At Risk or Not? Susceptibility Perceptions of Women Using Family Planning Services in an AIDS Epicenter

Studies using in-depth qualitative interviews have informed us about how women construct HIV/STD risk perception, based on their propensity to assess their own risk in terms of their partners' behaviors and characteristics and to view their partners as safe and trustworthy. In this study, conducted among 360 family planning clients recruited for an HIV/STD preventive intervention, we examined the perceptions of women who feel susceptible to HIV/STDs as well as those of women who feel safe from the threat of infection or who resolved earlier feelings of vulnerability. We found that women who feel susceptible accurately identify the factors that place them at risk: failure to practice condom-protected sexual intercourse and risky partners. Being diagnosed with an STD was an important trigger for the perception of personal vulnerability. Getting a negative HIV test result was the most common means of resolving perceptions of risk from the past. In logistic regression analyses of the behavioral predictors of perceived susceptibility and of a change in perception, the factors women identified were found to be significant.     

Differential of HIV prevalence in women and men who attended sexually transmitted disease clinics at HIV sentinel surveillance sites in Kenya, 1990-2001

Several studies in sub-Saharan Africa have reported that HIV prevalence in young women is higher than in young men. We used data from Kenya HIV sentinel surveillance conducted from 1990 to 2001 among sexually transmitted disease (STD) patients (15-49 years old) to investigate consistency of gender differentials over time and their risk factors. Of the 15,889 STD patients, the HIV prevalence ranged from 16.0% in 1990 to 41.8% in 1997. The odds ratios (ORs) of HIV infection for women compared to men decreased by age; women 15-24 years were nearly twice as likely as men of the same ages to be HIV infected (OR 1.7 [1.5-2.0]), but risk in those >44 years was almost equal (OR 0.8 [95% CI 0.7-1.2]). The odds of HIV infection for women compared to men were twice in unmarried patients (OR 2.1 [95% CI 1.8-2.3]). This association persisted after controlling for age groups or marital status, residence, level of education, and presence of STD syndromes. This pattern had been consistent over 12 years. Adolescent women with symptoms of STDs should be a focus for the HIV/STD intervention programmes because of their high risk for HIV.     

HIV/STD Risk and Sexual Strategies Among Women Family Planning Clients in New York: Project FIO

This report describes among 360 family planning clients in an HIV epicenter, women's HIV/STD risk characteristics, the barriers and facilitators of condom use within the context of relationships, and the use of alternative strategies for protection. Women attending the clinic were recruited for an HIV/STD preventive intervention and interviewed at baseline. At least 1 risk factor was reported by 77%, including a diagnosis of an STD within the last year for 30%. Recent STD diagnosis was associated with having a risky partner, but not with number of current partners. Women reporting consistent condom use had higher quality of couple communication, stronger intentions to prevent pregnancy, more positive reactions to condoms themselves and from their partners. Alternative risk reduction strategies, including using a barrier method other than condoms, refusing sex, engaging in nonpenetrative sex, leaving a relationship due to STD concerns, or undergoing mutual HIV testing had been used by 39% of women in the past 3 months.     

对STD高危人群进行全方位干预的社会效应

目的：通过性传播疾病(STD)门诊对STD高危人群进行全方位的干预，探索推广“同伴教育”，实行“STD／网络干预”的可行性。方法：以STD高危人群为中心，运用双向咨询、规范治疗、小组讨论、健康教育等全方位的健康促进方式进行干预，培养愿意从事“同伴教育”的自愿者，试行STD／艾滋病(AIDS)网络干预。结果：(1)干预后，高危人群的STD／AIDS知识水平有很大提高，就诊态度有明显转变，与干预前比较差异有极显著的统计学意义。(2)干预后，商业性行为者的性观念较干预前的差异有极显著的统计学意义，有35．71％和41．89％的性工作者仍赞同性自由和婚前、婚外性行为，干预前后差异无显著的统计学意义；92．91％的非商业性行为者仍然赞同婚前、婚外性行为，干预前后差异无显著的统计学意义。(3)不论干预前后，大部分人在不安全性交后，首先关心自己是否患病，在患病后，首先关心的是能否治愈。(4)干预后，＞95％的调查对象愿意参加同伴教育。40名同伴教育志愿者在3个月内引来204位高危朋友，干预面是其本身的510％。结论：平等、宽松、匿名的就诊环境与有效的生物学干预，是吸引高危人群就诊的重要保证。全方位的健康促进式STD／AIDS干预，对提高STD高危人群的STD／AIDS知识水平，转变就诊态度有明显效果。由于大多数受干预者愿意参加同伴教育，使STD／AIDS网络干预计划得以实施，并取得了初步成效。因此，在SET门诊进行STD／AIDS全方位干预，推广“同伴教育”实行“网络干预”是可行的。     

Syndromic treatment of sexually transmitted diseases reduces the proportion of incident HIV infections attributable to these diseases in rural Tanzania

OBJECTIVES: To compare the proportion of HIV seroconversions attributable to other sexually transmitted diseases in the intervention and comparison arms of the Mwanza sexually transmitted diseases (STD) intervention trial. DESIGN: Case-control study of 96 cases of HIV seroconversion and 974 HIV-negative controls, nested within the Mwanza trial cohort. METHODS: Data on reported STD symptoms during 2 years of follow-up, and serological evidence of recent syphilis, were used to obtain odds ratios (ORs) for HIV seroconversion, adjusted for community, age, marital status, sex partners and travel. Population-attributable fractions (PAF) of HIV seroconversions associated with these STD exposures were calculated separately for the intervention and comparison arms, and for men and women. RESULTS: In men in the comparison arm, adjusted ORs for ulcers (14.8), discharge (3.3), any symptom (4.1) and any STD (4.0) were highly significant. There were no significant associations between HIV incidence and STD exposures in the intervention arm. The PAF were consistently higher in the comparison arm than the intervention arm. In men, the PAF for any STD was 39.6% [95% confidence interval (CI), 12.4-58.3)] in the comparison arm but only 12.0% (CI, 0.0-35.9) in the intervention arm. The PAF for women were lower than for men. CONCLUSIONS: These are minimal PAF estimates and they do not account for STD effects on HIV infectiousness. Nevertheless, a substantial proportion of new HIV infections in men in the comparison arm were attributable to STD. Lower PAF in the intervention arm than in the comparison arm for men provide further evidence of the role of STD cofactors in HIV transmission, supporting the hypothesis that the Mwanza intervention reduced the duration of symptomatic STD, thus reducing the HIV risk associated with such STD.     

A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial

OBJECTIVE: To evaluate the efficacy of a theory-based tailored minimal self-help intervention to increase condom use among young women at risk for HIV/sexually transmitted disease (STD). DESIGN: Randomized controlled trial on an intent-to-treat basis in two managed care plans, in Washington state and North Carolina, with follow-up at 3 and 6 months. PARTICIPANTS: A proactively recruited sample of 1210 heterosexually active, non-monogamous, non-pregnant women, aged 18-24 years recruited June 1999-April 2000; 85% completed the 6-month follow-up. METHOD: Arm 1 received usual care. Arm 2 received a mailed computer-generated self-help magazine, individually tailored on survey items including stage of readiness to use condoms, barriers to condom use, partner type; condom samples and a condom-carrying case were included in the packet; this was followed 3 months later by a tailored 'booster' newsletter. The a priori 6-month main outcomes were percentage of women using condoms during the previous 3 months (overall and by partner type) and proportion of total episodes of intercourse during which condoms were used in the previous 3 months. RESULTS: Relative to usual care, intervention group women reported significantly more condom use overall [adjusted odds ratio (OR), 1.86; 95% confidence interval (CI), 1.32-2.65; P = 0.0005] and with recent primary partners (OR, 1.97; 95% CI, 1.37-2.86; P = 0.0003). They also reported using condoms for a higher proportion of intercourse episodes (52.7% versus 47.9%; P = 0.05). Significantly more intervention women carried condoms, discussed condoms with partners, and had higher self-efficacy to use condoms with primary partners. CONCLUSIONS: Tailored cognitive/behavioral minimal self-help interventions hold promise as HIV/STD prevention strategies for diverse populations of young at-risk women.     

AIDS awareness among a cohort of young Thai men: Exposure to information,level of knowledge,and perception of risk

Structured interviews and focus group discussions were conducted among 834 young Thai men drafted into military service by random lottery in northern Thailand. Level of AIDS risk, exposure to AIDS information, level of knowledge about AIDS, and perception of risk for acquiring HIV and AIDS were assessed at baseline and six months after induction into the Army in 1991. General fear of AIDS was high, yet personal perception of risk for acquiring HIV was low, even for those at enhanced behavioural risk of infection with HIV. Multivariate PATH analysis shows that exposure to information about AIDS significantly reduced risk taking from baseline to follow-up, but only by first affecting personal risk perception. Focus group discussions revealed that risk perception for acquiring AIDS was low due to never knowing a person with AIDS, because prostitutes had health certificates for STD, and since many believed that AIDS could be cured or prevented with folk medicines. Implications and recommendations for intervention programmes are discussed.     

Prevalence of HIV among low and high risk population of eastern part of northern India

A total of 7,904 persons visiting University Hospital of Banaras Hindu University (BHU), Varanasi, were screened for HIV antibody by ELISA and/or rapid test. The overall seroprevalence of HIV (3.17%) in this area was higher than that of Uttar Pradesh and India as a whole. The seroprevalence of HIV/AIDS among the high risk group (HRG) (6.42%) being significantly higher than low risk group (LRG) (0.37%). In the LRG, the prevalence among medical and surgical patients; and ANC (antenatal cases) was 1.17% and 0.14%, respectively. However, HIV infection was not detected in HCWs (healthcare workers), BHU students and foreigners. Among HRG, CSWs (commercial sex workers) had the highest prevalence (14.0%) and STD (sexually transmitted diseases) patients, the lowest prevalence (1.99%). The STD patients had significantly lower prevalence rate as compared to others in HRG. Majority of the HIV positive were found to be within the age group 15-44 years, with heterosexual mode as the main route of transmission. Seven HIV positive children were of 2-5 yr old age group. Majority of seropositive women (62.52%) were working in a low income jobs and were mainly infected by their spouses who was mostly migrating labourers of lower socioeconomic group and with less than primary level of education. Married females, being mainly the spouses of HIV positive males had the highest seropositivity (60.25%). These population people were directly transmitting the infection from the metropolitan cities to the rural areas of this region. Prevalence of HIV-2 was negligible as compared to HIV-1, the actual reason is yet to be explored.     

Risk behaviors among Asian women who work at massage parlors in San Francisco: perspectives from masseuses and owners/managers.

This study investigates cognitive, cultural, and contextual factors that influence HIV-related risk behaviors among Asian women who engage in sex work at massage parlors in San Francisco. Focus groups and qualitative interviews were conducted for Vietnamese and Thai masseuses and massage parlor owners/managers. Economic pressure as well as subjective evaluation of customers for the risk of HIV/STD infection increase unprotected sexual behaviors among Asian masseuses. Massage parlor owners/managers do not establish a clear policy for condom use at their parlors. Consequently, male customers often manipulate their intention not to use a condom while negotiating with masseuses. HIV/STD prevention intervention programs should address specific risks and needs for Asian masseuses, owners/managers, and male customers in order to promote health and well being among Asian masseuses who have been neglected by public health and social services.     

Women's HIV transmission risk perceptions and behaviors in the era of potent antiretroviral therapies.

The availability of potent antiretroviral medications has raised new concerns regarding continued HIV transmission risk behavior among seropositive persons. Relatively little is known about how women with HIV perceive secondary transmission risk in the context of HIV treatment advances. This study describes sexual risk perceptions and behaviors of 80 women enrolled in HIV outpatient care in 1999. Participants completed structured interviews assessing sexual risk perceptions, attitudes regarding severity of HIV disease, sources of HIV prevention information, and sexual practices during the previous 6 months. Medical histories including 6-month cumulative incidence of sexually transmitted diseases (STDs) were obtained from a clinic database. Thirty-five percent of the sample had engaged in unprotected intercourse or had been diagnosed with an STD in the past 6 months. Only 5% of women believed that medication-related reductions in viral load signify safer sex is unimportant, but 15% indicated they practice safer sex less often since the advent of new HIV treatments and 40% believed AIDS is now a less serious threat. These data suggest women's perceptions of diminished disease severity may be more influential than beliefs regarding diminished infectivity. Study results have implications for framing prevention messages for women and suggest that close integration of secondary prevention and clinical HIV services may be beneficial.     

性病门诊就诊者行为及艾滋病性病知识调查

目的 了解性病门诊就诊者的求医行为、出现性病相关症状后的性行为状况及其艾滋病性病相关知识态度水平。方法 2003年8月中旬连续2周时间，对前来北京市性病防治所就诊的325名性病门诊就诊者进行了问卷调查，调查采用不记名、面对面逐项询问的方式。结果 调查对象出现性病相关症状后3天内就诊者占24．7％。出现性病相关症状后继续有性生活者占43．2％，其中多性伴侣者占12.8％，平均性伴侣数为6．1，但无再与商业性伴侣发生性关系者。出现性病相关症状后与临时性伴侣的性生活平均为6．4次，坚持使用安全套者占22．2％，发生性关系时临时性伴侣知情者占15．0％。艾滋病传播知识全部回答正确者占27．3％。结论 调查对象的性病求医行为需要引导和促进。出现性病相关症状后仍具有较多的无保护性行为，且对方多不知情，存在着传播性病艾滋病的潜在危险。艾滋病性病传播、预防知识的知晓率水平均较低，应在该人群中加强宣传教育干预，开展自愿咨询检测，以降低危险性行为，遏制艾滋病性病的流行和传播。     

Skills training versus health education to prevent STDs/HIV in heterosexual women: a randomized controlled trial utilizing biological outcomes.

We compared the effectiveness of two different 16-session group interventions for reducing new STD infection among heterosexual women. Two hundred twenty-nine at-risk heterosexual women were randomly assigned to skills training (ST) based on the relapse prevention model or health education (HE). Participants were monitored during the year following intervention for STD acquisition, self-reports of sexual behavior, and risk reduction skills. Participants in the ST intervention were significantly less likely to be diagnosed with a STD in the year following intervention and demonstrated superior risk reduction skills at 12-month follow-up. Both conditions showed statistically significant reductions in self reports of risky sexual behavior following intervention and at 12-month follow-up. In this sample, the ST intervention was superior to HE for reducing STD acquisition.     

1999年全国性病监测系统不同人群性病患病率调查

目的了解不同人群的性病患病率.方法在性乱人群、供血员和孕妇中分别连续抽样采集标本,直到完成要求的监测样本量,并统一进行检测.结果性乱人群淋病、梅毒病患病率分别为6.64%和4.32%,HIV感染率为1.06%;供血员梅毒感染率为0.32%,HIV感染率为0.22%;孕妇淋病感染率为0.37%;梅毒感染率为0.13%.结论性乱人群为性病感染的高危人群,应加强主动发现病人的筛查工作;供血员、产前检查妇女为STD感染的低危人群,但这两种人群易于接近,可将STD检测纳入常规工作中.     

广州市少教学员STD/AIDS健康教育和行为干预效果分析

目的了解广州市少年教养(少教)所学员性病艾滋病防治知识的知晓情况。评价开展性病艾滋病健康教育与行为干预的效果。方法先采用匿名问卷调查该人群中性病艾滋病的防治知识知晓情况,然后采取健康讲座、派发宣传资料等干预措施。干预后再以问卷形式评估干预效果。结果少教学员的性病艾滋病知识的总认识率,干预前后分别为28%和34.1%(P>0.05);在行为与意识方面,对有可能感染性病艾滋病的危险行为的认知中,干预前后分别为35.9%和69.9%(P<0.01);性行为中使用安全套意向,干预前后分别为52.7%和68.4%(P<0.01);正确就医行为,干预前后分别69.3%和79.5%(P<0.01),均有显著提高。结论少教学员性病艾滋病相关理论知识知晓率虽提高不大,但健康教育与行为干预后预防性病艾滋病意识明显提高。有针对性地进行性病艾滋病的健康教育很有必要。     

Characteristics of Individuals and Couples Seeking HIV-1 Prevention Services in Nairobi, Kenya: The Voluntary HIV-1 Counseling and Testing Efficacy Study

This paper describes the recruitment and baseline characteristics of men, women, and couples who enrolled in the Voluntary Counseling and Testing Efficacy Study at the study site in Nairobi, Kenya. The purpose of this study was to test the effectiveness of Voluntary HIV Counseling and Testing (HIV VCT) to reduce sexual risk behavior. Between June 1995 and March 1996, 500 individual men, 500 individual women, and 515 couple members were recruited for a total sample of 1,515 participants. Participants were young (average age 29 years) and of low income. High levels of risk behavior and self-reported STD symptoms and a high rate of HIV seropositivity among those tested at baseline (15% of men and 27% of women) indicate that an at-risk sample was recruited. Women and participants reporting symptoms of a sexually transmitted infected were significantly more likely to be infected with HIV. Findings suggest that HIV VCT services combined with STD diagnosis and treatment and economic development services could motivate more at-risk individuals and couples to receive counseling and testing.     

Characteristics of sexual partners and STD infection among American adolescents

Adolescents are a high risk group for HIV infection and the characteristics of their partners may affect their susceptibility to infection. The goal of this study was to examine the effects of partner characteristics on sexually transmitted disease (STD) infection in a national sample of adolescents. Data from 8,024 sexually active adolescents who participated in the National Longitudinal Study of Adolescent Health (Add Health) in the United States were included in this study. Logistic models were used to examine the association of partner characteristics including age, neighbourhood, ethnicity, and school attendance on the self-report history of STD infection. The partner characteristics of age and school attendance were associated with the reporting of STD infection. The odds ratio for STD infection was 1.46 (95% confidence interval (CI) (1.22-1.75), P < 0.01) if the adolescent's partner was two or more years older and 1.37 (95% CI (1.16-1.62), P < 0.01) if the partner did not attend the adolescent's school. The odds ratios for having an older partner were also significant and positive for eight different STDs. Partner characteristics were associated with STD infection among American adolescents. Counselling is needed in clinics that serve adolescents to raise awareness of the risk of infection in these relationships and to improve skills in condom negotiation and use.     

Sexually transmitted disease/HIV and heterosexual risk among miners in townships of Yunnan Province, China

The HIV epidemics in some areas of Yunnan Province, southwestern China, are close to becoming generalized, demanding the need for a better understanding of sexually transmitted disease (STD) and heterosexual HIV risk. While female heterosexual risk is captured by sentinel surveillance, less is known about clients of commercial sex workers and other subsets of men at increased risk of STD/HIV. A convenience sample of 232 miners in townships of Yunnan Province completed a questionnaire and provided specimens for STD/HIV testing. Relative prevalences of HIV, gonorrhea, and chlamydia among sexually experienced miners surveyed were 0.5% (1/182), 0.5% (1/182), and 9.3% (17/182), respectively. Chlamydia seropositivity was significantly associated with receiving less education (p = 0.03). Among all respondents, 9.4% admitted to purchasing sex, 82.9% had not used a condom in the last 6 months, and substantial gaps in knowledge about STD/HIV were apparent. Because preventing heterosexual spread of HIV is crucial in this area of China to prevent a generalized epidemic, better understanding and designing low literacy interventions targeted at sex worker clients and similar subsets of high-risk migrants may be warranted.     

Abused women report greater male partner risk and gender-based risk for HIV: findings from a community-based study with Hispanic women

The purpose of this study was to assess the relationship between intimate partner violence (IPV) and sexual risk in terms of safer sex behaviour and intent, individual and gender-based HIV risk factors, and male partner HIV risk, among a lower-income community-based sample of Hispanic women reporting a current male sexual partner. Baseline survey data on HIV-related behaviours and risk factors gathered from participants (N=170) of an HIV intervention evaluation study for Hispanic women were used for current analyses. Participants were age 18-36 years, predominantly born outside of the continental US (88.8%) and not English fluent (68.2%). Adjusted logistic regression analyses and 95% confidence intervals were conducted to assess the relationships between male-perpetrated IPV in the past three months and sexual risk variables. One-fifth (21.2%) of the sample reported male-perpetrated IPV in the past three months. Abused women were significantly more likely than those not abused in the past three months to report high STD/HIV risk perceptions (OR=3.02, 95% CI=1.33-6.88), gender-based risk including sexual control by male partners (OR=3.09, 95% CI=1.41-6.76) and male partner risk including male infidelity (OR=4.58, 95% CI=1.57-13.32). Results support the need for emphasis on IPV prevention within HIV prevention programmes and demonstrate the need for HIV prevention efforts directed at men with a history of IPV perpetration.     

Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers

OBJECTIVE: To compare the seroincidence of HIV infection among female sex workers in Abidjan, C?te d'Ivoire before and during an intervention study to control sexually transmitted diseases (STD) and to study the effect of two STD diagnosis and treatment strategies on the prevalence of STD and on the seroincidence of HIV infection. METHOD: A screening facility for STD and HIV had been available since October 1992 for female sex workers. From June 1994, women who were HIV seronegative or HIV-2 positive during the screening could enroll in the intervention study in which participants reported once a month to a confidential clinic where they received health education, condoms and STD treatment if indicated. Women in the study were randomized either to a basic STD diagnosis and treatment strategy, which included a gynecologic examination when symptomatic, or to an intensive strategy that included a gynecologic examination regardless of symptoms. An outcome assessment every 6 months included a gynecologic examination, HIV serology and laboratory tests for STD. RESULTS: Of 542 women enrolled in the study, 225 (42%) had at least one outcome assessment. The HIV-1 seroincidence rate during the intervention study was significantly lower than before the study (6.5 versus 16.3 per 100 person-years; P = 0.02). During the study, the HIV-1 seroincidence rate was slightly lower in the intensive than in the basic strategy (5.3 versus 7.6 per 100 person-years; P = 0.5). CONCLUSION: National AIDS control programs should consider adopting as policy the type of integrated approach used in this intervention study for HIV prevention in female sex workers.