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Index A Abstinence by adolescents, 14, 173, 174, 177 n.42, 204 predictors of, 173, 174 promotion of, 14, 20~204, 206, 207 Acute norrnovolemic hemodilution, 338 Adolescents abortions by, 205 n.86 abstinence by, 173 AIDS cases, 141, 151-152, 157-160 anal intercourse by heterosexuals, 179-180 awareness about AIDS, 15-16, 182-183, 208-213, 21~217 blood donation by, 310315 childbearing, 15~156, 161, 166 clustering of risky behaviors, 194-197 community norms and behavior modification among, 21~219 contraception and condom use, 12-13, 177-179 data sources on, 11-12, 150, 168-170, 184-185 delinquents, 173, 174, 185, 197-199, 216 n.98, 223, 230 deliver of programs to, 221-231 drug use and users, 13, 18~194, 199, 200, 202-203, 227-231 environmental factors in risk of AIDS, 13 epidemiology of AIDS and HIV infection among, 148-167 fear of AIDS, 21~215 477 frequency of intercourse, 17~175 gender differences in AIDS and HIV prevalence, 56-57, 157-160 gender differences in drug use, 189-190 geographic distribution of AIDS and HIV prevalence, 161-166 goals of intervention programs for, 202-208 REV seroprevalence, 4, 11, 56, 147, 153-167, 200 hotlines for, 220, 222, 227 incubation period for AIDS in, 149~150 initiation of drug use, 13, 185-186 injection practices among, 186-187 knowledge levels and risky behavior, 21~217 number in U.S., 157 n.14, 233 n.ll7 member of sexual partners, 12, 175-177 in over studies, 156-157 out-of-school youth, 16, 197, 226-227 personal vulnerability messages in prevention, 215-216 pregnancy rates, 13, 205, 207 prevalence of AIDS, 141, 151-152, 157-160 prevalence of drug use, 187-190 prevalence of HIV, 4, 11, 56, 147, 15~167, 200 prevention programs, 11, 13-15, 17, 35, 201-232 prosunluon by, 15, 17, 19~200, 270

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478 ~ INDEX raciaVethnic differences in AIDS and HIV prevalence, 11, 16~161 raciaVethnic differences in drug use, 19~192 racialfethnic distribution of population, 160 n.20 raped/sexually abused, 200 risky behaviors, 12-13, 35, 147, 167-201 same-gender sexual behavior among, 13, 40, 18~181, 207, 216 n.98 school-based prevention programs, 224-226 services related to high-risk behaviors, 16 sexual behavior, 12-13, 147, 167-183, 199-200, 201, 203, 205, 409-412 sexually abused, 200 sexually transmitted diseases, 13, 167-168, 177, 181-182, 199, 227 n.lll skills-related interventions, 217-218 sources of messages to, 219-221 subpopulations at higher risk, 11, 12, 14-16, 167, 184, 197-200, 208, 211, 221-222, 226-227, 234 transmission modes for AIDS, 161 vaginal intercourse by, 17~173 Age AIDS cases by, 151, 152, 159, 163-164 and behavioral change, 40 and blood donation, 300, 314, 321-322, 337 and drug use, 192-193 and explicitness of AIDS educational material, 225-226, 234 and HIV seroprevalence, 24, 153, 321 at initiation of sexual activity, 167-168, 181 and premarital intercourse trends, 171 and risk taking by gay men, 85 and transmission mode for HIV, 161 see also Adolescents AIDS asymptomatic (incubation) period, 10~109, 149-150, 151, 211 changes in character of, 38 deaths from, 43, 69 n.52, 151 dementia, 69 medical and biological aspects of, 39-40 sexual behavior after diagnosis of, 99 stigma of, 116; see also Discrimination surrogate markers of, 291 wasting syndrome, 69 see also AIDS cases; Epidemic; Epidemiology of AIDS AIDS Behavioral Research Project, 82 n.1 AIDS cases among adolescents, 148, 151-lS2, 157-166 by age at diagnosis, 151-152, 159, 164 definition for surveillance, 68-69 by exposure category and year of diagnosis, 44, 5~51 among gay men, 4, 43, 44, 46 gender and, 3, 5~52, 157-160 geographic distribution of, 3, 161-166 among heterosexuals, 4, 40, 44, 49, 157 among hemophiliacs, 44, 291 among IV drug users, 4, 43, 44, 46, 48, 69, 157, 186 Kaposi's sarcoma with, 69 n.52 pediatric, 44 race/ethnicity and, 40, 43, 46, 54 n.24, 16~161 same-gender sexual activity and, 3 transfusion-related, 44, 49, 65 undercounting/misclassification of, 42, 48 in U.S., 1, 42-43 among women, 40, 48~9, 52, 54 n.24, 55, 60 see also Epidemiology of AIDS Alabama, sexual behavior of gay men in low-prevalence cities, 83 n.2 Alcohol use by adolescents, 13, 188-190, 192, 195, 196, 199, 200, 217-218, 219, 228 and HIV infection, 64 initiation of, 193, 217 n.100 peer influences on, 2I9 prevention of, 217-218, 228 and recall on suIveys, 31 and sexual activity, 5, 8, 41, 183, 188, 19~197, 199 Alcohol, Drug Abuse, and Mental Health Administration, 8, 36, 111, 306 American Association of Blood Banks, 293, 296 American Red Cross, 293, 297, 298 n.l3, 323 American Statistical Association, Commission on Statistical Standards, 366 Amphetamines, 23O, 420 Amsterdam HIV seroprevalence in, 45

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INDEX l 479 needle exchange program in, 125 n.67 Anal intercourse by heterosexual adolescents, 179-180 and HIV transmission, 66 legality of, 31, 395 by prostitutes, 260, 275 n.22 unprotected, 82, 83, 85, 87, 88 n.l2, 105 n.47, 109 Antidiscrimination legislation Americans with Disabilities Act, 118 claims processing, 120 costs of, 117 education rights of HIV-infected children, 121 effectiveness of, 9 enforcement of, 120 Fair Housing Amendment Act of 1988, 118 federal,117-118 HIV testing and, 119 monitoring and enforcement of, 117 purpose of, 116 Rehabilitation Act of 1973, 117-118 state and local, 117, 118-121 wor}cplace-related, 119 see also Litigation Atlanta HIV seroprevalence in, 18, 57, 257 sexual behavior of gay men in, 83 n.2 B Baltimore adolescent risk behaviors in, 191, 195, 229-230 AIDS hotline for adolescents in, 220 HIV seroprevalence in, 158, 159 Behavioral research on AIDS barriers to, 121-122, 282 cross-study comparisons, 6, 56 n.30, 70, 84, 169 of gay men, 84 IV drug users, 121 limitations of, 84 see also Behavioral surveys; Blood donor recruitment; Blood supply protection; Drug use; Ethnographic studies; IV drug users; Methodological issues; Recommendations; Research recommendations; Sexual behavior, Survey methods; Women Behavioral surveys of adolescent sexual activity, 409~12 of blood donor populations, 329-330 of drug use, 184-185, 187, 42(~428 feasibility for measuring high-risk behaviors, 366 follow-up, 195 limitations of, 180185 Monitoring the Future, 184, 185, 189, 192 National Adolescent Student Health Survey, 184, 209 National Household Survey on Drug Abuse, 184-185, 188, 189 National Longitudinal Survey of the Labor Market Experience of Youth, 168, 169 n.35, 173, 184, 185-186, 191, 193, 195, 196 National Survey of Adolescent Males, 168, 175, 178, 181 National Survey of Children, 200 National Survey of Family Growth, 168, 168 n.35, 174, 175, 177-179, 376, 377, 379 National Survey of Young Men and Women, 168, 169 n.35, 178 National Youth Survey, 194 with probability samples, 168, 190195, 209, 212, 216, 366-367 role in AIDS research, 359, 361-362, 365 sexual behavior, 168-170, 17~175, 177-179, 181, 365~01, 401-409 targets of, 36~361 training of interviewers, 297 see also Data Collection; General population surveys; Monitoring; Survey methods; Treatment Outcome Prospective Study Behaviors, risky see Anal intercourse; Behavioral surveys; Cocaine use; Crack use; Drug use; Heterosexual behavior, IV drug users; Sexual behavior, Transmission of HIV; Vaginal intercourse Bisexual men AIDS cases from, 43~5 blood donors, 24, 323, 324-325, 329 Blacks age of initiation of intercourse, 17~171, 196 AIDS cases among, 54 n.24, 55, 160 condom use by, 178

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480 ~ INDEX drug use by, 190-192 gay men, 105 HIV antibodies in infants, 54 HIV seroprevalence among, 11, 155, 166, 292 risk factors for, 5, 43, 46, 54 n.27 see also Minorities; Race/ethnicity Blood and blood products age and transmission of HIV through, 161 AIDS cases from, 161, 162 decreasing patient needs for, 338-339 decreasing unnecessary use of, 26, 27, 334-336 demand for, 289-290 distribution of, 294 fresh-frozen plasma, 333-336, 339 leukocytes, 332, 339 packed red blood cells, 332-336, 339 platelets, 332-335, 339 shelf life of, 294, 337 trends in utilization, 26, 332-334 whole blood, 339 see also Blood donation; Blood donor recruitment; Blood supply; Blood supply protection; Blood transfusions; Transfusion recipients Blood donation age and, 300, 321-322, 337 altruism and, 301, 302, 310 and attribution of responsibility, 312 autologous, 23, 26, 27, 37, 291, 33~338, 342, 343; see also Acute norrnovolemic hemodilution characteristics of donors, 22, 24, 293-294, 299-301, 318, 324-325 community needs and support as reasons for, 302-303 confidentiality of information, 21, 25, 296 deferral from, 3, 21, 23-24, 294, 307-308, 321 directed, 318-319 eligibility requirements, 21, 22, 24, 289, 294, 298 n.13, 305-306, 313-314, 321, 336 fear of, 22, 305, 30~307, 316 first-time, 292, 299, 303, 307, 308, 314, 319, 320 and free ridership, 312 gender differences in, 299 health history for, 21, 25, 294, 296, 325 HIV seroprevalence among donors, 24, 292, 318, 323-324 and HIV testing at collection centers, 25, 327 ideal experience, 22-23, 309 inconvenience of, 308-309, 316, 320 inhibiting factors, 22-23, 305-309, 315-316, 322-323 and iron supplements, 299-300, 322-323, 337-338, 342 medical ineligibility for, 22, 305-306 motivations for, 22, 301-305, 316, 329 payment for, 290, 292-293, 302 perceptions and risk, 32~325, 326, 329 penoperative salvage, 27, 338 pooling of, 332 by pregnant women, 337 preoperative, 337-338 reactions to, 22, 307, 321 repeat, 292, 299, 302, 30~308, 315, 316 research on, 309, 312-313, 316, 319 n.31, 326, 327-331 screening for HIV, 21, 23, 52, 308-309, 317, 329 size of donor population, 298 n.11 staffing issues, 29~297, 330 and theory of reasoned action, 312 voluntary system, 293, 302 see also Blood donor recruitment; Blood supply; Blood supply protection Blood donor recruitment "Adopt a Donor" program, 315 age factors in, 24, 314, 321-322 by appointment scheduling, 313 and attribution theory, 309-312 behavioral theory applied to, 309-317 door-in-the-face technique, 31~311 effectiveness of incentives, 302 emergency appeals, 314 families, 314-315 foot-in-the-door technique, 310-311 gender and, 24, 322-323 impediments to, 298 intention and action, 312-314 internal versus external antecedents to action, 309-312 list of potential donors, 311 organizational and theoretical issues linked in, 315-317 racial and ethnic minority groups, 24, 317-318, 319-322

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INDEX | 48 1 research needs on, 328-329 rewards and incentives for, 22, 301-302, 305, 310 role models and, 24, 314-315, 320 safety issues in, 318-323 social pressures and, 21, 22, 29~295, 303-305, 311, 317, 319, 320 strategies for, 23, 25, 37, 318-327 targets for, 22, 300 301 temporary deferral and, 313-314 Blood supply adequacy of, 4, 21, 22-23, 36-37, 41-42, 297-317 collection system in U.S., 292-297 effect of exclusionary policies on, 297-298 history and overview of problems, 291-292 organizations collecting blood, 293-294 recommendations for increasing, 23 shortages in, 290, 293, 298, 311 Blood supply protection AIDS-related intonation for donors, 295 appropriate use of transfused blood and blood components, 2~27, 37, 331-344 confidential unit exclusion procedure, 22, 295, 298 n.11, 304, 326-327, 329 decreasing patient needs for, 26, 338-339 decreasing unnecessary use of blood products, 26, 27, 334-336 donor perspective on exclusionary procedures, 323-327 educational materials, 325-326, 339-342, 343 effectiveness of interventions, 3-4, 9, 24, 167, 292, 295, 324 evaluation of interventions, 325, 328 exclusionary procedures, 21-22, 24, 25, 37, 291, 292, 290297, 323-327 HIV antibody testing, 291, 304 hospital audits of blood usage, 34~341 increasing autologous donation, 33~338 patient behavior modification and, 26-27, 37, 342 physician behavior modification and, 26-27, 37, 33~337, 339-342 recruitment of donors and, 318-323 research needs on, 329-330, 342-344 safety improvements, 23-25, 41 self-deferral, 292, 29~296, 305, 317, 322-324, 32~327 viral inactivation, 26, 339 see also Blood donor recruitment Blood transfusions autologous, 23, 26, 27, 333-334, 336-338 chronic renal failure and, 33~339 desmopressin acetate and, 26, 338 erythropoietin and, 26, 27, 338-339 and hemoglobin levels, 334-335, 337 patient behavior modification and, 2~27, 342 physician behavior modification and, 26-27, 339-342 platelet, 335 prophylactic, 335 rates, 26 red blood cell, 333, 335 risk of HIV transmission through, 292 unnecessary, 290, 291, 333 see also Transfusion recipients Boston sexual behavior of gay men in, 83 n.2 sterile needle programs in, 124 C California adolescent awareness about A~S/~V, 216 n.98 adolescent IV drug users in, 191 behavioral change among gay men in, 82 enforcement of antidiscrimination laws in, 120 REV seroprevalence in, 40 n.3, 57 Prostitutes Education Project, 274 sex for drugs in, 62-63 survey of HIV risk factors, 382-383 Centers for Disease Control "America Responds to AIDS" media campaign, 98, 22~221 community demonstration projects for women, 97 counseling and testing program, 102-103 data collection systems, 5 - , 71 demonstration and education projects for gay and bisexual men, 84 n.4 family of surveys, 12, 68, 151 "Guidelines for Effective School Health Education to Prevent the Spread of ADS," 204 205, 225 high school student surveys, 20~209 hotline, 222 minority youth intervention programs, 105, 22~227

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482 ~ INDEX neonatal surveillance, 11, 12, 53, 68, 70, 15~151, 155, 161 prostitute multicenter study, 18, 255, 257, 260, 263, 267 research reco~runendations for, 5-6, 12, 19 school-based education programs, 22~225 serosurveys, 372, 386-387 Chicago, clustering of adolescent risk behaviors in, 195 Chlamydial infections, 168 see also Genital lesions; Sexually transmitted diseases Cigarette smoking, by adolescents, 189, 190, 193, 196, 217 n.101, 218, 219-220, 228 Cocaine use by adolescents, 187, 188-190, 192, 193, 196, 230 changing patterns Of, 420 and HIV transmission, 41, 61 n.35 initiation of, 185-186 and sexual activity, 196, 197, 230 see also Crack use; IV drug users Colorado HIV seroprevalence in, 18, 45, 57, 256 restriction of HIV-infected individuals in, 278-279 Condom use by adolescents, 12-13, 177-180, 199-201, 20~204, 216 advertisements for, 113 awareness about AIDS/~V and, 216 n.98 by clients and pamers of prostitutes, 3, 19, 26~261, 272-273, 280 crack use and, 19, 183, 270 education about, 14, 107, 111, 122 n.64, 204, 206, 207, 216, 272 n.l8 effect of interventions on, 87, 88, 97-98, 123 effectiveness of, 177 n.43, 214, 280 as evidence of prostitution, 277-278, 281 by gay men, 83 n.2, 87, 88, 123 by hemophiliacs, 66 by IV drug users, 62, 63, 95, 96 mandatory, in brothels, 275 obstacles to, 8, 14, 20, 96, 112, 113 n.55, 122 n.64, 20~204, 261, 277-278, 280, 281 predictors of, 110, 112, 219 racial/ethnic differences in, 178 risky sexual behaviors and, 180, 199 and sex roles of women, 112, 219 and skills training, 96, 107, 231, 274 in STD prevention program, 214 testing for HIV and, 97-98, 280 Confidentiality of blood donor health history, 21, 25 and data collection, 70 Contraceptive practices of adolescents, 177-179, 188, 207-208 age and, 167 alcohol use and, 188 education about, 207-208 of HIV-infected women, 99 n.33 see also Condom use Council of Community Blood Centers, 293 Counseling of adolescents, 173, 220 assessment of effectiveness of, 102-103 as intervention for women, 95, 99-103, 111 lessons from genetic counseling, 7, 10~105 peer, 220, 276 sensitivity to cultural and ethnic differences in, 173 street, and drug treatment referral, 273 see also Education programs; Prevention programs/strategies; Testing and counseling for HIV Crack use by adolescents, 13, IS, 183, 190, 194, 200, 208, 230 and condom use, 183, 270 initiation of, 194 prostitution and, 62, 183, 208, 25~259, 262, 269-270 sexual effects of, 47, 183, 269 and sexual transrIiission of HIV, 2, 5, 15, 19, 36, 41, 46, 62-63, 69, 270, 282 and sexually transmitted diseases, 47, 183, 420 see also Cocaine use Cystic fibrosis, 104 D Data collection on adolescents, 11-12, 187 aspects of, 359-360 difficulties in, 70, 84, 107, 262-263 on IV drug users, 60 n.33, 187, 256 needs, 67, 107

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INDEX ~ 483 PHS funding for, 42 on prostitutes, 256, 262-263 review of current CDC programs, 5-6 on transfusion practices, 343 see also Behavioral surveys; Serosurveys; Survey methods Denver, behavioral change among gay men in, 82 Desmopressin acetate, 26 Detroit, HIV seroprevalence in, 45 Discrirn~nation (AIDS-related) defined, 115 extent of, 116-117 federal protections against, 117-118 history of, 115 as impediment to prevention, 115-121 state and local protections, 118-121 violence against gay men and lesbians, 12~121 see also Antidiscrimination legislation; Legislation and legal issues; Litigation Dominican Republic, health education projects for prostitutes, 272 n.l9 The Door, 232 Down's syndrome, 104 Drug treatment programs for adolescents, 208, 231 barriers to use by women, 93-94, 276 effectiveness of, 90-91, 92, 202-203 In health care facilities, 94 linked to needle exchange programs, 125 n.67 methadone maintenance, and HIV infection rates, 90-91 pregnant women in, 94 prenatal care with, 94 promotion of condom use through, 107 for prostitutes, 273, 276 referral networks, 15, 94, 124, 208, 273 Treatment Outcome Prospective Study, 187 waiting lists, 276 Drug trials, pregnant women in, 101 n.37 Drug use by adolescents, 13, 147, 183-197, 200, 202-203, 217-218, 227-231 age and, 186, 192 data sources and limitations, 32, 18~185, 191 duration of, and risk, 61 n.35 education interventions, 14, 206, 207, 214-215, 217-218, 223, 228 ethnographic studies of, 442 fear of AIDS and, 91, 230 gender differences in, 19~191 initiation of, 13, 61, 185-186 patterns of, 46, 186, 442 polydrug use, 63 n.39 prevalence of, 13, 55, 187-190, 227 n.111, 228 n.ll3 progression of, 229 by prostitutes, 17, 25~259 raciaVethnic differences in, 190-192 and recall on surveys, 31 and relapse, 89 and sexual activity, 2, 5, 8, 88-89, 195-197, 258 and sexual transmission, 17, 18, 255-2S9 social nature of, 61, 217, 229-230 sterile needle programs and, 10, 124, 203 surveys of, see Behavioral surveys; Survey methods and transmission of HIV, 30, 46, 442 undetTepori~ng of, 32, 185, 191; see also Survey methods by women, 6(}64 see also Gay men; IV drug users; Sterile needle programs; and specific drugs and other subpopulations Drug withdrawal, and injection practices, 62, 95 E Education programs for adolescents, 14, 15-16, 17, 204 207, 215, 217-218, 223, 228, 232-233 assertiveness tr=g, 217-218 for blood donors, 295-296, 32~326, 330340, 341, 343 CDC "Guidelines for Effective School Health Education to Prevent the Spread of AIDS," 204 205 cognitive behavioral self-management training, 87 about condoms and sperrnicides, 14, 107, 111, 122 n.64, 204, 206, 207, 216, 272 n.18 about drugs, 14, 20, 206, 207, 217-218 effectiveness of, 87-88, 95, 110, 111, 21~214, 221, 226 for gay men, 84 n.4, 86-88

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484 ~ INDEX gender differences in evaluation of, 223-224 for Hispanic youth, 222, 22~227 "information only" versus "psycho-educational" programs, 110 obstacles to, 14, 19, 121, 122, 204, 232 for patients about transfusions, 27 for physician behavior modification on transfusions, 27 planned variations in, 123, 215, 233 for prostitutes, 19, 20, 271, 272, 273, 280 on safer injection practices, 273 about same-gender sexual practices, 14 school-based, 16, 206, 223 about sexual behavior, 204, 206, 207 sexually explicity materials in, 122 n.64, 225-226 skills training in, 96, 107, 226 STAR (Students Taught Awareness and Resistance), 228 theater groups and rap sessions, 223 see also Counseling; Prevention programslstrategies; Testing and counseling for HIV E1 Puente, 232 Environmental factors, in adolescents' risk of AIDS, 13 Epidemic changes in risk populations, 38 data needs for tracking, 67-72; see also Survey methods dimensions of, 1 . . , progress In prevention, 0 social impacts of, 9 Epidemiology of AIDS among adolescents, 148-167 changes in U.S., 4 6, 43-48 among prostitutes, 25~263 among women, 48~7 see also AIDS cases; Survey methods Erythropoiet~n, 26 Ethnographic studies of AIDS, 4421 448 on crack houses, 259 of drug use pattems, 442 examples related to HIV transmission, 441 442 of female IV drug users, 6~61, 64 of female sexual partners of IV drug users, 96 n.27, 183 gaps and deficiencies in, 448 449 of male-male sexual contacts, 441 442 methods, 442 448 of prostitutes, 269, 272 F Fear of AIDS and blood donation, 305, 30~307 and IV drug use, 91, 230 and prevention, 91, 213-215 and prostitution, 270 Fifth International Conference on AIDS, 89 Florida blood donation by senior citizens in, 321 HIV seroprevalence in, 40 n.3, 54, 57 mandatory testing of prostitutes in, 279 serosurvey in, 372, 38~387 testing and counseling of gay men in, 83 n.2 Food and Drug Administration, 296 G Gay men age and risk taking, 85 AIDS cases, 4, 43~5, 50 behavioral change by, 40, 41, 82, 88-89, 109, 123, 218 clinical interventions, 87~8 condom use by, 83 n.2 community-level and individual interventions, 85-88, 109 ~ g users, 44, 50, 88-89, 162 high-risk subgroups, 84, 85 HIV seroprevalence, 40 impact of interventions among, 8, 82-89, 123 predictors of safer practices, 105 n.47 relapse in behaviors among, 109-110 research on, 84 safer-sex workshops, 87, 105 n.47, 123 testing and counseling of, 83 n.2 violence against, 12~121 see also Same-gender sexual behavior Gay Men's Health Cnsis, 123 Gender differences in adolescents, 5~57; 157-160; 189-190 in AIDS and HIV prevalence, 24, 5~52, 157-160 in blood donation, 299 and blood donor recruitment strategies, 322-323

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INDEX l 485 in drug use, 19~191 in evaluation of AIDS educational materials, 223-224 in incidence of sexually transmitted diseases, 182 see also Women General population surveys, 30, 203 n.83, 370-371, 376, 377 Genetic screening programs, as model for AIDS intervention, 7, 103-105 Genital lesions, and HIV transmission, 13, 177 Geographic distribution of AIOS/~V infection in adolescents, 3, 161-166 in hemophiliacs and transfusion recipients, 163 n.22 in IV drug users, 45, 90 pockets of high rates of infection, 53, 56, 163, 165-166 in prostitutes, 18 in women, 53-54, 56 Georgia, HIV seroprevalence in, 57 Gonorrhea, 13, 168 n.30, 181-182, 199 n.79, 267, 280 see also Genital lesions; Sexually transmitted diseases Great Bntain, syringe exchange programs in, 122 H Hallucinogens, 188, 189, 192, 193 Hashish, 188, 189 Hastings Center, 103 Health care age and use of clinics, 182 financial barriers to, 10 for HIV-infected adolescents, 232 litigation over access to services, 119-120 Hemophiliacs AIDS cases, 49 n.17, 52-53, 161, 163 n.22, 291 condom use by, 66 female sexual partners of infected men, 49, 52-53, 65-67, 111 programs for HIV-infected adolescents, 232 incubation period for AIDS in, 149-150 infectivity of, 83 n.3 in U.S., 52 n.l8 Hepatitis in blood from paid donors, 290 prevalence among IV drug users, 4 n.4 racial differences in prevalence, 319 n.32 screening for, 298 n.13 Heroin, 186, 187, 189, 190, 193, 229, 230; see also IV drug users Heterosexual behavior adolescent patterns of, 173-180 age of initiation of intercourse, 173-174 anal intercourse, 179-180 contraception and condom use, 88, 177-179 frequency of intercourse, 174-175 number of sexual partners, 32, 33, 175-177, 412 413 see also Vaginal intercourse; and other specific practices Heterosexual contacts AIDS cases from, 3, 4, 40, 44, 45, 5~51, 55, 161 efficiency of HIV transmission in, 69 risk to women from, 49 see also IV drug users; Prostitutes; Women High-risk populations adolescent subpopulations, 11, 12, 14-15, 167, 184, 197-200, 208, 211, 221-222, 22~227 changes in, 2, 34 prevention strategies for, 17, 231-232 see also specific populations Hispanics age of initiation of intercourse, 17~171 AIDS cases among, 54 n.24, 55, 160 drug use by, 190 education/~nformation campaigns directed to, 222, 220227 HIV antibodies in infants, 54 HIV seroprevalence among, 11, 156, 292 programs for HIV-infected adolescents, 232 risks factors for, 5, 43, 46 54 n.27, 184, 196 school dropout rates, 184, 226 sexual activity of prostitutes, 260 see also Minorities; Race/ethnicity Hispanos Unidos Contra el SII)A/AIDS, 227 HIV infection from antibody-negative blood, 291-292 cofactors in, 47 duration of injecting career and, 257 n.5 frequency of injection and, 257 n.5

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486 ~ INDEX infectivity associated with later stages of, 83-84 morbidity changes, 38 number of sexual partners and, 12, 18, 19, 253 n.2, 255 persistence of, 39 progression to AIDS, 39 and reproductive decision making, 99-101 saturation, 4 n.4 window period in serologic screening, 291 see also HIV seroprevalence; Serosurveys HIV-infected populations isolation of, 278-279 prevention program needs for, 208, 231-232 prophylactic treatment of, 116 see also Adolescents; Gay men; IV drug users; Women; and other specific populations HIV seroprevalence among adolescents, 4, 11, 56, 147, 150, 153-167, 200 among blood donors, 24, 292, 318, 323-324 among childbearing women, 155-156 in clients of prostitutes, 262 crack use and, 63 in female sexual partners of infected hemophiliacs, 65-66 among gay men, 40, 83 gender and, 4, 154, 157-160 geographic distribution of, 3, 40, 161-166, 255-257 intervention programs and, 83 among IV drug users, 4, 45, 166, 253 n.2 in Job Corps applicants, 153, 155, 159, 163, 165 in military applicants, 153-155, 157, 159, 16~161 in other studies, 156-157 for probability samples, 150 among prostitutes, 3, 18, 253, 256-257 race/ethnicity and, 60, 16~161 survey methods, 29, 383-391 among women, 3, 4, 6-7, 53, 56-60, 65-66, 150, 153 n.l 1, 155-156 see also HIV infection; Serosurveys Homeless people adolescents, 13, 15, 17, 165, 189, 199-200, 208, 227, 234 extent of, 227 HIV seroprevalence among, 200 interventions for, 208 risk of HIV infection, 13, 165, 199-200, 234 women, 61 Homosexuals, see Gay men; Same-gender sexual behavior Hotlines, 220, 222, 227 I Illinois, HIV seroprevalence in, 40 n.3 Infants seroconversion in, 53 n.20 seroprevalence rates, 54-55, 56 see also Pediatric AIDS; Perinatal transmission Information campaigns for adolescents, 213, 21~215, 222 "America Responds to AIDS" media campaign, 98, 220-221 and behavioral theory of adoption and diffusion of innovation, 123-124 for blood donation, 295-296 culturally and linguistically appropriate messages, 106 effectiveness of, 10, 90, 94-95, 10~107, 213-214, 216 empowerment messages, 97 evaluation of, 202 for gay men, 86 health promotion campaigns, 214-215, 220 for IV drug users, 90 obstacles to, 18 personal vulnerability messages, 98, 215-216 printed materials, 98 n.31, 223, 275 n.20, 325-326, 339-340 sexually explicit material in, 10, 121, 122-124, 225 see also Education programs; Prevention programs/strategies; Public awareness about AIDS Inhalants, 189, 190, 193 Interventions, see Education programs; Information campaigns; Prevention programs/strategies; Testing and counseling IV drug users adolescents, 13, 187, 189-191, 193-194, 200, 208

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INDEX ~ 487 AIDS cases, 4, 40, 43-46, 5~51, 55, 56, 69, 69 n.52, 161, 162, 186 awareness of AIDS and transmission routes, 125 n.67 behavioral changes in, 89-92, 94-95, 110, 125 n.67 blood donation by, 318 characteristics of, 6~61, 63 condom use by, 62, 63, 95, 96 n.26 contraception by, 63 female sexual partners of, 3, 48, 49, 54 n.27, 61 n.34, 64-65, 92-96, 166, 270 fertility patterns of, 63 n.41 gateway drugs, 228-229 gay men, 44, 50 HIV seroprevalence, 4, 11 45, 5~55, 91, 166, 253 n.2, 255-257 impact of AIDS on, 187 impact of interventions among, 8, 42, 89-92, 110, 125 n.67, 229 injection practices, 32, 61-62, 89, 91, 125 n.67, 166, 186-187, 229-231, 257 n.5 minorities, 46 outreach programs for 125 n.67, 231, 273 potential for spread of HIV through, 45-46, 125 pregnancy rates in, 99 n.34 prevention programs for, 42, 60 n.33, 89-92, 208, 227-231, 273, 274; see also Sterile needle programs prostitutes, 18-19, 253 n.2, 255-257, 265-267, 273, 281 referral to treatment, 60 n.33 relapse in risky behaviors, 110 running buddies, 61 sexual behavior of, 2, 18, 54, 62, 89, 95 shooting galleries, 61, 230, 257 n.5, 422 women, 49, 54-55, 6~64, 93-95 works, 61 see also Drug use; Drug treatment programs; Heroin; Sterile needle programs J Job Corps applicants HIV seroprevalence in, 153, 155, 159, 163, 165 screening for HIV, 67-68, 150, 153, 161 Joint Council of the Administration of Healthcare Organizations, 34~341 K Kansas City AIDS hotline for adolescents in, 220 STAR (Students Taught Awareness and Resistance) program, 228 Kaposi's sarcoma, 69 n.52 Koop, C. Everett, 205-206, 233 L Latinas/Latinos, see Hispanics Legislation (AIDS-related) and legal issues on AIDS educational materials, 204 effects on HIV transmission, 279 mandatory HIV testing, 279-280 prostitution by HIV-infected individuals, 277 restriction of infected individuals, 278-279 on sterile needle programs, 126 see also Antidiscri~nination legislation; _ . . . . . . . Dlscnm~natlon; . _lugatlon Lesbians blood donation by, 303 violence against, 120-121 . . . Lltlgatlon Chalk v. Orange County Department of Education, 118 Doe v. Centinela Hospital, 118 health care services as public accommodation and, 119-120 legal resources for, 120 Ray v. School District of DeSoto County, 118 School Board of Nassau County v. Arline, 117 shift in nature of cases, 119 Los Angeles AIDS cases in, 45 behavioral change among gay men in, 82 HIV seroprevalence in, 18, 57, 166, 256 cou~s~ana HIV seroprevalence in, 45, 58 sexual behavior of gay men in low-prevalence cities, 83 n.2 M Marijuana use by adolescents, 188-190, 192-193, 196, 228 initiation of, 185, 193

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488 ~ INDEX prevention of, 228 reporting of, 185 and sexual activity, 64, 195, 196 and use of other dogs, 186, 192-194, 228 Maryland, HIV seroprevalence in, 45, 58 Massachusetts adolescent awareness about AIDS in, 209, 212, 216 IV drug use by adolescents in, 189 Mathematical models, 7~71 Methodological issues accuracy of self-reports, 421 in blood donor studies, 319 n.31, 329 cross-study comparisons, 6, 56 n.30, 70, 84, 168 data collection and reporting, 84, 121 fallibility of measurement in other sciences, 362-365 inconsistent age groupings, 166 measurement bias, 422~28 partner reports, 401-406 replication of measurements using same respondents, 413~19 replication of surveys on samples of same population, 409 413 in sexual behavior studies, 169-170 validation, 401009 see also Data collection; Ethnographic studies; Survey methods Metropolitan Life Insurance Foundation, 226-227 Miami, HIV seroprevalence in, 18, 40, 56 n.30, 256 Michigan adolescent IV drug users in, 189 HIV seroprevalence in, 45, 58 information dissemination, 98 n.32 Military applicants HIV seroprevalence in, 153-154, 157, 159, 16{) 161, 163, 165 screening for HIV, 67~8, 150 Minnesota blood transfusion practices in, 336 MV seroprevalence in, 45, 58 Minonties AIDS/~V prevalence among, 34, 40, 41, 46, 54, 60, 16~161, 310320 awareness about AIDS/~V, 15, 106, 21 1-212 blood donation from, 24, 300, 317-318, 3 19-322 interventions needed for, 105-106 IV drug use by prostitutes, 18, 257, 265 see also Blacks; Hispanics; Race/ethnicity Mississippi, sexual behavior of gay men in Iow-prevalence cities, 83 n.2 Monitoring behavioral change, 69 crack use and sexual transmission of HIV, 69-70 see also Behavioral surveys; Serosurveys; Surveillance; Survey methods Monitonug the Future, 184, 185, 189, 192 Montefiore Medical Center, Adolescent AIDS program, 232 Mt. Sinai Hospital, Adolescent Health Service, 232 Multicenter AIDS Cohort Studies incidence rates among gay and bisexual men, 45 information provided by, 68, 84 n.4 N National Academy of Sciences, 103 National Adolescent Student Health Survey, 184, 209 National Blood Resource Education Program, 343 National Center for Health Statistics, 377, 384 National Coalition of Hispanic Health and Human Services Organizations, 22~227 National Health Interview Survey, 98 n.32, 106, 221, 299, 377-378 National Heart, Lung, and Blood Institute, 23, 25, 37, 330, 331 National Household Sunrey on Drug Abuse, 18~18S, 188, 189 National Institute of Allergy and Infectious Diseases' 68, 84 n.4 National Institute for Child Health and Human Development, 103 National Institute on Drug Abuse, demonstration projects, 6(~62, 93 n.l9, 258 National Institute of Mental Health, behavioral studies of gay men, 84 n.4, 105 National Institutes of Health, neonatal surveillance, 11, 12, 53

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INDEX ~ 489 National Longitudinal Survey of the Labor Market Experience of Youth, 168, 169 n.35, 173, 184, 185-186, 191, 193, 195, 196 National Network of Runaway and Youth Services, Inc., 227 National Opinion Research Center, General Social Survey, 30, 203 n.83, 376, 377, 39~391, 412-413 National Research Council, Committee for Research on Problems of Sex, 366 National Survey of Adolescent Males, 168, 175, 178, 181 National Survey of Children, 200 National Survey of Family Growth, 168, 168 n.35, 174, 175, 177-179, 376, 377, 379 National Survey of Young Men and Women, 168, 169 n.35, 178 National Youth Survey, 194 Needle exchange programs, see Sterile needle programs Needle-stick injures, HIV infection from, 53 Nevada HIV infection among prostitutes in, 18, 256 prostitution in, 266, 267, 277 New Jersey, HIV seroprevalence in, 18, 40, 55-56, 58, 153, 155, 25~257 New Mexico, blood donor recruitment in, 302 New York City abortions for HIV-infected women in, 101 ADAPI (Association for Drug Abuse Prevention and Treatment), 273-274 adolescent awareness about AIDS in, 211 n.93 AIDS cases in, 45, 49 n.13, 157, 159 behavioral change among drug users in, 92 n 17, 94-95, 229 behavioral change among gay men in, 82 blood donor population in, 298 n.ll, 321 Commission on Human Rights, 120 crack use in, 258-259, 262, 270 deaths from AIDS in, 43 enforcement of antidiscrimination laws in, 120 Gay Men's Health Crisis, 123 hepatitis prevalence in, 4 n.4 HIV seroprevalence in, 4 n.4, 11, 40, 45, 54, 58-59, 91, 153, 155, 161, 163, 165, 200, 262 IV drug use rates in, 166, 189 outreach programs, 273 programs for HIV-infected adolescents, 232 prostitution by adolescents in, 270 risk factors for blood donors in, 318 sexual activities of prostitutes in, 259-260, 261-262 sexual behaviors of adolescents in, 180 STDs among adolescents in, 199 n.79 syringe exchange pilot program in, 122 New York State adolescent drug use in, 192 HIV seroprevalence in, 155 Newark characteristics of street youth, 227 n.lll HIV seroprevalence in, 40 North Carolina, HIV seroprevalence in, 59 o Ohio, HIV seroprevalence in, 40 n.3 Opiates (other than heroin) adolescent use of, 190, 193 and HIV transmission, 41 Oral-genital sex condom use in, 274 legality of, 31 by prostitutes, 259-260 Oregon, sterile needle programs in, 124 p Pediatric AIDS by exposure category and year of diagnosis, 44 social consequences of, 101 n.38 Pelvic inflammatory disease, 63 n.40, 182 Pennsylvania, HIV seroprevalence in, 59 Perinatal transmission adolescent awareness of, 211 n.93 AIDS cases from, 44, 5~51, 55, 162 by ethnic group, 48, 55 IV drug use and, 63 prevention of, 9~103 risk of, 48 seroconversion rates in infants, 96 testing and, 99, 100 Pheny1ketonuria, 103-104 Physicians, behavior modification on transfusions, 2~27, 339-342 Prenatal care, and drug treatment programs, 94

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490 ~ INDEX Presidential Commission on the Human Immunodeficiency Virus Epidemic, 116, 120, 121 Prevention programs/strategies access to, 271-273 adolescent involvement in design and execution, 16 for adolescents, 11, 13-15, 17, 35, 201-232 challenges in cooling decade, 6-9, 105-108 clinical interventions, 87-88 community-level interventions, 85-88, 226-227, 282 co~Tununity norms and behavior modification, 218-219 counseling and testing of women, 99-103 delivery venues for, 16, 17, 94, 97, 221-231, 233-234, 272 and discnmination, 115-121 drug use and behavior change, 13-14, 88-89, 202-203 effectiveness of, 4, 6-8, 82-90, 93, 101-102, 111, 282 evaluation of, 7, 16, 42, 43, 71, 81-82, 97-98, 105 n.47, 201-202, 229, 282 facts and beliefs and, 216-217 fear of AIMS and, 91, 213-215 focus groups, 97 genetic screening programs as model for, 7, 103-105 goals of, 13-14 for high-risk populations, 231-232 for noninfected populations, 15, 208, 231-232 for horizontal transmission with drug use, 92-96 impediments to, 9-11, 17-18, 20, 91, 93, 11~126, 271, 276-281 for IV drug users, 89~92, 227-231 legislation affecting, 277-280 maintenance of nsk-reduction behavior, 108-114 for multiple-high-risk-behavior populations, 208 need for, 81; see also Recommendations peer-led, 20, 86-88, 97, 219-220, 231, 233, 271, 272 n.l9, 27~275 perceptions of risk and, 6~65, 9~96, 111 planned variations in, 35, 81-82, 108, 123, 233, 282 for populations not engaging in rislc behaviors, 206-207 for prostitutes, 17, 19, 20, 270-281 relapse problem, 2, 8, 63, 82 n.l, 89, 108-114 school-based programs, 16, 17, 214, 217, 22~226, 233-234 for sexually active, non-drug-using populations, 14, 207-208 skills training, 15, 86, 88, 96, 97, 107, 217-218, 220, 226, 228 and social attitudes and public policy, 121-122 sources of messages, 219-221 sterile needle programs, 12~126 transition to lower-paying legitimate jobs, 276 for vertical transmission, 96-103 voluntary contact notification procedures, 116 for women, 6-7, 67, 92-108 see also Education programs; ~fonnation campaigns; Testing and counseling for HIS; and other specific projects, programs, and populations Prostitutes and prostitution (female) access to interventions, 271-273 adolescents, 15, 17, 199-200, 208 advocacy groups, 272 Australian Prostitutes Collective, 275 bar (B girls), 264, 265 behavioral change in, 275 n.21 brothels, 256, 257-258, 26~267, 272, 273, 27~275, 277, 281 call girls, 256, 259-260, 263, 26~269, 271-272 client-related risks, 255, 261-263 condom use by partners of, 3, 19, 26~261, 272-273 context-related risks, 259-261 and crack use, 46, 208, 25~259, 262, 269-270 defined, 253 n.l, 277 drug use and sexual transmission, 17, 18, 255-259 education interventions, 19, 20, 271, 272-275, 280 effects of marginality, 28~281 e1iniinatiOn Of, 275-276 ePidem1010gY Of AIDS and REV infection among, 250263 eSCOrt SemCeS, 257-25S, 26~269, 272 fear Of AIDS and, 270

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INDEX l 49 1 HIV seroprevalence, 3, 18, 253 n.2, 250257, 281 impediments to interventions, 265, 276-281 interventions for, 17, 19, 20, 208, 254, 263-264, 270-281 IV drug users, 18-19, 2S3 n.2, 255-258, 265-266, 267, 273, 27S n.22, 281 law enforcement efforts against, 264-265, 269, 277-278 legislation affecting, 277-280 massage parlors, 267-268, 272, 27~275 needs and options for HIV prevention, 281-282 number of nonpaying sexual partners, 18, 19, 253 n.2 outreach programs, 256, 266, 271, 272 n.18, 27~275, 278 patterns of, 263-270 personal relationships of, 260, 261 pimps, 265, 268, 277, 281 population size, 254 red light districts, 267 risk factors for, 17, 18-20, 111, 253, 255-263, 273, 274, 281 Safe House Endorsement policy, 275 sex clubs, 27~275 sexual activity of, 259-260, 275 n.22 streetwalkers, 256, 257, 258 n.7, 259, 263, 260266, 280 stroll districts, 264 studies of, 1~20, 254, 256-257, 258 n.8, 260, 262-263, 267, 269, 272, 282 subpopulations at higher risk, 18 testing for HIV, 267, 275, 278, 281-282 truck-stop, 264 Prostitutes (male), 253 n.1 Public awareness about AIDS adolescents, 15-16, 182-183, 208-213, 216-217 and condom use, 216 n.98 IV drug users, 125 n.67 minonties, 15, 106, 210-212 see also Information campaigns Puget Sound Blood Center, blood transfusion practices in, 336 R Race/ethnicity adolescent population distribution, 160 n.20 and AIDS cases among women, 55 and AIDS and HIV prevalence among adolescents, 160-161, 163, 165 and awareness about AIDS, 21~212 and hepatitis B infection, 319 n.32 and HIV seroprevalence among blood donors, 24 and HIV seroprevalence among women, 54, 60 and premarital intercourse trends, 171-172 and progression of intimate relationships, 172 and sexual activity, 17~172, 174 Recommendations adolescent prevention programs, 35, 206-207 assessment of new drug problems relevant to HIV infection, 5, 47~8 blood supply protection, 37, 33~331 blood transfusion practices, 27, 342 counseling and testing as an intervention, 102, 105 data provision by CDC, 11-12, 71, 15~151 data summaries, 7-8, 35-36, 108 for increasing blood supplies, 23 interventions for minorities, 34, 107-108 monitoring of prostitutes, 19, 263 planned variations in intervention programs, 35, 201 see also Research recommendations Rehabilitation Act of 1973, 117 Relapse Prevention in adolescents, 108-114 and drug use, 89, 110 ire gay men, 109-110 programs for, 2, 8, 63, 82 n.1, 108-114 in women, 111 Reproductive decision making abortion, 10~101, 205 n.86 counseling and, 103-104 factors contributing to, 103-104 by IV drug users, 99-101 Research recommendations behaviors that transmit HIV, 35 for blood supply protection, 25, 37, 327-331, 342-343 clients of prostitutes, 19-20, 263 condomuse, 8,113-114 crack use and sexual behavior, 5, 36, 70 data reported by gay men, 6, 84 85 drug use and prostitution, 19, 258

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492 ~ INDEX evaluation of interventions, 7-8, 1~11, 17, 35-36, 41, 201 HIV transmission among minorities, 5, 34, 107-108 measurement of behaviors that transmit HIV, 33_34 multiple high-risk behaviors of adolescents, 197 protective measures other than condoms for women, 9, 35, 112-113 relapse prevention, 8, 36, 111 survey methodologies, 33-34, 36 see also Behavioral research on AIDS Rhode Island, HIV seroprevalence in, 59 Risk factors see Anal intercourse; Drug use; Heterosexual behavior, Transmission of HIV; and specific populations S Safe Choices Program, 227 Same-gender sexual behavior by adolescents, 13, 14, 40, 161, 179 n.52, 18~181, 207 age of initiation of, 181 AIDS cases from, 3, 43, 46, 162 as crimes, 31, 395 educational interventions, 14 ethnographic studies of, 441~42 and heterosexual behavior, 181 and transmission of HIV, 161, 441~42 underreporting of, 31, 33 see also Bisexual men; Gay men San Francisco adolescent drug use and sexual behavior in, 183, 191 AIDS incidence rates among gay and bisexual men, 45 behavioral change among gay men in, 82 blood donation in, 298 n.l2, 303 condom use by prostitutes in, 260, 278 crack use in, 63 n.39, 183, 270 HIV seroprevalence in, 18, 40, 45, 57, 256-256, 257, 372 Men's Health Study, 45, 68 n.51, 82 n.l9 85, 109, 372, 385-386 needle sharing and HIV infection in, 62 n.37 prostitution in, 268, 270, 275 n.22 serosurveys, 372, 385-386 sterile needle programs in, 124, 125 n.67 Stop AIDS Project, 86 surveys of sexual behavior, 372, 38~381 Youth Guidance Center, 199 Schools, prevention programs for adolescents in, 217, 223, 22~226, 23~234 Sedatives, 190, 193 Seroprevalence, see HIV infection; HIV seroprevalence; Serosurveys Serosurveys college campuses, 158, 159-160 convenience samples, 57-59, 67 of female sexual partners of hemophiliac men, 53 of homeless youth, 158, 165 of hospital patients, 156-157, 158 in juvenile detention centers, 158, 165-166 methods and execution of sampling design, 372-373, 384 national, 384-385, 387-388 principles and purpose of, 368, 384 of prostitutes' 254-255 in STD clinics, 158, 159 see also Gay men; REV infection; HIV seroprevalence; IV drug users; Job Corps applicants; Military applicants; and specific surveys Sex education effectiveness of, 221 by parents, 15-16, 221 by peer counselors, 220 safer sex programs for women, 274 skills training in, 217 Sexual behavior of adolescents, 12-13, 147, 168-183, 188, 199-201, 203-204, 206, 40~12 age of initiation of intercourse, 167-168, 17~172, 195, 199, 204, 206 alcohol use and, 5, 8, 41, 183, 188 changes in, 40, 41, 82, 88~9, 95 crack use and, 5, 41, 46~7, 62-63, 183, 270, 282 data sources on, 168-170 drug use and, 2, 18, 54, 62, 89, 183, 19~197, 199, 258 empirical studies of, 401~20 explicit information and, 1~11, 14 gender and sex roles and, 219 illegal, 31 number of sexual parmers, 12, 18, 19, 62, 85, 176, 412~13

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INDEX ~ 493 parent-child communication about, 15-16, 220 perceptions of risk and, 64 65, 95-96, 111 predictors of safer practices, 105 n.47 premarital intercourse trends, 170-171 reliability studies of self-reports of, 418-419 reporting of, 170 survey methods, 28-29, 30, 31-32, 369-383, 393-401, 441 442 unprotected intercourse, 62, 82, 83, 85, 87, 88 n.12, 105 n.47, 109, 201, 260, 276 see also Anal intercourse; Heterosexual behavior, Vaginal intercourse; and specific behaviors and populations Sexual transmission of HIV drug use and, 36, 255-259, 272; see also Crack use; IV drug users number of partners and, 12, 18, 19, 253 n.2, 255, 261, 270, 274, 275 n.22 survey methods to determine risk factors in, 28-29 see also Gay men; Genital lesions; Prostitutes/prostitution Sexually transmitted diseases age of initiation of sexual intercourse and, 167-168 among adolescents, 13, 167-168, 177, 181-182, 199, 227 n.111 crack use and, 47, 183 gender differences in incidence, 182 and HIV infection, 47, 66 n.47, 69-70 prevention programs, 213-214, 279, 280 serosurveys of clinic populations, 158, 1159 testing for, 267, 279 validation of sexual behavior surveys using rates of, 398 see also Genital lesions; and specific diseases Sickle-cell anemia, 104, 320 Social attitudes and behavior modification, 21~219 and blood donation, 21, 22, 294-295, 303-305 effect on implementation of interventions, 203-204, 232 about premarital sexual intercourse, 203-204 and public policy affecting interventions, 121-122 and reporting of behaviors, 395-396 sexually explicit information, 10, 14, 122-124, 232 Sterile needle programs in Amsterdam, 125 n.67 approved by local jurisdictions, 122, 124 as a bridge for treatment, 125 n.67, 203 effectiveness of, 124 evaluation of, 122, 124-126 funding of, 42 in Great Britain, 122 and illicit market for sterile equipment, 125 impediments to, 10, 121, 122, 124-126, 230 and IV dmg use, 10, 124, 203, 230 need for, 125, 273 unofficial, 124 Stimulants, 190, 193 Stockholm, HIV seroprevalence in, 45 Stop AIDS Project, 86 Stress management, 88 Surveillance case definition for, 68-69 and discriminatory policies, 116 see also Centers for Disease Control; Job Corps applicants; Military applicants; Serosurveys Survey methods for adolescents who are sexually active, 409 412 alternatives to self-reports, 431-432 aspects of, 359-360, 362 blood specimen collection with, 29, 375 cognitive research strategies, 438~40 constant bias assigned in measurements, 39~397 data collection procedures, 369-375, 440 449 for drug-using behaviors, 420~28, 442 empirical research to corroborate validity, 401 428 ethnographic data, 440~49 and execution of sampling designs in recent surveys, 37~373 face-to-face interviews, 369, 374 and feasibility of surveys, 428-429 improving measurements, 33-34 inference in presence of bias, 39~396 limitations of, 28, 65 literacy and, 430 male-male sexual contact, 441 442

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494 ~ INDEX measurement bias in, 422-428 nonresponse bias, 29-30, 36, 388-391 nonsampling issues, 36, 391-401 number of sexual partners reported by adults, 412~13 parmer reports, 401~06 physical evidence, 431 pilot studies, 371, 373, 384-385, 387-388, 43W36 pretests, 437 probability sampling, 68 psychometric approaches to validity, 398~01 questions about sexual behavior, 28-29, 36 random errors, 392, 393 randomized response techniques, 433034 recruitment of respondents, 27-29, 56, 67, 71, 99, 150, 261, 365-391 replication of measurements using same respondents, 413~19, 429 replication on samples of same population, 409013, 429 reporting biases, 31, 262 and response rates, 2~30, 367, 369-379 self-administered questionnaires, 368, 369, 374 self-report accuracy, 185, 421 for seroprevalence determinations, 29, 150, 383-391 for sexual behavior, 28-29, 30, 369-383, 393-420, 441 442 skills demonstration, 431~32 STD rates for validation, 169-170, 398 success factors, 29 surveys reviewed for this report, 368-369 systematic errors, 392-393 telephone interviews, 29, 379-383 terms and concepts, 391-393 testing of, 29, 34 validity and reliability, 3~32, 33, 191, 361, 374, 393-394, 397-428, 429~40 see also Behavioral surveys; Data collection; Methodological issues; Serosurveys Syphilis, 182, 199 n.79, 214, 267, 280, 420 see also Sexually transmitted diseases; Genital lesions Syringe exchange programs, see Sterile needle programs T Teenagers, see Adolescents Testing and counseling for HIV for adolescents, 208, 232 alternative sites for, 327 at blood collection centers, 25, 317, 327 blood donation screening, 21, 23 and condom use, 97-98, 280 confidential versus anonymous, 102, 208 evaluation of, 97-98, 202 fear of, 95 as intervention for gay men, 86 as intervention for women, 20, 99-105 latency period and, 291, 304, 329 mandatory, 275, 279-280, 281-282 and perinatal transmission, 99, 100 of prostitutes, 275, 279-280, 281-282 sensitivity of tests, 23, 291, 323 sources of services, 97 Texas adolescent IV drug users in, 189 HIV seroprevalence in, 40 n.3, 54 n.26 Toronto, sexual behavior of gay men ir low-prevalence cities, 83 n.2 Tranquilizers, 190, 193 Transfusion recipients AIDS cases among, 44, 49, 5~52, 55, 65, 291 female sexual partners of infected men, 5~52, 55, 65 67 Transmission of HIV and active viral replication' 65 n.47 by adolescents, 161 in black and Hispanic subpopulations, 5 data needs on, 11~115 dmg use patterns and, 442 efficiency of, 69 ethnographic studies related to, 441 442 frequency of intercourse and, 66 n.47 gender and, 161-162 genital lesions and, 13, 177 by hemophiliacs, 83 n.3 horizontal with IV drug use, 40, 92-96 infectivity associated with later stages of, 83~4 male-male sexual contacts and, 441 442 misperceptions about, 209, 212-213 modes of, 39, 161-162 risk factors for adolescents, 12-13 risk factors for prostitutes, 17, 18-20 shifts in patterns of, 3

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INDEX | 495 vertical (perinatal), 40, 48, 63~4, 96-103 Treatment Outcome Prospective Study, 187 U United States AIDS cases in, 1, 42-43, 159 blood collection in, 292-297 blood utilization trends in, 26 epidemiological changes in AIDS in, =6, 43-48 hemophiliacs in, 52 n.18 University of California, San Francisco, intervention for gay men, 8~87 University of Illinois, Chicago, health promotion program, 220 University of Mississippi, intervention for gay men, 86 U.S. Department of Health, Education, and Welfare, 103 V Vaginal intercourse by adolescents, 12, 17~173 age of initiation, 12, 32, 33 by prostitutes, 260, 261-262 unprotected, 62 see also Heterosexual behavior Vases inactivation in blood supplies, 339 see also Hill listings W Washington, D.C., adolescent IV drug users in, 189-191 Washington State Seattle survey of sexual behavior, 381-382 sterile needle programs in, 124 Wisconsin, blood donation in, 300, 303 Women adolescents, 56 age of initiation of sexual intercourse, 171-172 AIDS cases among, 40, 48~49, 52, 55, 161 blood donors, 24, 322-323, 326, 337 childbearing adolescents, 155-156, 166 condom use by, 8, 112, 179 counseling and testing in intervention program, 35, 99-103 data sources on, 150 drug users, 46, 48, 49, 60~4 epidemic among, 48-67 frequency of sexual activity, 175 health care barriers for, 10, 94 HIV seroprevalence, 3, 4, 6-7, 24, 53-54, 56-59, 150, 155-1S6, 166 horizontal transmission interventions, 92-96; see also IV drug users information needs on, 108 military applicants, 56 minorities, 40, 48, 54, 166 number of sexual partners, 176 outreach methods for, 93 prevention strategies for, 35, 92-105 relapse prevention for, 111 reproductive decison making, 99-101 risk profile, 24, 48-49, 92, 111, 161 sexual partners of hemophiliacs and transfusion recipients, 49 n.l7, 65~6 sexual parmers of IV drug users, 3, 48, 49, 54 n.27, 61 n.34, 6~65, 92-96 social norms shift, 175 vertical transmission interventions, 7, 96-103; see also Perinatal transmission see also Prostitutes; IV drug users Wyoming, HIV seroprevalence in, 362 y Youth, see Adolescents z Zidovudine, prophylactic use of, 43 n.6, 101 n.37, 108

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