Condom attitudes, perceived vulnerability, and sexual risk behaviors of young Latino male urban street gang members: implications for HIV prevention

Predictors for HIV testing among Chinese workers in infrastructure construction enterprises in Kenya

BACKGROUND

There are increasing Chinese migrants in sub-Saharan Africa currently. Most of them are engaged in infrastructure construction. Research has shown that they stay at particular risk of HIV and are recommended for HIV testing. However, their HIV testing behavior, and its relevant factors, have not been researched among them by now. This study describes the recent HIV testing behavior and relevant factors among Chinese migrant workers in Kenya.

METHODS

A cross-sectional survey was conducted among 110 male Chinese workers from six different Chinese infrastructure construction enterprises in Kenya. Furthermore, a two-stage cluster random sampling method was used to select participants. We used a questionnaire that included HIV testing history, demographic characteristics, and putative multilevel facilitators of HIV testing. Logistic regression was used to explore the predictors of recent HIV testing behavior among Chinese migrant workers in Kenya.

RESULT

Of the 110 participants, 30 (27.27%) were tested for HIV in the recent year. All participants were male, and the majority were married (73.2%). The mean age was 37.49 years (SD = 9.73; range: 23 to 63), and a considerable proportion refused to answer questions about transactional sexual behaviors in the last year. Most were able to obtain HIV-related information (91.8%) and were exposed to HIV-related information in the last year (68.2%), but only 47.6% had sufficient HIV knowledge. Nearly one-fifth of them believed that selling sex and paying for sex is acceptable. Multiple logistic regression analysis indicated that participants who could accept the 'pay for sex' (OR: 2.74; 95% CI: 1.02, 7.36) and exposed to HIV related information (OR: 4.75; 95% CI: 1.29, 17.44) were more likely to test for HIV in the recent 1 year.

CONCLUSION

Higher current HIV test rates were associated with a more open sexual attitude towards paying for sex and being exposed to HIV-related information in the last year among Chinese workers in Kenya. More specific attention to HIV should be attached to this population to increase the rate of HIV testing among them.

Gang membership, gender, and sexual behavior in and outside a romantic relationship

Prior research consistently finds that gang youth, compared to nongang youth, are more involved in risky behaviors such as violence and drug sales. Less attention has been given to comparisons in sexual behavior. While research demonstrates that gang membership is associated with risky sex and many gang members indicate that sex is a motivation for joining a gang, prior research is limited in its ability to account for self-selection into a gang, variations in involvement across gender, and different forms of sexual activity. This research addresses these limitations by using Add Health data and propensity score matching to examine the relationship between gang membership and sexual behavior inside and out of a romantic relationship as well as how this relationship differs by gender. While findings indicate that gang membership increases the likelihood of sexual intercourse, nonromantic sex, and the number of nonromantic sex partners, no unique gender differences were identified.

Gang membership and sexual violence: associations with childhood maltreatment and psychiatric morbidity

BACKGROUND

Gang members engage in many high-risk sexual activities that may be associated with psychiatric morbidity. Victim-focused research finds high prevalence of sexual violence towards women affiliated with gangs.

AIMS

To investigate associations between childhood maltreatment and psychiatric morbidity on coercive and high-risk sexual behaviour among gang members.

METHOD

Cross-sectional survey of 4665 men 18-34 years in Great Britain using random location sampling. The survey oversampled men from areas with high levels of violence and gang membership. Participants completed questionnaires covering violent and sexual behaviours, experiences of childhood disadvantage and trauma, and psychiatric diagnoses using standardised instruments.

RESULTS

Antisocial men and gang members had high levels of sexual violence and multiple risk behaviours for sexually transmitted infections, childhood maltreatment and mental disorders, including addictions. Physical, sexual and emotional trauma were strongly associated with adult sexual behaviour and more prevalent among gang members. Other violent behaviour, psychiatric morbidity and addictions accounted for high-risk and compulsive sexual behaviours among gang members but not antisocial men. Gang members showed precursors before age 15 years of adult preference for coercive rather than consenting sexual behaviour.

CONCLUSIONS

Gang members show inordinately high levels of childhood trauma and disadvantage, sexual and non-sexual violence, and psychiatric disorders, which are interrelated. The public health problem of sexual victimisation of affiliated women is explained by these findings. Healthcare professionals may have difficulties promoting desistance from adverse health-related behaviours among gang members whose multiple high-risk and violent sexual behaviours are associated with psychiatric morbidity, particularly addictions.

Impact of HIV risk perception on both pre-exposure prophylaxis and condom use

Risk perception is one of the several important factors impacting sexual health behaviours. This study investigated the evolution of HIV risk perception on pre-exposure prophylaxis adherence and condom use in men who have sex with men at high risk of HIV and associated factors. Group-based trajectory modelling helped in identifying patterns of risk perception, pre-exposure prophylaxis adherence and condom use over time. The association between the former and the latter two dimensions was then investigated. An estimated 61 per cent (p < 0.001) of participants perceiving low risk and 100 per cent (p < 0.001) of those perceiving high risk had systematic pre-exposure prophylaxis adherence, while an estimated 49 per cent (p < 0.001) and 99.8 per cent (p < 0.001), respectively, reported low-level condom use.

"Running Trains" and "Sexing-In": The Functions of Sex Within Adolescent Gangs

Gang members are exposed to unique sexual risks, yet little work has explored the influence of gang social norms. This study examines the functions and meanings of sex within gangs, with a specific focus on the ways in which sex is used to reinforce gang membership and norms, gender roles, and group cohesion. We conducted 58 semi-structured interviews with adolescent members of six gangs. Data were analyzed using thematic content analysis and constant comparative method in MAXQDA. Sexual risk behaviors within gangs are upheld and reinforced through unspoken norms and expectations. These high-risk sexual practices increase group cohesion and reinforce gender norms and power differences. Despite the prevalence of such practices, many gang members felt regret and remorse over their participation but noted it was just part of "the life." Our findings highlight the need for interventions to address the norms of the gang that reinforce sexual risk behavior.

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis

OBJECTIVES

This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons.

METHODS

The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program.

RESULTS

When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget.

CONCLUSIONS

In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

Sexual risk, substance use, mental health, and trauma experiences of gang-involved homeless youth

This study examined the associations of sexual risk behaviors, substance use, mental health, and trauma with varying levels of gang involvement in a sample of Los Angeles-based homeless youths. Data were collected from 505 homeless youths who self-reported various health information and whether they have ever identified as or been closely affiliated with a gang member. Multivariable logistic regression assessed associations of lifetime gang involvement with risk taking behaviors and negative health outcomes. Results revealed seventeen percent of youths have ever identified as a gang member and 46% as gang affiliated. Both gang members and affiliates were at greater risk of many negative behaviors than non-gang involved youths. Gang members and affiliates were more likely to report recent methamphetamine use, cocaine use, chronic marijuana use, having sex while intoxicated, and symptoms of depression, symptoms of posttraumatic stress disorder. They were also more likely to have experienced childhood sexual abuse and witnessing family violence. Gang members were more likely to ever attempt suicide, experience recent partner violence, and report physical abuse during childhood. Results suggest that lifetime gang involvement is related to a trajectory of negative outcomes and amplified risk for youths experiencing homelessness. Additionally, being closely connected to a gang member appears to have just as much as an impact on risk as personally identifying as a gang member. Given the lack of knowledge regarding the intersection between youth homelessness and gang involvement, future research is needed to inform policies and programs that can address the specific needs of this population.

Comparative analysis between condom use clusters and risk behaviours among Portuguese university students

The research on condom use has been focused on high-risk individuals, paying less attention to those who have moderate risk or safe sexual conducts. In order to design accurate interventions, potential differences among the condom use behavior groups must be considered. The goal was to assess possible differences in individuals presenting different types of risk behavior. 140 heterosexual university students answered a self-reported questionnaire about their sexual history, condom use habits, sexual self-esteem, sexual satisfaction, sexual control, attitudes towards condoms, self-efficacy to condom use, and emotions and feelings during sexual intercourse. A cluster analysis was conducted using the results about condom use and risk behaviors. Three groups with different risk levels emerged, presenting differences over sexual self-efficacy, attitudes towards condoms, socio-demographic variables, and sexual history. The results suggest the condom use inconsistency is highly associated with other risk behaviors but the contrary does not necessarily happens. Condom use consistent users also presented risk behaviors as smoking and drinking. The group differences suggest the risks were more affected by the combination of lack of skills with a negative attitude toward condoms than by contextual or personal variables. These differences sustain the need of an intervention adjusted to the individual's risk levels, since they differ on skills and beliefs that may hinder or promote the adoption of health behaviors.

Views on sex and sex education among gang-involved Latino youth in the United States

Although gang-involved Latino youth in the United States are uniquely at risk of adverse consequences from sexual behavior, little research is available that can guide those who wish to develop interventions to reduce sexual risk among these youth. To facilitate the development of effective interventions, we identified cultural and contextual factors that influence sexual behavior and sex education among gang-involved Latino youth in one U.S. community. By analyzing transcripts from interviews and focus groups with three different groups of key stakeholders--gang-experienced Latino youth, the parents of gang-experienced Latino youth, and the personnel of a program providing comprehensive human services for gang-involved Latino youth--we identified three domains to be considered in developing sexual risk-reduction interventions for gang-involved U.S. Latino youth. The focus of our discussion is on the implications of these findings for future development or adaptation of interventions.

Invincibility fable: tool development to measure invincibility

Invincibility is a phase of social-cognitive development of the adolescent and has been associated with risk behavior involvement.

OBJECTIVE

To determine psychometric properties of the Adolescent Invincibility Tool (AIT).

METHODS

Reliability was assessed and validity was examined using principal components analysis.

RESULTS

Internal consistency was demonstrated with a Cronbach's alpha of .88; factor analysis led to the confirmation of subscales. Criterion validity was validated with similar and opposing measures of invincibility.

DISCUSSION

Initial testing suggests that the AIT is a valid and reliable tool for screening invincibility. Further testing is recommended to determine relevance for other populations of youth.

Impact of nursing intervention on improving HIV, hepatitis knowledge and mental health among homeless young adults

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

The Role of Self-Image Concerns in Discrepancies Between Implicit and Explicit Self-Esteem

Four experiments examined the hypothesis that individuals who hold discrepant implicit and explicit self-esteem possess relatively strong self-image concerns. As a result, they may act irrationally when expressing sexual health attitudes. In support of the hypothesis, Experiments 1a and 1b demonstrate that large self-esteem discrepancy participants possess strong implicit self-image ambivalence relative to small self-esteem discrepancy participants. In Experiments 2 and 3, participants who varied in self-esteem discrepancies received either negative or positive (or no) feedback on an intelligence test, and then they were given an opportunity to express implicit and explicit attitudes toward condoms. Large self-esteem discrepancy participants who received a self-threat responded irrationally and expressed relatively strong negative implicit (but not explicit) attitudes toward condoms. However, this detrimental effect was completely reversed following a self-affirmation to large discrepancy participants. The implicit and explicit attitudes toward condoms of small discrepancy participants were unaffected by a self-threat or a self-affirmation.

Missed Opportunities for Universal HIV Screening in Primary Care Clinics

BACKGROUND

The Centers for Disease Control and Prevention (CDC) has reported that the number of new cases of HIV infection has been underreported annually by at least 40,000 cases. In 2006, the CDC recommended that voluntary HIV counseling and testing (VCT) was given to all patients aged 13 to 64 years in ambulatory care settings. The purpose of this qualitative study was to explore primary care providers' (PCP) perspectives on and experiences of facilitators and barriers to offering VCT as part of annual screening.

METHODS

This was a descriptive, exploratory study where fifteen primary care providers were individually interviewed. Only community-based primary care providers were interviewed, and no obstetrician/gynecologists were enrolled, as VCT is standard of care in that specialty.

RESULTS

Barriers included doubts about the CDC recommendation, time constraints, fear, and assumptions about age and marital status. Facilitators included normalizing HIV testing and the availability of resources and training. PCPs' role as an advocate and their professional style had the paradoxical potential of being both a barrier and a facilitator to VCT. Providers' ability to connect patients to community resources was linked to their persistence and experience.

CONCLUSIONS

Findings suggest more effort is needed by PCPs to facilitate HIV counseling and testing more frequently to their ambulatory care patients.

HIV risk perceptions among adolescents attending family planning clinics: an integrated perspective

Abstract The current study assessed the impact of individual, interpersonal, and contextual factors on HIV risk perception. A total of 426 female adolescents attending family planning clinics took part in this study. The majority, 60.1% were African-American and 39.9% were Hispanic. The results indicated that the majority of participants perceived themselves to be at no or low risk for contracting HIV. Individual, interpersonal as well as contextual factors correlated with HIV risk perception in the study. Adolescents who perceived themselves to be at no or low risk were more likely to be Hispanic, be married and had children. They also felt that they can control situations where they have to refuse sex or insist on condom use, had more frequent communication with sexual partners about condom use and held perceptions that peer norms support condom use. The findings in this study have important implications for risk reduction education for female adolescents. Risk reduction education should strengthen adolescents' personal skills to help them avoid HIV risk despite the various pressures they experience in their life.

Changes in risk perceptions in relation to self-reported colorectal cancer screening among first-degree relatives of colorectal cancer cases enrolled in a randomized trial

OBJECTIVE

This secondary data analysis was conducted to evaluate the applicability of the Risk Reappraisal Hypothesis, which has been proposed to explain the influence of performing a health behavior on perceived risk. Data were collected in the context of a randomized trial, which found that an individually tailored, multicomponent intervention was successful in increasing colorectal cancer (CRC) screening among first-degree relatives of CRC cases.

METHOD

The ethnically diverse study sample (N = 841; 29% Latino, 21% African American, 20% Asian) consisted of adult siblings and children (40-80 years) of CRC cases, identified through the California Cancer Registry. Data were collected at baseline and at 6- and 12-month follow-up. Changes in self-reported risk perception (perceived likelihood of developing CRC) were examined over the study period in relation to study condition and screening status.

RESULTS

Greater increases in perceived risk were observed among intervention versus control-group participants over the study period, but increases were limited to intervention participants who had not been screened. We also examined trajectories of perceived risk in relation to timing of screening receipt (e.g., before 6 months, 6-12 months, never). Continued upward shifts in risk were observed during the study period among intervention participants not screened during the study. In contrast, participants screened by 6 months displayed a reduction or leveling off in perceived risk between 6- and 12-month follow-up.

CONCLUSION

Results provide support for the applicability of the Risk Reappraisal Hypothesis within a high-risk sample enrolled in a CRC screening promotion trial. Future research is needed to explore the impact of short-term risk reductions on future CRC screening behavior.