Bringing HIV Prevention to Scale: An Urgent Global Priority

Illustrates the need for a scaled-up HIV prevention response in order to stem the epidemic, describes impediments to HIV prevention efforts and examples of successful initiatives, and includes recommendations for governments, health agencies, and donors

Effectiveness of Male Condoms: Frequently Asked Questions

More than two decades of research and experience have provided new insights into the role of male condoms for contraception and HIV prevention. However, given that the number of people infected and living with HIV continues to grow, it is essential to reassess what we have learned about HIV prevention. This is especially true regarding condoms, the controversial mainstay of HIV prevention programs. Opinions on condoms are often based on ideology rather than evidence, though evidence has accumulated steadily. The following is a list of frequently asked questions and answers about condom efficacy

Social-Cognitive Theory Mediators of Behavior Change in the National Institute of Mental Health Multisite HIV Prevention Trial

The National Institute of Mental Health Multisite HTV Prevention Trial was a trial of an intervention to reduce sexual HTV risk behaviors among 3,706 low-income at-risk men and women at 7 U.S. research sites. The intervention, based on social-cognitive theory and designed to influence behavior change by improving expected outcomes of condom use and increasing knowledge, skills, and self-efficacy to execute safer sex behaviors, was effective relative to a control condition in reducing sexual risk behavior. At 3 months after completion of the intervention, measures of these potential mediators were higher in the intervention than in the control condition. Although the effect of the intervention on sexual risk behavior was significantly reduced when the variables were controlled statistically, supporting the hypothesis of their mediation of the intervention effect, most of the effect remained unexplained, indicating the influence of unmeasured factors on outcome

A Test of Factors Mediating the Relationship Between Unwanted Sexual Activity During Childhood and Risky Sexual Practices Among Women Enrolled in the NIMH Multisite HIV Prevention Trial

This study examined both the direct and indirect associations between unwanted sexual activity during childhood and HIV-related sexual practices of adult women. The sample consisted of 3,346 women recruited from sexually transmitted disease (STD) clinics and health service organizations. The findings demonstrated that participants who reported unwanted sexual activity as a child (USC) were more likely than women who did not report such experience to indicate that they had problems with alcohol, used drugs, received money or drugs in exchange for sex, had unwanted sex, and used mental health services. The women reporting USC also noted a greater number of unprotected sex acts, a greater number of partners, and a greater proportion of sex acts accompanied by drugs or alcohol in the past 90 days. Mediated analyses showed that drug use, exchange of sex for money/drugs, unwanted sex, and to a lesser extent, problems with alcohol mediated the relationship between USC and unprotected sex acts, number of partners, and sex under the influence of drugs and alcohol. These findings suggest that participation in non-sexual risky behaviors among women who report USC may be a bridge to participation in sexual behaviors that increase their risk of HIV infection

Impact of HIV Testing and Counseling (HTC) Knowledge on HIV Prevention Practices Among Traditional Birth Attendants in Nigeria

Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT). Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs) play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and counseling (HTC) knowledge on the HIV prevention practices among TBAs in Nigeria. Five hundred TBAs were surveyed. Chi-square and logistic regression were used to assess differences in HIV prevention practices between TBAs with and without HTC knowledge. TBAs with HTC knowledge are significantly more likely to engage in HIV prevention practices than TBAs without HTC. Prevention practices included: wearing gloves during delivery (p \u3c 0.01), sterilization of delivery equipment (p \u3c 0.01), participation in blood safety training (p \u3c 0.01), and disposal of sharps (p \u3c 0.01). As long as a high percent of births occur outside health care facilities in Nigeria, there will be a need for TBAs. Providing TBAs with HTC training increases HIV prevention practices and can be a key to improve maternal and child health

The NIMH Multisite HIV Prevention Trial: Reducing HIV Sexual Risk Behavior

The efficacy of a behavioral intervention to reduce human immunodeficiency virus (HIV) risk behaviors was tested in a randomized, controlled trial with three high-risk populations at 37 clinics from seven sites across the United States. Compared with the 1855 individuals in the control condition, the 1851 participants assigned to a small-group, seven-session HIV risk reduction program reported fewer unprotected sexual acts, had higher levels of condom use, and were more likely to use condoms consistently over a 12-month follow-up period. On the basis of clinical record review, no difference in overall sexually transmitted disease (STD) reinfection rate was found between intervention and control condition participants. However, among men recruited from STD clinics, those assigned to the intervention condition had a gonorrhea incidence rate one-half that of those in the control condition. Intervention condition participants also reported fewer STD symptoms over the 12-month follow-up period. Study outcomes suggest that behavioral interventions can reduce HIV-related sexual risk behavior among low-income women and men served in public health settings. Studies that test strategies for reducing sexual risk behavior over longer periods of time are needed, especially with populations that remain most vulnerable to HIV infection

Playing public health: building the HIVe

In thinking through the impact of digital media on how frontline workers, activists, practitioners and researchers understand and fight HIV and AIDS, it is important to acknowledge that digital media does not only provide new channels and strategies for communicating information around HIV prevention and education. It also establishes innovative domains for conceiving of, and building, ‘resilient communities’ like The HIVe. Such digital interventions are cultural assets that confront biomedical and behavioural approaches to HIV prevention and education. Immersive and social technologies, network ubiquity and low cost mobile phones provide new tools for aggregating, representing, collecting and disseminating community-based and led data that ‘plays’ public health differently. This play involves fore-fronting the success of social science HIV prevention and education against the essentialist logic of dominant biomedical approaches. ‘Playing public health’ provides an entirely new and comprehensive picture of the agency of the HIV virus that goes beyond the pathology of the individual. This paper proposes the goal of putting HIV prevention back into the ‘game’ of public health and playing it to win by building The HIVe

The costs of scaling up HIV prevention for high risk groups: lessons learned from the Avahan Programme in India.

OBJECTIVE: The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. DESIGN: Prospective costing study. METHODS: This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$2011. RESULTS: Mean total unit costs (2004-08) per person reached at least once a year and per monthly contact were US$ 235(56-1864) and US$82(12-969) respectively. 35$ 477 per person reached in 2004 to US$145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. CONCLUSIONS: Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities

Proven HIV Prevention Strategies

Describes strategies that, used in combination, have proven to be effective in preventing sexual, blood-borne, and mother-to-child transmission of HIV. Discusses promising methods and structural interventions to reduce the vulnerability of those at risk