Anton M. Somlai

Estimating the prevalence of syringe-borne and sexually transmitted diseases among injection drug users in St Petersburg Russia.

Injection drug users (IDUs) are the vanguard of the human immunodeficiency virus (HIV) epidemic in Russia. We sought a non-invasive method to estimate a point prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and risk behaviours in IDUs attending the syringe exchange programme (SEP) in St Petersburg, Russia. One hundred and one IDUs returning syringes to the St Petersburg SEP were invited to complete a questionnaire requesting demographic, knowledge, and behavioural information, and to provide their syringes for antibody testing. The median age of IDUs was 23 years. Syringe prevalences were: 10.9% for HIV, 78.2% for HCV, 15.8% for HBV, and 6.9% for syphilis. All respondents recognized drug-related risk factors for getting AIDS. Only two-thirds of subjects recognized condoms to prevent sexually transmitted infections and half knew that oil-based lubricants are not appropriate for condoms. The IDU population studied was young and requires additional interventions to encourage safer sexual behaviours.

Predictors of HIV Sexual Risk Behaviors in a Community Sample of Injection Drug-Using Men and Women

Injection risk practices and unprotected sex between injection drug users (IDUs) and their sexual partners are responsible for a high proportion of AIDS cases and new HIV infections in the United States. The purpose of this study was to investigate the links between drug use behaviors and psychosocial factors with high-risk sexual behaviors among male and female IDUs. Understanding the determinants of sexual risk practices among drug users can lead to the development of more effective programs to prevent sexual HIV and STD transmission. This study enrolled a community sample of 101 IDUs (males = 65, females = 36), primarily African American and unemployed, who injected drugs and had unprotected sex in the past 3 months. The sample was categorized into highest sexual risk (multiple partners and intercourse without condoms) and lower sexual risk subgroups. Univariate analyses showed that IDUs at highest sexual risk had lower sexual risk reduction self-efficacy (p = .01) and were more likely to be African American (p = .02). Drug users at highest sexual risk also used noninjected cocaine and crack more frequently (p = .05), were less likely to inject heroin (p = .04), and tended to more often inject cocaine (p = .05). IDUs at highest sexual risk also tended to more often use crack and methamphetamines. Logistic regression analyses showed that injecting cocaine or crack, sexual risk reduction self-efficacy, and race were independent predictors of sexual risk behavior levels. Sexual risk reduction programs for this population are needed, with HIV prevention programs tailored to specific IDU risk reduction needs.

People living with HIV infection who attend and do not attend support groups : a pilot study of needs, characteristics and experiences

People living with Human Immunodeficiency Virus (HIV) confront a myriad of stressors over the course of their infection. Social support groups offer a means of addressing the support needs of people living with HIV. In the present study, 34 persons who had attended HIV support groups and 29 who had not attended groups completed measures of distress, coping, and social connectedness, and participated in open-ended interviews concerning their support group experiences. Results showed that those who attended support groups knew they were HIV-seropositive for a longer time, reported less emotional distress, and had more social contact than did non-attenders. However, non-attenders endorsed avoidant coping strategies to a greater extent. Analyses showed that time since testing positive accounted for differences between groups in social connectedness but not differences in anxiety, depression, or avoidance coping. Thus, HIV-seropositive persons become socially reconnected with time, but individuals with avoidant coping styles experience greater emotional distress and are unlikely to seek support groups. A sizeable proportion of people with HIV may therefore need supportive interventions, particularly nearer to the time that they test HIV-seropositive.

Programmes resources and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa Central / Eastern Europe and Central Asia Latin America and the Caribbean.

Abstract This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention.

Life Optimism, Substance Use, and AIDS-Specific Attitudes Associated with HIV Risk Behavior among Disadvantaged Innercity Women

The development of more effective human immunodeficiency virus (HIV) prevention programs for disadvantaged women requires identification of factors associated with risk. In the present study, 158 women - all of whom met criteria indicative of HIV risk - were recruited in innercity primary healthcare clinics and administered measurements that assessed variables in three domains believed pertinent to HIV sexual risk behavior: (1) substance use in the past 3 months, (2) acquired immunodeficiency syndrome (AIDS)-specific cognitive and attitudinal factors, including AIDS risk knowledge, condom attitudes, perceived risk for AIDS, behavior change intentions, and perceived self-efficacy, and (3) life context variables, including self-esteem, fatalism, personal optimism toward the future, and current life satisfaction. When women were categorized into highest and lower groups based on their recent risk behavior, AIDS-specific cognitive and attitudinal factors, as expected, differentiated the groups. However, women at highest risk for HIV also most often used a variety of substances and scored lower in self-esteem, held views more characterized by personal fatalism and low optimism concerning the future, and had greater life dissatisfaction than women at lower risk. HIV prevention programs for disadvantaged women require attention not only to AIDS-specific knowledge, attitudes, and skills development but also to broader issues of life context that, if unaddressed, may limit womens ability and motivation to reduce risk for HIV/AIDS.

HIV risk behaviour among men who have sex with men in public sex environments: An ecological evaluation

Men who have sex with men (MSM) in public sex environments (PSE) may be at high risk for HIV/AIDS. The majority of research on HIV risk behaviour among MSM has been conducted in open access venues more likely to be linked to networks that openly endorse preventive messages and safer sex norms. This study investigated risk practices among MSM in a PSE in order to develop effective prevention intervention strategies. Three outreach workers with previous MSM prevention experience trained in ethnographic and fieldwork observation techniques provided direct observation data. Seventy-seven observations, each lasting a minimum of two hours, were conducted over a five-month period at three city public parks. Of 614 men observed, over 250 exhibited activities and behaviours related to, or potentially related, to HIV-risk relevant sexual behaviour. Direct sexual contact between two or more men was observed 19 times, while men entering or leaving a sex area of the park was observed 66 times. Outreach workers were able to interact directly with 72 MSM, primarily discussing safer sex strategies. Sexual encounters occurred in more open areas of the PSE with partners migrating to secluded areas for intense and sexual interactions. Future prevention interventions will need to be tailored, and targeted, to specific sexual exchange access points in PSE.

Psychosocial predictors of life satisfaction among persons living with HIV infection and AIDS

As AIDS becomes a more chronic but manageable illness, understanding quality of life issues among persons living with this disease has become an important goal of health care researchers. However, most quality of life investigations of persons living with HIV disease have relied heavily on clinical samples (e.g., hospitalized patients, psychiatric outpatients). The present study sought to identify psychosocial predictors of general life satisfaction in a community sample of 275 persons living with HIV/AIDS in a large midwestern state. Principal components and multiple regression analyses revealed that improved physical/functional well-being, increased social support, more frequent use of active coping strategies, and fewer incidents of AIDS-related discrimination and stigma predicted higher levels of general life satisfaction (R2 = 39). Intervention strategies likely to produce higher levels of life satisfaction among persons living with HIV disease are discussed.

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.

Predictors of Continued High-Risk Sexual Behavior in a Community Sample of Persons Living with HIV/AIDS

Most HIV prevention research has focused on persons who are HIV-seronegative. However, some persons aware of their HIV infection may continue to engage in high-risk sexual behavior patterns that place their sexual partners at risk for HIV infection. The present study delineates rates of high-risk sexual behavior in a community sample of persons living with HIV/AIDS and identifies predictors of continued high-risk sex. An anonymous self-report survey assessing social support, access to health care services, health-related quality of life, perceptions of loneliness, life satisfaction, and sexual behavior was completed by 277 persons living with HIV/AIDS in a midwestern state. Predictors of continued high-risk sex included being in an affectionate relationship, greater physical well-being, more barriers to health care services due to geography and distance, and having a greater number of male sexual partners. HIV prevention programs are needed for persons living with HIV disease who have difficulty avoiding high-risk sexual behavior.

An empirical investigation of the relationship between spirituality, coping, and emotional distress in people living with HIV infection and AIDS.

Evaluates levels of psychological distress, coping mechanisms, and their relationship with the religious beliefs and spiritual practices of people (N=65) living with HIV and AIDS. Results of the research indicate a strong relationship for spiritual dimensions with mental health, psychological adjustment, and coping. Concludes that a blending of spiritual traditions and mental health approaches are needed to facilitate the coping of people living with HIV and AIDS.