Women and the prevention of HIV infection: an integrative review of the literature

Effectiveness of HIV prevention for women: what is working?

The HIV-AIDS remains a public health problem which disproportionally affects women. However, prevention strategies have rarely considered their specific efficacy for them. For this reason, this study examines the differential effectiveness of six intervention elements based on socio-cognitive theories addressing young women. A controlled between-groups design examined the change in risk profile among 167 young Spanish women (mean age 21.3 years old) involved in five sexual risk prevention interventions (informative talk, attitudinal discussion, role-play, fear induction and informative website) and one control non-intervening group (waiting list). Our findings support the differential efficacy of some HIV preventive intervention elements comparing others for women. In particular, the attitudinal discussion stands out followed by the informative talk and the role play. Contrarily, the fear induction component did not reveal relevant improvements. This study provides new evidence related to HIV prevention. Particularly, the higher efficacy of motivational components for these young Spanish women is revealed.

Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007

BACKGROUND

People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992-2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations.

METHODOLOGY

We calculated the number of PWID in the US annually from 1992-2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models.

RESULTS

PWID per 10,000 persons aged 15-64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002-2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated--the mean prevalence was 90 to 100 per 10,000 youth in 1992-1996, but increased to >120 PWID per 10,000 youth in 2006-2007.

CONCLUSIONS

Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes.

Moving beyond safe sex to women-controlled safe sex: a concept analysis

AIM

This paper is a report of a conceptual analysis of women-controlled safe sex.

BACKGROUND

Women bear disproportionate burdens from sexually related health compromising outcomes. Imbalanced societal gender and power positions contribute to high morbidities. The expression, women-controlled safe sex, aims to empower women to gain control of their sexual lives. Few researchers focus on contextualized socio-cultural definitions of sexual safety among women.

DATA SOURCES

The sample included scientific literature from Scopus, CINAHL, PubMed, PsychINFO and Sociological Abstracts. Papers were published 2000-2010.

REVIEW METHODS

Critical analyses of literature about women-controlled safe sex were performed in May 2011 using Rodgers' evolutionary concept analysis methods. The search focused on social and cultural influences on sexual practices aimed at increasing women's control over their sexual safety.

RESULTS

The analysis uncovered five attributes of women-controlled safe sex: technology; access to choices; women at-risk; 'condom migration' panic; and communication. Three antecedents included: male partner influence; body awareness; and self-efficacy. Consequences were categorized as positive or negative. Nine surrogate terms included: empowerment; gender power; female-controlled sexual barrier method; microbicides; diaphragm; sexual negotiation and communication; female condom; women-initiated disease transmission prevention; and spermicides. Finally, a consensus definition was identified: a socio-culturally influenced multi-level process for initiating sexual safety by women deemed at-risk for sexually related dangers, usually sexually transmitted infections and/or HIV/AIDS.

CONCLUSION

This concept analysis described current significance, uses, and applications of women-controlled safe sex in the scientific literature. The authors clarified its limited nature and conclude that additional conceptual refinement in nursing is necessary to influence women's health.

Women in HIV conference research: trends and content analysis of abstracts presented at 17 HIV/AIDS conferences from 2003 to 2010

OBJECTIVE

HIV/AIDS conferences provide an opportunity to review current research from around the world. Conferences are a good gauge of the amount of research conducted on HIV/AIDS and women because papers are disseminated widely and publicly, and can represent published or unpublished material. The objective of this study was to conduct content analysis and data coding to quantify trends in women-specific research in HIV/AIDS abstracts at the International AIDS Conferences (AIDS), the Canadian Association for HIV Research (CAHR) Conferences, and the Conferences on Retroviruses and Opportunistic Infections (CROI) over a 7-year time period.

METHODS

Abstracts titles and text containing female keywords were retrieved from the AIDS, CAHR, and CROI conferences between 2003 and 2009 and coded according to research category using content analysis.

RESULTS

Over 34,000 abstracts were searched. A total of 5,221 abstracts related to women (13.7%) were found over 7 years. Women-specific abstracts represented 16.2% (n = 4,245/26,175) at AIDS, 13.7% (n = 257/1,876) at CAHR, and 11.1% (n = 719/6,370) at CROI. The AIDS and CAHR conferences demonstrated a slightly increasing trend in women-specific abstracts over 7 years. In categorical coding, the most prevalent research category was reproductive health, and the most infrequent was policy and program evaluation.

CONCLUSION

The AIDS conferences showed an increase in women-specific abstracts over time, probably owing to a gender policy implemented in 2008 and a women's research award. The CAHR conference instituted a gender policy in 2011, and the CROI conference should follow suit. Conference abstracts should include breakdown and analysis by gender.

Worry: women's experience of HIV testing

Although HIV infection is increasing among all women, pregnant women are primarily targeted for testing. The authors explore the experience of nonpregnant women seeking HIV testing, particularly factors that influenced testing, waiting for results, and the testing process. They interviewed 26 first-time testers, analyzed transcripts independently, then compared and consensually validated. Phenomenological reflection guided thematic analysis. A pattern of Worry emerged from relational themes evident in three phases of the experience: (a) Deciding, (b) Testing, and (c) What Next? Participants identified HIV testing as stressful, even when they regarded the process positively. Findings can sensitize providers to women's perceptions, decision making, and barriers to testing. Providers are challenged to provide accessible testing that protects confidentiality in conjunction with supportive discussion of concerns.

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.

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Mothers who silence themselves: a concept with clinical implications for women living with HIV/AIDS and their children

The number of women newly infected with the human immunodeficiency virus (HIV) continues to rise. Women living with HIV or the acquired immunodeficiency syndrome (AIDS) are often mothers who deal with the unenviable task of balancing the stigma and physical needs of illness with the needs of their families and, in particular, their children (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). This article addresses both the communication style and subsequent concept identified in women living with HIV/AIDS called "silencing the self," and the clinical implications for pediatric nurses who support and offer family-centered care to their patients. Mothers living with HIV/AIDS, often view the needs of the children primary as they deal with the trajectory of their own illness. In doing this, they effectively "silence" their own needs and may actually put their own psychosocial and physical needs in abeyance. It is critical that nurses in pediatric practice consider how to tangibly assess, refer, and educate mothers who silence their own needs in the process of providing care for their children.

Women's health care: a new paradigm for the 21st century

Oppression based on gender exists in all aspects of women's lives and transcends contemporary cultures, economic systems, and even health care services. Radical feminism provides an alternative philosophic framework of health care that is based on a women-centered viewpoint, with the experiences of women as its unifying philosophy. Midwifery is a means to apply this new philosophic approach to the health care of women. A partnership between midwifery and feminist philosophy will allow women's voices to be heard, while guiding research in women's health care in new directions, and illuminating new approaches to current health problems. The new millennium provides an opportunity to explore an alternative framework and philosophy that will change the current paradigm of women's health care.

Content validity of a Scale to measure silencing and affectivity among women living with HIV/AIDS

This study measured quantitatively and explored qualitatively silencing behaviors and affectivity (mood) in women living with HIV/AIDS and confirmed the validity of the Silencing the Self Scale and the Positive and Negative Affect Scale. Silencing behaviors are interpersonal communication styles that suppress personal needs and feelings to preserve relationships with others. Silencing behaviors serve as protective strategies that allow one to divorce oneself from an overbearing culture. Affectivity is a way of measuring one's personal mood state by a positive to negative continuum. The results indicate that the women silenced themselves profoundly, especially when it came to putting the needs of their children or dependents before their own. The women also had high levels of negative affectivity. The research findings from this study extend nursing knowledge by addressing the unique social processes of women living with HIV/AIDS within health care service structures and significant social groups. Further exploration of "silencing" as a phenomenon of this group through measurement and experience will help define specific interventions that are meaningful to and for women living with HIV/AIDS.

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Awakening as a change process among women at risk for HIV who engage in survival sex

Women who exchange sex for survival requirements risk exposure to the human immunodeficiency virus (HIV). This grounded theory study was conducted to better understand these women's concerns, attitudes, and behaviors related to HIV, with the goal of informing prevention research. Interviews with 11 women engaged in survival sex were analyzed. Women described sliding into survival sex as a result of economic crises. Survival sex exposed women to violence, drug use, sexually transmitted infections, and HIV. Mitigating these risks is a process of awakening in which women reconstruct risk and survival and make changes in their behavior. These findings highlight the complexity of the problem of survival sex and suggest interventions to help women protect themselves against HIV.