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Lucy R Mgopa,1 B R Simon Rosser,2 Michael W Ross,3 Inari Mohammed,2 Gift Gadiel Lukumay,4 Agnes F Massae,4 Stella E Mushy,4 Dorkasi L Mwakawanga,4 Ever Mkonyi,2 Maria Trent,5 Zobeida E Bonilla,2 James Wadley,6 Sebalda Leshabari4, † 1Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania; 2Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; 3Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA; 4Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; 5Department of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA; 6Department of Counseling and Health Services, Lincoln University, Philadelphia, PA, USA†Dr. Leshabari passed away on October 16th, 2020.Correspondence: B R Simon RosserUniversity of Minnesota, 1300 S. 2 nd St. #300, Minneapolis, 55454, MN Tel +1 612- 624-0358Email rosser@umn.eduIntroduction: Africa has high rates of interpersonal violence and rape, although little is known about how these cases are handled in the clinical setting.Methods: We enrolled 121 health care professionals and students in Tanzania from the fields of midwifery, nursing and medicine, and conducted 18 focus group discussions stratified by both professional and clinical experience. Two clinical scenarios were presented across all groups and participants were asked to give their opinions on how the hospital they worked in would manage the cases. Case 1 focused on how to address a case of an injured woman beaten by her husband (and whether the perpetrator would be reported to the police). Case 2 focused on how to handle a rape victim who is brought to the hospital by the police.Results: Participants considered both cases as emergencies. There was a similarity in the clinical care procedures across both scenarios. This included building rapport with the patient, prioritization of the medical care, history taking, and referring to other specialties for follow-up. Participants differed in how they would handle the legal aspects of both cases, including whether and how to best follow mandated reporting policies. Providers wondered if they should report the husband in case study 1, the criteria for reporting, and where to report. Providers displayed a lack of knowledge about resources needed for sexual violence victim and the availability of resources.Conclusion: These findings indicate that cases of intimate partner violence and rape are likely to be under-reported within hospitals and clinics in Tanzania. Health care providers lack training in their required obligations and procedures that need to be followed to ensure victim’s safety. The findings confirm that there is a need for health care students in Tanzania (and possibly Africa) to receive comprehensive training in how to handle such cases.Keywords: IPV, violence, rape, GBV, health provider, Tanzania

Michael W Ross,1 James Ayers,2 William Schmidt,2 Thomas W Bugbee,2 Joan Knight,2 Brian K Muthyala,3 Nicholas P Newstrom11Program in Human Sexuality, Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN 55454, USA; 2UfaceME, Minneapolis, MN 55416, USA; 3Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USABackground: We developed an app (UfaceME) which simultaneously allows patient and clinician to be viewed on a split screen, then replayed and rated on a series of semantic differential scales and the ratings of the clinician of their own response to the interview, and the patient’s response, displayed on a graph.Method: We evaluated the app with trials with 14 medical student volunteers who alternated the roles of patient and clinician, using 2 randomly allocated sexual case histories. Semantic differentials for 10 adjectives were examined pre- and post-exercise. There were significant differences in 8 of the 10 adjectives. A focus group with the 14 subjects was also carried out and transcribed. The exercise was repeated with all 175 first-year medical students taking a sexual history.Results: Qualitative data indicated themes of being surprised and educated by non-verbal and verbal responses; seeing how the patient rated their responses; rating and watching discomfort; differences in clinician/patient perceptions and response; and the advantage of feedback. Quantitative data comparing self vs “patient” showed low correlations between perceptions of being “at ease”, moderate for appearing “distracted”, and high for appearing “engaged”.Conclusion: UfaceME was easily understood and used, and the opportunity to replay and rate performance on key semantic scales, and watch and assess verbal and non-verbal performance, including patient rating, provided valuable insight.Keywords: sexual history, interview skills app, medical students, training feedback

Little is known about the dating preferences of Asian American gay men. To conceptualize the dating preferences among these men, the impact domains model (IDM) was used to investigate if nativity and/or acculturation might explain dating preferences. Previous studies have pointed out the problematic nature of a racist cultural stereotype that Asian American gay men prefer white partners (Choi, Yep, & Kumekawa, 1998; Han, 2008). The current findings do not support that Asian American gay men prefer white partners. In our sample, 17.1% preferred dating white men and over 20% preferred Asian men. Over 60% had no clear racial/ethnic dating preference. Multivariate analyses indicated that those reporting higher ethnic acculturation (p

High levels of material with lymphotoxin- (LT) like activity, cytolytic for L-929 cells in vitro, were rapidly released by lymphoid cells obtained from rat, guinea pig, hamster, and rabbit after co-culture for 7 to 10 hr with lectin-coated L-929 cells in vitro. These supernatants were all rapidly fractionated under similar conditions by molecular sieving, ion exchange chromatography, and polyacrylamide gel electrophoresis, and the results were compared to those previously obtained for human and murine LT molecules. The activity in all supernatants was separated by gel filtration into multiple m.w. classes that were strikingly similar to those previously assigned to human and murine LT molecules, i.e. complex (>200,000 d), α (70 to 150,000 d), β (35 to 50,000 d), and γ (12 to 20,000 d). The α m.w. class was resolved on Ultrogel AcA 44 into two distinct m.w. forms, termed α heavy (α(H)) (110 to 150,000 d), and α light (α(L)) (70 to 100,000 d). All supernatants contained LT forms of the Cx, α(H) and α(L) m.w. classes. The smaller β and γ m.w. forms were not as evident in supernatants induced in this fashion. The percentage of activity in each m.w. class varied, but the majority of activity was generally due to α(H) and α(L) forms. However, the relative percentage of activity in any given m.w. class was dependent upon the ionic strength of the separating column buffer. The actual molecular dimensions of materials within the α m.w. class varied somewhat between species, however, they did not vary within the smaller m.w. β and γ forms when detected. The α(H) and α(L) m.w. forms could each be further resolved into multiple charge subclasses. Although the α(H) and α(L) forms in guinea pig and rabbit have been shown by immunologic and/or physical data to be related forms, they can be distinguished by charge from one another. This evidence supports the concept that LT molecules detected in supernatants from experimental animals, although heterogeneous, represent a system of related subunits similar to that defined for the human and mouse. Moreover, this system of cell toxins appears to be conserved in evolution and has common features in each of the animals examined in this study.

How accurately condoms are being used vary across populations and knowledge of the factors determining its proper use remains unclear. Knowledge of such differentials and determinants would aid in evaluating the contributions of condom use to HIV epidemic reduction. Baseline data from the Situationally Focused Individual HIV/AIDS intervention to promote HIV protective behavior among 2,213 Nigerian Military Personnel were analyzed. Educational status as a predictor variable was assessed using univariable and multivariable logistic regression model. Compared to those with less than high school education, those with high school and some college education were two times more likely to demonstrate knowledge of condom use and modeling, prevalence odds ratio (POR), 2.32, 95% Confidence Interval (CI)=1.60-3.37. After adjustment for the relevant covariates, higher education attainment was associated with non-significant 62% increase in knowledge and modeling, POR, 1.62, 95% CI=0.78-3.38. This study is indicative of low knowledge of condom use and modeling among the Nigerian military personnel; as well as a direct correlation between education attainment and knowledge of condom use and modeling. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) and sexually transmitted disease (STD)-related risks in peacekeeping troops is a concern when they are stationed in areas of high HIV prevalence. We carried out an assessment of a situationally focused individual HIV/STD reduction intervention (where avoidance of risk situations, as well as risk behaviors, are emphasized) in one Nigerian military unit (N = 1,222), with a comparable unit from the same service as a waiting list control (N = 987). The intervention consisted of a possible five modules that were presented to groups of up to 50 personnel. Data were collected on reported sexual behaviors, condom beliefs, sexual risk behaviors with casual partners, and number of interventions attended. Data indicated significant increases in reported condom use with casual partners and positive condom beliefs at 6- and 12-month follow-up. Risk behavior was reduced 30% from baseline at 6 months and 23% from baseline at 12 months. There was also a significant dose-response effect for number of interventions attended. These data suggest that relatively brief situationally focused individual interventions are effective in military and West African contexts in reducing HIV/STD risk behaviors. [ABSTRACT FROM AUTHOR]

The purposes of the study were to measure adherence with antiretroviral therapy to dose, schedule, and dietary instructions in a sample of patients with HIV infection in Stockholm, Sweden, over a 2-year period and identify baseline predictors of the three types of adherence. The study cohort consists of 144 patients who completed at least six out of seven follow-up self-reported adherence questionnaires. Baseline self-administrated questionnaire examined socio-demographics, medication-related, psychological, cognitive, and social context factors and self-reported adherence. Biomedical data were obtained through patients' medical records. Summary dose, schedule, and dietary instructions adherence scores provided outcome measures reflecting 100% adherence across all time points or not 100% adherence during at least one measurement period. A total of 61% maintained consistent full-dose adherence throughout baseline and all follow-up visits and equivalent proportion of 100% schedule adherence was 39%. Among patients with dietary instructions, 37% retained consistent adherence at all visits. Only schedule adherence was predicted by baseline data; perceived pressures from medical staff to take HIV medications (OR 0.51, p .05), life stress (OR 0.13, p .01), ART health concerns (OR 0.19, p .01), and ART prolongs one's life (OR 0.39, p .05) predicted reduced schedule adherence over time. Perceived medication pressures from those close to the patient (OR 1.76, p .05), post-traumatic stress disorder symptoms (OR 1.07 p 01), and adherence self-efficacy (OR 3.50, p .05) predicted positive schedule adherence over time. These results clearly illustrate difficulties in sustaining ART adherent behaviour, in particular schedule and dietary restrictions, over time and thus emphasizes the importance of multiple periodic assessments of all three types of adherence. Interventions aimed at improving schedule adherence should in particular focus on psychological and cognitive factors. [ABSTRACT FROM AUTHOR]

The purposes of the study were to measure adherence with antiretroviral therapy to dose, schedule, and dietary instructions in a sample of patients with HIV infection in Stockholm, Sweden, over a 2-year period and identify baseline predictors of the three types of adherence. The study cohort consists of 144 patients who completed at least six out of seven follow-up self-reported adherence questionnaires. Baseline self-administrated questionnaire examined socio-demographics, medication-related, psychological, cognitive, and social context factors and self-reported adherence. Biomedical data were obtained through patients' medical records. Summary dose, schedule, and dietary instructions adherence scores provided outcome measures reflecting 100% adherence across all time points or not 100% adherence during at least one measurement period. A total of 61% maintained consistent full-dose adherence throughout baseline and all follow-up visits and equivalent proportion of 100% schedule adherence was 39%. Among patients with dietary instructions, 37% retained consistent adherence at all visits. Only schedule adherence was predicted by baseline data; perceived pressures from those close to the patient to take HIV medications (OR 0.51, p<.05), life stress (OR 0.13, p 0.009), ART health concerns (OR 0.19, p 0.003), and ART prolongs one's life (OR 0.39, p 0.04) predicted reduced schedule adherence over time. Perceived medication pressures from medical staff (OR 1.76, p<.05), post-traumatic stress disorder symptoms (OR 1.07 p<.01), and adherence self-efficacy (OR 3.50, p<.05) predicted positive schedule adherence over time. These results clearly illustrate difficulties in sustaining ART adherent behaviour, in particular schedule and dietary restrictions, over time and thus emphasizes the importance of multiple periodic assessments of all three types of adherence. Interventions aimed at improving schedule adherence should in particular focus on psychological and cognitive factors. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether African-American men and women who smoke crack cocaine recognize the difference between the male and female condom and whether beliefs about male or female condoms are significantly different by type of condom.Methods: This study was nested in a larger study that is testing the efficacy of an intervention to encourage male and female condom use among African-American crack-cocaine smokers. Participants were randomly assigned to one of four study groups. Each study group received an identical questionnaire, except for the items measuring condom-use attitudes and beliefs, which were differentiated by type of condom.Results: One hundred and sixty-five crack smokers took part in the study. Of these, 62% were male and 84% were single. Means for the groups were compared using one-way ANOVA analyses and no significant differences were found in attitudes/beliefs about condoms by type.Conclusions: These data suggest that baseline attitude/belief measures about use of the female condom are invalid 'starting' points to test the efficacy of interventions designed to increase use of the female condoms because respondents are giving answers based on the attitudes/beliefs about the male condom or are giving 'random' responses. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to report on the construction of the HIV Medication Self-Reported Nonadherence Reasons (SNAR) index and its psychological correlates. Data were derived from a sample of 193 Swedish HIV-seropositive women and men receiving antiretroviral medications. Participants who reported dosing and/or scheduling and/or dietary instructions nonadherence in the past 7 days were presented with a modified AACTG list of 18 reasons for nonadherence. From these data, two conceptually and statistically independent factors were obtained, which accounted for 39% of the variance in the data. These factors were used as the basis for constructing two composite measures composing the SNAR index: the Medication concerns scale and the Routine disruption scale. The Medication concerns scale correlated significantly to suboptimal dose and scheduling adherence and Routine disruption scale with poorer dietary instructions adherence. Psychological distress was the best predictor of the SNAR index. The SNAR index has a clearly interpretable factor structure that allows the derived scales to be useful as multi-item measures of self-reported reasons for nonadherence to HIV antiretroviral medications. The psychological factors found to be associated with the index may imply a number of mental-health-related interventions to improve adherence, which deserve further exploration. [ABSTRACT FROM AUTHOR]

The development of treatment regimes for African-American HIV-infected crack cocaine users has often been based on assumptions about compliance with medication regimes rather than evidence. This study sought to obtain baseline information on the adherence to antiretroviral medications by members of this important risk population in Houston, Texas. It was found that for only 5 of a range of 16 antiviral medications was there a significant correlation between levels of compliance reported by respondents and their beliefs as to how effective these medications are. Medication compliance was also found not to be associated with frequency of crack cocaine use in the month prior to interview. Furthermore, irrespective of both gender and their reported extent of medication compliance, the respondents tended to report positive relationships with their treating physician, with higher levels of satisfaction reported by women. These results suggest that the majority of African-American crack cocaine users are able to comply with HIV treatment regimes, with more than half (53%) claiming full compliance for one or more medications, and a further one third (31%) claiming compliance more than half the time. Moreover, these findings suggest that they will continue to take antiretroviral medications even if they have doubts about the effectiveness of these medications. [ABSTRACT FROM AUTHOR]

Of 490 middle and high school students attending alternative schools who participated in this study, 18.2% of females and 6.7% of males reported a past unwanted sexual experience. Relative to nonabused subjects, female and male adolescents who reported a forced sexual experience were more likely to exhibit externalizing problems such as sexual risk behaviors and internalizing problems such as depression and suicidal thoughts in the past two weeks. Females with a history of a coercive sexual experience also had increased odds of drug and alcohol use, and violence-related behaviors. The magnitude of these associations ranged from a twofold increase to a tenfold increase. Controlling for ethnicity, family income, and family support had less impact on the strength of associations between a forced sexual experience and sexual risk behaviors for females than for males. A forced sexual experience remained significantly associated with depression for females and suicidal thoughts for males. Alcohol use in the past 30 days was the only substance use-related problem that remained significant for females. Violence-related behaviors did not remain significant in the presence of control variables for females. Interventions focusing on adolescents with a history of a coercive sexual experience in general, and in alternative schools in particular, are suggested by these results. More research focusing on the differential impact of a coercive sexual experience on males and females is crucial. [ABSTRACT FROM AUTHOR]

We studied the situational determinants of condom use for vaginal sex in 151 African-American crack cocaine users in Houston, Texas, using situational presentation (Sitpres) methodology, which uses hypothetical scenarios with randomly generated levels of eight variables across 10 scenarios that may impact the decision to use a condom. Multiple regression showed that variables associated with a high probability of using a condom were older age, how badly the partner wants to use a condom, and how badly the respondent wants vaginal sex. Crack craving or level of intoxication were not correlates. The Sitpres methodology was successfully used by these crack users and data indicated that it was sexual variables, rather than drug-associated variables, that were significantly associated with condom use. [ABSTRACT FROM AUTHOR]

This paper presents the results of an evaluation of a brief, educational HIV risk reduction intervention implemented in a community setting. Participants were 7,733 not-in-treatment drug users. Multi-item needle and sex risk measures were developed to assess the efficacy of the intervention. Behavior change was assessed within 6 empirically derived homogeneous risk groups. Drug users in all 6 groups reduced their needle use and sexual risks after participating in the brief educational intervention. Sexual risks were reduced to a greater extent than were risks associated with needle use, both in relative terms and when measured as a percentage of risk exhibited at intake. Brief educational interventions may be more effective in reducing sexual risk behaviors than it was previously believed. Needle risk, on the other hand, appears to be more robust, especially among high frequency cocaine injectors. Theses findings suggest that HIV prevention strategies may be more effective and more efficient if drug users are triaged into an intervention appropriate to their level of needle risk. [ABSTRACT FROM AUTHOR]

This paper addresses the question of whether sexual activity and partner characteristics differentiate people in different stages of change. Factors expected to distinguish people in different stages of change were partner type, drug use during sex, and HIV status. Three discriminant functions emerged. The loading matrix demonstrates that partner type was the strongest predictor that distinguished people in the precontemplation stage from those in the preparation, action, and maintenance stages (first function) (.962). The loadings on the second discriminant function suggest that when controlling for partner type, HIV status (.935) was the best predictor for distinguishing between the people in the maintenance stage and those in the other stages. The loadings on the third function were not significant. The overall classification results indicate that individuals using crack cocaine and engaging in high risk sexual behaviors can be classified into the stages of change for condom use based on these variables. [ABSTRACT FROM AUTHOR]

This study collected data from 362 men who had sex with men at cruising areas in the Netherlands, and measured characteristics of respondents, sexual risk behavior, and risk perceptions. Furthermore, the study assessed whether outreach activities at cruising areas promote safe sex behavior. Almost one in five respondents reported having sex with both men and women, and 18.5% of respondents reported sexual risk behavior at cruising areas. Men who had a conversation about safe sex with a volunteer used condoms more consistently than men who had not spoken with a volunteer. Finally, it was found that behaviorally bisexual men used condoms less frequently at cruising areas. The relatively high levels of risk-taking sex stress the importance of HIV prevention at cruising areas. Furthermore, special attention could be given to cruising area visitors who have sex with both men and women, because they report higher levels of risk behavior and have less access to safer sex information regarding homosexual behavior. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the relationships between social skills/anxieties in HIV/STD prevention and actual and anticipated sexual behaviors in year 11 and 12 Indian college students. A quantitative questionnaire examining HIV and STD risk behaviors, knowledge, attitudes and beliefs, and the AIDS Social Assertiveness Scale (ASAS) were administered to 1230 year 11 and 12 Indian college students. The 5 scales of the ASAS were scored and compared between three groups: those who had had sexual experience (HS), those who anticipated being unable to refuse sex (AS), and those who did not anticipate problems in refusing sex (DS). Those in the AS group had significantly greater anxieties about refusing sexual or other risk behaviors than the HS and DS groups, and there were also significantly greater anxieties about dealing with condoms in the AS and DS groups compared with the HS group. Confiding sexual or HIV/STD related problems to significant others was considered more anxietyprovoking for the AS group compared with the HS group, and the AS group were more anxious about interactions with people with HIV. Factor analysis produced the same 5 dimensions as those found in previous studies. Condom interactions and confiding in significant others were most anxiety provoking. It is concluded that social skills training in sexual negotiations, condom negotiations, and confiding HIV/STD-related concerns to significant others should reduce the risks of Indian college students having unwanted or unprotected sex. [ABSTRACT FROM AUTHOR]

This study examines the social anxieties associated with HIV prevention in adolescents in three African countries (Nigeria, Kenya, and Zimbabwe). The subjects used in this study were black Africans in form 2 or grade 10 in public high schools (Nigeria, n = 387; Kenya, n = 274; Zimbabwe n = 313). Subjects responded to the 33 item AIDS Social Assertiveness Scale (ASAS). Data indicated similar factor structures for each of the three countries and included five factors. The combined sample factor intercorrelations were modestly but significantly correlated. The mean scores for each factor were compared, and ANOVA of the factors by country, by gender, and by interaction between country and gender were performed. The factor structures were very similar between countries, each including five factors that had similar themes: condom interactions, refusal of risk, confiding in significant others, contact with people with HIV/AIDS, and general assertiveness. These factor structures were also very similar to one found in previous studies of Australian adolescents on the ASAS. The Kenyan means for four of the five factors were significantly lower than those for Nigeria, and were also significantly lower than the Zimbabwean means for two of the five factors, suggesting that Kenyan students are less anxious about social situations related to HIV/AIDS than others. Significant variance was found for several factors due to gender, country, and the interaction between gender and country. These results have important implications for designing education programs. The similarities of anxieties regarding HIV/AIDS social situations suggest that these clusters of social barriers to reduction of HIV infection risk might form the basis of educational interventions, and that dimensions of HIV social anxieties are similar across countries. [ABSTRACT FROM AUTHOR]

A total of 1230 year 11 and 12 anglophone college students, modal age 16 and 17, in three colleges in Mumbai (Bombay), India, were studied with regard to sexual behaviours or risk of sexual behaviours, beliefs about sex, HIV/STD knowledge, and perceived norms regarding sexual behaviours. Data indicated that 8% of males and 1% of females had had sexual experience, but over one-third were not sure at all of being able to abstain from sexual activity with either steady or casual partners. However, perceived norms were slanted toward sexual abstinence for the majority of the sample. Knowledge of the protective effects of condoms was high, although half of those who had had sex did not use condoms. Logistic regression showed that knowledge was higher among males, those who believed it was OK to have sex with a steady partner and that they should not wait until they were older, those who believed that condoms should be used even if the partner is known, and those who believed it was acceptable to have multiple partners. Gender differences in sexual activity and beliefs about sexual activity showed that males were less likely to believe in abstaining from sexual activity and to engage in it. We conclude that this age-group is appropriate for HIV/STD reduction education given the low rate of sexual activity but that, despite knowledge of the importance of condom use, the social skills to apply this knowledge are lacking. [ABSTRACT FROM AUTHOR]

This article reports on homosexually active men's beliefs about being at sexual risk. Results were generated from paid, in-depth, face-to-face interviews about sexual behavior carried out first with 4 pilot respondents, then with 21 gay respondents aged 18-39, half of whom were HIV seropositive. Findings suggest that there is not a close match between what is epidemiologically accepted as risk behavior and what respondents regarded as risk behavior. The heuristic on which the men based their perceptions of sexual risk comprised a pattern of activities in which there are few absolutes, contrary to the distinctions of 'safe', 'safer', and 'unsafe' categories used by health educators. The men used several categories as signifiers of risk: factors such as age, appearance, diction, and HIV knowledge together with variables reflecting epidemiological data, such as few partners, being the insertive partner in anal intercourse, and past history of infrequent unprotected anal intercourse, and situational determinants such as emotional needs, sexual arousal, and relationship status were constructed into a hierarchy of risk. These hierarchies or pseudo-epidemiological models of risk are similar to what Levine and Siegel (1992) term 'folk constructions' of risk of HIV transmission. [ABSTRACT FROM AUTHOR]

Although there is growing evidence of differences between women and men who inject drugs (IDUs) in terms of level of risk for HIV infection, very little research has been conducted specifically addressing the risk practices of women IDUs. This study formed part of a national study of HIV infection risks in IDUs and the purpose of the present analysis was an exploration of gender differences in HIV risk practices, focusing on the HIV risk practices of IDU women. 1,245 IDUs from the inner city area of Sydney took part in this study. Of these, 908 were men and 331 were women. Notable results were that female respondents were more likely to report sharing needles, they injected heroin more times in a typical using month and were more likely to have shared with someone they later found out was HIV seropositive. Female respondents also reported more sexual partners than men, were more likely to engage in prostitution, and were more likely to have sexual partners who were themselves IDUs. The results provide support for the proposition that women who inject drugs may be at greater risk of HIV infection through both their drug taking and their sexual practices. Further research is needed to explore the reasons underlying the risk practices of women who inject drugs and an understanding of these factors needs to be incorporated into HIV risk-reduction and drug harm-reduction policies and programs. [ABSTRACT FROM AUTHOR]

While the influences of the Internet on adult sexuality are well recognized, research on the potential connection between the Internet and young people's sexuality is still limited. We conducted a qualitative study to examine how young people (aged 15-19 years) in Hanoi, Vietnam used the Internet to develop sexual practices and identities. Our analysis of texts from focus groups, in-depth interviews, chat scripts and field notes reveals how the Internet is used to assemble sexual information that was not available from other sources such as the family and school. Young people's narratives also show how they use the Internet as a medium for expressing sexual identities and desires. In the light of these findings, we suggest expanding sex education to include issues that are important to young people such as emotions and relationships, rather than simply focusing more narrowly on reproduction, public health and other interests of the state. [ABSTRACT FROM AUTHOR]

This study examines the intersection between needle-sharing practices and HIV recovered from used syringes collected from 73 heroin injection drug users (IDUs) in Dar es Salaam, Tanzania, between October 2003 and January 2004. To extract blood residue, syringes were flushed and 10 microliters of solution mixed with 120 microliters of a latex solution was placed on a Capillus HIV-1/2 slide. Thirty-five (57%) of the useable syringes tested positive for HIV antibodies. Results varied significantly: 90% of syringes tested HIV positive in a mixed-income neighborhood 2 kilometers from the city center: 0% of syringes tested HIV positive in the outlying areas. In addition, semistructured interviews were conducted with 51 IDUs. The interviews were content coded, and codes were collapsed into emergent themes regarding syringe-use practices. Injecting is a recent practice, particularly among heroin users in neighborhoods far from the city center. Sharing syringes has resulted in a high proportion of used syringes containing HIV-positive blood residue. Geographic distance is an indicator of recent adoption of IDU in neighborhoods and correlates strongly with the distribution of syringes containing HIV-positive blood residue. [ABSTRACT FROM AUTHOR]

HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the 'geto' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin 'ghettoes' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion. [ABSTRACT FROM AUTHOR]

There is some evidence, although conflicting, to suggest that socialization or acculturation into the gay community is associated with lower levels of unsafe sex. We attempted to determine the relationship between acculturation and sexual safety. We examined data from 282 men (from the Dallas AIDS Community Demonstration Project) who had sex with men and were not in a monogamous relationship to determine the associations between safer sex and indices of acculturation. The indices of acculturation included regular reading of local and national gay newspapers and magazines, and belonging to an organization for gay men. The data indicated that there were significant relationships between acculturation, talking to sexual partners about HIV risk reduction and sexual identity, and the dependent variable of frequency of condom use for anal sex. A regression equation indicated that 21% of the variance of anal condom use was predicted by these variables. These data suggest that acculturation into the gay community is associated with safer sexual behaviour, and we discuss the implications of these data for using role models and normative beliefs in HIV prevention programmes. [ABSTRACT FROM AUTHOR]

Statistics show that the prevalence of crack cocaine use and embalming fluid and phencyclidine (PCP)-laced cigarettes or marijuana sticks, commonly referred to on the street as 'fry' or 'wet' is a problem; however, the relationship between these substances of abuse and concurrent polydrug use is unknown. In the present study, a cross-sectional survey was conducted among 426 African-American crack users in Houston, Texas, to investigate the difference between those who concurrently reported lifetime (defined as at least one usage of fry in life) fry use and those who stated they never used fry. The data were analyzed using chi-square and logistic regression analyses. Fry users were significantly more likely than non-users to not have a casual sex partner (92% users vs. 84% non-users, p <= 0.05) and were more likely to have been diagnosed with gonorrhea in the past 12 months (9% users vs. 2% non-users, p <= 0.05). In addition fry users had significantly higher odds of currently trading sex for drugs (OR = 2.30, p <= 0.05), marijuana use (OR = 12.11, p <= 0.05), and codeine (syrup) use (OR = 8.10, p <= 0.05). These findings are important in determining the 'cultural novelties' relative to crack and fry use among younger African Americans. [ABSTRACT FROM AUTHOR]

The goal of this study was to explore whether a history of sexual abuse is associated with high-risk sexual behaviors among female adolescents attending alternative schools in a large urban city in the southwestern United States, and to examine the role of depression and substance abuse in explaining this association. One hundred eighty-four sexually active female adolescents constituted the sample for this analysis. Forty-nine (26.6%) reported that they were forced to have sex. Having a history of sexual abuse substantially increased sexual risk behaviors. Adolescents reporting a history of sexual abuse, compared to those who did not report such a history, were significantly more likely to have initiated sexual activity (intercourse) before age 14, to have had three or more sexual partners in the last 3 months, and to have had a history of sexually transmitted diseases. These associations remained significant afar controlling for age, ethnicity, and family income. Depression and substance abuse did not explain the association between sexual abuse and high-risk sexual behaviors. It seems reasonable to conclude that adolescents with a history of sexual abuse have greater difficulty practicing safe sexual behaviors than do those who have not been sexually abused. Given the prevalence of child sexual abuse and the extent of its impact, it is critical that intervention strategies for adolescent females address the issue of abuse and help them adopt self-protective sexual behaviors. The findings also highlight the importance of targeting adolescents who attend alternative schools. [ABSTRACT FROM AUTHOR]