The interrelationship between violence, HIV/AIDS, and drug use in incarcerated women.

The purpose of this study was to examine how violence co-occurs with drug use and HIV/AIDS high-risk behaviors among women incarcerated for drug use. This study was a supplement to a larger, experimental study designed to reduce HIV/AIDS high-risk behaviors among incarcerated female drug users. The women who participated (N = 170) reported that violence was a major part of their lives and affected many of their behaviors. Among these 170 women, 26.6% used condoms for oral sex, 46.4% for vaginal intercourse, and 65% were either sexually or physically abused. Intimate partner abuse was reported by 33.9% of the women. About 16% reported forced sexual activity, and 17.5% feared their partners. Women who refused to give oral sex to their male partners and those who insisted on condom use during oral sex prior to jail were more likely to be sexually or physically abused (chi 2 = 4.104; chi 2 = 3.886, p < .05, respectively). Although statistically significant interrelationships were not found among the three variables, significant bivariate relationships were found between intimate violence and HIV/AIDS high-risk behaviors.     

Why Are Young College Women Not Using Condoms? Their Perceived Risk,Drug Use,and Developmental Vulnerability May Provide Important Clues to Sexual Risk

BACKGROUND: Young multiethnic college women (YMCW) are at risk for STDs and HIV secondary to high-risk sexual behaviors that are related to developmental issues such as invincibility, low perceived risk, and substance use. METHOD: One hundred YMCW on a southern California university campus completed surveys that examined variables that impacted their sexual risk. RESULTS: The study yielded many significantly correlated variables. Women with low perceived risk, lower use of drugs and alcohol, and who had parental involvement had lower sexual behavior risk. Women that were sexually assertive, had intentions to use condoms, and did not use substances used condoms more often. Older students in advanced grades who had steady partners used substances less and had decreased sexual risk, however, they experienced partner resistance to condoms, which canceled out any reduced risk. In a multiple regression analysis, condom use intention and substance use predicted condom use, perceived risk and substance use predicted sexual behavior risk. White women had significantly higher substance use, perceived sexual risk, and sexual behavior risk than did Latinas and African Americans. CONCLUSIONS: Despite their assertiveness and intentions, many participants had multiple sexual partners, and 64% of the YMCW were inconsistent condom users. Despite knowing the elevated risks, 52% used drugs and alcohol during sex. Negative attitudes (61%) about condoms were also demonstrated as a key factor in the lack of condom use.     

Prevention strategies other than male condoms employed by low-income women to prevent HIV infection

This study sought to determine HIV prevention strategies other than male condom use employed by low-income women who have sex with men (WSM) and to identify variables that predict use of these strategies. A cross-sectional survey of nearly 4,000 women receiving Women, Infants, and Children (WIC) benefits in 21 Missouri counties was conducted. The response rate was 58%, with 2,256 completed questionnaires returned. Women were asked to indicate one or more of nine methods they had ever used to prevent HIV infection. Women were also asked about their use of male condoms, preference for male condoms versus female condoms, and which partner usually made decisions about STD/HIV prevention. Of the 2,256 questionnaires returned, 1,325 WSM indicated use of at least one HIV prevention strategy other than condom use. Strategies were: being tested for HIV (68.2%), partner being tested for HIV (44.1%), asking partner about his sex history (41.1%), using oral contraceptives (18.8%), asking him if he has HIV (13.7%), douching (11.8%), withdrawal (9.4%), and having anal or oral sex (6.6%). Common predictors of these strategies were race, education, history of STD, condom use, and marital status. Basic misunderstandings about HIV prevention are common in specified subpopulations of low-income women. HIV prevention programs for low-income WSM should capitalize on women's efforts to prevent HIV by designing programs to help women replace ineffective prevention strategies with effective prevention strategies.     

Associations between homeless women's intimate relationships and their health and well-being

The purpose of this study was to describe the associations between intimate relationships, characterized in terms of presence or absence of conflictive interaction with the partner, and the health and well-being of homeless women. A sample of 558 homeless women were administered structured interviews by trained nurses or outreach workers of the participants' ethnicity. Women answered questions about their general physical health, health-threatening behaviors (i.e., risky drug and sexual behaviors), health-promoting behaviors (i.e., TB and Pap testing), psychological well-being and symptomatology, self-esteem, coping, and life satisfaction. Women in nonconflictive relationships reported significantly greater psychological well-being, self-esteem, and life satisfaction and less hostility and noninjection drug use than women with conflictive relationships or those without an intimate partner. Women with conflictive relationships were significantly more anxious and depressed than those with nonconflictive relationships. Results suggest that, when possible, it is advisable to involve the intimate partner in programs to facilitate the emotional well-being of homeless women.     

Safer Sex and Partner Violence in a Sample of Women

Sexually transmitted infections (STIs), including HIV, continue to be associated with significant morbidity and mortality among women. Intimate partner violence (IPV), affecting approximately 25% of women, has been shown to be a risk factor for HIV and STIs. This study describes the relationship between sexual risk, safer sex, and partner violence in a sample of women. Women who experienced IPV reported greater coercive sexual risk behaviors and a decreased ability to practice some safer sex behaviors. Nurse practitioners should be aware of the relationship between IPV and sexual risk and screen all women during routine visits.     

Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy.

As rates of HIV increase in Vietnam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic changes. The authors report results from qualitative interviews with 159 Vietnamese adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. In the qualitative interviews, youths report a strong adherence to ideals and values regarding abstinence outside of marriage. Youths reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%; p = .000). A total of 15 of 32 (46.9%) sexually active youths reported rarely or never using condoms. Females had significantly higher scores for perceived sexual stigma than males (t = -10.22 [95% confidence interval (CI); -3.72 to -2.52; p = .000) whereas males scored significantly lower than females on a scale of perceived self-efficacy for abstinence (t = 5.31 [95% CI; .27 to .59]; p = .000). The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence; however, these same values decrease adolescents' ability to obtain accurate information about sexuality and HIV and sexually transmitted infections and engage in safer sex.     

Incidence and correlates of physical violence among HIV-infected women at risk for pregnancy in the southeastern United States.

To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIV-infected women 17 to 49 years of age (mean = 30.1 years). Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical or sexual abuse. Women reporting greater violence were more likely to disclose their HIV-seropositive status to their sex partner. Using logistic regression, greater intent to get pregnant (odds ratio [OR] = 0.933), decreased present life satisfaction (OR = 1.048), having three or more children (OR = 0.474), and history of drug use (OR = 0.794) significantly distinguished between women who reported physical and/or sexual violence and those who did not.     

INTIMATE PARTNER SEXUAL ASSAULT AGAINST WOMEN AND ASSOCIATED VICTIM SUBSTANCE USE,SUICIDALITY, AND RISK FACTORS FOR FEMICIDE

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p = .002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

Gender and knowledge about HIV,risky sexual behavior,and safer sex practices

The purpose of this study was to examine gender differences in knowledge about HIV, the reported incidence of risky sexual behavior, and comfort with safer sexual practices among young adults. The conceptual framework was social role theory, which argues for the influence of gender roles on beliefs and social behaviors. Participants were 141 female and 131 male college students who responded to questions regarding their knowledge of HIV, risk-taking behaviors with respect to HIV, and comfort with safer sexual behaviors. Overall, respondents had accurate knowledge about HIV. However, men reported engaging in significantly more risky behaviors than women. More men reported that intercourse without a condom occurred in unplanned, spontaneous situations, while under the influence of alcohol or drugs, or with a person not well known. More women reported that intercourse without a condom occurred in long-term relationships. Women were significantly more comfortable abstaining from sexual intercourse and asking partners about their sexual history while men were significantly more comfortable buying condoms. Both men and women reported comfort using condoms. Gender roles help to explain why men are willing to take more risks, and in what situations risk taking is apt to occur. ©1995 John Wiley & Sons, Inc.     

Effectiveness of Increasing Emergency Department Patients' Self-perceived Risk for Being Human Immunodeficiency Virus (HIV) Infected Through Audio Computer Self-interview–based Feedback About Reported HIV Risk Behaviors

Objectives: Prior research has demonstrated that emergency department (ED) patient acceptance of human immunodeficiency virus (HIV) screening is partially dependent on patients’ self-perceived risk of infection. The primary objective of this study was to determine the effectiveness of audio computer-assisted self-interview (ACASI)-based feedback. The intervention aimed to increase patient’s self-perceived risk of being HIV infected by providing immediate feedback on their risk behaviors. Methods: This 1-year, randomized, controlled trial at a U.S. ED enrolled a random sample of 18- to 64-year-old subcritically ill or injured adult patients who were not known to be HIV infected. All participants completed an anonymous, ACASI-based questionnaire about their HIV risk behaviors related to injection drug use and sex, as well as their self-perceived risk for being HIV infected. Participants were randomly assigned to one of two study groups: an intervention group in which participants received immediate ACASI-based feedback in response to each of their reported risk behaviors or a no-intervention group without feedback. Participants were asked to indicate their level of HIV risk on a five-point scale before and after they answered the questions. Change in level of self-perceived HIV risk was calculated and compared by study group using Pearson’s chi-square test. An HIV risk behavior score that summarized reported HIV risk behavior was devised. Because HIV risk behaviors differ by sex, scores were calculated separately for each sex. Linear regression models that adjusted for study group and same subject covariance were employed to determine if higher HIV risk behavior scores were associated with an increase in self-perceived HIV risk. Results: Of the 566 trial participants, the median age was 29 years (interquartile range [IQR] = 22–43 years), 62.2% were females, and 66.9% had been tested previously for HIV. After answering the reported HIV risk behavior questions, 12.6% of participants had an increase, 79.9% had no change, and 7.5% had a decrease in self-perceived HIV risk. Of the 46.6% of participants who initially indicated that they were not at risk for HIV, 11.4% had an increase in self-perceived HIV risk after answering the reported HIV risk behavior questions. Change in self-perceived HIV risk did not differ by study group (p = 0.77). There were no differences in reported HIV risk scores between the intervention and no-intervention groups for females (p = 0.78) or males (p = 0.86). In the linear regression models, a greater increase in self-perceived HIV risk was associated with higher reported HIV risk behavior scores for females (β = 0.59, 95% confidence interval [CI] = 0.15, 1.04) but not for males (β = 1.00, 95% CI = −0.13 to 2.14). Conclusions: Some ED patients can be moved, although modestly, to recognize their risk for being HIV infected by asking about their HIV risk behaviors. However, ACASI-based feedback messages about HIV risk behaviors do not increase subjects’ self-perceived HIV risk. Female ED patients appear to increase their self-perceived HIV risk more than males when queried about their HIV risk behaviors.     

Knowledge, attitude, and practice about AIDS and condom utilization among health workers in Rwanda.

Health workers in rural Rwanda were surveyed cross-sectionally on knowledge, attitude, and practice (KAP) about AIDS, HIV, and condom utilization. Participants were 350 health workers from six randomly chosen communities (three rural, three semirural). In general, knowledge about HIV/AIDS was moderate to good, with an average of 63% of the questions answered correctly; men (and younger respondents) had a better knowledge than did women (p =.01; older participants, p =.015). However, in the specific area of HIV/AIDS symptoms, knowledge was inadequate. In general, the attitude of health workers toward condoms was not sufficiently positive. Regular use of condoms was reported by 17%; the only variable significantly associated with condom use was having more than one partner during the past year. Men and those who scored high on knowledge had a more positive attitude toward infected individuals than did women (p =.003) and those with less knowledge (p =.001). In conclusion, there is an urgent need to institute educational programs to reduce the stigma about condoms among health workers in Rwanda.     

Intimate partner sexual assault against women and associated victim substance use, suicidality, and risk factors for femicide

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p=.002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

A randomized clinical trial of an HIV-risk-reduction intervention among low-income Latina women

BACKGROUND: HIV infection has increased within the Latina community more than in any other ethnic or racial group within the United States. Latinas comprise only 13% of the U.S. population, yet they account for 20% of the cumulative reported cases of AIDS. OBJECTIVES: The purpose of the study was to evaluate a randomized culturally tailored intervention to prevent high-HIV-risk sexual behaviors for Latina women residing in urban areas. METHODS: Mexican and Puerto Rican women (18-44 years of age; N = 657) who were sexually active during the previous 3 months were recruited and randomized into intervention and control groups. The intervention, facilitated by bilingual, bicultural, trained Latina women, consisted of culturally tailored sessions on understanding their bodies, HIV/AIDS and sexually transmitted diseases, condoms (myths and use), negotiating safer sex practices, violence prevention, and partner communication. Bivariate and multivariate analyses assessed changes from baseline. RESULTS: The intervention improved HIV knowledge, partner communication, risk-reduction behavioral intentions, and condom use, and decreased perceived barriers to condom use. DISCUSSION: The efficacy of a culturally-sensitive intervention to reduce HIV/AIDS-risk behaviors in Latina women was demonstrated in the current study.     

浙江省杭州市有偿性服务男性人群艾滋病危险行为影响因素分析

目的了解浙江省杭州市为男同性恋者提供有偿性服务的男子(money boy， MB)艾滋病危险行为的影响因素。方法采用国家《艾滋病行为监测问卷》，在会所、浴室、酒吧等场所方便抽样调查206名MB，对年龄、文化程度、知识得分、性取向、商业性伴数等共18个因素与发生商业男男性行为时从不使用或有时使用安全套比率的关系采用单因素分析和多因素logistic回归分析。结果发生商业男男性行为时:最近一次未使用安全套和最近6个月从未使用或有时使用安全套的比率分别为25.2%、52.4％。多因素logistic回归分析显示:在公园寻找性服务对象，未曾检测过HIV，商业性伴数20人，MB人群从不使用或有时使用安全套的比率较高，OR值分别是7.15（95%CI:1.30～39.25），2.48（95%CI:1.11～5.52），2.68（95%CI:1.19～6.02）；而自己认为没有感染HIV可能性、第一个性伴为女性，其比率相对较低，OR 值分别是0.41（95%CI:0.18～0.95），0.44（95%CI:0.23～0.86）。结论MB人群艾滋病危险行为发生率高，寻找性服务对象的场所，曾经未检测过HIV和商业性伴数越多是危险因素；而自己认为没有感染HIV可能性和第一个性伴为女性是保护因素，在公园等重点场所持续开展MB人群的艾滋病宣传干预工作，包括咨询检测，提高自我保护意识。