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OCR for page 569
Index
A
Abortion clinics, seroprevalence surveys
in, 7-8, 57, 59
Acquired immune deficiency syndrome
(AIDS)
case-control studies of, 129
cause, 1
disease model of, 129
erroneous beliefs about, 263, 264
IV drug use and, 1018, 180240,
407-408
latency period, 3, 4, 5, 31-32, 62,
64-65, 68, 76, 451
in male homosexual population, 11
multidisciplinary research teams/
centers for, 25
number of sexual partners and, 129
probability of HIV infection
progressing to, 42 n.l4, 228
prostitutes and, 142-145
severity of epidemic, 213
sexual behavior and, 9-16, 73-169,
405-407
sharing of data on, 15, 168
similarities to past epidemics, 26, 28
sources of information on, 269
stereotyping of, 130
stigma and, 393-399
surveillance definition of, 32 n.2, 45
n.l7, 234
Adolescents and teenagers
age at first sexual experience, 95, 98,
148, 412, 414-415
condom use by, 288, 488-499
569
drug prevention programs for, 267, 295
in drug treatment programs, 191
education programs for, 302-307
homosexual experiences of, 118
implications of sexual behavior for
HIV transmission, 12
initiation of sexual intercourse, 12
IV drug use by, 191-192, 197
misconceptions about HIV
transmission, 264
number of sexual partners, 12
peer pressures, 278
precautions taken by, 12
premarital sexual behaviors, 95
research needs on, 15
risk perception, 273
sexual conduct of, 12, 118, 197, 261
sexual development of, 500, 511-518
trends in heterosexual behavior of,
80101
Africa
cofactors in HIV transmission in, 287
multiple-partner relationships in, 164
prostitution in, 137
sexual and ritualistic practices
relevant to spread of HIV, 163
AIDS cases
accuracy of incidence and prevalence
estimates, 33
geographic variation in, 103, 109, 235
and HIV prevalence, 3, 38, 42-45
in IV drug users, 16, 187
number of, 2, 4, 16, 37, 187, 197,
447048
OCR for page 570
570 ~ INDEX
reporting of, 32-33; see also
Reporting of AIDS/HIV infection
statistics on, 4-5
value as indicator of magnitude of
epidemic, 4, 31
AIDS-related complex, 45 n.17
Alcohol, Drug Abuse, and Mental
Health Administration
(ADAMHA), 10, 165, 438
Amphetamines, 187, 196, 219, 231, 431,
436, 439-440
Amsterdam, syringe exchange program-,
203-204, 208, 302
Anal intercourse
condom use in, 131, 134, 136, 287
cultural standards for, 161
frequency of, 113, 129
practices, 129, 131-134, 155-156, 280,
286
prevalence of, 11
by prostitutes, 137
risk of HIV infection from, 11,
133-134
unprotected, 11, 128, 131-133, 280;
280287
with women, 113, 137
Anonymity
in antibody testing, 21
in probability surveys of serostatus,
7-8, 48-49, 57, 58 n.30, 464-467
Anthropological research
on human sexual behavior, 157-164
on IV drug use, 215
Antibodies to HIV, in newborns, 7 n.7
Antibody tests for HIV
anonymity in, 21, 27
and behavior modification, 21
uncertainties in prevalence data, 46-47
Atlanta, HIV seroprevalence in, 40, 143
AZT (zidovodine), 280
B
Baltimore
ex-addict outreach program in, 204
HIV seroprevalence in, 40, 235
Bathhouses, 129, 135, 150, 272
Bayview Hunter's Point Foundation, 295
Behavioral research, see Social science
and behavioral research
Behavior change/modification
altruism and, 279
antibody testing and, 21, 279-282
assessing, 285-287
assistance and-support for, 20
barriers to, 198-199, 213-214,
274, 286, 288-290, 297-300
choices offered for, 20, 274, 277
community role in 291-297
costs to personal relationships, 281
evaluation of effectiveness of, 78, 259,
316-350
existing beliefs and values and, 20
fear in health messages and, 266-268
in homosexual male population,
11-12, 132, 133, 134-135, 136,
261, 286-287
innovative and controversial
approaches to, 300-302
by intravenous drug users, 198,
202-214, 240, 261, 298-299
length of program and stability of, 284
motivation for, 20, 260, 261, 276-282
normative beliefs and, 293
potential for, 261, 297
by prostitutes, 299-300
relapse prevention, 283-284, 285
risk perception and, 108-109, 204,
265, 271-273
role models and, 269
self-efficacy and, 277-279, 283, 285
in sexual behavior, 11-12, 132, 133,
134-135, 136, 209-211
skills training for, 20, 212, 268, 278,
283, 285
smoking prevention programs as an
example of, 278, 285
and social learning theory, 26~270,
283
social supports for, 261-262, 265-266,
285, 29~307
STD statistics as surrogate measure
of, 16
sustaining, 213, 283-285
Bias in surveys and self-reported data
correlation, 438, 442
in educational levels of survey
respondents, 36, 104 n.l6
in Kinsey sample, 123
nonresponse, 6 n.6, 8, 48 - 50, 58, 217
recall, 96 n.l2, 153, 218
reporting, 149
research to characterize, 46
sample selection, 6 n.6, 35-36, 46, 52,
54, 56, 58, 118, 234
OCR for page 571
INDEX ~ 571
in seroprevalence surveys, 35, 38, 45,
52
Bisexuality
lack of data on, 10
perceptions of, 163
social-psychological aspects of, 156,
504
Bisexual men
heterosexual rate of partnering,
152-153
HIV incidence and prevalence rates
among, 38
sampling for surveys, 15~153, 156
see also Homosexual men
Blood donation
as an avenue for testing, 280
lack of risk associated with, 264
Blood donors
HIV seroprevalence among, 35, 36, 37,
40, 41, 45 & n.16, 46
sampling bias, 35-36
Boston
education/outreach program for
prostitutes, 145
trends in same-gender sexual behavior
in, 131, 132
C
California
AIDS incidence in, 43
Drug Abuse Data System, 440
IV drug use in, 229, 439-441
Parents VVho Care program, 295
Prostitutes Education Project, 295
Casual contact, lack of risk from, 264
Celibacy
among heterosexuals, 105, 106-108
among homosexuals, 136
Centers for Disease Control (CDC)
AIDS data collection responsibilities,
24
data disclosure practices, 49
educational activities, 265
estimates of IV drug users, 228-229
evaluation of interventions, 23, 24
HIV seroprevalence surveys, 08,
50-62, 142
personnel burdens and needs at, 23-24
quality assurance programs for
laboratories, 47
report on HIV incidence and
prevalence, 34, 37, 38, 45, 226
sex research by, 10, 145, 165
time lag in reporting cases to, 32-33
Chancroid, 287
Chicago
estimates of IV drug users in, 439, 444
same-gender sexuality studies in,
120-121, 132, 134, 135
Children, see Infants and children
Client-Oriented Data Acquisition
Process (CODAP), 195 n.3, 216,
220, 232, 439
Cocaine
crack smoking, 144, 196, 281
frequency of use, 196 n.4, 223, 230,
231
injection of, 187, 196, 216, 223
number of users, 229, 431, 436,
439-440
research needs on, 219
and sexual behavior, 193-197
treatment for dependency, 214
use by prostitutes, 144
Cofactors in AIDS
prior to discovery of HIV, 129
sexually transmitted diseases, 13, 129,
137
Cohabitation/coupled relationships
case gathering on, 110
duration, 111
heterosexual, 109-110
homosexual, 109-110
monogamous, 12
sexual behavior outside of, 12, 111-112
sexual frequency in, 111
sexual relationships between, 13
turnover rates in, 13
Colorado
HIV seroprevalence in, 40, 143
prostitute outreach program in, 145
Community support
and behavior modification, 291-293
in seroprevalence surveys, 8, 150
intervention programs, 293-297
Condom use
by adolescents, 288, 488-499
for am intercourse, 132-133, 287
by heterosexuals, 273
by homosexuals, 131-133, 287, 288
impediments to, 168, 199, 288-290,
292
canons IV drug users, 198, 210, 279
for oral sex, 132-133
OCR for page 572
572 ~ INDEX
promotion of, 13, 20, 270-271, 275
by prostitutes, 141, 144-145, 146, 211,
300
rates of, 76, 273
research needs on, 13-14, 167-168
risk perception and, 108-109 & n.20,
278
for STD prevention, 260267, 275, 289
surveys of, 103, 21~211
Condoms
advertising on network television, 20,
26, 271, 376-378, 408
availability of, 13, 169
distribution of, 270-271
effectiveness against HIV infection
488-499
failure rates, 13, 133, 167-168,
289-290
misleading information on, 289-290
packaging for women, 270 n.3
purnh~ce frequencies, 103, 108
Confidentiality
of antibody testing and serostatus, 27,
282
of data collected in seroprevalence
surveys, 8-9, 4809, 57, 58, 69
data release and reporting standards,
49, 58
in Kinsey studies, 81
safeguards for assuring, 8-9, 27, 49,
69-70, 223
Counseling
with HIV testing, 21, 53
to reduce risky behavior, 78 n.2, 188,
209
Couples, see Cohabitation/coupled
relationships
Courtship patterns
of adolescents and young adults, 88,
91
prostitution and, 138
role of sexuality in, 91, 138
D
Deaths
from AIDS, 2, 4
from HIV-related illnesses, 32 & n.2
Detroit, HIV seroprevalence rates by
high-risk group in, 40
Discrimination
against gay men and lesbians, 27,
114-115, 127
fear of, and survey responses, 126
HIV testing and, 280
legal protection against, 9, 27, 69, 264
against research on same-gender
sexuality, 127
sexual conduct as a basis for, 27,
114-115, 127, 161
District of Col~l~nhia, see Washington,
D.C.
Divorce, 13
Drug abuse education and prevention
programs
community participation in, 295
role of fear in, 267
Drug Abuse Warning Network
(DAWN), 219, 232, 440
Drug treatment programs
adolescents in, 191
availability of, 17, 211, 284, 291
client types, 220
and condom use, 279
detoxification, 203, 220, 231, 235, 284,
435
demand for, 302
effectiveness of, 17, 187, 284
entry-reentry patterns, 232
ethnic aIld racial minorities in, 215
facilitation of entry into, 200209
free vouchers for, 203
HIV seroprevalence surveys in clinics.
6, 38, 53-54
methadone maintenance, 196, 198,
202, 204, 208, 220, 231, 235, 287,
435
out-patient drug-free, 231
recruitment for, 203, 224
recruitment of samples from, 187, 202,
215, 220, 224, 235, 279, 281, 287,
434-435
residential drug-free, 220, 231, 235,
435
resource allocation for, 188
and risk of HIV infection, 38
safer injection programs and, 208-209
and street counseling, 209
E
Edinburgh, Scotland, HIV
seroprevalence in, 236
Education, see Public education about
AIDS/HIV; Sex education
OCR for page 573
INDEX l 573
Educational levels
and AIDS/HIV educational messages,
263
and frequency of sexual intercourse, 89
and HIV infection, 146
and premarital sexual conduct, 90
and sexual partners, 146
of survey participants, 36, 104
Ellis, Havelock, 157
Emergency room patients
estimates of IV drug users as, 228
HIV seroprevalence surreys of, 45
Endocarditis, 32 n.2
Enzyme-linked immunosorbent assays,
55
Epidemics
definition relative to HIV/AIDS, 2-3,
26
dimensions of, 4, 18
doubling time, 77-78
dynamics, data needs on, 78-79
effects on poor and minorities,
380390
first wave, 78
historical lessons of, 388-399
patterns in, 2
reproductive rate of, 74, 76-77
second-wave, 77-78
self-susta~ng, 236
social response to, 372-375
traditional monitoring of, 67-68
Epidemiological surveys
adequacy of current statistics, 31
and AIDS latency period, 5, 62, 64
anonymity in, 7-9, 48-49, 57, 58 n.30,
464-467
barriers to, 8
biases in, 6 n.6, 8, 35, 36, 38, 45,
48-49, 52
blinded, 49-50, 53-54, 56, 60
CDC family of HIV seroprevalence
surveys, 6-8, 50-62; see also
National Seroprevalence Survey
coding for minorities/ethnic groups,
55 n.29
community involvement in, 8
confidentiality in, 8-9, 4809, 57, 58
convenience samples, limitations of,
454-456
costs of, 460-461
coverage, adequacy of, 462-463
cross-sectional, 52-53
data management plans, 58, 66
data sources for, 452-453
definition of AIDS for, 32 n.2, 45 n.17,
64, 234
demographic information in, 61
design considerations, 6, 11, 45, 54,
55-57, 64, 69, 130, 457-468; see
also Samples/sampling for surveys
development of systems for, 4-5,
31-32, 51, 6~67
generalization of data from, 7 & n.7,
22, 34, 51, 57, 59
ideal, for measuring HIV
seroprevalence, 47-50, 67-68,
452-453, 459-460
indicators of HIV infection for, 55
infonned consent for, 8
interpretation of statistics, 60
methods for estimating prevalence, 5,
36-37, 47-50, 56, 62~6
Multicenter AIDS Cohort Studies, 11,
45, 130
nonresponse rates, 57-58
objectives of, 50-51, 52, 69
probability sampling, 6, 7, 46, 48, 52,
59
quality assurance in testing for, 50
resource needs for, 33, 66
responsibility for, 461
sample size and efficiency of, 457-459
sample survey method, 66
by self-reports, 11
sensitivity of programs, 8
sbarin& of data from, 9
site selection for, 6, 48, 52, 53 n.23,
54-56, 61
testing of survey design, 8, 48, 51
n.22, 58, 462
traditional methods for, 67~8
usefulness of data from, 07
see also Surveys
Estimation of IV drug use
accuracy of, 431-432
aggregation of state estimates,
228-230, 435, 438-443
AIDS mortality data for, 228
back-extrapolation methods, 227,
436 437
barriers to, 225
critique of CDC estimates, 22~227,
420446
data sources for, 232, 436, 430441
OCR for page 574
574 ~ INDEX
definition of an IV drug user for,
226-227, 431-435
direct estimates, 227-228, 231-232,
436
dual-systems (capture recapture)
estimates, 227-228, 231-233,
437-438, 442
HIV seroprevalence data for, 228
indirect estimates, 227, 229, 436
informed guesstimates, 227, 229, 436,
442-443
Lange's approach, 443044
national estimates, 443
Newmeyer's ratio estimate, 444-445
regression models, 227, 440
synthetic estimation models, 233
survey use for, 227
Ethical issues
in evaluation of intervention
strategies, 342-343
in observation and reporting of illicit
behaviors, 222
see also Confidentiality
Ethnographic studies
applications, 218-219
of awareness/knowledge of AIDS/HIV
infection, 202
of crack use and prostitution, 197
of gay communities, 119
of IV drug users, 144, 192, 199, 202,
217-218
of prostitution, 140, 144
of social factors relevant to spread of
HIV, 163
Evaluation of intervention strategies
attrition and noncompliance in
experiments, 344-345
barriers to, 286, 483-484
collateral program effects in, 481-482
community demonstration projects,
265, 295
condom effectiveness example, 488-499
constraints on, 326
cost-effectiveness analysis, 471-499
defining and measuring outcomes, 205,
322-324, 474-477
dimensions of, 317-326
education programs, 164, 265, 266
ethical issues in, 342-343
implementation of, 347-350
inference strategies and, 22, 324-326
information base for, 212, 340,
478079
measurement and observation in,
322-324, 345-347
need for, 18, 19, 188, 331, 337
net program costs, estimating,
482083
nontreatment controls in, 21
personnel requirements for, 23, 24
planned variation in programs and,
213, 307-308
premarital screening example, 484088
resources for, 22-23, 164
responsibility for, 21, 316
role of, 21-23
sample heterogeneity, 481
valuing program consequences,
483-484
see also Randomized field experiments
F
Fear in health promotion messages, 19,
266-268
Florida, AIDS incidence in, 43
G
Gay communities
changes within, 127
educational interventions, 264-265,
270
ethnographic studies of, 119, 163
reform movements/political activism,
119, 126, 163
relationship to larger society, 505
research focus in, 127-128
as sampling sites, 155
social and sexual diversity in, 120
supporting role of, 291
Gender identity, 502-502; see also
Sexual development
Gonorrhea, 28, 150, 167, 275, 287
Gregg, Aim, 85-86
H
Hartford, HIV seroprevalence in, 235,
238-239
Health care plamiing
data needs for, 188
OCR for page 575
INDEX l 575
prevalence data on HIV infection and,
5-6, 34, 67, 78
Hemophiliacs, 38, 39, 432
Hepatitis B. 151, 188, 189, 232
Heroin, see Intravenous (IV) drug use
Heroin Lifestyle Study, 215-216
Heroin Problem Index, 232
Heterosexual transmission
AIDS cases from, 197
efficiency of, 197
among ethnic/minority grouper 3
female-to-male, 39
HIV incidence and prevalence, 38-40
by IV drug users, 197
male-to-female, 39
probabilities in, 76
by prostitutes, 137
Heterosexuals
adolescent/young adult sexual
behaviors, 88-101
adult sexual behaviors, 102-113
celibacy among, 105, 106-108
condom use by, 109
couples study data, 110-111
HIV incidence among, 38
HIV seroprevalence among, 38, 40
nonmonogamous, lack of data on, 74
number of sexual partners, 91, 104,
106-107
reproductive rate of HIV infection in,
77
risk of HIV transmission among, 113
risk perception among, 108-109, 130,
297-298
social cleavage of homosexuals and,
503-504
social norms of sexual behavior, 100
High-risk groups
data collection methodologies for, 167,
168
opinion leaders' role in prevention, 20
research needs on, 74, 166, 167
see also Bisexual men; Homosexual
men; Intravenous (IV) drug users;
Prostitutes/prostitution
HIV infection
AIDS case data as a proxy measure
of, 42-45
denial of susceptibility to, 19
helper T-cell counts as markers of, 129
indicators of, for survey purposes, 55
natural history of, 76
probability of progression to AIDS, 42
n.l4, 76 n.1
reproductive rate for, 76-77
sexual exposures and, 146
sharing of data on, 15
time course of infectiousness, 76
and tuberculosis, 57
HIV infection, spread of
barriers to tracking, 3
behavioral factors in, 1, 74; see also
-
Sexual behavior; Injection behavior
controlling, 4, 5, 1~23, 73; see also
Belisvior change/modification;
Intervention strategies for
HIV/AIDS
data needs on, 75-79
geographic correlations in, 42-45
IV drug use and, 16-18
modeling of, 74, 477-481
monitoring, (18, 31-70, 405, 447-469;
see also Epidemiological surveys
occurrence of AIDS and, 3
prevention of, see Public education
about AIDS/HIV
risk factors for, 11
sexual behavior and, 74
statistics on, 5-9
time course of, 42, 44-45
Homophobia, 162 n.37
Homosexual men
age of initiation of sexual activity, 148
awareness of and knowledge about
AIDS, 272, 296
behavior modification among, 11-12,
132, 133, 134-135, 136, 261, 279,
280, 286, 290, 296
celibacy among, 136
closeted, 152, 162, 504
cohort studies of, 11, 45, 130
condom use by, 132-133
cultural labeling of, 117
definition of, 82 n.5, 450
discrimination against, 27, 114-115,
127
drug use by, 130, 283
Educational intervention for, 264-265
exclusively, 62-63, 118, 123, 152, 450
HIV incidence rates among, 37, 38,
132
HIV seroprevalence among, 38, 62, 63
n.34
OCR for page 576
576 ~ INDEX
HIV transmission modes among, 128,
131, 147
legal difficulties of, 114-llS & n.22
married, 152, 424
minorities/ethnic groups, 155
monogamous relationships, 135-136
national study of 109, 121
number of sexual partners, 11, 111,
130, 134-136, 424
patterns of coupling and directional
relationships, 120, 127
perceptions of risk by, 133-134
population estimates, 10, 62~3, 64,
74, 114, 117-118, 450
primary relationships, 111, 133, 136,
181
psychiatric morbidity associated with
HIV testing of, 281
recruitment for studies/surveys, 46,
130, 150-153, 272
reproductive rate of HIV infection in,
77
research focus on, 127-128
research needs on, 15
risk of HIV infection among, 131
risk perception by, 133-134, 272
self-efficacy in, 279
sexual behavior of, 11, 111, 129, 130,
132-136, 148, 155, 280, 283
social cleavage of heterosexuals and,
503-504
STD rates among, 272
stereotyping of, 115, 130
stigmatization and victimization of,
27, 114-115, 291, 395-397,
504-505
surveys/studies of, 45, 46, 151-152
see also Gay communities;
Homosexual men; Lesbians;
Same-gender sex
Hospital patients
bias in samples drawn from, 35
HIV incidence among, 38
HIV seroprevalence surveys of, 6, 35,
38, 39, 41, 42, 48, 55-56
site selection criteria for surveys of,
48, 55
see also Emergency room patients
Human immunodeficiency virus (HIV)
discovery of, 128, 130
infectiousness of, 39, 497 - 499
see also HIV infection
I
Illinois, estimates of IV drug users in,
439
Immune system, infectiousness and
deterioration of, 39, 7077
Incidence of AIDS, 4-7, 41, 43
Incidence of HIV infection
CDC report on, 34
data collection on, 4
definition, 2 n.4, 33
estimation of, 33-34
among homosexual men, 37, 38, 132
uses of data on, 37, 64, 65
Infants and children
birth order, 60
HIV incidence among newborns, 38
maternal antibodies in newborns, 7
n.7, 39 n.11
probability of progressing from HIV
infection to AIDS, 43 n.14
seroprevalence surveys of newborns, 6,
7, 38, 39, 52, 57, 5~62
see also Mate~nal-infant transmission;
Pediatric AIDS
Injection behavior
changes in, 202-209, 281
ethnic differences in, 237
frequency of injections, 63, 190,
195-193, 203-204, 208, 223, 431
polydrug use, 196-197
Elf-reports of, 220
sharing drugs without sharing
equipment, 195
sharing of equipment, 14, 16, 76, 187,
189-195, 208, 213, 218, 223, 226,
237, 279
skin popping, 193, 431
social aspects of, 190-193, 218
during withdrawal, 192-193, 195, 213
Tnn.cbru~, HIV seroprevalence in, 214
Instituto Familiar de la Raza, outreach
activities, 295
Intergovernmental Personnel
Appointments, 24
International Conference on AIDS
(Fourth), 142, 210
Intervention strategies for HIV/AIDS
barriers to implementation of, 23, 109,
274, 275-276
bleach distribution programs, 203-205,
209, 213
OCR for page 577
INDEX
community role in, 20-21, 264-265,
270, 274, 275-276, 293-297
cost-effectiveness analysis, 471-499;
see also Evaluation of intervention
strategies
data needs for development of, 5
design of, 221, 260, 275, 300, 319-320
effort expended on, 260
escalation of, see Evaluation of
intervention strategies
implementation of, 18, 321-322 '
information needs for, 19
for IV drug users, 1017, 18, 202-214,
260
length of program, 284
measures of effectiveness of, 5, 205,
322-324
methodological issues, 260
monitoring of, 18
multidisciplinary research on, 25
need for improvement in, 260, 331
objectives of, 319, 34~342
opinion leaders' role in adoption of,
274
outreach activities, 18 n.11, 203, 204,
295
planned variations in, 260, 274,
307-308
poverty and, 26
Project Aware, 145
protocol, 319
psychological and social factors in
design of, 109, 274
safer sex programs, 132, 154, 209, 210,
264-265, 270, 279, 286-287, 295
social barriers to, 26-27, 274, 372-399
sterile needle programs, 17, 188,
203-205, 300-302
targeting of, 34, 46, 132, 165, 188,
300, 337-340
treatment of STDs as, 13
uncertainty about, 331-332
see also Behavior change/modification
Intravenous (IV) drug use
addiction and, 191, 192-193, 195, 198,
200, 226, 299, 431
AIDS and, 16-18, 186-240, 407008
amphetamines, 187, 194, 196, 219,
231, 431, 436, 439-440
cessation, 200
INDEX ~ 577
cocaine, 144, 187, 196, 214, 216, 219,
223, 229, 230, 231, 431, 436,
439 440
consumption patterns, 191, 230-231,
233
contamination sources, 193-195; see
also Needles, injection equipment,
and other Nonsterile implements
data on, 17-18, 234 n.l7
dynamics of, 20~201
family problems and, 191
geographic patterns of, 230
heroin, 63, 144, 187, 190, 196, 198,
199-200, 208, 215-216, 219, 221,
223, 228-233, 431-432, 436
initiation into, 190-191
market forces in, 191
marijuana use and, 187
mechanics of, 193-195
madding of, 231-234
phases of, 226
peer influence and, 191-192, 292-293
pleasure and discomfort in, 191
polydrug, 187, 190197, 217, 229, 230,
231
prevalence of, 219, 225-234
prevention of, 17; see also Drug
treatment progrmn~s
psychological denial of, 223
research methodologies for, 214-225
role in spread of HIV infection, 16-18,
190200, 431; see also
Heterosexual transmission;
Maternalinfant tran~nission
safer injection programs and, 17, 197
n.5, 203-204, 208, 213
scope of the problem, 225-240
self-reporting of, 221-223, 224, 299
in shooting galleries, 18 n.ll, 135,
192-193, 212, 216
social forces in, 191, 200
sources of information on, 219, 230
sterile needle program and, 20~204,
301-302
traditional research on, 215-217
see also Injection behavior
Intravenous (IV) drug users
adolescents, 191-192
AIDS cases among, 16, 187
awareness of and knowledge about
AIDS, 261
OCR for page 578
578 ~ INDEX
barriers to data collection on, 233-234
behavior rh~r~ges by, 189, 198,
202-209, 240, 261, 279, 281,
284-285, 287, 292-293, 298-299
behaviors that transmit HIV, 186-187,
189-202, 217-223; see also
Injection behavior; Sexual behavior
bleach distribution programs, 203-205
childbearing among, 187; see also
Maternalinfant transmission;
Women
condom use by, 198, 210
cooperation as research subjects, 217
data needs on, 187, 188, 189, 200-202,
223-225, 234
definition of, 226-228, 431-435
ax-addicts as outreach workers, 203,
209, 212, 216
HIV incidence among, 38
HIV seroprevalence among, 18, 38, 40,
41, 42 & n.13, 62, 63 n.34, 187,
189, 214, 234-240
friendship networks and intimate
relationships, 192, 210, 213
hepatitis transmission among, 188
infections (non-HIV) in, 188-190
intervention strategies for, 16-17, 200,
202-209, 260; see also Drug
treatment programs
non-AIDS deaths, 32 n.2, 228 n.l3,
234
population characteristics, 189, 198,
221, 232, 235-236, 240, 434-435
population size estimates, 5, 63,
225-226, 227-230; see also
Estimation of IV drug use
prostitutes, 14, 40, 137, 142, 144, 200
recruitment for studies, 187, 202, 215,
220, 224, 235, 237
reduction of risk among, 202-214
relapse among, 200, 212, 214, 231
reproductive rate of HIV infection in,
77
research needs on, 15, 200-202,
216-217, 232, 407-408
risk of HIV infection among, 14, 17,
144, 186, 217-218, 431
self-help interventions for, 164
sexual behavior of, 18, 76, 166, 187,
192, 197-201, 209-211, 283
sexual partners of, 15, 16, 137, 145,
164, 186, 192, 198-199, 218, 279
sources of information on AIDS, 269
sterile needle programs, 17, 203-205,
301-302
stigmatization of, 27, 211, 237,
298-299
street, 220, 221
surveillance of HIV seroprevalence,
52-54
surveys on behaviors of, 196, 198,
217-222, 230 n.l5; see also
Ethnographic studies
turnover rates, 230-231, 234
understanding of risk-associated
behaviors of, 200-202
J
Job Corps program participants and
HIV seroprevalence, 35
K
Kaposi's sarcoma, 32 n.2, 129
Kinsey studies
application to HIV prevalence studies,
10, 74, 8~87
approach, 79, 95
comparability of data from, 95
defects of, 9, 63, 85, 91, 123
definition of sexual contact, 95, 96,
117-118, 413
on female sexual behavior, 79, 100,
117, 419-421
on heterosexual behavior in
adolescents and young adults,
88-91, 9095, 100
impact and importance of, 9, 79, 85,
118-119
interviews, 80-82
on male sexual behavior, 10, 74, 79,
115-118, 138, 146, 422
prostitution data, 138, 146
quality of data from, 63, 74, 80~4
of same-gender sexual behavior,
114-118, 122-128
sampling, 82-84, 91
sexual theory in, 79, 85-86, 90-91,
115-116
strengths of, 80
utility of data, 84-85, 450
L
Las Vegas, HIV seroprevalence in, 143
OCR for page 579
INDEX
Legal issues
legal status of homosexual behaviors,
395-397
penalties for disclosure of
seroprevalence data, 9
protection against discrimination, 9
Lesbians
coupled relationships, 111
cultural labeling of, 117
lack of research on, 156-157
national study of, 109, 121
patterns of coupling and affectional
relationships, 120, 127
primary relationships, 11, 133, 136
research focus on, 127-128
sexual behavior, 111
see also Homosexual men
Los Angeles
AIDS cases in, 103, 109
education/outreach program for
prostitutes, 145
estimates of IV drug users in, 439-441
HIV seroprevalence in, 40, 143, 235,
238-239
sexual behavior of white and
Afro-American women in, 111-113
M
Marijuana, 187
Marital status
and frequency of sexual contact, 122
and number of sexual partners,
105-107, 560-565
and same-gender sexuality, 122-123,
124-125, 152
Marriage
first, age at, 12-13
sexual behavior outside of, 12, 111
see also Cohabitation/coupled
relationships
Maryland, HIV seroprevalence in, 44
Massachusetts
adolescent drug use in, 192
seroprevalence in women of
reproductive age, 39
Mass media
basis for seroprevalence reports, 36
evaluation of efforts of, 20
role in public education about
HIV/AIDS, 19-20, 202, 26& 271,
274
.
stigmatization, role in avoiding, 27
Masturbation, 86, 94, 116
Maternal-infant transmission
among ethnic/minority groups, 3
intervention strategies for, 18
IV drug use and, 186, 190200
risk of, 7 n.7, 39 n.11, 59 n.31
Menarche, and age at onset of sexual
activity, 148
Miami
AIDS cases in, 103, 109
HIV seroprevalence rates by high-risk
group in, 40, 142-143
Milan, Italy, HIV seroprevalence in, 236
Military applicants
AIDS incidence in, 45 n.16
age of, 39 n.10
educational levels of, 36
generalization of HIV test results
from, 35, 45
HIV seroprevalence among, 35, 36, 39,
40, 41, 42, 43-45
standardization of testing for, 47
women, 39
Minorities/ethnic groups
AIDS cases in, 235
coding for, in surveys, 55 n.29
collaboration with, in research, 25
disproportionate effects of epidemics
on, 298, 388-390
in drug treatment programs, 215
health care workers, 25
IV drug use by, 3, 230
overrepresentation in surveys of Job
Corps entrants and drug criers, 35,
215
prevalence of HIV infection among,
42, 237, 298
prostitution among, 137, 144, 156
research needs on, 15
same-gender sex, perceptions about,
155-156, 162, 291
see also Racial and ethnic minorities
Mississippi, HIV seroprevalence in, 45
Models/modeling of HIV/AIDS
adolescent risk of HIV infection,
480492
components model, 62-64
cost-effectiveness, for AIDS
prevention, 47~474
dynamic, 479 480
epidemiological model, 62, 64 66, 78,
448-452
OCR for page 580
580 ~ INDEX
forecasting, calibration of, 34
HIV prevalence, 46 n.l8, 62-66, 78,
440452
IV drug-using population, 227,
231-234
multiplicative model, 449 451
predictive powers of, 233
program effects on HIV transmission,
477-491
proportional model, 448-449
of sexual behavior, 85
of spread of HIV infection, 74, 78
temporal distribution model, 451-452
testing of, 233
Monitoring, see Epidemiological
surveys
Monogamy, 135-136, 261
Mothers
antibodies of, in newborns, 7 n.7
HIV incidence among, 38
~eroprevalence among, 6, 7, 38
Multicenter AIDS Cohort Studies, 11,
45, 130-131
N
National Association of State Alcohol
and Drug Abuse Directors, Inc.
(NASADAD), 229, 436, 438
National Center for Health Statistics
(NCHS), 7 - , 24, 48
National Institute on Allergy and
Infectious Diseases (NIAID), 130
National Institute of Child Health and
H,lman Development (NICHHD),
102, 103
National Institute on Drug Abuse
(NIDA)
estimates of IV drug users, 229
National Household Survey on Drug
Abuse, 227, 232
National Research Council, Committee
for Research in Problems of Sex,
73
National Seroprevalence Survey
in drug treatment clinics, 6, 38, 53-54
of childbearing women, 7-8, 39, 59
of newborns, 6, 7, 38, 39, 52, 57,
58-62
sample bias in, 6 n.6, 8
of sentinel hospital patients, 6, 35, 38,
39, 41, 42, 48, 55-56
in STD clinics, 6, 38, 46
in tuberculosis clinics, 6, 57
National Survey of Family Growth, 60,
95, 97, 416-417
Needles, injection equipment, and other
unsterile implements
contamination sources, 193 - 195
cookers, 194
cotton, 194
decontamination of, 193-195, 203, 205,
213, 264, 287
legal controls on, 190, 192, 193
needles, 194
rinse water, 194-195
sales of drug injection equipment, 203,
299
social context of needle sharing,
190193, 218
sterilized, availability for IV drug
users, 190, 204
syringe exchange program, 204-205
syringes, 193-194, 203
see also Injection behavior
Nevada, prostitution in, 139
Newark
AIDS cases in, 103, 109
IV drug users in, 444
New Guinea, sexual practices in,
160-161
New Jersey
outreach and education program for ~~ -
prostitutes, 145
seroprevalence surveys, 52 n.23
National Institute for Mental Health
(NIMH)
multidisciplinary AIDS research
centers, 25
same-gender sexuality studies, 120-121
National Institutes of Health (NIH)
sex research by, 10, 165
National Opinion Researth Center
(NORC), 94, 102, 103, 126
AIDS incidence in, 43, 103, 109
ex-addict outreach programs, 203, 209
HIV seroprevalence in, 38, 44, 45 n.16,
143
New Mexico, rates of unprotected anal
intercourse in, 11, 132
New York City
AIDS cases in, 103, 109, 129, 202
behavior modification in, 202, 287
birth rates for addicted women,
199-200
OCR for page 581
INDEX ~ 581
Greenwich Village, 152
HIV seroprevalence rates in, 38, 40,
44, 46, 146, 214, 235, 236,
238-239, 434
IV drug users in, 196, 197, 229, 232,
235, 261, 287, 434, 441-444
Narcotics Registry, 232, 441
non-AIDs deaths among IV drug users
in, 32 n.2, 234
outreach programs in, 209
prostitution and IV drug use in, 137
sales of infection equipment in, 203
same-gender sexual behavior in
131-135
tracking HIV infection in, 129
New York State
AIDS incidence in, 43
estimates of IV drug users in, 441043
rates of unprotected anal intercourse
in, 11, 132
Nitrites, inhaled, and sexually
transmitted disease, 129
o
Office of the Assistant Secretary for
Health, 21
Opportunistic infections and reporting
of AIDS, 32 n.2
Oral-^nal sex, 134
Oral-genital sex
condom use for, 132-134
cultural standards for, 86, 161
frequency of, 131
practices, 131, 134, 161
by prostitutes, 141, 146
risk of AIDS from, 133
p
Pacific Mental Health Services.
Operation Concern, 295
Pediatric AIDS
geographic distribution of, 16
and IV drug use, 16, 186
latency period for, 64 n.36
in minorities, 42
Phoenix, education/outreach program
for prostitutes, 145
Pneumocystis carsnfi pneumonia, 32
n.2
Presidential Cornrnission on the Human
Tlnmumodeficiency Virus Epidemic,
recommendations of, 47, 69, 70,
268
Prevalence of AIDS
correlation with HIV seroprevalence,
42
data collection on, 4
gender and, 41
race/ethnicity and, 42
Prevalence of HIV infection
age and, 41, 146
AIDS cases and, 38, 42-45, 62, 64, 235
barriers to obtaining data on, 8
CDC report on, 34
data collection on, 4, 5-6, 8
definition, 2 n.4, 33
educational level and, 146
and enumeration of high-risk groups,
10
estimates of, 5, 35, 38-45, 54, 63, 65,
74, 234-240, 447, 440452
false positives in testing and, 50
gender and, 41
generalization of data on, 7, 35, 36, 45
geographic variation in, 38, 39, 40,
42-45, 189, 235-239
and health care planning, 5-6
heterogeneity of, accounting for in
models, 495-497
incidence of HIV infection and, 62, 64,
65
infectiousness and, 497099
interpretation of data on, 45, 60
methods for estimating, 5, 36-37,
47-50, 56, 62-66
modeling of, 46 n.18, 440452
monitor trends in, 36-37
multiplicative model of, 440451
need for data on, 453
outreach study of, 46
probability of progression to AIDS
and, 62, 64
proportional model of, 448 449
race and, 41
ranking of high-risk groups by, 3045;
see also specific groups
reliability of data on, 5, 6-7
sensitivity analysis of condom efficacy
and, 492-494
sources of data on, 34-35, 235,
452-453
OCR for page 582
582 ~ INDEX
temporal distribution model, 451-452
uncertainties about, 45-47
uses of data on, 34~6, 6070
variation in, 37 - 38
Prevention strategies, see Intervention
strategies for HIV/AIDS
Project Aware, 145
Proj actions/prediction ~
of AIDS cases, basis for, 59
of AIDS deaths, 2-3
data needs for, 75
impediments to, 74, 103-104.
Prostitutes/prostitution
and AIDS, 142-145
behavior change by, 211, 290300
CDC studies of, 145
condom use by, 141, 144-145, 146,
211, 300
control of, 136, 130139
crack use by, 144
customers of, 89-90, 97, 137, 138,
140-141, 145-147, 166
data on, 10, 138-140
economic and psychological burdens
of, 141-142
ethnic/minority, 40, 140, 144, 156
exits and reentries, 139
female, 14, 40, 46, 136-147, 164,
299-300
HIV incidence among, 38
HIV infection through sexual
behavior, 14
HIV seroprevalence among, 38, 40, 46,
142
intervention programs for, 164, 295
arid IV drug use, 14, 40, 137, 142,
144, 166, 199, 236
male, 14, 156, 164, 504
mobility of, 236
motivation for using, 146-147
organization for, 145
outreach program for, 46, 145
as partners of IV drug users, 137, 166
personal relationships and sexual
practices, 144-145, 199, 290300
population size, 14, 139
recruitment of, 144
research needs on, 15, 166
research on, 140, 142
risk factors for HIV infection, 14, 137,
166, 199
role in spread of HIV infection,
136 137
sexual activities of, 141
sexually transmitted diseases in, 142,
166
site of work, 137, 130141, 144
social context of, 137, 138-142,
144-145, 147
surveys of, 137
use of safer sex techniques, 137,
144-145, 199
Public education about AIDS/HIV
infection
for adolescents and-teenagers, 302-307
adoption and diffusion of innovations
and, 273-275
antismoking campaigns as a model of
health promotion, 268
barriers to, 23, 263, 266, 275, 37~383
collaboration of target populations on,
25
credibility of, 270
development of, 78
design of, 263, 275
evaluation of programs, 164, 265
explicit/idiomatic language, 19, 25,
26, 263-264, 378-379, 382-383
facts in, 383-387
fear in health messages, 19, 266-268
federal efforts, 263, 265, 266, 383-387
hot lines, 265
importance of, 26
infonnation dissemination modes,
264-265
information needs for, 262-263
marketing techniques for, 27~271
mass media role in, 1020, 268-271
moral issues in, 383-387
outreach programs, 163, 203
poverty and, 26
presentation of material, 263
for prostitutes, 145
Public Health Service brochures, 263
public service advertisements, 264, 265
reading/educational level and, 263
risk perception and, 271-273
role in preventing spread of HIV
infection, 261, 262-266
in schools, 265
on sexual practices, 134, 264-265
375-383
OCR for page 583
INDEX I 583
social co^cts an, 26
tightly ~c-, 19
ha.
b=~, 2~
P~c he~tb as, stole ad
loch
d_ on, S3
see sbo U.S. PI Tab Seduce
P_o ~~
AIDS 1ncide~e in, 44
H~ ~= ~ ~^~
~- in, 38
q
qu~1ne, 27
ad ethnic ~n~tl~
a--ce~s, 148
A~~A~dc~ an, 162
A~~A~dc~ ala, 10~ 111-~3
AIDS case b~ em, 3
catch coated ~ sexual Nebula
` Hlsp~/Latinos,
15S-lS6, 162-163, 291
HIV s ma, 4O1 42,
237, 291
IV gag ~e=, 218 n.9
p~sthutes, 4O, 140
seal Bangor of, 98~9, 111-113,
148
sag b~ ~ H~ ~~1~
~~ H~p~/LaUn=, 291-292
Bawd Held Semis
Twelves to, 332-3=
of Bangor ~o~at10n paw for
h~-ex~ lea 285
ben~ts ad costs ~ 3~
cHteHa For ~c~s1~ 1~ 22
exalt of 32~329
ohs ~ taste cats in,
3~ =7
-
o~c~e =~e~nts, 22
~t~= for, 167
t~es~ld c~t10~ a, ~0~34
vamp ~ticl~t1~ in, =3~34
~_~1~
bab~10~ ~ soda sconces resay,
24, 165-166, 405, 408~, 410
beb~10r an statues, 285
TIC ^, ~
on coda ad sp~c1~ ~e, 13-14,
1~1 271, 4~, 407, 408
on cat 49, 2S2, 405
cam, 21, 282
Beta coHectlon system, 18, 165,
16~168, 201-202, 406, 407
am, 18, 211,
214, 284, 407, 408
e~t10n ~1~e~e~1~, 22-23,
316, 327, 4~1O, 411
_ ~ ~~ ~ ~
Re~ct1~ Act, ~4
~1~ ~+ 2~, 2=, 2~,
2~, arm, 408~09
IV gag he studies, 22, 201-202, 237,
24O, 406, 40~8
t~d~o~c~ rhea, 16~ 22+
4~, 408
-c~1~ ~ CDC see
gem, 7, 521 59, 405
t1~sd~n~ seal ahoy,
25-26, 367, 40~407, 410
Sac e~t1~ ~ AIDS/HIV,
TWO, 2~, 276, 30~8, 408-409
arty ashy boa_ fir H
tats, 47
r~udug baa to rhea,
41~411
rhea peyote 365, 36g~70
~ ~ ~ sat, ~
s^r ~=t1~ Boa_, 18, 211, 407
sex ecu, 19, 306, 4~
sex rhea, JO, 15, 165, 166, 405-407
saw ~ diva, 1~
SID rhea, 16, 167, 406
stale n-~ paw, 17, 302, 407
save saw ad Isle, 24, 59, S1
testy, 21, 47, 282, 40S, 409
Sag,
1~-169, 407
seeping of AIDS/HIV 1^cdon
~1- sate a, ~
acme ~ system fir, 32
_ ~ an, an,
alas in, 64
- sate a, 6
rejoice ne^ a, ~
the 1` betas Blows a, 32~3
he ~ dstb ce^10~te diva to lea
on, 32 n.2
Resew
blew to, 214, 35~371, 41~411
OCR for page 584
584 ~ INDEX
collaboration in, 364-367
generalizability of results, 22
federal personnel for, 367-371
on IV drug use, 214-225
personnel needs for, 24, 369-371
target populations for, 166
see also Epidemiological surveys; Sex
research; Social science and
behavioral research
Research needs
multidisciplinary teams/centers, 25
see also Evaluation of intervention
strategies
Risk of HIV infection
from anal intercourse, 11, 133-134
composite indicators of, 11, 54
counseling to reduce risky behavior,
78 n.2
effect of drug treatment programs on,
38
factors for spread of HIV infection, 11
among heterosexuals, 113
among homosexual men, 131
infectiousness and, 497099
among IV drug users, 14, 17, 144, 186,
196, 200-202, 217-218
maternal-infant, 7 n.7, 39 n.11, 59
n.31
from oral-genital sex, 133
among prostitutes, 14, 137
understanding behaviors associated
with, 200-202
among women, 39 n.9, 61
see also High-risk groups
Risk perception
and behavior modification, 108-109,
204, 265, 271-273
cognitive error and, 273
and condom use, 108-109 & n.20, 273
by heterosexuals, 108-109, 273
by homosexual men, 133-134, 272
and public education on AIDS/HIV
infection, 271-273
research on, 163
and sexual behavior, 108-109
Risk reduction
among IV drug users, 202-214
following testing Ed counseling,
280-281
research on, 204-207
in sexual behavior, 209-211, 28~281
Rockefeller Foundation, 73, 74, 85
S
Same-gender sex
age and, 122, 123
condom use in, 132-133
cultural standards for, 86, 114,
119-120, 155-156, 160-161,
162-163, 504
determinants of, 117, 503-504
difficulties in data gathering, 126
dimensions relevant to AIDS/HIV
infection, 113-tl4
estimated rates of, 126
frequency of, 122, 123
historical research, 128
Kinsey research on, 114-118, 122—128
lack of data on, 10
legal status of, 395-397
marital status and, 122-123, 12~125,
424
among men, 10-12; see also Gay
communities; Homosexual men;
Lesbian
in non-Western cultures, 160161
origin of preferences for, 115, 119-122,
128
post-Kinsey studies of, 11~122,
128-131
prevalence of, 74, 79, 117-118, 450
relationship to heterosexuality,
161-162
research by gay men and lesbians,
127-128
ritualized, 160-161
sampling frame, 150
social intolerance of, 11, 114-115, 117,
120, 126
surveys of, 1011
terms for describing, 114
trends in behavior, 113-136, 155
underreporting of, 11, 94
among women, 117, 160; see also
Lesbians
see also specific sexual practices
Samples/sampling for surveys
blinded, 49, 53, 56
blood specimens, 55, 60, 66
convenience, 6, 34, 46, 51, 67, 68, 69,
110-111, 120, 142, 150, 187,
210221, 234, 235, 414-415,
419-420, 423, 454-456
OCR for page 585
INDEX l 585
coverage, 48-50, 155-157, 462-464
customers of prostitutes, 146-147
deficiencies in, 6, 34, 46, 51, 54,
55-57, 74, 91
error, estimates of, 54, 442
exclusion criteria for, 45
frame, limitations of, 152
gay and bisexual men, 46, 132,
15~153
generalization from, 7 & n.7, 22, 34,
51, 132, 151, 152, 156, 220-221
for Hite report, 538-539
for ideal HIV seroprevalence survey,
47-48
IV drug users, 187, 202, 215, 220, 224,
227
multistage (cluster), 54, 225
network, 225
probability, 6, 7, 46, 48, 52, 59, 63,
66, 94, 95, 98, 103, 112, 122, 150,
151, 416-418, 423
random subsamples, 55
recruitment of, 34, 46, 8~84, 112,
130, 151, 187, 198, 220, 221
representativeness of, 102, 152
selection bias, 35-36, 46, 52, 54
for sex research, 91
size of, 54, 457-459
sources of variability in, 54
stability of populations over time, 37
stratification of, 51 n.22, 55, 57, 62,
105 n.l8
systematic differences in, 151
from treatment sources, 150 - 151
see also Kinsey studies
San Francisco
AIDS cases in, 103, 109
AIDS Foundation, 264, 270, 295
bleach distribution program, 203, 204,
209
gay community, 151-152, 264, 270, 272
HIV incidence and prevalence among
high-risk groups, 38, 132, 143, 151,
235, 237-239
Men's Health Study, 151-152
outreach programs, 145, 295-296
same-gender sexuality studies in,
120-121, 131-135
Screening for HIV
in newborns, 60
premarital, 484-488
reluctance to participate in, 68
trend data derived from programs for,
46
Serologic testing, see Antibody tests
for HIV; Screening for HIV;
Seropositive individuals;
Testing/tests for HIV
Seropositive individuals
deductive disclosures of, 9, 49
number of, 3
potential for transmission of HIV, 5
probability of developing AIDS, 5
see also Prevalence of HIV infection;
and specific high-risk groups
Seropositivity, injection behavior and,
195
Sex education
explicit language in, 19
recommendations on, 19, 409
safer sex programs, 13
Sex research
anthropological, 157-164
couples data, 109-111
data collection methods, 102
data reliability from, 9
deficient areas of, 10, 87, 157
design of, 78
federal support of, 10, 73
in fertility studies, 158
focus of recent studies, 81, 87, 88,
91-98, 128-131
fording for, 73-74
General Social Survey (1988), 103
Hite reports, 87-88, 527-546
on homosexual men, 155
legitimacy of, 85-86
Los Angeles Times survey, 103-104
by Masters and Johnson, 87, 149 n.34
methodological problems, 538-543
need for, 73, 74, 164-165, 211
non-AIDS applications of, 74
population studies, 91
post-Kinsey efforts, 010, 87-88,
91-101, 118-122
quackery in, 87-88
recommendations on, 10, 15, 18, 165,
405-407
of sex abuse and violence, 87 n.8
sex counts, 537, 546
OCR for page 586
586 ~ INDEX
of sexually explicit materials, 87 n.8
on sexual psychophysiology, 87 n.8
sharing of data from, 15
social constructions of gender, 158-159
status of? 9, 14, 73-75
symbolism approach, 158, 163
see also Kinsey studies
Sexual behavior
abstinence from sexual activity?
551-556
accuracy of information on, 33,
148-150
of adolescents and young adults,
88-101, 148, 261, 412, 414-415
age and, 41, 148-149, 412, 414-415,
421-422, 556-560
and AIDS, 9-16, 73-169, 405-407
anthropological perspective, 157-164
barriers to reporting of, 154
communicating about, 154, 198-199,
210, 375-376
in coupled relationships, 111
and courtship patterns, 88
cultural context, 78, 86, 158-162
data availability on, 79, 102, 164
data needs on, 75, 76
development cycles, 160
education on AIDS/HIV infection
and, 76, 26~264
extramarital, 10, 79, 91
frequency of, 76, 88-89, 111
gender roles, 97-98, 159-160
initiation of, 12, 95, 98-99, 113, 148,
166-167
and IV drug use, 18, 76, 166-167, 192,
196-200, 209-211, 283, 285
life course of sexuality and, 500-528
low-risk practices, 108
misreporting of, 85
multiple partners, 11, 12, 74, 134-136
in non-Western cultures, 159-162
normality issue, 79, 85-86
patterns, inference of, in adult
populations, 102
premarital conduct, 88-90, 91-95,
97-98, 101, 421-422, 424, 548-566
with prostitutes, 89, 97
religious view, 86
risk perception and, 108-109
risk reduction in, 209-211
self-reported, 96 n.12, 148-150, 224
as social/medical problems, 78
social negotiation and responsibility in
relationships, 97
social norms for, 85, 261
specificity in surveys, 154-155
surveys of, 95-96, 98, 102-109,
147-157, 548-566
twentieth century changes in, 96-97,
157-159, 505-506
understanding of, 9, 73, 74
verification of, 149
see also Behavior change/
modification; Prostitutes/
prostitution; Same-gender sex;
Women; and specific forms of
sexual behavior
Sexual development
cohabitation, marriage, and family
formation and, 520-523
in infancy, 506-507
in later childhood, 508-511
in middle adulthood, 523-527
in preschool children, 507-508
in young adults, 518-523
in young old, 527-528
in youth, 511-518
Sexual dreams, 116
Sexual intercourse, heterosexual
age of initiation, 12, 95, 98-99, 113,
412, 414-415
educational level and, 89
gender differences in rates, 88-89,
97-98
marriage/coupled relationships and,
12, 79-80
number of partners, 12, 98
precautions taken during, 12
premarital, 88-90, 91-93, 94, 421-422
unprotected, 108, 199
Sexually transmitted diseases (STDs)
availability of treatment, 13
as cofactors in transmission of HIV, 13
data on, 15-16
HIV seroprevalence surveys in clinics,
6, 38, 46, 150
incidence of, 16, 150, 287
nitrite inhalation and, 129
among prostitutes, 14, 142
public education on, 266
similarities between AIDS epidemic
and, 26, 28
statistics on, 167
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INDEX ~ 587
as surrogate measure of HIV infection
or sexual behavior, 16, 150, 167,
287
transmission parallels to HIV, 46
treatment of as part of HIV/AIDS
prevention, 13, 168-169
underreporting of, 16, 167
Sexual partners, number of
of adolescents and young adults, 98,
100-101
age and, 105-108
and age of initiation of sexual
intercourse, 12
and AIDS, 129
estimation of, 153
gender differences in, 98, 100-101,
105-108, 113
geographic differences in, 134-135
of heterosexuals, 91-93, 98, 100-101,
104, 106-107, 111-112, 423
among homosexuals, 11, 111-112, 121,
134-136, 153, 424
lifetime total, 153
marital status and, 105-108, 560-565
prior to symptoms of AIDS, 129
among prostitutes, 14
recall accuracy, 153
religion and, 108
spouses counted as, 108
of women, 423
Sexual transmission of HIV
evidence of, 128-129
intervention strategies for, 18
see also Heterosexual transmission
Shooting galleries, 18 n.l l, 135,
192-193, 212
Social science and behavioral research
barriers to, 23-25, 214
collaborative, 24-25, 219
federal support for, 216
on IV drug use, 215-217
need for, 23
personnel for, 23 - 24, 25
Social supports for behavior
modification
beliefs of family, group, and
community, 291-293
effectiveness of, 12, 265-266
evaluation of, 285
Spermicides
promotion of, 13
rates of use, 76
research recommended on, 14, 168
Stanford Three-Community Study, 294
StigrnPtization
in AIDS/HIV epidemic, 27, 393-399
definition of, 26, 390-391
dispelling, 397-399
effects of, 291, 297-298, 391 - 393
HIV testing and, 280
of homosexual men, 27, 114-115, 291,
395-397
of IV drug users, 27, 211, 237
Stockholm, HIV seroprevalence in, 214
Stop AIDS Project, 265, 295
Surveys
anonymity in, 148, 464-466
barriers to use of, 217, 222
behavioral specificity in, 154-155
biases in, 6 n.6, 8, 35, 36, 38, 45,
48-49, 52, 66, 217
blinded, 49-50, 53-54, 56, 60, 68
community support for, 150
confidentiality in, A, 223
costs of, 460-461
coverage, adequacy of, 462-463
cross-sectional, 52 - 53
cross-study comparisons from, 153
demographic characteristics in, 104
design problems, 6, 11, 45, 54, 55-57,
91, 102-103
educational levels of respondents, 36,
104
essay questionnaire and analysis,
543-546
General Social Survey (1988), 103, 126
Hite reports, 537-546
informing respondents of test results,
467 468
instruments, development/design of,
81-82, 103, 153-157, 205, 218, 460
interviewer characteristics, 222-223
interviewers versus self-ministered
assessments, 103, 154
limitations of, 217
Los Angela Times survey, 103-104,
108-109
methodological considerations in, 102,
147-157, 217-219, 549-551
missing values, imputing, 122, 123
National Health Interview Survey, 269
National Household Survey on Drug
Abuse, 227, 232, 436, 439
by National Institute on Drug Abuse
52 n.23
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588 ~ INDEX
National Longitudinal Survey, 148
National Survey of Family Growth,
60, 95, 97, 416-417
nonresponses, 48, 57-58, 66, 104, 123,
126, 152, 228
nonsampling errors in, 149
opinion polls, 102, 103-104
overrepresentat~on ot populations in,
35
participation rates, 53
reliability and validity of measures, 96
n.12, 155
response rates, 66, 94, 103 & n.15,
110, 112, 151, 152, 539-540
sample size in, 54
self-administered questionnaires, 222
self-reports in, 11, 96 n.l2, 148-150,
205, 221-223, 224, 299
of sexual behavior, 10-11, 94, 102-109,
147-157; see also Kinsey studies
site selection for, 6, 48, 52, 53 n.23,
54-56, 61
statistical power of, 54
tabulations in, 545-546
testing of survey design, 8, 48, 51
n.22, 58, 66
time frames of, 15~154
underreporting in, 11, 228
, . . - · ~ A,
underrepresentation in, 11)4
wording of questionnaires, 205, 219,
544
see also Bias in surveys and
reporting; Epidemiological surveys;
National Seroprevalence Survey;
Samples/sampling for surveys
Syphilis, 28, 167, 266-267, 287
T
Testing/tests for HIV
anonymous, 9, 21, 27, 57, 58, 264, 290
and behavior changes, 204-205,
279-282
benefits of, 279-280
blinded, 68
blood specimens eligible for surveys,
55
confidentiality of, 57, 69, 282
counseling with, 21, 53, 204-205, 264
cultural impacts of, 163
false positives in, 50
informed consent for, 8, 53, 69
informing survey respondents of
results of, 467-468
as an intervention strategy, 279-282
psychiatric morbidity associated with,
281-282
quality assurance in, 47, 50
research needs, 21, 282
standardization of, 47
stigma and discrimination associated
with, 280
of stratified population samples, 51
n-.22
at tuberculosis clinics, 68
Texas, IV drug use in, 229
Tranquilizers, 231
Transmission of HIV infection
accuracy of data on, 33
by asymptomatic individuals, 32
chain reaction in, 77
data needs on, 75-79
drug use behaviors contributing to,
180202
among ethnic/minority groups, 3
implications of adolescent sexual
behavior for, 12
and location of sexual practices, 135
misconceptions about, 263, 264
modeling program effects on, 477-481
opinion polls on, 102
probabilities of, 76
research needs on, 33
sexually transmitted diseases aIld, 13,
46
Transvestism, 162
Treatment Outcome Prospective Study,
198, 230-231
Tuberculosis
deaths from, among IV drug users, 32
n.2
HIV seroprevalence surveys in clinics,
6, 57, 68
Tuberculosis patients
HIV incidence among, 38
HIV seroprevalence surveys of, 38, 40,
57
treatment modification for
HIV-infected, 57, 68
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INDEX ~ 589
U
University of California at San
Francisco, AIDS Health Project,
295
Urinalysis, to validate self-reports of
drug use, 222
U.S. Drug Enforcement Agency, 219,
232
U.S. Public Health Service
achievements of, 70
AIDS brochures, 263
Coolfont report, 62, 449-450
fellowship programs, 24
recommended research role, 13-14,15
W
Washington, D.C.
AIDS incidence in, 43
HIV seroprevalence in, 44
pilot testing of seroprevalence survey
in, 8
tracking HIV infection in, 129
Western blot analysis, 55
Women
Afro-American and white women in
Los Angeles, 111-113
anal intercourse with, 113
barriers to behavioral change in, 198,
199, 291-292
cause of AIDS in, 14
childbearing, seroprevalence surveys
of, 7-8, 39, 59,61
HIV seroprevalence mnong, 60
initiation of sexual experience, 98, 113
IV drug use by, 14,197, 198,199-200,
281
marriage Ad sexuality ties for, 97
military applicants, 39
number of sexual partners, 98,
100-101,106-108, 113
premarital sexual intercourse, 8~89,
94, 95, 97, 101
psychiatric morbidity associated with
HIV testing in, 281
risk factors for transmission in, 39 n.9?
61, 198-199
sexual behavior of, 88-89, 94, 95, 97,
98, 111 - 113, 117? 158,159 - 160,
162, 197,198-199, 416-421,423
transvestites as sexual surrogates for,
162
unprotected intercourse by, 39 n.9, 200
violence in lives of, 503
see also Lesbians; Mothers;
Maternal-infant transmission
Women's AIDS Network, 295
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Representative terms from entire chapter:
hiv infection
