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Despite major progress against HIV, 21% of HIV+ people in the US are unaware that they are positive and an estimated 33% of those who know they are HIV+ are not engaged in care and treatment for their infection.Another 38% of newly diagnosed HIV+ individuals test so late that they receive an AIDS diagnosis at the same time as, or within one year of, learning they are positive. There were an estimated 56,300 new HIV infections per year between 1996 and 2006. Clearly, the US can and must do better in responding to the HIV/AIDS epidemic. One way to increase the percentage of HIV+ people engaged in care and treatment for their infection and improve their health outcomes is to focus on coordinating or co-locating HIV testing, care and treatment, social services and prevention programs. Increasing the percentage of HIV+ people who know their serostatus and are receiving care and antiretroviral treatment could also have benefits for HIV prevention. The National HIV/AIDS Strategy places testing and linkage to care, treatment and support services at the heart of the effort to improve the health outcomes of HIV+ individuals and prevent new infections. What is the scientific basis for this approach, how might it actually be implemented, and will it have the desired results in the real world?

Los programas educativos sobre la sexualidad y el VIH tienen varias metas: disminuir los embarazos no planeados, reducir las enfermedades de transmisión sexual (ETS) incluyendo la del VIH y mejorar la salud sexual de los jóvenes. En 2005 en los EE.UU., el 63% de todos los alumnos del último año de preparatoria (high school) habían tenido relaciones sexuales, pero sólo el 21 % de las alumnas usaron pastillas anticonceptivas antes del último coito y sólo el 70 % de los varones usaron condón en el último coito. En el 2000, el 8.4 % de las chicas entre 15 y 19 años se embarazaron, produciendo una de las tasas más altas de embarazo adolescente en el mundo occidental industrializado. Casi la mitad de los nuevos casos de ETS en EE.UU. del año 2000 (9.1 millones) se presentaron en jóvenes entre los 15 y los 24 años de edad. Algunos de los numerosos factores que influyen en la conducta sexual y el uso de protección entre los adolescentes tienen poco que ver con las relaciones sexuales, por ejemplo: la crianza en una comunidad desfavorecida, la falta de apego a los padres o el fracaso escolar. Otros factores de naturaleza sexual como las creencias, los valores, las percepciones de normas de los pares, las actitudes y habilidades relacionadas con la conducta sexual y con el uso del condón o de anticonceptivos, son factores en los que los programas de enseñanza potencialmente pueden incidir para generar cambios de conducta. Estos programas no pueden por sí solos eliminar las conductas sexuales riesgosas, pero sí pueden ser una pieza eficaz dentro de una iniciativa integral.

Sex and HIV education programs have multiple goals: to decrease unintended pregnancy, to decrease STDs including HIV and to improve sexual health among youth. In 2005, almost two-thirds (63%) of all high school seniors in the US had engaged in sex, yet only 21% of all female students used birth control pills before their last sex and only 70% of males used a condom during their last sexual intercourse. In 2000, 8.4% of 15-19 year old girls became pregnant, producing one of the highest teen pregnancy rates in the western industrial world. Persons aged 15-24 had 9.1 million new cases of STDs in 2000 and made up almost half of all new STD cases in the US. There are numerous factors affecting adolescent sexual behavior and use of protection. Some of these factors have little to do with sex, such as growing up in disadvantaged communities, having little attachment to parents or failing at school. Other factors are sexual in nature, such as beliefs, values, perceptions of peer norms, attitudes and skills involving sexual behavior and using condoms or contraception. It is these sexual factors that sex/HIV education programs can potentially affect, thereby impacting behavior. Sex/HIV education programs alone cannot totally reduce sexual risk-taking, but they can be an effective part of a more comprehensive initiative.

The overall goal of this study is to enhance the physical and mental health of rural Indian women living with AIDS and their children. We will achieve these goals through the use of trained village women as Accredited Social Health Activists (ASHA) to enhance the health of women and children through improved ART adherence, CD4 levels, and physical and mental health. This Indo-US collaboration between University of California, Los Angeles, University of California, San Francisco and All India Institutes of Medical Sciences (AIIMS) builds on our previous work with rural women living with AIDS and our successful ASHA program. Specific objectives include: Using a 2x2 factorial design, we plan to assess the effects of nutrition training and/or food supplements on primary outcomes for rural women living with AIDS in improving body composition and immune status (CD4 levels) as assessed at 6-, 12- and 18-month follow-up. Examining the effects of the program arms and their interaction on adherence to ART, psychological health, nutritional adequacy, and lipid profile over time.