Attitudes Toward HIV Voluntary Counseling and Testing (VCT) Among African American Men Who Have Sex With Men: Concerns Underlying Reluctance to Test.

Contemporary antiretroviral therapy (ART) can produce viral suppression of HIV, maintain health, and prevent onward HIV transmission from infected persons to their sexual partners, giving rise to the concept of treatment as prevention. Successful implementation of test-and-treat strategies rests on the early detection of HIV infection through voluntary counseling and testing (VCT) followed by entry and retention in care, ART initiation and adherence, and subsequent viral suppression. In the United States, African American men who have sex with men (MSM) bear a disproportionate burden of HIV and have high rates of undetected and untreated HIV infection. However, little research has examined racial minority MSM's views about HIV testing. In this study, in-depth interviews were conducted with 96 key informants knowledgeable about racial minority MSM as well as 100 African American MSM community members in Milwaukee, Cleveland, and Miami. Most men in the sample were aware of the availability of testing and knew testing locations, but many voiced great personal ambivalence about being tested, feared knowing their HIV status, expressed concern about stigma and loss of confidentiality, and held beliefs indicative of medical mistrust. Participants did not spontaneously cite benefits of being tested, risk reduction behavior changes made as a consequence of testing, nor the benefits of testing to get early medical care for HIV infection. There is a gap between the public health field's perception of testing benefits and the beliefs about testing held by racial minority MSM in this sample. To increase the desired outcomes from VCT for minority MSM, VCT promotion should address the concerns of African American MSM and underscore the benefits of early entry into medical care.

Do Assessments of HIV Risk Behaviors Change Behaviors and Prevention Intervention Efficacy? An Experimental Examination of the Influence of Type of Assessment and Risk Perceptions.

BACKGROUND: Behavioral assessments may change behaviors and responses to behavioral interventions, depending on assessment type and respondents' motivations. PURPOSE: We observed effects on sexual behavior and human immunodeficiency virus (HIV) prevention intervention efficacy of interviews assessing recent HIV risk behavior frequency or HIV risk behavior events among respondents with different perceptions of their risk for HIV. METHODS: Young South African sexually transmitted infection (STI) clinic clients (N=1,728) participated in a 3 (event-based vs. frequency-based vs. no interview) by 2 (evidence-based vs. standard of care risk-reduction session) RCT. RESULTS: The interviews increased reported safer sexual behavior among youth with higher but not lower risk perceptions. The intervention session was less effective when combined with interviews, particularly among lower risk perception youth. Patterns replicated for both interviews. CONCLUSIONS: HIV risk behavior assessments may increase resistance to interventions among unmotivated youth and enhance safer sexual behavior among motivated youth. Behavioral assessments may reduce HIV risk among motivated individuals.

Beyond the ball: implications for HIV risk and prevention among the constructed families of African American men who have sex with men.

African American men who have sex with men (AAMSM) are disproportionately burdened by new and existing HIV infections. In spite of this, few HIV prevention interventions have been developed that meet the specific needs of AAMSM and that are culturally appropriate and build on strengths and resources. In this paper, we examine constructed families, including those who belong to houses and those who do not, from a three city sample of 196 AAMSM. Results show that the majority of AAMSM who belong to constructed families do not participate in houses or balls. Both house and non-house affiliated constructed families are important sources of social support among AAMSM. Participants reported limited success in spreading HIV messages at ball events, but talk about HIV within their constructed families. Social network approaches to HIV prevention may capitalize on existing social ties within constructed families to promote safer sexual behaviors.

HIV misconceptions associated with condom use among black South Africans: an exploratory study.

In South Africa, approximately 20% of 15-49-year-olds are infected with HIV. Among black South Africans, high levels of HIV/AIDS misconceptions (e.g. HIV is manufactured by whites to reduce the black African population; AIDS is caused by supernatural forces or witchcraft) may be barriers to HIV prevention. We conducted a cross-sectional study of 150 young, black adults (aged 18-26; 56% males) visiting a public clinic for sexually transmitted infections, to investigate whether HIV/AIDS misconceptions were related to low condom use in main partner relationships. We assessed agreement with HIV/AIDS misconceptions relating to the supernatural (e.g. witchcraft as a cause of HIV) and to genocide (e.g. the withholding of a cure). In multivariate models, agreement that 'Witchcraft plays a role in HIV transmission' was significantly related to less positive attitudes about condoms, less belief in condom effectiveness for HIV prevention, and lower intentions to use condoms among men. The belief that 'Vitamins and fresh fruits and vegetables can cure AIDS' was associated with lower intentions among men to use condoms. Women who endorsed the belief linking HIV to witchcraft had a higher likelihood of unprotected sex with a main partner, whereas women who endorsed the belief that a cure for AIDS was being withheld had a lower likelihood of having had unprotected sex. Knowledge about distinct types of HIV/AIDS misconceptions and their correlates can help in the design of culturally appropriate HIV-prevention messages that address such beliefs.

HIV prevention programs of nongovernmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project.

OBJECTIVE: The objective of this paper is to describe HIV prevention programs conducted by nongovernmental organizations (NGO) that are meeting this challenge. METHODS: One NGO undertaking HIV prevention programs was evaluated in each of the 23 countries participating in the Global AIDS Intervention Network (GAIN) Project throughout Latin America and the Caribbean. A two-stage selection process was used: (1) a search in databases and other information sources; (2) identification of NGOs that were best established and most actively engaged in HIV prevention activity. Executive directors were questioned about staffing, budget issues, populations served and barriers faced by these entities. RESULTS: The 23 NGOs conducted 58 direct-service programs and had been conducting HIV prevention activities for a mean of 8 years (SD=4.45; range 1-18 years). Average annual program budget was US $205,393 (range: US $10,000 to US $1,440,000). The NGOs reported a mean of 4.5 full-time employees (range 0-15, SD=4.7). Many relied on volunteers (median=10, mean=51, range 0-700, SD=150) to conduct HIV prevention activities. The NGOs provided prevention services for the general community (82.6%), children and adolescents (34.8%) and men who have sex with men (30.4%). Activities conducted by NGOs included train-the-trainer activities (43.5%) and face-to-face prevention activities (34.8%). Obstacles cited included lack of funding (60.9%) and HIV-related stigma and discrimination (56.5%). CONCLUSION: The strategies used by NGOs to overcome barriers to prevention are a testament to their ingenuity and commitment, and serve as examples for NGOs in other world regions.

HIV prevention programs of non-governmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project

Objective: The objective of this paper is to describe HIV prevention programs conducted by nongovernmental organizations (NGO) that are meeting this challenge. Methods: One NGO undertaking HIV prevention program was evaluated in each of the 23 countries participating in the Global AIDS Intervention Network (GAIN) Project throughout Latin America and the Caribbean. A two-stage selection process was used: (1) a search in databases and other information sources; (2) identification of NGOs that were best established and most acrively engaged in HIV prevention activity. Executive directors were questioned about staffing, budget issues, populations served and barriers faced by these entities. Results: The 23 NGOs conducted 58 direct-service programs and had been conducting HIV prevention activities for a mean of 8 years (SD = 4.45;range 1-18 years). Average annual program budget was US$ 205,393 (range: US$ 10,000 to US$ 1,440,000). The NGOs reported a mean of 4.5 full-time employees (range 0-15, SD = 4.7). Many relied on volunteers (median = 10, mean = 51, range 0-700, SD = 150) to conduct HIV prevention activities. The NGOs provided prevention services for the general community (82.6 percent), children and adolescents (34.8 percent) and men who have sex with men (30.4 percent). Activities conducted by NGOs included train-the-trainer activities (43.5 percent) and face-to-face prevention activities (34.8 percent). Obstacles cited included lack of funding (60.9 percent) and HIV-related stigma and discrimination (56.5 percent). Conclusions: The strategies used by NGOs to overcome barriers to prevention are a testament to their ingenuity and commitment, and serve as examples for NGOs in other world regions. (AU)

Distance communication transfer of HIV prevention interventions to service providers.

Most acquired immunodeficiency syndrome (AIDS) service providers are in countries with little access to scientific developments relevant to their programs. It is critical to transfer advances from the scientific arena to service providers on a global scale. Human immunodeficiency virus (HIV) prevention organizations in 78 countries were randomized to receive either a control condition or a technology transfer condition with an interactive distance learning computer training curriculum and individualized distance consultation. Of 42 nongovernmental organizations in the technology transfer condition, 29 adopted the science-based program in their communities or trained other agencies to also use it. Advanced communication technologies can create a cost-effective infrastructure to disseminate new intervention models to service providers worldwide.

HIV prevention in Africa: programs and populations served by non-governmental organizations.

The AIDS epidemic in Africa remains an urgent health crisis. Non-governmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services and assistance to persons living with AIDS. African NGOs are conducting numerous HIV prevention programs with several at-risk populations, yet their efforts have only rarely been systematically documented. To address this gap in the literature, the authors surveyed one NGO in each of 29 African countries regarding their HIV prevention activities and populations served. This report provides details concerning HIV prevention activities across the continent and describes in detail innovative programs from Togo and South Africa. NGOs in the present sample operate with modest budgets and small staff sizes, yet conduct programs that reach large segments of their communities. NGOs were most likely to report community-level interventions such as peer-education or community outreach. Faced with an epidemic where the main transmission occurs via heterosexual activity, African NGOs were most likely to direct their attention to the general public and to youth. NGOs in Africa are struggling to implement sustainable, cost-effective programs with few resources. Strengthening the infrastructure and capacity of these key agencies is crucial to fighting the AIDS epidemic in Africa.