Longitudinal Associations Between HIV Risk Reduction and Out-of-School Time Program Participation

PurposeThe study aimed to determine the longitudinal associations between several variables assessing positive youth development and HIV risk-reduction practices.MethodsParticipants were 329 youth enrolled in out-of-school time programs in New York City. Longitudinal data were collected in three waves during 2008-2009 (baseline, 6-month follow-up, and 12-month follow-up). Because of the nested nature of the data, multivariate analyses were performed using multilevel models.ResultsAt baseline, HIV risk reduction was associated with female gender, greater individual-level program participation, and greater school connectedness. Over time, HIV risk reduction was associated with program-level participation: Individuals in groups with program-level participation scores 1 standard deviation below the average showed significant declines in risk reduction practices over the 1-year study period compared with individuals in more participatory programs.ConclusionsThis study provides support for the out-of-school environment as an important context for sustaining HIV risk reduction and positive health promotion practices.     

Reductions in HIV Risk Among Runaway Youth

Runaway youth are 6–12 times more likely to become infected with HIV than other youth. Using a quasi-experimental design, the efficacy of an HIV prevention program was evaluated over 2 years among 2 groups of runaways: (1) those at 2 shelters who received Street Smart, an intensive HIV intervention program, and (2) youth at 2 control shelters. Street Smart provided youth with access to health care and condoms and delivered a 10-session skill-focused prevention program based on social learning theory to youth. Prior to analysis of the intervention's outcomes, propensity scores were used to identify comparable subgroups of youth in the intervention (n = 101) and control conditions (n = 86). Compared to females in the control condition, females in the intervention condition significantly reduced their unprotected sexual acts at 2 years and alcohol use, marijuana use, and the number of drugs used over 12 months. Male adolescents in the intervention condition showed significant reductions in marijuana use over 6 months compared to control youth. Adolescent HIV prevention programs must proactively identify mechanisms for maintaining behavior change over the long-term, and innovative research designs are needed to allow examination of agency-level interventions.     

HIV Testing Among Men at Risk for Acquiring HIV Infection Before and After the 2006 CDC Recommendations

Objectives

Testing for human immunodeficiency virus (HIV) is the key first step in HIV treatment and prevention. In 2006, the Centers for Disease Control and Prevention (CDC) recommended annual HIV testing for people at high risk for HIV infection. We evaluated HIV testing among men with high-risk heterosexual (HRH) contact and sexually active men who have sex with men (MSM) before and after the CDC recommendations.

Methods

We used data from the National Survey of Family Growth, 2002 and 2006–2010, to assess proportions of HRH respondents and MSM reporting HIV testing in the prior 12 months, compare rates of testing before and after release of the 2006 CDC HIV testing guidelines, and examine demographic variables and receipt of health-care services as correlates of HIV testing.

Results

Among MSM, the proportion tested was 37.2% (95% confidence interval [CI] 28.2, 47.2) in 2002, 38.2% (95% CI 25.9, 52.2) in 2006–2008, and 41.7% (95% CI 29.2, 55.3) in 2008–2010; among HRH respondents, the proportion was 23.7% (95% CI 20.5, 27.3) in 2002, 24.5% (95% CI 20.9, 28.7) in 2006–2008, and 23.9% (95% CI 20.2, 28.1) in 2008–2010. HIV testing was more likely among MSM and HRH respondents who received testing or treatment for sexually transmitted disease in the prior 12 months, received a physical examination in the prior 12 months (MSM only), or were incarcerated in the prior 12 months.

Conclusions

The rate of annual HIV testing was low for men with sexual risk for HIV infection, and little improvement took place from 2002 to 2006–2010. Interventions aimed at men at risk, especially MSM, in both nonmedical and health-care settings, likely could increase HIV testing.New infections of human immunodeficiency virus (HIV) occur in the United States at a rate of approximately 50,000 per year, driven mostly by sexual transmission, particularly among men who have sex with men (MSM).¹ In 2010, male-to-male sexual contact accounted for 63% of new HIV infections (78% among males), and heterosexual contact accounted for 25% of new HIV infections (11% among males).^1,2 Although overall incidence has been relatively stable since 2006, among young MSM, particularly young black MSM, new infections continue to increase.^1,3An estimated 14% of adults and adolescents living with HIV infection in the United States are undiagnosed, of whom 11% are males with high-risk heterosexual (HRH) contact and 62% are MSM.⁴ To increase the proportion of HIV-infected people who are aware of their status and link them to treatment and prevention services, the Centers for Disease Control and Prevention (CDC) recommended in 2006 that all people aged 13–64 years be tested at least once for HIV infection and that people at high risk for HIV infection, including men with HRH contact and sexually active MSM,⁵ be tested annually.Using data from multiple waves of a nationally representative survey, we examined the percentage of HRH and MSM respondents who reported having been tested for HIV in the prior 12 months. We compared rates of testing before and after the revised HIV testing guidelines⁵ were released by CDC in 2006. Additionally, because the 2006 CDC guidelines recommended that HIV screening be conducted as part of routine clinical care in all health-care settings,⁵ we examined HIV testing among men stratified by their reported use of health-care services in the prior 12 months and by several sociodemographic variables.     

Latent Tuberculosis among Persons at Risk for Infection with HIV, Tijuana, Mexico

Because there is little routine tuberculosis (TB) screening in Mexico, the prevalence of latent TB infection (LTBI) is unknown. In the context of an increasing HIV epidemic in Tijuana, Mexico, understanding prevalence of LTBI to anticipate emergence of increased LTBI reactivation is critical. Therefore, we recruited injection drug users, noninjection drug users, female sex workers, and homeless persons for a study involving risk assessment, rapid HIV testing, and TB screening. Of 503 participants, the overall prevalences of TB infection, HIV infection, and TB/HIV co-infection were 57%, 4.2%, and 2.2%, respectively; no significant differences by risk group (p>0.05) were observed. Two participants had TB (prevalence 398/100,000). Incarceration in Mexico (odds ratio [OR] 2.28), age (OR 1.03 per year), and years lived in Tijuana (OR 1.02 per year) were independently associated with TB infection (p<0.05). Frequent LTBI in marginalized persons may lead to increases in TB as HIV spreads.     

Social Influences: Living Arrangements of Drug Using Women at Risk for HIV Infection

SUMMARY

The purpose of this study was to explore the associations among living arrangements, HIV seroprevalence, and HIV risk and protective factors among 1,322 drug users participating in the University of Miami CARES (Community AIDS Research and Evaluation Studies) HIV intervention program. Living arrangements may be associated with HIV prevention behaviors; however, these influences can be either protective or destructive and therefore merit further examination. Statistical analyses indicated differences in the living arrangements of women compared with men, and significant associations were noted among women's living arrangements, HIV seroprevalence, risk behaviors and protective behaviors. The data from this study suggest that future HIV prevention research should investigate not only high-risk individuals, but persons with whom they interact often, especially those with whom they live or with whom they have sex. The next phase of HIV and drug interventions should be attentive to the incorporation of social context and social influences, paying particular attention to understudied populations such as high-risk women.     

男男性接触者高危行为与HIV感染

艾滋病(acquired immunodeficiency syndrome,AIDS)是全球最严重的公共卫生和社会问题之一.自1981年第1例艾滋病患者在美国男性同性恋者中被发现以来,全球艾滋病病毒(human immunodeficiency virus,HIV)在世界200多个国家和地区相继流行[1].联合国艾滋病规划署(UNAIDS)和世界卫生组织(WHO)联合发布报告指出,2006年全球艾滋病病毒携带者人数为3 950万;新增艾滋病感染者430万,其中有290万人死于艾滋病[2].我国现有艾滋病病毒感染者约65万,其中艾滋病患者约7.5万人,疫情已经波及31个省(自治区、直辖市).据卫生部通报,截至2007-07底,全国历年累计报告艾滋病214 300例,其中艾滋病患者56 758例;死亡18 246例.艾滋病的流行情况不容乐观.     

绍兴县艾滋病高危人群HIV感染因素分析

为探索艾滋病高危人群HIV感染高危因素及感染状况，我们对既往有偿供血者、吸毒人群、艾滋病自愿咨询者等开展HIV感染及高危因素调查，现将结果报告如下。     

Storytelling Narratives: Social Bonding as Key for Youth at Risk

This research used a structured storytelling narrative methodology to capture the lived experience of youth participants to identify effective factors that helped them in three programs in Santa Barbara and Ventura Counties, California. Thirty-nine youth aged 8–17 participated in two storytelling protocols at their home sites; one was a written narrative of a vivid experience in the project, and the second was a group story about a character who had been a participant. Categorical content analysis reported the following themes: positive peer experiences, caring adults, family atmosphere and learning new skills particularly computer literacy. Participants reported changing from being isolated or acting out to succeeding in school.     

Sexual Mixing Patterns and Partner Characteristics of Black MSM in Massachusetts at Increased Risk for HIV Infection and Transmission

Black men who have sex with men (MSM) are at increased risk for HIV infection in the United States compared to other MSM. The aim of this study was to investigate Black MSM’s sexual mixing patterns and partner characteristics in relation to sexual risk taking, as a possible explanation for this observed increase in HIV incidence. Between January and July 2008, 197 Black MSM were recruited via modified respondent-driven sampling and completed optional pretest and post-test HIV serological testing, counseling, and a demographic, behavioral, and psychosocial assessment battery. Bivariate and multivariable logistic regression procedures were used to examine predictors of risky sex across partner types. Overall, 18% of the sample was HIV-infected; 50% reported unprotected intercourse with men, 30% with women, and 5% with transgender partners. Fifty-three percent identified as bisexual or straight, although all reported oral or anal sex with another man in the prior 12 months. Significant predictors of engaging in at least one episode of: (1) serodiscordant unprotected anal sex (UAS) with a male partner in the past 12 months: individuals at risk for social isolation (AOR = 4.23; p = 0.03), those with unstable housing (AOR = 4.19; p = 0.03), and those who used poppers at least weekly during sex (AOR = 5.90; p = 0.05); (2) UAS and/or unprotected vaginal intercourse with a female partner in the past 12 months: those with unstable housing (AOR = 4.85; p = 0.04), those who used cocaine at least weekly during sex (AOR = 16.78; p = 0.006), being HIV-infected (AOR = 0.07; p = 0.02), and feeling social norms favor condom use (AOR = 0.60; p = 0.05); (3) UAS with the participants’ most recent nonmain male sex partner: use of alcohol and drugs during last sex by participant (AOR = 4.04; p = 0.01), having sex with a Hispanic/Latino male (AOR = 2.71; p = 0.04) or a Black male (AOR = 0.50; p = 0.05) compared to a White male, and lower education (AOR = 1.31; p = 0.02). Findings suggest that sexual risk behaviors of Black MSM differ across partner type and by the characteristics of their sexual networks and that this subpopulation of MSM are at high risk for HIV acquisition and transmission. Effective prevention strategies need to address the distinct sexual and behavioral risk patterns presented by different sexual partnerships reported by Black MSM.     

北京地区出入境人员HIV感染情况分析

〔目的〕掌握北京地区2000—2008年375162名出入境人员HIV感染情况、流行病学特征,为有效开展疾病监测和预防工作提供科学依据。〔方法〕对375162名出入境人员的HIV检测结果进行分析。对HIV-1抗体阳性者进行流行病学调查〔结果〕检出HIV感染者共95例,年均感染率25.32/10万,其中出境人员HIV感染者18例,感染率7.52/10万;入境人员HIV感染者77例,感染率56.53/10万。感染者以青壮年为主,30～39岁年龄组人员感染率最高,占感染者总数的45.26%;男性感染者64人,占感染者总数的67.37%;女性感染者31人,占感染者总数的32.63%。〔结论〕加强重点人群的监管工作,提倡健康的生活方式是预防艾滋病传播最有效的方法。     

On Campus HIV Self-Testing Distribution at Tertiary Level Colleges in Zimbabwe Increases Access to HIV Testing for Youth

PurposeHIV self-testing allows youth to access testing outside of healthcare facilities. We investigated the feasibility of peer distribution of HIV self-testing (HIVST) kits to youth aged 16–24 years and examined the factors associated with testing off-site rather than at distribution points.MethodsFrom July 2019 to March 2020, HIVST kits were distributed on 12 tertiary education campuses throughout Zimbabwe. Participants chose to test at the HIVST distribution point or off-site. Factors associated with choosing to test off-site and factors associated with reporting a self-test result for those who tested off-site were investigated using logistic regression.ResultsIn total, 5,351 participants received an HIVST kit, over 129 days, of whom 3,319 (62%) tested off-site. The median age of recipients was 21 years (interquartile range 20–23); 64% were female. Overall, 2,933 (55%) returned results, 23 (1%) of which were reactive. Being female (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.03–1.31), living on campus (aOR 1.24, 95% CI 1.09–1.40), used a condom at last sex (aOR 1.44, 95% CI 1.26–1.65), and previous knowledge of HIVST (aOR 1.22, 95% CI 1.09–1.37) were associated with off-site testing. Attending a vocational college and teachers training college compared to a university was associated with choosing to return results for those who tested off-site (OR 2.40, 95% CI 1.65–3.48, p < .001).DiscussionHIVST distribution is an effective method of reaching a large number of youth over a short period of time. Efforts to increase awareness and roll out of HIVST on campuses should be coupled with support for linkage to HIV prevention and treatment services.     

大学生自我艾滋病感染危险预测和影响因素研究

目的 了解大学生自我艾滋病感染危险预测水平，为改进健康教育策略提供依据。方法 2003年对浙江某市2所综合性大学21448名大学生进行自答式问卷调查。结果 8．1％的大学生认为自己可能感染艾滋病，68．1％回答不可能，23．8％回答不知道。男学生有自我感知危险意识的比例为11．0％，女学生则为5．2％，差异有非常显著性（X^2=242．54，P〈0．001）；对性途径传播艾滋病形势了解的学生中9．0％有自我危险预测，有性交行为史的学生中12．8％有自我危险预测。与自我艾滋病感染危险预测有关的影响因素有学校、性别、是否了解经性途径传播艾滋病正在上升、是否有性交行为史等7个因素。结论 应重视并提高大学生的自我艾滋病感染危险预测水平，并进一步深化大学生有关艾滋病预防的健康教育内容和方式。     

成都市男男性行为人群艾滋病感染状况及危险因素分析

目的分析成都市2011年男男性行为人群艾滋病哨点监测结果,探索HIV感染影响因素,为制定有效的干预措施、防治策略提供依据。方法采用横断面问卷调查方法,获得人口学及行为学资料,并进行HIV抗体和梅毒检测。对HIV感染危险因素进行单因素x。检验和多因素Logistic回归分析。结果2011年成都市共调查男男性行为者251人,HIV感染率为15．54％,梅毒感染率13．55％,艾滋病相关知识知晓率90．03％;最近6个月与同性发生肛交性行为占86．5％,最近1次安全套使用率为62．21％,安全套坚持使用率为36．87％;20．72％的男男性行为者与异性发生过性行为,且安全套坚持使用率为19．23％。结论成都市男男性行为人群HIV感染率较高,且高危性行为广泛存在,艾滋病知识知晓率较高、但安全套坚持使用率较低,应进行安全套发放和VCT服务,减少HIV感染的影响因素。     

School-related Risk and Protective Factors Associated with Truancy among Urban Youth Placed at Risk

Truancy is a serious concern in the United States. Its negative effects are so pervasive that in 2003 the Office of Juvenile Justice and Delinquency Prevention named truancy prevention a national priority. Effective prevention of truancy requires a thorough understanding of the characteristics that describe truant youth as well as factors that may put them at risk for truancy. Unfortunately, surprisingly little is known about the correlates and/or causes of truancy. In this paper we explore associations between truancy and several salient school-related risk and protective factors among a sample of youth who grew up in socially disorganized neighborhoods of Denver, CO. We demonstrate that several school-related risk and protective factors are associated with truancy. Perhaps most importantly, we identify that the two most robust predictors are school performance and involvement with delinquent peers, and that these two variables form a synergistic relationship in which the relationship between delinquent peer association and truancy is mitigated among students who perform well in school. Editors’ Strategic Implications: The authors use data from a large probability sample drawn from neighborhoods with high crime rates to identify key correlates of truancy. They also draw attention to the dearth of efficacious truancy prevention efforts in spite of the magnitude of the problem.     

学生男男性行为人群行为特征及HIV感染危险因素

目的了解学生MSM性行为特征和HIV感染现状,探索危险因素。方法采用分类滚雪球方法招募MSM研究对象,以面对面问卷调查获得相关人口学及行为学资料,抽取5 ml静脉血进行HIV抗体血清学检测,分析其中学生MSM人群行为特征和HIV感染危险因素。结果学生MSM艾滋病知晓率达94.67%,78.11%的人用互联网寻找性伴,首次同性肛交的平均年龄为18.6岁,82.64%的人最近6个月有肛交行为,同性性伴数平均3.12个,坚持使用安全套的比例为39.86%,HIV感染率为8.88%;学生MSM的HIV感染率、最近6个月肛交比例、平均性伴个数、首次同性肛交平均年龄,均低于非学生MSM。结论首次同性肛交年龄小,多性伴,无保护肛交性行为使学生MSM成为HIV感染的高危人群之一,寻求有针对性的干预措施是该人群艾滋病防制工作重点。