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PubMed1997

Reduction in risk behavior among adults with severe mental illness who learned to advocate for HIV prevention.

OBJECTIVES: The study evaluated the relative impact of HIV risk reduction interventions for adults with severe mental illness living in the inner city. METHODS: A total of 104 chronically mentally ill men and women were interviewed to determine sexual risk behavior over the past month and to assess HIV risk-related psychological characteristics, including their knowledge about risk behavior, their belief in their ability to change their behavior, their perceptions of peer and social norms about safer sex, their expectancies about the outcomes of these changes, and their perceived barriers to condom use. Participants were then randomly assigned to one of three conditions: a single AIDS education session, a seven-session cognitive-behavioral HIV risk reduction group intervention, or a seven-session group intervention that combined the cognitive-behavioral intervention with training to act as a risk reduction advocate to friends (advocacy training). Individuals were reinterviewed three months after completion of the intervention. RESULTS: Although all participants exhibited change at follow-up in some risk-related psychological characteristics and sexual risk behaviors, participants who received the cognitive-behavioral intervention that included the advocacy training reported greater reductions in rates of unprotected sex and had fewer sexual partners at follow-up. CONCLUSIONS: HIV prevention interventions that teach risk reduction skills and then encourage participants to advocate behavior change to others appear to strengthen participants' capacity to change their behavior to reduce HIV risk, even those from a disenfranchised group such as severely mentally ill adults.

Adult↗
PubMed1999

Longitudinal changes in sexual risk behavior among HIV+ and HIV- male injecting drug users.

UNLABELLED: Injecting drug users (IDUs) play a prominent role in the transmission of human immunodeficiency virus (HIV), particularly in urban areas such as New York City, where they comprise nearly half of all adult acquired immunodeficiency syndrome (AIDS) cases. Intervention studies have demonstrated that IDUs are responsive to safer sex messages, but sexual behavior appears to be more resistant to change than drug use behavior. This multidisciplinary study (without an intervention component) assesses changes in sexual risk behavior as a function of time, HIV status, and disease progression in a cohort of HIV+ and HIV- male IDUs (N = 144) for 4 years. RESULTS: For HIV+ and HIV- men, there were increases in abstinence and monogamy, with decreases in the frequency of unprotected vaginal/anal sex and sexual risk index scores. With the exception of monogamy, HIV+ men reported lower levels of risk. Although there was also a decline in substance use, this accounted for only some of the decline in sexual risk behavior. Among the HIV+ men, a CD4 level below 200 was associated with more abstinence and monogamy. HIV-related medical symptoms were associated with increased abstinence, less unprotected sex, and lower sexual risk index scores. Lower neuropsychological memory test scores were associated with increased abstinence and lower sexual risk index scores. Neurological impairment and depression were not associated with sexual risk behavior. CONCLUSION: IDU men in New York City have modified their sexual behavior toward safer practices. Lower levels of risk are found among HIV+ men, particularly those with more progressed HIV illness. Nevertheless, a substantial amount of sexual risk behavior remained in this cohort, indicating the continued need for education and intervention.

Adult↗
PubMed2006

Trends in HIV-related risk behaviors among high school students--United States, 1991-2005.

Young persons who engage in unprotected sexual intercourse or use injection drugs are at increased risk for human immunodeficiency virus (HIV) infection. To examine changes in HIV-related risk behavior among high school students in the United States during 1991-2005, CDC analyzed data from eight national Youth Risk Behavior Surveys (YRBS) conducted during that period. This report summarizes the results of that analysis, which indicated that, during 1991-2005, the percentage of U.S. high school students engaging in HIV-related sexual risk behaviors decreased. During 1995-2005, the percentage of U.S. high school students who ever injected drugs remained less than 4%. However, many students still engage in HIV-related risk behaviors. Measures aimed at changing these behaviors should be strengthened to decrease the incidence and prevalence of HIV/AIDS among young persons and meet the national 2010 objective for adolescent sexual behavior (objective 25-11).

Adolescent↗
PubMed2002

High risk behaviors in a sample of Mexican-American college students.

This study explored different types of high risk behaviors of Mexican-American college students attending a small university in south Texas. High risk behaviors for contracting HIV/AIDS examined in this study included unprotected sex, drug use, and alcohol abuse. In 1995 in the United States, HIV/AIDS is the leading cause of death in people between the ages of 25 and 44. Because use of alcohol and certain recreational drugs lowers inhibitions, their use could increase the possibility of having unprotected and unplanned sex with multiple partners. Thus, it was expected that Mexican-American college students who use drugs and alcohol would be more likely to engage in unprotected sex. Data were from 105 men and 211 women between the ages of 18 and 30 years. Drug use and alcohol abuse were significantly associated with high risk sexual behavior. Individuals in monogamous relationships were more likely to not use condoms than those involved in casual relationships. Self-reported religiosity was not correlated with high risk behaviors, although there were implications that stronger religious affiliation did alter sexual beliefs and practices. Lastly, parental communication was not significantly associated with high risk behaviors, but family unity did seem related to some risky sexual practices.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Risk behaviors for sexually transmitted infections among men with mental disorders.

OBJECTIVE: Risk behaviors for sexually transmitted infections among men with mental disorders who were using outpatient psychiatric services and among men who had never been treated for a mental disorder were compared. METHODS: Ninety-two men with major mental disorders, including schizophrenia, bipolar disorder, and mood disorders, were individually matched for age and ethnicity with 92 men who had never been treated for mental illness. All subjects completed a semistructured interview about specific risk behaviors for sexually transmitted infections that they may have engaged in during the preceding year. RESULTS: The 49 patients with mental disorders who had been sexually active in the preceding year were significantly more likely than the 78 sexually active comparison subjects to have known their sexual partner for less than one day and to report having been pressured into unwanted sexual intercourse. A strong but not significant trend was found for sexually active patients to have had sex with a male partner and sex with a drug user. Overall, the patients with mental disorders answered ten questions measuring AIDS knowledge questions significantly less well than the comparison subjects. CONCLUSIONS: The results underscore the priority for developing programs for preventing risk behaviors for sexually transmitted infections among men with mental disorders.

Adult↗
PubMed2005

Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China.

BACKGROUND: The migrant population in China is at high risk for sexual risk behavior and alcohol intoxication. Information about the prevalence of alcohol intoxication and its association with sexual risk behavior among migrants is needed for designing effective intervention prevention programs for reduction in alcohol abuse and HIV infection. METHODS: Cross-sectional data were collected from 2153 sexually experienced young rural-to-urban migrants in Beijing and Nanjing, China, in 2002. RESULTS: Approximately one-third of the participants had been intoxicated with alcohol at least once during the previous month, with more males than females reporting intoxication (40.2% versus 23.7%, p<0.001). Compared to non-intoxicated participants, respondents with alcohol intoxication in previous 30 days reported more psychological problems, including higher depression scores, lower levels of satisfaction with life and work, and higher perception of peer involvement in risk behavior. Intoxicated respondents were more likely to engage in premarital sex than non-intoxicated respondents (76% versus 60.2%, p<0.001), have multiple sexual partners (13.4% versus 5.2%, p<0.001), purchase sex (12.6% versus 4.9%, p<0.001), and sell sex (10.1% versus 3.7%, p<0.001). However, there was no association between alcohol intoxication and inconsistent/non-use of condoms. Multivariate analysis controlling for depression, peer risk involvement, age, gender, and other socio-demographic variables indicated that alcohol intoxication was independently correlated with premarital sex, multiple sexual partners, and buying and selling sex. CONCLUSIONS: Compared to the general Chinese population, levels of intoxication were elevated among Chinese rural-to-urban migrants. Alcohol intoxication was associated with sexual risk behaviors. HIV/AIDS prevention and intervention efforts should include components of alcohol use/abuse prevention for an effective reduction of sexual risk among young rural-to-urban migrants in China.

Adolescent↗
PubMed1994

Health-risk behaviors among persons aged 12-21 years--United States, 1992.

Health-risk behaviors among youth may result in immediate health problems (e.g., injuries and sexually transmitted diseases) or extend into adulthood and increase risk for chronic diseases (e.g., heart disease and cancer). This report uses national data from the Youth Risk Behavior Survey (YRBS), conducted as part of the 1992 National Health Interview Survey (NHIS), to examine the prevalence of selected self-reported health-risk behaviors among persons aged 12-21 years.

Adolescent↗
PubMed2005

HIV risk behavior among amphetamine injectors at U.S. syringe exchange programs.

The goal of this study was to compare HIV risk behaviors of amphetamine and non-amphetamine injectors at syringe exchange programs (SEP) in the United States and to identify factors associated with injection risk. This analysis is based on data from a random cross-section of participants at 13 SEPs in different parts of the country. All interviews were done using Audio Computer-Assisted Personal Interviewing technology. Amphetamine injectors differ from other SEP participants in that they are younger and more likely to be White, to have had a recent same sex partner, and to be homeless. Rates of injection risk behavior are higher among amphetamine injectors than other SEP participants, but rates of condom use are similar. Factors associated with injection risk behavior are amphetamine injection, homelessness, depression, and having a recent same-gender sexual partner (for both men and women). SEPs have been repeatedly demonstrated to reduce injection risk behavior, but some groups of program participants continue to be at elevated risk. SEPs may need to develop new approaches to outreach and education to address the needs of amphetamine injectors and other populations at persistent risk.

Adult↗
PubMed2003

A profile of adolescent females with a history of sexual assault in texas: familial environment, risk behaviors, and health status.

STUDY OBJECTIVE: To describe the prevalence and correlates of sexual assault among adolescent females. DESIGN: A cross-sectional study. SETTING: A university family planning clinic in south Texas. PARTICIPANTS: Female adolescents <18 years who initiated care at a university family planning clinic in south Texas between June 28, 1992, and April 28, 1994. The adolescents' lifetime sexual assault experience. MAIN OUTCOME MEASURES: Of the 791 adolescents interviewed, 167 (21%) reported a history of sexual assault. Sexual assault was found to be highly associated with multiple risky behaviors and depressive symptoms. Among assaulted adolescents, nonsexual risk behaviors (e.g., substance use) were more common among those who also experienced physical assault than among those who did not. Sexual risk behaviors (e.g., earlier age at sexual debut) and related gynecological infections (e.g., STDs) were more prevalent among women reporting forced sexual intercourse than in those who reported molestation only. Furthermore, adolescents assaulted by a stranger had participated in the most risky behaviors and reported the worst health status, while those assaulted by a date/acquaintance reported higher rates of inconsistent condom use and gynecological infections but lower rates of substance use and depressive symptoms than those assaulted by a family member. CONCLUSION: A deeper understanding of the links between the characteristics of assault, risk behaviors, and health conditions may provide opportunities to design more individualized interventions.

Adolescent↗
PubMed2004

Screening for potentially transmitting sexual risk behaviors, urethral sexually transmitted infection, and sildenafil use among males entering care for HIV infection.

The study aims were to evaluate the prevalence and predictors of sexual risk behaviors and urethral sexually transmitted disease (STD) among males entering care for HIV infection and to examine if sildenafil prescriptions are associated with potentially transmitting sexual risk behavior (PTSRB). The research design included (1) self-administered questionnaire of symptoms of sexually transmitted infection (STI), number of recent sex partners, unprotected sexual risk behaviors, use of drugs/alcohol during sex, and HIV disclosure; (2) urine gonorrhea/chlamydia polymerase chain reaction (PCR); and (3) record review for sildenafil prescriptions. A PTSRB was defined as insertive anal, vaginal, or oral sex without a condom. Between March 2001 and March 2002, 413 entrants were surveyed. The prevalence of positive urine PCR among those with and without urethral symptoms was 16.7% and 2.4%, respectively. Fifty-one percent met criteria for PTSRB during the preceding month. Those reporting PTSRB were more likely to report multiple partners. In a multiple logistic regression model, the following were significant (p < 0.05) predictors of PTSRB: drug or alcohol use during sex; white race; only male partners, and sildenafil use. Drug use during sex was associated both with more sex partners and more sexual risk behaviors. Always disclosing HIV status was associated with fewer partners. There was a high prevalence of PTSRB among HIV-infected males entering care. Men who have sex with men (MSM), white race, drug/alcohol use during sex, and sildenafil use were independent risk factors. PTSRB was associated with having multiple partners. Physicians should discuss risk behaviors before prescribing sildenafil.

Adult↗
PubMed1991

HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis.

BACKGROUND AND PURPOSE: Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population. METHODS: We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities. RESULTS: In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time. CONCLUSIONS: Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection.

Community Participation↗
PubMedDate not supplied

Health-risk behaviors in a sample of first-time pregnant adolescents.

OBJECTIVE: The purpose of this study was to assess the frequency of prenatal health-risk behaviors (substance use, sexual risk taking, and prenatal class attendance) among a nonrandom sample of first-time pregnant adolescents. DESIGN: The design is descriptive. SAMPLE: 145 ethnically diverse first-time pregnant adolescents aged 15-18 years. MEASUREMENT: Health behavior questions modified from the Center for Disease Control's Youth Risk Behavior Surveillance System. RESULTS: The health-risk behavior most modified during pregnancy was alcohol use (64/145 drank but quit and 1/145 did not quit). Of the 52/145 who used street drugs, nine continued despite pregnancy. Of the 75/145 who smoked early in pregnancy, 39 continued. The majority did not use a condom at last sexual intercourse. Approximately half attended a prenatal class and half attended a teen parenting class. CONCLUSION: Health-risk behaviors captured by birth certificate data are thought to be underreported for all age groups, and the prevalence of health-risk behaviors in this sample of pregnant teens was often greater than the most recent national trend data available. The magnitude of the effects of health-risk behaviors on pregnancy outcomes necessitates improved data gathering to enhance planning and evaluation of research and interventions at community, system, and individual/family levels.

Adolescent↗
PubMed1999

Forced sexual intercourse and associated health-risk behaviors among female college students in the United States.

This study analyzed data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of lifetime rape among female college students and to examine the association between rape and health-risk behaviors. The NCHRBS used a mail questionnaire to assess health-risk behaviors among a nationally representative sample of undergraduate students. Twenty percent of female students reported ever having been forced to have sexual intercourse, most often during adolescence. When analyses controlled for demographic characteristics, female students who had ever been raped were significantly more likely than those who had not to report a wide range of health-risk behaviors. These results highlight a need to improve rape prevention and treatment programs for female adolescents.

Adolescent↗
PubMed1998

Readmissions to drug abuse treatment and HIV risk behavior.

The objectives of the study were (a) to investigate the characteristics of drug abuse treatment clients who return to treatment and (b) among those with readmissions, to describe changes over time in risk behavior for human immunodeficiency virus (HIV) infection and to identify factors associated with behavior change. Data were derived from a multisite HIV surveillance program in a single community; the program used a unique identifier to link HIV test results and behavioral information from multiple contacts. During a 30-month period, 1994 clients were admitted to three satellite facilities of a single treatment agency: detoxification, long-term residential, and outpatient. Of these clients, 574 (29%) had one or more readmissions to the same or a different facility during the 24 months following the index admission. Drug injectors, those tested for HIV, and those living in the community were more likely to be readmitted to treatment. There was little overall change in HIV risk behavior between the index admission and the readmission furthest in time from the index admission. Clients whose index visit was at the residential facility were more likely to reduce their injection risk behavior than those admitted to the other facilities. Clients readmitted to either the residential or the outpatient facility were more likely to have reduced their injection risk behavior than those readmitted to detoxification. Treatment facility was not associated with sexual risk behavior change. Men were more likely than women to reduce their high-risk sexual behaviors. The results underscore the need for treatment programs to make HIV testing readily available to their clients and to make special efforts to assist female clients to reduce their HIV risk.

Adolescent↗
PubMed2006

Prevalence and correlates of HIV risk behaviors among drug users in China.

This study examined the prevalence and correlates of HIV risk behaviors among 1,153 current drug users in China. Chi-squared tests of differences were used to test if drug users differed from non-users; logistic regression was used to identify behavior-specific risk factors. Results indicate that 60% of drug users injected drugs and more than one third shared needles. Compared to non-users, drug users had higher rates of risky sexual behavior and HIV/STDs. Among drug users, ethnic minorities and migrants were most vulnerable to unprotected casual sex and needle sharing. Drug users who experienced social isolation were associated with lower odds of risk behaviors; those who had experiences of anti-social behaviors and commercial sex, poor HIV knowledge, and perceived greater vulnerability were more prone to unprotected casual sex and needle sharing. Additional correlates of unprotected casual sex included being single, depression, and taking drugs/alcohol during sex. Additional risk factors of needle sharing included education and initiated drug use at younger ages. It is imperative that HIV interventions in China target drug users and address behavior-specific risk factors.

Adolescent↗
PubMed1991

Reducing HIV sexual risk behaviors among runaway adolescents.

OBJECTIVE: Reductions in runaways' sexual risk behaviors were evaluated in response to an intensive program to prevent human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). DESIGN: In a nonrandomized control trial, sexual risk behaviors among 78 runaways at one residential shelter who received up to 30 HIV/AIDS intervention sessions were compared with 67 runaways at a nonintervention shelter with sexual behaviors assessed at baseline and 3 and 6 months. SETTING: Runaways were recruited from the only two publicly funded shelters in New York, NY. PARTICIPANTS: The runaways were aged 11 to 18 years, 64% female, and predominantly black or Hispanic. INTERVENTION: The intervention addressed general knowledge about HIV/AIDS, coping skills, access to health care and other resources, and individual barriers to safer sex. MAIN OUTCOME MEASURES: Consistent condom use, a high-risk pattern of sexual behavior, and sexual abstinence over a 3-month time frame were assessed. MAIN RESULTS: As the number of intervention sessions increased, runaways' reports of consistent condom use increased significantly (at 3 months, unique R2 = .06, P less than .05; at 6 months, unique R2 = .09, P less than .05), and their reports of engaging in a high-risk pattern of sexual behavior decreased significantly (at 3 months, unique R2 = .03, P = .06; at 6 months, unique R2 = .04, P less than .05). Abstinence did not change. CONCLUSIONS: The demonstrated effectiveness of the intensive HIV/AIDS program highlights the importance of enlarging the scope of most current HIV/AIDS prevention programs.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Gender differences in HIV risk behaviors in an adult emergency department in New York City.

BACKGROUND: The human immunodeficiency virus (HIV) epidemic in the US increasingly involves urban heterosexual adults, particularly women, belonging to ethnic minority groups. An understanding of gender-based differences in HIV risk behaviors within these groups would be of value in the ongoing struggle to limit HIV transmission in metropolitan centers. METHODS: This was a prospective study of demographic and historical characteristics and HIV risk behaviors. The study utilized a structured interview format, which was administered to all patients treated by participating emergency department physicians. RESULTS: On univariate analysis of data obtained from 1,460 patients who had neither a known HIV infection nor a chief complaint or final emergency department diagnosis associated with HIV risk behaviors, men were more likely to be older, homeless, to have ever injected drugs, used crack, engaged in same-gender sex, paid for sex, been incarcerated, or had syphilis or gonorrhea. Women were more likely to report prior chlamydia infection or to report that their sole sex partners had other partners within the past year. On multivariate analysis, variables independently associated with male gender included homelessness, injection drug use, crack use, any prior sexually transmitted disease (in subjects 35 years of age or older), and sex with prostitutes. In a separate analysis of patients admitting to drug use, the male predominance of other risk behaviors was not observed; the only significant differences between genders were a higher rate of prostitution among women and a higher rate of sexual contact with a prostitute among men. CONCLUSIONS: In patients visiting an inner-city emergency department in the Bronx, HIV risk behaviors are generally more common in men, but rates of risk behaviors among male and female drug users are comparable.

Adult↗