AMP!: A Cross-Site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness, Attitudes, and Knowledge about HIV

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. 

We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. 

Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = 0.05), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = 0.001), HIV awareness (p = 0.001), and HIV attitudes (p = 0.001). 

Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = 0.01), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05)). 

Thus, AMP!'s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.

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By:  Taggart T1, Taboada A2, Stein JA2, Milburn NG3, Gere D2, Lightfoot AF4,5.

• 1Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA. ttaggart@email.unc.edu.
• 2Art & Global Health Center, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
• 3Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
• 4Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA.
• 5Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA. 
• Prev Sci. 2016 Apr 8.

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Injecting Drug Use, Sexual Risk, HIV Knowledge & Harm Reduction Uptake in a Large Prison in Bali, Indonesia

Purpose
The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. Design/methodology/approach - A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. 

Findings
Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. 

Research limitations/implications
The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. 

Practical implications
The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. Originality/value - This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

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By:  Sawitri AA1, Hartawan AA, Craine N, Sari AK, Septarini NW, Wirawan DN.

• 1Department of Community and Preventive Medicine, Udayana University Bali, Denpasar, Indonesia. 
• Int J Prison Health. 2016 Mar 14;12(1):27-38. doi: 10.1108/IJPH-05-2014-0011.

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Knowledge, Attitude & Practice of HIV/AIDS-Related Stigma & Discrimination Reduction among Nursing Students in Southwest Nigeria

BACKGROUND:

One of the reported obstacles to the achievement of universal access to Human Immunodeficiency Virus (HIV) prevention, treatment, care, and support programs includes stigma and discrimination from health workers, particularly nurses. Since nursing students would become future practising nurses and are most likely exposed to caring for people living with HIV/AIDS (PL WHA) during their training, it is of great importance to assess the knowledge, attitude, and practice of student nurses toward the reduction of HIV/AIDS-related stigma and discrimination.

MATERIALS AND METHODS:

A descriptive survey research design was used. A total of 150 nursing students were selected using the simple random sampling technique of fish bowl method with replacement. Data were obtained using a self-administered (33-item) validated questionnaire to assess the knowledge, attitude, and practice of student nurses with regard to HIV/AIDS-related stigma and discrimination reduction strategies. Reliability of the tool was tested using Cronbach alpha (R) yielding a reliability value of 0.72. Data collected were analyzed with descriptive statistics of frequencies and percentages.

RESULTS:

Majority (76.0%) of the respondents were females and 82.7% were married. Respondents were found to have high knowledge (94.0%) of strategies for reducing HIV/AIDS-related stigma and discrimination. Also, 64% had moderate discriminatory attitude, 74% engaged in low discriminatory practice, while 26% engaged in high discriminatory practice.

CONCLUSIONS:

Student nurses had adequate knowledge about strategies for reducing HIV/AIDS-related stigma and discrimination; negative discriminatory attitude toward PLWHA and some form of discriminatory practices exist in participants' training schools. It is, therefore, recommended that an educational package on reduction of HIV/AIDS-related stigma and discrimination be developed and implemented for the participants.

Full article at:   http://goo.gl/JXqCu8

By:  Farotimi AA1, Nwozichi CU1, Ojediran TD2.

• 1Department of Adult Health, School of Nursing, Babcock University, Ilishan Remo, Ogun, Nigeria.
• 2Department of Community/Maternal and Child Health Nursing, Babcock University, Ilishan Remo, Ogun, Nigeria. 
• Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):705-11. doi: 10.4103/1735-9066.170011.

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Ethnicity & HIV Risk Behaviour, Testing & Knowledge in Guatemala

OBJECTIVES:

To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

DESIGN:

Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

RESULTS:

The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

CONCLUSIONS:

The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

Full article at:   http://goo.gl/Rxe4bb

By:   Taylor TM¹, Hembling J, Bertrand JT.

¹ Global Health Systems and Development , Tulane University , New Orleans , LA , USA.

Ethn Health. 2015;20(2):163-77. doi: 10.1080/13557858.2014.893562. Epub 2014 May 16.

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Systematic Review of Human Immunodeficiency Virus (HIV) Knowledge Measurement Instruments Used on the Arabian Peninsula

In 1984, the Kingdom of Saudi Arabia (KSA) began surveillance for human immunodeficiency virus (HIV) incidence and prevalence. However, no culturally-appropriate standardized questionnaire has been developed to measure HIV prevention knowledge in this population. Evidence exists that married Saudi women are especially at higher risk for infection, but lack knowledge of HIV modes of transmission and underestimate their personal risk of becoming infected. The objective of this paper is to present a critical review of existing HIV knowledge measurement tools developed for the KSA and other Arabian Peninsula populations, and to utilize this review to guide the development of a culturally- and gender-sensitive tool. Studies included were in English reporting results of a quantitative survey instrument as either an interview or self-reported questionnaire with questions about knowledge of HIV or AIDS. Surveys must have been given in English or Arabic, and must have been done in a population in the KSA or the Arabian Peninsula. The following data sources were searched for eligible studies: Google Scholar, Google Web, PubMed, PLoS, WHO publications, UN publications, news, and other peer-reviewed publication databases.

Sixteen articles met criteria, and of these, 10 (63 %) were conducted in a KSA population, and a majority of the articles studied students of primary, secondary, or post-secondary schools (n = 9, 56 %). Five studies included only men, while the other 11 included both sexes.

The KSA’s public health goals should more specifically focus on measuring and improving knowledge in high-risk populations such as married women—an option currently limited by commonly available measurement instruments.

...In summary, 16 papers were reviewed that included HIV knowledge measurement in the KSA or bordering populations. On the positive side, all studies report high response rates, but other features of these reports indicate challenges. First, the absence of a culturally-specific KSA instrument has resulted in the inability to reliably and accurately measure HIV knowledge in KSA populations. Next, studies examined employed a variety of instruments, but they generally did not report reliability and validity studies, so their relative quality could not be compared. Further, gender-specific instruments were not developed, although transmission patterns in the KSA suggest that transmission modes are potentially much more gender-specific than in other countries. Finally, these articles generally reported on low-risk populations in the KSA. The KSA’s public health goals should more specifically focus on measuring and improving knowledge in high-risk populations such as married women—an option currently limited by commonly available measurement instruments.

In fact, it is interesting to observe that those measuring knowledge, attitudes, and behavior surrounding HIV in the KSA seem disconnected from the other researchers in the KSA studying the epidemiology of these conditions. It is recommended that researchers working on the epidemiology of HIV infection in the KSA and those surveying the public seeking to inform an effective response work together to develop culturally-appropriate instruments that measure knowledge pertinent to KSA’s population. Had researchers such as Abolfotouh, Mahfouz, Madani, and Fageeh collaborated, despite their disparate geographic locations, they might have prevented the use of inappropriate questions from the WHO KABP and other US- or European-based questionnaires that include many questions irrelevant to the KSA population.

In the 20 years since the landmark paper in 1995 by Abolfotouh, the evolution towards reliable, valid, and pertinent and gender-specific instruments for measuring HIV knowledge in the KSA population did not take place. Hence, today, little is known about the level of knowledge about HIV prevention in high-risk groups in KSA. KSA-specific instruments measuring knowledge pertinent to the epidemiology of HIV are desperately needed to facilitate the development of an effective public health response capable of accurately reaching at-risk populations...

Full article at:  http://goo.gl/Bna5Te

By: Maram T. Alghabashi# and Barbara Guthrie#

Bouve College of Health Sciences, Northeastern University, Boston, MA USA

Umm al-Qura University, Mecca, Saudi Arabia

Maram T. Alghabashi, Email: moc.liamtoh@ihsabahgla.m.

Contributor Information.

Corresponding author.

^#Contributed equally.

 

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