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Rapid and accurate health literacy screening tools could assist interventions to improve care in the HIV clinic setting. Prior studies described brief screening questions for identification of persons with low health literacy, but the performance of these questions in HIV clinics is unknown. We examined the accuracy of provider perception and previously described brief screening questions for identification of low health literacy among 147 persons attending two HIV specialty clinics. Mean age was 41 and 48% were African American. Using the short Test of Functional Health Literacy in Adults (S-TOFHLA) as reference measure, the combined prevalence of marginal and inadequate health literacy (low health literacy) was 16%. Sensitivity and specificity of provider perception for identifying persons with low health literacy were 0.47 and 0.79. The screening question 'How confident are you filling out medical forms by yourself?' had an area under the receiver operator characteristic curve (AUROC) of 0.67. Response of 'somewhat' to this question had sensitivity 0.30, specificity 0.91, positive likelihood ratio 3.4 (95% confidence interval [CI] 1.8-6.4) and negative likelihood ratio 0.76 (95% CI 0.4-1.4). Educational attainment was a more sensitive but less specific measure of low health literacy (sensitivity 0.90, specificity 0.61 for completed high school or fewer years education), but was overall a more accurate discriminator of health literacy than either provider perception or screening questions (AUROC 0.79; p < 0.05 for comparison of AUROCs). HW providers often misjudge patients' health literacy. In the absence of rapid and accurate health literacy screening tools, clinics caring for persons with HIV/AIDS should implement clinic-wide interventions to improve health communication. DOI: 10.1089/apc.2009.0319

As antiretroviral treatment of HIV infection has become increasingly accessible, attention has focused on whether these drugs can used for prevention because of increased tolerability of newer medications, decreased cost, and the limitations of other approaches. We review the status of antiretroviral HIV prevention, including chemoprophylaxis, as well as the effects of treatment of infected individuals on prevention. It is possible that the life-saving agents that have transformed the natural history of AIDS can be a critical component of HIV prevention efforts, but their ultimate role in affecting HIV transmission dynamics remains to be defined. (Am J Public Health. 2010;100:1867-1876. doi: 10.2105/AJPH.2009.184796)

Circumcision's potential link to HIV/sexually transmitted infections (STI) has been at the center of recent global public health debates. However, data related to circumcision and sexual health remain limited, with most research focused on heterosexual men. This study sought to assess behavioral differences among a large sample of circumcised and noncircumcised men who have sex with men (MSM) in the United States. Data were collected from 26,257 U.S. MSM through an online survey. Measures included circumcision status, health indicators, HIV/STI screening and diagnosis, sexual behaviors, and condom use. Bivariate and regression analyses were conducted to determine differences between HIV/STI status, sexual behaviors, and condom use among circumcised and noncircumcised men. Circumcision status did not significantly predict HIV testing (p > 0.05), or HIV serostatus (p > 0.05), and there were no significant differences based on circumcision status for most STI diagnosis [syphilis, gonorrhea, chlamydia, human papilloma virus (HPV)]. Being noncircumcised was predictive of herpes-2 diagnosis, however, condom use mediated this relationship. These data provide one of the first large national assessments of circumcision among MSM. While being noncircumcised did not increase the likelihood of HIV and most STI infections, results indicated that circumcision was associated with higher rates of condom use, suggesting that those who promote condoms among MSM may need to better understand condom-related behaviors and attitudes among noncircumcised men to enhance the extent to which they are willing to use condoms consistently. DOI: 10.1089/apc.2010.0082

Heterosexually transmitted HIV remains of critical concern in the United States and around the world, especially among vulnerable and disadvantaged women, complicated by socioeconomic circumstances, gender power, addiction, and experiences of abuse, among other conditions. Effective woman-initiated HIV prevention options, such as the female condom (FC), are needed that women can use in different sexual relationship contexts. We conducted a behavioral and attitudinal survey with 461 primarily African American and Latina (especially Puerto Rican) women in Hartford, Connecticut, to measure factors on the individual, partner relationship, peer, and community levels influencing their initial and continued use of FC (using the prototype FC1) for disease prevention. We used multivariate analyses and structural equation modeling to assess effects of multiple level factors on FC use and unprotected sex with primary, casual, and paying partners. Initial, recent, and continued FC use was associated with factors on the individual level (education, marital status, drug use, child abuse experiences, HIV status), partner level (number of sex partners, paying sex partner, relationship power), and peer level (more or influential peers saying positive things about FC). Community level factors of availability and support were consistently poor across all sectors, which limited overall FC use. Patterns differed between African American and Latina women in stages and contexts of FC use and unprotected sex. FC can make a valuable contribution to reducing heterosexually transmitted HIV among women in many circumstances. The greatest barrier to increased FC use is the lack of a supportive community environment for its promotion and use. DOI: 10.1089/apc.2009.0312

Sexual agreements are ubiquitous among gay men. Lower levels of investment in these agreements may be associated with breaking them or engaging in risky sexual behavior. A scale was developed to measure agreement investment levels among gay men. Qualitative data from 78 gay men in committed relationships were analyzed to inform item development, followed by quantitative analyses of two larger samples (n = 380, n = 1,001) to assess construct, convergent, and discriminant validity. The Sexual Agreement Investment Scale (SAIS) is a psychometrically sound measure of the level of investment in sexual agreements among gay men in relationships. Men with higher agreement investment were less likely to break agreements and less likely to engage in unprotected anal intercourse with outside partners. The SAIS can be used to measure investment in sexual agreements and its impact on sexual behavior in a wide variety of settings, including research on relationships, sexually, couples therapy and HIV prevention., Over the past two decades, the AIDS epidemic has greatly impacted the lives and sexual behavior of gay men in the United States. Although HIV incidence among gay men significantly [...]

Objectives: To examine the independent effects of mood disorder, age, race/ethnicity, personal income, being a current student, having a regular medical doctor and substance use in relationship to condom use at last intercourse in a Canadian population stratified by sex. Methods: We used Cycle 3.1 of the 2006 Canadian Community Health Survey (CCHS 3.1), a population-based, voluntary, cross-sectional survey of subjects ages 12-85 years. Data collection took place between January and December 2005. From the survey, a study sample of 20,975 people was drawn, consisting of individuals providing valid responses (yes/no) to mood disorder and last-time condom use. The question of sexual behaviours was asked only of those ages 15-49 years. Logistic regression was used to examine individual variables as potential determinants of last-time condom use stratified by sex. Results: The relationship between mood disorder and condom use was non-significant in both males (AOR= 0.85, 95% CI=0.70-1.04) and females (AOR=0.90, 95% CI=0.78-1.03). Increasing age was found to be inversely associated with last-time condom use in both males and females. Male factors significantly associated with last-time condom use were being of white ethnicity (AOR=0.71, 95% CI=0.64-0.79) and being a current student (AOR=1.28, 95% CI=1.16-1.42). Female factors associated with last-time condom use were being of white ethnicity (AOR=0.71, 95% CI = 0.63-0.79) and being a former drinker (AOR=2.25, 95% CI=1.63-3.11). Conclusion: Our results identify important determinants of last-time condom use in both males and females in the CCHS 3.1. These findings may have important implications for the devising and implementation of safe sex programs in a Canadian population ages 15-49 years. Key words: Condom use; determinants; sexually transmitted infections; Canada La traduction du resume se trouve a la fin de l&apos;article. Objectifs: Examiner les effets independants du trouble de l&apos;humeur, de l&apos;age, de la race/ethnie, du revenu personnel, du fait d&apos;etre etudiant, d&apos;avoir un medecin regulier et de la toxicomanie en relation avec l&apos;utilisation du condom au cours de la derniere relation sexuelle dans la population canadienne stratifiee selon le sexe. Methodes: Nous avons utilise le Cycle 3.1 de l&apos;Enquete sur la sante dans les collectivites canadiennes (ESCC 3.1) 2006, une enquete ponctuelle volontaire, fondee sur la population, realisee aupres de sujets ages entre 12 et 85 ans. Nous avons effectue la collecte de donnees entre janvier et decembre 2005. A partir de l&apos;enquete, un echantillon d&apos;etude de 20 975 personnes a ete etabli, lequel etait compose de personnes ayant fourni des reponses valides (oui/non) en ce qui a trait au trouble de l&apos;humeur et a la derniere utilisation du condom. La question des comportements sexuels a ete posee seulement aux personnes agees de 15 a 49 ans. Nous avons utilise la regression logistique afin d&apos;examiner les variables individuelles comme determinants potentiels de la derniere utilisation du condom, ainsi qu&apos;une stratification selon le sexe. Resultats: La relation entre le trouble de l&apos;humeur et l&apos;utilisation du condom n&apos;etait pas significative, tant chez l&apos;homme (AOR= 0,85, IC 95%=0,70-1,04) que chez la femme (AOR=0,90, IC 95%=0,78-1,03). L&apos;augmentation de l&apos;age est par ailleurs inversement associee a la derniere utilisation du condom pour les deux groupes. Chez l&apos;homme, les facteurs principalement associes a la derniere utilisation du condom sont la race blanche (AOR=0,71, IC 95%=0,64-0,79) et le fait d&apos;etre etudiant (AOR=1,28, IC 95%=1,16-1,42). Chez la femme, les facteurs associes a la derniere utilisation du condom sont la race blanche (AOR=0,71, IC 95%=0,63-0,79) le fait d&apos;etre une ancienne alcoolique (AOR=2,25, IC 95%=1,63-3,11). Conclusion: Nos resultats ont permis de cerner dans l&apos;ESCC 3.1 des determinants importants sur la derniere utilisation du condom, tant chez l&apos;homme que chez la femme. Ces decouvertes peuvent avoir des repercussions importantes sur l&apos;elaboration et la mise en oeuvre de programmes sur les pratiques sexuelles sans risque chez la population agee de 15 a 49 ans. Mots cles: utilisation du condom, determinants, infections transmises sexuellement, Canada, Over the past decade, increases have been reported in the incidence rates of chlamydia, gonorrhea and infectious syphilis, with HIV continuing to be an ongoing concern. (1) These increases are [...]

HIV-prevention measures specific to injection drug users (IDUs), such as opioid substitution treatment and needle-and-syringe programs, are not provided in many countries where injection drug use is endemic. We describe the incidence of diagnosed HIV infection in IDUs and the availability and coverage of opioid substitution and needle-and-syringe programs in the European Union and 5 middle-and high-income countries. Countries with greater provision of both prevention measures in 2000 to 2004 had lower incidence of diagnosed HIV infection in 2005 and 2006. doi: 10.2105/AJPH.2008.141846)

Objectives. We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. Methods. We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. Results. Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. :Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; [chi square] = 4.32; P [less than or equal to] .04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; [chi square] = 8.06; P [less than or equal to] .01). Conclusions. Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women. doi: 10.2105/AJPH.2007.131482)

We interviewed 1038 HIV-positive inpatients in public hospitals in Miami, Florida, and Atlanta, Georgia, to examine patient factors associated with use of HIV care, use of antiretroviral therapy, and unprotected sexual intercourse. Multivariate analyses and multiple logistic regression models showed that use of crack cocaine and heavy drinking were associated with never having had an HIV-care provider, high-risk sexual behavior, and not receiving antiretroviral therapy. Inpatient interventions that link and retain HIV-positive persons in primary care services could prevent HIV transmission and unnecessary hospitalizations. doi:10.2105/AJPH.2008.139931)

HIV continues to be transmitted at unacceptably high rates among African Americans, and most HIV-prevention interventions have focused on behavioral change. To theorize additional approaches to HIV prevention among African Americans, we discuss how sexual networks and drug-injection networks are as important as behavior for HIV transmission. We also describe how higher-order social structures and processes, such as residential racial segregation and racialized policing, may help shape risk networks and behaviors. We then discuss 3 themes in African American culture--survival, propriety, and struggle--that also help shape networks and behaviors. Finally, we conclude with a discussion of how these perspectives might help reduce HIV transmission among African Americans. doi:10.2105/AJPH.2008.140327)

Few HIV prevention interventions have been developed for African American men who have sex with men or who have sex with both men and women. Many interventions neglect the historical, structural or institutional, and sociocultural factors that hinder or support risk reduction in this high-risk group. We examined ways to incorporate these factors into Men of African American Legacy Empowering Self, a culturally congruent HIV intervention targeting African American men who have sex with men and women. We also studied how to apply key elements from successful interventions to future efforts. These elements include having gender specificity, a target population, a theoretical foundation, cultural and historical congruence, skill-building components, and well-defined goals. doi:10.2105/AJ PH.2008.140558)

The HIV/AIDS epidemic has exacted a devastating toll upon Black men who have sex with men (MSM) in the United States, and there is a tremendous need to escalate HIV-prevention efforts for this population. The social context in which Black MSM experience the impact of racism and heterosexism strongly affects their risk for HIV infection; thus, HIV-prevention research focused on Black MSM should focus on contextual and structural factors. There is a pronounced lack of community-level HIV-intervention research for Black MSM, but effective preliminary strategies involve adapting existing effective models and tailoring them to the needs of Black MSM. Future research should develop new, innovative approaches, especially structural interventions, that are specifically targeted toward HIV prevention among Black MSM. doi:10.2105/AJPH.2008.143214)

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the 'front end' of the juvenile justice system than are detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender-and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD testing among new arrestees. With integrated linkages to treatment and prevention after release, this model could greatly reduce the STD burden in this underserved, high-risk population. doi:10.2105/AJPH.2007.122937)

Although gender-specific theories are often deployed in interventions to reduce women's HIV risks, the same is often not true for interventions among men. Theories of masculinity are not guiding most US research on the risky sexual behavior of heterosexual men or on what can be done to intervene. We first assess the extent to which evidence-based HIV-prevention interventions among heterosexually active men in the United States draw upon relevant theories of masculinity. Next, we introduce a useful framework within masculinity and gender studies that can be applied to HIV-prevention interventions with heterosexually active men. Finally, we make suggestions to improve the gender specificity of HIV-prevention interventions for heterosexually active men in the United States. doi:10.2105/AJPH.2008.149625)

Black men 'on the down low' have been considered prime agents of HIV transmission in the Black community despite little empirical evidence. We assessed the relationship between down-low identification and sexual risk outcomes among 1151 Black MSM. Down-low Identification was not associated with unprotected anal or vaginal sex with male or female partners. Future HIV prevention programs and research should target sexual risk behaviors of Black men, irrespective of identity, and not focus on the 'down low.' (doi:10.2105/AJPH.2007.127217)

Abstract: Emergency contraception (EC) is used to decrease the risk of pregnancy after unprotected sexual intercourse. There are two types of EC: emergency contraceptive pills (ECPs), and the post-coital copper [...]

Abstract: The current study surveyed primary care physicians to gather information on their testing practices for Chlamydia trachomatis among 15- to 24-year-old young women and to identify factors associated with [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.05.008 Byline: Joanne E. Mantell (a), Shari L. Dworkin (a), Theresa M. Exner (a), Susie Hoffman (a)(b), Jenni A. Smit (c), Ida Susser (d) Keywords: Female-initiated barrier methods; Gender relations and roles; Female condom; Microbicides; Diaphragm; HIV/STI prevention Abstract: New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on 'female-controlled' preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-a-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations -- for better and for worse -- shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneously, we demonstrate how the introduction and sustained use of methods are shaped by gender relations and offer possibilities for reinforcing or challenging their current state. Based on our analyses, we offer key policy and programmatic recommendations to increase promotion and effective use of women-initiated HIV/STI protection methods for both women and men. Author Affiliation: (a) HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Department of Psychiatry, Columbia University NY, NY, USA (b) Mailman School of Public Health, Columbia University NY, NY, USA (c) Reproductive Health and HIV Research Unit, University of the Witwatersrand, South Africa (d) City University of New York, USA

A study provides evidence for the feasibility and effectiveness of conducting voluntary counseling and testing (VCT) for HIV in a bathhouse setting. A convenience sample of 133 testers showed that in the months after VCT, men were less likely to engage in unprotected anal intercourse (UAI), decreased their frequency of engaging in sex while drunk or high and were more likely to communicate about HIV with their sexual partners.

A Markov model was developed for a study that examines the public health benefits and cost of a partially effective prophylactic HIV vaccine over 10 years in a population restricted to 15-year-old South African adolescent girls and future offspring. An important role is played by a partially effective HIV vaccine in HIV prevention in adolescents and infants in South Africa irrespective of other public policy implementations.

A study was conducted to identify risk factors for HIV and sexually transmitted infection (STI) service use patterns among 299 female commercial sex workers in Georgetown, Guyana. Results concluded that an active program of screening and treatment of ulcerative STIs should be combined with substance abuse services for sex workers (SW), and that condom promotion services are reaching SW at high risk, but HIV stigma may prevent SW at high risk from accessing HIV test results.

The patterns and behaviors among direct and indirect female sex workers across Cambodia's five major cities from 1997 to 2003 are identified. The results conclude that from 1997 to 2003, Cambodian direct and indirect sex workers increased the use of condoms each year with commercial as well as noncommercial partners, contributing to the evidence that HIV prevention programs could produce significant change in risk behaviors.

This paper describes crystal methamphetamine (crystal) use and sexual risk behaviors for two web-based surveys of men who have sex with men (MSM). The subjects were recruited online. Crystal use was associated with young age, having a greater number of sex partners, having unprotected anal intercourse (UAI), having a sexually transmitted infection (STI), and being HIV-positive. Significant regional differences were seen in the prevalence of crystal use. Findings are discussed in relation to the need to integrate messages about the relationship between drug use and sexual behavior into HIV prevention programs. KEYWORDS. AIDS, crystal, gay, HIV, HIV prevention, homosexuality, Internet research, men who have sex with men (MSM), methamphetamine, STI, substance use, unprotected anal intercourse (UAI)

Methamphetamine use has been closely linked to sexual risk taking in the gay and bisexual population. While previous studies have noted this relationship, few empirical investigations have quantified this association. As part of a larger, longitudinal study of club drug use among gay and bisexual men in New York City, the authors assessed the sexual risk taking of those who identified as methamphetamine users. A subset of these men, who reported either a seronegative or unknown HIV status, was confirmed to be HIV-positive. Comparisons of this group to confirmed HIV-negative methamphetamine using men in this study's sample indicated that these not known to be HIV positive individuals differed in their reasons for methamphetamine use and in terms of their sexual risk taking. In particular, those who had seroconverted reported higher levels of unprotected receptive anal intercourse while high. Our study confirms that methamphetamine may play a causal role in HIV infection and may fuel the HIV epidemic at large. KEYWORDS. Gay, HIV, homosexual, men who have sex with men (MSM), methamphetamine, seroconversion, sexually transmitted infections (STIs), sexual risk taking

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jss.2005.02.023 Byline: Henk Koning, Hans van Vliet Keywords: Architecture; IEEE Std 1471; Viewpoints Abstract: With the growing impact of information technology the proper understanding of IT-architecture designs is becoming ever more important. Much debate has been going on about how to describe them. In 2000, the IEEE Std 1471 proposed a model of an architecture description and its context. In this paper we propose a lightweight method for modeling architectural information after (part of) the conceptual model of IEEE Std 1471 and defining IEEE Std 1471 viewpoints. The method gives support by outlining in textual form and in diagram form the relation of the concerns of the stakeholders to the architectural information. The definition of viewpoints can then be done with insight from these relations. The method has four steps: (1) creating stakeholder profiles, (2) summarizing internal design documentation, (3) relating the summary to the concerns of the stakeholders, and (4) defining viewpoints. We have conducted a round of discussion and testing in practice in various settings. In this paper we present the feedback we received and propose improvements. Author Affiliation: Faculty of Science, Vrije Universiteit, Amsterdam, De Boelelaan 1081a, 1081 HV Amsterdam, The Netherlands Article History: Received 7 December 2004; Revised 7 February 2005; Accepted 11 February 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.compeleceng.2005.02.003 Byline: Xianwei Wu (a), David Jeff Jackson (a), Hui-Chuan Chen (b) Keywords: Fractal encoding; Image compression; Intelligent classification Abstract: In this paper we present a fast fractal encoding method based on an intelligent search of a Standard Deviation (STD) value between range and domain blocks. First, we describe the basic fractal image compression theory and an improved bit allocation scheme for Jacquin's Iterated Function System (IFS) parameter. Experimental results show that using a Fixed Scale Parameter (FSP) can shorten encoding time without significantly affecting reconstructed image quality. Second, we present a search algorithm based on the STD introduced by Tong. We enhance Tong's STD search algorithm by introducing a domain Intelligent Classification Algorithm (ICA) based on STD-classified domain blocks. The domain block search pool is pruned by eliminating multiple domain blocks with similar STD values. We refer to this pruning as the De-Redundancy Method (DRM). The domain search process is adaptive with the range block STD value of interest controlling the size of the domain pool searched. We refer to this process as the Search Number Adaptive Control (SNAC). Finally, we present experimental results showing the efficiency of the proposed method, noting a significant improvement over Tong's original STD method without significant loss in the reconstructed image quality. Author Affiliation: (a) Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487-0286, USA (b) Department of Computer Science, The University of Alabama, Tuscaloosa, AL 35487-0290, USA Article History: Received 29 September 2003; Accepted 14 February 2005