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      Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention

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          Abstract

          We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group ( p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s10461-013-0601-2) contains supplementary material, which is available to authorized users.

          Resumen

          Analizamos los datos de un ensayo grade de intervención aleatorizado de prevención del VIH/VHC con jóvenes usuarios de drogas inyectables (UDI), Utilizando el análisis de variable latente categórico, se identificaron distintas clases de comportamiento sexual para hombres y mujeres. Se realizó un análisis de transición latente para probar el efecto de la intervención sobre las transiciones de alto riesgo a las clases de menor riesgo. Los hombres que estaban en una clase de alto riesgo al inicio del estudio que recibieron la intervención eran 86 % más propensos a estar en una clase de bajo riesgo durante el seguimiento en comparación con los del grupo control ( p = 0.025). Participantes en la intervención de alto riesgo tuvieron significativamente más probabilidades de transición a la clase que se caracteriza por relaciones sexuales sin protección con sólo una pareja principal, mientras que los participantes de intervención de bajo riesgo tuvieron significativamente menos probabilidades de transición a esa clase. Ningún efecto de la intervención fue detectado en el comportamiento de riesgo sexual de las mujeres o de los hombres que al inicio del estudio estaban teniendo relaciones sexuales sin protección con una pareja principal solamente.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s10461-013-0601-2) contains supplementary material, which is available to authorized users.

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          Most cited references35

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          Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women.

          Developed by Robert Connell, the theory of gender and power is a social structural theory based on existing philosophical writings of sexual inequality and gender and power imbalance. According to the theory of gender and power, there are three major social structures that characterize the gendered relationships between men and women: the sexual division of labor, the sexual division of power, and the structure of cathexis. The aim of this article is to apply an extended version of the theory of gender and power to examine the exposures, social/behavioral risk factors, and biological properties that increase women's vulnerability for acquiring HIV. Subsequently, the authors review several public health level HIV interventions aimed at reducing women's HIV risk. Employing the theory of gender and power among women marshals new kinds of data, asks new and broader questions with regard to women and their risk of HIV, and, most important, creates new options for prevention.
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            HIV prevention among drug users: outcome of a network-oriented peer outreach intervention.

            A network-oriented HIV prevention intervention based on social identity theory and peer outreach was implemented for HIV positive and negative drug users. A community sample of 250 were randomly assigned to an equal-attention control condition or a multisession, small-group experimental condition, which encouraged peer outreach; 94% of participants were African American, and 66% used cocaine or opiates. At follow-up, 92% of participants returned, and experimental compared with control group participants were 3 times more likely to report reduction of injection risk behaviors and 4 times more likely to report increased condom use with casual sex partners. Results suggest that psychosocial intervention emphasizing prosocial roles and social identity, and incorporating peer outreach strategies, can reduce HIV risk in low-income, drug-using communities.
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              Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis.

              Many new HIV-1 infections in the USA occur in injection drug users (IDUs). HIV-1seroconversion of IDUs is mainly associated with injection-related risk factors. Harm- reduction programmes concentrate on injection-risk behaviour. We aimed to establish whether injection or sexual risk factors, or both, were associated with HIV-1antibody seroconversion of street-recruited IDUs in San Francisco, from 1986 to 1998. IDUs were enrolled every 6 months from four community sites. We did a nested case-control study comparing 58 respondents who seroconverted between visits with 1134 controls who remained seronegative. Controls were matched with cases by sex and date. Adjusted odds ratios and 95% CI were calculated for men and women by use of conditional logistic regression. Men who had sex with men were 8.8 times as likely to seroconvert (95% CI 3.7-20.5) as heterosexual men. Women who reported having traded sex for money in the past year were 5.1 times as likely as others to seroconvert (95% CI 1.9-13.7). Women younger than 40 years were more likely to seroconvert than those 40 years or older (2.8 [1.05-7.6]), and women who reported having a steady sex-partner who injected drugs were less likely to seroconvert than other women (0.32 [0.11-0.92]). HIV-1 seroconversion of street-recruited IDUs in San Francisco is strongly associated with sexual behaviour. HIV-1risk might be reduced by incorporation of innovative sexual-risk-reduction strategies into harm-reduction programmes.
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                Author and article information

                Contributors
                +1 312-355-4892 , +1 312-996-1450 , mmamiti@uic.edu
                Journal
                AIDS Behav
                AIDS Behav
                AIDS and Behavior
                Springer US (Boston )
                1090-7165
                1573-3254
                22 August 2013
                22 August 2013
                2014
                : 18
                : 464-472
                Affiliations
                [ ]Division of Epidemiology and Biostatistics, School of Public Health, Community Outreach Intervention Projects , University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL 60612 USA
                [ ]Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL USA
                [ ]Center for Drug Use and HIV Research, National Development and Research Institutes, New York, NY USA
                [ ]Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
                [ ]The Aurum Institute, Johannesburg, South Africa
                [ ]Division of Global Public Health, School of Medicine, University of California, San Diego, CA USA
                Article
                601
                10.1007/s10461-013-0601-2
                3932146
                23975477
                146562e3-bba8-425b-9fca-c92e476aa56e
                © The Author(s) 2013

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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                Original Paper
                Custom metadata
                © Springer Science+Business Media New York 2014

                Infectious disease & Microbiology
                hiv,prevention,injection drug use,sexual risk behavior,latent class analysis

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