Rural Prevention Report
(Fall 1994, Vol. 1, No. 2)

RCAP Releases Two Studies on World AIDS Day

The Rural Center for AIDS/STD Prevention (RCAP) released reports on two of its first year projects on World AIDS Day, December 1. The studies involved a needs assessment of rural adults concerning HIV/STD prevention and an investigation of the financial impact of AIDS in Indiana. A full report of the studies will be given at the Rural Prevention Center conference, and printed in professional publications.

Needs Assessment
This project determined the perceptions of rural residents in Indiana concerning the seriousness of HIV/STD in their communities and the risk for HIV/STD. The study was directed by Mohammad R. Torabi, RCAP co-director and professor of health education at Indiana University.

The Indiana University Center for Survey Research collected the data in the fall of 1994 utilizing a standard telephone random digit dialing technique. The sample included over 500 adults who lived in households in non-metropolitan Indiana counties. The sampling error was plus or minus 5 percent.

Results of the study will be valuable in planning future RCAP activities. Preliminary findings of the study include:

• Nearly 39 percent and about 64 percent of the respondents view AIDS and STDs other than AIDS, respectively, as a very serious or somewhat serious problem in their communities.
• In terms of personal risk, about 21 percent felt that they were very much or somewhat at risk of getting HIV, while nearly 11 percent felt very much or somewhat at risk for other STDs than HIV.
• About 32 percent and 65 percent believed that teenagers were very much and somewhat at risk, respectively, of getting HIV. About 22 percent and 74 percent felt that adolescents were very much and somewhat at risk, respectively, for other STDs than HIV.
• Most the respondents who saw AIDS as a very serious or somewhat serious problem thought that it was extremely important that research is conducted on ways to prevent HIV. Of these same respondents, about 60 percent thought it was extremely important to have pamphlets or books available that describe ways to prevent HIV.
• Nearly 63 percent did not know enough about the RCAP to have an opinion on it. Of the rest of the respondents, nearly 29 percent strongly supported the RCAP with less than 1 percent somewhat or strongly opposed the existence of the RCAP.

Financial Impact
Using population data from the U.S. Census Bureau and the Indiana Department of Health, this study used a computer simulation to construct a model of HIV and AIDS incidence rates in Indiana since 1970 and to forecast future trends through the year 2000. Treatment costs for a person with HIV/AIDS was also calculated adding costs estimates of care, drugs, and other expenses. The study was led by James Anderson, RCAP co-director and professor of sociology and anthropology at Purdue University.

Major projections are shown in the table below.

Anderson indicated that the model estimates are important to effective planning and allocation of resources for prevention and treatment programs. The projections could be affected if certain assumptions change. The researchers plan further development of the model so that it can be used to plan prevention programs for specific populations at risk and geographic areas.

Table: HIV and AIDS in Indiana (Numbers are estimates as of the start of each year, based on a computer model).

*HIV is the human immunodeficiency virus, which causes AIDS.
Source: Rural Center for AIDS/STD Prevention c1994, The Louisville Courier Journal. Reprinted by permission.

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Funding Continued for Rural Prevention Center

The RCAP, which began operations in early 1994, has received continued funding for fiscal year 1995. The RCAP focuses on the development and evaluation of educational materials and approaches, the examination of social and behavioral barriers to HIV/STD prevention which can be applied to prevention programming, and creating avenues to reach the target audience.

Several first year activities will be continued or expanded, including (1) needs assessment of rural residents and women and children with HIV; (2) development and evaluation of educational material for 4-H clubs, and adolescents and their families; (3) study of HIV-related ethical issues of family therapists, the accuracy of estimates of adolescent risk behaviors, and the relationship of family factors, alcohol use and sexual behaviors, and (4) analysis of the financial impact of HIV/AIDS on individuals and families. Further, the RCAP will continue to produce FACT SHEETS and the Rural Prevention Report, and will expand the Prevention Resource Library.

Fiscal year 1995 projects are:

• Sources of Knowledge and Attitudes Toward HIV/AIDS and Sexuality Among Migrant Workers in the Midwestern Stream.
• Development of a HIV/STD Prevention Computer Software Program for Adolescents.
• Feasibility Study of Use of Technology for HIV/STD Prevention in Rural Areas.
• Assessing Rural Adolescent HIV/STD Education Needs: A Multi-stage Theoretical Approach.
• Behavioral and Demographic Dimensions of HIV/AIDS in Rural Indiana Jails.
• The Impact of Family Disclosure of HIV Status.
• Linkage of Family Caregivers, PWA's, and the Community Through Family and Community Assessment.
• Alcohol Use and Sexual Behavior Among Adolescents on Probation: A Qualitative Study.
• The Effects of Two Methods of Interactive AIDS/Sexuality Education on Adolescents' Ethical Decision-Making and High Risk Sexual Behavior.

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CDC Establishes "Classroom Calls" Service

The U.S. Centers for Disease Control and Prevention (CDC) National AIDS Hotline has introduced Classroom Calls, a free and confidential service for any type of group or classroom discussion of HIV and AIDS. The service provides an opportunity for students to ask questions about HIV/AIDS and how to prevent it. They also learn that they can call back, in private, and talk about any aspect related to HIV and AIDS.

Trained specialists provide answers based on current information from CDC. The service requires a speaker phone.

Call the CDC National AIDS Hotline (800-342-AIDS) for more information or to obtain a brochure about this service. Classroom Calls can be scheduled by calling the toll-free number and asking to speak with a supervisor. Calls can also be arranged for the National AIDS Hotline Spanish and TTY/Deaf Access Services (see below for contact information).

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Adolescent Substance Use and Risky Sexual Behaviors: CDC Reports

Researchers from CDC examined data from the 1990 national Youth Risk Behavior Survey (11,631 students) to determine whether use of selected substances is related to risky, HIV-related behaviors among youth.

About 88 percent of the students reported having had a drink of alcohol at least once during their lifetime, and 72 percent reported having taken a least one or two puffs of a cigarette during their lifetime. Fewer students reported ever having used marijuana (31.4 %), cocaine (6.6%), and other illicit drugs (13.1%).

About 54 percent reported ever having had sexual intercourse, with about 19 percent reported having four or more lifetime coitus partners. Among students reported ever having coitus, about 54 percent did not use a condom during the last coitus.

Students who reported no substance use were least likely to report having had coitus, having four or more coitus partners, and not having used a condom at last coitus. Adjusted for age, gender, and race/ethnicity, each of these sexual risk behaviors were greatest among students who had used marijuana, cocaine, or other illicit drugs. Students who had used only alcohol or cigarettes had smaller but significant increases in the likelihood of having had coitus and of having had four or more coitus partners.

HIV prevention programs for youth should recognize that substance use may be an important indicator of risk for HIV.

SOURCE
Lowry, R., Holtzman, D., Truman, B.I., Kann, L., Collins, J.L., & Kolbe, L.J. (1994). Substance use and HIV-related sexual behaviors among US high school students: Are they related? American Journal of Public Health, 84, 1116-1120.

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FACT SHEETS Available from RCAP

The RCAP has developed four FACT SHEETS. They are available free of charge upon request, with a limit of 25 copies of each per request.

The FACT SHEETS are:

• Preventing HIV/STD in Adolescents
• HIV Infection and Women
• Behavior Change Models for Reducing HIV/STD Risk
• Evaluating HIV/STD Education Programs

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RCAP to Conduct One-Day Conference

The first RCAP conference will take place on Thursday, February 9, 1995, in the Indiana Memorial Union at Indiana University, Bloomington. This one-day meeting, titled, "HIV/STD in Rural Areas: Prevention Issues," will feature presentations related to the RCAP's first year projects. A discussion of prevention issues with HIV-affected persons will also occur.

Further, the conference will include an open dialogue concerning prevention needs for rural areas.

For more information or a registration form, contact Marybeth Gasman, Senior Conference Coordinator, Indiana University Conference Bureau. Phone (812) 855-6451; FAX line: (812) 855-8077; or E-mail.

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In the Literature

Urban-nonurban Distribution of HIV Infection in Childbearing Women in the United States. S.C. Wasser, M.Gwinn, P. Fleming. Journal of Acquired Immune Deficiency Syndromes 6 (September 1993): 1035-1042.

• Women account for an increasing proportion of AIDS cases in the United States, and the number reported from small cities and rural areas is growing. Data were analyzed for more than 1.6 million newborn specimens tested for maternal antibody to HIV-1 in 35 states in 1989. Prevalence of HIV infection ranged from 1 to 12.2 per 1000, with the highest rates found in urban health districts. However, high rates were also found in some nonurban districts, particularly in the South.

Public Opinion from a Rural Region About Condoms for HIV Prevention. W.L. Yarber, M.R. Torabi. Wellness Perspectives: Research, Theory, and Practice 19 (Summer 1994): 63-75.

• A sample of 688 Indiana adult residents was randomly telephone interviewed in the Spring 1993. The study found mixed views toward condom availability in Indiana public high schools without parental permission and the airing of television condom commercials. Strong endorsement of condom promotion in Indiana public high schools and by the federal government was found. Nine out of ten subjects indicated that proper condom use is very effective or somewhat effective in preventing HIV transmission.

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National Hotlines

National AIDS Hotline

• English Service (7 days/week, 24 hours/day): (800) 342-2437
• Spanish Service (7 days/week, 8 a.m.-2 a.m. EST): (800) 344-7432
• TDD Service for the Deaf (Monday-Friday, 10 a.m.-10 p.m. EST): (800) 243-7889

National STD Hotline

• (Monday-Friday, 8 a.m.-11 p.m. EST): (800) 227-8922

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