A Multilevel Analysis of the Impact of Socio-Structural and Environmental Influences on Condom Use Among Female Sex Workers

This study uses multilevel analysis to examine individual, organizational and community levels of influence on condom use among female commercial sex workers (FSW) in the Philippines. A randomized controlled study involving 1,382 female commercial sex workers assigned to three intervention groups consisting of peer education, managerial training, combined peer and managerial intervention and a usual care control group was conducted. The results of the multilevel analysis show that FSWs who work in establishments with condom use rules tend to have a higher level of condom use (β = .70, P < 0.01). Among the different intervention groups, the combined peer and managerial intervention had the largest effect on condom use (β = 1.30, P < 0.01) compared with the usual care group. Using a three-level hierarchical model, we found that 62% of the variation lies within individuals, whereas 24% and 14% of the variation lies between establishments, and communities, respectively. Standard errors were underestimated when clustering of the FSWs in the different establishments and communities were not taken into consideration. The results demonstrate the importance of using multilevel analysis for community-based HIV/AIDS intervention programs to examine individual, establishment and community effects.     

A workplace intervention program and the increase in HIV knowledge,perceived accessibility and use of condoms among young factory workers in Thailand

Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a workplace program designed to engage the private sector in HIV prevention. A cross-sectional survey conducted in 2008 to measure program outcomes in factories in Thailand was used in this study. The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and workers, and distribution of educational materials and condoms. A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18–24 years), controlling for their individual socio-demographic characteristics. Interventions related to the management and services component including workplace AIDS policy formulation, condom services programs and behavioral change campaigns were found to be significantly related to increased AIDS knowledge, perceived accessibility to condoms and condom use with regular partners. The effect of the HIV/AIDS training for managers, peer leaders and workers was positive but not statistically significant. With some revision of program components, scaling up of workplace interventions and the engagement of the private sector in HIV prevention should be seriously considered.     

HIV Partner Notification: Predictors of Discussion and Agreements from Provider Reports

This study examines organizational, provider, client, and test-event level predictors of HIV partner notification (PN) discussion and agreements based on providers’ most recent HIV-positive post-test counseling session. Staff (n = 621) were sampled from for-profit, nonprofit, and county government HIV testing organizations (N = 159) in Los Angeles County from 2003 to 2007. Among providers who conducted an HIV-positive post-test counseling session (n = 204), 65% discussed PN but only 10% had confirmed agreement to provider-involved PN (PIPN). In multi-level regression analyses PN discussion was predicted by provider HIV-test training and knowledge, and patients requesting a test while presenting HIV/AIDS symptoms. The strongest predictor of PIPN agreement was public health HIV testing settings followed by counseling by program managers or infectious disease specialists across settings. None of the injecting drug users or patients presenting with AIDS, but not requesting a test, agreed to PIPN. Organizational and provider-level interventions on PN will be needed to realize cost-effective benefits of expanded HIV testing and counseling.     

A Randomized Controlled Trial of an HIV Prevention Intervention for Street-Based Female Sex Workers in Yerevan,Armenia: Preliminary Evidence of Efficacy

This study evaluated the efficacy of an HIV intervention among female sex workers (FSWs) randomized to an intervention or wait-list control. FSWs (N = 120) completed baseline, 3- and 6-month assessments. A health educator implemented 2-hour intervention emphasized gender-empowerment, self-efficacy to persuade clients to use condoms, condom application skills, and eroticizing safer sex. Over the 6-month follow-up, FSWs in the intervention reported more consistent condom use with clients (P = .004) and were more likely to apply condoms on clients (P = .0001). Intervention effects were observed for other psychosocial mediators of safer sex. Brief, gender and culturally congruent interventions can enhance HIV-preventive behaviors among FSWs.     

Efficacy of an HIV/STI Prevention Intervention for Black Men Who Have Sex with Men: Findings from the ManyMen, ManyVoices (3MV) Project

Black men who have sex with men (MSM) in the United States experience disproportionately high rates of HIV and other sexually transmitted infections (STIs); however, the number of evidence-based interventions for Black MSM is limited. This study evaluated the efficacy of Many Men, Many Voices (3MV), a small-group HIV/STI prevention intervention developed by Black MSM-serving community-based organizations and a university-based HIV/STI prevention and training program. The study sample included 338 Black MSM of HIV-negative or unknown HIV serostatus residing in New York city. Participants were randomly assigned to the 3MV intervention condition (n = 164) or wait-list comparison condition (n = 174). Relative to comparison participants, 3MV participants reported significantly greater reductions in any unprotected anal intercourse with casual male partners; a trend for consistent condom use during receptive anal intercourse with casual male partners; and significantly greater reductions in the number of male sex partners and greater increases in HIV testing. This study is the first randomized trial to demonstrate the efficacy of an HIV/STI prevention intervention for Black MSM.     

Social and Structural Factors Associated with Consistent Condom Use Among Female Entertainment Workers Trading Sex in the Philippines

This paper examined socio-structural factors of consistent condom use among female entertainment workers at high risk for acquiring HIV in Metro Manila, Quezon City, Philippines. Entertainers, aged 18 and over, from 25 establishments (spa/saunas, night clubs, karaoke bars), who traded sex during the previous 6 months, underwent cross-sectional surveys. The 143 entertainers (42% not always using condoms, 58% always using condoms) had median age (23), duration in sex work (7 months), education (9 years), and 29% were married/had live-in boyfriends. In a logistic multiple regression model, social-structural vs. individual factors were associated with inconsistent condom use: being forced/deceived into sex work, less manager contact, less STI/HIV prevention knowledge acquired from medical personnel/professionals, not following a co-workers’ condom use advice, and an interaction between establishment type and alcohol use with establishment guests. Interventions should consider the effects of physical (force/deception into work), social (peer, manager influence), and policy (STI/HIV prevention knowledge acquired from medical personnel/professionals) environments on consistent condom use.     

校外青少年艾滋病应对社区同伴教育成功实践

目的总结在社区开展校外青少年艾滋病防治干预工作的经验,为今后大规模开展青少年干预活动提供科学依据。方法采用基线调查与干预后测试的横断面调查方法 ,通过利用混合式半开放结构式访谈问卷,对7个省项目点的5000多名校外青少年,进行干预前后对照评估。结果通过在社区开展艾滋病防治干预活动,使参与活动的校外青少年艾滋病知识知晓率和安全套使用率显著提高。他们中＂最后一次性行为使用安全套＂的比例从基线的27.67%提高到59.88%,增长了34.86%（χ2=34,86,P〈0.000）;而＂过去3个月每次性行为都使用安全套＂的比例从基线的24.77%提高到51.44%,增长了26.67%（χ2=37,70,P〈0.000）,其中,女性的改变比男性更为显著。结论研究提供的证据肯定了同伴教育做为校外青少年艾滋病应对的基本策略。然而,这个以多个省项目点为背景的广泛社区为基础的实践进一步表明,成功的同伴教育只有在社区组织的广泛参与和支持的框架中才能更为持久、有效和易于推广。     

Correlates of Any Condom Use Among Russian Narcology Patients Reporting Recent Unprotected Sex

The purpose of this study was to assess whether HIV/sexually transmitted infection (STI) risk factors: risky sex (multiple sex partners and sex trade involvement), past HIV or STI diagnosis and substance use (at risk drinking and injection drug use) are associated with the outcome any condom use in the past 6 months among Russian narcology hospital patients. Participants (N = 178) included only those who reported unprotected sex in the past 6 months and were aged 18–55 years and 76% male. Any condom use in the past 6 months was reported by 55% of the sample. History of STIs was reported by 43% of participants; 15% were HIV-infected. Regression analyses adjusted for demographics demonstrated that those reporting multiple sex partners (OR_adj = 4.2, 95% CI = 2.0–8.7) and sex trade involvement (OR_adj = 2.4, 95% CI = 1.1–5.1) in the past 6 months had significantly higher odds of reporting any condom use in this same timeframe. HIV/STI and substance use were not associated with increased odds of condom use.     

HIV/AIDS Stigma and Refusal of HIV Testing Among Pregnant Women in Rural Kenya: Results from the MAMAS Study

HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally and may be associated with refusal of HIV testing. We conducted a cross-sectional study of women attending antenatal clinics in Kenya (N = 1525). Women completed an interview with measures of HIV/AIDS stigma and subsequently information on their acceptance of HIV testing was obtained from medical records. Associations of stigma measures with HIV testing refusal were examined using multivariate logistic regression. Rates of anticipated HIV/AIDS stigma were high—32% anticipated break-up of their relationship, and 45% anticipated losing their friends. Women who anticipated male partner stigma were more than twice as likely to refuse HIV testing, after adjusting for other individual-level predictors (OR = 2.10, 95% CI: 1.15–3.85). This study demonstrated quantitatively that anticipations of HIV/AIDS stigma can be barriers to acceptance of HIV testing by pregnant women and highlights the need to develop interventions that address pregnant women’s fears of HIV/AIDS stigma and violence from male partners.     

Psychosocial factors predicting risky sexual behaviour among long distance truck drivers in Lagos,Nigeria

Long distance truck drivers (LDTDs) have been identified as one of the groups at higher risk for human immunodeficiency virus (HIV) infection. Understanding how certain social and psychological variables that have a strong theoretical basis contribute to sexual risk behaviour will guide in the implementation process of HIV risk-reduction intervention in the trucking population. In line with the conceptualisation of Information, Motivation and Behavioural skills model, we examined the extent that HIV knowledge, attitude towards condom use, peer support to condom use, perceived vulnerability to HIV/AIDS, and condom use self-efficacy will independently and jointly explain sexual risk behaviours of LDTDs in a haulage company in Lagos, Nigeria. A cross-sectional survey design was used and 154 drivers with ages ranging from 27 to 68 years (M?=?44.03, SD?=?8.82) completed copies of a questionnaire comprising demographics and measures of psychological variables. Psychological factors that included HIV knowledge, attitude towards condom use, perceived vulnerability to HIV/AIDS, peer support to condom use, and condom use self-efficacy significantly jointly predicted sexual risk behaviours (R²?=?.59, F(5, 148)?=?42.63; p?R²?=?.15, F(6, 147)?=?4.39; p?相似文献   

Achievement of interventions on HIV infection prevention among migrants in China: A meta-analysis

In China, migrants with acquired immunodeficiency syndrome (AIDS) have become a serious problem in the field of AIDS prevention. This study aimed to evaluate the efficacy of interventions for human immunodeficiency virus (HIV) infection prevention for migrants in China and to identify factors associated with intervention efficacy. A computerized literature search of the Chinese National Knowledge Infrastructure, Wan Fang, and PubMed databases was conducted to collect related articles published in China. Only self-control intervention studies or studies containing sections regarding self-control interventions wherein the method of intervention was health education were included. Rev Manager 5.3 software was used to analyze the intervention effects in terms of knowledge, attitude, and behavior indexes. Relative to pre-intervention, the HIV interventions showed statistically significant efficacy in terms of sexual transmission of HIV, condom use for HIV prevention, change in attitude towards HIV/AIDS patients, incidence of commercial sex behavior, and recent condoms use during sex (P?相似文献   

商业流动人员AIDS知识同伴教育及安全套推广使用效果评估

目的 了解商业流动人员对艾滋病(AIDS)知识的掌握情况，探索在该人群中开展预防AIDS的健康教育模式。方法 对商业流动人员进行AIDS知识同伴教育和安全套推广使用，干预前后分两次抽样采取一对一问卷调查，辅予定性资料，评价干预效果。结果 干预后商业流动人员的AIDS知识知晓率有显著提高；性传播、血液传播、母婴传播AIDS的知晓率分别提高至98．90％、99．45％、98．08％；轻视态度由6．50％降至0．55％，回避态度由14．40％降至2．19％，断绝往来的态度由8．17％降至O．27％，关心、开导的态度由56．20％升至77.81％；安全套可预防AIDS的认知率由40．60％升至87．95％，安全套正确使用率由85．20％升至94．25％，干预前后差异有显著的统计学意义。结论 以同伴教育和安全套推广使用为主，结合大众媒体、现场宣传等综合干预手段，是适合商业流动人员行之有效的健康教育模式。     

Gender Differences in the Prevalence and Behavioral Risk Factors of HIV in South African Drug Users

South Africa continues to be the global epicenter of HIV infection. Further, extensive gender disparities in HIV infection exist with females four times as likely to be infected with HIV/AIDS as males (UNAIDS, AIDS epidemic update, 2006; WHO, Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections, 2006). A cross-sectional collection of drug users recruited in the Pretoria region of South Africa (N = 385) was used to model HIV infection as a function of sexual risk behaviors and drug use as modified by gender. Receiving money from illicit sources and knowing someone with AIDS were loosely associated with HIV. Gender interactions were observed for age, cocaine use and condom use. Gender stratified analyses revealed that males who used condoms, were younger and tested negative for cocaine use were less likely to test positive for HIV. Findings suggest that males may have more control of risk behaviors and support the need for gender specific prevention strategies.     

2010—2013年攀枝花市商业性性工作者安全套使用分析

目的 了解四川省攀枝花市商业性性工作者（CSW）安全套使用变化趋势及相关影响因素,为制定本地的艾滋病预防干预措施提供科学依据。方法 依据《国家级HIV综合监测点监测方案》,2010-2013每年在全市分层整群抽样和方便抽样,对CSW进行重复横断面问卷调查,了解该人群的社会人口学特征、艾滋病知识知晓、安全套使用情况及干预服务接受情况等,采用SPSS19.0统计软件分析。结果 2010-2013年共调查CSW 3 200人,CSW人群最近1次商业性行为安全套使用率,分别为64.3%、89.8%、93.9%、93.5%。最近1个月每次商业性行为坚持每次使用安全套的比例,分别为43.3%、61.8%、69%、70.8%,差异均有统计学意义（χ2=386.04,P〈0.01;χ2=225.42,P〈0.01）;促进安全套使用的因素主要是：文化程度、接受宣传检测干预、知识知晓。结论 2010-2013年攀枝花市CSW使用安全套比例逐年提高,但坚持每次使用安全套比例需进一步提高,今后还需加强推广安全套及发放宣传材料,并注重艾滋病防治知识宣传。     

红河州MSM艾滋病相关知识及行为的随访调查

目的了解云南省红河州男男性行为人群（MSM）的艾滋病防治知识、行为及艾滋病病毒（HIV）抗体和梅毒血清学年阳转情况,为制定干预措施提供依据。方法采用前瞻性队列研究,招募符合标准的MSM,每6个月随访调查1次,项目期共完成2次随访调查。结果共招募了200名MSM,6个月随访调查178人,队列保持率89．00％;12个月随访调查158人,队列保持率79．00％。艾滋病防治知识知晓率从招募时的93．67％提高到98．73％;最近6个月与同性肛交时每次都用安全套的比例从招募时的34．85％上升到80．65％,最近一次与同性肛交时每次都用安全套的比例从招募时的54．55％上升到87．10％,与异性性行为时每次都使用安全套的比例从12．50％提高到47．06％。研究期间有3人出现HIV抗体阳转,无梅毒阳转。结论随访调查中,MSM的艾滋病知识知晓率、安全套使用率有所提高,但同性肛交、异性性行为情况无明显变化。应加强对辖区MSM的干预服务工作,以及HIV和相关疾病的监测检测覆盖范围。     

Toward Errorless Condom Use: A Comparison of Two Courses to Improve Condom Use Skills

Traditionally, researchers have focused HIV/AIDS prevention efforts on increasing condom use, yet few researchers have assessed condom use skills. Because incorrect condom use may lead to condom failure, promoting condom use without ensuring participants have the skills necessary for correct condom use may lead to increased risk of exposure. This study compared the effects of two condom use courses on condom use skills. These courses were administered as part of a HIV/AIDS educational program for college students. Participants in the treatment groups (n=179) attended either a limited, 1-Session, or extensive, 3-Session, condom use course, and an additional 108 participants served as a Control Group. Condom use skills increased among participants in both treatment groups; however, the greatest improvement was among those in the 3-Session Group. This finding supports use of the extensive, 3-Session course as a more effective means for improving condom use skills.     

HIV Knowledge and Sexual Risk Behavior Among Pregnant Couples in South Africa: The PartnerPlus Project

In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.     

HIV Seropositivity and Correlates of Infection Among Heterosexually Active Adults in High-Risk Areas in South Florida

The U.S. HIV/AIDS epidemic disproportionately impacts lower-income populations. We conducted a cross-sectional study of heterosexually active adults (N = 1076) in areas with high poverty and HIV/AIDS rates in South Florida in 2007. Using venue-based sampling, anonymous interviews and HIV tests were conducted at randomly selected venues (primarily retail businesses not associated with risk behaviors). The sample’s HIV infection rate was 7.1%. Half (52.2%) of the infections were previously undiagnosed. Our findings underscore the impact of social and environmental factors on HIV risk, as well as the need to increase and optimize HIV testing and other prevention services.     

The influence of knowing someone with HIV/AIDS on preventive behaviors in Italy

The influence of knowing someone with HIV/AIDS on HIV preventive behaviors has become increasingly relevant in the literature, with controversial findings. The aim of this study was to investigate the relationship between knowing someone with HIV/AIDS and preventive behaviors in a representative sample of the Italian adult population. Drawing on two sociocognitive models, perceived threat and HIV/AIDS knowledge were proposed as mediators of this relationship. Results from 1969 telephone interviews were analyzed. Questions included sociodemographic information, knowing someone with HIV/AIDS, past sexual behaviors, HIV/AIDS knowledge, HIV/AIDS perceived threat (susceptibility and severity), and preventive behaviors (HIV testing and condom use). The results of mediation models showed that knowing someone with HIV/AIDS had an indirect effect on condom use through HIV-perceived susceptibility. Knowing someone with HIV/AIDS showed a direct and an indirect effect through HIV/AIDS knowledge on HIV testing.     

Effect of an HIV counseling and testing program on AIDS-related knowledge and practices in tuberculosis clinics in Abidjan, C?te d'Ivoire.

SETTING: Two out-patient tuberculosis treatment centers, Abidjan, C?te d'Ivoire. OBJECTIVE: To assess the effect of a human immunodeficiency virus (HIV) counseling and testing program on acquired immune-deficiency syndrome (AIDS) related knowledge and behaviors among persons with newly diagnosed tuberculosis. DESIGN: Since 1994, patients with newly diagnosed tuberculosis have received individual or group HIV pretest counseling, informed consent, free HIV testing for those who consent, and post test counseling. From January 1995 through August 1996 in Abidjan's two largest tuberculosis clinics, knowledge and beliefs about HIV/AIDS were assessed before and immediately after the group pretest sessions, and again 4 months later. RESULTS: Prior to pretest counseling, 68.9% and 68.0% of the 559 enrolled subjects could correctly identify five modes of HIV transmission and five modes of HIV prevention. These proportions increased significantly immediately after pretest counseling (90.0%, 86.6%, respectively), and remained higher 4 months later (83.7%, 87.7%) (all P < 0.01). Among men, consistent condom use during the preceding 4 months with a partner who was not a commercial sex worker increased from 9.9% at enrollment to 23.6% at the 4-month visit (P = 0.001), but not for women (6.3% vs. 9.5%, P = 0.40). CONCLUSIONS: An HIV pretest counseling program conducted in an out-patient tuberculosis clinic was well accepted, and significantly increased the level of HIV/AIDS knowledge and, among men, self-reported condom use.