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.     

Nonsupportive Peer Norms and Incarceration as HIV Risk Correlates for Young Black Men who have Sex with Men

Black men who have sex with men (BMSM) are at considerable risk for HIV infection. A convenience sample of BMSM (n = 252) attending nightclubs in three North Carolina cities was surveyed to investigate factors associated with unprotected anal intercourse (UAI). About 45% reported UAI in the past 2 months. BMSM who strongly agreed that their male friends used condoms for anal sex were significantly less likely to report any UAI. Recently incarcerated men were significantly more likely to report unprotected insertive anal sex. In secondary analyses, men who reported experiencing discrimination based on their race and nongay identified men reported more favorable peer norms for condom use. Men who reported that their family disapproved of their being gay were more likely to have been incarcerated in the past 2 months. HIV prevention for BMSM must promote supportive peer norms for condom use and address incarceration, racial discrimination, and family disapproval.     

Who is not using condoms among HIV-positive patients in treatment in the largest city in Brazil?

Data on risky sexual behaviors in people living with HIV/AIDS (PLWHA) is still scarce in some populations around the world. The purpose of this study was to assess the factors associated with the use of condoms in a representative sample of PLWHA in outpatient treatment in the city of São Paulo. Six hundred and sixty-seven HIV-positive patients (383 men and 284 women) who were being treated at eight centers participated in this study. Data were collected using a sociodemographic survey, the Beck depression and anxiety inventories, a survey of alcohol and other drugs use, the Alcohol Use Disorders Identification Test, a sexual behavior survey, and the Sexual Risk Behavior Assessment Schedule. The majority of study participants were sexually active (almost 62% of the sample had at least one sexual partner in the last three months), and at least one-fourth engaged in unsafe sex (25.3% did not use condoms during at least one instance of anal and/or vaginal intercourse in the past three months). Multivariate logistic regression showed that engaging in unprotected sex was more likely among females (p < .001), persons with an HIV-positive partner (p < .001), and people using cannabis before sex (p = .002). These findings should stimulate health-care workers to create specific groups for women, seroconcordant couples, and cannabis users to discuss condom use, as they seem to be vulnerable groups.     

Sexual risk behavior and uptake of HIV counseling and testing among youth in Metropolitan Kumasi,Ghana

Research on HIV counselling and testing (HCT) has proliferated in Ghana but limited evidence exists about the uptake of HCT among a large population that has been shown to engage in HIV risk-related behavior in Metropolitan Kumasi. With retrospective cross-sectional data from a representative sample of sexually active young people, multivariate logistic regression models examine the variables associated with HCT uptake in Kumasi. Among 906 participants (male 51% and female 49%, with a mean age ±SD, 25?±?6), 22% had utilized HCT in the last six months despite the higher knowledge of HCT (84%) mainly through mass media (65%) and health providers (27%). Besides, less than 20% of the sample intended to undergo HCT services. Multivariate logistic regression analysis showed that female gender (adjusted odds ratio [aOR]?=?1.830; 95% CI: 1.280–47.831; p?p?=?0.040), having sexual intercourse with irregular partner (aOR?=?5.597; 95% CI: 1.776–17.638; p?=?0.018), practiced unprotected sex (aOR?=?2.614; 95% CI: 1.821–6.472; p?=?0.002), having multiple sex partners (aOR?=?2.902; 95% CI: 1.405–7.226; p?p?相似文献   

Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using “Vialogues”: a randomized controlled trial

ABSTRACT

We conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24–32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p?=?0.029) and higher median percentage of condom use for anal intercourse (p?=?0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p?=?0.001), popper usage (p?=?0.002), median number of sexual partners (p?=?0.003), and increased median condom use percentage (p?=?0.006). Our study highlights that “Vialogues” intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.     

Mutual HIV status disclosure is associated with consistent condom use in public sector ART clients in Free State province,South Africa: a short report

Risky sexual behaviour in PLWHA on antiretroviral therapy threatens both prevention and treatment efforts, but disclosure promises to support safer sexual practices. This paper investigates the association between HIV self-disclosure and consistent condom use in a cohort of public sector patients on antiretroviral (ARV) treatment. Using data from the FEATS cohort study, logistic regression analysis shows that knowledge of your partner’s HIV status is positively associated with consistent condom use (OR 2.73, 95% CI 1.37–5.43, p?=?0.004) and so too mutual HIV disclosure (OR 3.38, 95% CI 1.60–7.18, p?=?0.001). Prevention and treatment programmes, through couple HIV counselling and testing (CHCT) and other assistance programmes, should focus on supporting the mutual disclosure of HIV status among PLWHA on ARV treatment.     

Barriers to achieving the first 90%: gender norms and HIV testing among men in the Democratic Republic of the Congo

Gender inequality and gender norms are key social drivers of the HIV epidemic through their influences on sexual relationships, behavior, and risk taking. However, few empirical studies have measured the influence of gender norms on HIV sexual-risk behaviors and HIV testing among men in sub-Saharan Africa. We analyzed cross-sectional, survey data from 399 sexually active men (ages 18–39) in Democratic Republic of the Congo to examine the relationship between the men's support for inequitable gender norms and their HIV-risk behaviors. Logistic regression analyses revealed that moderate and strong levels of support for inequitable gender norms were significantly associated with never having been tested for HIV (AOR?=?2.92, p?p?相似文献   

Alcohol use,expectancies and HIV-related sexual risk: a cross-sectional survey of male migrant workers in South India

Male migrant workers (MMWs) in India are vulnerable to developing alcohol-related problems and engaging in unprotected sex, putting them at risk of HIV. Research has shown that alcohol-related expectancies mediate vulnerability to alcoholism. We examined which expectancies were associated with sexual risk and drinking. We surveyed 1085 heterosexual MMWs in two South Indian municipalities, assessing expectancies, sex under the influence, and unprotected sex with female sex workers (FSW) and casual female partners in the prior 30 days. Men more strongly endorsed positive than negative expectancies (t?=?53.59, p?p?p?p?p?相似文献   

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.     

Sexual identity and behavior in an online sample of Indian men who have sex with men

Indian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n?=?279) or bisexual (n?=?123). There were significant differences in outedness between the two groups, with 48% of bisexually identified men reporting that they were out to “no one” and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p?p?p?p?p?相似文献   

Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis

Current HIV prevention interventions for female sex workers (FSWs) have tended to target the cognitive factors in changing their behaviors, yet little attention has been paid to the psychological factors that influence the behavior of women in sex work. This review aimed to explore the associations between the psychological health of FSWs and HIV risk. A total of eight studies published in English before July 2013 were identified and reviewed. FSWs had reported psychological issues, including depression, suicidal thoughts as well as lower quality of life, and the pooled prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections. Among the five studies which measured symptoms of depression, four documented that higher depression scores were significantly associated with inconsistent condom use among FSWs with their clients and/or partners. Meta-analysis using a fixed-effects model was performed to examine the association between depression and inconsistent condom use and found that higher scores in depression were significantly associated with inconsistent condom use (odds ratio?=?2.57, p?相似文献   

Perceived HIV risk as a predictor of sexual risk behaviors and discrimination among high-risk women

HIV risk perception and discrimination are important determinants of HIV prevention among vulnerable populations. Using Detroit’s 2016 National HIV Behavioral Surveillance (NHBS) Survey, we evaluated demographic variables, risk behaviors, and perception of HIV stigma and discrimination stratified by perceived HIV risk (high, medium, low) in a sample of high-risk women. Significant variables were identified using Pearson Chi-squared tests and one-way analysis of variance tests. Among 541 females surveyed, 93.0% were black and 87.7% lived in poverty. Women’s poverty (p?=?.010), employment (p?=?.012), insurance (p?=?.024) and homelessness status (p?<?.001) were all significantly associated with their level of HIV risk perception. Among women with low HIV risk perception (76.7%), the majority did not know their partner’s HIV status at last intercourse (68.7%, p?=?.007), had unprotected anal/vaginal sex in the past year (86.7%, p?=?.025), participated in sex exchange (63.4%, p?<?.001), and did not use condoms with a partner with HIV-unknown status (87.2%, p?<?.001). Half of the women agreed or strongly agreed most people would not be friends with someone with HIV (50.4%), and 46.3% agreed or strongly agreed most people would support PLWH to live or work where they want. Compared to women with low HIV risk perception, women with high perceived HIV risk were more likely to agree or strongly agree most people would discriminate against someone with HIV (87.3% vs. 76.8%) and that people who got HIV via sex exchange or drugs got what they deserve (46.6% vs. 25.8%). Women’s perceived HIV risk was not significantly associated with these discriminatory attitudes. Despite multiple risk behaviors significantly associated with the level of perceived HIV risk in the sample, the NHBS survey demonstrates many women with high-risk behaviors still perceive themselves to be at low risk. Our findings highlight a complex interaction of risk perception, risk behaviors and stigma surrounding HIV in high-risk women.     

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.     

Sexual safety practices of massage parlor-based sex workers and their clients

The Outreach and Research in Community Health Initiatives and Development (ORCHID) project examines social and structural factors that contribute to HIV/AIDS risk among women working in Vancouver's indoor sex industry and their clients. From 2006 to 2009, two mixed method studies were undertaken in ORCHID: one exploring experiences of women working in the indoor sex industry, mainly in massage parlors, and the other exploring experiences of men as sex “buyers.” Both studies emphasize sexual health and safety, risk and protective behaviors, and related contextual factors. No analyses examining the sexual health and safety practices of massage parlor-based sex workers and clients exist in the Canadian context. To address this gap, we analyze two survey datasets – with 118 sex workers and 116 clients. Upon comparing demographics of sex workers and clients, we discuss their condom use and sexually transmitted infections (STI) and HIV testing practices. Sex workers and clients reported high rates of condom use for vaginal/anal intercourse. While both groups reported lower rates of condom use for oral sex during sex transactions, clients did so to a greater extent (p < 0.001). Condom use with noncommercial sex partners was reported to be less consistent by both groups. STI testing was higher among sex workers than clients (p < 0.001). Initiatives targeting clients of massage parlor-based sex workers for STI education and testing are needed. Future research should investigate how different types of relationships between sex workers and clients impact their sexual safety practices.     

Sexual risk behaviors among HIV-patients receiving antiretroviral therapy in Southern Thailand: roles of antiretroviral adherence and serostatus disclosure

The objective of this study was to examine the extent of unprotected sex among patients already established in HIV-medical care and their associated factors. Sexually active patients who were receiving antiretroviral therapy (ART) from five public hospitals in Trang province, Southern Thailand, were interviewed. Of 279 studied patients, 37.3% had unprotected sex in the prior 3 months and 27.2% did not disclose their serostatus to sexual partners. The median duration interquartile range (IQR) of using ART was 47 (27–60) months and 26.7% were non-adherent to ART (i.e., taking less than 95% of the prescribed doses). More than one-third had the perception that ART use would protect against HIV transmission even with unprotected sex. About 36.6% reported that they were unaware of their current CD4 counts and nearly one-third did not receive any safe sex counseling at each medical follow-up. After adjustment for potential confounders, non-adherence to ART and HIV-nondisclosure were strongly associated with an increase in the risk of unprotected sex with the adjusted odds ratio (aOR) of 5.03 (95% CI 2.68–9.44) and 3.89 (95% CI 1.57–9.61), respectively. In contrast, the risk for engaging in unprotected sex was less likely among patients having a negative-serostatus partner (aOR?=?0.30; 95% CI 0.12–0.75), a longer duration of the use of ART (aOR?=?0.98; 95%CI 0.97–0.99) and an unawareness of their current CD4 levels (aOR?=?0.54; 95% CI 0.30–0.99). To maximize the benefits from ART, there should be a bigger emphasis on the “positive prevention” program and more efforts are needed to target the population at risk for unprotected sex. Strategies to encourage adherence to ART and for disclosure of serostatus are also required.     

Risk factors associated with HIV infection among young persons aged 15–24 years: Evidence from an in-depth analysis of the 2005–06 Zimbabwe Demographic and Health Survey

This study focuses on factors that predispose young persons aged 15–24 years in Zimbabwe to infection from HIV. Using the Mosley and Chen framework, multivariate modelling was used to assess the effect of demographic, socio-economic and behavioural factors on the risk of HIV infection among this target group. The study utilised data from the Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005–06. Only the variables that were significant in the bivariate analysis were included in the multivariate binary logistic regression. Young females aged 15–24 years are associated with a significant two-fold elevated risk of HIV infection relative to their male peers (p?<?0.000). Young persons aged 15–24 years who were divorced, widowed or not living together have significantly elevated risk compared with their never-married counterparts, OR?=?5.267 (p?=?0.000); OR?=?4.323 (p?=?0.000) and OR?=?3.272 (p?=?0.000), respectively. Young persons whose age at first sexual intercourse was less than 14 years are significantly associated with 2.696 times more risk of HIV infection relative to their peers whose age at first sexual intercourse was 20–24 years (p?=?0.000). Young persons aged 15–24 years with two or more sex partners in the past 12 months preceding the 2005–06 ZDHS survey had a significantly elevated risk of HIV infection of 1.568 times relative to their counterparts with no sex partners in the same period of time. Great challenges still exist for the control of HIV and AIDS among young persons in Zimbabwe. HIV prevention programmes targeted at young persons aged 15–24 years should provide invigorated focus on marital status, age at sexual debut, number of sexual partners, sexually transmitted infections and condom use so as to mitigate these predisposing factors for HIV infection.     

Behavior change communication and mobile populations: the evaluation of a cross-border HIV/AIDS communication strategy amongst migrants from Swaziland

This study investigates the effect of being exposed to the Soul City Southern Africa Regional OneLove campaign, a behavior change communication program, on sexual behavior and condom use among a mobile population in Swaziland. Data for this study come from a nationally representative sample of 845 individuals who reported traveling to neighboring countries for at least two weeks at any time in the previous two years. Respondents were asked about exposure to the campaign through television, radio, booklets, posters, and advertisements both in Swaziland and in the other countries where they had traveled in the previous two years. Odds ratios were used to estimate the relationships between the HIV/AIDS outcomes of interest and program exposure for the full sample as well as separately for males and females. The program had no effect on reducing known risky behaviors such as having multiple sexual partners. However, men exposed in Swaziland only (AOR?=?3.4, CI 1.2–9.4) and in Swaziland and another country (AOR?=?2.8, CI 1.0–7.7) were more likely to report using a condom at last sex. In the full sample, those exposed in Swaziland were more likely to report using a condom at last sex (AOR?=?2.6, CI 1.3–5.3) and a condom at last sex with a regular partner (AOR?=?2.3, CI 1.1–4.8). Men who reported multiple sexual partnerships and who were exposed in Swaziland and another country were nine times as likely to report condom at last sex than men with no exposure. Respondents exposed in Swaziland and another country were more likely to have been tested for HIV; this was true for the total population (AOR?=?2.9, CI 1.1–7.9) and for men separately (AOR?=?3.3, CI 1.1–10.1). These findings provide support for more regional HIV prevention programs in Southern Africa as a way to increase positive behaviors among mobile populations.     

Age differences in sexual risk behaviors and related factors among people living with HIV in Guangxi,China

Sexual risk behaviors by people living with HIV (PLHIV) can result in secondary HIV transmission and other health problems. Given the dearth of research on age differences in sexual behaviors among PLHIV, the objective of the study is to compare sexual risk behaviors and related factors among PLHIV by age groups. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 in Guangxi, China. PLHIV were selected randomly from 12 sites with the largest number of HIV/AIDS cases. The 2,987 PLHIV completing the survey were included in the study. Participants were asked about key sociodemographic characteristics, health condition, same-sex behavior, and sexual risk behaviors (number of sex partners, condom use consistency, and change in condom use after HIV diagnosis). Univariate logistic regression analyses were conducted to evaluate associations of sexual risk behaviors with age and other factors. Those variables with a p-value of less than 0.2 were entered into multivariate logistic regression models. All statistical analyses were conducted using SAS 9.4. Differences in sexual risk behaviors across age groups were observed. Compared with their younger counterparts, who were ≥?50 years of age were more likely to have multiple partners, use condoms inconsistently, and use condoms less than before HIV diagnosis. Moreover, lower education attainment, being in the lowest or highest category of income, having a sero-concordant or sero-unknown steady partner or no steady partner, and having contracted HIV from steady or casual/commercial partners, or through injection drug use appeared to be predictive of at least one of the sexual risk behaviors examined in the study. The findings call for HIV prevention interventions to be tailored to different age groups. The interventions that can help reduce unprotected sex among older PLHIV are urgently needed.     

Social intolerance,risky sexual behaviors and their association with HIV knowledge among Ugandan adults: results from a national survey

Understanding the link between HIV knowledge, risky sexual behaviors, and social intolerance such as stigma and discrimination is important for HIV prevention and treatment program planning. We investigated whether intolerant attitudes and practices among Ugandan adults were associated with HIV-transmission knowledge.

We analyzed data from a nationally representative population-based household survey, the 2011 Uganda AIDS Indicator Survey. A total of 15,526 participants who responded to questions on HIV knowledge, social intolerance and risky sexual behavior were included in this analysis.

Results show that 34.8% of respondents reported having fear of casual contact with people living with HIV (PLWA), 21% blame PLWAs for their disease, 62% would not want HIV infection in their family disclosed, while 25% reported engaging in risky sexual behaviors. After adjusting for age, sex, residence, and level of education, people with low HIV-transmission knowledge had almost three-fold higher odds of fear of casual contact with a PLWA (aOR?=?2.70, 95%CI?=?2.33–3.13), and had 30% higher odds of HIV-related stigmatizing attitudes (aOR?=?1.29, 95%CI?=?1.07–1.54). Further, they had 47% higher odds of having sex under the influence of alcohol (aOR?=?1.47, 95%CI?=?1.25–1.73) and 40% higher odds of having unprotected sex with any of their last three sex partners (aOR?=?1.39, 95%CI?=?1.06–1.89).

Our findings show that intolerant attitudes such as stigma still persist, particularly among people with low HIV-transmission knowledge. Improving knowledge about HIV/AIDS can foster positive attitudes and building safe practices among populations, and is critical for improving prevention and treatment programs.     

Social influence, AIDS/STD knowledge, and condom use among male clients of female sex workers in Bali.

The importance of social networks is increasingly being recognized in research on HIV risk behaviors. The objective of this article is to examine the association of AIDS and sexually transmitted disease (STD) knowledge, perceived susceptibility to HIV/STD infection, condom beliefs, demographic variables, and peer influence on the condom use of clients of Indonesian sex workers. Data for the study are drawn from the Bali STD/AIDS study conducted from 1997 to 1999 in Bali, Indonesia. During the project 2,026 men were selected for interviews in low price brothels. Statistical methods included multivariate regression models. Results of the study showed that younger men, men who have resided in Bali for at least a year, and more educated men were more likely to use condoms. Furthermore, men with stronger AIDS and STD knowledge and condom beliefs were more likely to use condoms. Men whose friends knew that they visited sex workers were less likely to use condoms. However, men who reported that their friends used condoms with sex workers and that their friends encouraged them to use condoms with sex workers were more likely to use condoms with sex workers. Implications for prevention of HIV infection are discussed.