Acquired Immunodeficiency Syndrome Risk Reduction Research Articles

Predictors of Intention to Change HIV Sexual and Injection Risk Behaviors among Heterosexual Methamphetamine-Using Offenders in Drug Treatment: A Test of the AIDS Risk Reduction Model

This study tested components of the acquired immunodeficiency syndrome (AIDS) Risk Reduction Model (ARRM) for a sample of methamphetamine-using offenders in drug treatment. Analyses included the first two stages of the ARRM, problem recognition and intention to reduce risk (potential precursors to later possible behavior change), assessing predictors of intentions to increase condom use, reduce other sexual risk, and disinfect needles. Path analysis results showed potential applicability of the ARRM as a basis for intervention development for this population. There was a consistent effect of self-efficacy for risk reduction strategies, as well as direct or indirect effects of problem recognition factors (AIDS knowledge, peer norms), on the three intention indicators. Prior sex risk behavior (condom use) was directly negatively related to intention to use condoms; prior needle use was indirectly negatively related to intention to disinfect. Intention to use condoms was lower for women. Results can help identify areas for intervention development.

Evolution of risk behaviors over 2 years among a cohort of urban African American adolescents.

To examine the evolution of risk behaviors over 2 years among a community-based cohort of low-income African American preadolescents and young adolescents enrolled in a randomized trial of an acquired immunodeficiency syndrome risk reduction intervention. Longitudinal, community-based cohort. Nine recreation centers serving 3 public housing developments. Three hundred eighty-three African American youths aged 9 through 15 years at baseline. Frequency distributions, chi 2 analyses, and regression analyses regarding 10 risk behaviors were conducted. To assess whether a specific risk behavior or its protective (nonrisk) behavioral analogue, composing a risk-nonrisk behavioral complex (eg, was sexually active and was sexually abstinent or used drugs and refrained from drugs), was stable over time, kappa values were determined for the 10 risk-nonrisk behavioral complexes. Instrument assessing risk/ behaviors administered at baseline and every 6 months aurally and visually via talking computer. The prevalence of sexual intercourse, cigarette smoking, alcohol consumption, and drug use increased notably over time. Drug use increased from a 6-month cumulative prevalence of 7% at baseline to 27% at the 24-month follow-up (P < .001). Cumulatively over the 2-year study interval, 81% of youths had engaged in fighting, 58% had engaged in sexual intercourse, and from 33% to 40% had engaged in truancy, knife or bat carrying or both, alcohol consumption, drug use, and cigarette smoking. All of the risk-nonrisk behavioral complexes except weapon carrying were stable during the semiannual assessment intervals. Fighting (kappa = 0.22, P < .01), sexual intercourse (kappa = 0.33, P < .001), alcohol consumption (kappa = 0.21, P < .001), and unprotected sexual intercourse (kappa = 0.34, P < .05) were stable for 2 years. Six risk-nonrisk behavioral complexes were stable for the 2-year interval among youths aged 13 through 15 years at baseline, while only 2 risk-nonrisk behavioral complexes were stable among younger youths. The intervention seemed to affect the stability of 4 risk behaviors: truancy, drug use, unprotected sexual intercourse, and, possibly, fighting. For unprotected sexual intercourse, this intervention effect seemed to be due to stabilization of nonparticipation in risky behavior. Intervention youths were less likely to adopt a risk behavior (ie, engage in it for > or = 2 risk assessment periods) than control youths, but they were not less likely to experiment with a risk behavior. There is evidence that although the prevalence of risk behaviors does change with age, most risk-nonrisk behavioral complexes seem to be relatively stable over time and stability may increase with time. Risk reduction interventions seem to decrease risk adoption, stabilize nonrisk behaviors, and possibly destabilize risk behavior.

Effectiveness of the 40 adolescent AIDS-risk reduction interventions: A quantitative review

(1) To review evaluations of Acquired Immunodeficiency Syndrome (AIDS) prevention interventions targeting adolescents to determine whether these efforts have been effective in reducing risk behaviors. (2) To examine the relation between intervention design issues and outcomes measures. A systematic review of five electronic databases and hand-searches of 11 journals, were undertaken for articles published from January 1983 through November 1995 that reported evaluations of adolescent AIDS risk-reduction interventions conducted in the United States. Outcomes examined include: improved attitudes about AIDS risk and protective behaviors, increased intention to abstain from sexual intercourse or to use condoms, and reduced sexual risk behaviors. Forty studies that met preestablished inclusion criteria were found. For each outcome assessed, a majority of studies found a positive intervention impact (88% of studies assessing changes in knowledge; 58% changes in attitude, 60% changes in intention to use condoms, 73% in condom use, and 64% in decreasing number of sexual partners). Interventions that demonstrated an increase in intention to use a condom were significantly more likely to be theory-based than those that did not show any significant changes in intention (100% vs. 0%, p = .048). Interventions that increased condom use and decreased the number of sexual partners were longer in duration than those that did not improve these outcomes. AIDS risk reduction interventions can be effective in improving knowledge, attitudes, and behavioral intentions and in reducing risk practices. The positive relationship between improved outcomes and several elements of intervention design underscores the need for increased focus on intervention design in future studies.

Correlates of HIV risk appraisal in women.

This study examined the relationship of safer sex behavior practices, knowledge of acquired immunodeficiency syndrome (AIDS), social norms, and familiarity with persons infected with the human immunodeficiency virus (HIV) with HIV risk appraisal in women. Risk appraisal was measured by perceived susceptibility and seriousness of AIDS. The AIDS Risk Reduction Model was used to construct a salient framework for this descriptive, correlational survey in which 208 urban women of mixed ethnicity residing in areas with high rates of sexually transmitted diseases/AIDS participated. Behavior, knowledge, and social norms, contributed significant amounts of variance to perceived susceptibility but none of the independent variables contributed significant amounts of variance in perceived seriousness. Overall findings indicate that risk behaviors are commonly reported. AIDS knowledge is incomplete, and denial of risk is pronounced.

AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok.

Human immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self-reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection.

AIDS Risk Reduction Among A Multiethnic Sample of Urban High School Students

To evaluate the effectiveness of a teacher-delivered curriculum in favorably modifying acquired immunodeficiency syndrome (AIDS)--related knowledge and beliefs, self-efficacy related to AIDS-preventive actions, and involvement in AIDS risk behaviors among an eligible population of 1316 New York City high school students. Students in two pairs of demographically similar high schools were assigned to receive either a special six-lesson AIDS-preventive curriculum (intervention group) or no formal AIDS-preventive curriculum (comparison group). Study participants were ninth- and 11th-grade students, 12 to 20 years of age (mean, 15.7 years), 41.5% male, and 72.1% black or Hispanic. The special curriculum focused on conveying facts about AIDS, fostering theoretically derived beliefs favorable to AIDS prevention, and teaching skills necessary for the successful performance of AIDS-preventive behaviors. AIDS-related knowledge, beliefs, self-efficacy, and behaviors were assessed among students in intervention and comparison groups at study baseline and at 3 months' follow-up. Significant (albeit modest) effects favoring intervention were observed for knowledge, beliefs, self-efficacy, and risk behavior scores. School-based AIDS-preventive curricula may play a role in curtailing transmission of the human immunodeficiency virus among multiethnic groups of urban adolescents; however, such curricula may need supplementation by a broader-based prevention effort to achieve substantial risk behavior change.

Hey girlfriend: an evaluation of AIDS prevention among women in the sex industry.

Increasingly, acquired immunodeficiency syndrome (AIDS) prevention programs have been developed to reach and influence street-based populations. Standard methods of evaluation do not fit the conditions of such programs. This article describes a process and outcome evaluation of an AIDS prevention program for sex workers in which qualitative and quantitative methods were combined in order to mediate research problems endemic to street-based populations. Methods included epidemiological questionnaires, open-ended interviews with participants, and ethnographic field notes. Process evaluation findings show that field staff who were indigenous to the neighborhood and population readily gained access to the community of sex workers and simultaneously became role models for positive behavior change. Outcome findings show that sex workers do feel at risk for AIDS, but usually from clients rather than from husbands or boyfriends. Accordingly, they use condoms more frequently with clients than with steady partners. Increasing condom use among sex workers with their steady partners remains an important challenge for AIDS prevention. Combining qualitative and quantitative research data provided a more comprehensive assessment of how to reach sex workers with effective AIDS risk reduction messages than either method could have provided alone.

Evaluating AIDS prevention: Outcome, implementation, and mediating variables

Experience in evaluating AIDS (Acquired Immunodeficiency Syndrome) prevention projects leads us suggest several conceptual, measurement, and analysis recommendations: 1. follow the logic of prevention programs to translate effect sizes into a yield for AIDS risk reduction; 2. assume that secular trends toward risk reduction will reduce or disguise effect sizes; 3. measure behavior as the distal outcome in most evaluations; 4. measure all behaviors that are relevant to risk reduction; 5. measure interval level variables if possible; 6. estimate coverage and bias in coverage; and 7. measure a variety of mediating variables that may affect behavior and assist in tailoring, health education to the at-risk populations.

Grants and Outcomes

Grants and Outcomes

Grants and Outcomes

Grants and Outcomes

Issues in the perception of AIDS risk and risk reduction activities by black and Hispanic/Latina women.

Until recently, most Americans thought of Acquired Immunodeficiency Syndrome (AIDS) as essentially a man’s disease afflicting homosexual, bisexual, and intravenous drug abusing males (“Women and AIDS,” 1986). However, women have been counted among AIDS cases ever since the deadly disease first emerged six years ago. Of the 66,464 individuals diagnosed with AIDS, reported as of July 4, 1988 to the Centers for Disease Control, 5,757 are women, representing nearly 9% of all cases (AIDS Weekly Surveillance Report. July 4, 1988). Although this number may seem of relatively small concern when compared with the number of men affected by AIDS, there are important reasons to focus special study on these women. First, the fact that most cases at present have been diagnosed in men reflects an early epidemiologic pattern of infection by a virus with a long, and still unknown, average latency before disease expression (National Academy of Sciences, Institute of Medicine, 1986). In actuality, the number of cases among women today is approximately equivalent to the number of cases among men only two to three years ago and is expected to reach between 22,000 and 30,000 cases by the year 1991 (Morgan & Curran, 1986). As can be seen in Table 1, most women with AIDS are of ethnic minority background (Cochran, Mays, & Roberts, 1988). Table 1 Total Number of AIDS Cases by Risk Group for Each Ethnic/Race Group by Gender, United States, July 4, 1988 Among Latinas, risk is differentially present across the diverse populations that comprise this ethnic group, but the Centers for Disease Control AIDS Public Access Data Tape does not permit making such important distinctions. For example, in 1985, more than 40% of AIDS deaths on the Lower East Side of New York City occurred among Puerto Ricans (Worth & Rodriguez, 1987). Second, the pattern of infection transmission for women is changing. Whereas in 1982 only 12% of the women diagnosed with AIDS were presumably infected by their male sexual partners, by 1986 26% of women with AIDS were contracting it through heterosexual contact (Guinan & Hardy, 1987). Of these women infected through sexual activity, 77% are Black or Latina. Estimates (reported in “Bleak Lives,” 1987) are that up to 50,000 women in New York City are human immunodeficiency virus (HIV) seropositive. For women in New York City, the prevalence of infection is thought to be 50% among intravenous (IV) drug users and 20% among those whose sexual partners are IV drug users. Of these women, 80%, or 40,000, are most likely Black or Latina. Since 1980, AIDS has become the sixth leading cause of years of potential life lost before age 65 for women in New York City, and for those between the ages of 25 and 29, AIDS is the most frequent cause of death (Kristal, 1986). Experts estimate that heterosexual transmission will increase sevenfold in the next five years (Villarosa & Roberts, 1987). Nationwide, it is thought that approximately 100,000 women are HIV-infected (“Bleak Lives,” 1987). A third reason to be concerned about AIDS in women is that most pediatric cases of AIDS in the past have and virtually all in the future will result from infection acquired from an HIV-positive mother (Brooks-Gunn, Boyer & Hein, this issue, pp. 958–964). Further reductions in the incidence of pediatric AIDS are dependent upon the choices and behavior of infected women, many of whom are unaware of their infection status. Finally, AIDS, as a behaviorally transmitted disease, often through sexual contact, involves the behavior of both men and women. Risk reduction relies on altering the intimate behaviors of individuals during sexual activity. In this context, it seems relevant to explore women’s sexual and contraceptive behavior. Because AIDS risk reduction activities are sometimes identical to contraception efforts (e.g., using condoms), it is reasonable to extrapolate what is known about women and contraceptive behaviors in anticipating potential issues with encouraging “safer” sexual practices aimed at reducing AIDS transmission. In focusing on AIDS and women, our primary concern is with poor, urban, ethnic women because, at present, this is one of the populations most at risk for acquiring an HIV infection. This look at issues surrounding perceptions of risk and risk reduction activities by Black and Latina women may prove valuable in attempts to stop the spread and transmission of the disease. In doing so, it will also become quickly apparent that the AIDS epidemic has highlighted both the good and bad aspects of our society, particularly as it relates to ethnic minorities.

AIDS risk reduction: a community health education intervention for minority high risk group members.

During the past year, members of the Detroit Health Department health education staff have developed an Acquired Immunodeficiency Syndrome (AIDS) community education intervention. The intervention was designed in response to the growing public health problem of AIDS and the need to provide the community with accurate information regarding the transmission and prevention of the disease. The gap in AIDS education and information was particularly evident in the black community. In attempting to develop a comprehensive health education program, the staff encountered a number of barriers. Traditional antagonisms between the high-risk groups, homosexual and bisexual males and intravenous drug abusers, and the health department hampered the ability of the intervention team to design a clinic centered program. Concurrently, lack of access to the high-risk population and reactionary public sentiment toward the disease posed serious problems for developing community support for the implementation of an effective community-based program. The intervention team also found that traditional methodologies of health education program planning were inadequate. The staff lacked sufficient data on the beliefs and attitudes of the high-risk populations necessary to design relevant risk reduction activities. Recognizing our limited awareness and accessibility to the high risk groups, a strategy was developed to encourage members of the high-risk population to assume a leadership role in the development and implementation of the community-based program. The success of the Community Health Awareness Group (C-HAG) is, in part, a result of the willingness of high risk individuals to assume some responsibility in educating themselves and others. It also speaks to the efficacy of collaborative relationships between health workers and target populations when designing public health interventions.