Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15-24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, white ethnicity and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals.

Objective The aim of this study was to investigate the ability of the gestational body mass index (BMI) method to screen for adverse birth outcomes and maternal morbidities. Design This was a substudy of a randomised controlled trial, the Philani Mentor Mothers’ study. Setting and subjects The Philani Mentor Mothers’ study took place in a peri-urban settlement, Khayelitsha, between 2009 and 2010. Pregnant women living in the area in 2009-2010 were recruited for the study. Outcome measures Maternal anthropometry (height and weight) and gestational weeks were obtained at baseline to calculate the gestational BMI, which is maternal BMI adjusted for gestational age. Participants were classified into four gestational BMI categories: underweight, normal, overweight and obese. Birth outcomes and maternal morbidities were obtained from clinic cards after the births. Results Pregnant women were recruited into the study (n = 1 058). Significant differences were found between the different gestational BMI categories and the following birth outcomes: maternal (p-value = 0.019), infant hospital stay (p-value = 0.03), infants staying for over 24 hours in hospital (p-value = 0.001), delivery mode (p-value = 0.001), birthweight (p-value = 0.006), birth length (p-value = 0.007), birth head circumference (p-value = 0.007) and pregnancy-induced hypertension (p-value = 0.001). Conclusion To the best of our knowledge, this is the first study that has used the gestational BMI method in a peri-urban South African pregnant population. Based on the findings that this method is able to identify unfavourable birth outcomes, it is recommended that it is implemented as a pilot study in selected rural, peri-urban and urban primary health clinics, and that its ease and effectiveness as a screening tool is evaluated. Appropriate medical and nutritional advice can then be given to pregnant women to improve both their own and their infants’ birth-related outcomes and maternal morbidities.

Objective-To examine the transmission behavior among youth living with HIV (YLH), pre-and post-HAART.Methods-Two cohorts were recruited: (1) 349 YLH during 1994 to 1996 and (2) 175 YLH during 1999 to 2000, after the wide availability of HAART. Differences in sexual and substance-use risk acts and quality of life were examined.Results-Post-HAART YLH were more likely to engage in unprotected sex and substance use, to be more emotionally distressed, and to have lower quality of life than were pre-HAART YLH.Conclusions-Targeted interventions for YLH that address reductions in transmission acts and aim to improve quality of life are still needed. KeywordsHAART; HIV/AIDS; youth with HIV; substance use; sexual risk behaviors HIV infection among adolescents and young adults continues to be a significant and growing problem. It is estimated that half of HIV infections worldwide and one quarter of infections in the United States were acquired in adolescence. [1][2][3] By 2002, the Centers for Disease Control and Prevention reported 31,000 cases of AIDS and, among states reporting, an additional 23,000 HIV infections among 13-to 24-year-olds. 4 The actual number of youth living with HIV (YLH) in the United States is likely to be much larger than these reports because of variable reporting procedures and limited early detection of HIV, particularly among youth. 5 Other estimates of the number of YLH in the United States range between 110,000 and 250,000. 6,7 Some subpopulations of youth are at higher relative risk for HIV infections than are other groups, particularly young gay or bisexual men as well as African American and Latino youth. 8 Thus, youth at greatest risk for HIV infection are also those who are likely to be disenfranchised and stigmatized. 9Address correspondence to Dr Lightfoot, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024-6521. mal@ucla.edu. NIH Public Access Author ManuscriptAm J Health Behav. Author manuscript; available in PMC 2010 March 22. NIH-PA Author ManuscriptSignificant improvements in HIV treatment have occurred over the past 8 years with the advent of highly active antiretroviral therapies (HAART). For example, the reduction of vertical transmission in response to HAART has been demonstrated, 10-12 lower viral loads have been linked to reduced probability of transmission, 13,14 and increasing numbers of persons on combination drug therapies are reporting "undetectable viral loads." 15 Although revolutionary in enhancing care options, HAART has also created new challenges in HIV primary and secondary prevention. HAART provides persons living with HIV (PLH) with a longer lifespan, resulting in more time and opportunities for transmission of HIV to occur. Simultaneously, evidence suggests that many PLH believe that sexual behaviors that could lead to transmission of HIV (ie, unprotected sex) are less risky if viral load is suppressed and the probability of transmission is lower. 16 There is also evidence that transmission behaviors have increased among PLH since the introduct...

Summary PMTCT services are integrated into antenatal care in South Africa, but post-birth care is at HIV clinics. Almost all Mothers Living with HIV (MLH) in 24 township neighborhoods (N=324) reported engagement in HIV care from pregnancy to 36 months post-birth. Less than half re-engaged in HIV care at 6 months (45%), 52.5% at 18 months, and 62.5% at 36 months. Most were prescribed ARVs if reengaged in care, yet only about half (53%) are on ARVs at 36 months post birth. Implementation of Option B+ will require substantially better engagement in care.

Persons living with HIV (PLH) often attribute HIV status to sexual partners based on observable partner characteristics. The present study investigated the relationship of sexual behavior with most recent "main" partner to that partner's perceived serostatus among 1,232 PLH interviewed in clinics and community agencies in Los Angeles, California. PLH who believed their most recent main partner to be HIV-negative more often identified partner appearance as a basis for their perceptions than those who believed their most recent main partner to be HIV-positive. PLH who perceived their most recent main partner as HIV-negative were more likely to assume responsibility for partner protection and always to use condoms, and less likely to report recent unprotected vaginal or anal sex with that partner. Unprotected receptive anal intercourse with their most recent main partner was less common among African American, Latino, and White participants who believed that partner to be HIV-negative. Although PLH appear protective toward HIV-negative main partners, interventions to encourage valid methods of identifying partner serostatus are needed.