Rapid Assessment of HIV Risk Behavior in Drug Using Sex Workers in Three Cities in South Africa

A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.     

Social development of commercial sex workers in India: an essential step in HIV/AIDS prevention

India has the highest number of HIV/AIDS cases in the world. Current HIV/AIDS prevention strategies are based on regular and appropriate condom use. However, most commercial sex workers (CSWs), who form the core/high-risk groups toward whom the prevention strategy is directed, are disempowered and socioeconomically marginalized. This does not allow them to insist on condom use by the client, especially in absence of governmental structural support. This paper discusses HIV/AIDS prevention issues that relate to CSWs in India; issues that play a vital role in initiation, perpetuation, and expansion of economic activity of CSWs; and those factors that influence the HIV/AIDS preventive practices of CSWs. This paper argues that CSWs can be empowered and emancipated; that HIV/AIDS control and prevention efforts in India must recognize that ad hoc promotion of condom use or similar such programs will not be effective to control HIV/AIDS; and that more extensive developmental work aimed at betterment of living conditions of CSWs is required for effective HIV/AIDS prevention.     

Relationship between network operators and risky sex behaviors among female versus transgender commercial sex workers in Pakistan

Unprotected sex among commercial sex workers (CSWs) remains a leading cause of HIV transmission internationally. Previous research on condom use among CSWs has focused on females, with limited research among transgenders or on the role of network operators who mediate paid sexual transactions. We test whether network operators increase the likelihood of condom use among female and transgender CSWs in four Pakistan provinces using the 2011 Integrated Behavioral and Biological Survey. We find that transgender CSWs recruiting clients through network operators had higher odds of consistently using condoms compared with female CSWs recruiting clients through another source (relative OR: 2·80, 95% CI: 1·67, 4·70). While transgender CSWs in Pakistan using network operators have higher rates of condom use, however, this protective effect does not hold among females. This suggests that network operators may be a valuable group to target for HIV prevention efforts.     

Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drugusing populations in Cape Town,Durban and Pretoria,South Africa

This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known ‘hotspots’ for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.     

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.     

Factors associated with inconsistent condom use in adolescents with negative or unknown HIV status in Northwest Cameroon

The purpose of this study is to evaluate the association between utilization of HIV testing and condom use amongst Cameroonian youths/adolescents who are not known to be HIV-infected. Worldwide, HIV is spreading most quickly amongst youths/adolescents. Between 44% and 82% of sexually active youths in Cameroon report inconsistent condom use. Data regarding utilization of HIV testing and condom use are lacking. A cross-sectional survey was administered to 431 youths ages 12–26 years in Cameroon from September 2011 to December 2011. Data on sociodemographics, sexual risk behaviors, self-reported HIV status, and condom use were collected. We compared rates of inconsistent condom use between those with known HIV negative status who utilized testing (HIV-N) and those with unknown status due to unutilized testing (HIV-U). Inconsistent condom use was defined as responding “never,” “sometimes,” or “usually,” while consistent condom use was defined as responding “always” to questions regarding frequency of condom use. Generalized estimating equations were applied to assess the association between HIV testing and inconsistent condom use, adjusting for other confounders. Of 414 eligible respondents, 205 were HIV-U and 209 were HIV-N. HIV-U subjects were younger (mean age = 16.4 vs. 17.9, p < 0.001) and more likely to report living in an urban area (p = 0.002) than HIV-N subjects. Seventy-two percent (137/191) of sexually active youths reported inconsistent condom use. After adjusting for potential confounders, HIV-U status (odds ratio [OR] = 3.97, 95% confidence interval [CI] = 1.68–6.01) was associated with inconsistent condom use. Similarly, female gender (OR = 3.2, 95% CI = 1.29–7.89) was associated with inconsistent condom use, while older age at sexual debut was associated with a decreased risk for inconsistent condom use (OR = 0.67, 95% CI = 0.56–0.81). Cameroonian adolescents report high rates of inconsistent condom use which we found to be associated with self-reported unknown HIV status due to unutilized HIV testing. Successful HIV prevention programs among African youths/adolescents may benefit from expanded HIV testing programs.     

HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study

Although many researchers found that drug use behaviors significantly increased HIV risk, few of them investigated the association between HIV risk and different drug use behaviors among female sex workers (FSWs) in China. The current study examines demographic and behavioral risk factors as well as the infections of HIV, syphilis, and among a subgroup of FSWs who are injection drug users (IDU) or noninjection drug users (NIDU) in comparison to Hepatitis C Virus (HCV) nondrug users (non-DU). We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs recruited from Guangxi, China. The Guangxi 2010 NSS sample included 2.6% NIDU and 0.5% IDU. Compared to non-DU, IDU were more likely to report no condom use in the last sex act (aOR = 3.25, 95%CI = 1.65, 6.40), inconsistent condom use in the past month (aOR = 4.88, 95%CI = 2.66, 8.96), having an HIV testing (aOR = 2.48, 95%CI = 1.34, 4.58), infections of HIV (aOR = 42.60, 95%CI = 9.45, 192.06), syphilis (aOR = 4.13, 95%CI = 1.86, 9.16), and HCV (aOR = 74.54, 95%CI = 30.26, 183.61). NIDU had 2.89 times higher than non-DU to report a history of sexually transmitted disease and 26% less likely to report inconsistent condom use in the past month (p < 0.05). We called for tailored, accessible, and nonjudgmental drug treatments coupled with effective sexual risk reduction interventions to help FSWs with various drug use problems to reduce their vulnerability and susceptibility of HIV risk in China as well as other cultural settings.     

卖淫妇女AIDS危险行为监测的试点研究

目的 调查了解卖淫妇女艾滋病(AIDS)相关的知识、态度和性行为变化情况，为制定和评估AIDS预防控制策略和措施提供依据。方法 采用二阶段整群抽样的方法，运用统一调查问卷，采用面对面的调查方法，连续2年在相同的2个城市，对娱乐场所内的卖淫妇女进行调查。结果 2000、2001年分别调查了411、385名卖淫妇女，卖淫妇女对AIDS传播途径知晓率有显著提高；对安全套预防AIDS、经性传播的态度和信念有明显转变；在个人求医态度方面，自己购药的比例有明显的下降，由2000年的20．2％下降到2001年9．9％；最近1次与固定性伙伴安全套的使用率由2000年的41．1％提高到2001年的49．6％，但与非固定性伙伴和最近3次与固定、非固定性伙伴的性行为中，安全套的使用率无显著变化。结论 卖淫妇女在性行为中安全套的使用率低，需要进一步加强宣传和干预。     

An Exploratory Study of HIV Prevention with Mexican/Latino Migrant Day Laborers

Abstract

The purpose of this exploratory study was to develop, implement, and evaluate a pilot HIV prevention intervention with one of the most mobile of U.S.-Mexico transborder populations: Mexican/Latino migrant day laborers (MDLs). Intervention development was informed by preliminary research that included an HIV risk survey of over a hundred MDLs, and a focus group to explore the topic of HIV in the lives of MDLs. Both quantitative and qualitative methods were used to evaluate the intervention, and to identify some of the contextual characteristics of HIV risk factors in the MDL experience. For example, the most frequent theme revealed by qualitative analysis was the stressful and vulnerable state of desesperacion [desperation], resulting from earning too little money, that participants linked to deviating from their migration goals and succumbing to alcohol and drug use, and risky sex. While empirical results are limited by the small sample of convenience (N = 23), lack of a control group, and loss of about half of the sample by one month followup evaluation, findings were encouragingly consistent with intervention goals: Post-intervention data revealed what appear to be substantial gains in carrying condoms (e.g., from 43% to 83%) as well as in knowledge of proper condom use. Further, frequency of sex with risky sex partners decreased in general, while condom use was reported for all sexual encounters assessed during post-evaluation. The theoretical framework used to guide the intervention, a hybrid of the Health Belief Model and Friere's model of participatory education, included visual triggers composed of customized Mexican lottery game cards to elicit discussion of HIV risk and prevention in the MDL experience.     

Consistent Condom Use in South African Youth’s Most Recent Sexual Relationships

Sexually active South African youth are at high risk for HIV infection but a low prevalence of condom use has been reported in this population. We examined correlates of consistent condom use with most recent sex partners among a nationally representative sample of youth 15–24 years old who reported having had sex in the previous 12 months (N = 6,649). Among men and women, having talked to a partner about using condoms was the most significant predictor of consistent condom use. However, youth who reported being in their most recent relationship for more than 1 year and who reported having had sex one or more times in the last month were more likely to report inconsistent condom use. HIV interventions should empower youth to talk about using condoms with their partners, encourage periodic testing for HIV, and reinforce condom use according to HIV status in long-term relationships.     

2005-2008年北京嫖客人群感染艾滋病的危险行为改变研究

目的了解2005-2008年嫖客艾滋病知识、行为特征及其艾滋病病毒（HIV）抗体阳性率、梅毒血清学试验（RPR）阳性率的变化趋势,为指导在嫖客人群中开展防治艾滋病行为干预提供依据。方法每年4-6月和10-12月,对新入收教所的嫖客进行普查,采用统一的男性监测调查表对调查对象进行流行病学调查。结果 2005-2008年共调查2888名嫖客,其文化程度有逐年增高趋势（χ2=146.907,P〈0.05）;其艾滋病传播途径的知晓率有逐年上升趋势（χ2=44.296,P〈0.05）,但AIDS非传播途径的知晓率低于传播途径的知晓率;最近一次与小姐发生性行为不使用安全套的比例有逐年上升的趋势（χ2=20.969,P〈0.05）;最近一个月与小姐发生性行为每次都使用安全套的比例呈现出逐年下降的趋势（χ2=60.455,P〈0.05）;最近一次与固定性伴发生性行为使用安全套的比例有逐年下降的趋势（χ2=59.795,P〈0.05）。结论嫖客中HIV处于低流行水平,但嫖客感染HIV的风险有逐年上升趋势,应加强对嫖客的监测和危险行为干预,提高其安全套使用率。     

HIV risk behavior and internalizing/externalizing psychopathology among adolescents in court-ordered treatment

ABSTRACT

Background: The confluence of drug use behaviors, sexual risk, and psychopathology may complicate human immunodeficiency virus (HIV) prevention intervention for adolescents engaging in substance use and criminal behavior. However, few studies have examined these risk associations. Objective: This study identified HIV risk behavior subgroups among adolescents in court-ordered substance abuse treatment and examined linkages with dimensions of internalizing and externalizing psychopathology. Methods: Internalizing and externalizing behaviors were assessed with the Millon Adolescent Clinical Inventory (MACI). Latent class analysis was used to identify subgroups on the basis of involvement in substance use proximal to sex, number of partners, and consistency of condom use. Results: Participants (n = 301) were identified as demonstrating high, medium, or low levels of sexual risk behavior. Greater externalizing psychopathology distinguished the high risk class from the medium risk class and from the low risk class. Conclusion: Detained youth with particularly serious oppositional-defiant behavioral characteristics, substance use, and sex risk behavior likely require intensive interventions that address the multiple systemic factors that contribute to the development and maintenance of this pattern.     

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.     

新疆4个市暗娼的AIDS/STD知识行为及危险因素调查分析

目的探讨新疆维吾尔自治区暗娼感染艾滋病/性病(AIDS/STD)的危险因素。方法2004年4~5月,对新疆乌鲁木齐市新市区、喀什市、伊宁市和吐鲁番市的661名暗娼展开艾滋病知识、行为问卷调查及妇科体检。结果4个市的暗娼对艾滋病已构成的威协认知率不高,3种传播途径掌握率高于75%,其它知识较为缺乏。商业性行为发生频率较高,安全套使用率及定期体检率低,而性传播疾病感染率较高,淋病为0~7.77%,沙眼衣原体为21.24%~23.30%,梅毒为1.1%~5.53%,尖锐湿疣为0.71%~2.91%。结论导致暗娼性传播疾病比例高、艾滋病流行初见势头的主要危险行为是安全套使用率不高,不能坚持定期体检,自我保护意识淡薄,获取的预防知识不够全面。提示今后干预工作中应转变观念,提供全方位的干预措施,从而阻止艾滋病经性途径传播。     

Risk behaviours of Hong Kong male residents travelling to mainland China: a potential bridge population for HIV infection

The objective was to assess levels of high-risk sexual behaviour, condom use, sexually transmitted disease (STD) history and AIDS-related perceptions among Hong Kong men returning from China by land; 1,254 systematically sampled subjects were interviewed. Of respondents, 32.5% had sexual intercourse with a commercial sex worker (CSW) in China in the past six months; 11.2% have done so on this trip. A third of those who reported having sex with CSWs did so without a condom. A fifth had a history of STDs: seventy per cent of respondents who did not use a condom with a CSW would not use a condom with their regular sexual partner. Less educated respondents, 31-40-year-olds and non-business and frequent travellers were more likely to have sex with a CSW. Those who practice high-risk sex fear AIDS more, are aware that their own risk of HIV infection is not negligible, but think that chances of HIV infection from CSWs in China are small. Although Hong Kong's estimated HIV prevalence among adults is low (0.06%), the huge volume of cross-border travel between Hong Kong and China and the common practice of high-risk sex by Hong Kong male travellers provide a bridge for emerging epidemics to spread.     

The Relative Role of Perceived Partner Risks in Promoting Condom Use in a Three-City Sample of High-Risk,Low-Income Women

We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.     

Promoting HIV Testing and Condom Use Among Filipina Commercial Sex Workers: Findings from a Quasi-Experimental Intervention Study

This study examines the effects of a multi-level social action-based theory (SABT) intervention to increase HIV testing and consistent condom use among female commercial sex workers (FCSWs). Respondents in four socio-demographically similar Philippine cities received an SABT intervention based on: (1) peer influence; (2) manager training; (3) combined peer/manager influence; or (4) usual care (control condition). HIV testing increased 86% from baseline (N = 980) to follow-up (N = 903), and was significantly associated with higher HIV/AIDS knowledge, lower probability of contracting HIV and increased condom use. After adjusting for socio-demographic, HIV knowledge and perceived control variables, FCSWs in the manager training and combined peer/manager conditions were significantly more likely to engage in consistent condom use. Mediational analyses revealed higher HIV/AIDS risk perceptions and a supportive work environment related to increased condom use. These findings support a growing body of research suggesting the need for multi-level sexual risk reduction interventions among FCSWs.     

Differences in HIV Risk Behaviors Among Women Who Exchange Sex for Drugs, Money, or Both Drugs and Money

The purpose of this study was to investigate differences in drug use and HIV risk behaviors among women who exchanged sex for drugs only, for money only, or for both drugs and money. Structured interview responses from 2,042 drug-using women in 23 cities who reported having exchanged sex in the prior 30 days were analyzed. Results indicated that women who exchanged sex for drugs only (n = 117), and for drugs and money (n = 965), were more likely to use alcohol and smoke crack than those who exchanged sex for money only(n = 960). They were also more likely to have had unprotected sex and sex with a drug injector. Those who exchanged sex only for drugs reported having sex half as often as the other two groups and had one fourth the number of partners, but used condoms the least when having sex. Women who exchanged sex for money only were the most likely to inject drugs and the least likely to have had unprotected sex. Promoting condom use and increasing availability of condoms to women who exchange sex, and to their partners, is crucial. Continued research into the relationship between crack use and sex-related HIV risk behaviors is also needed.     

A Systematic Review and Meta-Analysis of Behavioral Interventions to Reduce HIV Risk Behaviors of Hispanics in the United States and Puerto Rico

This systematic review examines the overall efficacy of HIV behavioral interventions designed to reduce HIV risk behaviors or incident sexually transmitted diseases (STDs) among Hispanics residing in the United States or Puerto Rico. Data from 20 randomized and nonrandomized trials (N = 6,173 participants) available through January 2006 were included in this review. Interventions successfully reduced the odds of unprotected sex and number of sex partners, increased the odds of condom use, and decreased the odds of acquiring new STD infections. Interventions successful in reducing the odds of any sex risk behavior used non-peer deliverers; included >or=4 intervention sessions; taught condom use or problem solving skills; or addressed barriers to condom use, sexual abstinence, or peer norms. Interventions that included the Hispanic cultural belief of machismo or those developed based on ethnographic interviews were successful in reducing the odds of sex risk behaviors among non-drug users. Interventions targeting injection drug users (IDUs; N = 3,569) significantly reduced the odds of injection drug use and the odds of sharing cotton or cookers, but did not significantly reduce the odds of engaging in risky sex behavior or needle sharing. Further development of culturally appropriate HIV prevention interventions for Hispanic populations, particularly men and persons living with HIV, are warranted.