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HIV infection and risk behaviors in two cross-sectional surveys of heterosexuals in alcoholism treatment.

OBJECTIVE: To measure the prevalence of human immunodeficiency virus (HIV) infection and high-risk behaviors among heterosexuals in alcoholism treatment, comparing two cross-sectional surveys completed 2 to 3 years apart. METHOD: Two groups of entrants to alcoholism treatment clinics were recruited, between October 1990 and December 1991 (n = 860; 639 men) and between January 1993 and March 1994 (n = 752; 520 men). Participants underwent a structured interview including an assessment of demographics. substance abuse characteristics and sexual behaviors, as well as serotesting for HIV antibodies. Associations were examined between HIV serostatus and several factors, including demographic variables, substance use and high-risk sexual behaviors. RESULTS: The overall HIV seroprevalence in the first and second samples was 5% (95% CI: 3-6%) and 5% (95% CI: 3-7%). When the two samples were compared, there were no significant differences in prevalence of HIV infection by categories of gender, race, income and most other demographic characteristics within either sample: history of injection drug use (IDU) was significantly related to HIV serostatus in both samples. Unsafe sexual practices were common in both samples. When samples were combined, those 30 years of age or older were more likely to be HIV infected, and men and women with no reported history of IDU still had an HIV prevalence of 3% and 2%, respectively. More than half of the respondents had two or more partners in the previous 6 months and reported a history of a sexually transmitted disease. CONCLUSIONS: There was no change in the substantial prevalence of HIV infection and high-risk behavior among heterosexual clients entering alcoholism treatment programs over the 3.5-year study period. The HIV prevalence among non-IDU clients remained several times higher than published estimates from similar community-based heterosexual samples. These data reinforce the concept that heterosexual noninjection drug users are at high risk for HIV and may benefit from intervention programs.

Adult↗

Changes in HIV risk behavior among injecting drug users: the impact of 21 versus 90 days of methadone detoxification.

OBJECTIVE: To evaluate the hypothesis that long-term methadone detoxification would produce greater HIV risk reduction among injecting drug users (IDU) than short-term detoxification. DESIGN: Random assignment to 21 or 90 days of free detoxification. SETTING: Storefront offices in two cities, with referrals to outpatient methadone detoxification. PARTICIPANTS: Out-of-treatment IDU (n = 1803), recruited through street outreach and word of mouth, between April 1990 and March 1991. Of these, 62.6% were successfully located for 6-month follow-up. MAIN OUTCOME MEASURES: Self-reported drug injection and sexual practices at baseline and follow-up. RESULTS: Substantial reductions in risk behavior were observed at follow-up. Substantial percentages of subjects reported less frequent drug injection (54%), use of shooting galleries (85%), needle-sharing (67%), and number of sex partners (73%), and more frequent use of bleach to disinfect needles (67%) and condom use (31%). There were no significant differences in behavioral change between 21 and 90-day treatment, and subjects who entered treatment did not report significantly greater risk reduction than untreated subjects. Discriminant analyses showed a marginal effect for duration of treatment on risk reduction, although results were inconsistent. CONCLUSIONS: Large scale behavioral risk reduction appears to be occurring in this population regardless of treatment condition. In minimal service methadone detoxification, subjects treated under a longer-term detoxification protocol demonstrated no greater risk reduction than those receiving short-term detoxification.

Analgesics, Opioid↗

Raw shellfish consumption and warning labels: results from the 1993 Texas Behavioral Risk Factor Surveillance System (BRFSS) survey.

We used the 1993 Texas Behavioral Risk Factor Surveillance System survey to assess the prevalence of raw shellfish consumption and to find the demographic and behavioral characteristics of raw shellfish consumers. We studied the general impact of warning labels reported by survey respondents. Data were analyzed using univariate and multiple logistic regression methods. Fourteen percent of the Texas surveyed reported consuming raw shellfish. Respondents with incomes greater than or equal to $25,000 and with education beyond high school were more likely to report consuming raw shellfish than were those with incomes less than $25,000 and with high school diplomas or less. Respondents at risk for acute and chronic drinking, driving while intoxicated, and driving without a seat belt were more likely than those not at risk of these behaviors to report consumption of raw shellfish. We did not find a significant difference between eaters and noneaters of raw shellfish regarding the impact of warning labels: however, among eaters of raw shellfish, older respondents were more likely than younger respondents to report that warning labels had no effect on them.

Adolescent↗

Prenatal behavioral risk screening by computer among Native Americans.

BACKGROUND AND OBJECTIVES: Computer interviews have potential value in screening pregnant patients for substance abuse and other behavioral risk factors linked to adverse pregnancy outcomes. The focus of this study was to determine whether a patient-interactive computerized assessment and education program was an acceptable and valid means of obtaining behavioral risk data. METHODS: Study participants completed a computer interview, and computer-generated reports of substance use and physical abuse within the past year were compared with information in the participants' prenatal records. The accuracy of computer interview reports of substance use was evaluated by performing urine drug screens. RESULTS: More than 95% of the 265 women who completed the computer interview rated it favorably. Drug use and physical abuse were reported significantly more often during the computer interview, compared with information obtained from the patients' medical records. Results of urine drug screens demonstrated a high concurrence rate between self-reports of drug use and the results of urine analyses. CONCLUSIONS: Results indicated that the computerized assessment was well received by patients and yielded valid information regarding risk factors for adverse pregnancy outcomes.

Adult↗

Evidence for the effects of HIV antibody counseling and testing on risk behaviors.

OBJECTIVE: To review published abstracts, journal articles, and presentations for evidence of the effects of human immunodeficiency virus (HIV) antibody counseling and testing on risk behaviors. Studies reviewed focused on homosexual men, intravenous drug users in treatment programs, pregnant women, and other heterosexuals. DATA SOURCES: Peer-reviewed journals (January 1986 through July 1990) and published abstracts and oral presentations from the second (1986) through the sixth (1990) International Conferences on AIDS. STUDY SELECTION: We identified 66 studies that included data on the behavioral effects of HIV antibody counseling and testing. By consensus of the authors, 16 of these were excluded because of small sample size or inadequate study design. DATA EXTRACTION: Studies were assessed by the authors according to methodological strength (sample selection, inclusion of appropriate comparison groups, and inclusion of statistical tests of significance). DATA SYNTHESIS: All longitudinal studies of homosexual men reported reductions in risky behavior among both tested and untested men, and a few reported greater decreases among seropositive men than among seronegative men and those untested or unaware of their serostatus. For intravenous drug users in treatment, we found reductions in intravenous drug use and sexual risk behaviors regardless of counseling and testing experience. We found little evidence for the impact of counseling and testing on pregnancy and/or pregnancy termination rates for either seropositive or seronegative high-risk women. We noted substantial risk reduction among heterosexual couples with one infected partner. Findings among other heterosexuals at increased risk were scanty and mixed. CONCLUSIONS: Further studies should specifically address the behavioral consequences of counseling and testing in various settings.

Counseling↗

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.

OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.

Adolescent↗

STD prevention and the challenge of gender and cultural diversity: knowledge, attitudes, and risk behaviors among black and Hispanic inner-city STD clinic patients.

BACKGROUND AND OBJECTIVES: This study describes gender and cultural differences in sex-related risk behaviors, knowledge, and attitudes among black and Hispanic men and women seeking services at an STD clinic in the South Bronx. STUDY DESIGN: Survey instruments were administered to 3,348 men and women selected as a proportionate random sample of clinic patients registered from January through December 1992. RESULTS: There were significant differences in risk behaviors, knowledge about AIDS and STDs, and attitudes related to condom use among men and women who sought services at this large inner-city clinic. Across groups, the majority of subjects had a history of prior STDs and previously had been treated at a STD clinic. Overall levels of knowledge were high, with the exception of specific issues related to condom use and STD symptoms. Gender and cultural differences were most apparent in sex practices, experience with condoms, and attitudes concerning the use of condoms in relationships. CONCLUSIONS: These data indicate the need to design clinic prevention programs that reflect the diversity of gender and culturally based attitudes, knowledge, and behaviors within inner-city populations. Minority men and women who seek services at STD clinics are known to be at high risk of HIV infection and other sexually transmitted diseases. Yet providing all members of this patient population with the same prevention messages is not sufficient; differences in sex practices, educational needs, and concerns about adopting safer sex behaviors must be taken into account. This study underscores how important it is for clinics to develop the multiple interventions necessary to provide patients with the specific information and skills they need--beyond admonishments to avoid risky sex and use condoms--and for clinic staff to be trained in providing education that is gender and culturally appropriate.

Adult↗

[Risk behaviors for HIV transmission among the recent clients of a syringe-exchange program in Madrid, 1993].

OBJECTIVE: To determine the prevalence of the major risk behavior in HIV transmission (syringe sharing and failure to use condoms) and associated factors among drug injectors recruited for a syringe exchange program (PIJ) in the city of Madrid. METHODS: Cross-section study. All the information was obtained in 1993 through structured interviews with 441 users who had injected drugs during the previous month and had resorted to the PIJ five times, at most. The reference period for drug use and risk behaviour was the month prior to the interview. The statistical analysis included bivariate methods and logistical regression techniques. RESULTS: 29.2% shared syringes (18% passing and 21.7% taking used syringes) and of those that had sexual intercourse (49.4%), 42.5% always used a condom. 89.5% had an HIV antibody test and of those that knew the results, 48.6% were HIV-positive. Multivariate analysis showed that the association between certain behaviour patterns was significant; i.e., taking used syringes and: passing used syringes (odds ratio -OR- = 6.1; 95% confidence interval -CI- = 3.0-12.5), being HIV-positive (OR = 4.1; CI = 1.8-9.1), being unaware of HIV antibody test status (OR = 4.2; CI = 1.7-10.2) and having used intravenous drugs for 5-9 years (OR = 2.9; CI = 1.1-7.9); the association was significant between passing used syringes and: using a mixture of heroin and cocaine (OR = 2.7; CI = 1.1-6.4) and being unaware of HIV antibody test status (OR = 2.5; CI = 1.1-6.0). In the sample as a whole, the association between not using condoms ever and consuming cocaine (OR = 1.7; CI = 1.1-2.9) or crack (OR = 3.0; CI = 1.5-5.9) was significant; furthermore, among those that had sexual intercourse, the association was significant between not using condoms ever and: having been in jail (OR = 2.9; CI = 1.3-6.4), injecting drugs 2-4 times a day (OR = 2.4; CI = 1.0-5.8), having sexual intercourse with drug injectors (OR = 2.6; CI = 1.2-5.9) and having intercourse with two or more partners (OR = 0.4; CI = 0.2-0.9). CONCLUSIONS: The prevalence of HIV infection and risk behavior in the transmission of this virus remain high among drug injectors in Madrid. The habit of sharing syringes is still common, especially among HIV-positive drug injectors (a high percentage take used syringe) and among those who are unaware of their HIV antibody test status. The use of condoms is less frequent among those who have sexual intercourse with other drug injectors or with only one partner.

Adult↗

Modifiable high-risk behaviors for cardiovascular disease among family physicians in the United States. A national Survey.

OBJECTIVES: To study the prevalence of modifiable high-risk behaviors that contribute to mortality and morbidity from cardiovascular disease among family physicians in the United States, to examine whether these prevalence rates would differ across geographic regions of the United States, and to determine whether a family history of coronary artery disease differentiated physicians who engage in these high-risk behaviors from those who do not. DESIGN: A mailed self-report survey. SETTING: Family physician members of the American Board of Family Practice. PARTICIPANTS: The survey was mailed to 1500 randomly selected members of the American Board of Family Practice. RESULTS: The response was 62%. The results showed that 97% of the physicians were nonsmokers, 54% engaged in exercise regularly, 36% considered themselves overweight, and 91% knew their lipid profile. Of the respondents, 63% reported having a family physician, 78% reported visiting their physician as needed, and 41% reported having had a physician visit in the past year. Forty-one percent of the physicians reported having a family history of coronary artery disease. There were no notable differences regarding the prevalence of these behaviors across the 5 geographic areas or between respondents with a family history of coronary artery disease and those without such a history. CONCLUSION: Our results suggest that the respondents as a group engage in health practices that help to prevent cardiovascular disease. However, the frequency of exercise among these physicians is below the recommended level, and efforts should be made in promoting exercise among this population.

Adult↗

Combination therapies for HIV and sexual risk behavior among gay men.

OBJECTIVE: To examine optimism in the light of recent advances in HIV treatment among gay men and its association with sexual risk behavior. METHODS: An anonymous questionnaire was completed by gay men who visited gyms in central London in March and April 1998 regarding their HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and their response on a five-point linear scale to two measures of optimism: "I am less worried about HIV now that treatments have improved," and "I believe that new drug therapies make people with HIV less infectious." RESULTS: Two thirds of the men (67.5%, 522 of 773) did not agree with the statement, "I am less worried about HIV now that treatments have improved," and only 42 (5.4%) said they agreed quite a lot or a lot. HIV-positive men were more likely to agree with this statement than HIV-negative men (p = .001) and men who had never been tested (p < .001). There was no association between agreement with this statement and frequency of UAI among HIV-positive or never-tested men (p > .3); there was, however, a positive association among HIV-negative men who reported UAI with a partner of unknown or discordant status (p = .003). The vast majority of men (81.4%; 634 of 779) did not agree with the statement, "I believe that new drug therapies make people with HIV less infectious." Regardless of HIV status, no significant association was seen between agreement with this statement and frequency of UAI (p > .1 for all comparisons). CONCLUSION: Most gay men surveyed in central London gyms did not endorse the optimism statements concerning improved treatments or reduced infectivity. Although HIV-positive gay men were more likely to be optimistic than other men, there was no association between their optimism and sexual risk behavior. Among HIV-negative men, optimism around improved treatments (but not around reduced infectivity) was associated with UAI with a partner of unknown or discordant HIV status. For some HIV-negative men in London, optimism in the light of recent advances in HIV treatment may have triggered, or have been used as a justification for, sexual risk-taking.

Adult↗

Large declines in sexual risk behavior with noncommercial partners among heterosexual injection drug users in Amsterdam, 1989-1995.

Previous studies among injection drug users have reported small or nonexistent reductions in sexual risk behavior with noncommercial partners, and a large potential for further heterosexual spread of human immunodeficiency virus (HIV) is thought to be present. In the present study, a long-term follow-up and detailed data on sexual behavior were available. Trends were determined using data collected at 5,214 visits of 653 heterosexual injection drug users who participated in the Amsterdam Cohort Study in Amsterdam, the Netherlands between April 1989 and May 1995. Analysis accounted for repeated measurements of one individual and the effect of participation in the study itself. The authors observed a large reduction in sexual risk behavior with noncommercial partners that became apparent only after stratification of trends by knowledge of HIV serostatus. Sex with noncommercial partners and inconsistent condom use both decreased, especially among known HIV-positive individuals. Apart from nonrandom condom use, there also was nonrandom mixing (selective partner choice). Because this was like-with-like mixing, the risk for further sexual transmission of HIV is diminished. In future studies, more detailed information on sexual behavior, mixing, and knowledge of serostatus should be collected. HIV-epidemic modelers should incorporate nonrandom condom use and nonrandom mixing to improve forecasting.

Adult↗

HIV-related risk behavior among Hispanic immigrant men in a population-based household survey in low-income neighborhoods of northern California.

OBJECTIVES/GOAL: We compared risk behaviors and HIV testing between recent (in the U.S. <5 years) and established (in the U.S. >5 years) Hispanic immigrant men (N = 410). STUDY: This study was a population-based, cross-sectional survey of HIV/sexually transmitted disease markers and risk behaviors in men age 18 to 35 years residing in low-income census block groups in 3 northern California counties. RESULTS: Recent immigrants were less likely to currently have a main sexual partner (45.3% vs. 67.2%, P <0.01) and more likely to have ever used commercial sex workers (40.0% vs. 27.6%, P <0.01). Recent immigrants were less likely to receive medical care in the last 6 months (21.2% vs. 31.3%, P = 0.04) or had ever been HIV tested (26.0% vs. 43.3%, P <0.01). Established immigrants more likely reported unprotected sex, hallucinogen or ecstasy use. CONCLUSIONS: Recent Hispanic immigrants have less stable sexual partnerships and less health-seeking behavior, including HIV testing. Established immigrants report HIV test rates comparable to the national average.

Adolescent↗

Prevalence and correlates of AIDS-risk behaviors among urban minority high school students.

BACKGROUND: To guide the development of an AIDS prevention program for urban minority high school students, the authors investigated the prevalence of AIDS-risk behaviors, and the relative explanatory power of demographic, contextual, and cognitive correlates of these behaviors, among black and Hispanic students in three New York City public high schools. METHODS: A survey was administered to a randomly selected sample of classrooms in the 9th through 12th grades of three public academic high schools in a New York City borough. Survey participants (n = 926) were 59% black and 34% Hispanic; the mean age was 16.4 (sd 1.4) years. RESULTS: Two-thirds of students reported having had sexual intercourse. Of the more than one-half of students who reported past-year intercourse, three-quarters had never or had inconsistently used condoms, one-third had multiple intercourse partners, one-tenth had a sexually transmitted disease, and one-twentieth had intercourse with a high-risk partner. Demographic (i.e., age, race/ethnicity) and contextual (i.e., academic failure, substance use, adverse life circumstances, cues to prevention) factors were most strongly associated with involvement in AIDS-risk behaviors; in contrast, cognitive factors (i.e., knowledge and beliefs about AIDS and AIDS-preventive actions) had little explanatory power. CONCLUSIONS: Addressing demographic and contextual risk factors for involvement in AIDS-related behaviors may prove to be a more powerful AIDS-prevention strategy among adolescents than simply teaching facts about AIDS and fostering prevention-related beliefs.

Acquired Immunodeficiency Syndrome↗

Psychopathology and HIV risk behaviors among injection drug users in and out of treatment.

To replicate prior descriptions of injection drug users (IDUs), 158 IDUs recruited via a street-outreach program were compared to 320 non-IDUs on measures of substance use, lifetime psychopathology, and HIV risk behavior. IDUs were more likely to receive a diagnosis of antisocial personality disorder, but not other psychiatric diagnoses, and to report dependence on multiple substances. IDUs reported more HIV risk behaviors, but perceived HIV risk did not differ from non-IDUs. Compared to IDUs who declined treatment, IDUs willing to accept treatment did not differ on drug-related problems, lifetime psychopathology, or perceived HIV risk.

Adolescent↗

Behavioral risk factors and human immunodeficiency virus (HIV) prevalence among intravenous drug users in Puerto Rico.

This study reports on four empirical models likely to contribute to understanding the behaviors linked with human immunodeficiency virus (HIV) among intravenous drug users. The sample comprises 1,637 intravenous drug users recruited between May 1989 and June 1990 in San Juan, Puerto Rico. Adjusting for sociodemographics, four logistic regression models were constructed to assess the association of risk behaviors with HIV seropositivity. In model 1, the variables found to be significantly associated with HIV seropositivity were injecting four times a day, injection as the only route of consuming drugs, and years of injection. In model 2, the only risk behavior significantly associated with HIV seropositivity was injecting drugs in shooting galleries. In model 3, all sex risk variables failed to meet the adjusted level of significance. In model 4, pneumonia, hepatitis, and syphilis were significantly linked with HIV infection. In order to assess the individual effects of the significant variables in each one of the four models, a logistic regression analysis was performed simultaneously controlling for all of the variables. After adjustment for the Bonferroni correction, age group 25-34 years, injection as the only route of using drugs, number of years of injection, and syphilis were the only significant variables remaining.

Age Factors↗

Parental monitoring, negotiated unsupervised time, and parental trust: the role of perceived parenting practices in adolescent health risk behaviors.

PURPOSE: To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents. METHODS: Data were derived from 692 adolescents in 9th and 10th grades (x = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a self-administered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana). RESULTS: For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males. CONCLUSIONS: Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.

Adolescent↗

Sexual risk behaviors of Gay, Lesbian, and bisexual youths in New York City: prevalence and correlates.

The lifetime and recent sexual risk behaviors of 156 Gay, Lesbian, and bisexual youths, recruited from Gay-focused organizations in New York City, were examined. The data indicated seven reasons why the youths are at risk for HIV and other STDs: They initiated sex during early adolescence; their first sexual partners were older than they were; HIV barrier methods (e.g., condoms) were initiated subsequent to sexual debut; many lifetime sexual partners and encounters were reported; some youths exchanged sex for goods; many youths reported having had at least one partner at risk for HIV; and the youths engaged in unprotected sexual behaviors during the past 3 months. Significant gender differences emerged (e.g., the male youths reported more lifetime same-sex partners than the female youths; the female youths reported more lifetime other-sex partners than the male youths). Recent sexual risk behaviors (i.e., numbers of same-sex partners, encounters, and unprotected sex during the past 3 months) were related significantly to the youths' average degree of emotional involvement in or average duration of intimate relationships.

Adolescent↗

Effects of oral donor questioning about high-risk behaviors for human immunodeficiency virus infection.

The purposes of this study were 1) to compare blood donor deferrals resulting from additional, oral questions about human immunodeficiency virus risk behaviors with deferrals resulting from currently used, written screening questions; 2) to examine differences in donor deferral resulting from use of an indirect (IQ) versus direct (DQ) additional oral question format; and 3) to evaluate written survey responses of donors and staff members to the additional questions. The IQ group (n = 3050) were asked if they understood the seven ineligible-donor risk behaviors, and the DQ group (n = 4753) were asked if they had engaged in any of these behaviors. Owing to positive answers or refusal to answer the additional questions, there was an increase in donor deferrals, over the level seen with customary screening. Only 1 percent of donors indicated they would not return if the questions were asked in the future. Embarrassment was indicated by 3 percent of the IQ group and 7 percent of the DQ group; 14 to 15 percent preferred to write their answers rather than give them orally. The staff members generally felt training was adequate (IQ = 92%, DQ = 83%) and were comfortable asking the questions (IQ = 82%, DQ = 78%). Mean screening times were 5.7 minutes before the addition of the oral questions, 7.5 minutes with IQ, and 7.6 minutes with DQ. This study confirms the value of IQ and DQ formats in identifying potentially infectious donors and suggests that the DQ format may be slightly more effective.

Attitude to Health↗