Library

Resource

Sex education

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.

Research Project

Application of Weighted Time-Series to Address Bias in Evaluation of Clinic- and Community-Level Research

This study will use simulation to develop, test and apply new analytic methods (weighted time-series) for evaluation of community-level interventions. It will then compare results using weighted time-series and conventional methods within the context of a clinic-level intervention to provide family-centered HIV care, voluntary counseling and testing (VCT) and prevention services at Family AIDS Care and Education Services (FACES), a community-based organization in Kenya. Because FACES includes observational data on virtually all patients in care at participating clinics, it provides an excellent platform to evaluate the effectiveness of this intervention using both cohort and time-series methods. The results of this study will be used to seek funding to test the broader application of these methods in both community- and clinic-level interventions. The specific aims of the proposed project are:
  • To provide the rationale and framework for applying weighted time-series to serial cross-sectional data.
  • To use simulation (created data) to apply and test the use of weighted time-series in a setting where the distribution of demographic characteristics and the health status of the population changes over time.
  • To use existing clinical data to compare the effect of introducing family-centered HIV care, VCT and prevention services on the transmission of HIV among the families served by participating clinics using cohort analysis, time-series analysis and weighted time-series.
Research Project

Assessment of Economic Factors Associated with the Psychological Well-Being of HIV+ Persons in Kenya

The specific aim of this study is to conduct a preliminary assessment of the association between measures of economic context and material well-being on the one hand, and positive and negative psychological wellbeing on the other. We postulate that positive psychological well-being is a key determinant of effective and sustainable care and treatment for HIV+ persons, with potential to help reduce situations of HIV transmission. The study will include 100 HIV+ men and 100 HIV+ women receiving care in Kenya. The total number of respondents will be equally distributed between the cities of Nairobi and Kisumu. A convenience sampling approach—stratified by gender—will be used in Kisumu. Oversampling of persons currently employed in the formal or informal sectors will be applied in Nairobi. Survey administration will be conducted simultaneously at both sites over a six month period. We will conduct three types of analyses:
  1. Assess and select measures for the degree of variation they exhibit.
  2. Conduct bivariate measures of association in order to assess unadjusted associations between the psychological well-being measures and those economic factors that demonstrate sufficient variation.
  3. Conduct logistic or multinomial logistic regressions in order to assess the extent of the relationship between the psychological well-being and the economic factors after accounting for potential confounders and effect modifiers.
Information drawn from this study will help fill the gap in understanding the connections between structural factors and psychological well-being of HIV+ persons.
Research Project

Disclosure Intervention for Zimbabwean Parents

We propose a randomized controlled trial of a disclosure intervention in which 300 PLH are randomized to either an: 1) experimental condition, a disclosure intervention (n = 150 parents) or 2) attention control condition, a nutrition intervention (n = 150). The intervention's impact will be assessed over two years (recruitment, 3, 6, 12, 18, & 24 months). The 3-session, culturally tailored disclosure intervention will be delivered by local nurses and address planning for developmentally appropriate disclosure (how and when to disclose), responding to children's reactions, building a supportive family environment, and custody planning. The attention control condition will be relevant to PLH, also delivered by nurses and address nutrition. Therefore, the Specific Aims are to: 1) Primary Aim: Assess the efficacy of the intervention to increase the frequency and timing of parental disclosure. We hypothesize that PLH randomized to the disclosure intervention will be significantly more likely to disclose their own HIV status to their children (parental disclosure) and disclose sooner than PLH randomized to the control condition. 2) Primary Aim: Assess the longitudinal impact of disclosure on parent (medical, psychological, social), child (psychological, behavioral, social) and family outcomes. We hypothesize that parent (health status, depression, anxiety, social support), child (depression, anxiety, HIV-transmission risk behaviors, social support) and family outcomes (family relationships, custody planning) will be significantly better for families in the intervention than families randomized to the control condition. 3) Secondary Aim: Assess the efficacy of the intervention to increase pediatric disclosure. We hypothesize that PLH randomized to the disclosure intervention will be significantly more likely to disclose to a child that s/he is HIV-positive (pediatric disclosure) than PLH randomized to the control condition. The proposed study addresses a neglected and profoundly understudied area that is of high importance to millions of families affected by HIV. If successful, the proposed study will provide evidence for a sustainable model and efficacious disclosure intervention in low-income settings.
Research Project

HIV Prevention among Township Men Who Have Sex with Men in South Africa

This project has two aims: 1
  1. To describe collective and individual belief systems of low-income township men who have sex with men (MSM) related to their sexuality, sexual health, choice of sexual partners, use of drugs and alcohol, use of condoms, utilization of health services, HIV voluntary counseling and testing (VCT) and disclosure of HIV status, in order to describe prevailing cultural norms around these subjects’ behaviors
  2. To assess the prevalence of HIV risk factors and HIV infection among MSM from Soweto township.
This study is the first of its kind in South Africa. Through in-depth interviews, focus group discussions, and structured observations of MSM social venues, we have been able to describe the gender identities and sexualities that are prevalent in township MSM communities. We will estimate the prevalence of risk behaviors and HIV infection in Soweto using respondent-driven sampling methodology. This will be the first HIV prevalence data for an MSM community in South Africa.