A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach

OBJECTIVE: Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. We review the research that has shaped this narrow perspective and propose that a broader, ecological perspective is needed to amplify and extend the efficacy of sexual risk reduction interventions. METHODS: We summarize adolescent sexual risk research and outline intervention research that is suggestive of an ecological perspective. Examples from the published literature that have investigated antecedents or conceptualized preventive interventions using a multilevel approach are provided. RESULTS: Adolescents are exposed to diverse sources of influence transecting different levels of causation. To adequately prevent, reduce, and maintain the likelihood of adolescents' adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation. This approach has been implemented in Brazil and was shown to be effective. CONCLUSION: Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents' adoption and maintenance of STD/HIV preventive behaviors.     

The impact of HIV/AIDS stigma on HIV counseling and testing in a high HIV prevalence population in Uganda

Background

Despite its importance in HIV/AIDS prevention and treatment, HIV/AIDS Counseling and Testing (HCT) is low in sub-Saharan Africa, where the disease continues to be a serious public health problem. This has in part been attributed to HIV/AIDS related stigma.

Objective

To assess the level of HIV/AIDS related stigma and its impact on uptake of HCT in a high HIV prevalence population in Uganda.

Methods

The paper used cross-sectional data on 135 men and 185 women in reproductive ages. Data were analyzed using the Pearson''s chi-square statistic and the random intercept binary logistic regression model to identify significant predictors of uptake of HCT.

Results

The result shows that only 18.4% of the respondents, most of them men expressed highly stigmatizing attitudes against PLHA and 59%, men and women alike, received HCT. Uptake of HCT was higher among men (OR=1.89, p<0.01) and women (OR=4.48, p <0.001) who expressed least stigmatizing attitudes. Secondary/higher education, work in the informal sector and being ever married were significant predictors of uptake of HCT. Compared to men, women aged 25–34, 35+ and with one sexual partner were more likely to have received HCT.

Conclusions

The low level of stigma, older age, higher level of education, being ever married and monogamous sexual relationships are significant predictors of increased uptake of HCT.     

江门市2003—2007年性病门诊患者HIV感染调查

目的了解近年江门市经性途径感染HIV的情况，为制定预防控制对策和措施提供科学依据。方法2003—2007年每年HIV监测期间对江门市性病门诊就诊的性病患者进行HIV抗体和其他性病病原体检测，并对HIV抗体确认阳性者进行个案调查。结果2003—2007年HIV监测期间共检测性病患者2394例，初筛HIV阳性11例，WB法确认HIV阳性10例，阳性率为0．72％。10例确诊病例为2005—2007年发现的患者，其中经性接触感染8例，2例吸毒感染的病例同时存在性乱史。合并梅毒感染6例，占60．00％。所有病例在发生性行为时，很少甚至不用安全套。结论随着艾滋病传播快速增长期的到来，经性传播正逐步成为江门市HIV感染的不可忽视的传播途径。性病专科临床医生应该发挥优势，在规范治疗性病的同时，应加强HIV抗体检测，并有针对性地进行性病艾滋病健康教育，以有效改变其危险性行为。     

From questionnaire to conversation: a structural intervention to improve HIV test counseling

Objective

We describe the effects of structural intervention to enhance the quality of HIV test counseling interaction with men who have sex with men (MSM) in San Francisco.

Methods

Audio recordings of 28 rapid HIV test sessions by seven counselors were collected in two phases: before and after implementation of a waiting room intervention prior to the session. The sessions were analyzed using sequence maps to visualize and compare the sequence and distribution of four activities: counseling, information delivery, data collection, and sample collection.

Results

Prior to the intervention, counselors and clients often oriented to data collection about the client's past risk as if it were a survey. In sessions recorded after the intervention, questions about past risk were dispersed throughout the session and embedded within an elaborated discussion of the client's particular life circumstances.

Conclusion

Direct observation with the aid of sequence maps illuminates the ways that counselors and clients collaboratively orient to various tasks.

Practice implications

We demonstrated the feasibility of a structural intervention that improved the quality of both counseling and the accuracy of client risk data without requiring additional session time or counselor training.     

Online support group use and psychological health for individuals living with HIV/AIDS

Objective

The Internet provides an opportunity for individuals with HIV/AIDS to obtain support and information in a timely and convenient manner. The present study examines the psychological effects of online support group use for individuals living with HIV/AIDS.

Methods

A total of 340 HIV positive online support group users completed an online survey.

Results

Results from structural equation modeling showed that individuals with higher levels of online support group participation had higher levels of empowering processes, which in turn, had higher levels of optimism toward life. Optimism was related to lower levels of loneliness and depression while loneliness was also related to higher levels of depression.

Conclusion

The findings suggest that participants with higher levels of online support group participation had better psychological health than those with lower levels of participation.

Practice implications

Findings suggest that the use of online support groups could be promoted to individuals with HIV/AIDS. Healthcare professionals should work to increase the motivation and confidence patients have in using online support groups. Health education should also be provided to patients with HIV/AIDS so to improve their skills and literacy in using online support groups.     

艾滋病自愿咨询检测行为影响因素调查

目的了解大众艾滋病相关认知水平对于自愿咨询检测（VCT）的影响，为VCT的社区倡导提供依据。方法限定时段内对于自愿咨询检测门诊的求询者和整群抽取的社区居民进行包括人口学特征、艾滋病相关认知、VCT需求和行为的调查。采用描述性统计和Logistic回归对资料进行分析。结果VCT对传播途径的认知水平（Z=3．24314，P=0．0012）和公共卫生焦虑程度（Z=1．92708，P=0．0540）明显高于社区居民。对于存在感染风险者，主要影响其自愿咨询检测行为的是性别（OR=0．051，P=0．0001）、传播途径认知水平（OR=12．161，P=0．0264）、应对病毒的自我效能感（OR=3，252，P=0．0343）和流行现状焦虑（OR=1．576，P=0．0305）等。结论人口学特征对于合理检测行为的影响并非关键，在VCT社区倡导中要加强流行状况的介绍提高防治紧迫感，详细解释传播风险以提高风险自觉性，同时通过介绍HIV的防治方法以提高应对病毒的自我效能感也有助于促进自愿咨询检测。     

重庆市城区农民工HIV/AIDS防治知识和态度调查

目的了解重庆市主城区农民工HIV/AIDS防治知识和态度,为防治艾滋病提供科学依据。方法随机选取重庆市主城区3个区9个建筑工地的农民工,每个区400人,共1200人,由经过培训的专业人员进行问卷调查,内容包括基本情况、艾滋病知识与态度、获得艾滋病知识途径等。结果发放问卷1260份,有效问卷1243份。8个HIV/AIDS防治知识问题中回答正确范围为33.95%～80.13%,全部回答正确的占15.12%。10种获得艾滋病知识途径中处于前三位的分别是电视（53.50%）、广播（37.01%）、免费宣传材料（31.62%）。结论重庆市主城区农民工对艾滋病防治知识有所了解,但存在歧视。建议对农民工这一特殊群体加强健康教育宣传,以降低艾滋病在这部分人群中的传播危险。     

Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: an integrated review

Objective

To examine factors that affect the utilization of HIV testing and counseling (HTC) services among heterosexual populations in Canada and the UK.

Methods

We conducted an integrated review of published and unpublished literature (1996–September 2010) using Scopus, OVID-EMBASE, CSA illumina, CINHAL, PROQuest, Web of Science, and Google.

Results

Twenty-seven studies met the inclusion criteria. We identified and categorized the key factors into three broad categories depending on their source. Personal-related factors included socio-demographic characteristics, risk perception, illness, HIV-related stigma, level of HIV and testing knowledge, and culture. Provider-related factors included provider-recommended HIV testing, provision of culturally and linguistically appropriate services, and doctor–patient relationship. System-related factors included integrating HIV testing with other health care services, anonymity of testing services, suitability of testing venues, technical aspects of HIV testing, and funding for immigrant health services.

Conclusion

The findings from our review indicate that HTC behaviors of heterosexuals in the Canada and the UK are likely influenced by several unchangeable (socio-demographic characteristics) and amenable factors. There is need to step-up research to confirm whether these associations are causal using stronger research designs.

Practical implication

We have made several recommendations that could be used to improve existing services in Canada.     

Community collaborative youth-focused HIV/AIDS prevention in South Africa and Trinidad: preliminary findings

BACKGROUND: South Africa and Trinidad and Tobago are disproportionately impacted by high rates of HIV/AIDS among adolescents. OBJECTIVE: The article describes the HIV crises in these countries; outlines a community participatory research framework to adapt and deliver family-based prevention; and presents preliminary data from intervention pilots in each setting. METHODS: Adapted interventions were piloted with N = 140 families in South Africa and N=16 families in Trinidad and Tobago to refine recruitment and retention efforts and to assess the adapted interventions' impact on family and risk-related constructs. RESULTS: Both settings reported promising results including high recruitment and retention and favourable pre to post changes in parent/youth frequency and comfort in talking about sensitive subjects, HIV transmission knowledge and attitudes about persons with HIV/AIDS. CONCLUSION: International HIV-prevention alliances are increasing. Such alliances are challenged by trust issues, power-differentials and ideological differences. Recommendations are provided on how some challenges can be overcome.     

Genetic counseling for BRCA1/2: a randomized controlled trial of two strategies to facilitate the education and counseling process

Due to the complexity of information surrounding BRCA1/2 counseling and testing and its time consuming nature, efforts to facilitate the genetic counseling and education process are needed. Using a 2 x 2 factorial design, two strategies were examined: a CD-ROM program for patients and a feedback checklist to the genetic counselor on patients' prior misconceptions. A total of 197 women attending a breast and ovarian cancer risk evaluation clinic for BRCA1/2 counseling were randomized into one of four conditions: standard care, CD-ROM only, feedback to counselor only, and both CD-ROM and feedback. Counseling outcomes included face-to-face time with the genetics team, knowledge acquisition, changes in worry about having a gene mutation, and genetic testing decisions. Overall, women who viewed the CD-ROM spent less time with the genetic counselor and were less likely to undergo genetic testing compared to women who did not view the CD-ROM. Feedback to the genetic counselor resulted in greater gains in knowledge of genetics and breast cancer. Among women less worried at baseline, those who viewed the CD-ROM showed no changes in worry following genetic counseling, in contrast to those who did not view the CD-ROM who increased in worry over time. This latter finding raises concerns about the impact of the increased worry on genetic testing decisions. No interaction effects of the two intervention arms were found. The study results support the importance of both strategies as valuable supplements to clinical BRCA1/2 counseling.     

The immunological synapse: the gateway to the HIV reservoir

A major challenge in the development of a cure for human immunodeficiency virus (HIV) has been the incomplete understanding of the basic mechanisms underlying HIV persistence during antiretroviral therapy. It is now realized that the establishment of a latently infected reservoir refractory to immune system recognition has thus far hindered eradication efforts. Recent investigation into the innate immune response has shed light on signaling pathways downstream of the immunological synapse critical for T-cell activation and establishment of T-cell memory. This has led to the understanding that the cell-to-cell contacts observed in an immunological synapse that involve the CD4⁺ T cell and antigen-presenting cell or T-cell–T-cell interactions enhance efficient viral spread and facilitate the induction and maintenance of latency in HIV-infected memory T cells. This review focuses on recent work characterizing the immunological synapse and the signaling pathways involved in T-cell activation and gene regulation in the context of HIV persistence.     

茂名市女性按摩从业人员性病/艾滋病相关知识及高危行为调查

目的了解茂名市女性按摩从业人员对性病/艾滋病相关知识的认知情况和高危行为,为茂名市的性病/艾滋病预防控制工作提供参考。方法采用便利抽样和整群抽样相结合的方法抽取茂名市5间酒店的650名女性按摩从业人员进行性病/艾滋病相关知识及高危行为问卷调查。结果 650名女性按摩从业人员中,以（22±2）岁左右的年青人为主,占69.23%,大部分未婚,文化程度偏低;调查对象对性病/艾滋病的基本知识的正答率达80%以上的仅占21.54%,对艾滋病三大传播途径的正答率也只有18.46%,只有13.85%的调查对象能正确完整回答安全套正确使用知识方面的题目,全部调查对象均没能正确认知国家＂四免一关怀＂政策;部分调查对象存在不安全性行为;在性病/艾滋病的求医上也存在误区。结论应加强对茂名市女性按摩从业人员的性病/艾滋病相关知识和安全性行为教育,倡导正确的求医行为,减少和避免该人群感染性病/艾滋病,构筑一道预防性病/艾滋病从高危人群向一般人群传播的屏障。     

The evolving role of HIV counseling and testing in resource-limited settings: HIV prevention and linkage to expanding HIV care access

The role of voluntary counseling and testing (VCT)of HIV in resource-limited settings has recently broadened from primarily that of a prevention intervention to its identification as the key entry point into expanding access to life-saving antiretroviral therapy, additional HIV-specific medical care, and other support services. To fulfill this expanded mandate, calls for routine counseling and testing in diverse health care settings, in addition to other innovative approaches to traditional VCT, are emerging. The efficacy and cost-effectiveness of traditional facility-based VCT with respect to risk-behavior reduction of HIV have been demonstrated rigorously in resource-limited settings. Additional research is needed urgently to evaluate the feasibility, acceptability, and effectiveness of streamlined counseling and testing interventions that seek to reach as many individuals as possible to meet dual prevention and treatment goals.     

许昌市2002-2010年吸毒哨点艾滋病性病监测情况

目的了解许昌市吸毒人员的高危行为和艾滋病及性病的感染状况,为制定艾滋病性病的预防控制措施提供依据。方法按照国家艾滋病哨点监测实施方案的要求,对监测期间新入所的吸毒人员进行行为学调查和艾滋病、梅毒、丙肝血清抗体检测。结果口吸毒者及注射吸毒者分别占吸毒人员总数的93.2%和6.80%;该吸毒人群中HIV抗体阳性率为0.41%,梅毒感染率为1.04%。结论许昌市吸毒人员艾滋病、性病感染危险因素广泛存在,应加强针对该人群的高危行为干预。     

HIV/AIDS knowledge among undergraduate university students: implications for health education programs in Ghana

Background

Globally, the spread of HIV/AIDS remains on the rise especially among adolescents who are at increased risk of infection. Sexual behavioural change remains one of the most effective ways of preventing further transmission among this vulnerable group.

Objective

To evaluate HIV/AIDS knowledge among undergraduate students'' and how it can be used in HIV prevention strategies in Ghana.

Methods

A cross-sectional study was conducted using structured questionnaires among 324 conveniently selected students enrolled at a tertiary institution in Accra, Ghana.

Results

The mean age of the respondents was 23 years. Although the mean score of the participants'' responses to 12 HIV/AIDS knowledge questions was 7.7 of 12 points, there was an inconsistent level of AIDS knowledge with significant gender difference. While students could identify the transmission modes and preventive measure, they were less knowledgeable about the causative agent of AIDS. Majority of the students reported having received AIDS information from both print and electronic media, but few of them received such information from parents. Although over 90% of the students knew where to access VCT services, 45% of them have not had HIV test.

Conclusion

The data underscore the urgent need for HIV/AIDS-related health education and prevention efforts targeting university students as well as younger age groups in Ghana     

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling

ObjectiveWe developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection.MethodsDrawing upon formative work around women’s preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process.ResultsNinety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool’s content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement.ConclusionOur decision support tool appears acceptable to women in the family planning setting.Practice implicationsFormative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial.     

Remote consultations and HIV/AIDS continuing education in low-resource settings

BACKGROUND: Telemedicine is a way to support physicians working in resource-poor settings, providing remote consultations and continuing medical education on HIV/AIDS care. METHODS: A hybrid E-mail/web support telemedicine service was created in 2003 at the Institute of Tropical Medicine, Antwerp, Belgium, with a discussion forum hosting more than 170 healthcare professionals from 40 different countries, generally resource constrained. Interesting posts and recurring questions from this discussion forum have been elaborated as case studies or frequently asked questions, available on the website for consultation. Education and support are also provided through interactive quizzes, user-friendly guidelines, and policy documents with a particular focus on HIV/AIDS care in developing countries. RESULTS: From April 2003 to March 2005, 342 questions were sent from over 17 countries in Africa, Asia, and South America. The vast majority of these questions (93%) were patient-oriented, with only 7% being general questions. Of the patient-oriented questions, 49% were related to antiretroviral therapy, and 44% were related to the diagnosis and treatment of opportunistic infections. CONCLUSIONS: Telemedicine is a cheap and effective method of providing clinical support and continuing education to healthcare workers treating HIV-positive patients in resource-poor settings.     

Internet based HIV prevention research targeting rural MSM: feasibility,acceptability, and preliminary efficacy

Internet delivered primary prevention interventions for HIV risk reduction present significant challenges. Changing lifestyle behaviors, such as beginning to use condoms, is difficult and men seeking dates on line may want to avoid thinking about HIV risk which may lead to low initiation and high dropout rates. Many Internet delivered HIV risk reduction programs have mimicked face-to-face outreach programs, failing to take advantage of the Internet’s capabilities or did not conduct evaluation. This study focuses on examining the feasibility, acceptability, and efficacy of an Internet delivered HIV risk reduction program for rural men who have sex with men (MSM). The program included online recruiting, three intervention modules, each with two sessions, online questionnaires. The intervention was developed based on iterative research and the Information-Motivation-Behavioral skills model. Participants (N = 475) were randomly assigned to one of six module orders and data were collected automatically at pre-test and after each module. Data supports the feasibility and acceptability of the program as demonstrated by good retention and rapid program completion. Knowledge, self-efficacy, outcome expectancies and motivation increase in a dose response fashion. Post-intervention behavior changes included reduced anal sex and significant increases in condom use. Limitations include a short follow-up period, a predominantly young white rural sample, and the lack of an attention control. Overall the results of the study provide support for the efficacy of Internet-based interventions to reduce risk of HIV infection. Results also support traditional research methods to evaluate HIV prevention programs delivered exclusively through the Internet.     

Genetic counseling: Growth of the profession and the professional

Growth of the profession of genetic counseling has gone hand-in-hand with professional development of individual genetic counselors. Genetic counseling has achieved most of the typical early milestones in the development of a profession. The profession is maturing at a time when the number of practitioners is predicted to vastly expand. The last two decades have seen a proliferation of genetic counselor roles and practice areas, and a distinct professional identity. It is likely that the next two decades will see an increase in educational paths, practice areas, and possibilities for professional advancement. How this maturation proceeds will be impacted by overall trends in healthcare, decisions made by international genetic counseling organizations, and thousands of individual decisions about career trajectories.     

中国HIV/AIDS患者外周血单核细胞上TLR4表达和血浆TNF-α水平

目的 观察中国HIV/AIDS患者外周血单核细胞上Toll样受体4(TLR4)表达水平和血浆TNF-α浓度,初步探讨TLR4在HIV感染中的作用.方法 分别运用流式细胞术、ELISA法测定46例HIV/AIDS患者和30例健康对照者的外周血单核细胞上TLR4的表达及血浆TNF-α浓度,采用t检验和相关分析进行数据分析.结果 HIV/AIDS患者外周血单核细胞TLR4的表达率、血浆TNF-α浓度分别是52.19%±4.37%和(35.79±5.08)pg/ml,均显著高于健康对照组;单核细胞上TLR4的表达率与血浆TNF-α浓度、HIV-1病毒载量的相关系数分别是0.645和0.708,呈正相关.结论 中国HIV/AIDS患者外周血单核细胞TLR4表达上调,并且与患者体内HIV复制存在一定的相关性.