No Easy Answers: Avoiding Potential Pitfalls of De‐implementation

In 2012, the Centers for Disease Control and Prevention (CDC) began to de‐emphasize and de‐implement multiple evidence‐based HIV prevention practices that had been around for 20 years, thus changing the scope of implementation across the globe. The authors provide evidence how existing interventions (e.g., CDC HIV interventions) may influence implementation of interventions that came after the program was discontinued. De‐implementation is an ecological event that influences, and is influenced by, many parts of a system, for instance, implementation of one type of intervention may influence the implementation of other interventions (biomedical and/or behavioral) after a long‐running program is discontinued. Researchers and policy makers ought to consider how de‐implementation of behavioral interventions is influenced by biomedical interventions mass‐produced by companies with lobbying power. The scientific study of de‐implementation will be inadequate without consideration of the political climate that surrounds de‐implementation of certain types of interventions and the promotion of more‐profitable ones.HighlightsImplementation of one type of intervention (behavioral) influences implementation of other types (biomedical) interventions.The surge of biomedical interventions influenced de‐implementation of behavioral interventions.Political climate and community exclusion from implementation decision‐making may lead to early de‐implementation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148259/1/ajcp12298.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148259/2/ajcp12298_am.pd

Can Medicaid Reimbursement Help Give Female Condoms a Second Chance in the United States?

The female condom is the only other barrier contraception method besides the male condom, and it is the only "woman-initiated" device for prevention of sexually transmitted infections. Although studies demonstrate high acceptability and effectiveness for this device, overall use in the United States remains low. The female condom has been available through Medicaid in many states since 1994. We provide the first published summary of data on Medicaid reimbursement for the female condom. Our findings demonstrate low rates of claims for female condoms but high rates of reimbursement. In light of the 2009 approval of a new, cheaper female condom and the recent passage of comprehensive health care reform, we call for research examining how health care providers can best promote consumer use of Medicaid reimbursement to obtain this important infection-prevention device

Child Sexual Abuse Prevention Programs: What Makes Them Effective in Protecting Children?

Child sexual abuse prevention programs have proliferated over the past several years. Many of these program approaches, which include plays, games and videos, are visually appealing and highly entertaining, and parents and teachers have widely embraced them. However, despite the popularity of such programs, little effort has been made to evaluate their effectiveness in changing children's behavior. As a result of participation in a sexual abuse prevention program, has a child's vulnerability to abuse been reduced, for example, or has his or her sense of personal safety been enhanced

Sexual Risk Behaviors, Alcohol Abuse, and Intimate Partner Violence Among Sex Workers in Mongolia: Implications for HIV Prevention Intervention Development

This study examines HIV/STI risk behaviors, alcohol abuse, intimate partner violence, and psychological distress among 48 female sex workers in Mongolia to inform the design of a gender-specific, HIV/STI prevention intervention for this population. Quantitative findings demonstrate that over 85% of women reported drinking alcohol at harmful levels; 70% reported using condoms inconsistently with any sexual partner; 83% reported using alcohol before engaging in sex with paying partners; and 38% reported high levels of depression. Focus group findings provide contextual support and narrative descriptions for the ways that poverty, alcohol abuse, interpersonal violence, and cultural norms that stigmatize and marginalize women are intertwined risk factors for STIs, including HIV, among these vulnerable women

Reducing Risk Behaviors Linked to Noncommunicable Diseases in Mongolia: A Randomized Controlled Trial

Objectives. We tested the efficacy of a 6-session, evidence-based health promotion intervention aimed at reducing noncommunicable disease (NCD) risk behaviors. Methods. Two hundred male and female factory workers in Ulaanbaatar, Mongolia were randomly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention. Results. The health promotion intervention increased daily fruit and vegetable intake and physical activity, increased readiness for NCD risk behavior reduction and health promotion knowledge, and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention. Conclusions. The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs. Dissemination of the intervention may improve productivity, reduce costs of health services, and better the quality of life for Mongolians

Systematizing Planning and Formative Phases of HIV Prevention Research: Case Studies from Brazil, Mongolia, and Kazakhstan

Objectives International Community-Based Participatory Research (CBPR) is vulnerable to contextual, political, and interpersonal issues that may hamper researchers’ abilities to develop and sustain partnerships with local communities. This paper responds to a call for systematizing CBPR practices and to the urgent need for frameworks with potential to facilitate partnership building between researchers and communities in both “developed” and “developing” countries. Methods Using three brief case examples, each from a different context, with different partners and varied research questions, we demonstrate how to apply the International Participatory Research Framework (IPRF). Results IPRF consists of triangulated procedures (steps and actions) that can facilitate known participatory outcomes: (1) community-defined research goals, (2) capacity for further research, and (3) policies and programs grounded in research. Conclusions We show how the application of this model is particularly helpful in the planning and formative phases of CBPR. Other partnerships can use this framework in its entirety or aspects thereof, in different contexts. Further evaluation of how this framework can help other international partnerships, studying myriad diseases and conditions, should be a focus of future international CBPR

Designing Effective HIV Prevention Strategies for Female Street Sex Workers

Homelessness, rape, partner abuse and other violent events associated with psychological distress are common occurrences in the lives of street sex workers and have not been considered in their impact on developing HIV prevention programs. Feelings of stigmatization due to the nature and illegal status of the occupation are likely to contribute to significant psychological distress. Psychological distress and drug dependency may, in turn, undermine the motivation and ability of sex workers to adopt safer sex behavior. Most HIV programs targeted to this population tend to ignore the multiple factors that are associated with sex work. Mental health and other basic services such as drug abuse treatment, public assistance, housing, education, and training for alternative employment are not integrated into HIV prevention approaches. Moreover, most HIV prevention programs for female sex workers are not culturally sensitive and fail to involve sex workers in designing an intervention reflective of the community's unique needs or infrastructure

Childhood Sexual Abuse and Risk Behaviors Among Men at High Risk for HIV Infection

Objectives: This study examined the association between unwanted sexual activity during childhood and risky behaviors among a sample of predominantly African American and Hispanic men. Methods: Data were obtained from baseline interviews completed by 2676 men enrolled in a multisite HIV prevention trial. Results: Approximately 25% of the men reported unwanted or uninvited sexual activity before 13 years of age, with Hispanic men more likely than African American men to report unwanted sexual activity during childhood. Men with a history of unwanted sexual activity during childhood were more likely to report unwanted sexual activity since age 13, the buying and selling of sex, problems with alcohol, and drug use. Men who reported unwanted sexual activity during childhood also reported a significantly greater frequency of unprotected sexual acts and more partners. Conclusions: Among men at high risk for HIV infection, unwanted sexual activity during childhood is more widespread than previously described and can increase the risk of participating in harmful health practices during adulthood, including risky sexual behaviors

Risk and resilience factors for depression and suicidal ideation in Mongolian college students

There were 16 state and 84 private universities in Mongolian and 67% of high school graduates were enrolled in higher levels of education in 2014 (Ministry of education, 2015). Over 67% of total students who enrolled in the higher levels of education were females. This cross-sectional study is a secondary analysis of data from a research project originally designed to describe the overall health and wellness of college students at a technical college in Ulaanbaatar, Mongolia

Piloting a Savings-Led Microfinance Intervention with Women Engaging in Sex Work in Mongolia: Further Innovation for HIV Risk Reduction

This paper describes a pilot study testing the feasibility of an innovative savings-led microfinance intervention in increasing the economic empowerment and reducing the sexual risk behavior of women engaging in sex work in Mongolia. Women’s economic vulnerability may increase their risk for HIV by compromising their ability to negotiate safer sex with partners and heightening the likelihood they will exchange sex for survival. Microfinance has been considered a potentially powerful structural HIV prevention strategy with women conducting sex work, as diversification of income sources may increase women’s capacity to negotiate safer transactional sex. With 50% of all reported female HIV cases in Mongolia detected among women engaging in sex work, direct prevention intervention with women conducting sex work represents an opportunity to prevent a potentially rapid increase in HIV infection in urban Mongolia. The piloted intervention consisted of a matched savings program in which matched savings could be used for business development or vocational education, combined with financial literacy and business development training for women engaging in sex work. Results of the pilot demonstrate participants’ increased confidence in their ability to manage finances, greater hope for pursuing vocational goals, moderate knowledge gains regarding financial literacy, and an initial transition from sex work to alternative income generation for five out of nine participants. The pilot findings highlight the potential for such an intervention and the need for a clinical trial testing the efficacy of savings-led microfinance programs in reducing HIV risk for women engaging in sex work in Mongolia