Prevention of HIV infection. Looking back, looking ahead.

For some, the occurrence of as many as 40,000 new human immunodeficiency virus (HIV) infections in the United States each year is evidence that HIV education and prevention efforts have failed. To the contrary, more than a decade of experience with HIV has demonstrated that lasting changes in behavior needed to avoid infection can occur as a result of carefully tailored, targeted, credible, and persistent HIV risk-reduction efforts. Given experience in other health behavior change endeavors, no interventions are likely to reduce the incidence of HIV infection to zero; indeed, insisting on too high a standard for HIV risk-reduction programs may actually undermine their effectiveness. A number of social, cultural, and attitudinal barriers continue to thwart the implementation of promising HIV risk-reduction programs. The remote prospects for a successful prophylactic vaccine for HIV and the difficulty in finding effective drug treatments have underscored the importance of sustained attention to HIV prevention and education. A series of "correlates of immunity" are identified--precedents that must exist to establish effective HIV prevention programs. These include sound policies promoting HIV risk reduction; access to health and social services, condoms, needles, and syringes; interventions shown to motivate behavioral change; organizations capable of reaching those at risk; and development and diffusion of technologies to interrupt the spread of the virus.

Screening for human immunodeficiency virus antibody in urine.

OBJECTIVE: To determine the diagnostic accuracy of an investigational test for human immunodeficiency virus (HIV) envelope antibodies in urine. DESIGN: Matched blood and urine specimens were tested for HIV by two independent laboratories, both of which were blinded to all results at the other site. Duplicate positive enzyme-linked immunoassay (EIA) results were confirmed by immunofluorescent antibody or western blot. SETTING: Six alcohol treatment centers in the San Francisco metropolitan area. PATIENTS: Five hundred ninety-two recovering alcoholics. MAIN OUTCOME MEASURES: Diagnosis of HIV infection by blood and urine EIA and western blot. RESULTS: The experimental urine EIA, when confirmed by urine western blot, led to a correct diagnosis in all samples. One sample was negative by urine EIA screening, positive by blood EIA, and exhibited an indeterminate blood western blot pattern (p24 band only). CONCLUSIONS: We encountered no false positive or false negative results using an investigational HIV antibody test for urine samples. There are several important advantages to HIV testing of urine versus serum or blood; however, there are also cogent reasons for limiting the use of alternative specimens for HIV testing.

Sexual risk and perception of risk for HIV infection among multiethnic family-planning clients.

Little is known about the relationship among having risks for human immunodeficiency virus (HIV) infection, perceiving oneself at risk, and initiating risk reduction for young sexually active women. We surveyed a multiethnic sample of 267 young-adult female family planning clients attending Planned Parenthood clinics to determine these relationships. Perceiving oneself at risk was significantly associated with having sex outside of a primary relationship in the past year, with having five or more sexual partners in the last five years, and with having a primary partner who has other partners. We found no significant relationship between perceiving oneself at risk and adopting risk-reduction strategies, such as inquiring about a partner's risks or using condoms. These data suggest that the women in this population may be overly optimistic about their invulnerability to HIV. While those women who perceived themselves to be at risk for becoming sexually infected with HIV were more likely to report high-risk behaviors, perception of risk did not motivate these women to adopt low-risk behavior. These data suggest that simple HIV education and acknowledgement may have little effect on reducing exposure to HIV among the women in this population. Alternative strategies for reducing risk must be explored.

PIP: A survey was made of 267 (40% white, 37% African-American, 10% Asian, 11% Latina, 2% other) 18-40 year old, female family planning clients attending Planned Parenthood clinics in San Francisco and Oakland, California, between June 1989 and October 1990. Survey questions included variables that have been associated with HIV risk, including perception of one's risk, sex with multiple partners, sex with high risk partners, sex with nonmonogamous partners, anal sex with primary and secondary partners, and condom use. Differences among ethnic groups in age, education, and associations between perception of risk for HIV infection and presence or absence of any reported risk factors, number of risk factors reported, and each of the protective behaviors were tested with the chi-square statistic. More than half the women reported having had a sexually transmitted disease (STD). African-American women were significantly more likely to report having had a STD compared with white women or the women of other ethnic backgrounds. 12% of the women reported that they always used condoms with their primary partners. Of them, 35% reported always using condoms in sex outside of primary relationships. Women reported screening their partners about their HIV risk history. This included asking potential partners about history of iv drug use (38%) and about their number of past sexual partners (54%). 40% of the women perceived themselves at risk for sexually transmitted HIV. Women who perceived that they were at risk were more likely to report having sex outside of a primary relationship in the past year, and to report having a primary partner who had other partners. No significant relationship between perceiving oneself at risk and engaging in any of the protective behaviors and no relationship between perceiving risk and condom use were found.