Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18-24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61-0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05-1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85-2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08-1.36), and marriage (aOR 1.55; 95% CI 1.37-1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18-24 vs. 25-32 years).

• MeSH
• dospělí MeSH
• HIV infekce diagnóza   prevence a kontrola   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pacientův souhlas se zdravotní péčí MeSH
• plošný screening statistika a číselné údaje   MeSH
• poradenství * MeSH
• průřezové studie MeSH
• sexuální partneři * MeSH
• socioekonomické faktory MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Jihoafrická republika MeSH
• Tanzanie MeSH
• Thajsko MeSH
• Zimbabwe MeSH

• MeSH
• chování MeSH
• infarkt myokardu prevence a kontrola   MeSH
• psychosomatické poruchy prevence a kontrola   MeSH

• MeSH
• chování MeSH
• epidemiologické metody MeSH
• kardiovaskulární nemoci prevence a kontrola   MeSH
• sociální podmínky MeSH

• MeSH
• chování MeSH
• kardiovaskulární nemoci MeSH
• monitorování fyziologických funkcí MeSH
• socialismus MeSH
• sociální psychologie MeSH
• Geografické názvy
• historické zeměpisné názvy MeSH

BACKGROUND: Although several interventions have shown reduced HIV incidence in clinical trials, the community-level effect of effective interventions on the epidemic when scaled up is unknown. We investigated whether a multicomponent, multilevel social and behavioural prevention strategy could reduce HIV incidence, increase HIV testing, reduce HIV risk behaviour, and change social and behavioural norms. METHODS: For this phase 3 cluster-randomised controlled trial, 34 communities in four sites in Africa and 14 communities in Thailand were randomly allocated in matched pairs to receive 36 months of community-based voluntary counselling and testing for HIV (intervention group) or standard counselling and testing alone (control group) between January, 2001, and December, 2011. The intervention was designed to make testing more accessible in communities, engage communities through outreach, and provide support services after testing. Randomisation was done by a computer-generated code and was not masked. Data were collected at baseline (n=14 567) and after intervention (n=56.683) by cross-sectional random surveys of community residents aged 18-32 years. The primary outcome was HIV incidence and was estimated with a cross-sectional multi-assay algorithm and antiretroviral drug screening assay. Thailand was excluded from incidence analyses because of low HIV prevalence. This trial is registered at ClinicalTrials.gov, number NCT00203749. FINDINGS: The estimated incidence of HIV in the intervention group was 1.52% versus 1.81% in the control group with an estimated reduction in HIV incidence of 13.9% (relative risk [RR] 0.86, 95% CI 0.73-1.02; p=0.082). HIV incidence was significantly reduced in women older than 24 years (RR=0.70, 0.54-0.90; p=0.0085), but not in other age or sex subgroups. Community-based voluntary counselling and testing increased testing rates by 25% overall (12-39; p=0.0003), by 45% (25-69; p<0·0001) in men and 15% (3-28; p=0.013) in women. No overall effect on sexual risk behaviour was recorded. Social norms regarding HIV testing were improved by 6% (95% CI 3-9) in communities in the intervention group. INTERPRETATION: These results are sufficiently robust, especially when taking into consideration the combined results of modest reductions in HIV incidence combined with increases in HIV testing and reductions in HIV risk behaviour, to recommend the Project Accept approach as an integral part of all interventions (including treatment as prevention) to reduce HIV transmission at the community level. FUNDING: US National Institute of Mental Health, the Division of AIDS of the US National Institute of Allergy and Infectious Diseases, and the Office of AIDS Research of the US National Institutes of Health.

• MeSH
• chování snižující riziko * MeSH
• dospělí MeSH
• HIV infekce diagnóza   epidemiologie   prevence a kontrola   MeSH
• hodnocení výsledků zdravotní péče MeSH
• incidence MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pacientův souhlas se zdravotní péčí * MeSH
• poradenství * MeSH
• spolupráce organizací a občanů * MeSH
• zdravé chování MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Afrika MeSH
• Thajsko MeSH

BACKGROUND: Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence. METHODS: Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir). RESULTS: ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors ± 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018). CONCLUSIONS: This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.

• MeSH
• antiretrovirové látky terapeutické užití   MeSH
• dospělí MeSH
• HIV infekce farmakoterapie   prevence a kontrola   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Národní institut pro duševní zdraví (USA) MeSH
• průřezové studie MeSH
• randomizované kontrolované studie jako téma MeSH
• retrospektivní studie MeSH
• spotřeba léčiv * MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Afrika MeSH
• Spojené státy americké MeSH

BACKGROUND: There is increased focus on HIV prevention with African men who report experiencing childhood sexual (CSA) or physical abuse (CPA). OBJECTIVE: To better understand the effects of a community-based intervention (Project Accept HPTN 043) on HIV prevention behaviors among men who report CSA or CPA experiences. METHODS: Project Accept compared a community-based voluntary mobile counseling and testing (CBVCT) intervention with standard VCT. The intervention employed individual HIV risk reduction planning with motivational interviewing in 34 African communities (16 communities at 2 sites in South Africa, 10 in Tanzania, and 8 in Zimbabwe). Communities were randomized unblinded in matched pairs to CBVCT or SVCT, delivered over 36 months. The post-intervention assessment was conducted using a single, cross-sectional random survey of 18-32 year-old community members (total N = 43,292). We analyzed the effect of the intervention on men with reported CSA or CPA across the African sites. Men were identified with a survey question asking about having experienced CSA or CPA across the lifespan. The effect of intervention on considered outcomes of the preventive behavior was statistically evaluated using the logistic regression models. RESULTS: Across the sites, the rates of CSA or CPA among men indicated that African men reflected the global prevalence (20%) with a range of 13-24%. The statistically significant effect of the intervention among these men was seen in their increased effort to receive their HIV test results (OR 2.71; CI: (1.08, 6.82); P: 0.034). The intervention effect on the other designated HIV prevention behaviors was less pronounced. CONCLUSION: The effect of the intervention on these men showed increased motivation to receive their HIV test results. However, more research is needed to understand the effects of community-based interventions on this group, and such interventions need to integrate other keys predictors of HIV including trauma, coping strategies, and intimate partner violence.

• MeSH
• direktivní poradenství MeSH
• dítě MeSH
• dospělí MeSH
• HIV infekce epidemiologie   prevence a kontrola   psychologie   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• náhodné rozdělení MeSH
• Národní institut pro duševní zdraví (USA) MeSH
• prevalence MeSH
• průřezové studie MeSH
• sexuální zneužívání dítěte psychologie   statistika a číselné údaje   MeSH
• spolupráce organizací a občanů * MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Jihoafrická republika MeSH
• Spojené státy americké MeSH
• Tanzanie MeSH
• Zimbabwe MeSH

• MeSH
• chování MeSH
• kardiovaskulární nemoci psychologie   MeSH
• lidé MeSH
• osobnost MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Using data from four sites in three African countries, this community randomized study examined the association between childhood sexual and/or physical abuse (CSA and/or CPA) and HIV disclosure, HIV-related stigma, stress, and social support among adults with and without a history of abuse. A history of abuse among men was associated with higher levels of adult-reported stress and HIV-related stigma, and with significantly lower rates of HIV test result disclosure to current partners. Women with a history of CSA and/or CPA had significantly higher perceived stigma, discrimination and stress. Although childhood abuse was significantly associated with adult stress and stigmatization, participants with histories of CSA and/or CPA also reported significantly higher perceived social support compared to people without such experiences. These findings may reflect support received in response to disclosure of CSA or CPA or emotional ambivalence in relationships that have been found to be associated with child abuse. We conclude that it is critical for HIV prevention interventions to advocate for the primary prevention of child abuse, for early identification of adolescents and adults who report experiencing childhood abuse, and to address stigma and stress-related attitudinal, behavioral and relationship difficulties experiences as an aftermath of early abuse that increase their risk of HIV.

• MeSH
• dítě MeSH
• domácí násilí psychologie   statistika a číselné údaje   MeSH
• dospělí s anamnézou domácího násilí nebo sexuálního zneužívání v dětství psychologie   MeSH
• dospělí MeSH
• HIV infekce diagnóza   prevence a kontrola   psychologie   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• poruchy spojené s užíváním psychoaktivních látek MeSH
• posttraumatická stresová porucha psychologie   MeSH
• prevalence MeSH
• průzkumy a dotazníky MeSH
• sdělení pravdy * MeSH
• sexuální chování psychologie   MeSH
• sexuální partneři MeSH
• sexuální zneužívání dítěte psychologie   MeSH
• sociální opora MeSH
• socioekonomické faktory MeSH
• společenské stigma * MeSH
• zdraví - znalosti, postoje, praxe MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Afrika MeSH
• subsaharská Afrika MeSH

OBJECTIVE: The objective of this study was to explore perceptions of peer substance use and related attitudes among European students. Challenging perceptions about peer substance use has become the basis of a form of prevention and intervention known as the social norms approach, which can be delivered using personalized online feedback. This article reports baseline alcohol use and attitudes data for university students across Europe collected as part of the Social Norms Intervention for the prevention of Polydrug usE project (Project SNIPE). METHOD: Students from universities in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the United Kingdom were recruited to take part in an online survey by the use of email invitations, social media, classroom announcements, flyers, and stalls in social areas, such as in cafeterias and bars on campus. A total of 4,482 students agreed to participate. RESULTS: Overall, respondents reported both perceived alcohol use and perceived acceptance of alcohol use among their peers that were higher than their own use or acceptance. Perceived peers' behaviors and attitudes were found to be predictive of personal behaviors and attitudes, with some variation across countries and by sex. CONCLUSIONS: The results suggest that students at the participating institutions across selected European countries exhibit overall similar patterns of perceptions as have been found on American college campuses. In conjunction with the finding that the perceived norm is predictive of personal behavior and attitudes, this research provides support to the view that the social norms approach may be a viable method to reduce alcohol consumption among students at European universities.

• MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• pití alkoholu epidemiologie   MeSH
• poruchy spojené s užíváním psychoaktivních látek epidemiologie   MeSH
• postoj MeSH
• sociální média MeSH
• sociální normy MeSH
• sociální percepce MeSH
• studenti statistika a číselné údaje   MeSH
• univerzity MeSH
• vyrovnaná skupina * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH