Library

Research Project

HIV Prevention Intervention for HIV-Positive Men in China

In China, sexual transmission has become the major driving force behind the HIV epidemic, accounting for more than half (52%) of the estimated 700,000 people currently living with HIV. Men who have sex with men (MSM) may contribute to the rapid acceleration of the epidemic throughout China. Studies with Chinese MSM have documented an increasing HIV prevalence, a high HIV incidence, and high rates of unprotected intercourse and sexually transmitted infections (e.g., syphilis) known to facilitate sexual transmission of HIV. Moreover, our work found that HIV-transmission risk behavior is highly prevalent among HIV-positive MSM in China. Nonetheless, no HIV prevention interventions have targeted HIV-positive Chinese MSM. Several interventions have demonstrated efficacy in reducing sexual risk behaviors among HIV-positive MSM in the U.S. Adapting such interventions for HIV-positive MSM in China would help accelerate the process of developing an efficacious intervention for this risk group. The proposed three-year study (R34) will adapt and pilot-test currently available evidence-based behavioral interventions to reduce HIV-transmission risk behavior among HIV-positive MSM in Chongqing, China. This study will be implemented in five phases, guided by Wainberg et al.’s intervention adaptation model. In Step 1, we will identify core components of efficacious interventions (e.g., key theoretical constructs, intervention messages, delivery modes) through the review of the literature. In Step 2, we will explore cultural, psychosocial, and contextual factors associated with sexual risk behaviors and generate ideas for intervention strategies for HIV-positive MSM by conducting 15 key informant interviews with individuals knowledgeable about HIV-positive MSM and 30 in-depth interviews with HIV positive MSM. In Step 3, we will adapt efficacious interventions through reviewing the core elements of efficacious interventions identified in Step 1 and collating those elements with qualitative data collected in Step 2 with an intervention adaptation working group of 10 health professionals and MSM lay workers who serve HIV-positive MSM. In Step 4, we will pilot-test the adapted intervention with 16 HIV-positive MSM and refine the intervention if necessary. In Step 5, we will test the feasibility of implementing and assessing the intervention refined in Step 4 by conducting the intervention with 50 HIV-positive MSM and having these 50 men complete baseline and 3-month surveys.
Research Project

Positive Prevention in Mozambique

Facilitated by The Twinning Center, the UCSF School of Nursing has partnered with the Ministry of Health in Mozambique in order to adapt, pilot, and implement an US evidence-based Positive Prevention (PP) intervention within rural Mozambique. The purpose of this project is to develop a PP intervention that will effectively address the needs of people living with HIV (PLHIV) in Mozambique through advancing understanding among healthcare providers, counseling and testing staff, and peer educators. Beginning in 2006, this intervention is taking place in two sites in Maputo Province in Mozambique. The first site focuses on building healthcare provider skills around effective risk assessment and prevention messages for their HIV-infected patients. The second site focuses on implementing similar needs assessment and prevention messages within one community–based Voluntary counseling and testing center and an accompanying peer support group. Collaboration among US and Mozambican partners (including healthcare providers, counseling and testing counselors, and PLHIV peer counselors) has guided the development of this PP intervention. The intervention currently includes case studies developed by Mozambican partners and a peer-led support group with enhanced one-to-one risk reduction counseling by counselors and PLHIV peers. Case studies are used in each setting to illustrate concepts such as assessment of transmission risk, behavioral risk reduction approaches, encouragement of partner testing and disclosure, prevention of mother-to-child transmission, and family planning.
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.

Resource

Needle exchange programs (NEP)

More than a million people in the US inject drugs frequently, at a cost to society in health care, lost productivity, accidents, and crime of more than $50 billion a year. People who inject drugs imperil their own health. If they contract HIV or hepatitis, their needle-sharing partners, sexual partners and offspring may become infected. It is estimated that half of all new HIV infections in the US are occurring among injection drug users (IDUs). For women, 61% of all AIDS cases are due to injection drug use or sex with partners who inject drugs. Injection drug use is the source of infection for more than half of all children born with HIV. Injection drug use is also the most common risk factor in persons with hepatitis C infection. Up to 90% of IDUs are estimated to be infected with hepatitis C, which is easily transmitted and can cause chronic liver disease. Hepatitis B is also transmitted via injection drug use. Needle exchange programs (NEPs) distribute clean needles and safely dispose of used ones for IDUs, and also generally offer a variety of related services, including referrals to drug treatment and HIV counseling and testing.

Resource

Mother-to-child transmission (MTCT)

In 2012, there were 2.3 million new HIV infections globally. A large proportion of people newly diagnosed with HIV worldwide are in their reproductive years and these men and women are likely to want children in the future. Addressing the sexual and reproductive health and rights of this population is critical to addressing the spread of HIV because HIV infection in childbearing women is the main cause of HIV infection in children. Treatment for those who are already infected is also central to stopping the spread of HIV to infants and to uninfected sexual partners.