Cost-effectiveness of HIV-prevention skills training for men who have sex with men

OBJECTIVE: A previous study empirically compared the effects of two HIV-prevention interventions for men who have sex with men: (i) a safer sex lecture, and (ii) the same lecture coupled with a 1.5 h skills-training group session. The skills-training intervention led to a significant increase in condom use at 12-month follow-up, compared with the lecture-only condition. The current study retrospectively assesses the incremental cost-effectiveness of skills training to determine whether it is worth the extra cost to add this component to an HIV-prevention intervention that would otherwise consist of a safer sex lecture only. DESIGN: Standard techniques of incremental cost-utility analysis were employed. METHODS: A societal perspective and a 5% discount rate were used. Cost categories assessed included: staff salary, fringe benefits, quality assurance, session materials, client transportation, client time valuation, and costs shared with other programs. A Bernoulli-process model of HIV transmission was used to estimate the number of HIV infections averted by the skills-training intervention component. For each infection averted, the discounted medical costs and quality-adjusted life years (QALY) saved were estimated. One- and multi-way sensitivity analyses were performed to assess the robustness of base-case results to changes in modeling assumptions. RESULTS: Under base-case assumptions, the incremental cost of the skills training was less than $13,000 (or about $40 per person). The discounted medical costs averted by incrementally preventing HIV infections were over $170,000; more than 21 discounted QALY were saved. The cost per QALY saved was negative, indicating cost-savings. These results are robust to changes in most modeling assumptions. However, the model is moderately sensitive to changes in the per-contact risk of HIV transmission. CONCLUSIONS: Under most reasonable assumptions, the incremental costs of the skills training were outweighed by the medical costs saved. Thus, not only is skills training effective in reducing risky behavior, it is also cost-saving.     

HIV/AIDS risk factors among adolescent students in Puerto Rico, 1994

PURPOSE: Identify several HIV risk behaviors among adolescent students. METHODS: The sample (n = 3,648) was selected using a two-staged stratified cluster sampling design, and weighted to represent all junior high and high school students. RESULTS: About 28.8% of the students reported ever having sexual activity. Less than half of the sexually active (44.5%) used condoms during their last sexual activity; 27.6% used them always. Only 54.7% knew correctly > 75% of the HIV knowledge questions. A HIV risk scale was constructed using five risk factors. About 15.9% of the students did not have any risk factor, 36.2% had one, 47.9% had two or more. Males and high school students had significantly more risk factors. Half of the students will abstain from having sex next year because they don't want to get HIV/AIDS. CONCLUSIONS: It is important to implement effective HIV prevention programs for adolescents in order to change their attitudes and behaviors.     

Effects of a brief video intervention on White university students' racial attitudes.

The authors investigated the effects of a brief video intervention on the racial attitudes of White university students. One hundred thirty-eight self-identified White students were randomly assigned to either an experimental condition in which they viewed a video documenting the pervasiveness of institutional racism and White privilege in the United States or a neutral control condition. Findings offer preliminary support that participants in the experimental, but not the control, condition showed significant increases in racial awareness (i.e., decrease in racial color-blindness), White empathy, and White guilt, at posttest. However, no significant differences in racial prejudice or White fear of racial minorities were observed at posttest. Implications for multicultural counseling training, diversity programming, and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Knowledge and attitudes toward sexuality in adolescents and their association with the family and other factors

Family structure and function and their association with knowledge and attitudes toward sexuality, contraception, and sexually transmitted diseases (STD) were studied in 918 students and 312 adolescents working in factories. Unmarried workers reported higher rates of sexual activity than did students (30.9% vs. 21.8%, p = .04 for males; 12.9% vs. 6.0%, p = .005 for females). Among sexually active males, 33.3% of students and 30.7% of workers used contraception, compared with 27.5% of female students and 9.5% of female workers. Workers were from larger families than students, and the male and female workers had lower scores for knowledge on sexuality, contraception, and STD than did students. Multiple stepwise regression showed that age and schooling of the parents were associated with knowledge and attitudes in the students. In workers, the position of the child in the family was a negative regressor for attitudes and knowledge on sexuality in males, and for knowledge on contraception and STD in females. In regard to family function, the significant factors were compromise between the parents, positive affective response, communication within the family, problem solution, and control of behavior. It was concluded that female workers are at higher risk for unwanted pregnancies and STD. The factors associated with knowledge and attitudes were age, schooling of the parents, mother working out of home, position of the adolescent in the family, and the diverse aspects of family function.     

Timing of HIV interventions on reductions in sexual risk among adolescents

Examined the effectiveness of an HIV intervention program among 151 adolescents ages 13 to 24 years who were randomly assigned to (a) seven sessions of 1.5 hr each (10.5 hr); (b) three sessions of 3.5 hr each (10.5 hr); or (c) a no-intervention condition. Using cognitive-behavioral intervention strategies, social skills and HIV-related beliefs, perceptions, and norms were targeted in both the three- and seven-session, small-group intervention conditions. Regression analysis indicated that over 3 months, the number of unprotected risk acts and the number of sexual partners were lower in the seven-session condition compared to the other conditions. Factors mediating risk acts changed in a complex manner. For example, perceived vulnerability increased for those with initially lower vulnerability scores among youths in the seven-session condition compared to others. Self-approval of condom use was also higher for those with initially low scores in the seven-session compared to the three-session condition. Self-efficacy for risk avoidance and condom use was significantly higher in the three-session condition for those with initially low scores compared to other groups. On the role-play measure, those with higher baseline scores in the low-pressure situation improved significantly only in the three-session intervention; in the high-pressure situation, the participants reported significantly higher scores in the seven-session intervention, and those with higher scores improved the most. Results suggest the importance of multisession HIV intervention programs to be delivered with fidelity in community settings.     

Material and social incentives to participation in behavioral interventions: A meta-analysis of gender disparities in enrollment and retention in experimental human immunodeficiency virus prevention interventions.

Objective: A meta-analysis was conducted to test theoretical hypotheses about the predictors of enrollment and completion of condom-use-promotion interventions among men and women. Design: A meta-analysis summarized research reports of the efficacy of experimental interventions on human immunodeficiency virus (HIV) prevention. Main Outcome Measures: The outcome measure consisted of (a) a measure of participation, obtained by subtracting the actual number of participants from the number of the invited people, and (b) a measure of retention was obtained by subtracting the number of participants who completed the intervention from the number of commencers. Results: Experimental interventions providing instrumental and financial resources (e.g., payments) increased initiation and retention more among predominantly male samples, whereas experimental interventions using group formats increased initiation and retention more among predominantly female samples. These patterns remained while controlling for past condom use, other HIV-risk behaviors, and demographics associated with gender composition. Conclusion: People seek out HIV-prevention interventions to fulfill gender-specific needs, and these differences must be taken into account in the design of HIV-prevention interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision-making orientation and AIDS-related knowledge, attitudes, and behaviors of Hispanic, African-American, and White adolescents.

Examined how adolescents' personal sense of directedness (i.e., peer, parent, or self-directed orientation) affects the decision-making processes of adolescent students regarding AIDS-related knowledge, attitudes, beliefs, behaviors, and skills (KABBS). The sample consisted of 10th-grade students in 8 public high schools (N?=?2,515) in Dade County (greater Miami), Florida. The findings showed that decision-making orientation and directedness was a significant predictor of AIDS-related KABBS of adolescents. Overall, the level of AIDS-related KABBS that were associated with low risk was found significantly more often among self-directed students and least often among peer-directed students. The findings of this study suggest that future preadult health-risk research should incorporate the concept of differences of information processing across adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Curriculum effect on nursing students' attitudes and knowledge towards organ donation and transplantation

OBJECTIVE: To determine the impact of a nursing school's curriculum on student nurses' attitudes towards organ donation and whether specific educational directives could improve these attitudes. DESIGN: Quasi-experimental. SAMPLE/SETTING: First-, third-, and fourth-year nursing students at a Canadian University School of Nursing. METHODS: A questionnaire was developed to measure student's attitudes towards organ donation and transplantation. The questionnaire was administered to first- and fourth-year students to determine whether 4 years of nursing education changed the attitudes of the students. Third-year students responded to the questionnaire before and after attending a lecture or lecture and small group sessions on organ donation to determine whether instruction could improve attitudes and knowledge. RESULTS: No difference in attitudes were found between first- and fourth-year nursing students. The introduction of specific education strategies improved the attitudes and knowledge base of third year students. Discussion sessions in addition to lecture were the preferred strategy. CONCLUSIONS: The present curriculum does not significantly impact on nursing students. Given the importance of organ transplantation, nursing curricula should incorporate effective strategies to teach students the role of the nurse in organ donation.     

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)     

Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents.

Substance-dependent adolescents (N?=?34) in a residential drug treatment facility received either a 6-session behavior skills training HIV-risk reduction intervention or standard HIV education. After the intervention, adolescents who received behavior skills training exhibited increased knowledge about HIV-AIDS, more favorable attitudes toward prevention and condom use, more internal locus of control, increased self-efficacy, increased recognition of HIV risk and decreases in high-risk sexual activity. Self-report data were corroborated by records for the treatment of sexually transmitted diseases. The results from this pilot demonstration effort suggest that skills training based on cognitive–behavioral principles may be effective in lowering high-risk adolescents' vulnerability to HIV infection and warrant evaluation in a controlled comparison with a larger sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participation in counseling programs: High-risk participants are reluctant to accept HIV-prevention counseling.

HIV-prevention intervention effectiveness depends on understanding whether clients with highest need for HIV-prevention counseling accept it. With this objective, a field study with a high-risk community sample from the southeastern United States (N = 350) investigated whether initial knowledge about HIV, motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use correlate with subsequent acceptance of an HIV-prevention counseling session. Ironically, participants with high (vs. low) motivation to use condoms, high (vs. low) condom-use-relevant behavioral skills, and high (vs. low) prior condom use were more likely to accept the HIV-prevention counseling. Moreover, the influence of motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use on acceptance of the counseling was mediated by expectations that the counseling session would be useful. Methods to reduce barriers to recruitment of clients for counseling programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes of medical students to HIV and AIDS

OBJECTIVE--To assess the knowledge and attitudes of medical students to HIV/AIDS and whether attitudes correlate with knowledge and clinical experience. To determine if students felt adequately prepared to deal with medical and psychological aspects of HIV/AIDS. SUBJECTS AND METHODS--The subjects consisted of 190 London and 99 Cambridge medical students at the end of their genitourinary medicine attachment, plus 230 Cambridge medical students at the end of their second pre-clinical year. Between March 1991 and February 1992 all were asked to complete an anonymous questionnaire, covering factual knowledge and attitudes towards HIV/AIDS. MAIN RESULTS--Cambridge genitourinary medicine students, despite spending less time studying HIV infection than their London counterparts gave more correct answers to the factual questions, although this difference did not reach significance (52.4% vs. 47.5%, p = 0.14). One third of students believed that many health care workers were at high risk of acquiring HIV at work and one fifth thought doctors should have the right to refuse to treat people with HIV. Fourteen percent of Cambridge genitourinary medicine students indicated that most British people with HIV have only themselves to blame, by comparison with 4% of London students (p = 0.003). Thirty-nine per cent of Cambridge genitourinary medicine students expressed reluctance to care for someone with AIDS by comparison with 10% of London students (p = 0.0001). CONCLUSIONS--It is important that medical educators convey accurate information about HIV, including the actual risks posed by occupational exposure and try to ensure that medical students spend sufficient time seeing patients with HIV/AIDS during their training.     

Characterizing and improving HIV/AIDS knowledge among cocaine-dependent outpatients.

The present study was an experimental test of efficacy of a brief education intervention for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. Participants were randomly assigned to an HIV/AIDS education intervention (experimental condition) or a sham intervention (control condition). Control participants were subsequently crossed over to the HIV/AIDS education intervention. Experimental participants had higher scores on tests of HIV/AIDS knowledge after receiving the education intervention than did control participants. Further supporting the intervention's efficacy, control participant scores also increased once participants were crossed over and received the education intervention. Scores at follow-up were lower than at postintervention but remained higher than baseline scores. Results support the intervention's efficacy for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. This intervention is brief, inexpensive, and easily implemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing knowledge and attitudes about skin cancer risk factors in adolescents.

Examined knowledge, attitudes, and behaviors related to skin cancer (SC), sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about SC was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to SC, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The 1-session, school-based intervention significantly increased knowledge of and perceived susceptibility to SC but not behavioral intentions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

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)     

The role of personal work goals in newcomers' job satisfaction and organizational commitment: A longitudinal analysis.

This study examined the importance of 3 characteristics of personal work goals (i.e., commitment, attainability, and progress) in accounting for changes in newcomers' affective job attitudes (i.e., job satisfaction and organizational commitment) during the 1st months of employment. Twenty weeks after organizational entry, 81 newcomers provided a list of their personal work goals. Goal attributes and job attitudes were assessed at 3 testing periods covering 8 months. Goal commitment was found to moderate the extent to which differences in the attainability of personal goals at the workplace accounted for changes in job satisfaction and organizational commitment. Goal progress mediated the interactive effect of goal commitment and attainability on newcomers' job attitudes. Findings are discussed with respect to their relevance for proactive approaches to organizational socialization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stable transduction of recombinant adeno-associated virus into hematopoietic stem cells from normal and sickle cell patients

The effectiveness of a health education programme for prevention of alcohol abuse and tobacco smoking among adolescents was assessed by an intervention study with a non-randomized control group. The study was carried out among 7th-9th grade school students in a Local Health Unit of the Brescia province, North Italy. Students were enrolled in either the intervention or the control group, based on the participation of their teachers to the educational programme. A total of 428 students were involved in the programme representing the intervention group, and 658 students not involved in the programme formed the control group. The health education programme included the prevention of alcohol abuse in the first school year (1989-90) and the prevention of tobacco smoking in the second year (1990-91). Each part of the programme included a series of lessons taken by the teachers for about 20 hours. Alcohol use and smoking habits, knowledge about, and attitudes toward alcohol and tobacco use of the students have been assessed by anonymous questionnaires. The questionnaires have been administered during school time at the beginning and the end of each school year, giving a total of 6 questionnaires, from Q1 to Q6. All the questionnaires included the same questions on alcohol and tobacco use, knowledge and attitudes. Of the 1086 students who attended the 7th grade in the year 1989-90, 428 were enrolled as intervention group and 658 as control group. As regards alcohol, the following findings were observed: 1. no difference was found in the percentages of students drinking at least one glass of wine or beer daily between the 2 groups at Q6; 2. no substantial change in the percentage of students aware of the health risks of alcohol abuse from Q1 to Q6 was observed. As regards tobacco smoking, the results of the study showed: 1. no difference between the 2 groups was found at Q6 as regards the proportion of students who smoked one or more cigarettes a month; 2. the percentages of students planning to smoke in the future were similar in the 2 groups in Q6; 3.the percentage of students with a high score on the health consequences of smoking was higher in the intervention than the control group at Q4, but again no difference between the groups was evident at Q6. In conclusion, the health education programme seemed to be unsuccessful in modifying behaviors and attitudes regarding alcohol and tobacco use during the 3-year follow-up.