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PubMed2005

Risk behaviors among Asian women who work at massage parlors in San Francisco: perspectives from masseuses and owners/managers.

This study investigates cognitive, cultural, and contextual factors that influence HIV-related risk behaviors among Asian women who engage in sex work at massage parlors in San Francisco. Focus groups and qualitative interviews were conducted for Vietnamese and Thai masseuses and massage parlor owners/managers. Economic pressure as well as subjective evaluation of customers for the risk of HIV/STD infection increase unprotected sexual behaviors among Asian masseuses. Massage parlor owners/managers do not establish a clear policy for condom use at their parlors. Consequently, male customers often manipulate their intention not to use a condom while negotiating with masseuses. HIV/STD prevention intervention programs should address specific risks and needs for Asian masseuses, owners/managers, and male customers in order to promote health and well being among Asian masseuses who have been neglected by public health and social services.

Asian↗
PubMed2005

The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998-2003.

BACKGROUND: The authors sought to monitor the impact of widespread varicella vaccination on the epidemiology of varicella and herpes zoster. While varicella incidence would be expected to decrease, mathematical models predict an initial increase in herpes zoster incidence if re-exposure to varicella protects against reactivation of the varicella zoster virus. METHODS: In 1998-2003, as varicella vaccine uptake increased, incidence of varicella and herpes zoster in Massachusetts was monitored using the random-digit-dial Behavioral Risk Factor Surveillance System. RESULTS: Between 1998 and 2003, varicella incidence declined from 16.5/1,000 to 3.5/1,000 (79%) overall with > or = 66% decreases for all age groups except adults (27% decrease). Age-standardized estimates of overall herpes zoster occurrence increased from 2.77/1,000 to 5.25/1,000 (90%) in the period 1999-2003, and the trend in both crude and adjusted rates was highly significant (p < 0.001). Annual age-specific rates were somewhat unstable, but all increased, and the trend was significant for the 25-44 year and 65+ year age groups. CONCLUSION: As varicella vaccine coverage in children increased, the incidence of varicella decreased and the occurrence of herpes zoster increased. If the observed increase in herpes zoster incidence is real, widespread vaccination of children is only one of several possible explanations. Further studies are needed to understand secular trends in herpes zoster before and after use of varicella vaccine in the United States and other countries.

Adolescent↗
PubMed2006

Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior.

The present study sought to investigate the prevalence of hepatitis C virus (HCV) among men who have sex with men (MSM) seen at a community health center, and to examine risk factors associated with infection. The study population included 218 MSM who were screened for HCV infection during routine clinic visits from May through December, 2001. Eighty-four percent of those screened (n = 183) agreed to complete a self-report questionnaire assessing drug use, sexual practices, and medical history. Participants ranged in age from 22 to 54 years. The majority of participants (82%) self-identified as Caucasian and 35% were HIV-positive. Prevalence of HCV infection was 11.5%. Men infected with HCV were more likely than HCV uninfected men to be coinfected with HIV and hepatitis B, and to have a history of rectal or urethral gonorrhea. HCV-infected men were more likely to have seen blood on shared cocaine straws and to have used crack cocaine in the past 6 months. Overall, 12% of HCV-infected men reported no parenteral risk factors for HCV infection. HCV seropositivity was significantly associated with an aggregate score representing high-risk behavior in the past six months. HCV prevention and screening should target MSM engaging in high-risk sex. Conversely, HIV and sexually transmitted infection risk reduction interventions should be targeted at MSM with HCV.

Adult↗
PubMed2000

Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners.

OBJECTIVE: There were two aims in this research. First, to examine the relationships between childhood sexual abuse and HIV drug and sexual risk taking behaviors among female prisoners, and second, to examine the relationship between a marginal adult living context and HIV drug and sexual risk taking behavior among female prisoners. METHOD: The data were collected through face-to-face interviews with a random sample of 500 women at admission to prison in 1994. Differences between women who were sexually abused while growing up (n = 130) were compared to women who reported no sexual abuse (n = 370) along various demographic, and HIV drug and sexual risk taking dimensions. RESULTS: A history of sexual abuse while growing up was associated with increased sexual risk taking behaviors in adulthood. A marginal adult living situation also emerged as an important factor increasing the risk for HIV infection. Examining the co-occurrence of both childhood sexual abuse and adult marginal living context revealed a strong relationship between these two factors and HIV risk taking activities. CONCLUSIONS: The findings indicate that childhood sexual abuse may be a predictor for HIV sexual risk taking behaviors among incarcerated women. The marginal and chaotic adult living style of these women was also associated the extent of their HIV drug and sexual risk taking behaviors. Our research suggests that the co-occurrence of sexual victimization and marginality is a stronger predictor of HIV risk than each variable alone.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Correlates of inmates' self-reported HIV/AIDS risk behaviors, prior incarceration, and marijuana use.

The primary purpose of this study was to determine associations between measures of prior incarceration and marijuana use with self-reported HIV/AIDS risk behaviors among a sample of soon-to-be-released adult male inmates. Analyses presented exclusively involve calculating two multiple logistic regression models to test the study hypothesis. The general model specified self-reported marijuana use as an outcome with selected demographic variables including ethnicity, age, education, and income prior to incarceration as predictor variables. Significant bivariate associations were recorded for age, education, and sexual self-expectation with respect to reincarceration. Specifically, the least amount of education reported, the more likely study participants were to have been incarcerated more than once.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Longitudinal pathways linking family factors and sibling relationship qualities to adolescent substance use and sexual risk behaviors.

This 3-wave, 5-year longitudinal study tested the contributions of family contextual factors and sibling relationship qualities to younger siblings' substance use, sexual risk behaviors, pregnancy, and sexually transmitted disease. More than 220 non-White families participated (67% Latino and 33% African American), all of which involved a younger sibling (133 girls and 89 boys; mean age = 13.6 years at Time 1) and an older sister (mean age = 17 years at Time 1). Results from structural equation latent growth curve modeling indicated that qualities of the sibling relationship (high older sister power, low warmth/closeness, and low conflict) mediated effects from several family risks (mothers' single parenting, older sisters' teen parenting, and family's receipt of aid) to younger sibling outcomes. Model results were generally stronger for sister-sister pairs than for sister-brother pairs. Findings add to theoretical models that emphasize the role of family and parenting processes in shaping sibling relationships, which, in turn, influence adolescent outcomes.

Adolescent↗
PubMed1993

Human immunodeficiency virus infection and risk behaviors among injection drug users in four Puerto Rican communities.

This study compares the prevalence of human immunodeficiency virus (HIV) infection and HIV risk behaviors among 1,702 injection drug users (IDUs) recruited within four catchment areas in metropolitan San Juan (79.9% male and 20.1% female). To assess the impact of different antecedent variables on intercommunity risk differences, we constructed separate logistic regression models for each one of the catchment areas in the analysis. Old San Juan/Santurce has the highest rate of HIV seropositivity. Furthermore, Old San Juan/Santurce IDUs were more likely to have had incarceration experience, to report using drugs only by injection, and to have been injecting drugs for 16 years or more. Also, this group was more likely to report practicing prostitution and to have been diagnosed with sexually transmitted diseases (STDs) than their peers from the other sites. The need of preventive programs in specific communities within metropolitan urban areas is discussed.

Adult↗
PubMed2003

Health and behavior risks of adolescents with mixed-race identity.

OBJECTIVES: This study compared the health and risk status of adolescents who identify with 1 race with those identifying with more than 1 race. METHODS: Data are derived from self-reports of race, using the National Longitudinal Study of Adolescent Health (Add Health), which provides a large representative national sample of adolescents in grades 7 through 12. Respondents could report more than 1 race. RESULTS: Mixed-race adolescents showed higher risk when compared with single-race adolescents on general health questions, school experience, smoking and drinking, and other risk variables. CONCLUSIONS: Adolescents who self-identify as more than 1 race are at higher health and behavior risks. The findings are compatible with interpreting the elevated risk of mixed race as associated with stress.

Adolescent↗
PubMed2005

Seizing the 9-month moment: addressing behavioral risks in prenatal patients.

OBJECTIVE: Our qualitative study explored prenatal care providers' methods for identifying and counseling pregnant women to reduce or stop smoking, alcohol use, illicit drug use, and the risk of domestic violence. METHODS: We conducted six focus groups (five with OB/Gyn physicians, one with nurse practitioners and certified nurse midwives), total N=49, using open-ended questions. Investigators analyzed transcripts to identify and describe themes. RESULTS: Three major themes emerged: (1) specific risk-prevention tactics or strategies exist that are useful during pregnancy; (2) some providers address patients' isolation or depression; and (3) providers can adopt a policy of "just chipping away" at risks. Specific tactics included normalizing risk prevention, using specific assessment techniques and counseling strategies, employing a patient-centered style of smoking reduction, and involving the family. CONCLUSIONS: Providers generally agreed that addressing behavioral risks in pregnant patients is challenging. Patient-centered techniques and awareness of patients' social contexts help patients disclose and discuss risks. PRACTICE IMPLICATIONS: Brief but routine assessment and risk reduction messages require little time of the provider, but can make a big difference to the patient, who may make changes later.

Attitude of Health Personnel↗
PubMed1995

AIDS knowledge, risk behaviors, and condom use among four groups of female sex workers in Bali, Indonesia.

The objectives of this study were to discover the AIDS knowledge, risk behaviors, and condom use of four groups of female professional sex workers (n = 614). Personal interviews were conducted with women working in low-price brothels, mid-price and high-price houses, and tourist areas. Only 51% of women in the low-price brothels had heard of AIDs, although most of the women in the other groups had heard of it. Knowledge of transmission and symptoms was weak in all groups, and most women were unaware of asymptomatic transmission. Most women felt safe from HIV due to ineffective strategies such as taking medications or client selection practices. Condom use with clients varied widely by group. Women in the low-price brothels reported the lowest levels of use (19% of encounters in the previous week), with women from the mid- and high-price groups reporting higher levels (68% mid-price; 71% high-price). Women working in the tourist areas reported the highest levels of use (90%). Interventions for each group need to reflect these differences in knowledge as well as the contexts of their work; important contextual factors to consider include the level of AIDS and STD knowledge in their environment, the characteristics of the clients served, and the degree of supervision that they receive.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Aids knowledge and risk behaviors among Midwest migrant farm workers.

The objectives of this study were to investigate the AIDS/HIV knowledge of Latino adolescent and adult migrant farm workers in Michigan, to determine risk behaviors related to HIV, and to determine differences in generational norms regarding sexual activity. For the most part, the Latino migrant population seemed knowledgeable about sexual modes of HIV transmission, although casual contact, through kissing and going to school or work with an infected individual, was also seen as a possible route of transmission for some. Several condom beliefs were identified that may be barriers to use, including the beliefs that condoms are only for use with prostitutes (35 % agreed) and that condoms are only for gay men (54% agreed). Only a small proportion (10%) agreed that condoms were good protection from AIDS. Most respondents knew what condoms were, although only 51% of the sample knew friends who used them. Adolescent females in the camps generally disapproved of premarital sex, while males and older females were more accepting. All these factors make it pertinent to implement HIV/AIDS education programs that are culturally sensitive, gender-specific, and effective in both generations.

Adolescent↗
PubMed1998

Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients.

A 10-hour small-group informational and skill-building intervention was tested among patients (N = 472) attending publicly funded sexually transmitted disease clinics in Maryland, Georgia, and New Jersey. After completing a 90-minute interview concerning HIV risk behaviors, condom use self-efficacy and condom outcome expectancies, participants were randomized to either an intervention or a control condition. Participants in both conditions displayed significant reductions in unprotected encounters and number of partners and increases in condom use. No differences between treatment conditions were observed, indicating that the motivational effects of the interview may have been stronger than the effects of the intervention in this population.

Adolescent↗
PubMed2001

Active and Former Injection Drug Users Report of HIV Risk Behaviors During Periods of Incarceration.

American prisons have increasing numbers of inmates incarcerated for drug offenses. This population is at high risk for HIV-infection and may continue HIV transmission risk behaviors while incarcerated. We find that 31% of injection drug users with a history of imprisonment had used illicit drugs in prison, and nearly half of these persons had injected drugs while incarcerated. Male gender and number of times incarcerated were associated with drug use in prison. Interventions for drug-using prisoners that are advocated in some European prisons, such as needle exchange programs and methadone maintenance, need attention in the United States.

Journal Article↗
PubMed2004

The influence of stigma on the sexual risk behavior of rural men who have sex with men.

Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.

Adolescent↗
PubMed2007

Sexual risk behavior and venues for meeting sex partners: an intercept survey of gay and bisexual men in LA and NYC.

Understanding the link between venues for meeting sex partners and sexual risk behavior is critical to developing and placing effective sexual health education and HIV prevention services. Non-monogamous gay and bisexual men (n = 886) were surveyed in New York and Los Angeles about the venues that they met recent sex partners: bathhouses, private sex parties, gay bars/clubs, the gym, via public cruising, and the Internet. Bars/clubs, bathhouses, and the Internet were the most endorsed venues for meeting partners. Men having met a majority of their partners (i.e., "preference") via these three venues were compared/contrasted. Those having preference for bars/clubs were dissimilar from men with preference for bathhouses or the Internet on multiple levels (e.g. age, number of sex partners, temptation for unsafe sex). However, these men were proportionally similar in whether they had engaged in a recent episode of unprotected anal intercourse (UAI). Logistic regressions predicting UAI suggested venues might not play a role in differentiating men who had preference for bars/clubs, bathhouses or the Internet. Additional regression analyses utilizing all six venues to predict UAI suggested other person-factors such as identity as a barebacker and temptation for unsafe sex better explain UAI. This research suggests HIV prevention and educational campaigns targeted within venues need also address socio-psychological person-factors in addition to environmental/venue contexts.

Adult↗
PubMed1999

Fathering pregnancies: marking health-risk behaviors in urban adolescents.

PURPOSE: To establish self-reported rates and associated correlates of fathering pregnancies in urban teen males, and to explore the possibility of using their pregnancy history as a marker for other health-risk behaviors. METHODS: A blinded, self-administered questionnaire was given to the predominantly African-American patients of an inner-city adolescent outpatient clinic. Urine was also collected in a blinded, anonymous fashion, matched to the questionnaires, and tested for five drugs of abuse. Males were classified as having or not having a pregnancy history (PH) according to a questionnaire response item. PH and non-PH participants were compared for eight risk factors using univariate and multivariate methods. RESULTS: A total of 24.2% reported a PH. These males were about 14 times more likely to report three or more sex partners in the last year, more than five times as likely to report a sexually transmitted disease history, more than three times as likely to test positive for drugs, and more than 2.5 times as likely to be inconsistent or nonusers of condoms as compared to males without a pregnancy history. An association between violent behavior and PH is unsupported. CONCLUSIONS: Pregnancy history can be a valuable marker for other risk factors among inner-city African-American males. With some patients, it may be easier for clinicians to discuss pregnancy history or fatherhood as opposed to drug abuse and other more sensitive risk factors. The topic can then be used as a gateway for discussion of other risk factors.

Adolescent↗
PubMed2005

Peer influences on risk behavior: an analysis of the effects of a close friend.

Cross-sectional research suggests that peer influence has a moderate to strong impact on adolescent risk behavior. Such estimates may be inflated owing to third-variable confounds representing either friendship selection effects or the operation of parallel events. Approximately 1,700 peer dyads in Grades 7 to 11 were studied over a 1-year period to estimate the influence of closest friends on sexual activity and binge drinking. Analyses suggested that peer influence was small but reliable when both selection effects and parallel events were taken into account. Peer influence varied as a function of individual-peer similarity and maternal relations but not in accord with other theoretical predictions. It is suggested that the magnitude of peer effects in previous research may be overestimated in many contexts.

Adolescent↗
PubMed1994

Preparations for AIDS vaccine trials. Developing brief valid screening instruments for HIV-related sexual risk behavior among gay and bisexual men.

Enrolling and tracking cohorts for HIV vaccine efficacy trials requires that participants disclose behaviors that place them at risk for exposure to HIV. Brief screening procedures have been suggested for this purpose. In a previous study gay and bisexual men in three U.S. cities reported unprotected anal intercourse on a brief screening instrument. Screen reports were compared to subsequent in-depth, face-to-face interview data; 29% of the men who reported unprotected anal intercourse during the interview failed to disclose this behavior during screening. For recruitment into an HIV vaccine feasibility study at the same study sites, screening procedures were modified to encourage accurate reporting: to lessen stigma, low risk as well as high risk sexual behaviors were assessed, and screens were administered by trained study staff who presented it as a tool for understanding the gay community. Failures to disclose risk decreased to 18%, a rate that, while lower than in the previous study, remains high. Men less likely to disclose unprotected sex during the screen engaged in fewer high risk sexual behaviors, had more stringent norms regarding sexual safety, and were less identified with the gay community than were men who disclosed unprotected sex. Failure to disclose risk may have significant implications for participant selection and behavior tracking during vaccine trials. More systematic assessments that are sensitive to target communities may facilitate disclosure.

AIDS Vaccines↗