Randomised trials of STD treatment for HIV prevention: report of an international workshop. HIV/STD Trials Workshop Group

Three community trials of the impact of STD treatment interventions on HIV incidence in rural populations have been completed or are in progress in Uganda and Tanzania. Investigators from these trials met for a joint technical workshop in Baltimore in May 1996. This report summarises the consensus of the workshop, with the aim of providing useful input to research on HIV intervention strategies. Issues discussed include: (i) the role of community randomised trials; (ii) strategies for STD management; (iii) epidemiological and statistical issues in the design and analysis of community randomised trials; (iv) diagnostic methods for STDs in population surveys; (v) treatment regimens for STDs in rural Africa; and (vi) ethical issues in community trials.     

Evaluating behavioral interventions for HIV prevention

We report a case of primary amyloidosis affecting the kidney and presenting as a renal infarction on computed tomography and ultrasound examination. To our knowledge, it is the first case in the radio-logical literature with these imaging characteristics.     

Cost analysis and HIV prevention interventions.

Comments on the review by J. A. Kelly et al (see record 1994-10963-001) regarding public health interventions designed to prevent, reduce, or eliminate behavior that put individuals at risk for becoming HIV-infected. D. R. Holtgrave expands on the review by discussing important economic policy issues, including the cost of HIV prevention interventions and the societal economic benefits of prevention programs. Methods for estimating the cost of an HIV prevention intervention are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of group interventions to reduce HIV/STD risk and change theoretical mediators among detained adolescents.

Criminally involved adolescents engage in high levels of risky sexual behavior and alcohol use, and alcohol use may contribute to lack of condom use. Detained adolescents (n = 484) were randomized to (1) a theory-based sexual risk reduction intervention (GPI), (2) the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component (GPI + GMET), or (3) an information-only control (INFO). All interventions were presented in same-sex groups in single sessions lasting from 2 to 4 hr. Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy, and intentions) were measured immediately following intervention administration. The primary outcomes were risky sexual behavior and sexual behavior while drinking measured 3 months later (65.1% retention). The GPI + GMET intervention demonstrated superiority over both other conditions in influencing theoretical mediators and over the INFO control in reducing risky sexual behavior. Self-efficacy and intentions were significant mediators between condition and later risky sexual behavior. This study contributes to an understanding of harm reduction among high-risk adolescents and has implications for understanding circumstances in which the inclusion of GMET components may be effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients and brothel managers in Kramat Tunggak, Jakarta, Indonesia: interweaving qualitative with quantitative studies for planning STD/AIDS prevention programs

Clients and brothel managers are often the most powerful decision-makers regarding condom use in brothels, but since publicly promoting condom use is still "culturally" difficult in Indonesia, the most feasible way of reaching clients is through the female commercial sex workers (FCSWs) and their managers. The existence of quasi-official brothel complexes in many major Indonesian cities, however, does make the government a key player in promoting condom use within these complexes. Interweaving qualitative with quantitative studies, this paper, which is part of a larger study, reveals the FCSWs' client/managers-related determinants of condom use. Policies that will promote condom use in brothel complexes are critical to the prevention of the spread of HIV throughout this community, as well as from it to the greater community.     

HIV prevention interventions: The effects of role-play and behavioural commitment on knowledge and attitudes.

Investigated the effects of active versus passive participation, as well as behavioral commitment, on the knowledge and attitudes of adolescents in an HIV-prevention intervention. Following completion of an HIV attitudes and knowledge test, a group of 144 9th grade students were randomly assigned to 1 of 4 treatment conditions that included either role-play, video, lecture, or no treatment. Half the participants in each condition were required to commit to attend to HIV-prevention information and educate another student about such issues. A post-test conducted at 4-wk follow-up indicated that students in the active participation condition (i.e., role-play) demonstrated increased knowledge about AIDS and HIV. Behavioral commitment to further HIV-prevention information did not moderate (i.e., enhance) the effects of active participation; however, commitment did lead to more positive attitudes toward HIV-prevention. The findings suggest that a role-play intervention may be a viable alternative to traditional lecture and video methods for enhancing knowledge towards HIV-prevention in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transgender HIV prevention: a qualitative needs assessment

Although clinical experience and preliminary research suggest that some transgender people are at significant risk for HIV, this stigmatized group has so far been largely ignored in HIV prevention. As part of the development of HIV prevention education targeting the transgender population, focus groups of selected transgender individuals assessed their HIV risks and prevention needs. Data were gathered in the following four areas: (1) the impact of HIV/AIDS on transgender persons; (2) risk factors; (3) information and services needed; and (4) recruitment strategies. Findings indicated that HIV/AIDS compounds stigmatization related to transgender identity, interferes with sexual experimentation during the transgender 'coming out' process, and may interfere with obtaining sex reassignment. Identified transgender-specific risk factors include: sexual identity conflict, shame and isolation, secrecy, search for affirmation, compulsive sexual behaviour, prostitution, and sharing needles while injecting hormones. Community involvement, peer education and affirmation of transgender identity were stressed as integral components of a successful intervention. Education of health professionals about transgender identity and sexuality and support groups for transgender people with HIV/AIDS are urgently needed.     

HIV/AIDS and drug abuse: epidemiology and prevention

In the United States, the AIDS epidemic is a dynamic process with increasing rates of AIDS reported among women, minority populations, heterosexual men, and users of drugs by routes other than injection. The 1993 CDC AIDS definition change has created some difficulties in interpreting trends in the United States. Drug use continues to represent a significant problem among HIV-infected persons. Several strategies have been advanced to decrease transmission of HIV among drug users, their sexual partners and children. However, more effective and comprehensive prevention and treatment strategies are needed.     

Sex isn't that simple: Culture and context in HIV prevention interventions for gay and bisexual male adolescents.

Gay and bisexual male adolescents and young adults in the United States have been disproportionately impacted by the HIV pandemic. Despite the steadily increasing rise in their HIV infection rates, there has not been a commensurate increase in HIV prevention programs targeted to the unique social and sexual lives of these youths. Programs that address cultural and contextual factors that influence sexual risk and protective behaviors need to be developed, implemented, and rigorously evaluated. These interventions should address the potential influences of sexual and gay culture on the HIV risk/protective behaviors of gay and bisexual adolescents, as well as the influence of more traditional cultural factors related to ethnicity. The influence of contextual developmental factors should also be addressed. This may include an incorporation into prevention programs of the societal-level influences of heterosexism and masculinity ideology and the individual-level influences of sexual identity and ethnic identity development. Researchers and interventionists need to be creative and innovative in their HIV prevention approaches and ensure that programs are grounded in the lives and realities of gay and bisexual adolescents and young adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV testing for HIV prevention: a comparative analysis of policies in Britain, Hungary and Sweden

Growth of vegetative cells and outgrowth of spores of enterotoxigenic psychrotrophic Bacillus cereus in refrigerated minimally processed food products is a public health concern. A study was undertaken to determine the combined effects of pH, nisin, and temperature on growth and survival of 20 strains of B. cereus. The minimum growth temperatures in tryptic soy broth (pH 7.3) and brain heart infusion broth (BHI broth, pH 7.4) were 5 degrees C for two strains and 8 degrees C for five other strains. Vegetative cells of four of eight strains grew at 8 degrees C in BHI broth (pH 6.01 and 6.57) containing 10 micrograms of nisin per ml. At 15 degrees C, all strains grew at pH 5.53 to 6.57; three strains tolerated nisin at 50 micrograms/ml (pH 6.57), whereas two other strains had a maximum tolerance of 10 micrograms of nisin per ml. Tolerance of vegetative cells of B. cereus to nisin increased as the pH of the broth was increased from 5.53 to 6.01 and again to pH 6.57. Outgrowth of spores (six of six strains tested) was inhibited by 5 and 50 micrograms of nisin per ml at 8 and 15 degrees C, respectively. At 15 degrees C, outgrowth of spores of two strains occurred at pH 6.52 in BHI broth containing 10 micrograms of nisin per ml. The effectiveness of nisin in controlling the growth of psychrotrophic strains of B. cereus capable of causing human illness was more pronounced at 8 degrees C than at 15 degrees C and as the pH was decreased from 6.57 to 5.53. Studies to determine the effectiveness of nisin in controlling growth of psychrotrophic B. cereus in nonpasteurized foods held at refrigeration temperatures are warranted.     

The Feather of Hope Aboriginal AIDS Prevention Society: a community approach to HIV/AIDS prevention

Urine production and weight deviation in a growth-retarded fetus with oligohydramnios was estimated by ultrasound on four occasions between weeks 27 and 33 of gestational age. The fetus demonstrated facial features typical of Potter's syndrome. Although this syndrome is associated with bilateral renal agenesis, the fetus in the present case presented with hypoplastic kidneys. Urine production was reduced when measured on three occasions but was surprisingly normal at week 31. In this report, we describe a way to assess urine production in a fetus.     

Incremental planning in sequence production.

People produce long sequences such as speech and music with incremental planning: mental preparation of a subset of sequence events. The authors model in music performance the sequence events that can be retrieved and prepared during production. Events are encoded in terms of their serial order and timing relative to other events in a planning increment, a contextually determined distribution of event activations. Planning is facilitated by events' metrical similarity and serial/temporal proximity and by developmental changes in short-term memory. The model's predictions of larger planning increments as production rate decreases and as producers' age-experience increases are confirmed in serial-ordering errors produced by adults and children. Incremental planning is considered as a general retrieval constraint in serially ordered behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics related to STD/HIV in men working in Mexico City bars where female prostitution takes place

Today, we are facing an exponential increase in implantation of cardioverter defibrillators (ICD). The intraoperative and follow-up results are reported in 105 patients (pts) with ventricular tachyarrythmias who underwent ICD implantation in the catheterization laboratory. Fifty-seven pts (54%) hat their first ICD implant (G 1), whereas 46 pts (44%) underwent pulse generator replacement or electrode revision (2 pts, 2%) (G 2). In all pts, ICD implant or pulse generator replacement was performed under general anesthesia from the beginning. In 57/58 pts (98%) in G 1, ICD implantation was possible with a mean defibrillation threshold (DFT) of 13 +/- 8 joules. One patient hat a DFT of > 25 joules and ICD implantation was not achieved. This patient underwent epicardial lead implantation 1 day later. One patient in G 1 had a vessel rupture (v. subclavia) intraoperatively. During a mean follow-up of 5 +/- 2 (< 1-13) months, three pts (3%) died from congestive heart failure, 2, 4 and 6 months after device implantation. An infection occurred in 1 patient in G 2, 3 months after generator replacement. Our data show that in the majority of patients ICD implantation in the cath-lab is possible, safe, and the complication rate is low. Therefore, ICD implantation in the cath-lab can generally be recommended.     

Associations of marijuana use and sex-related marijuana expectancies with HIV/STD risk behavior in high-risk adolescents.

Multiple studies suggest an association of marijuana use with increased rates of sexual risk behavior and sexually transmitted diseases (STDs). Most studies have focused on global associations of marijuana use with sexual risk outcomes and few have examined relevant cognitive variables. Adolescents in the juvenile justice system are at elevated risk for HIV/STDs and preliminary evidence suggests that marijuana is a potentially important cofactor for sexual risk behavior in this population. This study evaluated global, situational and event-level associations of marijuana use and sex-related marijuana expectancies with sexual risk outcomes in a large, racially diverse sample of adjudicated youth (n = 656, 66% male, mean age = 16.7 years). Cross-sectional and prospective analyses identified associations of marijuana use and dependence symptoms with sexual risk outcomes, including lower frequency of condom use and higher STD incidence. Stronger sex-related marijuana expectancies predicted greater intentions for and frequency of marijuana use in sexual situations. In event-level analyses that controlled for alcohol, marijuana use predicted a significantly decreased likelihood of condom use; this association was moderated by sex-related marijuana expectancies. Mediation analyses suggested that behavioral intentions partly accounted for the prospective association of expectancies with marijuana use before sex. These results provide further evidence that marijuana use is a potentially important cofactor for HIV/STD transmission in high-risk adolescents and suggest that cognitive factors could be important for characterizing this association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)