Eleanor Singer

Behavior changes after notification of HIV infection.

BACKGROUND To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. METHODS Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. RESULTS Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. CONCLUSIONS To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors.

THE IMPACT OF PRIVACY AND CONFIDENTIALITY CONCERNS ON SURVEY PARTICIPATION THE CASE OF THE 1990 U.S. CENSUS

This study investigates the relationship between concerns about confidentiality and privacy, on the one hand, and mail returns to the 1990 census, on the other. Such concerns significantly affect mail returns, even when demographic variables known to be related to both concerns and survey participation are controlled. However, their impact is not very large, and the effects of confidentiality and privacy concerns vary for black and white respondents

A randomized trial of an education and support program for HIV-infected individuals

ObjectivesTo assess the effectiveness of an intervention for providing information, and support to HIV-positive donors on changes in their sexual behavior, and to assess which donor characteristics are predictive of behavior change. DesignSubjects were randomly assigned to a structured intervention or community referral group. Follow-up assessments were conducted every 6 months. SettingNew York City, New York, USA. ParticipantsA cohort of 271 HIV-infected persons who donated blood to the New York Blood Center. InterventionDonors randomized to the structured intervention program met individually with a nurse for counseling, and were offered a six-session support group. The program was designed to provide information, encourage safer sexual behavior, and provide support. Main outcome measuresSexual behavior, psychological distress, and psychological help seeking, and immune function. ResultsIn both groups there was a large decrease over time in reports of unsafe sexual activity. However, more than 30% of participants in both groups reported unsafe sexual activity at the 1-year follow-up visit. Donors randomized to the structured intervention program did not report significantly more behavior change at the 1-year follow-up. ConclusionsBetter programs to promote behavior change in seropositive individuals are needed.

Sociodemographic and behavioral characteristics of HIV antibody-positive blood donors.

This paper describes the sociodemographic and behavioral characteristics of 173 blood donors who were confirmed by Western blot tests to have antibodies to human immunodeficiency virus (HIV), the etiologic agent for acquired immunodeficiency syndrome (AIDS). Seropositive donors were predominantly young, unmarried, and male, and major risk factors could be identified for almost all donors. However, more than 20 per cent of the study participants were women, and many participants were not aware that they were at risk of infection. The heterogeneity of the study population, the lack of awareness among many subjects of risk factors and self-exclusion procedures, and the high level of distress among many subjects after notification, emphasize the need for intensive, well-designed education and support programs.

Public attitudes toward genetic testing.

This article, which reports the results of a telephone survey of a national sample of the adult US population, was designed as a first measure of attitudes in an area likely to undergo significant change over the next few years. Among the major findings: (1) First, attitudes toward prenatal testing are overwhelmingly favorable at this time, with about two thirds of the respondents saying they would want to undergo such tests themselves (or would want their partner to do so) and believing that the tests will do more good than harm. (2) Second, information about the new technology is not yet widely dispersed in society, and knowledge is unrelated to attitudes in any of the areas we measured. (3) Third, attitudes toward testing for genetic defects and attitudes toward abortion if tests are positive appear to be quite distinct so far. (4) Fourth, the particular conception of genetic defects held by the respondent influences preferences for abortion but not preferences for testing. (5) Fifth, testing for fetal sex clearly falls outside the pale of acceptable behavior at this time, but not if the couple already has three offspring of the same sex.

Health Education about AIDS among Seropositive Blood Donors

The New York Blood Center is developing a health education and psychosocial sup port program for blood donors who are notified that they are HIV antibody positive. The goals of that program are: (1) to provide accurate and intelligible information about the test results to notified donors; (2) to encourage behavior that will reduce the likelihood of spreading the virus; (3) to encourage notified donors to behave in ways that will reduce the probability that they will develop AIDS; and (4) to provide sup port and facilitate functional coping responses. This article reviews the theoretical and empirical work which informs the intervention program, and it describes how the pro gram is being implemented.

Media Coverage of Disasters: Effect of Geographic Location

A content analysis of a sample of major newspapers, magazines, and network news for periods in 1960 and 1984 reveals that both the number of deaths in natural disaster, such as an earthquake, and its geographic location affect the amount of coverage it gets. News about U.S. natural disasters is given disproportionate attention in the U.S. press, but there are no consistent biases in favor of other parts of the world.

PUBLIC OPINION ABOUT AIDS BEFORE AND AFTER THE 1988 U.S. GOVERNMENT PUBLIC INFORMATION CAMPAIGN

In October, 1987, the Centers for Disease Control mounted a massive public information campaign to alert the public to the dangers of AIDS and to provide information about its transmission and prevention. Using data from two Gallup surveys, one just before the campaign began and the other several months after its conclusion, we examine changes in public information and misinformation about transmission, in concern about AIDS as an epidemic, and in reported behavior to avoid exposure to AIDS. We conclude that although some changes in knowledge did take place, these were essentially a continuation of trends beginning before the public information campaign and continuing well after its conclusion. For these and other reasons, we argue that the effects of the campaign on public information were minimal. However, between 1987 and 1988 there was a small but statistically significant increase in reported condom use, an increase paralleled by increased condom sales between 1986 and 1988. In addition, there was a substantial increase in the number of people expressing concern about AIDS as an epidemic for the population at large. The campaign may well have contributed to both of these changes.

Public attitudes toward fetal diagnosis and the termination of life

As measured in two recent national surveys, public attitudes toward prenatal genetic testing are overwhelmingly favorable, and attitudes toward genetic testing in general are also predominantly favorable on both surveys. Unlike genetic testing, however, abortion in case of fetal defect is endorsed by only a minority of both samples.The unreliability of the scales used to measure these attitudes in both surveys suggests that attitudes toward fetal diagnosis and genetic testing have not yet crystallized. In part, this unreliability undoubtedly reflects the nature and number of the questions asked; but in part the low reliability of the scale seems to reflect the novel subject matter and the publics lack of familiarity with it.At present, attitudes toward prenatal diagnosis and testing appear to be distinct from attitudes toward abortion and the termination of life. But attitudes toward prenatal testing predict attitudes toward the termination of life, and vice versa. Thus, as the public becomes more knowledgeable about the new technology and its implications, there is at least the potential for these two attitudes to become more closely linked in the future.

AIDS—AN UPDATE

This summary of public opinion about acquired immune deficiency syndrome (AIDS) updates our earlier review (Singer, Rogers, and Corcoran 1987). Since then, there has been a dramatic increase in public information about AIDS. The Surgeon Generals Report on AIDS was released in 1986, and figures compiled by the Centers for Disease Control indicate that media coverage of the disease surged in 1987, with a total of 11,852 stories, up sharply from approximately 5,000 stories each in 1986 and 1985. In early 1988, the federal government mounted a nationwide campaign to inform the public about AIDS, in particular about ways to prevent its spread. One consequence of this information explosion seems to have been a large increase in the number of people who feel they know a lot about the disease; the percentage giving this response more than doubled between 1987 and 1991. The number of media stories on AIDS in 1988, 1989, and 19907,584, 7,091, and 8,364, respectively-did not match the nearly 12,000 in 1987. But 1991 figures indicate the highest media interest yet13,209 stories. Nearly half (6,038) appeared in the last quarter of the year, which is when Magic Johnson, the superstar Los Angeles Lakers basketball player, announced that he was HIV positive. The total for the first two quarters of 1992 remained high: 7,981 stories, evidence that the media continue to find AIDS highly newsworthy. For this review, we assembled national surveys from the Roper Center for Public Opinion Research that had asked one or more questions about AIDS. Between January 1987 and July 1992, our cutoff date, we identified 116 such surveys: 27 in 1987, 13 in 1988, 9 in 1989, 24 in