Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators

The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population.     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological interventions with AIDS and HIV: Prevention and treatment.

In the decade since AIDS was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with HIV conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and iv drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "2nd wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Substance abuse prevention: Implications for reducing risk of HIV infection.

Formulates an AIDS risk-reduction strategy for use with adolescents. This strategy is based on the state of the art in substance abuse prevention and adolescent pregnancy prevention. The etiology of risk behaviors is discussed, and the history and success of substance abuse prevention and adolescent pregnancy prevention are reviewed. A promising approach is the competence enhancement approach, which appears to be generalizable to a variety of problem behaviors. A potential model for AIDS risk reduction is described, which may also prove to be effective in preventing AIDS. (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.     

Drug use and AIDS: Developments from the International Conference on AIDS.

This article presents recent information about injection drug use as it relates to the human immunodeficiency virus (HIV) epidemic. Presentations from the VIII International Conference on AIDS, held in Amsterdam in July 1992, are highlighted. Several recent developments are noteworthy for psychologists coping with addictive behaviors, including the return of tuberculosis as a communicable disease affecting people with acquired immunodeficiency syndrome (AIDS), advancements in prevention of HIV infection, and treatment of AIDS in drug users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Love, sex, and power: Considering women's realities in HIV prevention.

The rates of HIV infection and AIDS cases among women in the United States have increased significantly in the last decade. Thanks in large part to the work of advocacy groups and to action by the U.S. Congress, there has been some progress in making HIV/AIDS research and services more responsive to women's needs (e.g., including women in clinical drug trials and revising the Centers for Disease Control definition of AIDS to include infections typical in women). However, little progress has been made in addressing the need for prevention of HIV infection among women. This article examines how researchers using behavioral approaches to HIV prevention have largely ignored how gender, women's social status, and women's roles affect sexual risk behaviors and the ability to take steps to reduce risk of infection. Additional factors to be considered in theories that guide future HIV/AIDS prevention programs are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric and adolescent AIDS in the schools: The need for educative programs.

Suggests that as one of their roles, school psychologists ought to be prepared to offer leadership in the development and implementation of education programs addressing acquired immune deficiency syndrome (AIDS) in the schools, both for staff and for youths. The current state of knowledge about pediatric and adolescent AIDS in general and how that knowledge applies to the schools are discussed. Suggestions concerning how programs might be developed for school systems and recommendations regarding such programs are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological research and the prevention, etiology, and treatment of AIDS.

An overview of some of the issues and problems related to psychological research on AIDS and human immunodeficiency virus (HIV) infection is presented. Behavioral, cognitive, psychobiological, and neuropsychological issues are examined in relation to the development of a scientific research agenda on AIDS. The role of psychobiological variables in the etiology, treatment, and prevention of infection and disease are reviewed as they pertain to the fight against AIDS. The relation between AIDS and basic scientific processes is bidirectional in that AIDS may provide important insight into various basic processes and these same processes may also yield information useful to efforts to halt the spread of the disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in HIV seroprevalence, AIDS and prevention policy among intravenous drug users and men who have sex with men, before and after 1990 in Austria

This study reports for the first time on secular trends in human immunodeficiency virus (HIV) infection and AIDS, and possible associations with prevention policy in Austria. We analysed HIV seroprevalence and AIDS cases among intravenous drug users (IDU) and men who have sex with men (MSM). In this study we found a diminished rate of increase in new cases of AIDS and a decline in HIV seroprevalence among IDU but not among MSM. Among clients visiting HIV counselling and testing centres in Austria between 1987 and 1990, seroprevalence among IDU was estimated at 27.9% as compared to 19.6% between 1990 and 1992 (odds ratio (OR): 0.62; 0.45-0.85). Among MSM corresponding prevalence for these two periods was 12.1% and 10.9%, respectively, which was not a significant decline. In the period 1990 to 1994, the increase in AIDS cases per half-year levelled off for IDU (incidence rate ratio (IRR) :1.00; 0.99-1.01) but to a lesser extent among MSM (IRR: 1.01; 1.01-1.02). The most effective prevention policy intervention was considered to be the national Methadone Maintenance Program (MMTP), started in 1987, and the provision of sterile injection equipment. We observed that in the recent period there was a decline in the frequency of attendance among young (less than 28 years of age) MSM at counselling centres (OR: 1.27; 95 % CI: 1.08-1.49), accompanied by the observation that the rate of seroprevalence among this group did not decline. This is in contrast to young IDU where attendance did not decline but seroprevalence did. Although inference is limited from cross sectional studies, we argue for a reoriented and effectively monitored HIV prevention policy focused on young MSM.     

Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention.

Protease inhibitor combination therapies can reduce HIV viral load, improve immune system functioning, and decrease mortality from AIDS. These medical developments raise a host of critical new issues for behavioral research on HIV/AIDS. This article reviews developments in HIV combination therapy regimens and behavioral factors involved in these regimens and focuses on four key behavioral research areas: (a) the development of interventions to promote treatment adherence, (b) psychological coping with HIV/AIDS in the context of new treatments for the disease, (c) the possible influence of treatment on continued risk behavior, and (d) behavioral research in HIV prevention and care policy areas. Advances in HIV medical care have created important new opportunities for health psychologists to contribute to the well-being of persons with HIV/AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child and Adolescent HIV Risk: Familial and Cultural Perspectives.

The authors' goal is to review and integrate theory and research focused on the impact of the family, within a cultural perspective, on HIV prevention in childhood and adolescence. Families' impact on adolescents' HIV risk and prevention is examined through the lens of culture, focusing on the individual adolescent factors and family-level influences that converge to determine adolescents' HIV risk status. Family-based risk and health socialization during childhood and adolescence is theoretically and empirically evaluated, from developmental, cultural, and communication perspectives. The influence of families on adolescents' HIV knowledge, risk, and prevention strategies is explored from a developmental perspective. Finally, a future research agenda, focused on remaining issues that affect the ability to understand and modify HIV risk in adolescence, is outlined. (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)     

Pathology of AIDS in children

AIDS in children is a multisystem disease. The various infections, degenerative, proliferative and vascular lesions can be classified into three categories based on the known, presumed or undetermined pathogenesis. The primary lesions are due to HIV infection. The associated lesions are related to direct or indirect sequelae of HIV infection or its treatment. The third category is of lesions of undetermined pathogenesis. The pediatric pathologist plays an important role in the study and management of AIDS by demonstrating new pathologic lesions, by making the etiologic diagnosis of infection in children with AIDS, and by providing clinicopathologic correlation which leads to better understanding of the disease process and its natural history. Diagnosis of neoplastic disorders is also made by the pathologist. There is a dearth of systematic pathologic study of AIDS in children in developing countries. Although no basic differences between pathologic lesions in pediatric AIDS in Western countries, and in developing countries is expected, such a study would lead to better understanding and better management of the disorder as it affects children from the developing countries.     

Education and prevention--Special issues: Section introduction.

More than most diseases, AIDS exists within the world of intimate behavior. This is so because AIDS is frequently transmitted through the most intimate of human relationships, because HIV both infects and stigmatizes, and because AIDS often kills, not randomly, but along interpersonal lines of connection and commitment. AIDS forces us as scientists and practitioners to know people in ways we have never had to know them before. It is not enough for psychologists to take the liberal stance of"each to their own." It is not enough to look the other way and say "that is not my concern." Rather it is important that we educate ourselves about HIV and its transmission and prevention. We are teachers, researchers, practitioners, consultants, friends, parents, and lovers. In all of these roles, we can contribute to halting this disease. The articles in this section focus on these concerns in several populations who are often overlooked or misunderstood. These populations were not in the first wave of funded research, treatment, or prevention. They have emerged from the shadow of what we now know about the effects of AIDS on gay men, Whites, and adults. Each article examines the realities and intimate choices of individuals and ways in which to educate. These articles bring to life decisions and circumstances that particular subpopulations must confront, as well as the status of our behavior change models and risk reduction efforts in relation to these decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Idiopathic renal arteriovenous fistula: treatment with embolization

As the acquired immunodeficiency syndrome (AIDS) epidemic spreads to the pediatric population, a recommendation is made for more research on mother-to-infant human immunodeficiency virus (HIV) transmission, in light of current policies, and the scientific community is challenged to re-evaluate its attitude to the pathogenesis of HIV transmission by breast milk.     

Vaccination of pregnant macaques protects newborns against mucosal simian immunodeficiency virus infection

Simian immunodeficiency virus (SIV) infection of newborn rhesus macaques is a rapid, sensitive animal model of human pediatric AIDS. Newborn macaques were readily infected by uncloned SIVmac following oral-conjunctival exposure and had persistently high viremia and rapid development of AIDS. In contrast, when 3 pregnant macaques were vaccinated against SIV, 2 of the newborns that had transplacentally acquired antiviral antibodies were protected against mucosal SIV infection at birth. These results suggest that intervention strategies such as active immunization of human immunodeficiency virus (HIV)-infected pregnant women and anti-HIV immunoglobulin administration may decrease the rate of perinatal HIV infection.     

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.