HIV Infection Among Young Pregnant Women in Brazil: Prevalence and Associated Risk Factors

Men who have sex with men (MSM) are confronted with different health problems. Next to a higher HIV prevalence and a higher reporting of depressive symptoms and other mental health problems, there is also evidence of substance dependence and sexual compulsivity occurring simultaneously. Using a sample of 591 HIV-negative Belgian MSM, we examine the relationships between depressive symptoms and other risk factors of unprotected anal intercourse (UAI) practice with casual partners. These risk factors include depressive symptoms, sexual behavioural indicators, individual risk perception of UAI, intrapersonal factors measured by the sexual sensation seeking scale, substance use, sources of social support and social norming regarding condom use and finally the location where or media through which men find sex partners. Our findings show that multifactorial, intertwined factors contribute to the explanation of UAI among MSM at risk for HIV infection. These findings underline the need for an integrated sexual health approach for MSM.     

Alcohol and Sexual Risk Behaviors Among Male Central Asian Labor Migrants and Non-migrants in Kazakhstan: Implications for HIV Prevention

This paper examines the association between alcohol consumption and sexual risk behaviors (unprotected sex, multiple sex partners, sex under influence of drugs or alcohol and commercial sex) in a sample of Central Asian migrant and non-migrant laborers in the largest marketplace in Kazakhstan. We used data from The Silk Road Health Project, conducted from 2010 to 2013 with 1342 male migrant and non-migrant market workers. Participants were selected through respondent driven sampling at the Baraholka Market in Almaty, Kazakhstan. We used regression analyses adjusting for potential confounders to examine the relationship between alcohol consumption and sexual risk behavior. We found that hazardous drinking was associated with an increase in the odds of sex under the influence of drugs (aOR = 6.09, 95% CI 3.48, 10.65; p < .001) and purchasing commercial sex (aOR = 2.02, 95% CI 1.02, 4.02; p < .05). We identified potential targets for HIV interventions to reduce sexual risk behaviors among this key population.     

Rates and Correlates of HIV and STI Infection Among Homeless Women

We studied the prevalence of biologically confirmed HIV, Chlamydia, and gonorrhea in a randomly selected sample of sheltered homeless women in New York City, and explored their association with demographic, homeless history, and clinical risk factors. 329 women were randomly selected from 28 family and single adult shelters. The estimated prevalence of HIV in the study sample is 0.6 % (±0.3 %); for Chlamydia it is 6.7 % (±2.2 %); for gonorrhea it is 0.9 % (±0.04 %). A history of childhood sexual abuse, arrest history, current psychotic symptoms, and substance use disorder placed women at greater risk of infection. We consider contextual factors that may yield underestimates of HIV prevalence in our sample and discuss how a more comprehensive prevalence estimate might be constructed. Findings underscore the importance of offering HIV/STI testing, counseling, and HIV risk prevention interventions to homeless women and suggest that interventions should be tailored to the needs of specific subgroups of homeless women.     

Seroprevalence and Risk Factors for HIV Infection Among Incarcerated Men in Sorocaba, Brazil

We describe prevalence and risk factors for HIV infection among 1,059 inmates in two prisons in Sorocaba, Brazil. Sociodemographics, prison history, and sexual and drug exposures were assessed by interviewer–administered questionnaire. HIV infection was detected in 115 (12.6%) inmates. Seroprevalence was 35% among those with a history of IDU (OR = 11.4, 95% CI 5.58–23.5). Sex with female visitors was reported by 66%, and homosexual practices with other inmates by 10%. Independent predictors of HIV infection were age <35 years (OR = 1.9, 95% CI 1.1–3.4), birthplace (natives of Sorocaba; OR = 2.1, 95% CI 1.2–3.8), and number of previous incarcerations (1 compared to 0) (OR = 1.7, 95% CI 1.07–2.7). Prevalence of HIV infection among these inmates is comparable to rates in metropolitan Sao Paulo and other prison populations internationally. The use of injecting drugs is the most important risk exposure in this population. These findings indicate an urgent need to institute prevention programs for this population both inside and outside prisons.     

Sexual Behavior and Risk Factors for HIV Infection Among Homosexual and Bisexual Men in Thailand

HIV prevalence and associated risk behaviors were examined among Thai bisexually active men (MSMW, n = 450) and men who have sex with men only (MSM-only, n = 1,125). Cross sectional venue-day-time sampling was used to collect data. Chi-square and logistic regression were used to identify HIV risk factors. HIV prevalence was 8.2% among MSMW and 21.2% among MSM-only. Consistent condom use with male partners was higher among MSMW (77.6%) than MSM-only (62.9%), and lower with female partners (44.4%). Lack of family confidant, migration, concern about acquiring HIV infection, and self-reported STD were associated with HIV prevalence among MSMW. Older age, lower educational level, residing in Bangkok or Chiang Mai, living away from family, recruitment from a sauna, increased frequency of visiting the surveyed venue, practicing receptive or both receptive and insertive anal intercourse, inconsistent condom use with male paying partners, and a history of drug use were associated with HIV prevalence in MSM-only.     

Prevalence of HIV Infection and Risk Factors Among Female Sex Workers in a Southeast Province of Vietnam

Female sex workers (FSWs) are at heightened risk of HIV infection. This research aims to determine the prevalence of HIV and relevant risk factors and related behavior among FSWs in Ba Ria – Vung Tau, a southeast province of Vietnam. 420 FSWs were interviewed using a structured questionnaire and biological samples tested for HIV. 2.6 % were found to be HIV positive. HIV infection was significantly higher in FSWs who had low income (≤AUD 200 per month), have had anal sex, have had sex with injecting drug users, and had a low level of HIV/AIDS-related knowledge. Improved employment opportunities and income are important to reduce the pressure for young women to engage in sex work for income purposes, but in public health terms, existing HIV treatment, prevention and intervention programs needs better targeting and improvements to reduce the risk of HIV infection.     

Trauma Exposure, PTSD, and HIV Sexual Risk Behaviors among Labor Migrants from Tajikistan

Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.     

Protective Factors and HIV Risk Behavior Among South African Men

The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed.     

Metabolic Syndrome Risk Factors Among a Sample of Overweight and Obese Mexican Children

J Clin Hypertens (Greenwich). The objective of this study was to estimate the prevalence and correlations of components of the metabolic syndrome (MetS) using the International Diabetes Federation (IDF) pediatric definition in a cross-sectional study of 215 overweight/obese Mexican children aged 6 to 12. There are no previous studies of this kind in Mexican children. Clinical, anthropometric, and laboratory measurements were performed. The prevalence of MetS using the pediatric IDF criteria was 6.7% (95% confidence interval, 4.0–11.1). A higher proportion of children in the younger age group had waist circumference above the cutoff, while a higher proportion in the older age group had hyperglycemia. Children with MetS had higher percentages of body fat, body mass index, total cholesterol, and low-density lipoprotein cholesterol. Increased triglycerides, decreased high-density lipoprotein cholesterol, and waist circumference were most highly associated with MetS. This has significant implications for public health.     

Between Tradition and Change: Condom Use with Primary Sexual Partners Among Mexican Migrants

The frequency of male Mexico-US migration has been associated with increased HIV risk for sexual partners awaiting their return in Mexico. This study examined the association between sexual partner characteristics and condom use among a sample of 354 male migrants from two Mexican municipalities. Migrants were interviewed about their past year's sex practices. Results indicated that migrants were more likely to use condoms with their non-spousal partners, partners with less education than the migrant, and partners with higher employment status. Condom use was greater among younger migrants and residents of the more densely populated municipality. Findings suggest the coexistence of a traditional cultural orientation that does not support condom use and another one that does provided the sex partner is formally employed. Prevention programs must strengthen the structural conditions fostering greater equality between the sexes and adapt their approaches for different population density, age and partner types.     

Psychosocial,Behavioral, and Cultural Predictors of Sexual Risk for HIV Infection Among Latino Men Who Have Sex with Men

This study sought to replicate and extend an investigation by Diaz et al. (1999) on determinants of HIV risk among Latino gay and bisexual men living in San Francisco who were predominantly English-speaking. Compared to the Diaz et al. study, the current study sample consisted of predominantly Spanish-speaking MSM, who resided outside of HIV/AIDS epicenters and whose countries of origin were primarily Central & South American. The relationships of unprotected anal sex and multiple sexual partners with demographic, developmental, behavioral, cultural and psychosocial variables were examined. Data were collected in a convenience sample of 250 participants (primarily immigrants from El Salvador) residing in Virginia. Most men in the sample had more than one sexual partner in the last 3 months (62%) and more than a third had unprotected anal sex with a casual partner in the same time period. Communication about HIV, sexual attraction, machismo, and experiences of discrimination based on homosexual behavior were predictive of HIV risk behaviors. The findings support an integrative approach to investigating HIV risk among Latino MSM. Implications for prevention programs are discussed.     

Determinants of HIV Risk Reduction Behaviors Among Female Partners of Men with Hemophilia and HIV Infection

Determinants of safer sexual behaviors (abstinence or consistent condom use) among female partners of HIV-infected adult men with hemophilia were examined. A model was proposed predicting that emotional adjustment, communication skills, self-efficacy, and perceived advantages of condom use would influence the practice of safer sexual behaviors. Confidential surveys were completed by 119 seronegative female partners of men with hemophilia and HIV infection who received care from one of 27 hemophilia treatment centers across the United States. The proposed model was tested using LISREL, and the model explained 40% of the variance in safer sexual behaviors. Emotional adjustment was a significant predictor of both intimate and emotional communication skills. Intimate and emotional communication skills were related to self-efficacy for communicating about safer sex, which in turn influenced both communication about safer sex and perceived advantages of condom use. Communication about safer sex with a partner and perceived advantages of condom use had direct effects on safer sexual behaviors. HIV prevention interventions with women known to have seropositive partners should be multifaceted. Skill-building interventions emphasizing communication skills, increasing self-efficacy for communication about safer sex with a partner, and promoting positive attitudes about safer sex should be considered.     

The Role of Behavioral and Neurocognitive Functioning in Substance Use Among Youth with Perinatally Acquired HIV Infection and Perinatal HIV Exposure Without Infection

This study examined associations of self-regulatory behavior and cognitive functioning with substance use (SU) to inform interventions for youth with perinatal HIV infection (YPHIV) or exposure but uninfected (YPHEU). Youth aged 7–15 years (YPHIV, n?=?390; YPHEU, n?=?211) were followed longitudinally with cognitive testing and behavioral questionnaires including self-report of alcohol, marijuana, tobacco, and other SU. Cox proportional hazards analyses were used to examine correlates of initiating each substance for those without prior use at baseline and generalized estimating equation analyses were used to address associations of cognitive/behavioral measurements with SU prevalence for the entire sample. Lower self-reported self-regulation skills, but higher cognitive functioning abilities, were associated with initiation and prevalent use of alcohol and marijuana regardless of HIV status. Our findings suggest SU screening tools and self-regulation interventions developed for general adolescent populations should be implemented for those with PHIV, who may be at heightened risk for SU-related health consequences.

     

Awareness of Hepatitis C Infection Among Women With and At Risk for HIV

BACKGROUND Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women. OBJECTIVE To assess awareness of HCV, and describe diagnostic referrals and HCV treatment among women in the Women’s Interagency HIV Study (WIHS). DESIGN Prospective epidemiologic cohort. PARTICIPANTS Of 3,768 HIV-infected and uninfected women in WIHS, 1,166 (31%) were HCV antibody positive. MEASUREMENTS AND MAIN RESULTS Awareness of HCV infection and probability of referrals for diagnostic evaluations and treatment using logistic regression. Follow-up HCV information was available for 681 (390 died, 15 withdrew, 80 missed visit) in 2004. Of these 681, 522 (76.7%) reported knowing their HCV diagnosis. Of these, 247 of 522 (47.3%) stated their providers recommended a liver biopsy, whereas 139 of 247 or 56.3% reported having a liver biopsy. A total of 170 of 522 (32.6%) reported being offered treatment and 74.1% (n = 126 of 170) reported receiving HCV treatment. In multivariate regression analyses, African-American race, Hispanic/Latina ethnicity, poverty, and current crack/cocaine/heroin use were negatively associated with treatment referrals, whereas elevated alanine aminotransferase (ALT) was associated with increased likelihood of referral and increased likelihood of treatment. CONCLUSION One quarter of women with HCV in this cohort were not aware of their diagnosis. Among those aware of their HCV, 1 in 4 received liver biopsy and treatment for HCV. Both provider and patient education interventions regarding HCV testing and HCV treatment options and guidelines are needed to enhance HCV awareness and participation in HCV evaluation and treatment. Part of this work was presented at the XV International AIDS Conference, July 11, 2004. The WIHS centers (Principal Investigators) are located at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); the Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); Data Coordinating Center (Stephen Gange).     

Psychosocial and Behavioral Predictors of Partner Notification After HIV and STI Exposure and Infection Among MSM

Partner notification (PN) is an essential element of local and state-level HIV/STI prevention and control programs. The current study quantitatively assessed the psychosocial and behavioral predictors of PN use among men who have sex with men (MSM) (n = 189) using multivariable logistic regression procedures. STI history or being HIV-infected were significant predictors of having notified past sexual partners of HIV/STI exposure; engaging in unprotected insertive anal sex and using poppers during sex in the 12 months prior to enrollment resulted in greater odds of PN. Symptoms of social anxiety and having a drinking problem were significant predictors of future willingness to use state department of public health PN services. Efforts to increase PN acceptability should focus on HIV-uninfected MSM, particularly those with STI history. Results suggest how to increase acceptability and use of PN as a public health strategy and underscore the need for counseling as part of the notification process.     

Labor Migration and HIV Risk: A Systematic Review of the Literature

To inform the development of multilevel strategies for addressing HIV risk among labor migrants, 97 articles from the health and social science literatures were systematically reviewed. The study locations were Africa (23 %), the Americas (26 %), Europe (7 %), South East Asia (21 %), and Western Pacific (24 %). Among the studies meeting inclusion criteria, HIV risk was associated with multilevel determinants at the levels of policy, sociocultural context, health and mental health, and sexual practices. The policy determinants most often associated with HIV risk were: prolonged and/or frequent absence, financial status, and difficult working and housing conditions. The sociocultural context determinants most often associated with HIV risk were: cultural norms, family separation, and low social support. The health and mental health factors most often associated with HIV risk were: substance use, other STIs, mental health problems, no HIV testing, and needle use. The sexual practices most often associated with increased HIV risk were: limited condom use, multiple partnering, clients of sex workers, low HIV knowledge, and low perceived HIV risk. Magnitude of effects through multivariate statistics were demonstrated more for health and mental health and sexual practices, than for policy or sociocultural context. The consistency of these findings across multiple diverse global labor migration sites underlines the need for multilevel intervention strategies. However, to better inform the development, implementation, and evaluation of multilevel interventions, additional research is needed that overcomes prior methodological limitations and focuses on building new contextually tailored interventions and policies.     

Neighborhood Environments and Sexual Risk Behaviors for HIV Infection Among U.S. Women: A Systematic Review

Empirical evidence indicates that aspects of the neighborhood environment may affect HIV prevention efforts. Therefore, the neighborhood environment should be considered when implementing prevention interventions. However, much of the empirical evidence is derived from studies conducted among drug users, men, or adolescents. Such evidence may not be as applicable to adult women whose primary risk for HIV infection is via heterosexual sexual behavior. Therefore, a systematic review examining the relationship between neighborhood environments and HIV sexual risk behaviors among adult U.S. women was conducted. Three databases were searched for articles published in English in peer-reviewed journals between 1/1/1980 and 12/31/2016 meeting relevant criteria. Seven articles identified from the three databases or additional hand searches met inclusion criteria and were summarized. Findings were mixed with several studies indicating associations between neighborhood environments and HIV sexual risk behaviors. However, all summarized studies were cross-sectional. Longitudinal studies conducted among women are needed.     

Outcomes of a Behavioral Intervention to Reduce HIV Risk Among Drug-involved Female Sex Workers

Although street-based female sex workers (FSWs) are highly vulnerable to HIV, they often lack access to needed health services and medical care. This paper reports the results of a recently completed randomized intervention trial for FSWs in Miami, Florida, which tested the relative efficacy of two case management interventions that aimed to link underserved FSWs with health services and to reduce risk behaviors for HIV. Participants were recruited using targeted sampling strategies and were randomly assigned to: a Strengths-Based/Professional Only (PO) or a Strengths-Based/Professional-Peer condition (PP). Follow-up data were collected 3 and 6 months post-baseline. Outcome analyses indicated that both intervention groups displayed significant reductions in HIV risk behaviors and significant increases in services utilization; the Professional-Peer condition provided no added benefit. HIV seropositive FSWs responded particularly well to the interventions, suggesting the utility of brief strengths-based case management interventions for this population in future initiatives.     

Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women

Background Clinician’s knowledge of a woman’s cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. Objective To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician’s behavior. Design Cross-sectional population-based telephone survey. Participants Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001–2002. Measurements Predictors: well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. Outcomes: Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index. Results 58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB. Conclusions Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients’ worries about breast cancer. This research was presented in part at the Society of General Internal Medicine meeting, May 2005, New Orleans.