Attitudes, beliefs, and practices of nursing students concerning HIV/AIDS: implications for prevention in women

Nursing students are a group of predominantly young women who may be sexually active but who are well educated and presumably health conscious. It might be expected, therefore, that they are not a population at risk for sexually acquired HIV infection. Recent studies indicate that heterosexual women constitute the fastest growing population of persons with AIDS in the United States and Canada (Health and Welfare Canada, 1993b; Wofsky, 1992) and that women and adolescents will constitute the next surge of the AIDS epidemic (Novello, 1993). First-year nursing students in a major Canadian city were surveyed regarding HIV-related knowledge, attitudes, beliefs, and behaviors. The women were highly knowledgeable about HIV transmission but 15% to 25% reported high risk sexual behavior. The results reinforce that knowledge is not enough to prevent HIV infection among young women and that interventions must be based on an understanding of the social context of women's lives.     

HIV/AIDS risk in heterosexual college students. A review of a decade of literature

Empirical studies dealing with the psychosocial correlates of HIV risk among heterosexual college students are reviewed, including findings related to such theoretical variables as HIV/AIDS-related knowledge, personal and partner's attitudes toward condom use, perceived susceptibility, communication with sex partners, and sexual self-efficacy. Although college students are highly knowledgeable about basic HIV/AIDS facts, they retain some misperceptions about disease transmission. They hold neutral-to-negative hedonistic and practical attitudes about using condoms: those who have engaged in risky behavior accurately perceive their greater susceptibility to infection and experience anxiety regarding transmission of HIV infection. Heterosexual college students communicate infrequently with their partners about safer sex, but they often agree to a partner's suggestion that they use condoms. Higher levels of sexual self-efficacy among college students have been associated with a lower risk for HIV transmission. Limitations and clinical implications of the findings and recommendations for future interventions are discussed.     

Australian and South African undergraduates' HIV-related knowledge, attitudes, and behaviors

To understand safe sex behavior in two countries which have been differentially affected by the HIV/AIDS epidemic, the present study compared the AIDS-related knowledge, attitudes, and behaviors of 920 heterosexual undergraduate students in Australia and 228 heterosexual undergraduate students in South Africa. South African students were found to have significantly less knowledge about HIV/AIDS, and significantly less favorable attitudes toward safe sex behavior than their Australian counterparts. They were also more likely to report that they have avoided various groups of people for fear of contracting AIDS. Experience from Australia over the period 1986-1995 suggests that significant improvements in the AIDS-related knowledge, attitudes, and behaviors of South African undergraduates are achievable.     

Discontinuation of treatment with IFN-beta leads to exacerbation of experimental autoimmune encephalomyelitis in Lewis rats. Rapid reversal of the antiproliferative activity of IFN-beta and excessive expansion of autoreactive T cells as disease promoting mechanisms

BACKGROUND: It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso. METHODS: We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups. RESULTS: Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%). CONCLUSIONS: These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.     

Women, sex, and HIV: Social and contextual factors, meta-analysis of published interventions, and implications for practice and research.

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safer sex knowledge, behavior, and attitudes of inner-city women.

Sexual behavior, knowledge of HIV transmission and prevention, perceived risk of AIDS, and safer sex behavior were studied in a sample of 289 single, pregnant, inner-city women. African-American and European-American women were equally represented. Women had poor AIDS knowledge. Sexual behavior placed women at risk for HIV infection due to the lack of condom or spermicide use. Women did not perceive themselves at risk for the AIDS virus, although they did recognize that heterosexuals were at risk. Their lack of risk perception was partly based on their having a single sexual partner. They did not regard their partner's current or past behavior as placing them at risk. Recommendations for intervention and cultural differences are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of AIDS susceptibility among minority and nonminority women at risk for HIV infection.

272 women sampled from mass transit waiting areas in an urban center completed anonymous surveys of AIDS-related risk behavior, perceptions of susceptibility, and knowledge. Variable patterns of HIV risk behaviors were identified, with 22% of women reporting high-risk behavior. Perceptions of susceptibility were associated with an interaction between ethnicity and level of risk; nonminority women at high risk reported greater concern about AIDS than did minority women at high risk, who did not differ from women at low risk. With an array of life problems and inaccurate information about HIV transmission, minority women were found to be at continued risk for AIDS-related behavior. Implications for culturally sensitive and relevant AIDS prevention efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention indicators for evaluating the progress of national AIDS programmes

Major interventions to reduce HIV transmission involve increasing knowledge about preventing HIV transmission for sustained behavioral changes; and enhancing the control of sexually transmitted diseases (STD), which increase the probability of HIV transmission. Activities have also been developed to prevent the transmission of HIV by blood, donor selection, and more rational use of transfusions. Behavioral changes among injecting drug users have also been promoted. Recommendations are made for the evaluation of AIDS programs, focusing on prevention of sexual transmission of HIV, and outlining the approach developed by the Global Program on AIDS (GPA; Geneva, Switzerland) for use by national programs. Based on the feasibility, accuracy, reliability and validity of the quantitative assessment of programs, 10 indicators of progress and outcomes of prevention activities have been developed by GPA. These include indicators of population knowledge regarding preventive practices, reported sexual behavior and use of condoms in the general population, STD service evaluation, and indicators of program impact. The latter are measured through the reported STD incidence in the general male population, and syphilis and HIV prevalence in women. The four methods are proposed for measuring the 10 core prevention indicators (PI). Five PIs are measured during a population survey: reported knowledge of preventive practices (PI-1), condom availability at peripheral level (PI-3), reported frequency of nonregular sexual partners (PI-4), reported condom use during nonregular sexual encounters (PI-5), and reported STD incidence among men (PI-9). Condom availability at central level (PI-2) is assessed through key-informant interviews with major distributors. Structured health facility surveys allow assessment of the appropriateness of STD case management (PI-6 and PI-7). A serosurvey among antenatal clinic attenders aged 15-24 years allows the measurement of HIV and syphilis seroprevalence in that population (PI-8 and PI-10). GPA recommends that such surveys be repeated after a period of 1 to several years.     

The role of reactive nitrogen intermediates in modulation of gametocyte infectivity of rodent malaria parasites

Two hundred and fourteen young women received acquired immunodeficiency syndrome (AIDS) prevention interventions at an inner-city family health center serving minority patients predominantly. The community in which the health center is located has a high incidence of intravenous (IV) drug abuse. Either a peer or a health care provider delivered the intervention. In the peer-delivered intervention, a trained peer educator reviewed with patients an AIDS "Rap" videotape and several AIDS brochures, which imparted information about human immunodeficiency virus (HIV), its transmission, and prevention. In the provider-delivered intervention, family practice residents, attending physicians, and nurse practitioners used a patient-centered counseling approach to convey the same information. Questionnaires administered immediately before and after the intervention and at one month follow-up evaluated changes in knowledge, attitudes, and behavior. Analyses of data from both combined intervention groups revealed significant improvements in several areas of knowledge, including the effectiveness of using a condom and cleaning IV drug implements with bleach to prevent transmission of HIV. Many improvements were retained at the one-month follow-up. In addition, subjects in both groups who were sexually active stated immediately after the intervention that asking a sexual partner about past sexual experience would now be less difficult, and at one-month follow-up they reported a significant decrease in the frequency of vaginal sex. Our findings suggest that counseling by physicians can achieve more changes in knowledge of sexual risks, whereas peer education can achieve greater changes in knowledge about IV drug use. Results show that both approaches to AIDS prevention used in this study can significantly affect knowledge, attitudes, and sexual behavior.     

Prognostic value of dipyridamole thallium-201 screening to minimize perioperative cardiac complications in diabetics undergoing kidney or kidney-pancreas transplantation

A survey of knowledge, attitude and practice (KAP) regarding human immunodeficiency virus infection was performed on 899 students from 3 government-administered high schools located in the Bangkok Metropolitan area. Initially, all students completed a written questionnaire (pre-test) regarding HIV/AIDS. Following this, they attended a slide lecture presentation given by a specialist physician. The same test questionnaire was then completed by the same students six weeks (post-test) later for comparison of their previous KAP. The subjects composed of male to female ratio equal to that of the median age 15-16 years old. Sixty-seven per cent of the subjects were living with their parents, 16.3 per cent with relatives and 15 per cent with friends. Ninety nine per cent of the subjects had received information on HIV/AIDS before enrollment to this study. The source of knowledge ranged from television (89.1%), teachers (81.6%), pamphlets (80.2%), newspapers (75%), radio (55%), health care workers (53.4%), friends (38.6%) and only 32.5 per cent from their parents. The subjects' knowledge about HIV/AIDS and risk factors in the post-test questionnaire was significantly increased (P < 0.001) from the pre-test status. However, their attitudes to an HIV infected person were not significantly changed in the post-test questionnaire: only the "attending school" question showed significantly (P < 0.05) increased numbers of agreement. Similarly, the attitudes and practices to prevent HIV infection were not significantly (P > 0.05) different between pre-test and post-test questionnaires. The result of this study is to recommend regular school-based programs of education to increase awareness of preventive strategies for HIV/AIDS and sexually transmitted diseases.     

AIDS education is more than telling people what not to do

Education is only one of may approaches which may be used to bring about behavioral change. While it is clear that awareness in Africa about AIDS has grown since education campaigns were launched in the late 1980s, significant misunderstandings and misconceptions remain. The author invited seventeen nongovernmental organizations to participate in a review workshop in 1992 with the goal of learning about which communication methods are currently being used in AIDS education programs in Zimbabwe. Talks, lectures, leader controlled discussions, focus groups, drama/role play, posters, stories, and client counseling are being used to teach about AIDS. Little evidence, however, indicates that sexually active individuals within targeted risk groups have changed their behaviors to reduce the risk of HIV transmission. The denial of risk due to traditional beliefs about disease causation stemming from God or other external forces and the tendency to shift the blame for infection to women are cited as causal factors for the lack of behavior modification. Program planners and administrators must reach beyond the vague and diffuse education campaigns implemented thus far. AIDS workers must instead by trained to focus their attention upon the development of effective, targeted interventions involving communities and at-risk subpopulations.     

Depressive symptoms and risk factors for HIV acquisition among black women attending urban health centers in Baltimore

Blacks comprise 55% of all AIDS cases among women, and have 9 times the risk of white women of mortality from AIDS. Thus, prevention of HIV infection is critical among black women. Programs to prevent HIV infection have focused upon the adoption of behavioral strategies such as limiting the number of sexual partners, avoiding intercourse with i.v. drug users, and using condoms. However, such programs are dependent upon the ability of the woman to assume responsibility for her health and successfully adopt behavior changes. Generally overlooked in the development of health education interventions are those factors, such as depressive symptoms, which may make it very difficult for an individual to adopt healthy behaviors. In the present study, an analysis was conducted of the association between depressive symptoms and risk factors for the acquisition of HIV infection among black women using two urban health centers. Those women with higher levels of depressive symptoms were significantly more likely than other women to report more risk factors for HIV acquisition. The implications of these findings for the development of preventive interventions are discussed.     

Coping with AIDS and AIDS-risk reduction efforts among gay men

Because AIDS has been identified as a major source of stress among gay men, coping models may contribute to an understanding of factors related to changes in and failure to change sexual behavior. Gay men in Long Beach, California, were surveyed to determine whether appraisal and coping are factors in efforts to reduce transmission risk for the human immunodeficiency virus (HIV). Factor analysis of the appraisal and coping items yielded factor structures similar to those reported by earlier coping investigators and that were differentially associated with reported reductions in risk for HIV transmission and with reported intent to engage in high- and low-risk sexual behaviors. Risk-reduction efforts and intent were associated with health-threat (to self or to partner) primary appraisals, secondary appraisals that respondents could change or do something about AIDS, and the coping factors of self-control, seeking social support, and confrontive coping (expression of anger). In addition, intent to engage in relatively high-risk behavior was associated with passive coping (acceptance). These results are discussed in terms of their relevance for risk-reduction education programs and for future research.     

HIV risk reduction interventions for persons with severe mental illness

Recent seroprevalence studies have shown alarming rates of HIV infection among severely mentally ill men and women in large urban areas, and HIV behavioral epidemiology research indicates that a substantial proportion of seriously mentally ill adults engage in activities that increase their vulnerability to HIV/AIDS. In this paper, the research literature on HIV prevention interventions is reviewed including reports that have described HIV prevention programs, studies that have used uncontrolled pre- and postintervention methods to evaluate risk reduction interventions, and those that have used rigorous randomized designs and examined risk behavior change. Collectively, these studies show that intensive, small-group interventions that target a variety of risk-related dimensions-including knowledge, attitudes, and motivations, and behavioral and cognitive skills-can produce at least short-term reductions in high-risk sexual behavior among the severely mentally ill. A number of gaps in the research literature are identified including the need to: (a) better tailor interventions to risk situations encountered by the mentally ill; (b) develop gender-tailored interventions; (c) examine and implement HIV prevention programs so they help persons sustain behavior change; (d) explore one-on-one counseling and community-level intervention methods; and (e) develop risk reduction interventions for already-seropositive individuals. Implications for service provision are discussed.     

Effect of replacing a high linoleate oil with a low linoleate, high alpha-linolenate oil, as compared with supplementing EPA or DHA, on reducing lipid mediator production in rat polymorphonuclear leukocytes

Training designed to improve AIDS knowledge, attitude, and practice was delivered to 96 traditional healers in the Central African Republic. The training (17 to 36 hours) was conducted by traditional healers with the assistance of staff from the Ministry of Health. Training included the following topics: prevention of HIV transmission during traditional practice; diagnosis, treatment, and prevention of sexually transmitted diseases; condom promotion; AIDS education at the community level; psychosocial support for people with AIDS; and promotion of a positive image for traditional healers. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. These assessments were conducted using structured interviews. Improvement in knowledge and/or attitudes was observed in all areas assessed except for prevention of HIV transmission during traditional practice. We concluded that AIDS training can be successfully delivered to traditional healers.     

The study of sexual behavior in relation to the transmission of human immunodeficiency virus: Caveats and recommendations.

To create the behavior-change programs essential for limiting the acquired immune deficiency syndrome (AIDS) epidemic, we must obtain a precise understanding of the sexual behavior, knowledge, and attitudes of our nation's various ethnic, racial, social, age, regional, and sexual orientation groups. Such information is necessary for developing the precisely targeted educational programs that currently are our most effective means of reducing risk behaviors and halting the spread of the disease in the United States. These behavioral data are also crucial to biomedical investigations, making possible the identification of appropriate subjects for programs ranging from the testing of vaccines to the evaluation of the threat to pregnant women and their offspring. In this article, we summarize data on sexual behaviors associated with the transmission of the AIDS virus (i.e., human immunodeficiency virus [HIV]) and discuss selected issues relevant to the conduct of research on human sexuality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Planning and evaluating strategies for AIDS health education interventions in the Muslim community in Uganda

In 1992 the Islamic Medical Association of Uganda designed an AIDS prevention project. A baseline survey was conducted to assess prevailing knowledge, attitudes, and practices among the Muslim communities in two districts. A low rate of incorrect beliefs about HIV transmission was found, although gaps in knowledge remain, particularly regarding vertical transmission and asymptomatic HIV infection. Less than 10% knew that condoms can protect against HIV transmission. Lack of knowledge was documented regarding the risk of HIV transmission associated with practices common in the Islamic community, such as polygamous marriages, circumcision, and ablution of the dead. The AIDS prevention project has incorporated specific messages and interventions as a result of these findings.     

Condom use: A self-efficacy model.

A survey of heterosexually active college students gathered information about condom use, self-efficacy (SE), outcome expectancies, sexual attitudes, peer group influences, AIDS knowledge, and a perceived vulnerability to AIDS. On the basis of A. Bandura's (1986) social-cognitive theory, a structural model with SE as the central mediator was formulated and evaluated with LISREL. This model explained 46% of the variance in condom use from judgments of SE and effects attributable to peers and 53% of the variance in SE from outcome expectancies and peer group influences. Sexual attitudes, AIDS knowledge, and perceived vulnerability did not predict condom use. Most students were well-informed about HIV transmission but reported not feeling at risk, even though many engaged in risky sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and psychosocial consequences of HIV antibody counseling and testing with African American women

This study compared a sample of low-income African American women in the southeastern United States who had and had not yet undergone HIV counseling and testing on risk-related cognitive mediating variables and self-reported sexual behaviors. Four hundred sixty (N = 460) African American women were recruited from health clinics and community settings in a southern city. Forty-five percent of the women (n = 207) had undergone HIV counseling and testing, whereas 55% (n = 253) had never been tested. Women who were seropositive were excluded from the analyses. After providing informed consent, the women completed a battery of cognitive mediating measures assessing AIDS knowledge, attitudes theoretically relevant to risk reduction, and self-reported sexual behavior. In addition, each participant demonstrated condom application skills using a penile model. Women who had undergone testing were younger, rated HIV disease as more serious, considered AIDS a greater health concern, had more positive attitudes toward HIV prevention, expressed greater intentions to use condoms, and evidenced a greater commitment to self-protective behavior than women who were not yet tested. Women who had undergone HIV antibody testing, however, showed no differences in sexual behavior from women who were never tested. Sexual behavior, including numbers of partners, frequency of unprotected intercourse, and inconsistent condom use, left women in both groups at significant and comparable risk for HIV and sexually transmitted disease infection. HIV counseling and testing alone may not be effective primary prevention strategies for promoting risk reduction among African American women.     

Changes in knowledge of HIV/AIDS and attitudes for PWA in Tokyo: 1992-1995

In order to assess changes in knowledge of HIV/AIDS and attitude for People With HIV/AIDS (PWA), interview surveys (Dec. 1992, Jan. 1994, Jan. 1995) were carried out annually on random samples of the general public in Tokyo, age between 15-69 years. In total, 4,270 individuals were sampled, with an average response rate of 63.2%. Answers were scored and classified in 12 sex and age sub-groups. Additionally, correlations between scores of questions and social indices were analyzed. The results of the study are as follows: 1) The 15-19, 20-29 and 30-39 age groups showed higher scores on knowledge about HIV transmission modes. During the entire study period, the score increased in 7 groups, but decreased in 5 groups. 2) The 30-39 and 40-49 age groups showed higher scores on knowledge about HIV antibody test. During the period, the score increased in 11 groups, and among them 6 groups showed statistically significant (p < 0.05) increases. However, the score decreased in 9 groups at the third survey. 3) The 15-19, 20-29 and 30-39 age groups showed higher scores on acceptable attitudes for PWA. During the period, the score increased in all groups, and among them 3 groups showed statistically significant (p < 0.05) increases. 4) Rank correlations between two scores-knowledge quantity about the transmission modes and acceptable attitudes for PWA-were positive (0.2 < R) and statistically significant (p < 0.05) in 11 groups at the first survey, 9 groups at the second, and 6 groups at the third. 5) During the entire study period, 6 groups showed positive correlations (0.7 < R) between two changes: (1) score of knowledge about the transmission modes and (2) score of acceptable attitudes. 6) During the entire study period, 10 groups showed positive correlations (0.7 < R) between two changes: (1) score of acceptable attitudes and (2) number of newspaper articles regarding acceptance or discrimination of the PWA. 7) Knowledge about HIV/AIDS in the general public in Tokyo showed increase in younger generation, but there is concern of decrease in the older generation. These result indicate that acceptable attitude forward PWA are affected by related knowledge about the transmission modes and mass-media information, and must be considered in HIV/AIDS programs.