Vaginal microbicides may improve prevention outcomes for high-risk inner-city women.

Heterosexually transmitted HIV remains of critical concern in the United States and around the world, especially among vulnerable and disadvantaged women, complicated by socioeconomic circumstances, gender power, addiction, and experiences of abuse, among other conditions. Effective woman-initiated HIV prevention options, such as the female condom (FC), are needed that women can use in different sexual relationship contexts. We conducted a behavioral and attitudinal survey with 461 primarily African American and Latina (especially Puerto Rican) women in Hartford, Connecticut, to measure factors on the individual, partner relationship, peer, and community levels influencing their initial and continued use of FC (using the prototype FC1) for disease prevention. We used multivariate analyses and structural equation modeling to assess effects of multiple level factors on FC use and unprotected sex with primary, casual, and paying partners. Initial, recent, and continued FC use was associated with factors on the individual level (education, marital status, drug use, child abuse experiences, HIV status), partner level (number of sex partners, paying sex partner, relationship power), and peer level (more or influential peers saying positive things about FC). Community level factors of availability and support were consistently poor across all sectors, which limited overall FC use. Patterns differed between African American and Latina women in stages and contexts of FC use and unprotected sex. FC can make a valuable contribution to reducing heterosexually transmitted HIV among women in many circumstances. The greatest barrier to increased FC use is the lack of a supportive community environment for its promotion and use.

Highlights Participatory system dynamics modeling helps improve the HIV service system to reduce the epidemic. We engaged local stakeholders to critique their HIV service system using system dynamics modeling. Participants showed enhanced communication and consensus about systems understanding and solutions.

The purpose of this study was to illuminate the experiences of poor, urban HIV-positive drug users. Sixty participants were asked about HIV risk behaviors, the impact of HIV on their lives, religious beliefs, life plans, relationships, and work-related issues both prior to and since diagnosis. A theoretical framework was developed using Frank's (1995; Illness Narratives and Boss and Couden's (2002) Ambiguous Loss theories. Themes pertaining to both physical and emotional or spiritual dimensions were located within Benefit, Loss, or Status Quo orientations. The findings contribute to researchers' understanding of the HIV/AIDS illness experiences among the very marginalized and they have important implications for physical and mental health care professionals working with HIV-positive drug users.Increasingly, public health responses to the AIDS epidemic are shifting to the treatment and care end of the treatment/prevention continuum. The movement of both public and private intervention resources toward the provision of care, treatment, and secondary rather than Correspondence concerning this article should be addressed to Katie E.

This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse (CSA) histories. CSA survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the CSA group. The mechanisms of risk are different for those with divergent CSA histories and thus interventions should be developed to educate women with a history of CSA about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use. KeywordsChildhood Sexual Abuse; Drug Use; Sexual Risk; HIV Risk; STI Risk Rates of childhood sexual abuse (CSA) among U.S. adult women have been estimated at anywhere between 14% (Bensley, Van Eenwyk, & Simmons, 2000) and 33% (Elze, Auslander, McMillen, Edmond, & Thompson, 2001). Women who are deemed to be at highest risk for sexually transmitted infections (STIs) including HIV (e.g., methadone treatment drop-outs, injection drug users, homeless women, female prisoners) have been reported to have even Address correspondence to Katie Mosack, Department of Psychology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201. NIH Public AccessAuthor Manuscript J Child Sex Abus. Author manuscript; available in PMC 2011 January 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript higher rates of CSA experiences than the general population (Kang, Deren, & Goldstein, 2002;Mullings, Marquart, & Brewer, 2000;Noell, Rohde, Seeley, & Ochs, 2001;Plotzker, Metzger, & Holmes, 2007;Sikkema, Hansen, Meade, Kochman, & Fox, 2009). Alarmingly, rates of CSA among women with HIV are estimated to range from 32% to 59% (Bedimo, Kissinger, & Bessinger, 1997;Gielen, McDonnell, Wu, O'Campo, & Faden, 2001;Simoni & Cooperman, 2000). Having experienced CSA has been associated with later risk behaviors, including having several sexual partners (Batten, Follette, & Aban, 2001;Hillis, Anda, Felitti, & Marchbanks, 2001;Johnsen & Harlow, 1996;Krahé, Sheinberger-Olwig, Waizenhofer, & Kolpin, 1999;Meston, Heiman, & Trapnell, 1999), having anal sex (Wingood & DiClemente, 1997), and failing to use condoms (Batten et al., 2001;Johnsen & Harlow, 1996;Meston et al., 1999;Noell et al., 2001). Additionally, women who have been sexually abused in childhood are at risk for subsequent sexual victimization as adolescents or adults (Arias, 2004;Johnsen & Harlow, 1996;Krahé et al., 1999;Lodico, Gruber, & DiClemente, 1996;Noll et al., 2003;Randolph & Mosack, 2006).Despite evidence indicating an association between CSA and adult sexual risk, causal pathways and mediators between CSA and STI risk have been understudied (Noll, 2005). Some research suggests that the long-term sequelae of CSA, including drug use and problems with sexual adjustment, likely m...

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China.

Findings indicated that many women will potentially initiate and continue using FC when basic barriers are removed. Brief FC education with free trial samples should be built into standard clinical practice and public health programs.

Microbicides may be acceptable among sex workers in rural settings in China; however, contextual factors should be carefully considered in education and promotion of microbicides in the future.