Perceived condom norms and HIV risks among social and sexual networks of young African American men who have sex with men.

The association between condom norms and unprotected sexual intercourse was examined within social and sexual networks of young African American men who have sex with men (MSM) in an HIV epicenter of the southern United States. We used a chain-link design to recruit 158 young African American men: 95 initial participants, 56 contacts of participants (alters) and 7 contacts of alters. Men in the high-risk group, compared with those in the no-risk group, perceived significantly lower approval concerning condom use in their social and sexual networks. Also, 100 participants could be connected to each other in 86 dyads of social and sexual networks. Within these dyads, men perceived that their friends and acquaintances approved for them to use condoms but that their friends and acquaintances did not use condoms themselves. Low HIV risk behavior appears associated with perceived social norms that support one's use of condoms, even when perceived norms do not support condom use by network members themselves.

Finding the "community" in community-level HIV/AIDS interventions: formative research with young African American men who have sex with men.

Data from 76 qualitative interviews with 18- to 29-year-old African American men who have sex with men (MSM) in Chicago and Atlanta were examined to identify perceptions of "community" and components of a community-level HIV/AIDS intervention. Many men reported feeling marginal to African American and gay White communities because of perceived homophobia and racism. Those who reported feeling part of gay African American communities characterized communities in terms of settings, social structures, and functions, including social support, socialization, and mobility. Despite these positive functions, divisions among groups of MSM, lack of settings for nonsexual interaction with other MSM, lack of leadership, and negative attitudes toward homosexuality may make it difficult for men to participate in activities to alter community contexts that influence behavior. Rather, changing norms, increasing social support, and community building should be part of initial community-level interventions. Community building might identify leaders, create new settings, and create opportunities for dialogue between MSM and African American community groups to address negative perceptions of homosexuality.

Colorectal cancer screening in older men and women: qualitative research findings and implications for intervention.

As part of the formative research for developing interventions to increase colorectal cancer screening in men and women aged 50 and older, 14 focus groups were conducted to identify (1) knowledge, attitudes, and beliefs about colorectal cancer and colorectal cancer screening, (2) barriers to screening, and (3) strategies for motivating and supporting behavior change. Participants had either private insurance or Medicare and reported different levels of experience with colorectal cancer screening. Overall, they were poorly informed about colorectal cancer and the possible benefits of screening, reporting little or no information from physicians or mass media, negative attitudes toward screening procedures, and fear of cancer. Despite references to the subject matter as embarrassing or private, both men and women, African Americans and whites, appeared to talk candidly and comfortably in the permissive context of the focus group. This study's findings suggest that public education campaigns, decision aids, and targeted interventions are urgently needed to put colorectal cancer screening on the public's "radar screen," to increase awareness of the prevention and early detection benefits of screening, and to encourage people 50 and older-and the health care providers who serve them-to make screening a high priority.

Engaging women's interest in colorectal cancer screening: a public health strategy.

Screening rates for colorectal cancer are unacceptably low. New guidelines, public education campaigns, and expanded coverage of screening costs by healthcare insurance are expected to increase screening rates, but interventions targeting women may accelerate this change. Most American women already participate in regular cancer screening, in the form of Papanicolaou (Pap) tests and mammography, so they may be receptive to tailored messages about the need to add regular colorectal cancer screening to their preventive health regimen. In addition, their role in promoting the health of family members may position women to influence screening behavior in family and friends. Women may be particularly valuable change agents in populations where screening rates are traditionally low, such as medically underserved populations, the elderly or low socioeconomic status groups with competing health priorities, and populations with cultural values or practices inconsistent with the adoption of a new screening behavior. To serve as agents of change in their family and social networks, women must understand that colorectal cancer is not solely a man's disease and that the benefits of colorectal screening are similar to those of Pap testing and mammography. Colorectal cancer screening should also be promoted within a framework of a lifelong strategy for health maintenance for both men and women. The message to women should emphasize the value of colorectal cancer screening rather than the disagreement among experts over preferred screening strategies and should emphasize the value of shared decision making between the patient and her healthcare provider.

Community empowerment paradigm drift and the primary prevention of HIV/AIDS.

Long discussed in the public health arena, the concept of empowerment has only recently entered the discourse on the primary prevention of HIV/AIDS in the United States. Despite its broad appeal, empowerment has not been systematically incorporated into theory-based interventions, which may reflect a lack of consensus on the meaning of empowerment, how to measure it, and the intervention strategies it implies. The purpose of this paper is to consider the relevance of empowerment to community interventions for persons at risk for HIV, particularly women. The origins of empowerment are reviewed; community empowerment as an intervention framework is described and its core assumptions defined. There is some evidence of the growing influence of empowerment and related concepts in recent HIV-related policy, research, and programs funded through the Centers for Disease Control and Prevention. However, adoption of an empowerment framework for HIV prevention will require further theory and measurement development, as well as changes in how public health researchers and practitioners work with the communities they serve.

Male bisexual behavior and HIV risk in the United States: synthesis of research with implications for behavioral interventions.

This paper reviews recent literature on male bisexuality and HIV risk and suggests new directions for intervention and research in the United States. AIDS case reports and behavioral studies based on convenience samples suggest that behaviorally bisexual men use condoms inconsistently with male and female partners, seldom disclose their bisexuality to their female partners, and are more likely than exclusively homosexual men to report multiple HIV risk behaviors. Male bisexuality may present greatest HIV risk in the context of (a) male prostitution, (b) injecting drug use, (c) sexual identity exploration, and (d) culturally specific gender roles and norms such as those that may characterize some African American and Hispanic communities in the United States. We review individual and community level interventions to reach men within these four contexts as well as the larger population of bisexual men. We also suggest a heuristic model to encourage additional research examining multiple dimensions of bisexual behavior and HIV risk.

Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects.

The AIDS Community Demonstration Projects provided community-level HIV prevention interventions to historically hard-to-reach groups at high risk for HIV infection. The projects operated under a common research protocol which encompassed formative research, intervention delivery, process evaluation, and outcome evaluation. A formative research process specifically focusing on intervention development was devised to assist project staff in identifying, prioritizing, accessing, and understanding the intervention target groups. This process was central to the creation of interventions that were acceptable and unique to the target populations. Intended to be rapid, the process took 6 months to complete. Drawn from the disciplines of anthropology, community psychology, sociology, and public health, the formative research process followed distinct steps which included (a) defining the populations at high-risk for HIV; (b) gathering information about these populations through interviews with persons who were outside of, but who had contact with, the target groups (such as staff from the health department and alcohol and drug treatment facilities, as well as persons who interacted in an informal manner with the target groups, such as clerks in neighborhood grocery stores and bartenders); (c) interviewing people with access to the target populations (gatekeepers), and conducting observations in areas where these high-risk groups were reported to gather (from previous interviews); (d) interviewing members of these groups at high risk for HIV infection or transmission; and (e) systematically integrating information throughout the process. Semistructured interview schedules were used for all data collection in this process. This standardized systematic method yielded valuable information about the focal groups in each demonstration project site. The method, if adopted by others, would assist community intervention specialists in developing interventions that are culturally appropriate and meaningful to their respective target populations.

HIV risk behavior among Peace Corps Volunteers.

OBJECTIVE: To describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors. METHOD: Cross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention. RESULTS: Non-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use. CONCLUSION: These data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

PIP: At least 10 former Peace Corps volunteers are believed to have acquired human immunodeficiency virus (HIV) during their time of service. To assess HIV risk behavior among current Peace Corps volunteers, cross-sectional data were collected from 1242 randomly selected volunteers in 28 countries in 1991. 474 (38%) were stationed in sub-Saharan Africa. Non-sexual HIV-related risk activities included injection from local health facilities (209) and ears or body parts pierced (59). Of the 1018 volunteers who were unmarried or not living with a spouse, 61% of men and 60% of women indicated they had at least one sexual partner during their time of service; 30% and 20%, respectively, had three or more partners. Only 17 men and 12 women reported having a same-sex partner. 52% of sexually active Peace Corps volunteers stationed in Eastern Europe, 43% of those in Central or South America, 36% in sub-Saharan Africa, and 32% in Asia and the Pacific had a sexual partner from the host country. 32% of these volunteers used condoms on every occasion with partners from the host country, 49% used condoms some of the time, and 19% never used them. For male volunteers, consistent condom use was negatively associated with alcohol use and positively related to the perception that HIV was a problem in the host country; for female volunteers, younger age and fewer partners were the significant correlates of condom use. The inconsistent use of condoms in countries where HIV is widespread suggests a need for Peace Corps leaders to educate volunteers about local seroprevalence rates, cultural differences in sexual negotiation, and the importance of condom use.

Limits to conceptual rule-learing by schizophrenic patients.

Two studies of conceptual rule-learning by 36 hospitalized psychiatric patients revealed that (a) while all were clinically diagnosed as schizophrenic, they differed widely in their ability to discover abstract rules; (b) the Whitaker Index of Schizophrenic Thinking (WIST) strongly predicted the patients' ability to learn and to apply a conceptual rule; and (c) regardless of severity of conceptual impairment, the patients were unaffected by modest levels of externally generated irrelevant information as presented through the modality of vision. Deficits in abstractive ability, when they exist, are believed to be due to a schizophrenic patient's inability to prevent task-irrelevant information that originates in long-term memory from spilling into and despoiling the operations of working memory.

Reproductive and vegetative morphology of a cretaceous angiosperm.

Recent collections from plant-bearing deposits of Cenomanian age in central Kansas have yielded angiosperm axes with helically arranged, seed-bearing, conduplicate carpels. Large leaves associated with these fruits are thought to represent parts of the same kind of plant because the leaves and fruits are the only plant fossils at this locality to have distinctive, morphologically identical, yellow bodies within their carbonaceous remains. These fossils provide a rare opportunity to study the morphology of an ancient angiosperm and illustrate the antiquity of certain features considered primitive by comparative angiosperm morphologists.