Understanding the barriers that reduce the effectiveness of HIV/AIDS prevention strategies for Puerto Rican women living in low-income households in Ponce, PR: a qualitative study.

BACKGROUND: The HIV/AIDS epidemic has been strongly felt in Hispanic/Latino communities. Estimates of AIDS prevalence among Latinos in the US reveal that just nine States and the Commonwealth of Puerto Rico account for 89% of the Latinos living with AIDS in 2004. Previous research reveals social and cultural factors play an important role in HIV prevention. METHODS: Four focus groups were conducted, with 39 women, ages 21-67, participating in the discussions. The objectives of this research were to assess knowledge regarding HIV transmission among women living in low-income households, to ascertain barriers to safe sex in this population, and to elicit opinions about effective prevention strategies. RESULTS: Our results suggest that participants recognized HIV/AIDS modes of transmission and risk behaviors, as well as their barriers to practicing safe sex. They identified promiscuity, unprotected sex, infidelity, drug and alcohol use, and sharing syringes as behaviors which would place them at risk of HIV/AIDS transmission. They specifically identified lack of negotiating skills, fear of sexual violence, partner refusal to use condoms, and lack of control over their partner's sexual behavior as barriers to practicing safe sex. Finally results also indicate that current HIV/AIDS prevention strategies in Puerto Rico are inadequate for these women. DISCUSSION: To address these issues the authors suggest cultural and social factors to be considered for the development of more effective HIV/AIDS prevention programs.

The role of sympathy on avoidance intention toward persons living with HIV/AIDS in Jamaica.

As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Jamaica, concerns of attitudes become more important. As such, the objective of the present study is to examine the attitudes of university students in Jamaica toward PLWHA including sympathy and avoidance intentions. A large sample of university students (N=1,252) was surveyed between June 2001 and February 2002 using a 193-item questionnaire that measured HIV-related knowledge, attitudes and behaviors. Results revealed that less than half of the students reported sympathetic attitudes toward homosexual males or female prostitutes living with HIV/AIDS (41% and 44%, respectively) while the majority reported sympathetic attitudes toward heterosexual males and non-prostitute females living with the disease (67% and 81%, respectively). Most students (80%) reported no avoidance intentions toward family members or friends living with the disease. Sympathy, HIV knowledge, education and awareness were associated with no avoidance intention of HIV-positive family members and friends. These findings suggest that sympathy could be important in improving prosocial intentions toward PLWHA and warrants further research.

HIV testing practices in Jamaica.

OBJECTIVES: Prevention programmes often promote HIV testing as one possible strategy for combating the spread of the disease. The objectives of the present study were to examine levels of HIV testing practices in a large sample of Jamaicans and the relationships among HIV testing, sociodemographic variables and HIV-related behaviours. METHODS: A total of 1800 persons, aged 15-49 years, were surveyed between May and August 2004 using a household-level, interviewer-administered questionnaire. The questionnaire included HIV-related knowledge, attitudinal and behavioural items. For the present analyses, data from 1558 sexually experienced persons were examined. RESULTS: Approximately 38% of the sexually experienced sample reported a history of HIV testing. Hierarchical logistic regression analyses revealed that adults, females, persons with post-high school education and married persons were more likely to report previous HIV testing. Also, those who had attended an HIV/AIDS education workshop or discussion and those who reported knowing persons living with HIV/AIDS were more likely to report previous testing. However, HIV testing was not associated with condom use or with the number of sexual partners. CONCLUSIONS: The lack of significant findings establishing a relationship between testing and risky sexual behaviours should not negate the importance of HIV testing. Being informed regarding personal HIV serostatus is one of the first steps in self-protection. Effective messages and programmes promoting HIV testing need to be developed and implemented in Jamaica, in order to educate people about how to assess their level of risk with respect to contracting HIV infection.

Predictors of consistent condom use: a hierarchical analysis of adults from Kenya, Tanzania and Trinidad.

The two regions hardest hit by the HIV/AIDS epidemic are sub-Saharan Africa and the Caribbean. It is estimated that more than 28 million persons within these regions are currently living with HIV/AIDS. Therefore, it is imperative that more effective models of protective behaviour change be developed and implemented. Data from 4293 adults from Kenya, Tanzania and Trinidad who agreed to participate in the Voluntary Counseling and Testing Efficacy Study were examined employing hierarchical regression modelling. Only 19% reported consistent condom use with most recent sex partner. Factors associated with consistent condom use were relation to most recent sex partner, gender, study site, perceived difficulty in requesting condom use and actually making requests for condom use. Interventions that are grounded in theory and consider the relationship between the various independent variables along with the dependent variable may be more effective in promoting HIV protective behaviour change, such as consistent condom use, than current prevention efforts.

Sexually transmitted disease symptoms. A comparative analysis of male and female youth in Jamaica

Data from Reproductive Health Survey 1997 were used to examine symptoms of (STD) and sex behaviour of adolescents and young adults in Jamaica. Overall, nine per cent of the sample reported symptoms of STD in the year prior to the survey. Rates of high-risk sexual behaviours were high with one-fifth of the sample reporting multiple sex partners in the last three months. Slightly more than half reported condom use at coitus. Logistical regression analyses indicated that being older, having multiple sex partners, using condoms inconsistently with steady partners, and having cultural attitudes conducive to high-risk sexual activity were all associated with having symptoms of STD. These findings indicate that certain sub-populations are more likely to have symptoms of STD. STD prevention programmes should recognize the various risk groups at increased risk of STD and, ultimately, HIV. Interventions should be targeted to those who continue to have unprotected sex with multiple sex partners. In addition, cultural factors should be considered in the development of such prevention programes. (AU)

Sexually transmitted disease symptoms. A comparative analysis of male and female youth in Jamaica

Data from Reproductive Health Survey 1997 were used to examine symptoms of sexually transmitted diseases (STD) and sex behaviour of adolescents and young adults in Jamaica. Overall, nine per cent of the sample reported symptoms of STD in the year prior to the survey. Rates of high-risk sexual behaviours were high with one-fifth of the sample reporting multiple sex partners in the last three months. Slightly more than half reported condom use at last coitus. Logistical regression analyses indicated that being older, having multiple sex partners, using condoms inconsistently with steady partners, and having cultural attitudes conducive to high-risk sexual activity were all associated with having symptoms of STD. These findings indicate that certain sub-populations are more likely to have symptoms of STD. STD prevention programmes should recognize the various risk groups at increased risk of STD and, ultimately, HIV. Interventions should be targeted to those who continue to have unprotected sex with multiple sex partners. In addition, cultural factors should be considered in the development of such prevention programmes.

Sexually transmitted disease symptoms. A comparative analysis of male and female youth in Jamaica.

Data from Reproductive Health Survey 1997 were used to examine symptoms of sexually transmitted diseases (STD) and sex behaviour of adolescents and young adults in Jamaica. Overall, nine per cent of the sample reported symptoms of STD in the year prior to the survey. Rates of high-risk sexual behaviours were high with one-fifth of the sample reporting multiple sex partners in the last three months. Slightly more than half reported condom use at last coitus. Logistical regression analyses indicated that being older, having multiple sex partners, using condoms inconsistently with steady partners, and having cultural attitudes conducive to high-risk sexual activity were all associated with having symptoms of STD. These findings indicate that certain sub-populations are more likely to have symptoms of STD. STD prevention programmes should recognize the various risk groups at increased risk of STD and, ultimately, HIV. Interventions should be targeted to those who continue to have unprotected sex with multiple sex partners. In addition, cultural factors should be considered in the development of such prevention programmes.

Close relationships and safer sex among HIV-infected men with haemophilia.

The present study sought to inform future behavioural intervention efforts by obtaining information from HIV-positive heterosexual men with haemophilia about their attitudes towards close relationships, attitudes towards risk reduction practices, and actual risk reduction practices. HIV-infected males with haemophilia (n = 358) responded to a self-administered questionnaire. Men who reported being involved in a close relationship (n = 237) were compared to men who said that they were not involved at the time of data collection (n = 121). Involved men were more likely than uninvolved men to agree that close relationships provide benefits such as physical intimacy and communication, and that these benefits are important. Men who were not involved perceived more negative consequences of discussing HIV risk reduction with partners (including partner rejection and negative emotional reactions) than did involved men and were much more concerned about the potential negative consequences of risk reduction discussions. Involvement was associated with having disclosed HIV-seropositivity and having discussed HIV risk reduction. Risk reduction interventions for men with haemophilia who are not involved in close, sexual relationships should address positive and negative attitudes towards close relationships and towards discussing risk reduction. Interventions should emphasize communication skills and rehearsal of serostatus disclosure as well as of risk reduction discussions.