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Objective: The aim of this study was to examine whether brief training of human immunodeficiency virus (HIV) medical providers increased the frequency with which they routinely delivered prevention counselling to patients, and whether patient characteristics were associated with receipt of that counselling. Design: Longitudinal. Setting: Seven HIV clinics in the United States. Method: Medical providers received training to deliver counselling to their HIV-positive patients. The evaluation was conducted with a longitudinal cohort ("N" = 729) of patients at baseline (before providers received training) and at six and 12 months after the intervention was initiated. Participants reported on receipt of routine counselling (at more than half of their primary care visits) about safer sex, disclosing HIV infection to sex partners, and alcohol/drug use. Logistic regression and generalized estimating equations (GEE) methods assessed changes in receipt of counselling over time. Results: The percentage of participants reporting routine safer-sex counselling increased significantly across time (b = 0.12, standard error [SE] = 0.04; "p" = 0.004), as did receipt of routine counselling about disclosing their HIV infection to sex partners (b = 0.21, SE = 0.05; "p" less than 0.001). The trend was not significant for counselling about alcohol or drug use. Sub-group analysis indicated that the upward trend in routine safer-sex counselling was significant for men who have sex with men (MSM), for participants who had more than one sexual partner in the past three months, and for those who had a CD4 count of greater than 500cells/mm[superscript 3]. Conclusion: Brief training increased the frequency with which HIV medical providers routinely delivered prevention counselling to their patients at risk of transmitting HIV to others. (Contains 4 tables.)

A study of characteristics of US adults who had ever and never tested for HIV found that most adults had not been tested for HIV, and most who never tested preferred testing in clinical settings. Background: The initial phase of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative prioritized efforts in 57 geographic areas. The US Centers for Disease Control and Prevention recommends persons aged 13 to 64 years be tested for HIV at least once as part of routine health care; however, it is unclear how effectively these testing recommendations have been implemented in EHE priority areas. Methods: In 2021 to 2022, we analyzed data from a Web-based, nationally representative survey of adults fielded in 2021. HIV testing preferences were compared by testing history, demographic characteristics, behaviors, and geography. Results: An estimated 72.5% of US adults had never tested for HIV. Never testing was most prevalent among those aged 18 to 29 or those 50 years or older, non-Hispanic White persons, and those living in the Midwest. Among persons living in EHE priority areas and persons reporting at least one behavior that increases risk of HIV transmission, 69.1% and 48.0%, respectively, had never tested for HIV. The top 3 HIV testing preferences among never testers were as follows: testing for HIV during a routine health care visit (41.2%), testing at an urgent care or walk-in clinic (9.6%), and self-testing (8.1%). Conclusions: Most adults had not been tested for HIV, confirming that US Centers for Disease Control and Prevention recommendations are not being fully implemented, even in EHE priority areas. Moreover, most adults who never tested preferred testing in clinical settings, highlighting missed opportunities. As the EHE initiative continues to advance, it is critical to leverage preferred HIV testing modalities, such as routine testing in clinical settings or HIV self-testing. [ABSTRACT FROM AUTHOR]

With the continued transmission of HIV each year, novel approaches to HIV prevention are needed. Since 2003, the U.S. HIV prevention focus has shifted from primarily targeting HIV-negative at-risk persons to including safer sex programs for people already infected with HIV. At least 20-30% of people infected with H1V engage in risky sexual practices. Based on these data, policymakers have recommended that interventionists develop strategies to help HIV-infected people reduce their risky sexual behaviors. In the past, the few safer sex interventions that targeted HIV-infected people met with limited success because they basically adapted strategies previously used with HIV-uninfected individuals. In addition, often these adaptations did not address issues of serostatus disclosure, HIV stigma, or motivation to protect others from HIV. We had previously tested, in a demonstration project named the Start Talking About Risks (STAR) Program, a monthly three-session motivational interviewing (MI)-based intervention to help people living with HIV practice safer sex. In this study, we refined that program by enhancing its frequency and intensity and adding written and audio components to support the counseling. We theorized that an intervention such as MI, which is tailored to each individual's circumstances more than standardized prevention messages, would be more successful when supplemented with other components. We qualitatively assessed participants' perceptions, reactions, and preferences to the refined prevention with positives counseling program we called SafeTalk and learned that participants found the SafeTalk MI counseling and educational materials appealing, understandable, and relevant to their lives. DOI: 10.1089/apc.2009.0252

Objectives. We explored factors influencing sexual behavior, disclosure of same-sex behavior, and condom-use practices among Black bisexual men. Methods. We conducted semistructured interviews with 38 Black men in Atlanta, Georgia, who reported having had oral, vaginal, or anal sex with both men and women in the prior 6 months. Results. Participants described approaches to disclosure of same-sex behavior as part of a complex decisional balance influenced by both situational and individual factors and ranging from full disclosure to total secrecy. Influences on sexual behavior and condom-use practices included: (1) type of relationship, (2) gender-specific considerations, (3) perceptions of comfort or trust, and (4) fear of disease or pregnancy. Conclusions. Disclosure of same-sex behavior was not a major influence on the sexual behavior and condom-use practices of the Black bisexual men in our study, who demonstrated heterogeneity in approaches to sexual behavior, disclosure of same-sex behavior, and condom-use practices. Additional research is needed to assess the social determinants of sexual risk for this population. Future HIV-prevention efforts should include initiatives to encourage accuracy in risk assessment and in taking sexual histories in clinical settings. (Am J Public Health. 2010;100:159-164. doi: 10.2105/AJPH.2008.158725)

Current national guidelines recommend that all HIV care providers routinely counsel their HIV-infected patients about reducing HIV transmission behaviors. In this article we identify the challenges and lessons learned from implementing a provider-delivered HIV transmission risk-reduction intervention for HIV-infected patients (Positive Steps). Based on a multi-site Centers for Disease Control and Prevention (CDC) initiative, we integrated the Positive Steps program into an infectious diseases clinic in North Carolina. Of the nearly 1200 HIV-infected patients, 59% were African American, 44% were white, 33% were women, and over 50% were between 25 and 44 years of age. We obtained feedback from a community advisory board, input from clinic staff, and conducted formative interviews with clinic patients and providers to achieve overall acceptance of the program within the clinic. Clinic providers underwent training to deliver standardized prevention counseling. During program implementation we conducted a quality assessment of program components, including reviewing whether patients were screened for HIV transmission risk behaviors and whether providers counseled their patients. Once Positive Steps was implemented, on average, 69% of patients were screened and 77% of screened patients were counseled during the first 12 months. In analyses of quarterly exit surveys of patients after their medical exams, on average, 73% of respondents reported being asked about safer sex and 51% reported having safer-sex discussions with their providers across six quarterly periods. Of those who had discussions, 91% reported that those discussions were 'very' or 'moderately helpful.' Providers reported time and competing medical priorities as barriers for discussing prevention with patients, however, provider-delivered counseling was routinely performed for 12 months. Overall, the findings indicate that the Positive Steps program was successfully integrated in an infectious diseases clinic and received well by patients.

Disclosing child sexual abuse (CSA) is a necessary first step to access the legal, health, and psycho-social services that survivors and their families need. However, disclosure rates are low: of young women who experienced CSA in Zimbabwe, only 9% disclosed the first incident. The purpose of this qualitative study was to explore and describe perceived barriers to disclosing CSA in Zimbabwe. We conducted focus group discussions with children aged 10–14 years (n = 40) and their parents/caregivers aged 20–62 years (n = 40), participating in an intervention trial in Chitungwiza, Zimbabwe. We found that potential retaliation against survivors and their families is a major barrier to disclosing CSA. These retaliatory acts, which we refer to as "re-victimization," arise from stigma or the victim feeling blamed or doubted and manifest through physical violence, emotional violence, and deprivation of family life and education. Our findings suggest that addressing social and cultural norms related to sex and strengthening legal protection for CSA survivors and their families could encourage CSA disclosure and could help end this violence. Our findings also highlight a need to increase children's awareness of their rights and to create safe systems for disclosure of sexual abuse. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine whether brief training of human immunodeficiency virus(HIV) medical providers increased the frequency with which they routinely delivered prevention counsellingto patients, and whether patient characteristics were associated with receipt of that counselling.Design: Longitudinal.Setting: Seven HIV clinics in the United States.Method: Medical providers received training to deliver counselling to their HIV-positive patients. Theevaluation was conducted with a longitudinal cohort (N = 729) of patients at baseline (before providersreceived training) and at six and 12 months after the intervention was initiated. Participants reported onreceipt of routine counselling (at more than half of their primary care visits) about safer sex, disclosing HIVinfection to sex partners, and alcohol/drug use. Logistic regression and generalized estimating equations(GEE) methods assessed changes in receipt of counselling over time.Results: The percentage of participants reporting routine safer-sex counselling increased significantlyacross time (b = 0.12, standard error [SE] = 0.04; p = 0.004), as did receipt of routine counselling aboutdisclosing their HIV infection to sex partners (b = 0.21, SE = 0.05; p < 0.001). The trend was not significantfor counselling about alcohol or drug use. Sub-group analysis indicated that the upward trend in routinesafer-sex counselling was significant for men who have sex with men (MSM), for participants who had morethan one sexual partner in the past three months, and for those who had a CD4 count of > 500cells/mm3.Conclusion: Brief training increased the frequency with which HIV medical providers routinely deliveredprevention counselling to their patients at risk of transmitting HIV to others. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure. Materials and Methods: To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively. Results: Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands' HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing. Interpretation and Conclusion: The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India. [ABSTRACT FROM AUTHOR]

Objectives: To know the perceptions regarding barriers and facilitators to cART adherence among people living with HIV/AIDS MATERIALS AND METHODS: To adapt U.S. based SAFETALK "prevention with positives" intervention to be culturally relevant in Gujarat, India in assisting PLWHA, a formative study was conducted. We conducted 30 in-depth interviews with PLWHA in the local language, assessing the experiences, perceived barriers, and facilitators to combination antiretroviral therapy (cART) among PLWHA in Gujarat. PLWHA were selected from the Voluntary Counseling and Testing Centre (VCTC) in Gujarat. To triangulate interview findings, we conducted two focus group discussions (FGDs) with medical and non-medical providers, respectively., Results: Travel and commuting to clinic, fear of possible physical reactions, high cost of ART from private practitioners, CD4 count being in normal limits and resistance to medication acted as barriers to cART adherence. Initiation of cART was facilitated by family members' suggestion, advice of treating doctors and counselors, appropriate counseling before starting cART, belief that cART would aid in living a better and longer life and due to lowering of the CD4 count., Interpretation and Conclusions: Our study suggests that several issues need to be considered when providing cART. Further research is needed to study interactions between patients and their health care providers.