AIDS

The Second Decade

Author: Moses, Lincoln E.; Turner, Charles F.; Miller, Heather G.
Publisher: National Academies Press
ISBN: 9780309042871
eISBN Pdf: 9780309568449
Place of publication: United States
Year of digital publication: 1990
Month: January
Pages: 510
DDC: 616
Language: English

Caption

Expanding on the 1989 National Research Council volume AIDS, Sexual Behavior, and Intravenous Drug Use, this book reports on changing patterns in the distribution of cases and the results of intervention efforts under way. It focuses on two important subpopulations that are becoming more and more at risk: adolescents and women. The committee also reviews strategies to protect blood supplies and to improve the quality of surveys used in AIDS research.

AIDS: The Second Decade updates trends in AIDS cases and HIV infection among the homosexual community, intravenous drug users, women, minorities, and other groups; presents an overview of a wide range of behavioral intervention strategies directed at specific groups; discusses discrimination against people with AIDS and HIV infection; and presents available data on the proportion of teenagers engaging in the behaviors that can transmit the virus and on female prostitutes and HIV infection.

AIDS
Copyright
Preface
Acknowledgments
- NOTE ON CONTRIBUTIONS
Contents
Summary
- THE CHANGING EPIDEMIOLOGY OF AIDS IN THE UNITED STATES
- PREVENTION: THE CONTINUING CHALLENGE
  - AIDS Prevention Challenges in the Coming Decade
  - Impediments to Improved Intervention
- ADOLESCENTS
  - Behaviors That Put Adolescents at Risk
  - AIDS Prevention Programs for Teens
  - Reaching Adolescents
  - Doing Better with Adolescents in the Second Decade
- PROSTITUTES
  - Risk Factors
  - Interventions
- PROTECTING THE BLOOD SUPPLY
  - Exclusionary Procedures
  - Maintaining an Adequate Supply of Blood
  - Improving the Safety of the Blood Supply
  - The Appropriate Use of Blood
- SURVEY METHODS IN AIDS RESEARCH
  - Sampling
  - Nonresponse Bias
  - Validity and Reliability
    - Sexual Behavior
    - Drug-Using Behaviors
  - Summary of Findings
    - Improving Measurements
- SYNOPSIS AND MAJOR RECOMMENDATIONS
1 The AIDS Epidemic in the Second Decade
- INTRODUCTION
- THE CHANGING EPIDEMIOLOGY OF AIDS IN THE UNITED STATES
- A PICTURE OF EMERGING RISK: THE AIDS EPIDEMIC AMONG WOMEN
  - Women Who Inject Drugs
  - Female Sexual Partners of IV Drug Users
  - Female Sexual Partners of Male Hemophiliacs and Transfusion Recipients
- TRACKING THE EPIDEMIC: DATA NEEDS
- REFERENCES
2 Prevention: The Continuing Challenge
- IMPACT OF INTERVENTIONS AMONG GAY MEN
  - Community-Level and Individual Intervention Efforts
  - The Impact of Drug Use on Behavior Change
- INTERVENTIONS FOR INTRAVENOUS DRUG USERS
- AIDS PREVENTION STRATEGIES FOR WOMEN
  - Preventing Horizontal Transmission in the Context of Drug Use
  - Preventing Vertical Transmission
    - The Role of Counseling and Testing in Women's Intervention Programs
  - Lessons from Genetic Counseling
  - AIDS Prevention Challenges in the Coming Decade
- MAINTAINING RISK REDUCTION BEHAVIOR
- IMPEDIMENTS TO IMPROVED INTERVENTION
  - AIDS-Related Discrimination
    - Federal Protections
    - State and Local Protections
    - Social Attitudes and Public Policy: Obstacles to Continued Progress
    - Sexually Explicit Information
    - Sterile Needle Programs
- REFERENCES
3 AIDS and Adolescents
- THE EPIDEMIOLOGY OF AIDS AND HIV AMONG ADOLESCENTS
  - The Scope of the Problem
  - Conclusion
- BEHAVIORS THAT PUT ADOLESCENTS AT RISK
  - Sexual Behavior
    - Data Sources
    - Vaginal Intercourse
    - Abstinent Teenagers
    - Patterns of Heterosexual Behavior
    - Same-Gender Sexual Behavior Among Adolescents
    - Sexually Transmitted Diseases
    - Conclusion
  - Drug Use
    - Data Sources and Limitations
    - Initiation of Drug Use
    - Injection Practices Among Adolescents
    - Prevalence of Drug Use
    - Differential Patterns of Drug Use
  - Clustering of Risk Behaviors
  - Subpopulations of Teens at Higher Risk
  - Conclusion
- INTERVENING TO PREVENT FURTHER SPREAD OF INFECTION
  - Role of Evaluation Research
  - Goals of Intervention Programs for Teens
    - General Goals
    - Specific Program Goals
- WHAT DO TEENS KNOW ABOUT AIDS?
- REACHING ADOLESCENTS
  - Aspects of Prevention Programs
    - Fear
    - Personal Vulnerability
    - Facts and Beliefs
    - Skills
    - Community Norms
    - Sources of Messages
  - Venues for Program Delivery
    - Programs for All Adolescents
    - School-Based Programs
    - Programs for Out-of-School Youth
    - Reaching Teenage Drug Users
  - Program Needs for High-Risk and HIV-Seropositive Youth
- DOING BETTER IN THE SECOND DECADE
- REFERENCES
4 Interventions for Female Prostitutes
- THE EPIDEMIOLOGY OF AIDS AND HIV INFECTION AMONG PROSTITUTES
  - Risks Related to Drug Use and Sexual Transmission
  - Context-Related Risks
  - Client-Related Risks
- PATTERNS OF PROSTITUTION
  - Street Prostitution
  - Brothels
  - Massage Parlors
  - Outcall Prostitution
  - Crack and Prostitution
- INTERVENTION PROGRAMS
  - Access
  - Types of Interventions
- IMPEDIMENTS TO MORE EFFECTIVE INTERVENTIONS
  - Laws Against Prostitution
  - AIDS-Related Legislation
    - Restriction of Infected Individuals
    - Mandatory HIV Testing
  - Other Effects of Marginality
- FUTURE NEEDS AND OPTIONS FOR HIV PREVENTION
- REFERENCES
5 AIDS and the Blood Supply
- BRIEF HISTORY AND OVERVIEW OF THE PROBLEM
- THE BLOOD COLLECTION SYSTEM IN THE UNITED STATES
  - The Organization of Blood Collection
  - Exclusionary Procedures
  - Exclusionary Procedures: The Organizational Perspective
- MAINTAINING AN ADEQUATE SUPPLY OF SAFE BLOOD
  - Who Donates Blood?
  - What Motivates Donors to Give Blood?
    - Extrinsic and Intrinsic Rewards and Incentives
    - Perceived Community Needs and Community Support
    - Social Pressure
  - Factors That Inhibit Donation
    - Medical Ineligibility
    - Fear
    - Reactions to Donation
    - Deferral
    - Inconvenience
  - Behavioral Theory and Its Application to Donor Recruitment
    - Internal Versus External Antecedents to Action
    - Intention and Action
    - Role Models
    - Linking Organizational and Theoretical Issues in Donor Recruitment Strategies
- PROTECTING THE BLOOD SUPPLY FROM HIV INFECTION
  - Recruiting “Safe” Donors
    - Racial and Ethnic Minority Groups
    - Age Groups
    - Genders
  - Exclusionary Procedures: The Donor Perspective
  - The Inappropriate Use of Blood Collection Agencies for HIV Testing
- RESEARCH TO IMPROVE THE EXISTING SYSTEM
- REDUCING THE RISK OF HIV INFECTION THROUGH APPROPRIATE USE OF TRANSFUSED BLOOD AND BLOOD COMPONENTS
  - Trends in Blood Utilization
  - Reducing Transfusion Exposure
    - Decreasing Unnecessary Use of Blood Products
    - Increasing Autologous Donation
    - Decreasing Patient Need for Blood Products
    - Inactivating Viruses
    - Modifying Physician Behavior
    - Modifying Patient Behavior
  - Directions for Future Research
- REFERENCES
6 Methodological Issues in AIDS Surveys
- FALLIBILITY OF MEASUREMENT IN OTHER SCIENCES
- RECRUITMENT OF RESPONDENTS IN SEX AND SEROPREVALENCE SURVEYS
  - Scope of the Review
  - Participation in Sex Surveys
    - Data Collection Procedures and Response Rates
    - Survey Configurations Associated with High Response Rates
    - Use of Telephone Surveys
    - Participation in Seroprevalence Surveys
  - Nonresponse Bias in Sex and Seroprevalence Surveys
- NONSAMPLING ISSUES IN AIDS SURVEYS
  - Terms and Concepts
  - Survey Measurement of Sexual Behaviors
    - Overview
    - Inference in the Presence of Bias
    - Assumption of Constant Bias in Measurements
    - Approaches to Validation
- EMPIRICAL STUDIES OF SEXUAL BEHAVIORS
  - Validation
    - Partner Reports
    - Other Validation Techniques
  - Replication of Surveys on Samples of the Same Population
    - Proportion of Teenagers Who Are Sexually Active
    - Number of Sexual Partners Reported by Adults
  - Replication of Measurements Using Same Respondents
- EMPIRICAL STUDIES OF DRUG-USING BEHAVIORS
  - Accuracy of Self-Reports of Drug Use Behaviors
  - Measurement Bias
- SUMMARY OF FINDINGS
  - Feasibility
    - Replicability
    - Validity
    - Reliability
- IMPROVING VALIDITY AND RELIABILITY
  - Literacy
  - Alternatives to Self-Reports
    - Physical Evidence
    - Skills Demonstrations
  - Other Safeguards for Surveys
    - Randomized Response Techniques
    - Pilot Studies
    - Pretests
    - Cognitive Research Strategies
- ETHNOGRAPHIC STUDIES
  - Examples of Studies Related to HIV Transmission
    - Male-Male Sexual Contacts
    - Variation in Drug Use Patterns
  - Ethnographic Methods
    - Ethnographic Methods in AIDS Research
    - Findings of Ethnographic Research on AIDS
  - Gaps and Deficiencies in Current Ethnographic Research
- RECOMMENDATIONS
- REFERENCES
Appendix
Index