The AIDS virus is spread by human behaviors enacted in a variety of social situations. In order to prevent further infection, we need to know more about these behaviors. This volume explores what is known about the number of people infected, risk-associated behaviors, facilitation of behavioral change, and barriers to more effective prevention efforts.
- AIDS
- Copyright
- PREFACE
- ACKNOWLEDGMENTS
- NOTE ON AUTHORSHIP
- Contents
- SUMMARY
- Monitoring The Spread Of HIV And Aids
- Statistics On Aids
- Statistics On HIV Infection
- Cdc's Family Of HIV Seroprevalence Surveys
- National Seroprevalence Survey
- Assuring Confidentiality
- Sexual Behavior And Aids
- Same-Gender Sex Among Men
- Teenage And Adult Heterosexuals
- Female Prostitution
- Research And Data Needs
- Data On Sexually Transmitted Diseases
- IV Drug Use And Aids
- Limiting The Spread Of HIV Infection
- Facilitating Change In Health Behaviors
- Evaluating Interventions
- Randomized Field Experiments
- Resources For Evaluation
- Overcoming Barriers To Research And Intervention
- Barriers To Research
- Social Barriers To Intervention
- PART I UNDERSTANDING THE SPREAD OF HIV INFECTION
- 1 Monitoring The Epidemic's Course
- PREVALENCE AND INCIDENCE OF HIV INFECTION
- Uses Of HIV Prevalence And Incidence Data
- Prevalence Data
- Monitoring Trends
- Incidence Data
- Variation In Estimated Hiv Prevalence For Selected Groups
- Homosexual and Bisexual Men.
- IV Drug Users.
- Hemophiliacs.
- Heterosexual Partners of Persons with HIV Infection or at Recognized Risk.
- Patients at General Care Hospitals.
- Newborn Infants and Women of Reproductive Age.
- Prostitutes.
- Tuberculosis Patients.
- Heterosexuals Without Known Risk Factors.12
- Variation by Age.
- Variation by Gender.
- Variation Among Blacks, Whites, and Hispanics.
- Geographic Spread of the Epidemic.
- Uncertainties About HIV Prevalence
- Principles And Methods Of Estimating Prevalence
- Probability Samples
- Full Coverage Of The Sample
- Accurate Testing
- Combining Results
- THE 1989 HIV SURVEILLANCE SYSTEM
- Surveillance Of Iv Drug Users
- Sentinel Hospital Surveillance
- Surveys Of STD And TB Clinics And Clinics Serving Women Of Reproductive Age
- Data Management
- Neonatal Screening
- ESTIMATES OF NATIONAL HIV PREVALENCE AND INCIDENCE
- The Components Model
- The Epidemiological Model
- Sample Survey Method
- CONCLUSION
- Attributes Of An HIV Monitoring System
- Other Uses Of Data On HIV
- References
- 2 Sexual Behavior And Aids
- STATUS OF THE RESEARCH FIELD
- NEEDED DATA
- Data Needed To Understand The Epidemic's Future Course
- Data Needed To Understand The Epidemic's Dynamics
- THE KINSEY STUDIES
- Quality Of The Kinsey Data
- Utility Of The Kinsey Data
- Kinsey And The Issue Of Sexual Normality
- After The Kinsey Studies
- TRENDS IN HETEROSEXUAL BEHAVIOR IN ADOLESCENCE AND YOUNG ADULTHOOD
- Kinsey's Findings
- Studies After Kinsey
- Further Trends During The 1970s
- ADULT HETEROSEXUAL BEHAVIORS
- Details Of Survey Execution
- 1988 General Social Survey
- Los Angeles Times Survey
- Survey Results
- Condom Use And Risk Perception
- Special Studies
- Couples Study Data
- White And Afro-American Women In Los Angeles
- TRENDS IN SEXUAL BEHAVIOR AMONG PERSONS OF THE SAME GENDER
- The Kinsey Research
- From Kinsey To The AIDS Epidemic
- 1970 Kinsey Institute Data On Same-Gender Sexual Behavior
- Research On Same-Gender Male Sex Since The Onset Of The Aids Crisis
- Trends In Same-Gender Sexual Behavior
- Anal Intercourse
- Condom Use
- Other Sexual Activities
- Celibacy, Monogamy, And Multiple Partners
- FEMALE PROSTITUTION
- Social Context Of Prostitution
- Prostitution And Aids
- The Customers Of Prostitutes
- METHODOLOGICAL CONSIDERATIONS IN SURVEYS OF SEXUAL BEHAVIOR
- Accuracy Of Self-Reported Data On Sexual Behavior
- Sampling Gay And Bisexual Men
- Developing Reliable Survey Instruments
- Measurement Time Frames
- Interviewer Versus Self-Administered Assessments
- Behavioral Specificity
- Reliability And Validity Of Measures
- Sample Coverage
- ANTHROPOLOGY'S PERSPECTIVE ON HUMAN SEXUAL BEHAVIOR
- From 1929 To The 1970s
- The 1980s Prior To AIDS
- Anthropological Research Since Aids
- CONCLUSIONS AND RECOMMENDATIONS
- BIBLIOGRAPHY
- 3 AIDS and IV Drug Use
- DRUG-USE BEHAVIORS THAT TRANSMIT HIV
- Sharing Drug Injection Equipment
- Social Context Of Needle-Sharing
- Initiation into Drug Use.
- Adolescent IV Drug Use.
- Friendship Networks and Intimate Relationships.
- Shooting Galleries.
- Mechanics Of Drug Use And Sources Of Contamination
- The Syringe.
- The Needle.
- The Cooker.
- The Cotton.
- The Rinse Water.
- Frequency Of Injection
- Polydrug Use
- Sexual Behaviors And IV Drug Use
- Toward A Better Understanding Of Risk-Associated Behaviors
- RISK REDUCTION AMONG IV DRUG USERS
- Changes In Injection Behavior
- Changes In Sexual Behavior
- Toward Reducing Risk-Associated Behavior Among IV Drug Users
- CONDUCTING RESEARCH ON IV DRUG USE
- Research Traditions
- Investigating Risk-Associated Drug Behaviors
- Methods
- Convenience Samples
- Self-Reported Information
- Toward Better Quality Data
- MEASURING THE SCOPE OF THE PROBLEM
- Prevalence Of IV Drug Use
- Definition Of An IV Drug User
- Techniques For Estimating The Total Number Of IV Drug Users
- National Aggregates Of State Estimates
- Consumption And Turnover Rates Among IV Drug Users
- Modeling The IV Drug-Using Population: Constraints And Limitations
- Prevalence Of AIDS And HIV Infection Among IV Drug Users
- CONCLUSION
- Bibliography
- PART II INTERVENING TO LIMIT THE SPREAD OF HIV INFECTION
- 4 Facilitating Change In Health Behaviors
- EDUCATION PROGRAMS
- The Role Of Education And Knowledge In Preventing The Spread Of Hiv Infection
- The Function Of Fear In Health Messages
- The Role Of The Media
- Risk Perception
- Adoption And Diffusion Of Innovations
- MOTIVATING AND SUSTAINING BEHAVIORAL CHANGE
- Self-Efficacy
- Altruism
- HIV Antibody Testing
- Sustaining Behavioral Change
- Assessing Change
- Impediments To Individual Action: The Example Of Condom Use
- SOCIAL SUPPORT FOR BEHAVIORAL CHANGE
- Family, Group, And Community Beliefs
- Community-Level Intervention Programs
- Impediments To Effecting Behavioral Change
- In-Groups Versus Out-Groups: Creating Distance From Risk
- IV Drug Users
- Female Prostitutes
- Innovative And Controversial Approaches To Behavioral Change
- Education Programs For Teenagers
- THE ROLE OF PLANNED VARIATIONS AND EVALUATION
- References
- 5 Evaluating The Effects Of AIDS Interventions
- DIMENSIONS OF EVALUATION
- Program Objectives
- Program Design
- Program Implementation
- Defining And Measuring Outcomes
- Inferring Results: The Value Of Controlled Experiments
- Constraints On Evaluation
- RANDOMIZED FIELD EXPERIMENTS
- Examples
- Benefits And Costs Of Well-Designed Experiments
- Threshold Conditions For Randomized Experiments
- Does Present Practice or Policy Need Improvement?
- Is There Significant Uncertainty About The Effectiveness Of The Proposed Treatment?
- Are There Acceptable Alternatives to Randomized Experiments?
- Will The Results Of The Experiment Be Used To Improve Practice Or Policy?
- Voluntary Participation
- Organizations As The Treatment Unit In Field Experiments
- SPECIAL CONCERNS OF EVALUATION IN THE CONTEXT OF HIV INFECTION AND AIDS
- Target Groups
- Information Base
- Objectives Of AIDS Intervention Programs
- Ethical Issues
- Attrition And Noncompliance
- Measurement And Observation
- IMPLEMENTING GOOD EVALUATIONS
- Bibliography
- PART III IMPEDIMENTS TO RESEARCH AND INTERVENTION
- 6 Barriers to Research
- COLLABORATION IN RESEARCH
- FEDERAL RESEARCH PERSONNEL
- Immediate Needs
- Future Needs
- References
- 7 Social Barriers To Aids Prevention
- SOCIAL RESPONSE TO EPIDEMICS
- COMMUNICATING ABOUT SEX
- BARRIERS TO ACTION: RECENT EXAMPLES
- Condom Advertising On Network Television
- Communicating With Inoffensive Language
- Federal AIDS Education Efforts
- Communicating Facts Versus Moral Suasion
- Reflecting Values Versus Imposing Them
- HISTORICAL LESSONS
- The Effects Of Epidemics On Poor People And Minorities
- Stigma
- Defining Stigma
- Effects Of Stigmatization
- Stigma And The Aids Epidemic
- Legal Status Of Homosexual Behaviors
- Toward Dispelling Stigma
- References
- APPENDIXES
- Appendix A The Committee's Recommendations
- Monitoring The Epidemic's Course
- Human Sexual Behavior And AIDS
- AIDS AND IV DRUG USE
- FACILITATING CHANGE IN HEALTH BEHAVIORS
- EVALUATING THE EFFECTS OF AIDS INTERVENTIONS
- BARRIERS TO RESEARCH
- Appendix B Supplemental Data
- BACKGROUND PAPERS
- ON THE ACCURACY OF ESTIMATES OF NUMBERS OF INTRAVENOUS DRUG USERS
- What Is The Definition Of Intravenous Drug User?
- What Definitions Are Used In The "Review"?
- What Population Definition Was Used For Estimating Seroprevalence?
- How Were Numbers Of Ivdus Estimated?
- Overview
- Aggregation Of State Agencies' Estimates
- Illinois And Chicago
- California And Los Angeles
- New York State And New York City
- National Estimates
- Lange's Approach
- Newmeyer's Ratio Estimate
- Conclusions
- References
- MONITORING THE SPREAD OF HIV INFECTION
- Current Estimates
- Proportional Model
- Multiplicative Model
- Temporal Distribution Model
- Proposal
- Requirements
- Limitations Of Samples Of Convenience
- Design Considerations
- Overview
- Sample Size And Efficiency
- Design
- Interview Data
- Cost
- Auspices
- Pretesting
- Adequacy Of Survey Coverage
- Guaranteeing Anonymity
- Perception Of Anonymity
- Informing Respondents Of Test Results
- Conclusion
- References
- COST-EFFECTIVENESS ANALYSIS OF AIDS PREVENTION PROGRAMS: CONCEPTS, COMPLICATIONS, AND ILLUSTRATIONS
- A Cost-Effectiveness Model For Aids Prevention
- Assessing Program Effectivess
- Measures Of Health Outcome
- Final Outcome Measures
- Intermediate Outcome Measures
- Modeling Program Effects On Hiv Transmission
- Data Requirements
- Dynamic Modeling
- Epidemic Control
- Heterogeneity
- Collateral Program Effects
- Estimating Net Program Costs
- Problems In Valuing Program Consequences
- Appendix A
- Illustrative Cost-Effectiveness Analysis: Premarital Screening
- Appendix B
- Effectiveness Of Condoms Against HIV Infection Among Adolescents
- Personal Risk Of HIV Infection: A Simple Model Of The Adolescent
- Sensitivity Analysis Of HIV Prevalence And Condom Efficacy
- Accounting For Variations In Condom Use Among Adolescents
- Accounting For Heterogeneity Of HIV Prevalence
- Accounting For The Possibility Of "Superinfectors"
- References
- SEXUALITY ACROSS THE LIFE COURSE IN THE UNITED STATES
- Childhood
- Infancy
- Preschool
- Later Childhood
- Youth
- Young Adulthood And Family Formation
- Young Adulthood
- Cohabitation, Marriage, And Family Formation
- Adulthood
- Middle Adulthood
- Later Adulthood
- The Later Ages
- Afterword
- References
- SEX COUNTS: A METHODOLOGICAL CRITIQUE OF HITE'S WOMEN AND LOVE
- Methodology: General Observations
- Sampling
- Response Rates
- Representativeness And Census/Demographic Comparisons
- Essay Questionnaire And Analysis
- Wording Of Essay Questions
- Analysis Of Essay Questions
- Cross Tabulations Of Essay Questions
- Conclusion
- References
- TRENDS IN PREMARITAL SEXUAL BEHAVIOR
- Methods
- Findings
- Abstinence From Premarital Sexual Activity
- Age At First Premarital Sexual Activity
- Number Of Premarital Sexual Partners
- Sexual Activity Of Never-Married Respondents
- Conclusions
- References
- INDEX
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