A school-based AIDS education programme for secondary school students in Nigeria: a review of effectiveness.

Nigerian secondary school students are becoming sexually active at an increasing earlier age. Sexually active students are at risk of contacting STDs, including HIV infection. As a result, health education initiatives to increase level of knowledge, influence attitudes and encourage safe sexual practices are being implemented in schools, but the effectiveness of these programmes have not been evaluated. In this study, the knowledge, attitude and sexual risk behaviors of 223 students who received a comprehensive health education intervention were compared with 217 controls. At post-test, intervention students exhibited greater knowledge about HIV/AIDS transmission and prevention (P < 0.05). Intervention students were less likely to feel AIDS is a white man's disease and were more likely to be tolerant of people living with the disease (P < 0.05). After the intervention, the mean number of reported sexual partners among the experimental students significantly decreased from 1.51 to 1.06, while it increased from 1.3 to 1.39 among the controls. Among the intervention students there was also an increase in consistent use of the condom and the use of the condom at last sexual intercourse. We conclude that students can benefit from specific education programmes that transmit important information necessary to prevent risky behavior, and improve knowledge and attitudes on HIV/AIDS.     

Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence

OBJECTIVES: We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. METHODS: In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. RESULTS: Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. CONCLUSIONS: Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.     

Explaining racial disparities in HIV/AIDS incidence among women in the U.S.: a systematic review

Surveillance data indicate that HIV incidence among Black women is more than 20 times that among White women and more than 4 times that among Hispanic women. Several studies have examined HIV risk factors by race/ethnicity including high-risk sex, drug use, inconsistent disclosure of same-sex behavior by male partners, and sexually transmitted diseases (STDs). We formed these risk factors into four hypotheses that attempt to explain the higher incidence of HIV infection among Black women. We further conducted a literature review by searching three online databases for studies published between 1985 and 2006 addressing the four hypotheses. Literature suggests that Black women are no more likely to have unprotected sex, have multiple sexual partners, or use drugs than women of other racial/ethnic groups. However, some studies suggest that Black women are more likely to have risky sex partners and STDs. We also found that Black men are less likely to disclose their same-sex behavior to female partners. These four hypotheses are insufficient in explaining the greater burden of HIV among Black women. Future investigations should continue to explore these and other social and behavioral factors such as poverty, health-care access, and receptivity to prevention messages to explain racial/ethnic disparities in HIV incidence.     

Greater risk for HIV infection of black men who have sex with men: a critical literature review

HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity.We found that high rates of HIV infection for Black MSM were partly attributable to a high prevalence of sexually transmitted diseases that facilitate HIV transmission and to undetected or late diagnosis of HIV infection; they were not attributable to a higher frequency of risky sexual behavior, nongay identity, or sexual nondisclosure, or to reported use of alcohol or illicit substances. Evidence was insufficient to evaluate the remaining hypotheses.Future studies must address these hypotheses to provide additional explanations for the greater prevalence of HIV infection among Black MSM.     

AIDS-related knowledge, attitudes, and behaviors among juvenile delinquents in Israel.

Fifty-six Israeli adolescents under the care of probation officers were interviewed about their AIDS-related knowledge, attitudes, and behaviors. The results suggest that these adolescents put themselves at risk of HIV infection. A substantial proportion of the sample demonstrated a lack of knowledge on issues relevant for AIDS prevention. The majority held negative attitudes toward condoms but were also sexually active, and some had experienced unprotected sexual intercourse, anal sex, and drug use. Most of the respondents, moreover, showed a lack of competence in handling situations that pressure them to act unsafely. Implications for practice are discussed.     

Sexually transmitted infections. Current clinical and therapeutic data

A recent increase of syphilis and gonorrhea has been observed in France. More recently, the resurgence of very infrequent STDs, such as lymphogranuloma venerum, has been noticed in Western Europe. This data illustrates the emergence of high-risk behavior and the relative failure of prevention for sexually transmitted infection and HIV infection, especially in homosexual men. Since the onset of the AIDS epidemic, oral sex has been increasingly used both by heterosexual and homosexual partners. Even if the risk of HIV transmission with oral sex is very low, oral sex is a major mode of transmission for syphilis, gonorrhea, and genital herpes. Condoms are seldom used for oral sex. The transmission of STI by oral sex is less documented in heterosexual than in homosexual patients. The level of knowledge does not seem to reduce risky behavior in the most concerned population. An infection not normally considered as sexually transmitted (i.e. hepatitis C) may be transmitted by high risk sexual behavior increasing the risk of blood-blood contact, as recently reported among HIV-infected homosexual men. The emergence of high-risk sexual practices (traumatic practices, fisting) in a specific population required focused prevention measures to avoid blood-transmitted infections. The increased risk of HIV transmission by ST co-infection (syphilis, genital herpes, gonorrhea) and the potential morbidity of STI in HIV infected patients should also be emphasized.     

Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial.

BACKGROUND. We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. METHODS. We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. RESULTS. At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005). CONCLUSION. HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.     

Sexual knowledge, attitudes, and risk behaviors of students in Turkey

This survey produced baseline information about student knowledge of sexually transmitted diseases (STDs), their sexual attitudes, and their behavior to help establish control and education programs. The study was conducted at Ege University, Izmir, Turkey, during the 1999-2000 academic year. A total of 2,217 first- and fourth-year students determined by stratified sampling constituted the study group. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors, sexual attitudes, behavior, and history of STDs. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females. Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal. Mean score on the knowledge questions was 16.29 (highest score 30). The most widely known STD was HIV infection and AIDS. Students' knowledge of transmission routes, signs and symptoms, and risk groups of STDs was insufficient. Main sources of knowledge were visual and print media, and friends. Most students (84.7%) viewed prevention from STDs as a person's own responsibility. Young people in Turkey are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and sexually transmitted diseases is insufficient. Study results suggest a need for implementation of STD control programs and provision of school sexuality education for adolescents and young adults.     

AIDS risk and prevention among adolescents

Although relatively few teenagers have been diagnosed with AIDS and the extent of asymptomatic human immunodeficiency virus (HIV) infection among adolescents remains largely unknown, there is cause for concern about teens' risk of contracting HIV disease The incubation period (the time from initial infection to the development of full-blown AIDS) is estimated to average eight years, and therefore it is probable that most of the individuals in their twenties who have AIDS (20% of all the people with AIDS) contracted HIV during their teenage years. The sexual and drug use activities of many teenagers place them at increased risk for HIV transmission. Sexually transmitted diseases (STDs) are pervasive and a major cause of morbidity among sexually active adolescents. The rates of STDs have continued to rise even during the 'age of AIDS'. These rates are of concern since the behaviors associated with the acquisition and transmission of STDs are also the behaviors associated with HIV transmission. In addition, the presence of STDs may increase the likelihood of HIV transmission. Although condoms reduce the risk of HIV transmission, their use remains low among sexually active teenagers. Reducing or eliminating high risk behaviors is the only way to limit further spread of HIV. Effective prevention programs should be based on models and theories of risk behavior so that the programs can be designed to change those factors which lead to the undesirable risky behaviors. The AIDS Risk Reduction Model (ARRM) is presented as an example of such a social-physiological model. The ARRM model characterizes why people persist in engaging in high risk activities or make efforts to alter those activities. The three stages theorized to be necessary to reduce risky sexual activities are: (1) recognizing that one's activities make oneself vulnerable to contracting HIV; (2) making the decision to alter risky sexual behaviors and committing to that decision; (3) overcoming barriers to enacting the decision, including problems in sexual communication and seeking help when necessary to learn strategies to reduce risky behaviors. Each stage includes a number of constructs identified in prior research as important for engaging in 'healthy' or low risk behaviors. Innovative strategies must be developed and implemented to reach all adolescents, ranging from teenagers who attend school and live with their families to those teens who are runaways, live in detention facilities or are otherwise 'disenfranchised'. To be most effective, HIV prevention programs must utilize strategies which combine cognitive and behavioral skills training.(ABSTRACT TRUNCATED AT 400 WORDS)     

Adolescents and AIDS: a survey of knowledge, attitudes and beliefs about AIDS in San Francisco.

To assess adolescents' knowledge, attitudes, and beliefs about AIDS in San Francisco, data were obtained from 1,326 adolescents. There was marked variability in knowledge across informational items, particularly about the precautionary measures to be taken during sexual intercourse which may reduce the risk of infection. We conclude that development and implementation of school health education programs on AIDS and other sexually transmitted diseases are needed in this population.     

Predictors of condom use in sexually active adolescents

Unprotected sexual intercourse places a substantial number of adolescents at risk for sexually transmitted disease (STD) and human immunodeficiency virus (HIV) infection. While the most effective means of preventing STD/ HIV infection among sexually active adolescents is consistent condom use, little is known about the factors that influence their consistent use among adolescents. This study of adolescents (n = 1049, mean AGE = 16.2 years) found that of the 266 teens who recently became sexually active, only 29% reported using condoms consistently. Consistent condom use was more frequent in males, those with little history of risk behavior and those with stronger intentions to use condoms in the future. Fear and anxiety of HIV, attitudes about risks other than HIV, and other safe behavior intentions were not significantly related to consistent condom use. Although intentions and recent behavior were significantly related, a different group of factors was found to predict intention to use condoms (e.g., perception of condom use by friends, general impulsive attitudes). Identifying and understanding the factors that influence adolescent sexual behavior and intentions is important for developing maximally effective HIV education/prevention programs.     

佛山市城市青少年健康危险行为研究（四）——易导致意外怀孕和性传播疾病的性行为

目的了解佛山市城市青少年易导致意外怀孕和性传播疾病的性行为现状。方法对佛山市中心城区12所全日制初高中、职校和大学3844名在校学生，采用中国青少年健康相关行为问卷调查表进行调查。结果大、中学生15．0％看过色情书籍或色情音像制品。高中学生中只有72．9％的接受过艾滋病相关知识教育，75．1％的学生知道艾滋病病原体是病毒，只有50．8％能对艾滋病感染者持正确态度，84．9％接受过青春期性教育，34．5％有旱恋现象，2．8％曾发生过性行为，不同学校类型高中旱恋及性行为发生率以职业中学为高，而健康教育以职业中学薄弱。大学生中8．7％有性交行为，3．8％有多性伴性行为，性行为发生率男生高于女生。结论城市青少年中性健康危险行为状况不容乐观，其危险行为有年龄、性别和学校类型等差异，应尽快有针对性地开展生殖健康教育和艾滋病预防教育，加强对青少年性行为、性观念的正确引导十分必要。     

Adolescents' perceptions of risk for HIV infection: implications for future research

Few studies have investigated adolescents' perceptions of their risk for HIV infection. Findings from two studies of adolescents in Massachusetts indicate that there are differences in the knowledge, beliefs, behaviors, and perceptions of risk among adolescents and suggest the need for understanding the differences among adolescents from different racial or ethnic backgrounds. In both studies, white students were the most knowledgeable about casual, sexual, and drug use transmission of HIV followed by black, Hispanic, and Asian students. In both studies more black adolescents than other racial or ethnic groups were sexually active, and black and Hispanic adolescents began having sexual intercourse at an earlier age than white or Asian adolescents. Asian and Hispanic adolescents were most worried about getting AIDS. Although more Hispanics than other groups reported changing their behavior because of AIDS, fewer of them who had changed their sexual or contraceptive behavior were using effective methods. Despite clear differences in the perceived risk of getting AIDS among these adolescents, the underlying reasons remain to be explicated, using, among other data collection methods, ethnographic techniques to probe adolescents' risk perceptions, their understandings of sickness, and their explanatory models of AIDS. Life events affect risk taking behaviors and also shape perceptions of risk. To understand what it is that adolescents consider 'risky' requires seeing their life options as they do in the larger context of their aspirations and worries about how 'to fit in'.     

Comparison of human immunodeficiency virus related knowledge, attitudes, intentions, and behaviors among sexually active and abstinent young adolescents.

Although young sexually active adolescents are at greater risk for human immunodeficiency virus (HIV) acquisition than their abstinent peers, little is known about their respective HIV-related knowledge, attitudes, and general risk behaviors. This study of middle school adolescents (n = 1379; mean age, 13.2 years) found that the sexually active boys, compared with their peers, were less knowledgeable about HIV, less fearful of HIV, less tolerant of people with acquired immunodeficiency syndrome (AIDS), riskier in non-HIV-related attitudes and had a greater history of other risk behavior. A similar, but less marked pattern, was found for girls. It is suggested that physicians counsel all adolescents about HIV and sexuality during office visits and that early adolescent sexuality should prompt special efforts in HIV education/counseling.     

School-based HIV/AIDS education,risky sexual behaviors,and HIV testing among high school students in the United States

This study assessed the practical value of HIV/AIDS education among at-risk adolescents in the United States. Data were drawn from the 2013 Youth Risk Behavior Surveillance System spanning students in grades 9-12 who have engaged in sexual intercourse. A multivariate hierarchical logistic regression analysis was employed to test: (1) the individual effects of school-based HIV/AIDS education and risky sexual behaviors on the probability of HIV testing and (2) the interaction effects to estimate the degree to which the education effect varied by specific risky sexual behavior. The results indicated that students who engaged in risky sexual activities and received HIV/AIDS education were more likely to test for HIV compared to those who did not receive HIV/AIDS education. The relationship between education and HIV testing also varied according to the number of recent sexual partners. The findings have policy and practice implications. Specifically, HIV/AIDS education that promotes HIV testing should be encouraged particularly with the high-risk student population.     

Highlights from the Canada youth and AIDS study

The identification of Acquired Immunodeficiency Syndrome (AIDS) in 1981, and the subsequent isolation of the human immunodeficiency virus (HIV) in 1983, signaled the beginning of worldwide concern over the potential impact of the disease. As the global incidence of AIDS and HIV infection increased, Canadians expressed growing apprehension about the epidemic's affect on themselves. Because adolescents potentially are at risk for HIV infection, a special need existed to determine how Canadian youth were responding to the AIDS epidemic. During the summer of 1987, the Federal Centre for AIDS, in conjunction with the National Health Research and Development Program and the Canadian Public Health Association, commissioned a nationwide study. A national sample of more than 38,000 youth in grades 7, 9, 11, and the first year of college and university were surveyed about their knowledge, attitudes, and behavior concerning AIDS and other sexually transmitted diseases (STDs). Also included in the total sample were youth who had recently dropped out of school and those who lived on the streets of large cities. In this article, the authors summarize findings from the study and offer conclusions and recommendations for action.     

某地HIV/AIDS者确诊后一年内高危性行为的改变及影响因素研究

目的 了解艾滋病病毒感染者/艾滋病患者（HIV/AIDS）确诊后一年内高危性行为变化情况及其影响因素。方法 从国家艾滋病综合防治数据信息管理系统下载2010年1月1日—2019年12月31日的相关资料,描述性行为发生率的变化趋势,采用广义估计方程（GEE）模型分析HIV/AIDS确诊后一年内高危性行为的相关因素。 结果 2 528例HIV/AIDS中,确诊前性行为发生率60.48%而确诊后一年内在57.09%～60.11%之间,女性（趋势χ2 = 5.417,P = 0.020）和未婚者（趋势χ2 = 6.684,P = 0.010）确诊后一年内的性行为发生率呈下降趋势,男性（趋势χ2 = 4.301,P = 0.038）、已婚（趋势χ2 = 4.061,P = 0.044）和ART者（趋势χ2 = 4.783,P = 0.029）的性行为发生率呈上升趋势。高危性行为发生率由61.61%下降至3.98%（趋势χ2 = 1 606.933,P＜0.001）,多因素结果显示:已婚（OR = 2.374,95%CI:1.478～3.811）和未ART者（OR = 1.837,95%CI:1.431～2.358）更易发生高危性行为。性别和年龄亚组分析显示,已婚和未接受ART治疗与高危性行为的关联方向保持一致。 结论 HIV/AIDS确诊后一年内仍保持性活跃且存在高危性行为,仍具备二代传播、感染其他性传播疾病和不同HIV型别毒株或耐药毒株风险,应提供精准干预,促进HIV/AIDS坚持使用安全套。     

Positive outlook as a moderator of the effectiveness of an HIV/STI intervention with adolescents in detention

Justice-involved adolescents engage in high levels of risky sexual behavior, underscoring the need for targeted, effective, prevention interventions geared toward this population. In a randomized controlled trial, 484 detained adolescents received a theory-based intervention or an information-only control. We have previously demonstrated that the theory-based intervention was superior to the control condition in changing theoretical mediators and in producing longitudinal decreases in risky sexual behavior. In the present study, we examined differential response to the intervention based on the adolescents' level of positive outlook (composed of self-esteem, perceived control over the future and optimism toward the future). Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy and intentions) were measured immediately post-intervention, and behavioral data were obtained 3, 6, 9 and 12 months later. Positive outlook significantly moderated program effects both in the context of the mediational path model and in the context of the longitudinal growth model. Specifically, intervention effects were strongest for those scoring relatively lower on the positive outlook dimension, whereas adolescents high in positive outlook demonstrated greater attitudes and self-efficacy and decreased risky sexual behavior, regardless of condition. Findings are discussed in terms of targeting and tailoring of intervention content.     

Survey on HIV risk perception and sexual behaviours among seafarers

Because the nature of their work seafarers spend long periods of time away from their families and therefore represent a group at risk for sexually transmitted diseases, including HIV infection. This paper reports the results of a survey to evaluate awareness and knowledge of the risk of HIV infection among seafarers. Risky behaviours for HIV transmission were also assessed. The survey was conducted using anonymous questionnaires on 197 workers of 9 vessels and 26 office employees of an Italian shipping company (FINAVAL S.p.A., Rome). The respondents considered HIV/AIDS as one of the diseases with a high risk of transmission. Most respondents had a good general knowledge of HIV/AIDS and on the ways of its transmission. However, there is still lack of knowledge on the basics of this disease. On the other hand, in spite of knowledge and awareness about the risks of the disease, only 56.35% of the interviewed crewmembers used protection in sexual intercourse with occasional partners. Compared to data available in literature, the percentage of self-protecting people is increasing, but the number of seafarers exposing themselves to risky behaviours is still high. As expected, condoms are used with regular partners with lower frequency compared to occasional intercourse. The results of this survey indicate that adequate prevention campaigns and major attention paid to seafarers health is useful for stimulating responsible conduct for the prevention of infectious diseases, including HIV infection. Nevertheless, it is still necessary to increase information about the risk of sexually transmitted diseases and how to reduce it.