Nuanced approaches to HIV/AIDS research

We examined the type of lubricants, and extent of lubricant use among men who have sex with men (MSM) in India using data from two rounds of cross-sectional surveys conducted in 2005-07 (Round 1, R1) and 2009-10 (Round 2, R2) as part of evaluation of a large-scale HIV prevention program in three Indian states. In both rounds, MSM were recruited from cruising sites using time-location cluster sampling. We used binary logistic regression to assess the association between lubricant use and socio-demographic and programmatic indicators. 7,775 HR-MSM were interviewed in both rounds (R1-3,895, R2-3,880). The profile of the respondents was almost similar in both rounds. More than half reported using lubricants in both rounds (R1-54%, R2-64%). Use of water-based lubricants (R1-35%, R2-58%) was higher than oil-based lubricants (R1-45%, R2-41%) in R2 and a high proportion of MSM in both rounds (R1-64%, R2-77%) were exposed to any HIV prevention interventions. Characteristics associated with increased odds for lubricant use were exposure to any HIV prevention interventions (AOR- 3.23, CI: 2.73, 3.82). Similarly, kothi-identified MSM had higher odds for lubricant use in both rounds. The national HIV program needs to promote use of water-based lubricants and distribute free lubricants, which could significantly decrease HIV risk among MSM.

The aim of this study is to understand HIV related risk behaviour and prevalence of HIV/AIDS among IDUs in the districts Manipur, Nagaland and Maharashtra of India between two rounds. The data from IBBA round 1(2005-2007) and round 2 (2009-2010) has been used. A significant decline in the age at initiation of drugs among IDUs and proportion of needle sharing is found in all the districts except Wokha in Nagaland in the round 2. The proportion of paid sex and condom use has increased among the IDUs in round 2. Mobility is important predictor to explain the STI symptoms and HIV sero-positivity driving towards risky sexual behaviour. The prevalence of STI and HIV is much higher in multiple sexual partners as injecting drug users .Those who have condom use in the last sexual act are less likely to have any STIs and HIV in the past one year in Manipur.

Using propensity score matching methodology, this paper examine the impact of community group membership on experience of physical violence, any positive sexual transmitted infections, and HIV tested and collected result among female sex workers (FSWs) in India. A cross sectional survey was administered in 2009-2010 and covered 7,806 FSWs through probability sampling. About 38 percent of FSWs reported being member of community group and majority of FSWs were aged above 24 years, currently married, street based FSWs by typology, had experience of physical violence, had HIV test done and collected result. The average effect of treatment (being a member of community group) on treated (experience of physical violence and consistent condom use with regular partner) was 21% and 10%, respectively. The average effect of membership was marginally high among those who tested for HIV and collected results. On sexually transmitted infections, average impact was 5% higher compared to those who did not have any STIs. These finding suggest that community group membership are an effective intervention strategy to reduce risk of STIs and HIV among the FSWs.

This paper is based from the 2011 Indonesian Gender and Reproductive Health Survey of Year 6 and Year 12 students, teachers and school principals (N=8972). The aim is to evaluate students’ understanding on reproductive health knowledge and HIV and AIDS. In Indonesia reproductive health education is taught and included in school, though the content is not comprehensive. Subjects that have teaching materials on reproductive health and HIV and AIDS include Biology, Science, Sport and Healthy Living (PENJASKES) and to some extend Social Sciences and Islamic teaching. Our bivariate and logistic regression analysis demonstrates that Year 6 and Year 12 students and their teachers have a relatively high degree of knowledge about reproductive health matters and HIV and AIDS. However there is substantial variation by type of school and geographic location. This surprisingly good result provides an opportunity for the Ministry of Education and Culture in collaboration with the Ministry of Health to strengthen its reproductive health education curriculum, and to provide more training for teachers so that reproductive health education can be integrated in related subjects and can be taught more accurately and enthusiastically.

This paper examines the relationship of social networking, knowledge of HIV, and sexual risk behaviors of male migrant workers in Rajshahi City, Bangladesh. Data for this study came from a random sample of 200 male migrant workers residing in Rajshahi City of Bangladesh. Both bivariate and multivariate analyses were performed for this study. The findings of this study confirmed that migrant populations are more likely to engage in sexual relationship that may result in increased risk of HIV infections. The predicted variables, educational status, watched adult movie or pornographic materials, smoking habit and taking illegal drugs have shown the significant effects on the likelihood of engaging in risky sexual behavior. While having knowledge that HIV/AIDS causes death does significantly reduce the likelihood of engaging in risky sexual behavior it does not completely mediate the effects of viewing pornographic material, smoking, consuming illegal drugs and being illiterate.

The study of sexual behaviour lies at the heart of understanding the reproductive behavior in human populations and the transmission dynamics of sexually transmitted infections including HIV/AIDS. Perhaps the most widely conjectured demographic and health consequences of polygyny and concurrency of sexual partners is their potential effect on the transmission of HIV and other STIs. Yet, while the combination of long-term concurrent sexual partnerships and high infectiousness early in HIV infection has been suggested as a key driver of extensive spread of HIV in general populations in sub-Saharan Africa (SSA), this has never been rigorously investigated within the framework of multiple marital and non-marital sexual partners owing to the complex feature of family structure in settings where polygyny is prevalent. This paper takes advantage of large scale population-based repeated surveys of nationally representative populations from developing countries to assess, within a multilevel framework, the role of family structure dynamics on gender differences in HIV risk and prevalence and how these differences have changed across countries and over time.

With the increasing pervasiveness of social media, the Internet has become an important venue for dating and sex. Not only does it introduce a unique array of opportunities and risks for men who have sex with men (MSM), it presents a valuable means through which to study sexual behavior. In this study, we collected data on what men report in their online profiles on two dating/hookup websites to explore possible geographical differences in social and cultural norms surrounding sex and HIV (N=5,588). Across the fifteen selected cities, significant differences emerged in reported HIV serostatus and stated preference for safer sex (condom use). These patterns suggest important contextual and demographic variations and point to a need for targeted, population-specific interventions. With a better understanding of the local factors driving risky sexual behavior, health communication messages and tailored online interventions could be developed to address the needs and concerns of specific groups.

Research on HIV among men who have sex with men has focused on individual behavioral and biomedical factors driving transmission risks, but these cannot be fully understood without also understanding the social context within which sexual minorities live. Using data from 703 gay and bisexual men in Atlanta, this study explores the factors associated with homosexual identity formation and disclosure (“outness”) and examines how these constructs are associated with sexual risk taking. In multivariable regression models, sexual identity and outness were associated with age, race, education, employment, and experience of discrimination. Independent of these factors, having a more established and open homosexual identity was associated with lower sexual risk behaviors. These results highlight the need to address discriminatory policies and values in society and call for programs to provide support and promote healthy identity development among vulnerable groups.

It is important to clarify whether gender inequalities in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) prevalence in sub-Saharan Africa are explained by differences in the distributions of HIV risk factors, differences in the effects these risk factors, or some combination of both.
Data from Demographic and Health Survey and the AIDS Indicator Survey coming from Kenya, Lesotho and Tanzania were used. We used extension of the Blinder-Oaxaca method to decompose the gender inequality in HIV/AIDS prevalence.
After adjusting, female gender was associated with a higher prevalence of HIV/AIDS in Kenya and Lesotho, but not in Tanzania. Decomposition analyses demonstrated that in Kenya and Lesotho, gender inequality in HIV/AIDS was attributable to the difference in the effects of characteristics on HIV/AIDS. In Tanzania this inequality was explained by the differences in distributions of HIV risk factors between men and women.
These different patterns have important implications for policies to reduce gender inequalities in HIV/AIDS

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n=310), in-depth interviews (n=11), key informant interviews (n=5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.35 95% CI 0.13-0.92, p=0.033). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study’s typology.