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A comparison of HIV risk behaviors among women drug users from two cities in a rural state: recommendations for targeted prevention.

Most HIV prevention programs for women target individual risk behaviors while the influence of larger contextual factors, such as city of residence, are often neglected. This preliminary study compares women drug users from two different cities in the largely rural state of Kentucky on HIV risk behaviors. The women are from Lexington, a medium sized metropolitan area, and from Louisville, a large metropolitan area. Comparisons between the women from the two cities indicate that there are many similarities in their risk behaviors, but also some important differences. The women from Lexington (the smaller city), are more likely to be at risk for becoming infected with HIV due to their drug use, while the women from Louisville (the larger city) are more likely to be at risk because of their sex exchange practices and economic situation. The implications for prevention are discussed.

Adult↗

Alcohol consumption and sexually transmitted disease risk behavior: partner mix among male Korean university students.

BACKGROUND: This study examined alcohol consumption and sexually transmitted disease risk behavior as related to prostitute visits and sex partner mix among male Korean university students in 1993 to 1994. METHODS: Questionnaires were completed by a representative sample of 1103 university students in Seoul. Lifetime sexually transmitted disease risk behavior was categorized as none, only one, and multiple sexual experiences with prostitutes, whereas risk according to partner mix was classified as no sexual experience with prostitutes, sexual experience with prostitutes only, and with both prostitutes and girlfriends. The proportional odds model was applied to the data. RESULTS: A total of 25.8% of the university students had visited prostitutes--17.6% visited twice or more, and 12.9% had sexual experiences with both prostitutes and girlfriends. Heavier alcohol consumption was significantly related to multiple visits to prostitutes (odds ratio = 1.71) and to sexual experiences with both prostitutes and girlfriends (odds ratio = 2.30). CONCLUSIONS: In this first systematic study of the association between alcohol consumption and sexual experiences among Korean male university students, alcohol use was associated with risky sexual behaviors, and with first and most recent sexual experience with prostitutes, supporting our hypotheses.

Adolescent↗

Sexual abuse history, risk behavior, and sexually transmitted diseases: the impact of age at abuse.

OBJECTIVE: The objective of this study was to examine the relationship between age at onset of sexual abuse, risk behaviors, and a diagnosis of sexually transmitted disease (STD) in a clinic-attending adolescent population. METHODS: Bivariate analyses were used to test association among age at onset of sexual abuse, risk behaviors, and STD diagnosis (n = 2175). Relationship between sexual abuse and STD acquisition was assessed by regression analysis. RESULTS: More females than males reported sexual abuse, 26.75% and 5.4%, respectively. Abuse at or before 10 years of age was associated with more lifetime and recent partners. History of abuse was associated with higher rates of STD tests. In regression analysis, for males and females, the odds of having an STD were 2.5 times greater if abuse occurred at 10 years or younger. CONCLUSION: Sexual abuse at a younger age is associated with more sexual risk behaviors and is a risk factor for STDs.

Adolescent↗

Psychosocial correlates of HIV risk behavior in adolescent girls.

OBJECTIVE: To present the preintervention data collected for a pilot HIV-prevention randomized controlled trial specifically developed for single, sexually active adolescent girls. DESIGN: Comparative, descriptive design using confidential self-administered questionnaires. SETTING: An urban family planning clinic that provided gynecologic services to adolescents. PARTICIPANTS: One hundred twenty-nine single, sexually active adolescent girls 15 to 19 years of age (44% minority, 34% economically disadvantaged). MAIN OUTCOME MEASURES: In addition to demographics and risk behaviors, the following were assessed: HIV-related information (i.e., knowledge) and motivation to reduce risk (i.e., perceived vulnerability, readiness to change HIV risk behaviors, behavioral intentions, pros and cons of condom use, and confidence in condom use). RESULTS: Assessments revealed limited HIV-related knowledge, ambivalence regarding risk reduction, and considerable risk behaviors. Compared with girls at lower risk for HIV infection (i.e., consistent condom users), those at higher risk (i.e., inconsistent or noncondom-users) were more likely to be White and older and to have better HIV-related knowledge but less motivation to reduce risk (i.e., behavioral intentions to use condoms, condom-use confidence) than girls at lower risk. CONCLUSION: These data document (a) the need for HIV prevention interventions targeted to all sexually active adolescent girls and (b) the importance of including a motivational component in the intervention.

Adolescent↗

Drug problems and "at risk" women's involvement in HIV risk behaviors.

OBJECTIVES: This paper focuses on two research questions: is there a relationship between women's number of drug problems and the extent to which they engage in HIV risk behaviors? What factors influence the extent to which women experience drug-related problems? METHODS: This study is based on 250 adult "at risk" women (predominantly African American) in the Atlanta, Georgia metropolitan area. Street outreach efforts, targeted sampling, and ethnographic mapping procedures were used to identify potential study participants. RESULTS: The more drug problems women experienced, the greater their involvement in HIV risk behaviors was. The number of drug problems experienced was a significant contributor to the model predicting women's HIV risk involvement, along with religiosity, living with substance abusers, and age of first drug use. Depression, optimism, coping with stress, and number of different drugs used predicted the extent to which women experienced drug problems. CONCLUSIONS: Drug problems are an important predictor of women's involvement in HIV risk behaviors. Programs wishing to reduce their risk for contracting HIV should target drug-involved women and help them to stop using drugs.

Adolescent↗

Alcohol use and HIV risk behaviors among rural adolescents in Khanh Hoa Province Viet Nam.

Research suggests that youth are consuming more alcohol and at younger ages than in the past. Data also indicate that alcohol consumption is associated with participation in other risk behaviors including aggression and sexual behaviors. As part of a randomized control effectiveness trial for an HIV prevention program, 480 Vietnamese youth (15-20 years old) living in eight rural communes in Khanh Hoa Province were administered a paper and pencil baseline evaluation. The evaluation included items for actual and intended alcohol use, perceptions of peers' alcohol consumption, and attitudinal questions regarding alcohol. The tool included questions on engagement and intention to engage in sexual behaviors. In addition, 96 randomly selected youth participated in qualitative interviews on similar topics. Among the 480 surveyed youth, 29.2% had consumed alcohol. Among those youth, 17.6% reported intoxication in the past 6 months. While young men were significantly more likely to drink than young women (P < 0.00), those young women who did drink were as likely to report intoxication. Alcohol use was significantly associated with engagement in sexual behaviors (P < 0.00) and intention to engage in sexual behaviors (P < 0.02). The qualitative data provided information on the social contexts of drinking behaviors and more in-depth findings regarding associated risk behaviors. With limited information about alcohol consumption among Vietnamese youth, these findings suggest that there is a need for more extensive research on alcohol use and associated risk behaviors among this population, and for targeted alcohol prevention and harm-reduction programs.

Adolescent↗

HIV-related risk behaviors in Cambodia and effects of mobility.

OBJECTIVES: To study HIV risk behaviors in different population groups, linkages to bridge populations, and to examine factors affecting such behaviors and links. METHODS: Ten population groups in 4 provinces were surveyed. Stratified random cluster sampling was used, and interviews were conducted to provide information on sociodemographic characteristics, mobility, and risk behaviors. The groups surveyed were female sex workers (FSWs), household men and women, youths in vocational training, and men with high-mobility occupations (fishermen, mototaxi drivers, police, military, casino workers, and deminers). The total number surveyed was 3848. RESULTS: The proportion reporting sex in the past year with FSWs differed sharply between male groups ranging from 20% to 51% in the high-mobility groups and 5% to 10% in the other groups. Noncommercial sex varied less by group. Consistent condom protection (always used condoms in the past 3 months) with FSWs was high (>85% for most groups). However, condom use was significantly less with noncommercial partners, a high proportion of whom complained about a lack of condom availability. For the different male groups, travel away from home >1 month in the past year was a strong independent determinant of both sex with FSWs and noncommercial sex. Casual sex was more common in young unmarried men. Women in the general population did not report casual sex, but 41% of them were "worried about being infected by their husbands." CONCLUSIONS: The results suggest mobility is a strong determinant of casual sex. Although FSWs may still act as an important bridge for HIV transmission in Cambodia, noncommercial sex is becoming increasingly important due to the relatively low condom use in such relationships.

Cambodia↗

Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature.

We reviewed the existing empirical literature to assess cognitive and situational factors that may affect the validity of adolescents' self-reports of alcohol and other drug use, tobacco use, behaviors related to unintentional injuries and violence, dietary behaviors, physical activity, and sexual behavior. Specifically, we searched for peer-reviewed journal articles published in 1980 or later that examined the factors affecting self-report of the six categories of behavior listed above. We also searched for studies describing objective measures for each behavior. Self-reports of each of six types of health-risk behaviors are affected by both cognitive and situational factors. These factors, however, do not threaten the validity of self-reports of each type of behavior equally. The importance of assessing health-risk behaviors as part of research activities involving adolescents necessitates the use of self-report measures. Researchers should familiarize themselves with the threats to validity inherent in this type of assessment and design research that minimizes these threats as much as possible.

Adolescent↗

Risk behaviors among injecting drug users in Northern Ireland.

Compared to elsewhere in the United Kingdom, drug policy in Northern Ireland has for the most part failed to incorporate harm reduction strategies. In light of the conservative drug policies, the purpose of this study was to investigate the nature and extent of risk behaviors among injecting drug users (IDUs) in Northern Ireland. Data for this study were drawn from in-depth interviews with 39 IDUs in Northern Ireland. The findings suggest that most IDUs engage in extensive risk behaviors that pose risk for HIV, Hepatitis B and C. and other infectious disease. Moreover, these risk behaviors are linked to the scarcity of new needles and a general lack of knowledge about injection practices that reduce risk for infectious disease. These findings are discussed in the context of conservative drug policies.

Acquired Immunodeficiency Syndrome↗

Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men.

Alcohol use and sensation-seeking personality characteristics are commonly associated with sexual risk behavior in populations at risk for HIV infection. However, these associations are not well understood and have not yet been examined in people living with HIV-AIDS. We used path analyses to test a model of sensation seeking, alcohol use expectancies, and sexual risk behaviors among 197 HIV seropositive men. Results showed that alcohol use outcome expectancies and alcohol used in sexual contexts were closely associated with unprotected intercourse and that sensation seeking was significantly related to alcohol use expectancies. Sensation seeking did not mediate the association between alcohol use and unprotected sexual behavior. Further analyses showed that the association between sensation seeking and alcohol use in unprotected sexual contexts was accounted for by expectancies that alcohol use improves sexual performance and enhances sexual pleasure. Analyses also indicated that men living with HIV-AIDS who used alcohol in sexual contexts were characterized by greater overall frequency and quantity of drinking. Prevention interventions may be improved by tailoring them for alcohol-using HIV-infected men, particularly by challenging beliefs and expectations that alcohol enhances sexual performance and sexual pleasure.

Acquired Immunodeficiency Syndrome↗

Person and environment in HIV risk behavior change between adolescence and young adulthood.

This article explores how personal and environmental variables influence change in human immunodeficiency virus (HIV)-related risk behaviors between adolescence and young adulthood. Repeated interviews with 602 youths from 10 cities across the United States provide the data. These interviews first occurred in 1984-1985 and 1985-1986 when the youths were adolescents and were repeated again in 1989-1990 and 1991-1992 when they were all young adults. A longitudinal multivariate analysis shows that 31% of the variance in HIV risk behaviors by inner-city young adults is predicted by a combination of adolescent risk behaviors, personal variables (suicidality, substance misuse, antisocial behavior), environmental variables (history of child abuse, poor relations with parents, stressful events, peer misbehavior, number of AIDS prevention messages), and interactions between variables (number of neighborhood murders with child abuse, number of neighborhood murders with substance misuse, and unemployment rates with antisocial behavior).

Adolescent↗

AIDS risk behaviors, knowledge, and attitudes among pregnant adolescents and young mothers.

This study assessed AIDS risk behaviors, knowledge, and related attitudes of pregnant adolescents and young mothers (n = 151). Results revealed that a substantial portion of the sample engaged in sexual behaviors (e.g., unprotected sex and multiple sex partners) that increased their risk for acquiring HIV and possibly transmitting the disease to their children. Knowledge about major modes of HIV transmission was high; however, commonly held misconceptions were expressed concerning the spread of disease and methods of prevention. Results suggest that neither the experience of having an unplanned pregnancy nor knowing about HIV transmission was a sufficient motivator to reduce risk behaviors in this sample.

Acquired Immunodeficiency Syndrome↗

Multiple risk behaviors among smokers in the childhood cancer survivors study cohort.

The literature on health behaviors of young adult cancer survivors is very limited, and thus little is known about preventable risk factors in this population. This paper describes the prevalence of five behavioral risk factors among 541 young adult survivors of childhood cancers from the CCSS cohort who were identified as smokers and enrolled in a randomized controlled trial of a smoking cessation intervention. The relationship between presence of multiple risk factors and a number of smoking-related factors was examined. About 31% of the sample engaged in zero or one health-risk behavior in addition to smoking; 63% engaged in 2 or 3, and 6% engaged in 4 or 5. There were positive linear relationships between number of risk factors and smoking rate and nicotine dependence. Number of risk factors was not associated with self-efficacy for quitting, but was related to readiness to quit. This study demonstrated that childhood cancer survivors who smoke have a number of other risk factors for the development of preventable disease and the presence of these risks was associated with factors that decrease the likelihood of quitting smoking. Attention to other health behaviors may be an important strategy for helping smokers quit. In particular, helping childhood cancer survivors who smoke to reduce other risk behaviors might also encourage them to quit smoking.

Adolescent↗

[Dynamic surveillance of risk behaviors facilitating sexually transmitted disease/acquired immunodeficiency syndrome transmission among permanent residents in Kunming city in 1996-1999].

OBJECTIVE: To monitor the trends of risk behaviors promoting sexually transmitted disease/Acquired immunodeficiency syndrome (STD/AIDS) transmission among general public in order to develop appropriate intervention strategies and to evaluate impact of intervention programs. METHODS: Two hundred subjects were randomly selected and interviewed every other month in Kunming city from 1996 to 1999. STD-AIDS-related information on knowledge, attitudes and behavior were collected during the interview. RESULTS: The knowledge of STD and AIDS transmission increased from 49.2% to 62.8% (chi 2 = 96.5, P < 0.01) and from 16.6% to 35.2% (chi 2 = 146.5, P < 0.01), respectively. Knowledge on condom use and attitude to AIDS did not change much. Self-reported prevalence of risk behaviors remained low. Residents aged between 15 and 39 had unprotected sex behavior (0.8%-2.5%) and drug use (0.3%-2.4%). CONCLUSION: The awareness on STD and AIDS transmission increased gradually. Risk behavior of STD/HIV infection existed among residents aged between 15 and 39 years, which called for intervention programs in the future.

Acquired Immunodeficiency Syndrome↗

Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men. The San Francisco/Berkeley Young Men's Survey.

OBJECTIVE: To estimate the prevalence of human immunodeficiency virus (HIV) infection and risk behaviors among young homosexual and bisexual men sampled from public venues in San Francisco and Berkeley, Calif. DESIGN: A survey of 425 young homosexual and bisexual men sampled from 26 locations during 1992 and 1993. Participants were interviewed and blood specimens were drawn and tested for HIV, level of CD4+ T lymphocytes, and markers of hepatitis B and syphilis. SETTING: Public venues in San Francisco and Berkeley, including street corners and sidewalks, dance clubs, bars, and parks. POPULATION STUDIED: Homosexual and bisexual men aged 17 to 22 years. MAIN OUTCOME MEASURES: Prevalence of HIV infection and risk behaviors. RESULTS: The HIV seroprevalence was 9.4% (95% confidence interval, 6.8% to 12.6%). The prevalence of markers for hepatitis B was 19.8% (95% confidence interval, 16.1% to 23.9%), and that for syphilis was 1.0% (95% confidence interval, 0.3% to 2.4%). The HIV seroprevalence was significantly higher among African Americans (21.2%) than among other racial/ethnic groups (P = .002). Approximately one third (32.7%) of the participants reported unprotected anal intercourse, and 11.8% reported injecting drug use in the previous 6 months. At the time of interview, 70.0% of the HIV-infected men did not know that they were HIV seropositive, and only 22.5% were receiving medical care for HIV infection. CONCLUSIONS: The prevalence of HIV infection is high among this young population of homosexual and bisexual men, particularly among young African-American men. The high rates of HIV-related risk behaviors suggest a considerable risk for HIV transmission in this population. Prevention programs and health services need to be tailored to address the needs of a new generation of homosexual and bisexual men.

Adolescent↗

HIV risk behavioral surveillance: a methodology for monitoring behavioral trends.

OBJECTIVE: This article summarizes issues and recommendations for conducting HIV risk behavioral surveillance surveys (BSS) based on experiences from ten BSS projects in eight countries in Asia and Africa. BACKGROUND: BSS consists of systematic and repeated cross-sectional surveys of HIV and sexually transmitted disease-related behaviors, with other knowledge and attitudinal variables added where appropriate. Its major purpose and utility is in detecting trends among selected vulnerable and high-risk population groups whose behavioral change can have the most impact on the epidemic. BSS is also useful for tracking trends in behaviors over time in regions exposed to HIV prevention activities, as a contributing component to the comprehensive monitoring and evaluation of interventions. RECOMMENDATIONS: (i) implement BSS as an essential adjunct to HIV/STD epidemiological surveillance; (ii) use BSS for evaluation purposes in combination with process data and triangulate results with qualitative research; (iii) choose sentinel groups based on epidemiological considerations, evaluation and monitoring needs, representative sampling frames, and political and cultural considerations; (iv) maintain 1-year intervals between survey waves for most groups in order to provide yearly updates on behavioral trends for programmatic adjustments; (v) use internationally standardized indicators and question wording; (vi) maintain strict quality control standards to enhance data validity and reliability; and (vii) develop a clear dissemination strategy during BSS design to increase the likelihood of utilization of BSS results. CONCLUSION: BSS represents a cost-effective way to determine whether programmatic behavioral targets and goals are being met, to identify persisting risk behaviors over time, and to indicate whether new intervention approaches are necessary.

Africa↗

Crack users in east Harlem, New York and Philadelphia, Pennsylvania: HIV-related risk behaviors and predictors of serostatus.

Crack use has been associated with increased risk for HIV seropositivity. This study was undertaken to examine HIV-related risk behaviors among crack users in East Harlem, New York and Philadelphia, Pennsylvania, two northeastern communities which have reported extensive crack use. Crack users recruited in East Harlem (n = 1434) and Philadelphia (n = 694) were compared on demographics, drug and sex-related risk behaviors, health-related behaviors, and HIV serostatus. Many significant differences were found, and seropositivity was higher in the New York sample (25% vs. 11%, chi 2 = 36.28, p < .001). Being a recent drug injector was a significant predictors of seropositivity in both communities, and differences between communities were found in additional predictors of serostatus. Results suggest that tailored HIV interventions may be needed for different communities. In addition, aggregate data across communities, even those that may be in geographical proximity, may obfuscate differences important to incorporate in developing prevention/intervention efforts.

Adult↗

Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting.

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (chi 2 = 48.5, P less than .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused boys. The results confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.

Adolescent↗