Perception of HIV/AIDS risk among urban, low-income senior-housing residents

Sexual culture in low-income older adult housing: norms, behaviours and risks

This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness. Reasons for non-intimacy were age and health problems. Generally speaking, both men and women had positive attitudes towards sex. Men took risks by having multiple partners and using condoms irregularly; women believed they could avoid risks by taking time to get to know their partners, but never used condoms. Forty per cent of men who saw sex workers were not regular condom users. They traded risk of gossip, violence and infection for companionship with women seeking money and physical safety. Findings have implications for policies, counselling and interventions for older sexually active adults in institutional and residential settings.

Persistent misconceptions about HIV transmission among males and females in Malawi

Background

The prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus.

Methods

Using the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females.

Results

We found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing misconceptions among females and males (OR = 0.85, p < 0.001; OR = 0.85, p < 0.001, respectively). Compared to those in the Northern region, both females and males in the Central (OR = 0.54, p < 0.001; OR = 0.53, p < 0.001, respectively) and Southern regions (OR = 0.49, p < 0.001; OR = 0.43, p < 0.001, respectively) were less likely to endorse misconceptions about HIV transmission. Moreover, marital status and ethnicity were significant predictors of HIV transmission misconceptions among females but not among males. Also, household wealth quintiles, education, religion, and urban–rural residence were significantly associated with endorsing misconceptions about HIV transmission.

Conclusion

Based on our findings, we recommend that education on HIV transmission in Malawi should integrate cultural and ethnic considerations of HIV/AIDS.

Use of the PHM Framework to Create Safe-Sex Ads Targeted to Mature Women 50 and Older

This research applies the Witte's persuasive health message (PHM) framework to the development of creative concepts that promote sexual health strategies to senior-aged women. The PHM framework proposes an integrated approach to improving message effectiveness and maximizing persuasion in health communication campaigns. A focus group method was used to explore two research questions focused on message effectiveness and persuasion. The findings suggest the PHM framework can be a useful starting point for ensuring that health communicators identify the criteria most relevant to successful ad promotions.

HIV Susceptibility Among Migrant Miners in Chokwe: A Case Study

This article examines the association between risky sexual behavior and HIV risk perception among miners. A cross-sectional survey (n = 293) was conducted with miners who worked in South African mines and lived in the Chokwe district of Gaza Province in southern Mozambique. The study used ordinary logistic and cumulative logistic models to understand what drives miners to HIV susceptibility. The study revealed that most miners were at risk of HIV infection as a result of risky sexual behavior. However, there was a strong negative association between risky sexual behavior and HIV risk perception. Seventy percent of the miners practicing risky sexual behavior reported low HIV risk perception. This demonstrates that miners tend to underestimate their HIV risk, which makes them more susceptible to contracting HIV. Risk perception among miners is related to a range of factors, both individual and environmental. Informed risk awareness is essential for these men to adopt preventive measures against HIV/AIDS. Therefore, it is important to consider cultural beliefs, as they influence the understanding of HIV risk perception.

Social Capital and Sexual Risk-Taking Behaviors Among Older Adults in the United States

Using the General Social Survey (GSS) 2012, a national household-based probability sample of non-institutionalized U.S. adults, this study examined the association of social capital and sexual risk behaviors among older adults aged 55 years and older. Of the 547 respondents, 87% reported not using condoms during their last intercourse, and nearly 15% reported engaging in sexual risk behaviors, such as casual sex, paid sex, male to male sex, and drug use. Binary logistic regression results showed that age, gender, marital status, education, race, sexual orientation, and sexual frequencies were significant predictors of older adults' unprotected sex. Social capital was not a predictor of unprotected sex but was positively associated with other human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk behaviors such as sex with strangers, having multiple sex partners, injecting drugs, and having male to male sex. Findings of this study highlight the importance of HIV/STD prevention programs for older adults.

Assessing young people's perceptions of HIV risks in Nyanza, Kenya: are school and community level factors relevant?

The majority of cognitive models used in HIV prevention identify risk perception as essential, and the first step towards safer sexual behaviors. Yet, previous studies have rarely examined risk perceptions as an outcome variable, and the few that have, limited their analysis to individual-level determinants. Conspicuously missing in the literature is how school/community level factors affect risk perceptions among school-going youth. Using data collected from primary school youth in Nyanza, Kenya and employing hierarchical linear modeling, this study examines how both individual and community level factors shape individuals' perceived risks of contracting HIV. Results indicate that measures captured at both individual and school/community levels were significantly associated with risk perception. At the individual level, and for boys, high risk perception was associated with higher knowledge about HIV, rejection of myths surrounding HIV transmission, higher condom use self-efficacy and having engaged in risky sexual behaviors. For girls, it was pressure from others to engage in sexual activity, having engaged in risky sexual behaviors and knowing someone infected with HIV that resulted in increased risk perceptions. Beyond individual level variables, some school/community level factors are significantly associated with risk perception. For instance, boys and girls in communities with higher estimates of AIDS deaths reported higher risk perceptions. Boys in communities where AIDS was acknowledged as the cause of death at funerals were less likely to report high risk perceptions. The findings suggest that interventions targeting HIV prevention among young people in Nyanza, Kenya could benefit immensely from an understanding of how schools and communities affect risk perceptions and behavioral change.

Understanding of the risk of HIV infection among the elderly in Ga-Rankuwa, South Africa

The literature pertaining to the elderly shows that HIV infection among this population is on the increase, suggesting that the elderly population engages in activities risky for HIV infection. Reports on such behaviour include frequent sexual relations with much younger people and having multiple partners. A study was carried out in Ga-Rankuwa, a black township in Gauteng Province, South Africa to explore and describe the understanding of these elderly people regarding their risks of HIV infection and AIDS. Using a qualitative, exploratory design, three focus-group interviews were conducted with 32 women aged over 50 years. Findings revealed that older persons have knowledge about transmission of HIV infection and AIDS. However, a few had misconceptions as to how HIV infection is transmitted, as they believed that poor nutrition and sharing facilities play a role. Knowledge of mechanisms of protecting themselves against infection, such as use of a condom during coitus and wearing gloves when caring for infected family members, was also evident. The elderly indicated that they would prefer an older person, who they could identify with, to educate them more about HIV infection and AIDS. Although majority of participants had knowledge of how HIV is transmitted, and issues that put them at risk of transmission, a few the older persons had misconceptions about how HIV is transmitted due to lack of knowledge, as they believed that poor nutrition and sharing facilities can transmit infection. The lack of knowledge underscores the importance of addressing sexual risk with older people. It was very clear that more needs to be done in terms of education campaigns to dispel the myths of HIV infection and to empower the elderly.

Risk perceptions of STIs/HIV and sexual risk behaviours among sexually experienced adolescents in the northern part of Lao PDR

BACKGROUND

Young people in Laos are more vulnerable to STIs/HIV due to their sexual risk behaviours, low perceptions of risk and their socio-cultural environments. Perceived risk of contracting STIs/HIV is crucial for the assessment of their risk regarding their actual sexual risk behaviors. Thus, the objective of this paper is to explore perceptions of risk related to STIs/HIV and identify factors associated with this perceived risk among adolescents.

METHODS

This was a cross sectional study of sexually experienced adolescents aged 14 to 19 years old in the Luangnamtha province. The multistage sampling techniques were used for selecting 1008 adolescents aged 14-19 years old. Of these, 483 respondents reported having had sexual experience was selected for analysis. Univariate and Logistic regression were performed.

RESULT

Six per cent of respondents reported ever having had anal sex. Slightly less than two thirds initiated their first sexual intercourse before age 15. Two thirds of the sexually experienced males reported two or more sexual partners during their lifetime with the mean 3.1+3.65 while only twelve per cent of girls reported this cumulative number of partners. Slightly more than half (57.6%) regarded themselves to have no risk at all with 17.2 per cent considered themselves to have low risk. Respondents had poor knowledge on STIs/HIV. Factors associated with risk perception of getting STIs were: being male, high level of knowledge about STIs and having had symptoms of STIs in last six months. Perceived risk of getting HIV was significantly associated with being male, having more knowledge about STIs and HIV.

CONCLUSION

Adolescents in this study engaged in sexual risk behaviours, but they have low perception of risk getting STI/HIV. Socio-demographic factors, knowledge of STIs/HIV, and the level of exposure to STIs were the main determinants of the risk perception of STIs/HIV. Our finding supports the need to target adolescents in Luangnamtha province for HIV prevention intervention by addressing inaccurate perception of risk and increasing their knowledge on STIs/HIV.

Perception of vulnerability to HIV infection among older people in Nairobi, Kenya: a need for intervention

It is evident that sexual activity tends to decrease with age. Nonetheless, it is still prevalent enough to be considered a risk factor for the spread of HIV among older people. This paper uses quantitative data for 2053 individuals to examine HIV risk perception and correlates of perceived risk among older people aged 50 years and older living in Nairobi slums. It emerged that a majority of older people did not consider themselves at risk of infection. Of those who felt at risk, a greater proportion sensed only a small chance of contracting HIV. Women cited 'no sexual activity' while men mentioned 'having only one and/or a faithful sexual partner' as the primary reasons for perceiving minimal risk of HIV infection. There were no differences by sex in the basis for perceiving moderate-to-great risk of infection. Religion is a key factor in risk perception with Muslims perceiving higher levels of risk and, conversely, devotees irrespective of faith perceiving lower levels of risk. Older people willing to be tested for HIV had a decreased likelihood of perceived risk compared with those unwilling to be tested. This paper recommends evaluation of older people's perception of risk in order to better inform interventions aimed at minimizing their vulnerability to HIV infection.

Perceptions of HIV risk among internet-using, HIV-negative barebacking men

The current study examines the risk perceptions of HIV-negative men who have sex with men (MSM) who use the Internet to seek unprotected sex. The research questions include the following: How great do these men perceive their HIV risk to be? Are their perceptions based on HIV knowledge or related to their risk behaviors? What factors are associated with greater/lesser perceived risk? Results revealed that more than half of the men believed that they had no or only a slight chance of contracting HIV. Risk perceptions were not related to HIV knowledge or to involvement in HIV risk practices. Four factors were identified as being associated with greater perception of HIV risk: self-identity as a sexual "bottom," having sex while high, greater use of bareback-focused websites, and younger age. Internet-using HIV-negative men who have sex with men tend to underestimate their risk for acquiring HIV, and interventions need to help them accurately assess their risk.

Is quality of life poorer for older adults with HIV/AIDS? International evidence using the WHOQOL-HIV

Increasingly older adults are being diagnosed with HIV/AIDS. In 2002, UNAIDS indicated that 13 aspects of quality of life (QoL) were poorer for older adults, but only sparse, inconsistent cross-cultural evidence is available. This statement was investigated using a reliable, valid measure (the WHOQOL-HIV) distributed in nine cultures (eight countries). HIV positive and well adults (n = 2089) were assessed across 30 QoL facets; 403 were 40+ years. It was confirmed that sleep, fatigue and sex-life were poorer areas of QoL for older HIV adults than younger. Furthermore, they could be misinterpreted as normal ageing signs. Moreover, older people reported greater dependency on medication. However, older HIV adults had better QoL than expected on 11 dimensions; negative feelings, social inclusion, and several environmental and spiritual facets. This highlights the extent of poor QoL in younger adults. After accounting for culture and gender, overall QoL and health in older HIV adults was explained by eight facets comprising 61.3% of the variance. Social relationships were paramount, especially personal relationships (41%), but support and sex-life also. Energy, negative feelings, cognitions, financial resources and HIV symptoms also contributed. Social interventions for ageing communities would improve well-being. This evidence could support global ageing and HIV policy.

Relationship between reported prior condom use and current self-perceived risk of acquiring HIV among mobile female sex workers in southern India

Background

With the evolution of Health Belief Model, risk perception has been identified as one of several core components of public health interventions. While female sex workers (FSWs) in India continue to be at most risk of acquiring and transmitting HIV, little is known about their perception towards risk of acquiring HIV and how this perception depends upon their history of consistent condom use behavior with different type of partners. The objective of this study is to fill this gap in the literature by examining this relationship among mobile FSWs in southern India.

Methods

We analyzed data for 5,413 mobile FSWs from a cross-sectional behavioral survey conducted in 22 districts from four states in southern India. This survey assessed participants’ demographics, condom use in sex with different types of partners, continuation of sex while experiencing STI symptoms, alcohol use before having sex, and self-perceived risk of acquiring HIV. Descriptive analyses and multilevel logistic regression models were used to examine the associations between risky sexual behaviors and self-perceived risk of acquiring HIV; and to understand the geographical differences in HIV risk perception.

Results

Of the total mobile FSWs, only two-fifths (40%) perceived themselves to be at high risk of acquiring HIV; more so in the state of Andhra Pradesh (56%) and less in Maharashtra (17%). FSWs seem to assess their current risk of acquiring HIV primarily on the basis of their past condom use behavior with occasional clients and less on the basis of their past condom use behaviors with regular clients and non-paying partners. Prior inconsistent condom use with occasional clients was independently associated with current perception of high HIV risk (adjusted odds ratio [aOR)] = 2.1, 95% confidence interval [CI]: 1.7-2.6). In contrast, prior inconsistent condom use with non-paying partners was associated with current perception of low HIV risk (aOR= 0.7, 95% CI: 0.5-0.9). The congruence between HIV risk perception and condom use with occasional clients was high: only 12% of FSWs reported inconsistent condom use with occasional clients but perceived themselves to be at low risk of acquiring HIV.

Conclusion

The association between high risk perception of acquiring HIV and inconsistent condom use, especially with regular clients and non-paying partners, has not been completely internalized by this high risk group of mobile FSWs in India. Motivational efforts to prevent HIV should emphasize the importance of accurately assessing an individual’s risk of acquiring HIV based on condom use behavior with all types of partners: occasional and regular clients as well as non-paying partners; and encourage behavior change based on an accurate self-assessment of HIV risk.

Understanding low-income, minority older adult self-perceptions of HIV risk

The number of people ages 50 or older living with HIV in the United States is increasing. Yet, few older adults see themselves at risk of infection. This study examines the heuristic reasoning that low income, minority adults, ages 50 or older use in calculating the likelihood of infection. The data are drawn from face-to-face interviews with a sample of 134 African American and Latino residents, ages 50 to 86, living in low-income housing in Chicago, Illinois, and Hartford, Connecticut. Results show that nearly half of the study's participants thought themselves to be at some level of risk for HIV. In self-assessing their risk, they relied on seven heuristic categories: self-imperilment, social imperilment, fate, incidental contact, situational safety, medical iatrogenesis, and self-protection. These findings extend our understanding of how individuals make sense of their likelihood of experiencing a major health threat and provide insight into more effective HIV prevention programming for older adults.

Frequent HIV testing among participants of a routine HIV testing program

Massachusetts developed a routine HIV testing program in four sites from January-September 2002. Of the 2,502 patients tested, 453 (18.1%) reported ≥2 HIV tests within the prior three years. In multivariate analyses, frequent HIV testing was associated with younger age (18-30 years, OR = 1.42), a history of injection drug use (OR = 6.35), and men who had sex with men (OR = 3.49). Participants who reported multiple sexual partners (OR = 2.17) and high risk sexual behavior (OR = 2.02) were significantly more likely to have had a prior HIV test. Patients whose HIV risk was unknown had the highest association with frequent testing (OR = 13.18). Because characteristics of frequent HIV testers may inform behavioral interventions, there is a need to understand the motivation for repeatedly accessing HIV testing services.

Mental health in senior housing: racial/ethnic patterns and correlates of major depressive disorder

OBJECTIVES

Mental health problems are associated with disability, overuse of medical care, higher rates of mortality and suicide as well as personal suffering for older adults. Residents of urban, low-income senior housing may face increased risk of a variety of mental health problems, including depression. This study identified the prevalence of multiple mental health problems in older residents of low-income senior housing and explored correlates of major depressive disorder for the two largest ethnic groups: black and Latino.

METHOD

In-person diagnostic interviews identified rates of mental illness in a sample of 635 residents of 13 low-income senior housing buildings in a medium-sized northeastern city. Applying George's Social Antecedent Model of Depression, logistic regression analyses identified shared and unique correlates of depression for Latino and black participants.

RESULTS

This population had high rates of major depressive disorder (26%), generalized anxiety disorder (12%) and other mental health problems that varied significantly by ethnic and racial group. Separate multivariate models for Latino and black people showed that younger age, more chronic conditions and social distress were related to major depressive disorder for both ethnic groups. Perceived environmental stress, shorter tenure in the building, poorer perceived health, higher life stress and fewer leisure activities were associated with depression for Latinos only.

CONCLUSION

Mental health screening and treatment services are needed in senior housing to address these high rates of mental illness. Unique constellations of correlates of depression for different ethnic groups underscore a need for culturally competent approaches to identification and treatment.

Behavior, knowledge and perception of risks about sexually transmitted diseases in a group of people over 50 years old

The goal was to analyze the behavior, knowledge and risk perception about sexually transmitted diseases / AIDS (STD/AIDS) in people over 50 years old. 165 public servants at a State Secretary in Mato Grosso, Brazil were interviewed. The chi-square test and logistic regression tests were used for the analysis of risk perception and the behavior and knowledge variables about STD/AIDS. Most of the respondents were female (60.6%), 63.2 had a fixed partner, 72.4% had sexual relations in the past six months, and only 13.3% always wore condoms, with 21.5% being male and 8% female. Perception of risk was associated with non-use of condoms in their last sexual relation (p<0.001) and answering that anyone may acquire a STD/AIDS (p=0.039). The challenge of public policies is to increase actions, directing them to promote the health of the adult and elderly populations, especially regarding sexuality and vulnerability to STD/AIDS.

Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection

In a cross-sectional analysis, we investigated frequency of sexual activity and factors associated with risky sexual behavior among 624 oldermen, aged 49-80, with or at risk for HIV infection. During the prior 6 months, 75% reported sexual activity with at least one partner, and one quarter of both the HIV-negative and HIV-positive men had more than one sexual partner. Only 18% of the HIV-negative men and 58% of the HIV-positive men always used condoms with their sexual partners. Factors independently and positively associated with risky sexual behavior included lack of HIV infection, any drug use in the past 6 months, greater importance of sex in one's life, weekly or more frequent sexual activity in the past 6 months, and ever taking sildenafil. These results suggest that older men with or at risk for HIV infection are sexually active, participate in risky sexual behavior, and need safer sex interventions.

Injection drug users' strategies to manage perceptions of personal risk: how do IDUs see HIV as having affected them?

The U.S. public health community is in its 3rd decade of seeking to prevent and treat HIV/AIDS. Injection drug users (IDUs) are central to targeted HIV prevention interventions as approximately one third of new U.S. infections are attributable to injection drug use (Santibanez et al.,Journal of Urban Health, 83[1], 86-100, 2006). Targeted behavior change efforts are often explicitly built upon the risk perception of targeted individuals. In this article, we consider the efficacy of behavior change based on IDUs' perceptions of elevated risk. Our qualitative analysis of 28 interviews with HIV negative IDUs in inner city Baltimore suggests that participants did not see themselves as personally affected by HIV. Rather, respondents constructed accounts in which they differentiated themselves from the type of people who are so affected, thereby creating a less stigmatizing identity. We argue that effective HIV prevention should explicitly acknowledge and address the stigmatized IDU identity, rather than assuming readiness for behavior change.