Eric A. Ratliff

Health-seeking behaviour for sexually transmitted infections and HIV testing among female sex workers in Vietnam

Abstract This qualitative study was conducted to explore health-seeking behaviour for sexually transmitted infections (STIs) and HIV testing among female sex workers (FSWs) in the cities of Hanoi and Da Nang, Vietnam. Data were gathered from in-depth interviews, focus groups and participant observation. Results suggest that womens decision to seek STI treatment and HIV testing is influenced by the complex interplay of personal risk perceptions, social relationships and community discourse. The women exhibited adequate knowledge of HIV while their knowledge of STIs was limited. They demonstrated high-risk perceptions of HIV, but they showed little concern for STIs. Most women sought treatment at pharmacies when they noticed symptoms of the genital tract. Their decision to seek care in health facilities and HIV testing was hampered by the high costs of treatment, judgmental attitudes of service providers, and a lack of information on testing services. Future interventions need to focus on strengthening knowledge of STIs and the STI-HIV association, and increasing awareness of HIV counselling and testing services. Training for STI service providers including pharmacies and private practitioners on sex-worker friendly and non-judgmental services and counselling skills should be emphasized to provide timely diagnosis and treatment of STIs, and to refer women to HIV testing.

Male homosexual identities, relationships, and practices among young men who have sex with men in Vietnam: implications for HIV prevention.

Rapid socioeconomic transformation in Vietnam in last 15 years has been followed by more liberation of sexual expression and representation of sexual identity among young people. There has been an increase in the visibility of homosexual men in major cities of Vietnam who were largely an unknown population until the emergence of the HIV epidemic. Men who have sex with men (MSM) are now considered as one of the target groups in many HIV prevention programs. This qualitative study examines local identities, relationships, and sexual practices among young MSM aged 15-24 in the cities of Hanoi and Ho Chi Minh City. Our analyses were based on 26 in-depth interviews and 10 focus group discussions with young MSM recruited through public place intercepts and cruising areas. Data document the linguistic classification, sexual relationships and behaviors, identity and process of homosexual identification, and the potential linkage between sexual identity and sexual behaviors of MSM in Vietnam. Data also highlight the stages of homosexual community development in urban Vietnam and important differences between Vietnam and the West in the representation of homosexual identity, relationships, and practices. In light of the findings, we suggest that the continuing development and elaboration of a homosexual community in Hanoi and Ho Chi Minh City offers significant opportunities for targeted HIV/AIDS prevention activities in the Vietnamese MSM population.

Internet influences on sexual practices among young people in Hanoi, Vietnam.

While the influences of the Internet on adult sexuality are well recognized, research on the potential connection between the Internet and young peoples sexuality is still limited. We conducted a qualitative study to examine how young people (aged 15–19 years) in Hanoi, Vietnam used the Internet to develop sexual practices and identities. Our analysis of texts from focus groups, in‐depth interviews, chat scripts and field notes reveals how the Internet is used to assemble sexual information that was not available from other sources such as the family and school. Young peoples narratives also show how they use the Internet as a medium for expressing sexual identities and desires. In the light of these findings, we suggest expanding sex education to include issues that are important to young people such as emotions and relationships, rather than simply focusing more narrowly on reproduction, public health and other interests of the state.

Decisions to participate in research : views of underserved minority drug users with or at risk for HIV

Abstract Under-representation of minority populations, particularly African Americans, in HIV/AIDS research is problematic because African Americans bear a greater disease burden from HIV/AIDS. Studies of motivations for participating in research have emphasized factors affecting individuals’ willingness to participate and barriers to participation, especially in regard to HIV vaccine research. Little is known about how underserved minority drug users perceive research and their decisions to participate. This study describes African American drug users’ perceptions of research participation and their decisions to participate based on three kinds of hypothetical HIV/AIDS-related clinical studies. In-depth, qualitative interviews were conducted with 37 underserved, African American crack cocaine users, recruited from participants already enrolled in three different behavioral HIV prevention studies. Interviews were recorded, transcribed, coded for themes and sub-themes and analyzed using directed and conventional content analysis. Participants’ decisions to take part in research often involved multiple motivations for participating. In addition, decisions to participate were characterized by four themes: a desire for information; skepticism and mistrust of research and researchers; perceptions of medical care and monitoring within a study; and participant control in decisions to participate or decline participation. Lack of adequate information and/or medical care and monitoring within a study were related to mistrust, while the provision of information was viewed by some individuals as a right and acknowledgement of the participants contribution to the study. Participants perceived, rightly or wrongly, that medical monitoring would control some of the risks of a study. Participants also described situations of exerting control over decisions to enter or withdraw from a research study. Preliminary findings suggest that continuous communication and provision of information may enhance enrollment and adherence. Further exploration of decisions to participate in research will add to the understanding of this complex phenomenon and enhance the ability of individuals with HIV/AIDS to benefit from research.

Women as ‘sex workers,’ men as ‘boyfriends’: Shifting identities in Philippine go‐go bars and their significance in STD/AIDS control

Abstract Research and intervention programs for AIDS prevention place people within ‘risk groups’ to target specific populations that are believed to be more prone to contract and transmit HIV and other STDs. The ‘sex worker’ is one of these convenient constructions used to label women who exchange sex for money or other material gains. Research presented in this paper examines the activities of female go‐go dancers in the Philippines and their relationships with male customers, showing how women attempt to distance themselves from the stigmatized ‘sex worker’ identity. Health personnel and government officials consider these women to be ‘sex workers,’ yet they do not situate themselves within this category. Their activities also challenge the accepted definition regarding prostitution, as many sexual encounters occur with men they identify as ‘boyfriends.’ In these situations they are less likely to request condom use because of the social and emotional ambiguities concerning their relationships.

An Overview of HIV Prevention Interventions for People Who Inject Drugs in Tanzania

In the past decade, Tanzania has seen a rapid rise in the number of people who inject drugs (PWID), specifically heroin. While the overall HIV prevalence in Tanzania has declined recently to 5.6%, in 2009, the HIV prevalence among PWID remains alarmingly high at 35%. In this paper, we describe how the Tanzania AIDS Prevention Program (TAPP), Médecins du Monde France (MdM-F), and other organisations have been at the forefront of addressing this public health issue in Africa, implementing a wide array of harm reduction interventions including medication-assisted treatment (MAT), needle and syringe programs (NSP), and “sober houses” for residential treatment in the capital, Dar es Salaam, and in Zanzibar. Looking toward the future, we discuss the need to (1) extend existing services and programs to reach more PWID and others at risk for HIV, (2) develop additional programs to strengthen existing programs, and (3) expand activities to include structural interventions to address vulnerabilities that increase HIV risk for all Tanzanians.

Perceptions of Risk in Research Participation Among Underserved Minority Drug Users

Research with underserved minority drug users is essential to quality health care and prevention. Understanding how participants perceive risk in research is necessary to inform research regulators so that research protections are neither lax, exposing participants to harm, nor overly stringent, thereby denying access to beneficial research. Data from 37 semistructured interviews of underserved, African-American crack cocaine users, collected from February to May 2006 in a large, urban setting, were analyzed using content analysis. In three hypothetical studies, participants recognized risks as relative and articulated and evaluated specific risks. Research regulators may enhance the accuracy of risk assessment in research by incorporating the views of participants. Study implications and limitations are noted. Future research on risk perception in research participation is suggested.

A Psychosocial Comparison of New Orleans and Houston Crack Smokers in the Wake of Hurricane Katrina

The purpose of this study was to compare psychological distress in a sample of African American crack cocaine users who relocated to Houston from New Orleans after Hurricane Katrina to African American drug users resident in Houston. Fifty-four African Americans from New Orleans were compared to a sample of 162 people in Houston. Data were collected between June 2002 and December 2005. There were no significant differences between the two groups on either depression or anxiety, but the New Orleans sample scored higher on the self-esteem scale and scored slightly lower on the risk-taking scale.

Improving condom self-efficacy and use among individuals living with HIV: The positive choices mapping intervention

Few interventions have been designed to improve behavioural outcomes and reduce risk of HIV transmission of individuals living with HIV, most focusing on preventative efforts directed at individuals who are HIV‐negative. However, people living with HIV present individual and public health risks (infection with a different strain of HIV, health complications from contracting STDs, continued sexual activity with individuals with unknown HIV status) that have become the focus of intervention efforts. The current paper explores a promising new intervention, The Positive Choices Mapping (PCM) intervention, designed to increase condom self‐efficacy and use among African American crack cocaine smokers who are living with HIV. The intervention was grounded in Social Cognitive Theory and incorporated an empirically backed visual representation strategy (node‐link mapping). The focus of the current paper is on the main components of the intervention.

iCHAMPSS: Usability and Psychosocial Impact for Increasing Implementation of Sexual Health Education

Introduction. Diffusion of sexual health evidence-based programs (EBPs) in schools is a complex and challenging process. iCHAMPSS (CHoosing And Maintaining effective Programs for Sex education in Schools) is an innovative theory- and Web-based decision support system that may help facilitate this process. The purpose of this study was to pilot-test iCHAMPSS for usability and short-term psychosocial impact. Method. School district stakeholders from across Texas were recruited (N = 16) and given access to iCHAMPSS for 3 weeks in fall 2014. Pre- and posttests were administered to measure usability parameters and short-term psychosocial outcomes. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Results. Most participants reported that iCHAMPSS was easy to use, credible, helpful, and of sufficient motivational appeal. iCHAMPSS significantly increased participants’ self-efficacy to obtain approval from their board of trustees to implement a sexual health EBP. Positive, though nonsignificant, trends included increased knowledge to locate EBPs, skills to prioritize sexual health education at the district level, and ability to choose an EBP that best meets district needs. Conclusions. iCHAMPSS is an innovative decision support system that could accelerate uptake of EBPs by facilitating diffusion and advance the field of dissemination and implementation science for the promotion of sexual health EBPs.