Melissa J. Perry

Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments

OBJECTIVES Women in impoverished inner-city neighborhoods are at high risk for contracting HIV. A randomized, multisite community-level HIV prevention trial was undertaken with women living in 18 low-income housing developments in 5 US cities. METHODS Baseline and 12-month follow-up population risk characteristics were assessed by surveying 690 women at both time points. In the 9 intervention condition housing developments, a community-level intervention was undertaken that included HIV risk reduction workshops and community HIV prevention events implemented by women who were popular opinion leaders among their peers. RESULTS The proportion of women in the intervention developments who had any unprotected intercourse in the past 2 months declined from 50% to 37.6%, and the percentage of womens acts of intercourse protected by condoms increased from 30.2% to 47.2%. Among women exposed to intervention activities, the mean frequency of unprotected acts of intercourse in the past 2 months tended to be lower at follow-up (mean = 4.0) than at baseline (mean = 6.0). These changes were corroborated by changes in other risk indicators. CONCLUSIONS Community-level interventions that involve and engage women in neighborhood-based HIV prevention activities can bring about reductions in high-risk sexual behaviors.

Factors Predicting Continued High-Risk Behavior among Gay Men in Small Cities: Psychological, Behavioral, and Demographic Characteristics Related to Unsafe Sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within ones peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

The Female Condom: What We Have Learned Thus Far

High rates of sexually transmitted diseases (STDs), including HIV, and unplanned pregnancies persist in the United States. Women are more likely than men to be infected with an STD and to bear the burdens associated with unplanned pregnancies and with STD-associated complications. Condom use is advocated for sexually active individuals. However, for some persons condom use remains infrequent and inconsistent; this is particularly true for women, who may face substantial barriers (e.g., partner aggression) to enacting consistent condom use. The female condom is the only female-controlled barrier method currently available to protect women from STDs and unplanned pregnancies. In this paper, we review and summarize the literature on the female condom with regard to efficacy, use-effectiveness, and acceptability among potential and current users. In addition, we identify gaps in the literature and suggest paths for future research.

The Relationship Between Social Class and Mental Disorder

The inverse relationship between social class and rates of mental disorders was first documented in early mental hygiene studies at the beginning of this century and similar findings have been demonstrated in numerous contemporary studies. Interpretations of this persistent relationship include a downward drift explanation that posits that a decline in social status occurs as a result of precipitating mental illness, and a social causation model that emphasizes the importance of psychosocial stressors in the onset of mental disorders. A wealth of evidence supporting the social causation model is reviewed, drawing on mental health epidemiology, womens mental health, unemployment and physical health research. Political and economic origins of the downward drift hypothesis are also discussed.The inverse relationship between social class and rates of mental disorders was first documented in early mental hygiene studies at the beginning of this century and similar findings have been demonstrated in numerous contemporary studies. Interpretations of this persistent relationship include a downward drift explanation that posits that a decline in social status occurs as a result of precipitating mental illness, and a social causation model that emphasizes the importance of psychosocial stressors in the onset of mental disorders. A wealth of evidence supporting the social causation model is reviewed, drawing on mental health epidemiology, womens mental health, unemployment and physical health research. Political and economic origins of the downward drift hypothesis are also discussed.

High risk sexual behavior and alcohol consumption among bar-going gay men.

Objectives:To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men. Methods:Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States. Results:Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption. Conclusions:This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.

Enhancing social diffusion theory as a basis for prevention intervention: A conceptual and strategic framework

Abstract Social diffusion theory has recently been recognized as a promising approach for large-scale disease prevention and health promotion efforts. This paper describes how principles and tactics from social cognitive theory, operant psychology, social psychology, social marketing, and the overarching stages of change model can be used to further develop the conceptual and strategic (technological) bases of social diffusion theory. Within an integrative framework, we discuss in detail more effective ways to train peer mediators of behavior change as one example of how social diffusion theory can benefit from this conceptual and strategic reformulation. We then further illustrate the use of peer mediators of change in human immunodeficiency virus (HIV) and cancer prevention intervention studies with both interventions training peer mediators to diffuse information, norms, and risk reduction strategies. Although the results of these studies showed reductions in high-risk behaviors across population segments, more closely following the framework discussed in this article should further increase the behavior change potential of future interventions based on social diffusion theory.

Predictors of condom use and human immunodeficiency virus test seeking among women living in inner-city public housing developments.

Background and Objectives: To examine prevalence and predictors of condom use and human immunodeficiency virus (HIV) test seeking among women living in inner‐city housing developments. Study Design: Between April and June 1994, 671 women living in low‐income housing developments in five cities in the United States completed an anonymous self‐report questionnaire eliciting information on acquired immune deficiency syndrome (AIDS) risk behavior and characteristics indicative of risk. Results: Most participants were women of color who were economically disadvantaged. Fifteen percent reported multiple sex partners, and 30% of women with one sex partner believed he had sex with someone else in the past year. Predictors of condom use included increased rates of safe‐sex negotiation, stronger risk reduction intentions, absence of condom barrier beliefs, and multiple sex partners. Women tested for HIV in the past year were younger, perceived themselves to be at risk for HIV infection, reported more conversations with other women about AIDS concerns, and had condoms readily available. Conclusions: HIV public health prevention interventions are urgently needed for women who live in low‐income urban housing developments.

HIV antibody testing of gay men in smaller US cities

The incidence of new AIDS diagnoses among gay males indicates that risk reduction in smaller communities may be lagging behind that reported in larger cities. Contradictory evidence exists, largely from urban areas, concerning the utility of HIV testing as a means of promoting behavioural change. This study examined the relationship between HIV antibody testing and subsequent high-risk sexual behaviours among gay men in cities of 180,000 or fewer inhabitants. In February and March of 1992, male gay bar patrons in sixteen small US cities were administered an anonymous questionnaire concerning recent sexual behaviour and HIV testing history. Of the 1820 respondents, 28.1% had recently engaged in unprotected anal intercourse and 60.7% had been tested for HIV antibodies. Those who had been tested were more sexually active and reported more protected and safer sexual activities. Analyses at the individual and city levels converged to demonstrate that communities as well as individuals evidence increased self-protection in association with HIV antibody testing.

Gender, Race and Economic Perspectives on the Social Epidemiology of HIV Infection: Implications for Prevention

This paper describes the impact of gender, race, and economics on the social epidemiology of AIDS.

Economic and Social Causes of Sexism and of the Exploitation of Women

Psychologists have neglected the role of the social, economic and political systems in determining behaviour. Rather, our field, consciously or unconsciously, has been instrumental in upholding the status quo. We have accepted societys ruling ideas that perpetuate exploitation, especially of women in the world of work. Women are often the last to be hired and the first to be fired. They are employed part-time and fired early to avoid the cost of fringe benefits and retirement costs. Ideas about womens roles, generated by capitalism and patriarchal religions, are responsible for widespread sexism and the exploitation of many powerless groups, but especially girls and women. This paper reviews several examples of sexist exploitation that have an economic base.