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Background: This study examined the prevalence and correlates of sexual behavior, sexual risk, and behavioral risk reduction strategies among a diverse sample of HIV-positive adults over age 50. Methods: Individual surveys were conducted with 914 HIV-positive adults age 50 and over (640 male, 264 female, l0 transgender) living in New York City. Results: Over half the sample reported sexual activity in the past 3 months, and one-third of sexually active participants reported unprotected anal or vaginal sex in that time period. Sexually active participants were more likely to be younger and male, but did not differ on physical health status. Participants reported a range of risk-management strategies, including 100% condom use (49% of sexually active participants), serosorting (17%), and strategic positioning (4%). The prevalence of strategies differed by gender/sexual identity subgroups. In multivariate modeling, unprotected sex was significantly associated with recent substance use and loneliness. Conclusions: Older HIV-positive adults are sexually active, and engage in both high-risk and risk-management behaviors. Loneliness emerged as the dominant risk factor in this sample. Findings provide meaningful implications for HIV prevention interventions targeting this population. DOI: 10.1097/OLQ.0b013e3181e15f20

Background: Dual contraception is important for averting HIV-1 transmission, unintended pregnancy, and maternal-to-child HIV-1 transmission. Few studies have explored contraceptive use in HIV-1 serodiscordant couples, a population at high risk for HIV-1 transmission. Methods: Data from a prospective study of 3407 women in HIV-1 heterosexual serodiscordant partnerships were analyzed to describe use and correlates of contraception. Results: Among 2298 HIV-1 seropositive women, 23.5% used contraception at enrollment and 30.2% used contraception after 24 months of follow-up; among 1109 HIV-1 seronegative women, contraceptive use decreased from 21.3% to 14.2%. For both HIV-1 seropositive and seronegative women, contraceptive use was less common among women from East Africa compared to women from southern Africa (adjusted odds ratio [AOR], 0.6; 95% confidence interval [CI], 0.5-0.8 and AOR, 0.6; 95% CI, 0.4-0.8, respectively) and more common among women with at least one child (AOR, 2.4; 95% CI, 1.7-3.4 and AOR, 2.3; 95% CI, 1.2-4.5, respectively). Condom use increased significantly during follow-up from 71.2% to 92.6% and 73.5% to 95.6% among HIV-1 seropositive and HIV-1 seronegative women, respectively, at baseline and 24 months. However, contraceptive use was associated with unprotected sexual activity among both HIV-1 seropositive and seronegative women (AOR, 1.3; 95% CI, 1.1-1.5 and AOR, 1.4; 95% CI, 1.1-1.8, respectively), although not among women who initiated contraception during follow-up. Conclusions: Counseling and provision of dual contraception should receive high priority in programs that care for women in HIV-1 serodiscordant partnerships. DOI: 10.1097/OLQ.0b013e3181e1a162

Background and Objective: Alcohol use has been suggested to interfere with condom use and to increase sexual risk behaviors. However, data on the prevalence of this practice among female sex workers and its association with condom use and sexually transmitted infections (STIs) are limited. Methods: Data were collected through the baseline survey of an HIV prevention project among 454 establishment-based female sex workers in Guangxi, China, in 2004. Both global association and situational analysis were performed using 2 measures of alcohol use (alcohol intoxication and drinking alcohol before having sex with a client). Multiple logistic regression analyses were performed to examine the association of alcohol use with women's condom use and STIs. Results: One-third of women reported being intoxicated with alcohol at least once a month during the previous 6 months, and about 30% reported using alcohol before having sex with clients. In comparison with women who did not use alcohol before engaging in sex with clients, women who did so reported significantly less consistent condom use and higher rates of both current STIs and a history of STI. However, alcohol intoxication was not associated with condom use and STIs. These findings indicate event-specific rather than global associations of alcohol use with inconsistent condom use and STIs. Conclusion: Alcohol use before commercial sex is associated with unprotected sex and increased risk for STIs. Interventions that address both alcohol use and HIV risk behaviors in the context of commercial sex may have a great impact in preventing the spread of HIV in China. DOI: 10.1097/OLQ.0b013e3181e2118a

Background: Analyzing pooled data from 4 recent microbicide trials, we aimed to determine characteristics of participants at higher risk of HIV and sexually transmitted infections (STIs), to inform targeted recruitment, preserved study power, and potentially smaller study sizes in future trials. Methods: We evaluated the relationships between participants' characteristics and the incidence of HIV, STIs, and reproductive tract infections (RTIs). We calculated incidence rates as the number of infection events divided by the person-years of observation. We applied Cox regression models to assess the relationships between baseline demographic, reproductive and behavioral factors and incident HIV, STIs and RTIs. Results: The pooled incidence rates for HIV, chlamydia, and gonorrhea were 2.1, 6.4 and 9.9 per 100 person-years, respectively. Proportions of participants with trichomoniasis, bacterial vaginosis (BV), and candidiasis were 0.06, 0.40, and 0.40, respectively. In final multivariable models, age and education were significantly (and inversely) associated with incident HIV; baseline chlamydia, baseline trichomoniasis, and younger age were associated with incident Chlamydia; and baseline gonorrhea infection, younger age, less education, nulliparous status, baseline chlamydia, and condom use for contraception were associated with incident gonorrhea. Three factors were associated with trichomoniasis: baseline trichomoniasis infection, baseline chlamydia, and baseline BV. Conclusions: Only younger age was robustly associated with multiple STI outcomes in our multivariable analyses. Although there was little evidence of associations between baseline STIs and incident HIV, they were strongly associated with incident STIs. We found no evidence that measured baseline sexual behavior factors were associated with incident HIV or STIs. DOI: 10.1097/OLQ.0b013e3181e15f0b

Background: Intervention effects estimated from nonrandomized intervention studies are plagued by biases, yet social or structural intervention studies are rarely randomized. There are underutilized statistical methods available to mitigate biases due to self-selection, missing data, and confounding in longitudinal, observational data permitting estimation of causal effects. We demonstrate the use of Inverse Probability Weighting (IPW) to evaluate the effect of participating in a combined clinical and social sexually transmitted infection/human immunodeficiency virus prevention intervention on reduction of incident chlamydia and gonorrhea infections among sex workers in Brazil. Methods: We demonstrate the step-by-step use of IPW, including presentation of the theoretical background, data set up, model selection for weighting, application of weights, estimation of effects using varied modeling procedures, and discussion of assumptions for use of IPW. Results: A total of 420 sex workers contributed 840 data points on incident chlamydia and gonorrhea infection. Participators were compared with nonparticipators following application of inverse probability weights to correct for differences in covariate patterns between exposure groups and between those who remained in the intervention and those who were lost-to-follow-up. Estimators using 4 model selection procedures provided estimates of intervention effect between odds ratio 0.43 (95% CI, 0.22-0.85) and 0.53 (95% CI, 0.26-1.1). Conclusions: After correcting for selection bias, loss-to-follow-up, and confounding, our analysis suggests a protective effect of participating in the intervention. Evaluations of behavioral, social, and multilevel interventions to prevent sexually transmitted infection can benefit by introduction of weighting methods such as IPW. DOI: 10.1097/OLQ.0b013e3181d73feb

Objectives: The HIV epidemic spreads among men who have sex with men (MSM) in China. The objective of this study was to examine and compare HIV/AIDS knowledge and sexual risk for HIV between MSM who engaged in concurrent sexual partnerships and MSM who did not. Methods: A cross-sectional study using respondent driven sampling was conducted among 351 MSM in Shenzhen, China. Results: About half (49%) of respondents reported having concurrent sexual partnerships during the past 6 months. Among MSM with concurrent sexual partnerships, 62% had only male partners and 38% had both male and female partners. The proportion of inconsistent condom use was 42% among MSM with concurrent partners and 30% among MSM without. These 2 groups reported a similar level of self-perceived risk for HIV. Compared to MSM without concurrent sexual partners, those with such partners were more likely to work in entertainment venues and had a lower level of HIV/AIDS knowledge. Conclusions: The large number of MSM engaging in concurrent sexual partnerships and the high prevalence of bisexuality could accelerate the spread of HIV to the general population unless effective HIV interventions for MSM are implemented in China. DOI: 10.1097/OLQ.0b013e3181d707c9

Background: Trichomonas vaginalis (T. vaginalis) is the most common nonviral sexually transmitted infection in the world. Despite the coexisting global epidemics of T. vaginalis and HIV, little attention has focused on the emerging evidence that T. vaginalis increases susceptibility to, and potentially transmission of, HIV. Methods: We evaluated T. vaginalis infection in the context of a multisite, randomized controlled trial amongst women in South Africa and Zimbabwe, to determine first, if risk of HIV acquisition was increased among women recently infected with T. vaginalis, and second, if risk of T. vaginalis acquisition was increased among women infected with HIV. Results: After controlling for potential confounders, participants infected with T. vaginalis were more likely to test positive for HIV at their following visit, compared to participants uninfected with T. vaginalis (adjusted hazard ratio = 2.05; 95% CI, 1.05-4.02). Similarly, HIV-positive participants were twice as likely to have acquired T. vaginalis infection at the following visit, compared to HIV-negative participants (adjusted hazard ratio = 2.12; 95% CI, 1.35-3.32). Conclusions: We found an increased risk of both HIV acquisition associated with T. vaginalis infection and risk of T. vaginalis acquisition associated with HIV infection. This bidirectional relationship represents a potentially important factor in sustaining the HIV epidemic in populations where T. vaginalis is endemic. DOI: 10.1097/OLQ.0b013e3181cfcc4b

Concurrent sexual partnerships are an important behavioral driver of HIV epidemics. This analysis examines the prevalence and correlates of concurrency among young adults in the Cape Metropolitan Area, South Africa. 13% reported concurrency during their last sexual partnership with variability by sex and race. Concurrency was associated wiht race, knowledge of a partner's infidelity, and other risky sexual behaviors. Key Words: concurrency, HIV prevention, concurrent sexual partnerships, multiple partners DOI: 10.1097/OLQ.0b013e3181bcdf75

Background: Routine HIV testing is recommended for all adolescents ages 13 years and older. This study aims to report the prevalence of HIV testing among black adolescents, describe characteristics of adolescents who have been tested, and identify potentially modifiable factors associated with greater likelihood of testing across gender. Methods: Black adolescents ages 13 to 18 were recruited from community-based outreach in 4 US cities. Present analyses include sexually active participants (N = 990; 52.3% female). Results: Twenty-nine percent of adolescents had ever been tested for HIV. In a multivariate logistic regression adjusted for significant demographics, the strongest predictor of HIV testing among girls was prior STI testing (OR = 88.39) followed by pregnancy (OR = 2.75), risk reduction self-efficacy (OR = 2.28), and STI knowledge (OR = 2.25). Among boys, having had an STI test (OR = 38.09), having talked about testing with partners (OR = 3.49), and less religiosity (OR = 2.07) were associated with HIV testing. Conclusions: Blacks adolescents are disproportionately at risk for HIV/AIDS, yet less than one-third of participants reported being tested. Those receiving sexual or reproductive healthcare services were most likely to be tested, but many teens at risk for HIV do not seek available services and others may face barriers to accessing healthcare. Findings provide support for increasing school-based educational programs due to the low rates of STI/HIV knowledge among teens. Additionally, culturally-sensitive programs promoting HIV testing among teens should foster skill-building for preventive behaviors and increase partner communication about testing.

Objective: To develop a model for prioritizing economic sectors for HIV preventive intervention programs in the workplace. Methods: This study was undertaken in Karnataka state, India. A 3-stage survey process was undertaken. In the first stage, we reviewed secondary data available from various government departments, identified industries in the private sector with large workforces, and mapped their geographical distribution. In the second stage, an initial rapid risk assessment of industrial sectors was undertaken, using key-informant interviews conducted in relation to a number of enterprises, and in consultation with stakeholders. In the third stage, we used both quantitative (polling booth survey) and qualitative methods (key informant interviews, in-depth interviews, focus group discussions) to study high-risk sectors in-depth, and assessed the need and feasibility of HIV workplace intervention programs. Results: The highest risk sectors were found to be mining, garment/ textile, sugar, construction/infrastructure, and fishing industries. Workers in all sectors had at best partial knowledge about HIV/AIDS, coupled with common misconceptions about HIV transmission. There were intersector and intrasector variations in risk and vulnerability across different geographical locations and across different categories of workers. This has implications for the design and implementation of workplace intervention programs. Conclusions: There is tremendous scope for HIV preventive interventions in workplaces in India. Given the variation in HIV risk across economic sectors and limited available resources, there will be increased pressure to prioritize intervention efforts towards high-risk sectors. This study offers a model for rapidly assessing the risk level of economic sectors for HIV intervention programs.

Objectives: A rapid influx of Latino migrant workers came to New Orleans after Hurricane-Katrina. Many of these men were unaccompanied by their primary sex partner potentially placing them at high-risk for HIV/STIs. The purpose of this study was to assess HIV/STI sexual risk behavior of these men. Methods: A venue-based sample of Latinos who came to New Orleans post-Hurricane Katrina were administered an anonymous, structured interview in Spanish in a mobile unit and urine tested for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) using the nucleic acid amplification technique. Results: Participants (n = 180) had a mean age of 33 (range, 18-79), did not speak or understand English very well (93.9%), were undocumented (91.2%), were married (63.5%), and had children (67.4%), though the percent living with spouse and children was 6.1% and 4.9%, respectively. Although most men were born in Honduras (49.7%) and Mexico (25.4%), 61.9% came to New Orleans from another US state. The majority drank alcohol in the past week (75.5%), and of those, 68.7% engaged in binge drinking. A lower percentage used marijuana (16.6%) and cocaine (5.5%) at least once in the prior week. No men reported injection drug use. Self-reported history of HIV was 10%. No men tested positive for GC and 5 (2.8%) tested positive for CT. In the last month, 68.9% engaged in sex with high-risk sex partners, 30.0% were in potential bridge position, 50.0% used condoms inconsistently, 30.6% did not use a condom the last time they had sex, and 21.1% were abstinent. Since arriving, 9.4% reported leaving and returning to New Orleans. Conclusion: Latino migrant workers in New Orleans reported risky sexual behaviors and low condom use within a potential bridge position. Although a low prevalence of CT and GC was found, there was a high percent of self-reported HIV infection. The cultural and contextual factors that place these migrant workers and their sex partner(s) at risk for HIV/STI need further investigation.

Objectives: To understand the stabilization in HIV prevalence in South Africa, and why HIV prevalence has not declined further, despite behavior change and apparently moderate risk behaviors. Study Design: HIV prevalence and 4 HIV-related sexual behaviors in 15- to 24-year old South Africans and Ugandans were compared, before and during HIV prevalence stabilization and decrease, respectively. Results: According to standard indicators, 15- to 24-year-old South Africans have shown behavior change and have moderate risk behaviors. Yet, the HIV prevalence of South African youth is more than twice the prevalence among Ugandan youth, despite 2 times greater reported condom use and an increase in secondary abstinence among young females. We observed inconsistent use of condoms and an extended age distribution of risk together with age and partner mixing. These increase the cumulative risk beyond indicators which are based on sexual behavior in the last year and condom use at last sexual act. In addition, the extended age distribution of risk together with age and partner mixing, increase the cumulative risk beyond standard indicators which are based on sexual behavior in the last year and condom use at last sexual act. Conclusions: Comprehensive HIV prevention in South Africa needs to be intensified beyond individual age groups for example youth, clearly promote consistent condom use and reduction in sexual partners, and focus on the transmission dynamics including older age groups. This should be based on careful behavioral analysis of the epidemic, which goes beyond standard indicators. This study shows the significant risks beyond apparently improving behavioral indicators in Southern Africa, and helps explains the seriousness of the epidemics in this region.

Background: Bacterial vaginosis (BV) is common and has been associated with increased HIV-1 susceptibility. The objective of this study was to identify risk factors for BV in African women at high risk for acquiring HIV-1. Methods: We conducted a prospective study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant women were eligible if they did not have symptoms of abnormal vaginal itching or discharge at the time of enrollment. At monthly follow-up, a vaginal examination and laboratory testing for genital tract infections were performed. Multivariate Andersen-Gill proportional hazards analysis was used to identify correlates of BV. Results: Participants completed a median of 378 (interquartile range 350-412) days of follow-up. Compared with women reporting no vaginal washing, those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29, 95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98-2.61), and >28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of BV. Higher BV incidence was also associated with the use of cloth for intravaginal cleansing (aHR 1.48, 95% CI 1.06-2.08) and with recent unprotected intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59, 95% CI 0.48-0.73). Conclusions: Vaginal washing and unprotected intercourse were associated with increased risk of BV. These findings could help to inform the development of novel vaginal health approaches for HIV-1 risk reduction in women.

Objective: To describe current practices of primary care (PC) clinicians for STD/HIV control services: risk assessment, prevention counseling, and offering tests. Study Design: We identified clinical strategies through qualitative interviews. We then surveyed by mail a random sample of Washington State family physicians, general internists, obstetrician--gynecologists, nurse practitioners, and certified nurse midwives. We identified characteristics of clinicians and their practices associated with each strategy and universal provision of each service. Results: We report on 519 clinicians (80% adjusted response rate). Clinicians provided services to selected patients they considered high risk. Universal practices were less common: risk assessment (56%), prevention counseling (60%), STD tests (30%), and HIV tests (19%). Universal services were more common among nurses, those recently trained, and those seeing more STD patients. Conclusion: Different types of PC clinicians use widely differing clinical strategies and many use selective rather than universal approaches to STD/HIV control services. Further research is needed to develop tailored interventions to improve provision of these services.

Objectives: To compare the prevalence of condom use with clients and regular sex partners between female sex workers (FSWs) who were or were not injecting drug users (IDUs). Methods: Behavioral surveillance data (2002-2004) conducted in Sichuan, China were analyzed. Mapping exercises were done. About 250 to 400 FSWs were anonymously interviewed from selected establishments in 19 surveillance sites. Results: Of all 15,379 FSWs studied, 3.2% were IDUs. This group, when compared with the non-IDU group, was less likely to have used condoms with clients (last episode: 71.1% vs. 81.2%, OR = 0.6, P < 0.01; consistent use in the last month: 26.7% vs. 40.4%, OR = 0.5, P < 0.01) or to possess a condom (68.7% vs. 77.8%, OR = 0.6, P < 0.01). The between-group difference in last month's consistent condom use with clients remained significant in the multivariate analyses, after adjusting for other significant factors [age, education level, age at first sex, having a regular sex partner, HIV-related knowledge and perceptions, HIV antibody testing (OR = 1.1-2.9, P < 0.05); STD symptoms, type of sex workers, longer duration of sex work, larger number of clients per week, and not having received HIV-related information (OR = 0.4-0.9)]. Comparable results were obtained for condom use with the last client. Such between-group differences were, however, not observed for condom use with regular sex partners (P > 0.05). Exposure to HIV-related services was associated with condom use with clients (OR = 1.3-2.8, P < 0.05). Conclusions: Higher sexual risk behaviors were found among FSWs who were also IDUs, when compared with those who were non-IUDs. A double-risk bridging population for HIV transmission thereby exists.

Objective: The objective of this study was to assess associations between unprotected anal intercourse (UAI) and substance use before and after HIV diagnosis among recently HIV-infected MSM. Study Design: Two hundred seven MSM completed computer-assisted self-interviews regarding type and timing of sexual activity and substance use with their last 3 partners. Date of HIV diagnosis was extracted from medical records. Generalized estimating equations, including interaction terms, were used to assess associations between substance use and UAI before and after HIV diagnosis. Results: Among partners with whom sexual activity occurred before diagnosis, UAI was associated with methamphetamine use alone (odds ratio = 7.12) and a combination of methamphetamine and other substances (odds ratio = 4.06). However, after HIV diagnosis, UAI was associated with use of substances other than methamphetamine (odds ratio = 3.36), but not methamphetamine alone. Conclusions: Use of illicit substances may be differentially associated with UAI based on knowledge of HIV status and could have implications for prevention of HIV transmission.

Goals: We assessed baseline prevalence of human immunodeficiency virus type 1 (HIV-1) and other STDs, as well as behavioral and biologic risk factors for HIV-1 in a population of female bar/hotel workers in Moshi, Tanzania. Study Design: Between 2002 and 2003, we enrolled 1042 female bar/hotel workers in an ongoing prospective cohort study. We analyzed data collected at baseline to assess the associations between alcohol, sexual behavior, STDs, and HIV-1 infection. Results: The prevalence of HIV-1 infection was 19.0% (95% confidence interval [CI] = 16.6%-21.4%). Consistent condom use was low (11.1%). HIV-1 was associated with genital ulcers on examination (adjusted odds ratio [AOR] = 2.08, 95% CI = 1.16-3.74), herpes simplex virus type 2 (HSV-2) (AOR = 3.80, 95% CI = 2.42-5.97), and problem drinking (AOR = 1.92, 95% CI = 1.06-3.47). Other independent predictors of HIV-1 were increasing age, number of sex partners, cohabitating, formerly married, location of employment, and having a husband with another wife. Conclusions: These findings suggest that programs designed to control HSV-2, reduce the number of sexual partners and alcohol use, and promote condom use could be effective in reducing transmission of HIV-1 in this population.

Objectives: Heterosexual transmission has long been considered the predominant route of transmission of HIV-1 in sub-Saharan Africa. However, some have argued that unsafe medical injections account for the majority of transmission in this region. Goal: The goal of this study was to compare the HIV-1 epidemics associated with different transmission routes. Study: An age-structured deterministic compartmental model of HIV-1 transmission through both sexual contact and unsafe injections was developed and simulations of sexual transmission and iatrogenic transmission were compared with observed prevalence. Results: Iatrogenic transmission probabilities and numbers of unsafe injections required to generate observed prevalence are unfeasibly high. Simulations of sexually transmitted HIV-1 generate observed prevalence using transmission probabilities and average partner change rates that are within plausible bounds. Conclusions: Heterosexual transmission seems a more likely route of transmission in the region. However, heterogeneity in contact patterns is of key importance. Further information on groups who are likely to receive more injections is required.

Objective: The objective of this study was to assess measurement of full HIV serostatus disclosure (before sex), delayed disclosure (after sex), and no disclosure to both current and recent past (in the last year) sex partners. Goal: The goal of this study was to propose a refined measure of HIV disclosure. Study Design: This study consisted of a cross-sectional study using audio computer-assisted survey interviews with 63 persons with HIV/ AIDS who reported on 145 sex partnerships. Results: Considering all sex partners in the past year, full disclosure occurred in 54%, delayed disclosure in 22%, and no disclosure occurred in 24%. Delayed/no disclosure among all partners in the past year was substantially higher than standard measures of no disclosure among current partners only, 46% (95% confidence interval [CI], 38-54%) versus 12% (95% CI, 5-19%). No disclosure was more common in past partnerships than current partnerships (40% vs. 12%, P Conclusions: Standard measures may underestimate nondisclosure. Counseling and interventions that promote disclosure should include strategies for disclosure in ongoing relationships, assistance in notifying past partners, and a focus on partnership characteristics and dynamics.

Objective: The objective of this study was to determine herpes simplex virus type 2 (HSV-2) seroprevalence at HIV-1 diagnosis and seroincidence [pounds sterling] year after HIV-1 diagnosis. Methods: HSV type-specific antibodies were detected by enzyme immunoassay. Results: The cohort comprised 850 adults diagnosed HIV-positive in 1986-2001 and followed for a median of 3 years. HSV-2 seroprevalence was 63% (95% confidence interval [CI], 60-66%) and was associated with female gender, heterosexual risk group, black ethnicity, and older age. HSV-2 seroincidence was 1.8 per 100 person-years (95% CI, 0.8-2.8) and was associated with other sexually transmitted diseases, including human papilloma virus infection (P = 0.005) and gonorrhea (P = 0.05). A diagnosis of genital herpes was made in 21% HSV-2-seropositive persons and was more likely in those who tested HIV-positive before 1997 (adjusted odds ratio, 5.11; 95% CI, 3.28-7.98; P = 0.0001). Conclusions: Results confirm the epidemiologic association between HIV-1 and HSV-2. HSV-2 seroconversion was a marker of high-risk sexual behavior. The likelihood of developing symptoms of genital herpes declined from 1997 onward.

Objectives: To address the role of men who have sex with men (MSM) in the human immunodeficiency virus (HIV)/sexually transmitted disease (STD) epidemic in China. Goal: To explore the prevalence of risky sexual behaviors and the existing prevention efforts among men who have sex with men (MSM) in China. Study Design: Review of behavioral and STD/HIV prevention studies addressing MSM in China. Results: Sexual risk behaviors including unprotected group sex, anal sex, casual sex, and commercial sex were prevalent among Chinese MSM. Many Chinese MSM also engaged in unprotected sex with both men and women. Most MSM either did not perceive that they were at risk of HIV/AIDS or underestimated their risk of infection. Surveillance and intervention research among these men are still in the preliminary stages. Conclusions: Chinese MSM are at risk for HIV/STD infection and potential transmission of HIV to the general population. In addition to sexual risk reduction among MSM, reduction of homosexuality-related stigma should be part of effective intervention efforts. Volunteers from the MSM community and health care workers in primary health care system may serve as valuable resources for HIV/STD prevention and control among MSM.

Background: Sexual transmission of HIV in China is rapidly increasing, in part driven by commercial sex work. Goal: This article examines variations in occupational control among one type of brothel-based prostitutes in China, and the relationship between the terms and content of this work and the risk of HIV/AIDS. Organizational factors are discussed as part of the current political, economic, and social context of sex work in China. Study: The analysis is based on ethnographic observation and in-depth interviews conducted in south China in 2000 and 2001 involving 158 female prostitutes from 45 brothels in 4 red light districts. Qualitative analysis of interview and observational data used development of thematic codes measuring occupational control. Results: Brothel-based female sex workers in China are a heterogeneous population, displaying considerable variability in the organization of life and work, relationships with managers and clients, ability to negotiate condom use, knowledge of sexually transmitted diseases and HIV, and occupational identity, all of which may result in different risks of acquiring HIV. Conclusion: HIV prevention activities in China must focus on sociocultural aspects of sex work. Such interventions depend on detailed knowledge of its organization. The results of this study demonstrate the importance of prevention activities directed at the brothel managers and clients, as well as the sex workers.

Goal: The goal of this study was to determine sexual behavior, injecting drug use, knowledge and representations of HIV transmission among adolescents in Russia, Georgia, and the Ukraine. Study: We conducted semistructured interviews on sexual behavior and structured inventories assessing knowledge of HIV transmission, sexual behavior and drug use, and social representations of the epidemic. Results: Shelter children are more likely than school children to have had sex and injected drugs. Georgian school children are more likely than the other school children to have sex and inject drugs. Shelter children and Georgians are the most likely to hold mistaken representations about the epidemic. Conclusions: Particular groups (Russian and Ukrainian shelter children, Georgian school children) urgently require education about the risks of HIV/AIDS.

Lifetime and age-conditional probabilities of human immunodeficiency virus (HIV) diagnosis risk in Missouri were assessed using cross-sectional HIV diagnosis and mortality rates. An increased lifetime risk of HIV diagnosis was associated with males, blacks, and persons residing in metropolitan areas. The estimates emphasize the disparity in risk by race/ethnicity and area of residence. DOI: 10.1097/OLQ.0b013e3181e77f8e

The human immunodeficiency virus (HIV) is responsible for the sexually transmitted disease (STD) acquired immunodeficiency syndrome (AIDS). HIV is transmitted by transferring infected blood. Groups at particular risk are intravenous drug users and homosexuals. Although seroprevalence, the presence of antibodies to HIV in the blood (indicating exposure to HIV), occurs less frequently among heterosexuals, heterosexual transmission of HIV is common in underdeveloped countries. Clinics in the United States which focus on treating individuals with STDs see many high-risk patient groups. Particular sexual behaviors found in these patients, such as having many different sexual partners and lack of condom use, contribute to an increased risk for HIV infection. A history of high risk sexual behavior can be used to track HIV seroprevalence among heterosexuals attending STD clinics. Of the 23 studies available, nine include information on the seroprevalence of STD clinic patients. Of 21,352 patients attending these clinics between 1985 and 1987, 899 (4.2 percent) tested positive for HIV; 5.9 percent of men and 1.7 percent of women. The average rate of seroprevalence found through clinic visits was 3.5 percent. The average rate of seroprevalence was 32.2 percent in clinics having a high homosexual population. The average rate of seroprevalence among heterosexual intravenous drug users ranged was 3.6 percent. Homosexual and bisexual men had the highest rate, 32.2 percent seroprevalence. The average rate of seroprevalence in heterosexuals denying intravenous drug use was 0.9 percent. The rates of seroprevalence in various regions and among various age groups is also noted. It is concluded that STD clinics document high rates of seroprevalence and that these clinics can be used to track the incidence of HIV infection relative to the high-risk sexual behaviors of the patients.