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Assessment of HIV-related sexual risk behaviors among the general female population in Hong Kong.

This study examined sexual practices among the female population in Hong Kong. A total of 2,076 women between 18 and 50 years were interviewed by using a computerized telephone survey method. Sexually active women (59.3%) were classified into the "Husband Only Group" (HOG, n = 1,005), the "Steady Boyfriend Only Group" (SBG, n = 192), and the "Higher Risk Group" (HRG, n = 35). Over 60% of the HRG members did not perceive condom use as an efficacious means for HIV/AIDS prevention. Within the HOG and SBG, 30.0% and 41.1% reported that they always used condoms (25.7% in the HRG). Condom use was often suggested by both men and women of the SBG, but was often initiated by the women only in the HRG. "Trust" and "lack of necessity" were common reasons for not using condoms. About 85% of the respondents would ask their partners to use condoms if they suspected their partners having engaged in commercial sex; however, only 75% would have the final control. The HRG members seemed to be less able to insist on using condoms (55.6%, OR = 0.41, p < .05) and were more likely than the HOG to perceive some chance of contracting HIV (OR = 10.88, p < .01). The prevalence of high risk behaviors among women in Hong Kong was not high; however, those at risk were often inconsistent condom users and they had weak control over condom use. Women in Hong Kong had low awareness of HIV-related risk.

Acquired Immunodeficiency Syndrome↗

AIDS: risk behaviors among rural Mexican women married to migrant workers in the United States.

International migration between Mexico and the United States has been acknowledged as a phenomenon that may contribute to the spread of AIDS in rural Mexico. The purpose of this study is to identify the information held by the participants regarding AIDS and to describe selected high-risk behaviors for AIDS transmission among a representative sample of rural women living in Mexico who are married to immigrant temporary workers to the United States. The women who participated in the study were married, of reproductive age, and had active sex lives with their spouses. Results revealed that most of the women interviewed had at least some knowledge about AIDS. Although some misconceptions were evident, most of the information they had was accurate. About one-third of the women felt at risk for AIDS, mostly because they doubted their husbands' fidelity, or because in the last five years they had donated blood, received a blood transfusion, or received an intramuscular or intravenous injection. The results of the study are discussed within the sociocultural context that surrounds the lives of the women interviewed.

Acquired Immunodeficiency Syndrome↗

Attachment, adolescent competencies, and substance use: developmental considerations in the study of risk behaviors.

Social-control-based deviance theories highlight parental bonding as a protective factor for problem behaviors in that bonds are viewed as reflecting the adolescent's adoption of conventional societal attitudes and values. Developmental theory and research suggest an alternative conceptualization of the linkages between family bonding and adolescent risk behaviors. This conceptualization requires concurrent examination of a range of adolescent competencies as well as consideration of parent and peer contexts. Support is found for several hypotheses derived from a developmental approach proposing: (a) positive associations between adolescent-parent attachment and adolescent competencies--autonomy, peer relationship competency, and coping; (b) coherence in the pattern of negative associations between attachment/competencies and substance use problems; and (c) a disjunctive pattern of associations with substance use reflected by positive associations with peer competencies but not with parental attachment.

Adaptation, Psychological↗

Behavioral risk factors among women presenting for genetic testing.

Considerable research attention has been given to the impact of genetic testing on psychological outcomes. Participation in genetic testing also may impact on health behaviors that increase the risk of cancer and other chronic diseases. The purpose of this study is to describe behavioral cancer risk factors of women who requested genetic testing for breast and ovarian cancer susceptibility (BRCA1, BRCA2). Before participation in a genetic testing program, 119 women completed a series of questionnaires designed to assess their health behaviors, perception of risk, and depressive symptomatology. Eight percent of participants were current smokers, 27% did not engage in at least moderate exercise, 46% did not regularly protect themselves from the sun, 39% did not consume at least five servings of fruits and vegetables per day, and 9% drank at least one alcoholic beverage per day. Poisson regression analysis revealed that age was the only predictor of behavioral risk profiles, with older women having fewer cancer risk behaviors. These patients who presented for genetic testing generally had better health behaviors than the general population. However, given their possible high-risk status, these patients should consider further improving their preventable cancer risk factors and, in particular, their diet, sun protection, and physical activity levels. Inclusion of behavioral risk factor counseling in the context of the genetic testing process may be an important opportunity to reach this at-risk population.

Adult↗

Longitudinal change in HIV transmission risk behaviors by gay male physicians.

Gay male physicians were surveyed in 1984 and 1985 about their knowledge and attitudes regarding HIV transmission and AIDS and changes they had made in social, health-related, and sexual activities since the onset of the AIDS epidemic. Most of the 37 subjects who participated in both surveys progressively lessened their participation in HIV transmission risk behaviors over time. Health belief, AIDS knowledge, health coping, social support, mood state, and age factors all contributed to changes in sexual behavior. The modeling of sexual-behavior changes showed general stability over time. This study provides further evidence that multiple psychosocial factors are associated with changes in sexual behavior, even in gay male physicians.

Adult↗

Health risk behaviors of Hispanics in the United States: findings from HHANES, 1982-84.

With data from the Hispanic Health and Nutrition Examination Survey (HHANES), we examined several health risk behaviors (cigarette smoking, alcohol use, dietary practices, and recency of health screening) of Mexican American, Cuban American, and Puerto Rican adults (ages 20-74). For each sample, a greater percentage of men than women smoked cigarettes and used alcohol. Heavy smoking (20+ cigarettes per day) was most prevalent for Cuban American males, and heavy drinking (1.00+ oz ethanol per day) was most prevalent for Mexican American and Puerto Rican men. Acculturation correlated positively with alcohol use (particularly for females) and negatively with dietary balance (for Mexican American men and women). The Puerto Ricans' diet was less balanced than that of the other two groups. For each sample, more men than women had not had a routine physical or dental examination within the past five years; the recency of screening was lowest for Mexican American men. Screening (including Pap smear for the women) was lower for those who smoked cigarettes and for those with poor dietary practices, indicating that many Hispanics at special risk of disease underutilize preventive health services, increasing the likelihood of diagnosis at a later stage of illness.

Acculturation↗

Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behavior in adolescents.

We examined the content, construct and concurrent validity of scales to assess beliefs and self-efficacy related to adolescents' sexual risk behavior. We addressed content validity in the scale development process by drawing on literature and theory, and by pre-testing items with focus groups. We used confirmatory factor analysis of two models, an intercourse involvement model and a condom use model, to assess construct validity. The final intercourse involvement model included three scales: norms about sexual intercourse, attitudes about sexual intercourse and self-efficacy in refusing sex. The final condom use model included five scales: norms about condoms, attitudes about condom use, self-efficacy in communicating about condoms, self-efficacy in buying/using condoms and barriers to condom use. After two alterations to the models, the chi 2 and other indices indicated that the data fit the models well. Supporting the concurrent validity of the scales, high school students who had never had sexual intercourse had more negative attitudes toward sexual intercourse among teenagers, perceived norms toward sexual intercourse among teenagers to be more negative and expressed greater self-efficacy in refusing sex than did those who had experienced sexual intercourse. Consistent condom users had more positive attitudes and norms about condoms, had higher self-efficacy in communicating about and buying/using condoms, and perceived fewer barriers to condom purchase and use than did inconsistent condom users.

Adolescent↗

Increases in HIV-related sexual risk behavior among community samples of gay men in London and Glasgow: how do they compare?

OBJECTIVE: In this paper, we compare trends in sexual risk among gay men in the largest city in England (London) and the largest city in Scotland (Glasgow). METHODS: Self-complete questionnaires administered to representative samples of men visiting the commercial gay scenes in London and Glasgow in 1996, 1999, and 2002 (N = 8247). RESULTS: Multivariate logistic regression was used to assess the trends in unprotected anal intercourse (UAI), UAI with partners of unknown/discordant HIV status, and UAI with more than 1 partner. Each increased significantly in 1999 and 2002 in London, but only in 2002 in Glasgow. Testing for HIV also increased significantly in London, but not in Glasgow. Overall, HIV testing levels were considerably lower in Glasgow (in 2002, 49.1% vs. 74.6% in London). Overall, sexual risk was higher in London, but UAI with partners of unknown/discordant HIV status was higher in Glasgow (in 2002, 27.4% vs. 21.3%). CONCLUSIONS: Although the same pattern of increase in HIV-related sexual risk behavior was apparent in the cities, differences in HIV testing and nonconcordant UAI suggest different HIV prevention needs and that targeted health promotion interventions are required in London and Glasgow. City-specific factors should be considered in the development of appropriate sexual health interventions.

Adolescent↗

Draw the line/respect the line: a randomized trial of a middle school intervention to reduce sexual risk behaviors.

OBJECTIVES: This study evaluated the long-term effectiveness of Draw the Line/Respect the Line, a theoretically based curriculum designed to reduce sexual risk behaviors among middle school adolescents. METHODS: The randomized controlled trial involved 19 schools in northern California. A cohort of 2829 sixth graders was tracked for 36 months. RESULTS: The intervention delayed sexual initiation among boys, but not girls. Boys in the intervention condition also exhibited significantly greater knowledge than control students, perceived fewer peer norms supporting sexual intercourse, had more positive attitudes toward not having sex, had stronger sexual limits, and were less likely to be in situations that could lead to sexual behaviors. Psychosocial effects for girls were limited. CONCLUSIONS: The program was effective for boys, but not for girls.

Adolescent↗

Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: An event level analysis of timeline followback data.

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.

Adult↗

Adherence to methadone is associated with a lower level of HIV-related risk behaviors in drug users.

There have been limited studies on the potential role of methadone treatment in HIV prevention in Asia. Over an 8-week period, we assessed the profiles of drug-taking and HIV risk behaviors, and tried to identify their relationships with methadone adherence in 690 clients who attended Hong Kong's methadone treatment program. In the preceding month, 71% of respondents reported using drugs and two-thirds of those respondents who had injected drugs at some time in their lives injected then. Infrequent clients who attended methadone clinics <2 times in the previous week were twice more likely to have injected drugs in the last month and six times more likely to have >5 injections in the last week than frequent clinic attendees. Also, clients taking <60 mg methadone daily were twice more likely to have >5 injections in the last week than those taking > or = 60 mg methadone. The findings called for further studies on harm reduction programs for HIV prevention among drug users in Asian countries.

Adolescent↗

Is genital mycosis associated with HIV risk behaviors among heterosexuals? ACSF Investigators. Analyse des comportements sexuels en France.

OBJECTIVES: This study examined in both sexes whether genital mycosis is as strongly associated with human immunodeficiency virus (HIV) sexual risk behavior as are other sexually transmitted diseases. METHODS: Heterosexuals in the French National Survey of Sexual Behavior who reported a history of either mycosis or another sexually transmitted disease in the previous 5 years were compared with heterosexuals who reported no such disease. Odds ratios were adjusted for age, education, place of residence, and number of sexual partners. RESULTS: Among men, mycosis and other sexually transmitted diseases showed similar associations with age and number of sexual partners. Among women, mycosis was also associated with a high number of sexual partners, albeit to a lesser extent than other sexually transmitted diseases. Lifetime experience of heterosexual anal penetration was reported significantly more often by men with a history of mycosis. CONCLUSION: These results suggest that most male mycosis is sexually acquired and constitutes a self-reported indicator as good as other sexually transmitted diseases for high risk. Female mycosis may help define an intermediate HIV risk group.

Adolescent↗

HIV needle risk behaviors and drug use: a comparison of crack-smoking and nonsmoking injection drug users in Ohio.

This study compares the drug use and needle risk behaviors among 733 crack-smoking injection drug users (IDUs) and 518 nonsmoking IDUs. Participants were recruited in Dayton and Columbus, Ohio, for the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program from 1992 to 1996. Crack-smoking IDUs were more likely to be male, African-American, and 30 to 40 years of age, but less likely to be married or living with a sex partner compared to nonsmokers. Daily crack users were less likely to be daily injectors but more likely to use alcohol daily when compared to non-crack users and less-than-daily crack smokers. IDUs who smoked crack less than daily were more likely to have injected with needles and syringes used by others. There is an urgent need for additional research on the relationship between drug injection and crack smoking as well as improved HIV risk-reduction interventions that include drug abuse treatment components focusing on issues surrounding crack-cocaine addiction.

Adult↗

Risk behaviors by audio computer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drug users.

Audio computer assisted self-interview (ACASI) has been shown to elicit significantly higher reports of sensitive HIV risk behaviors compared with interviewer-administered questionnaires (IAQ). Injection drug users were randomized to either ACASI (n = 556) or IAQ (n = 586) in order to evaluate reporting differences. A significant interaction was found between mode of administration (ACASI/IAQ) and HIV status. HIV-seropositive respondents on ACASI compared with IAQ were less likely to report condom use (odds ratio [OR] = .42, p < .01) and condom use frequency (OR = .28, p < .002), compared with HIV-seronegative respondents. Based on ACASI results, HIV-seropositive individuals engaged in fewer preventive behaviors than suggested by IAQ. These findings support the validity of ACASI as an important mode of data collection in reducing socially desirable responding, especially among HIV-seropositive subjects.

Adult↗

Injection risk behavior among women syringe exchangers in San Francisco.

Women who inject drugs in cities where syringe exchange programs (SEPs) are well established may have different risks for HIV infection. In 1997, we interviewed 149 female syringe exchangers in San Francisco, CA, a city with high rates of injection drug use that is home to one of the largest and oldest SEPs in the United States. In this report, we describe their sociodemographics, health, and risk behavior, and we examine factors associated with recent syringe sharing. Fifty percent of respondents were women of color and the median age was 38 years. Most (86%) injected heroin and nearly half were currently homeless or had recently been incarcerated. One-third of all women reported needle sharing in the prior month. This was higher than the rate of needle sharing reported by a mixed gender sample of San Francisco exchangers in 1993, although it resembled the rate reported by a mixed gender sample in 1992. In a multivariate analysis, syringe sharing was associated with age, housing status, and sexual partnerships. Syringe sharers were more likely to be young, homeless, or have a sexual partner who was also an injection drug user. While wide access to sterile syringes is an important strategy to reduce HIV transmission among injection drug users (IDU), syringe exchange alone cannot eradicate risky injection by female IDU. Additional efforts to reduce risky injection practices should focus on younger and homeless female IDU, as well as address selective risk taking between sexual partners.

Adult↗

High prevalence of HIV risk-behavior and the identification of predictors for sharing injecting materials among young drug users in Prague, Czech Republic.

This study is one of the first studies in the Czech Republic evaluating the extent of the HIV epidemic among drug users. Interview data on demographics, drug use, sexual practices, and HIV knowledge and risk perception were obtained from study participants and a saliva sample was obtained for an HIV antibody test. Although the HIV infection rate is low (0.2%), the prevalence of high risk behaviors, such as sharing injecting equipment and unsafe sexual practices, indicate a potential for rapid HIV spread in this high risk population. Preventive measures need to be targeted toward drug users, especially those of younger age and women.

AIDS Serodiagnosis↗

Clinical presentation and risk behaviors of patients with acquired immunodeficiency syndrome in Thailand, 1994--1998: regional variation and temporal trends.

From 1994 through 1998, the clinical and demographic features and risk behaviors of 101,945 adolescent and adult patients with acquired immunodeficiency syndrome (AIDS) were reported to the Ministry of Public Health in Thailand. The number of reported cases of AIDS infection increased from 12,005 in 1994 to 24,722 in 1997. Nearly 40% of the cases were reported from the northern provinces, which contained only approximately 20% of the adult population. About 80% of cases were among male patients, and 87% had been acquired via sexual contact. Tuberculosis was the most commonly reported opportunistic infection, occurring in 28.9% of patients; it was more commonly reported among injection drug abusers, especially in Bangkok. Pneumocystis carinii pneumonia and cryptococcal meningitis each occurred in nearly 20% of patients and were more frequently reported in patients with risk factors related to sex than in injection drug abusers. Penicillium marneffei infections were reported in 6.8% of patients from the northern provinces but less frequently elsewhere. These data suggest that AIDS is common in Thailand, and human immunodeficiency virus-infected persons should be given prophylaxis for tuberculosis, fungal infections, and P. carinii pneumonia.

AIDS-Related Opportunistic Infections↗

CDC consultation on methamphetamine use and sexual risk behavior for HIV/STD infection: summary and suggestions.

In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.

Centers for Disease Control and Prevention, U.S.↗