Assuntos
Estudos Longitudinais , Informática Médica/métodos , Pediatria/métodos , Medicina de Precisão/métodos , Projetos de Pesquisa/tendências , Centros Médicos Acadêmicos , Criança , Serviços de Saúde da Criança/organização & administração , Humanos , National Institutes of Health (U.S.) , Pediatria/organização & administração , Pesquisa Translacional Biomédica/organização & administração , Estados UnidosRESUMO
OBJECTIVE: To examine the HIV risk behaviours of men who have sex with men only (MSMO) and men who have sex with men and women (MSMW), aged 12-24â years, in five US cities and in San Juan, Puerto Rico. METHODS: Data were collected through four annual cross-sectional anonymous surveys at community venues and included questions about sexual partnerships, sexual practices including condom use and substance use. Demographic and risk profiles were summarised for both groups. RESULTS: A total of 1198 men were included in this analysis, including 565 MSMO and 633 MSMW. There were statistically significant differences between the two groups for many risk factors examined in multivariable models. MSMW were more likely to identify as bisexual, be in a long-term relationship, have a history of homelessness, have ever used marijuana, have ever been tested for HIV and to have been tested for HIV within the past 6â months. MSMW may be more likely to ever exchange sex for money and ever have a sexually transmitted infection than MSMO. CONCLUSIONS: MSMW were more likely to report several markers of socioeconomic vulnerability or behaviours associated with increased risk for HIV than MSMO. MSMW contribute to HIV prevalence in the USA, and better understanding of the risk profile of this group is essential to understand heterosexual HIV transmission. MSMW, particularly those who identify as bisexual or questioning, may feel uncomfortable participating in programmes that are designed for gay-identified men. Therefore, prevention strategies need to target distinct subgroups that compose the population of MSM.
Assuntos
Bissexualidade/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Bissexualidade/psicologia , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Assunção de Riscos , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos/epidemiologia , Sexo sem Proteção/psicologia , Adulto JovemRESUMO
PURPOSE: Hispanic/Latino adolescents and young adults are disproportionately impacted by the HIV/AIDS epidemic; yet little is known about the best strategies to increase HIV testing in this group. Network-based approaches are feasible and acceptable means for screening at-risk adults for HIV infection, but it is unknown whether these approaches are appropriate for at-risk young Hispanics/Latinos. Thus, we compared an alternative venue-based testing (AVT) strategy with a social and sexual network-based interviewing and HIV testing (SSNIT) strategy. METHODS: All participants were Hispanics/Latinos aged 13-24 years with self-reported HIV risk; they were recruited from 11 cities in the United States and Puerto Rico and completed an audio computer-assisted self-interview and underwent HIV screening. RESULTS: A total of 1,596 participants (94.5% of those approached) were enrolled: 784 (49.1%) through AVT and 812 (50.9%) through SSNIT. HIV infection was identified in three SSNIT (.37%) and four AVT (.51%) participants (p = .7213). CONCLUSIONS: Despite high levels of HIV risk, a low prevalence of HIV infection was identified with no differences by recruitment strategy. We found overwhelming support for the acceptability and feasibility of AVT and SSNIT for engaging and screening at-risk young Hispanics/Latinos. Further research is needed to better understand how to strategically implement such strategies to improve identification of undiagnosed HIV infection.
Assuntos
Serviços de Saúde Comunitária/métodos , Infecções por HIV/diagnóstico , Hispânico ou Latino/estatística & dados numéricos , Programas de Rastreamento/métodos , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Hispânico ou Latino/etnologia , Humanos , Entrevistas como Assunto/métodos , Masculino , Prevalência , Porto Rico/etnologia , Risco , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
HIV prevention efforts have expanded beyond individual-level interventions to address structural determinants of risk. Coalitions have been an important vehicle for addressing similar intractable and deeply rooted health-related issues. A root cause analysis process may aid coalitions in identifying fundamental, structural-level contributors to risk and in identifying appropriate solutions. For this article, strategic plans for 13 coalitions were analyzed both before and after a root cause analysis approach was applied to determine the coalitions' strategic plans potential impact and comprehensiveness. After root cause analysis, strategic plans trended toward targeting policies and practices rather than on single agency programmatic changes. Plans expanded to target multiple sectors and several changes within sectors to penetrate deeply into a sector or system. Findings suggest that root cause analysis may be a viable tool to assist coalitions in identifying structural determinants and possible solutions for HIV risk.
Assuntos
Redes Comunitárias/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Infecções por HIV/prevenção & controle , Análise de Causa Fundamental , Adolescente , Feminino , Infecções por HIV/etiologia , Humanos , Masculino , Técnicas de Planejamento , Porto Rico , Fatores de Risco , Estados UnidosRESUMO
Success in addressing HIV and AIDS among men who have sex with men, a key population in the global epidemic, is impeded by homophobia. Homophobia as a barrier to HIV prevention and AIDS treatment is a particularly acute problem in the prison setting. In this qualitative study, we explore HIV and AIDS, stigma and homosexuality in the largest all male prison in Jamaica by conducting iterative in-depth interviews with 25 inmates. Participant narratives unveil a purposeful manipulation of beliefs related to homosexuality that impedes an effective response to HIV and AIDS both in prison and wider society. Findings indicate that homophobia is both a social construction and a tangible tool used to leverage power and a sense of solidarity in a larger political and economic landscape. This use of homophobia may not be unique to Jamaica and is an important issue to address in other low- and middle-income post-colonialist societies.
Assuntos
Cultura , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Preconceito , Prisioneiros/psicologia , Prisões/estatística & dados numéricos , Adulto , Antropologia Cultural , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Entrevista Psicológica , Jamaica/epidemiologia , Masculino , Masturbação/epidemiologia , Masturbação/psicologia , Pessoa de Meia-Idade , Prisioneiros/estatística & dados numéricos , Pesquisa Qualitativa , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
Although prisons have been noted as important venues for HIV testing, few studies have explored the factors within this context that may influence HIV test acceptance. Moreover, there is a dearth of research related to HIV and incarcerated populations in middle and low-income countries, where both the burden of HIV and the number of people incarcerated is higher compared to high-income countries. This study explores the relationship between HIV coping self-efficacy, HIV-related stigma, and HIV test acceptance in the largest prisons in Jamaica. A random sample of inmates (n=298) recruited from an HIV testing demonstration project were asked to complete a cross-sectional quantitative survey. Participants who reported high HIV coping self-efficacy (adjusted odds ratio (AOR) 1.86: 95% confidence interval CI 1.24-2.78, p-value=0.003), some perceived risk of HIV (AOR 2.51: 95% (CI) 1.57-4.01, p-value=0.000), and low HIV testing stigma (AOR 1.71: 95% CI 1.05-2.79, p-value=0.032) were more likely to test for HIV. Correlates of HIV coping self-efficacy included external and internal HIV stigma (AOR 1.28: 95% CI 1.25-1.32, p-value=0.000 and AOR 1.76: 95% CI 1.34-2.30, p-value=0.000, respectively), social support (AOR 2.09: 95% CI 1.19-3.68, p-value=0.010), and HIV knowledge (AOR 2.33: 95% CI 1.04-5.22, p-value=0.040). Policy and programs should focus on the interrelationships of these constructs to increase participation in HIV testing in prison.
Assuntos
Sorodiagnóstico da AIDS/psicologia , Soropositividade para HIV/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prisioneiros/psicologia , Autoeficácia , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adaptação Psicológica , Adolescente , Adulto , Idoso , Aconselhamento , Estudos Transversais , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Estereotipagem , Adulto JovemRESUMO
Increasingly, HIV prevention efforts must focus on altering features of the social and physical environment to reduce risks associated with HIV acquisition and transmission. Community coalitions provide a vehicle for bringing about sustainable structural changes. This article shares lessons and key strategies regarding how three community coalitions located in Miami and Tampa, Florida, and San Juan, Puerto Rico engaged their respective communities in bringing about structural changes affecting policies, practices and programs related to HIV prevention for 12-24-year-olds. Outcomes of this work include increased access to HIV testing and counseling in the juvenile correctional system (Miami), increased monitoring of sexual abuse between young women and older men within public housing, and support services to deter age discordant relationships (Tampa) and increased access to community-based HIV testing (San Juan).
Assuntos
Redes Comunitárias/organização & administração , Infecções por HIV/prevenção & controle , Delitos Sexuais/prevenção & controle , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Negro ou Afro-Americano , Criança , Pesquisa Participativa Baseada na Comunidade , Relações Comunidade-Instituição , Feminino , Florida , Hispânico ou Latino , Humanos , Masculino , Estudos de Casos Organizacionais , Prisões , Porto Rico , Educação Sexual , População Urbana , Adulto JovemRESUMO
Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N =318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.
Assuntos
Comunicação , Preservativos/estatística & dados numéricos , Trabalho Sexual , Apoio Social , Adolescente , Adulto , República Dominicana , Feminino , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Sub-disciplines of psychology have historically focused on the development and evaluation of interventions addressing social issues. However, little has been published regarding the development and evaluation of organizational structures that successfully support such interventions. By bridging the gap between the fields of community psychology and organization development, organizational structures and processes can be designed to enhance the effectiveness of social change programs. This article describes the interface between these two areas of psychology by presenting an integrative model that combines community psychology principles and values with organization development methodologies. This framework has been used to evaluate the organizational structure of a multi-site community-based research project entitled Connect to Protect (C2P) aimed at reducing HIV incidence among youth.(AU)
Varias sub-disciplinas de la psicología se han enfocado en el desarrollo de intervenciones para subsanar los problemas sociales. Sin embargo, se ha publicado poco sobre el desarrollo y evaluación de infraestructuras organizacionales que presten apoyo a dichas intervenciones para que sean exitosas. A través de un vínculo entre la psicología comunitaria y psicología organizacional podemos desarrollar estructuras organizacionales y procesos que incrementen la eficacia de programas de cambio social. Este articulo presenta la conexión entre estas dos áreas de la psicología a través de un modelo integrado que combina los supuestos y valores de la psicología comunitaria con la metodología de la psicología organizacional. Dicho modelo se utilizó para evaluar la estructura organizacional que provee apoyo a Conectar Para Proteger (C2P); una iniciativa investigativa a nivel comunitaria implantada en múltiples ciudad en los Estados Unidos y Puerto Rico. Cuyo propósito es reducir la incidencia de VIH entre jóvenes.(AU)
RESUMO
Prior research has demonstrated an important link between relationship intimacy and condom use. Limited research has been conducted on this connection within the realm of female sex work. We examined the association between perceived relationship intimacy and consistent condom use among 258 female sex workers and 278 male regular paying partners who participated in a cross-sectional survey in the Dominican Republic. In multivariate analysis, higher intimacy among sex workers and regular paying partners was negatively associated with consistent condom use. Among those reporting higher perceived intimacy, male participants were more than twice as likely to report consistent condom use as female participants. Female sex workers in relationships of higher perceived intimacy are at greater risk of HIV/AIDS than their male regular paying partners. Gender-sensitive HIV prevention programs are needed to address the differential influence of relationship intimacy on condom use in the context of sex work.
Assuntos
Preservativos/estatística & dados numéricos , Motivação , Negociação , Trabalho Sexual/psicologia , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adolescente , Adulto , Estudos Transversais , República Dominicana , Feminino , Humanos , Análise Multivariada , AutoeficáciaRESUMO
OBJECTIVE: To determine whether African American adolescents, whose recent sex partners reported having another sex partner, are at increased risk for exposure to genital chlamydial infection or gonorrhea. STUDY DESIGN: A household sample of low-income urban African American adolescents 14 to 19 years of age, up to two of their close friends, and their sex partners were interviewed and tested for gonorrhea and chlamydial infection. RESULTS: Thirty-four of 145 adolescents had at least one recent sex partner infected with Neisseria gonorrhoeae and/or Chlamydia trachomatis. The adjusted model showed that adolescents, whose recent sex partners reported having another sex partner, were more likely to have a recent sex partner with gonorrhea and/or chlamydial infection. CONCLUSION: In addition to individual factors, network factors may explain why African American adolescents are at increased risk for exposure to sexually transmitted infections (STIs). Multi-level community-based interventions may need to address network factors along with personal behaviors in order to prevent STIs among low-income urban African American adolescents.
Assuntos
Negro ou Afro-Americano , Infecções por Chlamydia/transmissão , Gonorreia/transmissão , Parceiros Sexuais , Adolescente , Infecções por Chlamydia/epidemiologia , Feminino , Gonorreia/epidemiologia , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , População UrbanaRESUMO
OBJECTIVE: To examine the influence of environmental-structural factors in promoting consistent condom use (CCU) among female sex workers (FSW) and their regular paying partners in the Dominican Republic. METHODS: A cross-sectional survey was conducted with 288 FSW recruited from 41 sex establishments in Santo Domingo from March to June 1998. Sex workers were asked about their sexual behavior, self-efficacy at negotiating safe sex, perceived intimacy with their most recent regular paying partner, and the physical, social and policy environment of the establishment where they worked. Factor and reliability analysis were utilized to develop aggregate measures for self-efficacy (Cronbach's Alpha 0.60), intimacy (Cronbach's Alpha 0.80), and environmental-structural support (Cronbach's Alpha 0.72). RESULTS: Controlling for sociodemographic characteristics of participants in multivariate analyses, environmental-structural support for condom use and HIV/sexually transmitted infection (STI) prevention was a significant predictor of CCU (OR 2.16; CI 1.18-3.97) among FSW and their regular paying partners. Safe sex self-efficacy (OR 2.80; CI 1.31-5.97) and low perceived intimacy with the most recent regular paying partner (OR 7.20; CI 3.49-14.83) were also significantly associated with CCU in multivariate analysis. CONCLUSION: Environmental-structural support for condom use and HIV/STI prevention is a significant predictor of CCU among FSW in the context of regular paying partnerships. Environmental-structural factors, in addition to relational and individual cognitive factors, should be assessed and addressed by behaviorally guided theory, research and interventions related to HIV/STI prevention and female sex work.