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A grounded theory approach was used to describe how males and females in late adolescence communicate with their sexual partners about sexual risk behaviors. Interviews were audiotaped with 18 women and 15 men from a university in the southeastern United States. Verbatim transcripts were analyzed using constant comparative analysis. Building trust was identified as the core variable for both men and women. For women, prerequisites for building trust were being involved in caring relationships and indirectly gathering information about potential sexual partners. For men, prerequisites were being involved in caring relationships and using their instincts. Women usually initiated safe-sex talk, but men were willing to discuss it, once the conversation was initiated. Findings can serve as a guide for developing nursing strategies that promote more effective communication about sexual risk behavior in this age group.
The HIV/AIDS epidemic in Sub-Saharan Africa poses a massive diffusion and persuasion challenge for health professionals. Individuals working with adolescents to prevent the spread of HIV/AIDS must gain an understanding of adolescent's preference in obtaining information about HIV/AIDS and sexual behaviors. This study describes the primary and preferred sources of information regarding HIV/AIDS and sexual risk behavior in relation to several socio-demographic variables (n=941) in Swaziland, Southern Africa. Although print/broadcast media was the primary source for HIV/AIDS and sexual risk behavior information for the students, most participants preferred information from the healthcare workers. This study suggests a greater role for healthcare providers in providing HIV/AIDS and sexual risk information.
This journal issue includes seven articles (six plus this introduction) from the "cocaine workgroup" of the National Institute on Drug Abuse (NIDA) treatment demonstration grants. In this introduction, results of the first attempts to compare data from seven disparate demonstration grant sites are summarized: Overall, rates of recent cocaine use were high in all locations, injection drug use was common, age of first drug use was between 14 and 17 years with age of first cocaine use between 20 and 25 years, arrests were common at all sites especially among cocaine injectors, and polydrug use was the norm. Interestingly, both gender and ethnic status were significantly associated with polydrug use and marijuana use among the cocaine users. These results indicated that it is possible to define variables precisely for analysis across sites and laid the groundwork for the next set of analyses in which the common theme of human immunodeficiency virus (HIV) risk behaviors among cocaine abusers was agreed upon. This next set of analyses are included in the following six papers. Overall, these reports confirm recent data about the association of cocaine use with HIV risk behaviors. They extend considerably the literature on the association of cocaine with HIV risk behaviors, and the report from New York in which therapeutic community treatment was shown to be feasible and possibly useful to methadone clients represents an interesting and new finding. In conclusion, cross-site collaborations can take different forms and this collection of papers represents one successful approach.
OBJECTIVE: To find the prevalence of HIV infection and risk behaviors among injecting drug users (IDUs) in Karachi, Pakistan. DESIGN: A cross-sectional study of IDUs conducted in Karachi, Pakistan from February through June 1996. RESULTS: Of the 242 IDUs, 11 (4%) refused HIV testing. One (0.4%; 95% confidence interval (CI) = 0.37-0.48%) was HIV positive. All subjects were male. Over the past 6 months 47% had engaged in receptive needle sharing, 38% had perceived a change in their social network, 22% had had sexual intercourse, of whom only 7% always used condoms, and none had washed their needles with bleach. Younger age (28 vs. 31 years; p = 0.01), younger age at first injection (25 vs. 28 years; p = 0.001), fewer years of schooling (3 vs. 5 years; p = 0.001), lower monthly income (70 dollars vs. 80 dollars; p = 0.03), inhaling fumes of heroin from a foil in the year before injecting (OR = 4.8; CI = 2.2-10.3), injecting first time with heroin (OR = 3.6; CI = 1.2-12.6), having a temporary job (OR = 2.5; CI = 1.2-5.2), and a perceived change in one's social network (OR = 4.4; CI = 2.4-7.9) were all associated with receptive needle sharing. IDUs who knew about HIV spread through contaminated needles were less likely to share (OR = 0.4; CI 0.2-0.8). In the final logistic regression model receptive needle sharing was associated with inhaling of fumes of heroin on a foil in the year prior to injecting (adjusted OR = 5.6; CI = 2.6-12.0), a perceived change in one's social network (adjusted OR = 4.0; CI = 2.2-7.4), and inversely associated with age at first time of injection (beta = -0.07; p = 0.002). CONCLUSION: Background HIV prevalence was low among IDUs in Karachi despite high-risk behavior in 1996. In order to control HIV transmission among IDUs in Pakistan, continual HIV surveillance with well-coordinated and effective HIV risk reduction, and drug demand reduction programs need to be implemented among drug users.
This study examined the relationships among sociodemographic characteristics, family processes, and the initiation of health risk behaviors in early adolescence. Subjects were 189 6th and 7th graders from a public middle school. A path-analytic model was used to analyze data. Results showed that students who received autonomy support from parents were less likely to initiate sexual intercourse. Students who were emotionally detached from their parents were more likely to fight and use substances. Those who were emotionally detached tended to come from families with low levels of cohesion and acceptance. Sociodemographic variables, such as family structure, gender, and ethnicity, had both direct and indirect effects on health risk behaviors, but the indirect effects were quite small.
This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1%, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.
This study assessed whether behavioral differences explained higher human immunodeficiency virus (HIV) seroprevalence among injection drug users (IDUs) in three East Coast versus two West Coast cities in the United States. Sociodemographic, sexual, and injecting information were collected during semiannual face-to-face interviews. Baseline data from New York City; Baltimore, Maryland; and New Haven, Connecticut, were compared with data from Los Angeles, California, and San Jose, California. Among 1,528 East Coast and 1,149 West Coast participants, HIV sero-prevalence was 21.5% and 2.3%, respectively (odds ratio [OR] 11.9; 95% confidence interval [CI] 7.9-17.8). HIV risk behaviors were common among IDUs on both coasts, and several were more common among West Coast participants. Adjusting for potential risk factors, East (vs. West) Coast of residence remained highly associated with HIV status (adjusted OR 12.14; 95% CI 7.36-20.00). Differences in HIV sero-prevalence between East and West Coast cities did not reflect self-reported injection or sexual risk behavior differences. This suggests that other factors must be considered, such as the probability of having HIV-infected injection or sexual partners. Prevention efforts are needed on the West Coast to decrease HIV-associated risk behaviors among IDUs, and further efforts are also needed to reduce HIV incidence on the East Coast.
OBJECTIVES: The authors examined HIV risk behaviors among African American, Asian/Pacific Islander (API), and Latina male-to-female (MTF) transgender persons in order to improve HIV prevention programs. METHODS: Individual survey interviews with MTF transgender persons of color (n = 332; 112 African Americans, 110 Latinas, and 110 APIs) were conducted. RESULTS: Prevalence and correlates of receptive anal sex and unprotected receptive anal sex (URAS) varied by type of partner (primary, casual, or commercial sex partners). URAS with primary partners was associated with drug use before sex; URAS with casual partners was associated with HIV-positive status and drug use before sex; and URAS with commercial sex partners was associated with African American ethnicity and low income. CONCLUSIONS: Findings on current risk behaviors among MTF transgender persons provided meaningful implications for HIV prevention interventions.
Relations among latent constructs of Social Conformity, Sensation Seeking, Polydrug Use, Sexual Experience, Abortion, and Risky AIDS Behaviors were examined among a community sample of women (N = 438, mean age = 25.5 years) using confirmatory factor analysis (CFA) and predictive structural equation models (SEM). In the CFA, Risky AIDS Behavior was strongly related to more Polydrug Use and less Social Conformity and modestly related to Sexual Experience and Abortions. In SEMs, Social Conformity significantly predicted less Risky AIDS Behavior and less Polydrug Use but did not predict Abortions. Prior Sexual Experience predicted more Polydrug Use and Abortions. We conclude that the same psychological processes and predispositions that relate low social conformity to drug use and other unhealthy behaviors also influence AIDS-risk behaviors, even among a community sample of women.
An effective state heart disease and stroke prevention program must be able to monitor changes in heart disease and stroke risk factors of the state population. The Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey, has been an important source for monitoring health-related factors and evaluating the success of programs. The BRFSS currently includes modules on hypertension and cholesterol screening and awareness, cardiovascular disease preventive practices, and recognition of the signs and symptoms of heart attack and stroke as well as relevant modules on fruit and vegetable intake, physical activity, tobacco use, and diabetes. Publication topics included monitoring risk factors and clinical services, assessing progress toward national goals, assessing health disparities, and health status and health-related quality of life issues. States have used the BRFSS data for monitoring health risks in the state, assessing state and national health objectives, determining and providing data for public health campaigns, providing information for legislative proposals, and providing information that helps to initiate collaboration. Major methodologic issues involve validating self-reported data against direct measurement and assessing the effects of changes in telecommunications. As Centers for Disease Control's (CDC) national heart disease and stroke prevention program and each state health department program develop, state and even local level data will become more important to measure the burden of disease and program impact. State heart disease and stroke prevention programs are encouraged to work closely with state BRFSS coordinators to obtain vital information to measure the burden of heart disease and stroke in their state and to be able to measure program impact on addressing the first and third leading causes of death in the U.S.
Four hundred fifty-five women in family-planning and sexually transmitted disease (STD) clinics were surveyed to determine the degree of participation in behaviors known to be associated with increased risk of human immunodeficiency virus (HIV) infection. A previous history of STD (20%) and multiple sexual partners (73%) were shown to be the high-risk behaviors most prevalent in these populations. Sexual intercourse with persons in high-risk groups (6%) and intravenous (IV) drug use (3.7%) were less prevalent. Differences between the populations from each type of clinic and between races were noted. Overall, almost one third of family-planning clinic clients and nearly half of STD clinic clients reported participation in at least one risk behavior, emphasizing the need for educational efforts toward disease prevention in these settings.
OBJECTIVE: This study examined two potential mechanisms linking violence exposure and health risk behavior among adolescents in psychiatric care: sensation seeking and coping with stress through escape behavior. METHOD: Male (59%) and female adolescents (N = 251), ages 12 to 19 years, from diverse ethnic backgrounds (61% African American, 19% white, 12% Latino, 8% biracial or other ethnicity) completed a computer-administered survey assessing study variables from 1999-2004. Overall clinic consent rate was 41%. Age and gender were included in all analyses. RESULTS: Consistent with the literature on nonpsychiatric samples, violence exposure was associated with both increased substance use and sexual risk taking. Violence exposure was not associated with motivation to engage in risk behavior as a means of escape, although motivation to cope through escape was associated with a greater likelihood of substance use. Sensation seeking was related to substance use and sexual risk taking among all adolescents and with violence exposure primarily within male adolescents. CONCLUSIONS: Clinical interventions should promote adaptive coping strategies that emphasize maintaining healthy behavior, effective problem solving skills, and stress management techniques.
OBJECTIVE: The purpose of this study was to examine the relationships between childhood abuse/neglect experiences (sexual abuse, physical abuse, emotional abuse, and child neglect) and adult life functioning among Methadone Maintenance Treatment Program (MMTP) drop-outs. METHOD: 432 subjects who dropped out of MMTP were recruited in New York City in 1997-1999. Adult life functioning was measured by HIV drug and sex risk behaviors, Addiction Severity Index (ASI) composite scores, and depression. The chi(2) tests, t tests, correlation, and multiple logistic regressions were performed to examine the relationships between abuse experiences and adult life functioning. RESULTS: The prevalence of child abuse/neglect history was high among MMTP drop-outs: sexual abuse-36%; physical abuse-60%; emotional abuse-57%; child physical neglect-66%; all four experiences-25%. As assessed via ASI composite scores, those who had been abused in childhood had significantly more medical, legal, relationship, and psychological problems than those who had not. Overall, several significant associations were found between the abuse experiences and HIV risk behaviors. Those who had experienced child neglect were more likely to be HIV positive. In multivariate analyses, childhood physical abuse was a significant predictor of having multiple sex partners while depression was significantly related to injection drug use in adulthood (p<.05). There were trends for the relationships between childhood sexual abuse and HIV sex risk behavior (p<.10) and between gender and injection drug use (p<.10). CONCLUSIONS: The findings support a need for drug treatment programs that include specialized therapies for those who suffered childhood abuse and neglect experiences.
OBJECTIVE: Few studies have examined the impact of placement in foster care prospectively to determine what early responses might predict later functioning. The current study examined protective and vulnerability factors in a longitudinal study of youth placed in foster care. METHODOLOGY: A cohort of 214 ethnically-diverse youth, ages 7-12, who entered foster care between May 1990 and October 1991 were recruited for the Time 1 study if they remained in foster care for at least 5 months. For the Time 1 study, youth and their caregivers were interviewed and assessed approximately 6 months following their initial placement. Six years later, as adolescents, the youth were re-interviewed regarding their involvement in four domains of risk behavior. RESULTS: Bivariate analyses indicated that several Time 1 control variables (e.g., age, ethnicity, type of maltreatment, behavior problems) and Time 1 psychosocial predictor variables (i.e., dimensions of social support and self-perception) were related to the Time 2 risk behavior outcomes. Regression analyses with all variables accounted for between 33 and 46% of the variance, with the psychosocial predictor variables, as a group, significant over and above the control variables. CONCLUSIONS: The results suggest that there are some modifiable protective and vulnerability factors present shortly after maltreated youth are placed in foster care that predict their engagement in adolescent risk behaviors 6 years later.
OBJECTIVE: To determine the demographic characteristics and risk behaviors associated with HIV positive and negative injection drug users (IDUs) who were screened for inclusion in a prospective cohort study to estimate HIV incidence in Xinjiang, China. METHODS: Data analyses were performed on the demographic and risk assessment data collected at screening from high-risk IDUs, defined as anyone who reported injecting drugs at least three times per week in the last month or injected drugs after sharing equipment on at least three occasions in the last three months. RESULTS: HIV antibody prevalence among 781 IDUs at baseline survey was 29%. The following factors were significantly associated with an increase in risk for HIV infection: age > or =26years (OR=3.16, 95% CI [2.02;4.94]), lack of college education (OR=2.32, 95% CI [1.02;5.25]), frequency of heroin use (OR=1.23, 95% CI [1.02;1.47]) and sharing of rinse water (OR=1.47, 95% CI [1.18;1.84]). Female gender (OR=0.44, 95% CI [0.22;0.86]), being Han vs Uighur ethnicity (OR=0.18, 95% CI [0.11;0.27]), and other race vs Uighur ethnicity (OR=0.23, 95% CI [0.12;0.44]) were significantly associated with a lower risk of HIV infection. CONCLUSIONS: HIV infection among high risk IDUs in Xinjiang, China is high and is associated with older male Uighur IDUs who lack college education, frequently inject heroin, and/or share rinse water. There is a great potential for HIV transmission from IDUs to the general population. Therefore, related risk behaviors in IDUs, especially their sexual behavior, should be closely monitored.
This study compared health care utilization and HIV-related risk behaviors between HIV-infected African American (n=123) and Hispanic (n=97) drug users recruited in New York City. African Americans were more likely to use crack, while Hispanics were more likely to use heroin and speedball. African Americans were more likely than Hispanics to report having traded sex for drugs or money. The two groups did not significantly differ in HIV care utilization (e.g., taking HIV medications). In multiple logistic regression analyses, for African Americans, taking HIV medications was significantly related to enrollment in HIV clinics and non-use of crack, while for Hispanics, being married and attending HIV support groups were significant factors. Drug treatment enrollment was significantly related to non-use of crack and injection drug use among African Americans, and a trend (p=.07) was found between injection drug use and drug treatment enrollment among Hispanics. The findings indicate the continuing need for harm reduction programs for HIV positive drug using populations. Programs for these populations should also take into account the different risk behaviors among different racial/ethnic groups, in order to tailor culturally sensitive programs for HIV care and intervention.
PURPOSE: This study aimed to describe prevalence of and risk factors for HIV among persons with newly diagnosed class III (confirmed) and class V (suspected) cases of tuberculosis (TB) patients in Los Angeles County. METHODS: HIV testing was performed on 1307 blood specimens after routine tests were completed at six TB clinics in Los Angeles County. HIV test results were matched to demographic and risk behavior information by use of an unlinked study methodology. RESULTS: The overall HIV prevalence rate was 10.8%. By demographic characteristics, the highest prevalence rates were observed among persons born in the United States (15.7%), males (14.1%), blacks (14.3%), and those aged 30-44 years (14.4%). Confirmed TB cases (14%) were more likely to be HIV-infected than were suspect cases (9.6%). Risk behaviors associated with positive HIV serostatus included the injection of nonprescription drugs, having sex with an injection drug user, and use of noninjection forms of heroin, cocaine, and tranquilizers. Men who have sex with men were more likely to be HIV-infected than were heterosexual males. CONCLUSIONS: HIV testing and counseling should be a standard of care in TB clinics. The observed high HIV prevalence rate reinforces the importance of designing prevention strategies that specifically target patients with TB.