "the way in which married couples make choices from among contraceptive alternatives, and the way in which these choices lead to use.... Three predominant themes structure this chapter. First, can currently popular decision-making theories be satisfactorily applied to joint contraceptive decision-making? Second, do spouse's perceptions (and misperceptions) of the other's beliefs, attitudes, etc. influence the decision outcome? And, third, do demographic considerations (such as a couple's stage in the life-cycle or ethnicity) alter the utility of decision theories?" Data are from a study of 453 couples interviewed in Gainesville, Florida.

Americas↗
PubMed2001

Women's barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing.

In view of the ever-increasing HIV/AIDS epidemic in sub-Saharan Africa, the expansion of HIV-1 voluntary counselling and testing (VCT) as an integral part of prevention strategies and medical research is both a reality and an urgent need. As the availability of HIV-1 VCT grows two limitations need to be addressed, namely: low rates of HIV-1 serostatus disclosure to sexual partners and negative outcomes of serostatus disclosure. Results from a study among men, women and couples at an HIV-1 VCT clinic in Dar es Salaam, Tanzania are presented. The individual, relational and environmental factors that influence the decision to test for HIV-1 and to share test results with partners are described. The most salient barriers to HIV-1 testing and serostatus disclosure described by women include fear of partners' reaction, decision-making and communication patterns between partners, and partners' attitudes towards HIV-1 testing. Perception of personal risk for HIV-1 is the major factor driving women to overcome barriers to HIV-1 testing. The implications of findings for the promotion of HIV-1 VCT programmes, the implementation of partner notification policies and the development of post-test support services are discussed.

Africa South of the Sahara↗
PubMed1992

An experiential program to reduce AIDS risk among female sex partners of injection-drug users.

This article describes the development and implementation of an acquired immune deficiency syndrome (AIDS) intervention program for female sex partners of male injection-drug users. Four psychoeducational workshops were designed to motivate personal risk reduction, provide participants with necessary cognitive and behavioral skills, and enhance participants' perceived ability to enact positive changes in their lives. The development of the workshop modules was guided by traditional theories of health behavior change and social learning. Also included in the intervention are referral and advocacy services, personal risk reduction counseling, and human immunodeficiency virus (HIV) antibody testing. Preliminary results indicate that the program has made a significant impact on the AIDS risk of participants--91 percent of women who completed the program reported that they had made positive changes in their lives to reduce their risk of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Sexual negotiation in the AIDS era: negotiated safety revisited.

OBJECTIVE: To test the safety of the 'negotiated safety' strategy-the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions. METHOD: Data from recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables. RESULTS: The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection. CONCLUSIONS: The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.

Adolescent↗
PubMed1998

Improving quality of sexually transmitted disease case management in rural South Africa.

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.

Case Management↗
PubMed1997

Reasons for not using condoms of clients at urban sexually transmitted diseases clinics.

BACKGROUND AND GOAL: Greater understanding of the factors related to inconsistent condom use is essential in the development of strategies to promote condom use among clients who access public, inner-city sexually transmitted diseases (STD) clinics. Therefore, this study aimed to explore reasons for not using condoms among 260 predominantly African American heterosexual male and female clients presenting for care at two inner-city STD clinics. STUDY DESIGN: Clients selected for this descriptive analysis reported having had at least one unprotected episode of sexual intercourse in the last 10 episodes. In face-to-face interviews, clients provided information about sexual activity, sexual partners, and condom use in the previous 30 days. In addition, they were asked to indicate the main reason for not using condoms when having unprotected sex. RESULTS: Content analysis showed six major categories of reasons for not using condoms: reasons related to partner relationships, reasons related to sexual sensation, reasons related to situational constraint, reasons related to condoms themselves, reasons related to pregnancy, and reasons related to types of sexual activity. Most frequent explanations given for not using condoms included partner trust (19.6%), the feel of condoms (11.9%), and lack of condom availability (11.5%). Clients also reported barriers to condom use that included beliefs about condom sensation and partner relationships. CONCLUSIONS: These results show the continued barriers that exist with respect to condom use in at-risk populations and emphasize the need to tailor meaningful interventions in order to promote condom use among persons who, for differing reasons, choose not to use them.

Adult↗
PubMed1999

Disclosure of HIV status to sexual partners: predictors and temporal patterns.

BACKGROUND AND OBJECTIVES: Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction. GOAL OF THIS STUDY: The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure. STUDY DESIGN: A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic. RESULTS: Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed. CONCLUSIONS: These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.

Adult↗
PubMed2000

The role of couple negotiation in unmet need for contraception and the decision to stop childbearing in Uganda.

This study uses survey and focus-group data from the 1995-96 Negotiating Reproductive Outcomes study in Uganda to describe the nature of the decision to stop childbearing and to question the simplifying assumption of consensus decision-making implicit in much demographic research on unmet need. Negotiation is characterized in four stages, from normative precedent for decision-making to communication, disagreement, and conflict resolution. Indirect forms of communication between partners predominate, contributing to the tendency of both men and women to overestimate each other's demand for additional children. Partner opposition is found to cause a statistically significant increase in unmet need reported by women and a shift in contraceptive mix favoring use of traditional methods over modern methods. For women, partner opposition may account for as much as 20 percent of unmet need in urban areas, 12 percent in rural areas, and 15 percent overall.

Adult↗
PubMed1998

First sexual intercourse: age, coercion, and later regrets reported by a birth cohort.

OBJECTIVES: To investigate how age at first sexual intercourse is related to the reported circumstances and to determine how these corresponded to views in early adulthood about its timing. DESIGN: Cross sectional study within a birth cohort using a questionnaire presented by computer. SETTING: Dunedin, New Zealand in 1993-4. SUBJECTS: 477 men and 458 women enrolled in the Dunedin Multidisciplinary Health and Development Study, comprising 92% of survivors of the cohort. RESULTS: The median age at first intercourse was 17 years for men and 16 years for women. Only one man (0.2%) but 30 (7%) women reported being forced to have intercourse on the first occasion. For women, there were increasing rates of coercion with younger age at first intercourse. More men than women reported that they and their partner were equally willing (77% (316/413) v 53% (222/419)). Mutual willingness of both partners was greater for those who reported that it was also the first time for their partner. Timing of first intercourse was considered about right by 49% (200/411) of men and 38% (148/388) of women. Many women (54% (211/388) reported that they should have waited longer, and this rose to 70% (90/129) for women reporting intercourse before age 16. CONCLUSIONS: Most women regretted having sexual intercourse before age 16. First intercourse at younger ages is associated with risks that are shared unequally between men and women. This information is important to young people themselves.

Adult↗
PubMedDate not supplied

Ethics and the AIDS pandemic in the developing world.

Traditional ethics provide insight, but often fall short of guiding the complex biomedical ethical concerns of research conducted in developing countries. The need to create research within a framework that is appropriate to the social, medical, and political context of developing countries is examined through the current AIDS pandemic in sub-Saharan Africa. A specific case study focuses on this issue. Over 70 percent of the 40 million people with HIV/AIDS live in sub-Saharan Africa. With at least one in five African adults infected with the disease, sub-Saharan Africa is now acknowledged as the epicenter of HIV/AIDS. The scale and scope of the disease in the environment of a developing economy presents unique issues that challenge the role and practices of traditional ethics in healthcare research programs. Medical research within developing countries, particularly for HIV/AIDS, requires a distinctive approach. For these populations, investigators must incorporate new thinking into traditional biomedical research ethics which will address the role of innovation; access to treatment; the impact of fear, stigma, and denial; concerns around autonomy for vulnerable populations; capacity building; and sustainable care to communities. Since May 1999, Secure the Future, a philanthropic program that focuses on care and support for women and children infected and affected by HIV/AIDS, has attempted to fulfill these ethical concepts in its processes. The program is a public and private sector partnership between governments, communities, practitioners, academia, and Bristol-Myers Squibb Company to respond to AIDS in five countries in sub-Saharan African countries: Botswana, Lesotho, Namibia, South Africa, and Swaziland. To ensure symmetry between ethical principles and local context, collaborative projects undergo a comprehensive review process. This includes review and approval by a national secretariat to ensure projects support objectives of national policies and local communities; approval by an ethics committee comprised of participating institutions; blinded peer review; and an examination by an external advisory board comprised of local and international medical experts, persons living with AIDS (PLWA), religious communities, governments, and nongovernmental organizations (NGOs). An independent monitor also oversees the approved programs. Cost-effective and practical interventions against HIV/AIDS must encompass ethical approaches appropriate to the contexts of the respective developing countries. Lessons learned to date are to focus on innovation; establish unassailable ethical standards that are sensitive to local contexts; ensure transparent communications among partners and the broader community; and build sustainable capacity.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Changes in the job situation due to telemedicine.

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.

Adult↗
PubMed1995

Ambivalence among women applying for abortion.

BACKGROUND: Our purpose was to characterize women expressing ambivalence when applying for abortion. MATERIAL AND METHODS: Data were collected, by self-administered questionnaires, from 339 women. Thirty percent were in doubt about the decision when the abortion was due. Socio-economic factors more often influenced the choice among ambivalent women than among those not in any doubt. RESULTS: Ambivalent women more often felt exposed to social pressure and some felt that the abortion was not their own choice. Their decision-making was marked by doubt during the entire process. CONCLUSIONS: There is a need for professional support during this decision-making process. Many of the ambivalent women stated that their decision might not have been the same under different personal circumstances.

Abortion Applicants↗