Missing the HIV message (American Public Health Assn. annual meeting)

Washington -- Although the HIV/AIDS epidemic is decades old and preventive measures have been widely promoted, another 40,000 people become infected each year. And, despite considerable progress in reducing the disease's impact among populations hardest hit initially -- gay men and intravenous drug users -- other populations, especially racial and ethnic minorities, continue to bear a disproportionate burden, according to a recent report from the Centers for Disease Control and Prevention.

That's why researchers are crafting prevention messages to reach these vulnerable people. Several presenters at the American Public Health Assn.'s 135th annual meeting, held Nov. 3-7 in Washington, D.C., provided examples of effective programs.

Some researchers zeroed in on young minority students at colleges and universities, a group not traditionally thought of as at high risk for contracting the AIDS virus.

Young, female, Hispanic college students were the focus of research done at Florida International University in Miami. Hispanic women ages 16 to 24 are one of the fastest-growing groups for getting HIV infection, said Robert Malow, PhD, professor of public health and director of FIU's AIDS Prevention Project.

These women, who may have been born in Latin American nations such as Cuba, Panama, Honduras, Guatemala and Columbia, are often caught in a cultural crunch. While focusing on the importance of remaining virgins for marriage, they are also intent upon not chasing men away. They may practice oral and anal sex in order to maintain their virginity, but are unaware of the HIV risks those options involve, he said.

The need to educate this often-sheltered population led to the formation of the university's peer education program, SENORITAS -- Student Education Needed in Order to Reduce Infection and Transmission of AIDS/HIV and STIs.

Spreading the word

The situation is similar for African-American college students, noted CDC medical epidemiologist Madeline Sutton, MD, MPH. She led surveys on student attitudes and behaviors about HIV and AIDS and found a difference between perceived and actual risk.

Of 1,172 students surveyed at historically black colleges and universities, 79% said they were at low risk for acquiring the virus, but only 55% had used condoms during their last sexual encounter. In addition, many of the students, both males and females, reported encounters with multiple partners during the previous 12 months.

On the plus side, many said they would be willing to have an HIV test. And those who said they already had been tested said they had done so after a talk with a doctor or other health professional, said Dr. Sutton. She urged physicians to take advantage of their persuasive powers. "Students take it to heart when we sit down and discuss with them getting an HIV test."

Physicians and other health professionals were also found to be believers in packaging the prevention message with medical care, according to a survey sent to 136 physicians, nurse practitioners and physician assistants by the AIDS Activities Coordinating Office in Philadelphia.

The surveyors thought physicians and others might be too time-strapped by patient care to think about prevention, said Marlene Matosky, MPH, RN, a member of the research team. But that wasn't the case.

Although nearly everyone who responded thought prevention was important, almost half said they would like to be more effective at communicating the message to patients. The physicians particularly needed materials to distribute to those already infected. As a result, the city is now gearing up to supply such handouts as well as information on bleach kits to use when cleaning needles, needle-exchange programs and condom distribution sites, Matosky said.

Another session focused on reaching Hispanic men who have sex with men. These men do not necessarily consider themselves to be gay and so are often missed by the messages that began going out to that group decades ago, said Ana Martinez-Donate, PhD, assistant professor of health promotion and behavioral sciences at San Diego State University's Graduate School of Public Health.

She led a research team in a campaign called Hombres Sanos, or "healthy men." It promotes condom use and HIV testing among this high-risk group. Researchers distributed materials at nightspots and barbershops and aired radio promos. The effort has produced good results, she said. Condom use increased, as did the men's perception of their risk.