Hepatitis B vaccination: how to reach risk groups

Current hepatitis B vaccination programmes targeting risk groups have met with little success in controlling HBV infection in the general population. Despite the long-standing existence of unambiguous recommendations for risk-group vaccination, hepatitis B vaccination coverage remains low in most risk groups in most high-income countries. This low coverage may be attributed to a lack of perceived risk of hepatitis B and the absence of appropriate health care programmes targeting hepatitis B monitoring and vaccination for certain risk groups, particularly sex workers, injecting drug users, and prisoners. The Viral Hepatitis Prevention Board (VHPB) recognises the importance of raising the awareness of health care providers, policymakers, and the general public, about hepatitis B as a risk to both the community in general and to specific groups considered at increased risk. The VHPB also recognises that new strategies will have to be developed and implemented.     

Changing social and HIV/AIDS risk behaviours: Effects of life skills education among urban street youths

Abstract

The objective of this study was to examine the effect of a life skills education intervention among male and female youth in Ibadan, Nigeria, on knowledge about prevention and safe sexual practices, sexual roles and responsibilities, HIV/AIDS, money management, assertiveness and communication through follow-up interviews four weeks and eight weeks following the intervention. The participants were 98 males and females, and part of an initial survey of social and health problems of street youths in Ibadan, Nigeria. They were locality-separated, with consecutive assignments to two groups of experimental (n?=?54, exposure to a manual driven life skills education) and control (n?=?44, non-exposure to life skills education, but attention given) participants, and evaluated subsequently at four weeks and then at eight-week follow-ups. At the four-week post-intervention assessment, the experimental group showed significantly increased scores in the knowledge of antisocial behaviour prevention (p < 0.01), about HIV/AIDS (p < 0.001), about safe sexual practices (p < 0.001), about social roles and responsibilities and about assertiveness and communication (p < 0.01). At eight-week follow-up assessment, substantial significant reductions in reported antisocial and unsafe sexual behaviours were observed across the experimental group compared with the control group. The results suggest that street youths can be empowered through life skills education but with limitation to safe sexual practices over a sustained period of time in Nigeria.     

艾滋病高危人群干预活动中文化的影响

截至2009年底我国估计存活的艾滋病毒感染者和艾滋病患者(HIV/AIDS)约74万,2009年新发HIV感染者4.8万;疫情仍呈上升趋势[1].流行病学研究显示,特定的干预行为可以有效防止HIV传播,特别是对于女性性行为工作者(female sex worker,FSW)这样的高危人群[2].在艾滋病被发现的最初十年里,世界各国的公共卫生机构针对高危人群开展了"知-信-行"模式指导下的以生物医学理论为基础的干预项目[3].     

Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents

This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.     

The early response to AIDS in Switzerland: A personal view

Switzerland responded quickly to the AIDS epidemic, through cooperation with the most affected groups, explicit education of politicians and the public, and concerted action from health authorities. Important elements of the early response included: a brochure informing every Swiss household about AIDS, its transmission, and the social unity that would be required to deal with it; evaluation showing that the public was learning the facts but behavior of those at risk was not changing; and then a public campaign, STOP AIDS, that continues. Health authorities learned from and worked intensively with groups infected early, and found a continuing challenge in explaining to politicians and the public why the government should support prevention activities for gay men, hemophiliacs, and intravenous drug users. This is a personal perspective from an early, and long-term participant.     

Passive versus active parental permission: implications for the ability of school-based depression screening to reach youth at risk

BACKGROUND: Depression is prevalent among children and adolescents and often goes untreated with adverse effects on academic success and healthy development. Depression screening can facilitate early identification and timely referral to prevention and treatment programs. Conducting school-based emotional health screening, however, raises the controversial issue of how to obtain informed parental permission. METHODS: During implementation of a depression screening program in an urban school district in the Pacific Northwest, the district's parental permission protocol changed from passive (information provided to parents via a school mailer with parents having the option to actively decline their child's participation) to active (information provided to parents via a school mailer requiring the written permission of the parents for their child's participation). This change provided an opportunity to examine differences in participation under these 2 conditions. RESULTS: A total of 1533 students were enrolled in this program across both years. Compared to conditions of passive permission, participation was dramatically reduced when children were required to have written parental permission, dropping from 85% to 66% of eligible children. Furthermore, under conditions of active parental permission, participation decreased differentially among student subgroups with increased risk for depression. CONCLUSIONS: Successful implementation of school-based emotional health screening programs requires careful consideration of how to inform and obtain permission from parents.     

Perceptions of risk and strategies for prevention: responses to HIV/AIDS in rural Malawi

This paper combines quantitative and qualitative data to investigate changes in perceived risk of contracting HIV/AIDS in rural Malawi. Using longitudinal survey data, we find that Malawians worried less about contracting HIV/AIDS in 2001 than in 1998. According to qualitative interviews and observational journal accounts, HIV/AIDS and strategies to prevent it are a frequent topic of conversation amongst married Malawians. Women report worrying most about their husbands as a possible source of infection, discussing with them the importance of avoiding infection, and, increasingly, using divorce to reduce their risk. Men report worrying most about their extramarital partners and adopting preventive strategies such as fewer partners and more careful partner selection. We show that the decline in perceived risk is significantly associated with declines in the behaviors that Malawians worry most about and perceptions of risk in individuals' social networks. We interpret these findings as evidence that Malawians are changing their behavior in ways that may reduce the spread of HIV/AIDS.     

Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter.

BACKGROUND. A greater understanding of the determinants of risky behaviors is an essential precursor to the development of successful AIDS prevention programs for adolescents. METHODS. A survey measuring AIDS-related behaviors, beliefs, and knowledge was administered to a sample of 531 10th-grade students residing in an AIDS epicenter. RESULTS. Of the 56.8% of students reporting past-year involvement in sexual intercourse, 67.3% reported unprotected intercourse with low-risk partners, 1.3% reported unprotected intercourse with high-risk partners, and 6.6% reported a past-year history of a sexually transmitted disease. Students whose friends had intercourse and never or inconsistently used condoms, who personally sanctioned intercourse involvement, who believed that the majority of their peers had intercourse, and who perceived low preventive action self-efficacy, were 5.1, 3.0, 2.1, 3.7, and 2.8 times more likely, respectively, to score in the riskier categories of an AIDS behavior index. CONCLUSIONS. These findings suggest that addressing socioenvironmental influences on risky and preventive behaviors may prove to be the most effective AIDS prevention strategy among adolescents.     

2003-2006年阳泉市艾滋病哨点及其他高危人群监测结果分析

目的了解2003-2006年阳泉市艾滋病病毒哨点及相关高危人群艾滋病病毒（HIV）、梅毒检测（RPR）结果，为性病艾滋病预防控制工作提供参考。方法采用酶联免疫吸附法进行哨点人员和艾滋病高危人群的艾滋病病毒、梅毒检测。结果4年检测性病就诊者1333人，未发现初筛HIV阳性和复检阳性者；4年中，RPR阳性率分别为5．06％、4．92％、7．14％和9．00％。4年检测暗娟865人，未发现初筛HIV阳性和复检阳性者。4年检测吸毒者588人，2003、2004、2005年初筛均未检测出HIV阳性者，2006年初筛和复检均检测出2例（1．10％）HIV阳性者。临床检验哨点有记录的检测结果68人份，2003年与2006年检验结果缺失。2004年初筛阳性结果24份（54．55％），复检阳性结果4份（9．09％），2005年初筛与复检均有阳性结果4份（16．67％），没有RPR阳性结果。其他高危人群也有HIV与RPR阳性结果检出。结论4年中阳泉市在不同高危人群中均有HIV和RPR阳性检出结果，控制艾滋病、性病传播形式不容乐观。应加强预防艾滋病、性病知识的健康教育，采取有力措施，遏制艾滋病、性病的传播。     

我国农村地区艾滋病流行因素及健康教育策略

目前,艾滋病流行仍然处于全国低流行和局部地区及特定人群高流行并存的态势,同时逐步从高危人群向一般人群扩散[1]。自2002年以来,病例报告数明显增多,其中大部分为有采供血和注射吸毒史的艾滋病病毒(HIV)感染者,主要生活在农村地区。虽然艾滋病传播与个人行为密切相关,但是,社     

The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community.

The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable.     

Knowledge,attitudes and behaviours in relation to safe sex,sexually transmitted infections (STI) and HIV/AIDS among remote living north Queensland youth

Objective: To assess the knowledge, attitudes and behaviours of remote Aboriginal and Torres Strait Islander youth living in far north Queensland in relation to sexually transmitted infections, HIV/AIDS and safe sex. Methods: Community consultation followed by local recruitment of a sample of young people who, in a facilitated same gender focus group setting, completed a questionnaire followed by open discussion of the issues in a range of remote locations during 2007. Results: The remote living Indigenous youth demonstrated lower levels of knowledge in relation to STI and HIV and higher levels of partner change than was demonstrated in the 2002 national secondary school survey. Despite the high rates of bacterial STI in the region, there was an extremely low level of awareness of personal risk in relation to STI and HIV. Conclusion: There is an urgent need to strengthen school‐based sex education and to develop innovative approaches to sexual health promotion in addition to improving clinical sexual health service provision.     

New cigarette brands with flavors that appeal to youth: tobacco marketing strategies

Tobacco manufacturers have recently introduced a proliferation of exotic brands featuring candylike flavors. We reviewed internal tobacco industry documents and patents to assess the role of flavored cigarettes in the targeting of young smokers. This research revealed the development of flavor delivery technologies hidden from consumers and public health professionals, including the use of a plastic pellet placed in the cigarette filter. These findings raise concerns as to the potential added health risks associated with using new flavored tobacco products, and they underscore the need for effective assessment and monitoring of tobacco products.     

HIV and AIDS, stigma and AIDS support groups: Perspectives from women living with HIV and AIDS in central Thailand

In this paper, community attitudes toward women living with HIV and AIDS at the present time from the perspectives of women in Thailand are examined. We also look at strategies women use in order to deal with any stigma and discrimination that they may feel or experience in the community. The paper is based on our larger study of the experiences of women living with HIV and AIDS and their participation in clinical trials. In late 2007 and early 2008 we carried out a number of in-depth interviews with women living with HIV and AIDS in central Thailand. We find that women living with HIV and AIDS still deal with stigma and discrimination in their everyday life. However, from the women's narratives, we also find more positive attitudes from local communities. Some women deal with stigma and discrimination by joining and participating in HIV and AIDS support groups that have emerged in response to the AIDS epidemic in Thailand. We argue that women are not passive victims, but that they act in their own agencies to counteract any negativity they might encounter.     

AIDS education in Tanzania: promoting risk reduction among primary school children.

OBJECTIVES: The purpose of this study was to test the effects of an education program in Tanzania designed to reduce children's risk of human immunodeficiency virus (HIV) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome (AIDS). METHODS: A randomized controlled community trial including baseline and 12-month follow-up surveys was employed. Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and randomly assigned to intervention (n = 6) or comparison (n = 12) conditions. Of the 1063 sixth-grade students (average age: 13.6 years) who participated at baseline, 814 participated in the follow-up survey. RESULTS: At follow-up, statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication, AIDS knowledge, attitudes toward people with AIDS, and subjective norms and behavioral intentions toward having sexual intercourse. A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year (7% vs 17%). CONCLUSIONS: It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children.