Adolescent girls in India carry a disproportionate burden of health and social risks; girls that do not finish secondary education are more likely to have an earlier age of sexual initiation, engage ...in risky sexual behavior, and consequentially be at greater risk of dying from pregnancy-related causes. This paper presents a comparison of girls in school and girls not in school from 665 participants in rural West Bengal, India. The social cognitive theory (SCT), a comprehensive theoretical model, was used as a framework to describe the personal, behavioral, and environmental factors affecting the lives of these adolescent girls. There were significant differences between girls in and out of school in all three categories of the SCT; girls in school were more likely to have heard of sexually transmitted diseases or infections than girls not in school (p<0.0001). Girls in school were also more likely than girls not in school to boil water before drinking (p=0.0078), and girls in school lived in dwellings with 2.3 rooms on average, whereas girls not in school lived in dwellings with only 1.7 rooms (p<0.0001). Indian adolescent girls who are not in school are disadvantaged both economically and by their lack of health knowledge and proper health behaviors when compared with girls who are still in school. In addition, to programs to keep girls in school, efforts should also be made to provide informal education to girls not in school to improve their health knowledge and behaviors.
Objective: To determine strategies to overcome barriers to HIV testing among persons at risk. Methods: We developed a survey that elicited testing motivators, barriers, and preferences for new ...strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Results: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. Conclusions: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status. PUBLICATION ABSTRACT
Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are ...available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.
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Programs for voluntary counseling and testing (VCT) for HIV play an increasingly important role in comprehensive prevention and care strategies. New technological advancements and behavioral ...interventions can improve the effectiveness of VCT as a tool for preventing new HIV infections and helping HIV-positive individuals access appropriate care. With growing consensus that early access to HIV therapy increases its effectiveness, and that individuals diagnosed with HIV reduce risk behavior, VCT has become integral to the continuum of HIV primary care. However, federal funding of VCT has declined, with concomitant decreases in numbers of people being tested. An estimated 200,000 people in the United States remain unaware that they are HIV positive, and many at-risk individuals do not seek out standard HIV counseling and testing services. To increase the acceptability and effectiveness of VCT, the authors recommend that VCT programs employ outreach programs offering anonymous testing to reach those at heightened risk of HIV infection, and to make rapid use of new technologies and counseling strategies to improve the reach and efficacy. Given the important role that VCT can play in both prevention and early treatment, the authors recommend significant increases in federal support.
Background: Home specimen collection and telephone counseling (HSCTC) may be a convenient new method for detection of HIV infection among cohorts at high-risk for HIV. Goal: To evaluate attitudes ...about HSCTC among participants, HIV counselors, and community advisory board members associated with a national multisite study of persons at high risk for HIV. Study Design: Twelve focus groups and surveys were conducted at six sites among 126 counselors, community advisory board members, and cohort participants. Results: Staff and community advisory board members raised concerns about the acceptability, feasibility, safety, and effectiveness of HSCTC. In contrast, participants (92%) reported a willingness to collect blood and oral samples on a frequent basis, and preferred telephone (73%) to office-based counseling. Conclusion: Home specimen collection and telephone counseling appear to be preferred by study participants at high risk of HIV infection. Staff and community advisory board members had stronger reservations than prospective users.
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Gay bathhouses and public health policy Woods, William J; Binson, Diane; Bérubé, Allan ...
Journal of homosexuality,
01/2003, Volume:
44, Issue:
3-4
Journal Article
Peer reviewed
Examines public health implications of public sex environments, focusing on prevention of HIV and other sexually transmitted infections among gay men in the US; 10 articles. Co-published as a ...monograph (soft. ISBN 1-56023-273-0) ($34.95) (hard. ISBN 1-56023-272-2) ($49.95) (LC 2003005401). Contents: Public health policy and gay bathhouses, by William J. Woods and Diane Binson; A theoretical approach to bathhouse environments, by Diane Binson and William J. Woods; The history of gay bathhouses, by Allan Bérubé; Number and distribution of gay bathhouses in the United States and Canada, by William J. Woods, Daniel Tracy, and Diane Binson; The San Francisco bathhouse battles of 1984: civil liberties, AIDS risk, and shifts in health policy, by Christopher Disman; Legal aspects of regulating bathhouses: cases from 1984 to 1995, by Scott Burris; Sex and the baths: a not-so-secret report, by Michael Helquist and Rick Osmon; Beyond the baths: the other sex business, by Michael Helquist and Rick Osmon; Desiging and HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability, by Freya Spielberg, et al.; Comparing sexual behavior patterns between two bathhouses: implications for HIV prevention intervention policy, by Matt G. Mutchler, et al.
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