HIV-related Sexual Risk Behaviors Research Articles

HIV-Related Sexual Behaviors among Migrants and Non-migrants in Rural Ethiopia:Role of RuraltoUrbanMigration in HIV Transmission

Objective: To compare HIV-related sexual risk behavior among temporary ruraltourban migrants and non-migrants and to explore the role of migration in HIV transmission in a rural area of Ethiopia.Methods: A cross-sectional comparative study was conducted in Bure Woreda, West Gojam, Amhara Region, Ethiopia. A total of 1,310 male subjects (655 rural to urban migrants and 655 non-migrants) were selected randomly and were assessed,analyzed using SPSS version 17 software for their HIV related sexual risk behavioursincluding the role of migration in HIV transmission in a rural Ethiopia. Twopartsof questionnaires were prepared and used for comparing the above groups. The first part of the questionnaires included non-sensitive questions such as demographics and HIV knowledge while the second part comprisedsensitive questions related to sexual behaviors. Results: When multiple sexual partners, sex with commercial sex workers, sexual transmitted infections and premarital sex compared between the two groups, the proportions of rural to urban migrantsVs non- migrants who had multiple sexual partners (31.4 % Vs 7.4%), sex with commercial sex workers (22.3% Vs 13.3%), sexual transmitted infections (11.7% Vs 3.2%) and premarital sex (20.8% Vs 14.2 %)were significantly higher in ruraltourban migrants than non-migrants. Among those who had multiple sexual partners, only 12.7 % of, rural to urban migrants and9.8 % of non-migrants reported consistent condom use with sexual partners other than their spouse. Conclusions: As both rural to urban migrants and non-migrants are at risk for HIV infection, intervention programmes targeting both groups are recommended. However, in order to contain the bridging effect on HIV transmission from urban to rural areas particular attention should be given for the rural to urban migrant population.

Depressive Symptoms, Substance Use, and HIV-Related High-Risk Behaviors Among Opioid-Dependent Individuals: Results From the Clinical Trials Network

The sample included 343 opioid-dependent adults enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Opioid-dependent individuals were recruited from 12 sites across the United States from January 2001 to July 2002. We examined associations between depressive symptoms, co-occurring substance use (i.e., the use of substances other than opioids), and HIV-related sexual and injection risk behaviors. Data were collected using the Addiction Severity Index and the HIV Risk Behavior Scale, and analyzed using linear regression. Depressive symptoms were associated with an increased level of injection risk behaviors but were not associated with risky sexual behaviors. The co-occurring use of amphetamines also increased the likelihood of risky sexual behaviors. The study limitations and clinical implications are noted. The study was funded by the U.S. National Institute on Drug Abuse.

Polling Booth Surveys: A Novel Approach for Reducing Social Desirability Bias in HIV-Related Behavioural Surveys in Resource-Poor Settings

This study compared rates of HIV-related sexual risk behaviours reported in individual face-to-face (FTFI) and group anonymous polling booth (PBS) interviews in India. In PBS, respondents grouped by gender and marital status answered yes/no questions by putting tokens with question numbers in colour-coded containers. Data were subsequently collated for each group as a whole, so responses were not traceable back to individuals. Male and female PBS participants reported substantially higher rates of pre-marital, extra-marital, commercial and anal sex than FTFI participants; e.g. 11 vs. 2% married males reported paying for sex; 6 vs. 1% unmarried males reported homosexual anal sex.

Parents matter in HIV-risk among probation youth.

We investigated the relationship between parenting practices (i.e., parental monitoring, parent permissiveness, and parent-teen communication), and probation youth's HIV-related sexual risk behavior (i.e., ever having sex, condom use, alcohol and marijuana use before sex). Participants were 61 male and female juvenile offenders, ages 13-17, on probation and awaiting sentencing. Results indicated different relationships between parenting and HIV-related sexual risk behavior for probation boys and girls. Parental monitoring, parenting permissiveness, and parent-teen communication were collectively related to whether girls' ever had sex and with boys' use of alcohol and marijuana use before last sex. Findings underscore the important role of parenting on probation teens' HIV risk behaviors.

HIV-related knowledge, attitudes and sexual risk behaviours among Montenegrin youth

Context: Montenegro has a low-level HIV epidemic, but the majority of registered HIV cases have been diagnosed in patients between the ages of 20- to 34-years-old. Th e aim of this study was to assess the level of HIV-related knowledge, attitudes towards people living with HIV (PLHIV) and sexual behaviour among youth aged 15-24 in Montenegro. Methods: A nationally representative cross-sectional survey assessed 1164 young people aged 15-24. Th e data were collected in December 2009 using face-to-face interviewing for topics concerning HIV-related awareness and attitudes, whereas a self-administered questionnaire covered topics related to sexual experiences and behaviour. Results: In general, the level of HIV-related knowledge and accepting attitudes towards people living with HIV were unsatisfactory. Of the surveyed population, slightly more than half reported current sexual activity. Th e reported level of sexual risk behaviour diff ered signifi cantly according to participant sex and region. Early sexual initiation and not using condoms during the fi rst episodes of sexual intercourse were found to be signifi cant predictors of more frequent sexual risk behaviour. Conclusions: Despite the relatively high awareness pertaining to routes of HIV transmission, the surveyed population reported misconceptions related to HIV transmission. A significant proportion of young people have engaged in risky sexual behaviours. Th ese results strongly support the introduction of secondary school curriculum related to HIV/STI prevention as well other risk behaviours observed in this age cohort.

Sorting through chickens and eggs: A longitudinal examination of the associations between attitudes, norms, and sexual risk behavior.

Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true--that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions. Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities--that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse. Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior. These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men.

PP-166 Assessment of the knowledge of AIDS and HIV related sexual risk behavior among university students in Maiduguri

PP-166 Assessment of the knowledge of AIDS and HIV related sexual risk behavior among university students in Maiduguri

Individual and network interventions with injection drug users in 5 Ukraine cities.

We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities. Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up. Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors. Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors.

Clients of sex workers in Switzerland: it makes sense to counsel and propose rapid test for HIV on the street, a preliminary report

BackgroundClients of street sex workers may be at higher risk for HIV infection than the general population. Furthermore, there is a lack of knowledge regarding HIV testing of clients of sex workers in developed countries.MethodThis pilot study assessed the feasibility and acceptance of rapid HIV testing by the clients of street-based sex workers in Lausanne, Switzerland. For 5 evenings, clients in cars were stopped by trained field staff for face-to-face interviews focusing on sex-related HIV risk behaviors and HIV testing history. The clients were then offered a free anonymous rapid HIV test in a bus parked nearby. Rapid HIV testing and counselling were performed by experienced nurse practitioners. Clients with reactive tests were offered confirmatory testing, medical evaluation, and care in our HIV clinic.ResultWe intercepted 144 men, 112 (77.8%) agreed to be interviewed. Among them, 50 (46.6%) had never been tested for HIV. A total of 31 (27.7%) rapid HIV tests were performed, 16 (51.6%) in clients who had not previously been tested. None were reactive. Initially, 19 (16.9%) additional clients agreed to HIV testing but later declined due to the 40-minute queue for testing.ConclusionThis pilot study showed that rapid HIV testing in the red light district of Lausanne was feasible, and that the clients of sex workers accepted testing at an unexpectedly high rate. This setting seems particularly appropriate for targeted HIV screening, since more than 40% of the clients had not previously been tested for HIV even though they engaged in sex-related HIV risk behaviour.

Familial and Cultural Influences on Sexual Risk Behaviors among Mexican, Puerto Rican, and Dominican Youth

The present study examined the relationship among acculturation, familismo, and HIV-related adolescent sexual risk behavior. Data were collected from Latino mother-adolescent dyads to permit parent and adolescent analyses of familismo for predicting oral, vaginal, and anal sexual behaviors. A random sample of 702 Latino eighth-grade students and their mothers was recruited from New York City. The sample included Mexicans (n = 203), Puerto Ricans (n = 239), and Dominicans (n = 260). Acculturation was unrelated to sexual behavior, but adolescent familismo was related to girls' but not boys' sexual behavior. The most important facet of familismo was subjugation to the family, which was negatively associated with girls' sexual behavior. The implications for HIV prevention programs for Latino youth are discussed.

Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia

BackgroundThe HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has important implications for prevention programs.MethodsWe examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex-related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE) analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users.ResultsAmong Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE.ConclusionThe type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs.

HIV/AIDS-related sexual risk behaviors in male rural-to-urban migrants in China

There is a lack of research concerning the connection between HIV-related sexual risk behaviors (SRBs) and the psychological characteristics of middle-aged male migrants in China. This study was aimed at describing how psychological characteristics affected the SRBs of migrant men in two Chinese cities. A cross-sectional survey in Hangzhou and Guangzhou was used to collect sociodemographic and psychological data from male migrants over 3 age groups: 20-29 (Group I), 30-39 (Group II), and 40-59 years (Group III). The mean incidence of the participants' extramarital sex was higher in Group I than Group III, while the mean Hedonism Seeking Scale (Yang et al., 2006) score was higher in Group III than Group I. Results suggest that poor health status, higher stress levels and higher hedonism seeking increase sexual risk taking in middle-aged male migrants, while the longer the duration of living in an urban area and living with a partner reduce such behaviors in all groups.

Migrant Drug Users: Predictors of HIV-Related Sexual and Injection Risk Behaviors

Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term "migrant" was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey). A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors. Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness. Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.

Outcomes using two tailored behavioral treatments for substance abuse in urban gay and bisexual men

This project evaluated two behavioral therapies for substance abuse and concomitant sexual risk behaviors applied to primarily stimulant-abusing gay and bisexual men in Los Angeles. One hundred twenty-eight participants were randomly assigned to 16 weeks of a gay-specific cognitive–behavioral therapy (GCBT, n = 64) or to a gay-specific social support therapy (GSST; n = 64), with follow-up evaluations at 17, 26, and 52 weeks after randomization. No overall statistically significant differences were observed between conditions along retention, substance use, or HIV-related sexual risk behaviors. All participants showed a minimum of twofold reductions in substance use and concomitant sexual risk behaviors from baseline to 52-week evaluations. Among methamphetamine-using participants, the GCBT condition showed significant effects over GSST for reducing and sustaining reductions of methamphetamine. Findings replicate prior work and indicate that GCBT produces reliable, significant, and sustained reductions in stimulant use and sexual risk behaviors, particularly in methamphetamine-abusing gay and bisexual men.

Gender–Specific HIV Prevention with Urban Early-Adolescent Girls: Outcomes of the Keepin' It Safe Program

This study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls. Intervention effects were examined in a randomized, pretest-posttest wait-list control-group design. Changes in HIV/AIDS knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors were tested using linear regression models that were controlled for baseline values of each outcome. Recruited through youth services agencies located in the greater New York City area, study participants comprised 204 adolescent girls aged 11-14 years. Girls exposed to Keepin' It Safe, relative to wait-list control girls, increased their HIV/AIDS knowledge, perceived efficacy and enjoyment of abstinence, perceived efficacy and enjoyment of condoms, and sexual assertiveness, suggesting that a theory-based, gender-specific, CD-ROM-mediated HIV prevention program can enhance knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors among urban early-adolescent girls.

Behavioral Interventions to Reduce HIV-related Sexual Risk Behavior: Review and Synthesis of Meta-Analytic Evidence

Over the past 25 years, scores of behavioral interventions to reduce HIV-related sexual risk behavior have been developed and evaluated. The purpose of the current study was to synthesize what is known about such interventions by systematically reviewing and synthesizing extant meta-analyses of the literature. Comprehensive search procedures resulted in a set of 18 meta-analyses that targeted HIV-related sexual risk behavior in a defined target population. The median meta-analysis in the review contained k = 19 primary studies with a cumulative N = 9,423 participants. All meta-analyses (11/11) that examined condom use found a statistically significant increase (median effect: OR = 1.34); 9/11 for reducing unprotected sex (median effect: OR = .76); 3/8 for reducing numbers of sexual partners (median effect: OR = .87); 4/6 for reduction of STDs (median effect: OR = .74); and 5/5 for reducing composite sexual risk (median effect: OR = .78). Summaries of moderator analyses suggested particular participant, intervention, and methodological characteristics that may influence the success of interventions. Implications include achieving a broader understanding of intervention moderators as well as increasing effectiveness trials and translation/dissemination of efficacious interventions to those populations most at risk.

Community characteristics associated with HIV risk among injection drug users in the San Francisco Bay Area: a multilevel analysis.

Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.

Reconceptualizing Adolescent Sexual Risk in a Parent‐Based Expansion of the Theory of Planned Behavior

To expand the theory of planned behavior (TPB) to explicate the influence of parents on adolescent behaviors and describe its application to adolescent sexual risk behaviors. Parents have repeatedly been shown to be among the most significant influences on adolescents' sexual risk-related attitudes, intentions, and behaviors. However, many of the leading theoretical frameworks for understanding HIV-related sexual risk behavior are individual-level models that do not include important influences outside the individual, such as parents and families. The proposed expansion of the TPB indicates the conceptual underpinnings for the design of family-based prevention programs to reduce HIV-related risk behaviors among adolescents. Additional research is needed to examine the predictive validity of the expanded model, and instrument development is needed for many of the expanded model constructs, most notably the parent constructs.

Religiosity, Denominational Affiliation, and Sexual Behaviors Among People With HIV in the United States

This study sought to describe religiosity and denominational affiliation among the U.S. population living with HIV and to test whether either is associated with HIV-related sexual risk behaviors. A nationally representative sample of 1,421 people in care for HIV, 932 of whom reported recent sexual activity, was used. Religiosity was associated with fewer sexual partners and a lower likelihood of engaging in unprotected sex and in high-risk sex. Catholics were less likely to report unprotected sex than were other Christians, adherents of non-Christian religions, and those reporting no religious affiliation. Catholics were also less likely than other Christians to report high-risk sex and reported fewer sexual partners compared to those of non-Christian religions. We did not observe a difference between Catholics and Evangelicals in the three sexual behaviors investigated. Results suggest that religiosity and some religious teachings may promote safer sex among people with HIV.

Severe Anxiety Symptomatology and HIV Risk Behavior Among Hispanic Injection Drug Users in Puerto Rico

Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.