Library
Mujeres
¿Qué necesitan las mujeres en la prevención del VIH en EEUU?
¿corren riesgo de contraer el VIH?
Sí. El VIH afecta a cada vez más mujeres y muchachas en EEUU. En 1985, las mujeres componían el sólo el 8 % de los casos de SIDA en EEUU, en comparación con el 27 % en el año 2005. Para el 2005, las mujeres ya representaban el 30 % de las nuevas infecciones por VIH, de las cuales el 60 % eran afroamericanas, el 19 % caucásicas, el 19 % hispanas y el 1 % asiáticas/isleñas del Pacífico e indígenas americanas/nativas de Alaska, respectivamente.
¿qué mujeres son más afectadas por el VIH?
El VIH/SIDA afecta desproporcionadamente a las mujeres afroamericanas y las hispanas. Aunque estos dos grupos componen sólo el 23 % de la población femenina de EEUU, en el año 2005 representaban el 79 % de los casos nuevos de infección por VIH (afroamericanas: 60 %, hispanas: 19 %). En el 2004 la infección por VIH fue la primera causa de muerte entre mujeres negras (incluidas las afroamericanas) entre 25 y 34 años de edad. El VIH/SIDA también afecta a mujeres más jóvenes. En años recientes, el mayor número de diagnósticos de VIH/SIDA entre mujeres se dio en las que tenían entre 15 y 39 años de edad. En el 2005, las mujeres jóvenes representaban el 28 % de los casos de SIDA entre mujeres y hombres de 20 a 24 años de edad.
¿qué pone en riesgo a las mujeres?
La mayoría de las mujeres contraen el VIH por medio del contacto heterosexual, especialmente si su pareja se inyecta drogas. En el 2005, el 80 % de las nuevas infecciones entre mujeres se debían al contacto heterosexual. Las mujeres son más propensas que los hombres a adquirir el VIH durante el coito debido a que, dentro del tracto genital femenino, una mayor superficie queda expuesta. El consumo de drogas (inyectables o no inyectables) aumenta el riesgo que corren las mujeres de contraer el VIH y está fuertemente vinculado a las prácticas sexuales riesgosas. Aproximadamente el 20 % de los nuevos casos femeninos de VIH se relaciona con el uso de drogas inyectables. Las consumidoras de cocaína en roca (crack) también pueden correr un riesgo elevado de transmisión del VIH, en particular si venden o intercambian el sexo por drogas. Las infecciones de transmisión sexual (ITS) que no sean el VIH pueden aumentar las posibilidades de adquirir o de transmitir el VIH. En EEUU, la clamidia y la gonorrea (ambas infecciones asintomáticas) son las ITS que se reportan con mayor frecuencia, con las tasas más altas entre las mujeres no caucásicas, las mujeres jóvenes y las adolescentes. El abuso sexual (en la niñez y en la edad adulta) y la violencia doméstica juegan un papel fundamental en aumentar el riesgo de contraer el VIH. Cada año 2.1 millones de mujeres son violadas y cuatro millones son víctimas de la violencia doméstica en EE.UU.; de estas mujeres, más de 10,000 mujeres violadas y 79,000 de las víctimas de abuso requieren hospitalización. Las mujeres que han sufrido abuso sexual desde temprana edad y en forma crónica son siete veces más propensas a participar en conductas que las ponen en riesgo de contraer el VIH que otras mujeres sin antecedentes de trauma. Las mujeres sufren desproporcionadamente de la pobreza, en particular las mujeres no caucásicas con VIH, lo cual reduce sus posibilidades de tener seguro médico y acceso a servicios médicos o preventivos de alta calidad. En EEUU, unos dos tercios de las mujeres con VIH tienen ingresos anuales por debajo de $10,000. La pobreza puede aumentar los riesgos de VIH tales como el intercambio del sexo por dinero, alojamiento o drogas. Entre las mujeres jóvenes y de bajos ingresos encuestadas en California, las que afirmaron haber hecho trabajo sexual tenían tasas más altas de sífilis, herpes, hepatitis C y antecedentes de abuso sexual. El abuso, la violencia y la pobreza pueden minar el poder de la mujer a la hora de negociar el uso de condones o de escoger parejas sexualmente más seguras. También pueden llevar a problemas psicológicos como la depresión, la ansiedad y el trastorno de estrés postraumático (PTSD en inglés). Tener parejas concurrentes puede incrementar el riesgo de contraer el VIH y es más común entre las mujeres jóvenes solteras pobres.
¿qué se puede hacer para ayudar?
Involucrar a las parejas masculinas. Para poder protegerse contra el VIH, las mujeres no sólo dependen de sus propias habilidades, actitudes y conductas con respecto al uso de condones, sino también de las de sus compañeros sexuales. En muchas relaciones románticas la intimidad pesa más que la protección contra el VIH. La inclusión de los hombres en los programas de prevención del VIH puede profundizar la intimidad y confianza y mejorar la comunicación y negociación sexual incluyendo las preguntas sobre parejas sexuales anteriores y actuales. Recibir el apoyo de otras mujeres. Muchos programas de prevención para mujeres ofrecen grupos para reducir el aislamiento y permitir el apoyo mutuo entre mujeres y la normalización de prácticas más seguras. Un aumento del apoyo social puede incrementar la autoestima y promover la toma de decisiones más saludables. Un programa en Washington, DC generó apoyo y empoderamiento para mujeres afroamericanas VIH+ por medio de pláticas educativas durante comidas comunales y la provisión de pequeños obsequios (junto con condones) a manera de incentivo o agradecimiento. Ayudar con otros problemas no relacionados con el VIH. Las mujeres vulnerables al VIH encaran muchos desafíos conductuales y estructurales además del VIH: la pobreza y otras dificultades económicas, el desempleo, la violencia y las relaciones de pareja dañinas, la migración, las ITS, el uso de drogas y la necesidad de cuidar de niños y otros familiares. Los programas de prevención del VIH para mujeres deben brindarles transporte, cuidado infantil, alimentos nutritivos y remuneración en forma de comida, tarjetas telefónicas o de tiendas y paquetes de regalos. También deben ofrecer remisiones adecuadas y actualizadas para servicios de empleo, vivienda, atención médica y de salud mental en caso de trauma, abuso y depresión.
¿qué se está haciendo al respecto?
Actualmente existen 17 intervenciones para mujeres las cuales han sido reconocidas por los CDC como ejemplos de “las mejores evidencias” o “evidencias prometedoras” o bien que forman parte del proyecto Diffusion of Effective Behavioral Interventions (DEBI): CHOICES, Communal Effectance-AIDS Prevention, Female and Culturally Specific Negotiation, Project FIO, Project SAFE, RAPP, SiHLE, SISTA, Sisters Saving Sisters, Sister to Sister, WHP, WiLLOW, Women’s Co-op, Condom Promotion, Insights, Safer Sex y SEPA. En San Francisco, el proyecto Women’s Leadership and Community Planningorganiza una capacitación de dos días para mujeres con VIH en California que quieren asumir papeles de mayor liderazgo en los concilios de planificación estatal. En las jornadas de capacitación las mujeres forman redes de contacto, aprenden sobre la pronunciación de discursos, la toma de decisiones y el manejo de conflictos. Ellas se mantienen en contacto por medio de conferencias telefónicas mensuales. Después de la primera capacitación, 6 de las 13 asistentes pasaron a ocupar puestos de liderazgo en sus concilios locales o estatales. Respeto/Proteger: Respecting and Protecting our Relationships es un programa de prevención del VIH para madres y padres adolescentes latinos en Los Ángeles, CA. Creado y probado conjuntamente por una organización comunitaria e investigadores académicos, el programa reconoce los riesgos que las adolescentes afrontan, como la pobreza, el uso de drogas y alcohol, y antecedentes de ITS, abuso físico o abuso sexual. La intervención consiste en seis sesiones destinadas a sanar el espíritu herido y cultivar los sentimientos de protección materna y paterna por medio de enseñanzas culturales tradicionales.
¿qué queda por hacer?
Los programas para los hombres (especialmente los UDIs) también beneficiarán a las mujeres. El intercambio de jeringas y el tratamiento para dejar las drogas son esenciales. Las agencias de salud pública necesitan aumentar la conciencia sobre el abuso sexual y la violencia domestica, no sólo para ayudar a los hombres y a las mujeres a aprender cómo evitarlas, sino también para mitigar sus efectos sobre la epidemia del VIH. También se necesitan campañas de detección del VIH dirigidas sólo a mujeres y sitios de pruebas donde las mujeres se sientan cómodas. Dada la falta de evidencias de intervenciones biomédicas (microbicidas y vacunas) eficaces, persiste la necesidad de brindar intervenciones conductuales y estructurales de prevención del VIH para mujeres. Sin embargo, debe continuar la investigación sobre cómo las mujeres pueden protegerse utilizando una herramienta accesible, económica, cómoda y discreta. Es importante trasladar y concretar los hallazgos de los estudios en programas tangibles de salud pública y en políticas eficaces. Son especialmente valiosas aquellas intervenciones que tomen en cuenta la sexualidad, la familia, la cultura, el empoderamiento, la autoestima y las habilidades de negociación, así como las intervenciones ubicadas en una variedad de ambientes comunitarios.
¿Quién lo dice?
1. Kaiser Family Foundation. Women and HIV/AIDS in the United States. Policy Fact Sheet. July 2007. 2. Centers for Disease Control and Prevention. Cases of HIV infection and AIDS in the United States and Dependent Areas, 2005. HIV/AIDS Surveillance Report. 2007;17. 3. Centers for Disease Control and Prevention. HIV/AIDS fact sheet: HIV/AIDS among women. June 2007. 4. National Institute of Allergy and Infectious Diseases at National Institutes of Health. Research on HIV infection in women. 2006. 5. Theall KP, Sterk CE, Elifson KW, et al. Factors associated with positive HIV serostatus among women who use drugs: continued evidence for expanding factors of influence. Public Health Reports. 2003;118:415-424. 6. Sangani P, Rutherford G, Wilkinson D. Population-based interventions for reducing sexually transmitted infections, including HIV infection.Cochrane Database of Systematic Reviews. 2004; 2:CD001220. 7. Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives in Sexual and Reproductive Health. 2004;36:6-10. 8. Koenig LJ, Moore J. Women, violence, and HIV: A critical evaluation with implications for HIV services. Maternal and Child Health Journal. 2000;4:103-109. 9. Wyatt GE, Myers HF, Loeb TB. Women, trauma, and HIV: an overview. AIDS and Behavior. 2004;8:401-403. 10. Bozzette SA, Berry SH, Duan N, et al. The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. New Engand Journal of Medicine. 1998;339:1897-1904. 11. Cohan DL, Kim A, Ruiz J, et al. Health indicators among low income women who report a history of sex work: the population based Northern California Young Women’s Survey. Sexually Transmitted Infections. 2005;81:428-433. 12. Adimora AA, Schoenbach VJ, Bonas DM, et al. Concurrent sexual partnerships among women in the United States. Epidemiology. 2002;13:320-327. 13. Prosper! The Women’s Collective, Washington DC. 14. Dworkin SL, Ehrhardt AA. Going beyond “ABC” to include “GEM”: critical reflections on progress in the HIV/AIDS epidemic. American Journal of Public Health. 2007;97:13-18. 15. Centers for Disease Control and Prevention. Updated Compendium of Evidence-Based Interventions, 2007. 16. Women’s Leadership and Community Planning project, CompassPoint, San Francisco, CA. 17. Lesser J, Koniak-Griffin D, Gonzalez-Figueroa E, et al. Childhood abuse history and risk behaviors among teen parents in a culturally rooted, couple-focused HIV prevention program. Journal of the Association of Nurses in AIDS Care. 2007;18:18-27. 18. Landovitz RJ. Recent efforts in biomedical prevention of HIV. Topics in HIV Medicine. 2007;15:99-103.
Preparado por Roshan Rahnama, MPH, CAPS Traducido por Rocky Schnaath Septiembre 2008. Hoja de Dato #4SR
Condom use Among Hispanics - Male
Hispanic Condom Use Study 1991 Questionnaire for Use with Males
TIME AT BEGINNING: ______________
Many of the questions we will be asking relate to sexual matters and it is
possible that you may feel a bit uncomfortable. But please remember that your
responses are completely confidential and that you may indicate if there are
any questions you do not wish to answer.
I would like to ask you some general questions about AIDS. Your answer can be
"yes," "probably yes," "probably no," or "no."
1. Do you think it's possible to get the AIDS virus from a mosquito bite?
Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (06)
2. Do you think it's possible to get the AIDS virus by sitting on a public toilet?
1 Yes 2 Probably Yes 3 Probably No 4 No (07)
3. Do you think AIDS is a problem only for homosexuals and drug addicts?
1 Yes 2 Probably Yes 3 Probably No 4 No (08)
4. Do you think it's possible to know by appearance if a person has the AIDS
virus?
1 Yes 2 Probably Yes 3 Probably No 4 No (09)
5. Have you personally known someone who had AIDS or was infected with
the AIDS virus?
1 Yes 2 Probably Yes 3 Probably No 4 No (10)
8 DON'T KNOW
6. How often do you worry that you might get the virus that causes AIDS?
Would you say very often, often, sometimes, or never?
(11)
1 Very often 2 Often 3 Sometimes 4 Never
I'll be asking some questions about condoms or rubbers.
7. Would you like me to use the word "condom" or "rubber?"
4 CONDOM 5 RUBBER (12)
6 NO PREFERENCE (USE "CONDOM")
The following items ask for information about how condoms/rubbers are used.
If you have never used condoms/rubbers, your answers are still important
to us.
8. Do you think vaseline is a good lubricant or cream for condoms/rubbers?
1 YES 0 NO 8 DOESN'T KNOW (13)
9. Do you think a condom/rubber should be unrolled before putting it on a
man's penis?
1 YES 0 NO 8 DOESN'T KNOW (14)
Now we would like to ask you some questions about your experiences with
condoms/rubbers and other sexual activities. I will be using the word
"partner" to refer to the person with whom one has sex. This information is
very important for our study. Each person has different sexual experiences,
so some questions may not apply to you.
10. How often do you carry a condom/rubber with you? Would you say always,
sometimes, hardly ever, or never?
1 Always 2 Sometimes 3 Hardly ever 4 Never (15)
11. Have you ever used condoms/rubbers?
1 YES 0 NO [GO TO Q 15] 9 RA (16)
12. Have you ever used condoms/rubbers to avoid a pregnancy?
1 YES 0 NO 9 RA (17)
13. Have you ever used condoms/rubbers to avoid diseases?
1 YES 0 NO 9 RA (18)
14. How did you get condoms/rubbers?
[IF RESPONDENT GIVES MORE THAN ONE ANSWER, ASK WHERE HE HAS BOUGHT
THEM OR GOTTEN THEM MORE OFTEN AND CIRCLE ONLY THAT RESPONSE]
[DO NOT READ RESPONSES]
______ BOUGHT THEM ASK: Where?
1 PHARMACY OR DRUG STORE
2 RESTROOM VENDING MACHINES
3 SUPERMARKET
9 RA
(19)
______ GIVEN TO THEM ASK: Where?
4 AT A HEALTH CENTER
5 ON THE STREET
6 BY A FRIEND/RELATIVE
7 FROM A PARTNER
8 ELSEWHERE __________________________
9 RA
15. In these questions we'll talk about a steady sex partner. A steady sex
partner is a person one has sex with in an ongoing relationship and might be
a spouse.
Imagine that you will have sex with a wife or steady partner in the next 30
days. How often do you think you would use condoms/rubbers? Would you say
always, more than half the time, half the time, less than half the time, or
never?
[IF RESPONDENT SAYS NOT APPLICABLE, SAY: "Even if you don't know, please
try to guess."]
1 Always (20)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 RA
16. Imagine that you will have sex with a partner other than a steady partner
in the next 30 days. How often do you think you would use condoms/rubbers?
[IF RESPONDENT SAYS NOT APPLICABLE, SAY: "Even if you don't know, please
try to guess."]
1 Always (21)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 RA
17. Have you had sex at least once in the past 12 months, that is, since
[THIS MONTH] of 1990?
1 YES [GO TO Q19] 0 NO [GO TO Q18] 9 RA [GO TO Q18] (22)
18. Have you had sex at least once in the last 5 years?
1 YES [GO TO Q19] 0 NO [GO TO Q26] 9 RA [GO TO Q26] (23)
19. As I said, some questions may not apply to you. If a question does not apply
to you, please let me know.
When you had sex with your wife or steady partner in the last 12 months, how
often did you use condoms/rubbers? Would you say always, more than half the
time, half the time, less than half the time, or never?
1 Always (24)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
7 NO STEADY PARTNER
8 NO SEX PAST 12 MONTHS [GO TO Q26]
9 RA
20. When you had sex with a woman other than your wife or steady partner in
the last 12 months, how often did you use condoms/rubbers?
1 Always (25)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
7 NO CASUAL PARTNER
8 NO FEMALE PARTNER [GO TO Q22]
9 RA
21. How many women have you had sex with in the last 12 months in total?
___ ___ NUMBER OF WOMEN (26-27)
[90 OR MORE = 90] 99 RA
22. If you had sex with any male partner in the last 12 months, how often
were condoms/rubbers used? Would you say always, more than half the time,
half the time, less than half the time, or never?
1 Always (28)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
7 NO SEX WITH MALE PARTNER [GO TO Q24]
8 NO SEX AT ALL [GO TO Q26]
9 REFUSED TO ANSWER
23. How many men have you had sex with in the last 12 months in total?
___ ___ NUMBER OF MEN (29-30)
[90 OR MORE = 90]
98 NO SEX AT ALL [GO TO Q26]
99 RA
IF Q21 AND Q23 ARE 00, GO TO Q26
24. In the last 12 months, how often did you drink alcoholic beverages before
having sex? Would you say always, more than half the time, half the time, less
than half the time, or never?
1 Always (31)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
7 NO SEX LAST 12 MONTHS [GO TO Q26]
9 REFUSED TO ANSWER
25. In the last 12 months, how often did you use drugs before having sex?
1 Always (32)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 REFUSED TO ANSWER
26. Do you think you're going to have sex in the next 30 days? Would you say
yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (33)
27. Is it possible to know beforehand if you're going to have sex?
1 Yes 2 Probably Yes 3 Probably No 4 No (34)
In the following questions I am going to ask your opinions about the use of
condoms/rubbers. If you have never had sex or if you have never used a
condom/rubber, please answer the questions trying to imagine how you would
feel in each case.
28. Do you think condoms/rubbers are only for men having sex with female
prostitutes? Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (35)
29. Do you think it's difficult to find places to buy condoms/rubbers?
1 Yes 2 Probably Yes 3 Probably No 4 No (36)
30. Would you use a condom/rubber even if you had to stop to buy them or look
for them?
1 Yes 2 Probably Yes 3 Probably No 4 No (37)
31. Would you use a condom/rubber even if you had been drinking alcoholic
beverages or using drugs?
1 Yes 2 Probably Yes 3 Probably No 4 No (38)
BLANK (39)
33. Would you be able to refuse to have sex if your partner didn't want you to
use a condom/rubber?
1 Yes 2 Probably Yes 3 Probably No 4 No (40)
34. Imagine that you used a condom/rubber the next time you had sex.
Would you feel less sexual pleasure than if you didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (41)
35. If you used a condom/rubber, would sex last longer than if you didn't use
one?
1 Yes 2 Probably Yes 3 Probably No 4 No (42)
36. If you used a condom/rubber, would you feel guilty?
1 Yes 2 Probably Yes 3 Probably No 4 No (43)
37. If you used a condom/rubber, would you feel an emotional barrier with
your sex partner?
1 Yes 2 Probably Yes 3 Probably No 4 No (44)
38. Do you think the condom/rubber would cause a burning sensation?
1 Yes 2 Probably Yes 3 Probably No 4 No (45)
39. Do you think putting on a condom/rubber would interrupt sex?
1 Yes 2 Probably Yes 3 Probably No 4 No (46)
40. Do you think sex would be cleaner than if you didn't use a condom/rubber?
1 Yes 2 Probably Yes 3 Probably No 4 No (47)
Continue to imagine that you used a condom/rubber the next time you had sex
41. Do you think the condom/rubber would feel uncomfortable or too tight?
1 Yes 2 Probably Yes 3 Probably No 4 No (48)
42. Do you think the condom/rubber might come off inside your partner?
1 Yes 2 Probably Yes 3 Probably No 4 No (49)
43. Do you think the condom/rubber might break?
1 Yes 2 Probably Yes 3 Probably No 4 No (50)
44. If you used a condom/rubber, do you think you might get cancer?
1 Yes 2 Probably Yes 3 Probably No 4 No (51)
45. If you used a condom/rubber, do you think a female partner would get
pregnant?
1 Yes 2 Probably Yes 3 Probably No 4 No 9 RA (52)
46. If you used a condom/rubber, would it be more difficult for you to
ejaculate or come than if you didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (53)
47. If you used a condom/rubber, would it be more difficult for you to keep an
erection than if you didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (54)
In the following questions we'll talk about two types of partners: steady sex
partners and casual sex partners. As you recall, a steady sex partner is a
person one has sex with in an ongoing relationship. A casual sex partner refers
to a person one doesn't know very well and has sex with only once or a few
times.
48. Would you be able to use a condom/rubber with a steady partner?
Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (55)
49. Would you be able to use a condom/rubber with a casual partner?
1 Yes 2 Probably Yes 3 Probably No 4 No (56)
Imagine that you were going to have sex with a casual partner and you used
a condom/rubber
50. Do you think you could get a venereal disease such as gonorrhea or
syphilis?
Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (57)
51. If you used a condom/rubber with this casual partner, do you think you
could get the virus that causes AIDS?
1 Yes 2 Probably Yes 3 Probably No 4 No (58)
52. If you used a condom/rubber with this casual partner, would you worry
less about giving a steady partner a disease such as syphilis, gonorrhea or
AIDS?
1 Yes 2 Probably Yes 3 Probably No 4 No (59)
Imagine that you insisted on using a condom/rubber the next time you had sex
with a steady partner,
53. Would it lead the steady partner to think you had had sex with someone
else?
1 Yes 2 Probably Yes 3 Probably No 4 No (60)
54. If you insisted on using condoms/rubbers, do you think a steady partner
would get angry?
1 Yes 2 Probably Yes 3 Probably No 4 No (61)
55. Would a casual partner get angry?
1 Yes 2 Probably Yes 3 Probably No 4 No (62)
BLANK (63-64)
58. If you insisted on using a condom/rubber, do you think a steady partner
would refuse to have sex with you?
1 Yes 2 Probably Yes 3 Probably No 4 No (65)
59. Would a casual partner refuse to have sex with you?
1 Yes 2 Probably Yes 3 Probably No 4 No (66)
60. Imagine that you carried condoms/rubbers in your pocket or wallet.
Do you think that your men friends would think badly of you?
1 Yes 2 Probably Yes 3 Probably No 4 No (67)
9 RA
61. If you had condoms/rubbers with you, would a casual partner respect you
more than if you didn't have them?
1 Yes 2 Probably Yes 3 Probably No 4 No (68)
62. If a woman has condoms/rubbers with her, do you think she is willing to
have sex with someone she just met?
1 Yes 2 Probably Yes 3 Probably No 4 No (69)
Respondent ID __ __ __ __.
(01-04)
Card = 3 (05)
In the following questions we want to know how much you would be bothered
by some things that could happen to a person who used condoms/rubbers.
These questions may seem repetitive but they are very important and we
would appreciate your patience.
The responses can be "A lot" "Somewhat" or "Very little"
63. How much would it bother you to feel less pleasure during sex? Would it
bother you a lot, somewhat or very little?
1 A lot 2 Somewhat 3 Very little (06)
64. How much would it bother you to feel a burning sensation in your sex
organs?
1 A lot 2 Somewhat 3 Very little (07)
65. How much would it bother you to interrupt sex?
1 A lot 2 Somewhat 3 Very little (08)
66. How much would it bother you to feel guilty?
1 A lot 2 Somewhat 3 Very little (09)
67. How much would it bother you to have a condom/rubber that feels
uncomfortable or too tight?
1 A lot 2 Somewhat 3 Very little (10)
68. How much would it bother you if a condom/rubber came off inside your
partner?
1 A lot 2 Somewhat 3 Very little (11)
69. How much would it bother you if a condom/rubber broke?
1 A lot 2 Somewhat 3 Very little (12)
70. How much would it bother you if you felt an emotional barrier with your
partner?
1 A lot 2 Somewhat 3 Very little (13)
BLANK (14)
72. How much would it bother you if you had trouble ejaculating?
1 A lot 2 Somewhat 3 Very little (15)
73. How much would it bother you if you had trouble keeping an erection?
1 A lot 2 Somewhat 3 Very little (16)
74. How much would it bother you to get a venereal disease like gonorrhea
or syphilis?
1 A lot 2 Somewhat 3 Very little (17)
75. How much would it bother you to have a steady partner think you had had
sex with someone else?
1 A lot 2 Somewhat 3 Very little (18)
76. How much would it bother you to have a steady partner get angry?
1 A lot 2 Somewhat 3 Very little (19)
77. How much would it bother you to have a casual partner get angry?
1 A lot 2 Somewhat 3 Very little (20)
78. How much would it bother you to have a steady partner refuse to have
sex with you?
1 A lot 2 Somewhat 3 Very little (21)
79. How much would it bother you to have a casual partner refuse to have
sex with you?
1 A lot 2 Somewhat 3 Very little (22)
80. How much would it bother you to have your men friends think badly of you?
1 A lot 2 Somewhat 3 Very little (23)
81. Now, please tell me, how much would you like to have a casual partner
respect you more? Would you say a lot, somewhat, or very little?
6 A lot 5 Somewhat 4 Very little (24)
82. How much would you like not having to worry about giving a steady partner
a disease like syphilis, gonorrhea or AIDS?
6 A lot 5 Somewhat 4 Very little (25)
83. How much would you like to have sex feel cleaner?
6 A lot 5 Somewhat 4 Very little (26)
For the following items, first tell me if you would like it or dislike it, then
tell me how much you would like or dislike it.
84. Would you like or dislike having a female sex partner get pregnant now?
How much, a lot, somewhat or very little?
like it: 6 A lot 5 Somewhat 4 Very little (27)
dislike it: 1 A lot 2 Somewhat 3 Very little
85. Would you like or dislike having sex last longer? How much?
like it: 6 A lot 5 Somewhat 4 Very little (28)
dislike it: 1 A lot 2 Somewhat 3 Very little
BLANK (29)
87. Would you like or dislike using a condom/rubber with a steady partner?
How much?
like it: 6 A lot 5 Somewhat 4 Very little (30)
dislike it: 1 A lot 2 Somewhat 3 Very little
88. Would you like or dislike using a condom/rubber with a casual partner?
How much?
like it: 6 A lot 5 Somewhat 4 Very little (31)
dislike it: 1 A lot 2 Somewhat 3 Very little
89. Would you like or dislike carrying a condom/rubber with you? How much?
like it: 6 A lot 5 Somewhat 4 Very little (32)
dislike it: 1 A lot 2 Somewhat 3 Very little
90. How many of your closest men friends do you think carry condoms with
them?
Would you say almost all, more than half, half, less than half or almost none?
[IF THE PERSON DOESN'T KNOW, SAY: "Even if you don't know, please try to
guess"]
(33)
1 Almost 2 More 3 Half 4 Less 5 Almost
all than half than half None
7 NO FRIENDS [GO TO Q93]
91. How many of your closest men friends do you think use condoms/rubbers
when they have sex with a steady partner?
(34)
1 Almost 2 More 3 Half 4 Less 5 Almost
all than half than half None
92. How many of your closest men friends do you think use condoms/rubbers
when they have sex with a casual partner?
(35)
1 Almost 2 More 3 Half 4 Less 5 Almost
all than half than half None
7 NO FRIENDS HAVE CASUAL PARTNERS
93. Try to imagine how comfortable you would feel in the following situations.
How comfortable would you feel buying a condom/rubber? Would you feel very
comfortable, somewhat comfortable, somewhat uncomfortable or very
uncomfortable?
1 Very 2 Somewhat 3 Somewhat 4 Very (36)
comfortable comfortable uncomfortable uncomfortable
94. How comfortable would you feel insisting on using a condom/rubber
with a steady partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (37)
comfortable comfortable uncomfortable uncomfortable
95. How comfortable would you feel insisting on using a condom/rubber with a casual partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (38)
comfortable comfortable uncomfortable uncomfortable
96. How comfortable would you feel putting on a condom/rubber?
1 Very 2 Somewhat 3 Somewhat 4 Very (39)
comfortable comfortable uncomfortable uncomfortable
97. How comfortable would you feel having a condom/rubber put on you?
1 Very 2 Somewhat 3 Somewhat 4 Very (40)
comfortable comfortable uncomfortable uncomfortable
98. How comfortable would you feel using a condom/rubber with a steady
partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (41)
comfortable comfortable uncomfortable uncomfortable
99. How comfortable would you feel using a condom/rubber with a casual
partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (42)
comfortable comfortable uncomfortable uncomfortable
100. How comfortable would you feel being naked in front of a sex partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (43)
comfortable comfortable uncomfortable uncomfortable
101. How comfortable would you feel having sex with the lights on?
1 Very 2 Somewhat 3 Somewhat 4 Very (44)
comfortable comfortable uncomfortable uncomfortable
102. How comfortable would you feel having sex with a new partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (45)
comfortable comfortable uncomfortable uncomfortable
Now I'd like to ask you:
103. Do you have any children?
00 NO YES How many? ___ ___ (46-47)
104. Have you been circumcised?
1 YES 0 NO 8 DON'T KNOW 9 RA (48)
IF NECESSARY, ASK: Do you have a wife or steady partner who is a woman?
YES [GO TO Q105] ***No [GO TO Q111]
105. Is your wife or steady partner pregnant?
1 YES [GO TO Q. 111] (49)
0 NO
7 HE/SHE CANNOT HAVE CHILDREN [GO TO Q111]
8 DON'T KNOW
9 RA
106. Is she trying to get pregnant?
1 YES [GO TO Q. 111] (50)
0 NO
7 HE/SHE CANNOT HAVE CHILDREN [GO TO Q111]
9 RA
107. Has she given birth in the last 3 months?
1 YES [GO TO Q. 111] (51)
0 NO
7 HE/SHE CANNOT HAVE CHILDREN [GO TO Q111]
9 RA
108. Have you or your steady partner used some form of birth control other
than condoms/rubbers in the last 12 months?
YES >>>>>>>>>>>>>>[IF THE ANSWER IS YES] Which kind? (52)
[CIRCLE ALL THAT APPLY]
1 PILL
0 NO 2 IUD
3 DIAPHRAGM
4 SPONGE/FOAM/JELLY
5 DOUCHE
9 RA 6 WITHDRAWAL
7 ABORTION
8 OTHER ___________________
IF ANSWER IS YES, GO TO Q111
109. Is there a reason why your partner is unable to have children either due
to an operation or some other cause?
1 YES [GO TO Q. 111] (53)
0 NO
8 DON'T KNOW
9 RA
110. Is there a reason why you are unable to have children either due to an
operation or some other cause?
1 YES (54)
0 NO
8 DON'T KNOW
9 RA
111. Now I'm going to ask you some questions about how you have been feeling
during the last seven days. Since [ TODAY'S DAY OF THE WEEK] of last week
Were you bothered by things that usually don't bother you?
O NO [IF THE ANSWER IS YES, SAY]: (55)
How many days during the past week?
[DO NOT READ RESPONSES]
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
112. Did you feel like not eating or was your appetite poor?
O NO [IF THE ANSWER IS YES, SAY]: (56)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
113. Did you feel like you couldn't shake off the blues even with the help of
family and friends?
O NO [IF THE ANSWER IS YES, SAY]: (57)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
114. Did you feel depressed?
O NO [IF THE ANSWER IS YES, SAY]: (58)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
115. Did you feel as if your life had been a failure?
O NO [IF THE ANSWER IS YES, SAY]: (59)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
116. Did you feel afraid?
O NO [IF THE ANSWER IS YES, SAY]: (60)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
117. Was your sleep restless?
O NO [IF THE ANSWER IS YES, SAY]: (61)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
118. Did you feel lonely?
O NO [IF THE ANSWER IS YES, SAY]: (62)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
119. Did you feel sad?
O NO [IF THE ANSWER IS YES, SAY]: (63)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
120. Did you have crying spells?
O NO [IF THE ANSWER IS YES, SAY]: (64)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
IF NON-HISPANIC, GO TO Q128
IF HISPANIC, CONTINUE BELOW
121. Now, please tell me, where were you born?
1 USA [GO TO THE FOLLOWING QUESTION] (65)
2 PUERTO RICO [GO TO Q. 123]
3 MEXICO [GO TO Q. 123]
4 REPUBLICA DOMINICANA [GO TO Q. 123]
5 COLOMBIA [GO TO Q. 123]
6 CENTRAL AMERICA [GO TO Q. 123]
7 SOUTH AMERICA, (NO COLOMBIA) [GO TO Q. 123]
8 SPAIN OR CUBA [GO TO Q. 123]
9 OTHER _______________________ [GO TO THE FOLLOWING QUESTION]
FOR HISPANICS BORN IN THE U.S. OR COUNTRIES LISTED IN 9 ABOVE
122. The families of the majority of people living in the United States come
from other countries. Where is your family from?
[DO NOT READ ALTERNATIVES IF RESPONSE IS MORE THAN ONE COUNTRY,
ASK:]"Which country is the majority of your family from or which country do
you feel closest to?" [CIRCLE ONLY ONE]
2 PUERTO RICO (66)
3 MEXICO
4 REPUBLICA DOMINICANA
5 COLOMBIA
6 CENTRAL AMERICA
7 SOUTH AMERICA, (NO COLOMBIA)
8 SPAIN OR CUBA
123. How long have you lived in the United States?
___ ___ YEARS [LESS THAN A YEAR = ONE YEAR{01}] (67-68)
Respondent ID __ __ __ __.
(01-04)
Card = 4 (05)
124. In general what language do you read and speak? Would you say Spanish
only, Spanish more than English, both equally, English more than Spanish, or
English only?
(06)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
125. What language do you usually speak at home?
(07)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
126. In which language do you usually think?
(08)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
127. What language do you usually speak with your friends?
(09)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
ASK EVERYONE
128. How many years of formal education have you completed?
___ ___ YEARS (10-11)
129. Are you:
1 Married or living with your partner (12)
2 Single
3 Separated or divorced
4 Widowed
130. What is your religion? __________________________
(13)
1 CATHOLIC
2 CHRISTIAN OTHER THAN CATHOLIC
3 OTHER: (SPECIFY: ________________)
4 NONE
131. How important is religion in your life? Would you say:
(14)
1 Extremely important
2 Very important
3 Important
4 Somewhat important
5 Not important at all
BLANK (15-16)
133. Would you say that you live in a town, city, suburb of a city, or a rural
area?
1 TOWN 2 CITY 3 SUBURB 4 RURAL AREA (17)
134. Could you please give me your Zip Code?
__ __ __ __ __ ZIP CODE (18-22)
[99998 >> DK 99999 >> RA]
135. Tell me when I get to the category that best describes your family
income for 1990. [IF LIVING ALONE, ASK FOR PERSONAL INCOME]
[READ RESPONSES]
1 Less than $10,000 (23)
2 $10,001 to 20,000
3 $20,001 to 40,000
4 More than $40,000
8 DON'T KNOW
9 RA
As I already explained, your phone number was chosen at random. To avoid
calling your house again, could you please tell me if there is another
telephone number in your house?
[IF THE ANSWER IS YES] What is it?__________________
Is there more than one number?
OTHER NUMBER(S) ________________________
136. NUMBER OF TELEPHONE LINES _______ (24)
[INCLUDING THE ONE BEING CALLED]
IF NON HISPANIC, GO TO PARAGRAPH BEGINNING:
'This is all for now."
IF HISPANIC, CONTINUE BELOW
137. In the future, it is possible that we will do a study of sexual attitudes
and behavior among Hispanic adolescents. The questions will be very different
from the ones you just answered and will be appropriate for adolescents.
To include an adolescent in that study not only would we need the adolescent's
consent but also the permission of a parent or guardian.
Is there an adolescent in this house who is 15, 16 or 17 years old?
YES How many? _____ NO 0 [GO TO END] (25)
Could you give me the name of the parent or guardian who could give permission
to interview the adolescent, if we do call?
____________________________________________________
138. Could you give me the name(s) of the adolescent(s)?
___________________________________________
ASK IF UNCLEAR: NUMBER OF FEMALES______ (26)
This is all for now. My supervisor may call you back to validate that this
interview was completed. Thank you for your help with this interview.
If you would like any further information about AIDS or AIDS prevention, you
can call this number 1-800-342-2437 [AIDS]. Would you like me to repeat
that number? The call is free and you don't have to give your name.
Again, thank you very much!
__________________________________________________________
TIME AT THE END OF INTERVIEW:___________
139. LENGTH OF INTERVIEW [ IN MINUTES] ___ ___ (27-28)
140. LANGUAGE OF INTERVIEW: 0 ENGLISH (29)
141. LANGUAGE CHOICE:
1 RESPONDENT 0 RANDOMLY BY INTERVIEWER (30)
142. INTERVIEWER'S NAME:_________________________ [ ___ ___ ___ ] (31-33)
DATE OF INTERVIEW:_____________________________
INTERVIEW TERMINATED BEFORE COMPLETION
1 YES 0 NO (34)
[IF THE ANSWER IS YES] __ __ __ ITEM NUMBER (35-37)
IS RESPONDENT A MEMBER OF HOUSEHOLD?
1 YES 0 NO (38)National Youth HIV/AIDS Awareness Day — April 10, 2017 [booklet]
Research & Resources
This brochure lists research projects with Youth or young adults as well as helpful resources produced by CAPS/PRC. You might use it to:- Stay up-to-date on research and learn what we found out from research
- Provide materials in trainings/presentations
- Advocate for services/funding
- Write grants
- Develop new or modify existing HIV prevention programs
- Evaluate current programs
- Connect with CAPS/PRC to develop new projects. Lead researchers (PIs) are listed for each study. Contact us below to connect.
Acronyms
MSM: Men who have sex with men PI: Principal Investigator (lead researcher on the study)International HIV Prevention Research at the Center for AIDS Prevention Studies, University of California San Francisco
Hombres negros
¿Qué debe hacerse para prevenir el VIH en los hombres negros?
Elaborado por Bob Haas y Barbara Green-Ajufo, DrPH, MPH
¿Quiénes son los hombres negros?
En los Estados Unidos, los hombres negros son descendientes de las diversas etnias de la diáspora africana. Son amigos y familiares: padres, abuelos, esposos, novios, hermanos, tíos, hijos, sobrinos y primos. Son colegas, profesionales y obreros. Tienen diferentes orientaciones sexuales, profesan diversas creencias religiosas y hablan diferentes idiomas, entre otras particularidades demográficas.
¿Es un riesgo el VIH para los hombres negros?
El VIH representa una crisis de salud para los hombres negros, sin importar su edad o su orientación sexual. En el 2015, el 33% de las infecciones por el VIH en los Estados Unidos fueron en hombres negros. El VIH se diagnostica en hombres negros ochos veces más que en hombres blancos y dos veces más que en hombres hispanos que no son negros. El riesgo de infección por el VIH en hombres negros es alto relativo a la población masculina en general. De cada 20 hombres negros, uno será diagnosticado con VIH. De no revertirse las tendencias actuales, esta prevalencia continuará. [2-4] Las estadísticas a continuación muestran la probabilidad en hombres negros de ser diagnosticados con VIH durante su vida.
- Hombres que tienen sexo con hombres (HSH): hombres negros (1/2); población masculina en general (1/6)
- Personas que se inyectan drogas: hombres negros (1/9); población masculina en general (1/36)
- Hombres heterosexuales: hombres negros (1/86); población masculina en general: 1/473
Entre los HSH, incluidos homosexuales y bisexuales, los hombres negros que tienen sexo con hombres (HNSH) tienen la mayor probabilidad de ser diagnosticados con el VIH (39% en 2015). [5] Los HNSH jóvenes corren un riesgo aún más alto. De todos los HNSH que fueron diagnosticados con el VIH en 2015, un 75% tenía menos de 34 años—con proporciones iguales para jóvenes de 13 a 24 años (37.7%) y jóvenes de 25 a 34 años (37.3%). [6]
Varias investigaciones han demostrado que los HNSH no suelen practicar más actos sexuales riesgosos (sexo anal sin condón o tener varias parejas) que los hombres de otros grupos raciales o étnicos. Sin embargo, tienen mayor probabilidad de ser diagnosticados con el VIH, sin importar la edad. [7-10] Según un estudio, el VIH es nueve veces más común entre los jóvenes negros que tienen sexo con hombres que entre los jóvenes blancos que tienen prácticas sexuales semejantes. [7]
La demanda y conciencia sobre la Profilaxis Pre-Exposición (PrEP)—un tratamiento biomédico eficaz—es menor entre HNSH que entre HSH blancos, por lo que se les receta menos. [11] De todas las recetas para PrEP en los Estados Unidos entre enero y septiembre de 2015, un 74% fue para blancos, un 12% para latinos y sólo un 10% para afro-americanos. [12]
¿Cuáles son los factores de riesgo del VIH para los hombres negros?
Muchos factores influyen en el riesgo para el VIH en los hombres negros.
Estigma y discriminación: Es menos probable que los hombres negros que han experimentado estigma o discriminación usen PrEP como medida preventiva [13] o revelen que viven con el VIH. [14] Además, los hombres que han experimentado traumas relacionados con la discriminación por ser gay, negro o por vivir con el VIH, suelen tener más sexo anal sin protección. [15]. Se ha demostrado que las altas tasas de infección por el VIH, las actitudes racistas de parte de los homosexuales no negros, las redes sociales y los ambientes en los que se relacionan los homosexuales estigmatizan y aislan a los HNSH de los demás HSH. [16]
Disparidades en el continuo del cuidado para el VIH: Por la discriminación histórica hacia la población negra por parte de los sistemas de salud, los hombres negros suelen acudir menos a los servicios médicos. [17] Por consiguiente, es más probable que los HNSH, comparados con HSH blancos, no conozcan su estado serológico, sean diagnosticados tardíamente y descuiden su cuidado y tratamiento médico. [18-19]
Pobreza: Por la discriminación y el reducido acceso y retención en educación de calidad, prevalece más el desempleo o el subempleo en hombres negros que en hombres blancos. [20] Por ello, las posibilidades de vivir en la pobreza son mayores para los hombres negros, lo que también tiende a reducir el acceso a servicios médicos de calidad. [20] Las tasas de VIH aumentan de 3 a 5.5 veces de acuerdo con el incremento de la pobreza de un barrio (menos de 10% en barrios con nivel de pobreza bajo y más de 30% en barrios con nivel de pobreza alto). [21-22] Para las personas negras que viven con VIH, la pobreza está asociada a una menor vinculación en el cuidado médico para el VIH. [23]
Trauma sexual: Las tasas de asalto y abuso sexual son altas en HSH y están vinculadas a un mayor riesgo de infección por el VIH. Un 39% de los HSH en el estudio EXPLORE reportaron haber sufrido abuso sexual durante su niñez; y era más probable que los participantes negros en ese estudio hubieran tenido una historia de asalto sexual que no la hubieran tenido. [24-25]
Enfermedades transmitidas sexualmente (ETS): La presencia de ETS incrementa la probabilidad de transmitir o de contraer el VIH. ETS y tasas altas del VIH en la población negra incrementan la probabilidad de transmisión del VIH. [27-29]
Redes sociales y sexo con hombres de su raza: Las altas tasas del VIH en HNSH y la preferencia por tener relaciones con hombres de su propia raza incrementan la probabilidad de tener una pareja sexual que vive con el VIH. El análisis de varios estudios mostró que al menos un 29% de los HNSH en redes sexuales viven con el VIH; dentro de estas redes, el 47% de los hombres que viven con el VIH desconocen que son portadores del virus. [30]
¿Qué se está haciendo?
Los resultados de las investigaciones realizadas con hombres negros de diversas edades, orientaciones sexuales y estados serológicos que se detallan a continuación han demostrado reducir las prácticas sexuales de riesgo y han incrementado la participación en el cuidado médico. [31]
Intervenciones comparativas aleatorizadas: Dos estudios "Muchos hombres, muchas voces"(Many Men Many Voices) y "Hermano a hermano" (Brother to Brother) demuestran que existe una relación positiva ya sea entre la reducción del número de instancias de sexo anal sin protección con parejas casuales, el número de cualquier acto sexual anal insertivo sin protección, número de parejas sexuales masculinas, y/o una mayor probabilidad de hacerse la prueba del VIH.
Intervenciones de encuestas pre-post o repetidas: Los HNSH que participaron en las intervenciones "D-up! Connect with Pride", "BRUTHAS", "Motivational Interviewing (MI)" y "Special Projects of National Significance (SPNS)" reportaron mejores resultados que los hombres cuya participación en estas intervenciones fue limitada o nula. Dichos estudios mostraron ya sea una reducción de sexo anal sin protección en diferentes momentos durante la intervención, una reducción de las instancias de sexo anal sin protección con la pareja principal, una reducción en el número de parejas sexuales, más uso del condón con la pareja principal, menos número de encuentros con prácticas sexuales riesgosas con parejas femeninas y/o una reducción de tener sexo bajo la influencia de drogas.
Diferentes estudios también registran un incremento en el apoyo social y la autoestima y disminución de la soledad, así como una mayor probabilidad de hacerse la prueba y consejería para el VIH, regresar a buscar los resultados de la prueba del VIH, y menos citas médicas perdidas. Un estudio demostró que entre más tiempo dedicaban los participantes a las reuniones de manejo de caso, más tiempo dedicaban también al cuidado médico para el VIH.
Estudio mixto de pre-post y grupo de control: Los hombres jóvenes de color que participaron en la intervención denominada STYLE (Strength through youth livin' empowered) reportaron un 83% de retención en el cuidado médico; asimismo, su probabilidad de asistir a sus visitas médicas era mayor que para los que no participaron (2.58, 95% CI 1.34-4.98).
¿Qué falta por hacer?
La prevención del VIH en hombres negros no debe enfocarse solamente en las prácticas sexuales de alto riesgo sino también en los factores sociales y estructurales. Hacen falta políticas sanitarias que prevengan nuevas infecciones, que ayuden a entender las disparidades de transmisión del VIH que existen entre la población blanca y negra y que esclarezcan el papel de las intervenciones estructurales.[32-33] Necesitamos combinar intervenciones biomédicas con intervenciones de comportamiento; entender que las particularidades de los diferentes grupos requieren abordajes distintos; reducir la transmisión de ETS; tener en cuenta circunstancias traumáticas; reducir las barreras estructurales y de acceso; y considerar la intersección de las condiciones de salud y condiciones sociales.
Es también urgente tener en cuenta el estigma y las huellas invisibles que deja. Exposiciones de datos deben integrar el contexto, la perspectiva de la comunidad y explicaciones comprehensivas. Deben desarrollarse estrategias que ayuden a las parejas y a los familiares a escuchar cuando su ser querido revela que es homosexual o que vive con el VIH. También es necesario aplicar ampliamente intervenciones exitosas en aquellas áreas donde las tasas del VIH en los hombres negros son más altas.
¿Quién lo dice?
1. CDC. HIV among Afr. Americans. Feb 2017.
2. Gavett G. Timeline: 30 Yrs. of AIDS in Blk. Americans. KQED Frontline. Jul 10, 2012.
3. Hess K, et al. Est. lifetime risk of dx of HIV infect in the U.S. CROI 2016. Boston, abstract 52.
4. CDC. Lifetime risk of HIV dx. Feb 2016.
5. CDC. HIV in the U.S.: At A Glance. Dec 2, 2016.
6. CDC. HIV among Afr. Am. gay and bisexual men. Jul 2016.
7. Millett GA, et al. Greater Risk for HIV Infect of Blk MSM: Lit Rev. AJPH. Jun 2006;96(6):1007-19.
8. Millet GA, et al. Disparities in HIV Infect among Blk and Wht MSM: Meta-Analysis. AIDS. Oct 1 2007;21(15):2083-91.
9. Magnus M, et al. Elevated HIV Prev. Despite Lower Rates of Sexual Risk Behav among Blk MSM in DC. AIDS Patient Care STDS. Oct 2010;24(10): 615–22.
10. Maulsby C, et al. HIV among Blk MSM in the U.S.: Lit. Rev. AIDS and Behav Jan 2014;18(1):10-25.
11. Cohen SE, et al. Response to race and PH impact potential of PrEP in the U.S. J Acquir Immune Defic Syndr. Sep 1 2015;70(1):e33-e35.
12. Highleyman L. PrEP use rising in U.S. but large racial disparities remain. nam aidsmap. Jun 24, 2016.
13. Chaill S, et al. Stigma, med mistrust, and racism affect PrEP awareness and uptake in Blk compared to Wht MSM in Jackson, MS and Boston, MA. AIDS Care, 2017.
14. Overstreet NM, et al. Internalized stigma and HIV status disclosure among HIV-pos MSM. AIDS Care 2013;25 4, 466-471.
15. Fields EL, et al. Assoc. of Discrimination-Related Trauma with Sexual Risk among HIV-Pos Afr. Am. MSM. AJPH. May 2013;103(5):875-80.
16. Raymond HF, et al. Racial Mixing and HIV Risk among MSM. AIDS Behav Aug 2009;13(4):630-37.
17. Lisa Eaton, et al. Role of Stigma and Med Mistrust in Routine Hlth Care Engagement of MSM. AJPH. Feb 2015;105(2): e75–e82.
18. Levy ME, et al. Understand Structural Barriers to Accessing HIV Test & Prev Servs among Blk MSM in the U.S. AIDS Behav. 2014 May; 18(5): 972–996.
19. Christopoulos KA, et al. Link and Retention in HIV Care among MSM in the U.S. Clin Infect Dis. 2011 Jan 15; 52(Suppl 2): S214–S222.
20. Ethnic and Racial Minorities and SES. Factsheet. APA. http://www.apa.org/pi/ses/resources/publications/factsheet-erm.pdf
21. Alameda Co. CA eHARS data (2008-2012). Verbal communication with Nina Murgai, Dir, HIV/AIDS Surv Unit.
22. Wiewel EW, et al. Assoc bwt Neighborhood Poverty and HIV Dx among Males and Females in NYC, 2010-2011. PH Rep. Mar-Apr 2016;131(2):290-302.
23. Lechtenberg RJ, et al. Poverty, Race, Engagement: Diff Assoc with Retention in Care among PLWH in Alameda Co. UCSF CFAR HIV Hlth Disparities Symposium, Mar 24, 2017.
24. Mimiaga MM, et al. Child Sexual Abuse Assoc with HIV Risk–Taking Behav and Infect among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr. 2009 Jul 1:51(3):340-348.
25. Millett GA, et al. Rev of HIV epidemics in Blk MSM across African diaspora. Lancet. Jul 28 – Aug 3;380(9839):411-23.
26. CDC. STDs and HIV – CDC Factsheet. Nov 17, 2015.
27. CDC. 2015 STDs Surveillance – STDs in Racial and Ethnic Minorities. Jan 23, 2017.
28. Scott HM, et al. Racial/ethnic and sexual behav disparities in rates of STIs, SF (1999-2008). BMC Pub Hlth. Jun 6, 2010;10:315.
29. Pathela P, et al. MSM have higher risk for newly dx HIV and syphilis compared with heterosexual men in NYC. J Acquir Immune Defic Syndr. Dec 1, 2011;58(4):408-16.
30. Hurt CB, et al. Invest Sexual Network of Blk MSM: Implications for Transmission and Prev of HIV Infect in U.S. J Acquir Immune Defic Syndr. Dec 1, 2012;61(4):515-21.
31. Maulsby C, et al. Rev of HIV Interv for Blk MSM. BMC Pub Hlth. 2013;13:625.
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Gracias a Emily Arnold, Jesse Brooks, Lorenzo Hinojosa, Loren Jones, Micah Lubensky, Daryl Mangosing, Janet Myers, Nasheedah Bynes-Muhammad, Rob Newells, John Peterson, Greg Rebchook, Andrew Reynolds y Wilson Vincent por revisar esta hoja informativa. Agradecemos la reproducción y la difusión de esta hoja, siempre que sea de manera gratuita y que se cite a la University of California San Francisco.
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Esta publicación es un producto del Centro de Investigación sobre la Prevención con el apoyo de los Centros de Control y Prevención de Enfermedades (Cooperative Agreement Number 5U48DP004998).