Rural Center for AIDS/STD Prevention: Newsletter (4)

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Rural Prevention Report
(Fall 1995, Vol. 2, No. 2)

Greatest Increase in HIV Epidemic Occuring in South and Midwest

The geographic pattern of the AIDS epidemic has changed since the beginning of the AIDS problem, according to the U.S. Centers for Disease Control and Prevention (CDC). In its review of the first half million AIDS cases in the United States, the CDC reported that the greatest proportionate increases in the HIV epidemic occurred in the South and Midwest. This change heightens the need for prevention education in rural areas and small towns, particularly in the South and Midwest.

A total of 501,310 AIDS cases (311,381 deaths) had been reported to the CDC by the end of October 1995. CDC compared AIDS cases between then and the beginning of the AIDS problem.

Even though the majority of AIDS cases still occur in the Northeast and West, the percentage of total U.S. AIDS cases increased from 25.7% to 34.9% for the South and from 7.5% to 10.1% for the Midwest between the 1981-1987 period to October 1995 (see figure 1.) These areas have the largest proportion of the total U.S. population, of which many reside in the rural communities.

The CDC also reported that during 1993-October 1995:

In the South and Midwest, higher proportions of cases among adolescents and young adults (aged 13-19 years) occurred in small (50,000-499,999 population) metropolitan statistical areas (MSAs) and non-MSAs (rural areas) (27% and 24%, respectively) compared with 9% in the Northeast and 11% in the West.
The proportion of cases among adolescents and young adults residing in small MSAs and rural areas that resulted from heterosexual transmission was highest in the South (32% of 2842), followed by the Midwest (22% of 678), the West (18% of 691), and the Northeast (7% of 1745).
Among adolescent and young adult injecting drug users, 30% of 531 cases in the Midwest occurred among persons residing in MSAs and rural areas, 23% of 2370 in the South, 17% of 930 in the West, and 8% of 3304 in the Northeast.
Among cases in adolescent and young adult men who have sex with men, 25% of 8481 cases in the South occurred in persons who resided in small MSAs and rural areas, 21% of 2870 in the Midwest, 9% of 3311 in the Northeast, and 9% of 5706 in the West.

The CDC concluded that the regional variations, especially in adolescents and young adults, underscores the importance of developing HIV prevention programs based on local trends of HIV transmission. In the South and Midwest, more detailed identification of the epidemiological patterns in small cities and rural areas is needed for creating effective regional prevention programs. Strengthening the behavioral and social science bases of HIV prevention was also suggested.

The report also highlighted changes in the epidemiological patterns during 1993-October 1995 compared with those during earlier periods. Although men who have sex with men continue to account for the largest proportion of cases, the AIDS epidemic is increasing more rapidly among injecting-drug users and persons infected through heterosexual contact with a partner at risk for or known to have HIV infection or AIDS.

Injecting-drug users now account for about 27% of the cases in contrast to about 17% for the 1981-87 period to about 10% for now. Women now account for about 18% of the cases, whereas in the 1981-87 period they represented 8% of the cases. Whites still have the greatest number of AIDS cases, but the proportion of cases for blacks and Hispanics is dramatically increasing.

SOURCE
Centers for Disease Control and Prevention (1995). First 500,000 AIDS cases - United States, 1995. Morbidity and Mortality Weekly Report 44(46): 849-853.

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RCAP Conference at Purdue University

The RCAP will have its second conference, "HIV/STD in Rural Areas: Prevention Issues," on Thursday, March 21, 1996, at Purdue University, West Lafayette. Terry Tafoya, Ph.D., will present a keynote address, titled "Singing Your Own Song: HIV/STD Prevention and Cultural Diversity in a Rural Setting." Dr. Tafoya is a Taos Pueblo and Warm Springs Indian who was co-founder of the National Native American AIDS Prevention Center. Using traditional, Native American storytelling, Dr. Tafoya will illustrate how different communities require approaches that vary from the standard model.

The conference will also feature presentations of RCAP projects and an opportunity for participants to present brief summaries of their own work or ideas concerning HIV/STD prevention in rural areas. To receive a program and a registration form, contact: Nona Schaler at Purdue University Conferences or call (800) 359-2968.

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Self Reported STD Incidence Varies by Gender, Race, and Class

Researchers examined gender, race and class differences in the likelihood of ever having had a sexually transmitted disease among a national sample of 20-37 year-old women and 20-39 year-old men. The data used in this analysis were obtained from in-person interview data of the National Survey of Men (3,321 men) and the National Survey of Women (1,669 women), both conducted in 1991. The analysis was confined to men and women who reported ever having coitus. Subjects indicated whether or not they ever had an STD.

Data analysis indicated that the likelihood of a self-reported STD infection varied by gender, race and socioeconomic status, even after accounting for differences in sexual and health care behaviors.

Women and black respondents were more than three times as likely to report an STD as men and white respondents.
Men and women with 12 or fewer years of education were about 30% less likely than those with more schooling to report having had an STD.
Income, welfare status and access to health care had no significant associations with self-reported STD incidence.
The likelihood of an STD increases with an increase in the number of lifetime sex partners reported. Compared to those who had only one partner, those reporting 2-3 partners are five times as likely to have had an STD; the odds are as high as 31:1 for those reporting sixteen or more partners.

The researchers state that the prevention of STDs depends on a comprehensive understanding of the social and behavioral patterns involved, a capability to identify target groups for behavioral intervention, and the ability to create effective interventions.

SOURCE
Tanfer, K., Cubbins, L. A., & Billy, J. O. G.. (1995) Gender, race, class and self-reported sexually transmitted disease incidence. Family Planning Perspectives, 27: 196-202.

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Clarifying Use of "Mutual Monogamy" in HIV Prevention Messages

AIDS educators have strived to disseminate accurate prescriptive messages about HIV. Several terms and phrases have been modified or changed to better describe an issue. The word "monogamy" has traditionally been used to describe being married to only one person, but has taken on a broader meaning in the age of AIDS and is now used to characterize sexual behavior.

Ways in which "monogamy" is defined, applied, and interpreted in the literature and by college students were assessed. Inconsistent, ambiguous and inaccurate use of the word was found. The authors state that the exclusive use of "monogamy" disseminates the abstinence-only message to many of the clientele served--the unmarried. They suggest that the term "mutually exclusive sexual relationship" is the best message about non-marital sexual behavior.

SOURCE
Parrillo, A. Va., & Clark, J. K. (1995). Clarifying prescriptive messages about HIV: The case of long-term mutually monogamous relationships. The Journal of Health Education, 25: 353-359.

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Report Cites Prevention Lessons Learned from First Decade of AIDS

An overview of community-based HIV prevention efforts and the lessons derived from their successes and failures is described in a recent American Public Health Association book, AIDS Prevention in the Community: Lessons from the First Decade. The book states that community organizations, because they are familiar with the target audience and engage them in programs, have been invaluable in HIV control efforts during the first decade of the epidemic.

Many organizations can now provide us with their cumulative experience in securing the support of individuals, institutions, and funding agencies. Case histories describing the work of 12 community-based organizations are presented, including a HIV prevention program for migrant farm workers. The characteristics of the populations served, the methods used, evaluation procedures, and analysis of strengths and accomplishments are given. The case histories can help practitioners learn from each other's experiences.

The book concludes with specific recommendations to broaden the role of community organizations in public health practice.

SOURCE
Freudenberg, N., & Zimmerman, M. A. (Eds.). (1995). AIDS Prevention in the Community: Lessons from the First Decade. Washington, DC: American Public Health Association.

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Tape of Satellite Videoconference Available

The RCAP conducted a live, national satellite videoconference, "AIDS in Rural Communities: Education for Prevention," September 19, 1995. The program featured four model programs of Cooperative Extension educators in partnerships with other agencies in presenting HIV prevention for youth and families.

A videotape copy of the broadcast is available free, upon request, from the RCAP.

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RCAP Has Moved

ince the last newsletter, the RCAP Headquarters and Prevention Resource Library have moved to another location on the Indiana University campus. We also have a new mailing address and fax number.

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RCAP Receives Continued Funding

The RCAP, which began operations in early 1994 has received continued funding for fiscal year 1996. Six new and several continuing projects will be conducted. For a complete list of projects, please go to Projects section of this website.

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RCAP on WWW

To broaden its accessibility, the RCAP has developed a World Wide Web page. The page provides up-to-date information about the RCAP projects, conferences, publications and other activities. All of the RCAP newsletters and fact sheets are included. The page also links numerous national and international HIV/STD-related home pages. To visit the RCAP World Wide Web page, go to RCAP Homepage.

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In the Literature

Misunderstanding of "Safer Sex" by Heterosexually Active Adults. N.S. Wenger, F. S. Kusseling, & M. F. Shapiro. Public Health Reports. 110 (September/October 1995): 618-621.

Persons enrolled in HIV education trials at a STD clinic and a university student health service were surveyed concerning sexual behavior with their latest sexual partner. The concept of safer sex was often misunderstood. For example, of 646 sexually active persons, 36% reported safer sex with 53% of this group also reported having vaginal or anal intercourse without a condom. Among those reporting safer sex despite not using a condom, only about one-fifth asked partners about their HIV status and slightly less than half asked about injecting drug use and number of prior partners.

AIDS Education Intervention Utilizing a Person with AIDS: Examination and Clarification. E. B. Dennehy, C. A. Edwards, & R. L. Keller. AIDS Education and Prevention 7 (April 1995): 124-133.

The utility of a person with AIDS (PWA) in conveying AIDS information to college students was assessed. The PWA disclosed how he acquired HIV. Students benefited more from an AIDS education lecture when it was presented by someone perceived to be a PWA. Regardless of mode of transmission, the PWA lecture resulted in greater increases in knowledge than a neutral presenter.

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