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  1. 1
    Peer Reviewed

    UNAIDS ‘multiple sexual partners’ core indicator: Promoting sexual networks to reduce potential biases.

    Dimbuene ZT; Emina JB; Sankoh O

    Global Health Action. 2014; 7:23103.

    UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. This paper explores the validity and effectiveness of the ‘multiple sexual partners’ core indicator, which is only partially captured with current available data. The paper also suggests an innovative approach for collecting more informative data that can be used to provide an accurate measure of the UNAIDS’s ‘multiple sexual partners’ core indicator. Specifically, the paper addresses three major limitations associated with the indicator when it is measured with respondents’ sexual behaviors. First, the indicator assumes that a person’s risk of contracting HIV / AIDS / STIs is merely a function of his / her own sexual behavior. Second, the indicator does not account for a partner’s sexual history, which is very important in assessing an individual’s risk level. Finally, the 12-month period used to define a person’s risks can be misleading, especially because HIV / AIDS theoretically has a period of latency longer than a year. The paper concludes that, programmatically, improvements in data collection are a top priority for reducing the observed bias in the ‘multiple sexual partners’ core indicator.
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  2. 2

    World AIDS Day -- December 1, 1998.


    Talking with young people about AIDS is the theme designated by the Joint UN Program on HIV/AIDS for World AIDS Day, December 1, 1998. Approximately 30 million people were living with HIV/AIDS by the beginning of 1998, many of whom were infected as adolescents or young adults. In the US, in areas reporting both AIDS cases and HIV infection, 3% of people with AIDS and 14% of those with HIV infection reported during January 1994 to June 1997 were aged 13-24 years. Reducing rates of high-risk sexual and drug-using behaviors among teenagers and young adults should therefore continue to be an important primary HIV prevention priority. Data from 12 local and state health departments participating in the Supplement to HIV/AIDS Surveillance Project indicate that many HIV-infected adolescents and young adults continue having sexual intercourse without condoms and with multiple sex partners, although some adopt sexual risk reduction behavior after learning that they are infected. Additional information on World AIDS Day and AIDS and HIV infection in teenagers and young adults may be obtained from the US Centers for Disease Control and Prevention.
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  3. 3

    Malawi wakes up to harsh AIDS reality.

    AIDS ANALYSIS AFRICA. 1996 Feb; 6(1):1.

    Considerable data on AIDS in Malawi are available at the local level, but much of the information long languished instead of being formally collected and put together to provide an overall picture of the epidemic in the country. A World Health Organization (WHO) epidemiologist, however, has completed the first comprehensive, nationwide survey of HIV prevalence rates in Malawi. 1.6 million of Malawi's 11 million population are infected with HIV, making it one of countries in Africa worst affected by the epidemic. In 1995 alone, there were an estimated 265,000 new HIV cases and 74,900 deaths from AIDS. There are also fears about the safety of the blood supply. The WHO survey suggests that three of the country's 62 hospitals are not testing blood for HIV. Moreover, the effectiveness of the system is undermined by the widespread carelessness and dishonesty of overworked technicians who conduct the tests. While the reasons are many and complex for the spread of HIV, it seems that the policies of former President Hastings Kamuzu Banda were a contributory factor. President Banda's neglect of grassroots health care, especially in rural areas, and his refusal to allow public debate on the disease no doubt fueled the spread of HIV in Malawi. Traditional sex practices also probably play a role. For example, in some ethnic groups, young teenage girls are sexually initiated by men specially chosen for their physical prowess. Any one of these men who happens to be HIV-seropositive and has sex with many of these young girls may pass the virus on to many other people.
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  4. 4

    HIV / AIDS: knowledge, attitudes, beliefs and practices.

    AIDS SURVEILLANCE REPORT. 1995 Jan; (4):3, 5-6.

    More than forty studies were reviewed in 1995 on the knowledge, attitudes, beliefs, and practices of individuals with respect to HIV/AIDS in American Samoa, Cambodia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong, Japan, Lao People's Democratic Republic, Malaysia, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu, and Vietnam. In all but one of the twenty studies which inquired, more than 80% of respondents had heard of AIDS. In a number of countries, correct knowledge about the sexual transmission of HIV/AIDS was found to be at least 80%. A similar level of knowledge was found about needle transmission of HIV/AIDS, although comparatively lower levels of knowledge about HIV transmission via sexual intercourse, needle use/reuse, and maternal-child exchange was, however, identified in Cambodia, Fiji, Malaysia, Solomon Islands, and the high-risk populations of Vietnam and French Polynesia. Relatively high levels of incorrect answers were observed for the incorrect modes of HIV transmission. Moreover, 20% of respondents in each of the eight studies are in favor of exiling or isolating HIV-infected persons; in two countries, support for isolation or exile was 60% or greater. Overall, risk behaviors appear to exist at levels which will support an HIV epidemic in the countries studied. Levels of other sexually transmitted diseases and reported levels of extramarital and premarital sex, especially among males, support this conclusion. Commercial sex appears to occur at a substantial level in most of the societies studied, while condom use in casual and commercial sexual encounters seems to be the exception rather than the rule.
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  5. 5

    Research on sexual behaviour that transmits HIV: the GPA / WHO collaborative surveys -- preliminary findings.

    Carael M; Cleland J; Deheneffe JC; Adeokun L

    In: Sexual behaviour and networking: anthropological and socio-cultural studies on the transmission of HIV, edited by Tim Dyson. Liege, Belgium, Editions Derouaux-Ordina, [1992]. 65-87.

    6 national surveys were conducted over the period 1988-90 in the Central African Republic, Cote d'Ivoire, Lesotho, Togo, Kenya, and Rwanda in collaboration with the WHO Global Program on AIDS. The surveys include questions on sexual behavior; preliminary findings are reported in this paper. The authors point out the limitations of the survey approach and acknowledge the need for complementary anthropological research. At the aggregate level, however, the researchers found a higher degree of sexual activity in urban compared with rural areas; younger age cohorts may be having more premarital and extramarital sex than did older cohorts during the same stage of their lives; and that the rate of casual sex is higher for men, with the incidence positively related to urban residence and educational level. The surveys also suggest that in some societies a large number of men have casual/commercial sex with a relatively small group of women, while small groups of older men in other societies have sex with larger groups of younger women. These differences may be associated with the decline of polygyny in much of East and southern Africa compared with its relative persistence in West Africa.
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  6. 6

    The Africa syndrome. India confronts the spectre of a massive epidemic.

    McDonald H

    FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.

    As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
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  7. 7

    Prevention of sexual transmission of human immunodeficiency virus.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1990. iii, 27 p. (WHO AIDS Series 6)

    The sexual route of transmission (homosexual or heterosexual) accounts for the majority of cases of human immunodeficiency virus (HIV) infection throughout the world. At present, there are only 4 approaches to the prevention of the sexual transmission of HIV: 1) education aimed at motivating individuals to change high-risk behaviors; 2) latex condom use, preferably in conjunction with a spermicide containing nonoxynol-9; 3) early diagnosis through HIV antibody testing; and 4) partner notification, either by the infected individual or a 3rd party. The World Health Organization has developed guidelines for public health authorities, health care providers, HIV-infected persons, the sexual partners of seropositive individuals, and the general public on specific steps that should be taken. HIV-positive persons are urged to notify current and former sexual partners about their seropositivity, to adopt safe sex practices that do not involve the exchange of bodily fluids, and, in the case of infected females, to avoid pregnancy. The general public can reduce its risk of acquiring HIV by the careful selection of sexual partners (i.e., avoidance of sexual relations with unknown persons, prostitutes, or intravenous drug users), a reduction in the number of sexual partners, and avoidance of any sexual practices that involve the sharing of semen, vaginal and cervical secretions, and blood if the individual's drug taking and sexual histories are unknown. Appendices to this pamphlet discuss the complex medical, logistic, social, legal, and ethical issues raised by partner notification and the growing evidence that sexually transmitted diseases, particularly ulcers, may enhance the risk of HIV infection.
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  8. 8

    Changing behavior: barrier methods in high-risk populations.

    Potts M; Feldblum PJ

    In: Heterosexual transmission of AIDS: proceedings of the Second Contraceptive Research and Development (CONRAD) Program International Workshop, held in Norfolk, Virginia, February 1-3, 1989, edited by Nancy J. Alexander, Henry L. Gabelnick, and Jeffery M. Spieler. New York, New York, Wiley-Liss, 1990. 69-79.

    Individuals who have many sexual partners are at higher risk of acquiring the human immunodeficiency virus (HIV) and transmitting it. The major issues in preventing the spread of the HIV virus are: 1) promoting the distribution and utilization of barrier methods and 2) providing the accessibility to health education and service programs. The social marketing programs for condoms (in Colombia, India and Bangladesh) are the most cost-effective way of reaching the majority of low-risk populations in developing countries. The effectiveness of barrier methods increases with duration and correlates with the personality of the user--for example, smokers have a higher failure rate for condom usage than non-smokers. Unfortunately those most in need of using condoms, intravenous drug users and prostitutes, are the least likely to use them. Family Health International's AIDSTECH PROGRAM began working with groups of prostitutes in Ghana, Cameroon, Mali, Burkina Faso and Mexico to teach prostitutes and their peers about AIDS and how to prevent transmission of the HIV infection. The program was successful with significant changes in prostitute and client behavior. Based on this success, AIDSTECH has developed additional intervention programs in 26 countries worldwide. These projects begin as small projects expanding into larger-scale programs. The most critical issue involved in changing the behavior patterns of people is the political will of governments to invest and initiate service programs that will reach the most vulnerable and high risk populations. Donor agencies should focus on Sub-Saharan Africa where a practical global strategy is coordinated and cost-effective and makes HIV interventions possible.
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  9. 9

    Consensus statement from the consultation on HIV epidemiology and prostitution, Geneva, 3-6 July 1989.

    Consultation on HIV Epidemiology and Prostitution (1989: Geneva)

    [Unpublished] 1989. 5 p. (WHO/GPA/INF/89.11)

    Interventions capable of reducing the risk of HIV infection among prostitutes and their clients were the topics of a special consultation in July 1989 convened by WHO's Global Program on AIDS and Sexually Transmitted Disease (STD) Program. Since mathematical modelling of HIV transmission indicated that population groups with the highest rate of sexual partner change contribute disproportionately to the transmission of HIV, interventions targeted at prostitutes have the potential to greatly reduce the impact of the AIDS epidemic. Greater use of condoms among prostitutes, increased awareness of the STD-AIDS link, the substitution of alternative methods of sexual stimulation for penetrative sex, better utilization of health care services by prostitutes and their clients for the diagnosis and treatment of STDs, and increased support of safer sex practices from managers of prostitute businesses all have proved to be effective interventions. However, more widespread application of these interventions has been hindered by the following: an unwillingness on the part of clients and managers to support sex workers' demand for the routine use of condoms; an inability to reach less visible prostitutes; a lack of political and financial support for such programs; the presence among prostitutes of other high- risk behaviors such as intravenous drug use; and legal restrictions that instill a belief in prostitutes that they cannot control their lives. Most effective have been interventions that empower prostitutes to determine their working conditions and enhance their ability to negotiate with clients and managers for adequate health care and safer sex practices.
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