responsible-sexual-behavior

=Responsible Sexual Behavior =
 * **Contents** * Learner Objectives
 * Required Readings and Websites
 * Healthy People 2020 Objective
 * Related Epidemiological Data
 * Screening Guidelines and Assessment Parameters
 * Behavioral Intervention Recommendations
 * Discussion of Intervention Efficacy ||

Learner Objectives »

 * Analyze how sexual orientation and responsible sexual behavior impacts Healthy People 2020 goals.
 * Compare and contrast approaches to sexual risk screening, counseling, and immunization across the lifespan.
 * Use appropriated USPSTF screening and immunization recommendations for people at risk due to sexual behaviors and sexual orientation.

 Required readings and Websites »
>>
 * Montano, D. and Kasprzyk, D. (2008) Theory of Reasoned action, theory of planned behavior, and the integrated behavioral model. In Glanz, K., Rimer, B., Viswanath, K (editors). Health Behavior and Health Education. 4th Edition, Jossey-Bass, San Francisco. Pp. 82-92 (ARES).
 * [|Harris, A (2010), Sex, Stigma, and the Holy Ghost]


 * [|Healthy People 2020 (2011). Sexually Transmitted Disease].

>> >> >> >> >> >> >> >> (RECOMMENDED READING)** >>
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">[|Healthy People 2020 (2011) HIV].
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">[|USPSTF website to identify appropriate prevention interventions].
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">[|CDC (2011) HIV AIDS Topics and resources].
 * *** <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">media type="youtube" key="YGgtV6XuL98" height="315" width="560" **
 * **<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">[|Guide to Community Preventive Services (2011 A). Health communication & social marketing: health communication campaigns that include mass media and health-related product distribution]. **(RECOMMENDED READING)
 * **<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">[|Guide to Community Preventive Services B. (2011 B) Prevention of HIV/AIDS, other STIs and Pregnancy: group-based comprehensive risk reduction interventions for adolescents]. **

<span style="color: #000099; font-family: Verdana,Geneva,sans-serif;">Healthy People 2020 Objective »
<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Prevent human immunodeficiency virus (HIV) infection and its related illness and death. Healthy People 2010 Objective: Increase the proportion of sexually active persons who use condoms.

==<span style="color: #000099; font-family: Verdana,Geneva,sans-serif;">Related Epidemiological Data, Influences on Health Behavior Topic on ethnicity, race, developmental stage, sexual orientation. » ==

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">In the United States, the fastest growing sector of people with new HIV is Black men. White, Black, and Latino men who have sex with men (MSM) are the most affected sub populations (Centers for Disease Control and Prevention [CDC], 2011). However HIV is also increasing in women mainly through heterosexual transmission. Black women have the highest HIV incidence rates among women, due in part to the fact that people from similar cultures tend to have sex with each other, and the high prevalence of HIV in Black males. In addition cultural and social prejudices toward individuals who are Lesbian, Gay, Both, or Transgender (LGBT), poverty, and lack of access to care are related to the spread of HIV.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">In 2009, more than a 39% of new HIV diagnoses were among people between 13 – 29 years old (CDC, 2011). Women and girls of color—especially black women and girls—bear a disproportionately heavy burden of HIV/AIDS. MSM is mode of transmission causing 61% of new HIV cases. However, high risk heterosexual contact accounted for 27% incidence of new infections. Intravenous drug users (IDU) accounted for 9% of HIV incidence. Unfortunately, AIDS and HIV infection disproportionately affect ethnic minority men and women in the United States. Sexual acquisition of HIV infection is most prevalent among young adult men and women between the ages of 13- 29 years (CDC, 2011).

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The development of an effective therapeutic treatment of prophylactic vaccine might not become a reality in the foreseeable future. Thus, reducing the risk of HIV infection among sexually active women requires the adoption of preventative strategies that effectively inhibit viral transmission (Bandura, 1994). Behavioral interventions based on theories of health behavior and designed to reduce HIV-related sexual risk practices, are critical for preventing further acceleration of HIV among women. Although behavioral interventions have been developed for a number of at-risk populations (Choi & Coates, 1995), programs developed specifically for women have lagged behind those developed for other populations (Wingood & DiClemente, 1996). A paucity of published empirical literature describes interventions targeted specifically toward women. Thus, there is an urgent need to develop and evaluate HIV prevention programs designed to promote the adoption and maintenance of HIV prevention strategies, such as monogamous sexual relationships and condom use, among women.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Potential impact of HIV on individuals and society.**

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Acquired Immune Deficiency Syndrome (AIDS) is the late stage of HIV infection. AIDS is diagnosed when a person’s immune system is severely damaged and when the person has difficulty fighting diseases and certain cancers. Before the development of certain medications, people with HIV could progress to AIDS in just a few years. Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid-1990s.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">No one should become complacent about HIV and AIDS. While current medications can dramatically improve the health of people living with HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a person’s life. The person with HIV needs to be carefully monitored, and treatment comes with costs and potential side effects. At this time, there is no cure for HIV infection.

<span style="color: #000099; font-family: Verdana,Geneva,sans-serif;">Screening Guidelines and Assessment Parameters »
<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Screening guidelines and assessment parameters and methods.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians


 * 1) <span style="font-family: verdana,geneva,sans-serif; font-size: 110%;"><span style="font-family: verdana,geneva,sans-serif; font-size: 110%;">Screen all pregnant women for human immunodeficiency virus (HIV).
 * 2) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Screen for HIV all adolescents and adults at increased risk for HIV infection.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">HIV Risk factors to assess (CDC, 2011) are,


 * 1) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Addiction to illegal drugs
 * 2) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Methamphetamine use increases risk for HIV/AIDS due to CNS stimulation and reducing inhibitions
 * 3) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">High prevalence of club drugs (methamphetamine, ecstasy, ketamine, and GHB [gamma hydroxyl butyrate]) in tandem with unsafe sex practices.
 * 4) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Number of partners, anal sex, unprotected anal sex.
 * 5) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Perinatal infection if mother is HIV positive.
 * 6) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">People who sell sex for drugs or money
 * 7) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Men who have sex with men (MSM).
 * 8) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Heterosexual partners of people who have risk factors for HIV.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">USPSFT Screening recommendations for women 17-30 who are sexually active and pregnant include the following. **A** recommendations have high certainty of substantial net benefits and clinicians should offer these services, and **B** recommendations have high certainty of moderate benefits, and clinicians should offer these services. For a more complete description of these recommendations see below. "Discussion of intervention efficacy."

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The USPSTF Immunization guidelines for 17-30 year old women who are sexually active include the following, >
 * 1) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). (Minimum age: 10 years for Boostrix® and 11 years for Adacel®)
 * 2) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Human papillomavirus vaccine (HPV). (Minimum age: 9 years). Administer the series to females at age 13 through 18 years if not previously vaccinated. **Not recommended** if pregnant.
 * 3) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Varicella 2 doses (for persons who lack immunity, **contraindicated** if pregnant or immuno-compromising condition).
 * 4) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Zoster not recommended (**contraindicated** if pregnant or immuno-compromising condition).
 * 5) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Measles, mumps, rubella (MMR) 1 or 2 doses (for persons who lack immunity, **contraindicated** if pregnant or immuno-compromising condition)
 * 6) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Influenza 1 dose annually. (Recommended if some other risk factor is present).
 * 7) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Pneumococcal, Hepatitis A, Hepatitis B, and Meningococcal (recommended if some other risk factor is present).

<span style="color: #000099; font-family: Verdana,Geneva,sans-serif;">Behavioral Intervention Recommendations »
<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">CDC (2011) recommends the following interventions for prevent HIV-AIDS,


 * 1) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Behavioral interventions, which have proven effective in reducing the risk of acquiring or transmitting HIV like access to condoms and clean needles.
 * 2) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Ensuring people have the information, motivation, and skills necessary to reduce their risk continues to be important.
 * 3) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">HIV testing is critical in preventing the spread of HIV. Most people change behaviors to protect their partners if they know they are infected with HIV.
 * 4) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Linkage to treatment and care, which enables individuals with HIV to live longer, healthier lives and reduce their risk of transmitting HIV. It is imperative that individuals with HIV know their HIV status and are linked to ongoing care and prevention services. Substance abuse treatment is recommended if applicable.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Mass Media Interventions (Guide to Community Preventive Services, 2011 A)**

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Based on strong evidence of effectiveness for producing intended behavior changes, the Community Preventive Services Task Force recommends health communication campaigns that use multiple channels, one of which must be mass media, combined with the distribution of free or reduced-price health-related products. Health related products are,
 * Shown through an evidence-based process (such as a peer-reviewed systematic review or multiple rigorous studies) to improve health-related outcomes (e.g., increased physical activity; smoking cessation; reductions in disease, injury, or death)
 * Are tangible
 * Are not a service (e.g., mammogram)
 * Are not exclusively available though prescription or administration by a health professional (e.g., vaccination or prescribed medication)
 * Require repeated use for desired health promotion and/or disease and injury prevention effects (e.g., using condoms, wearing helmets) rather than a one-time behavior (e.g., installing smoke alarms)
 * Cannot be a specific food product (e.g., oatmeal) marketed as being “healthful”

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The specific behaviors promoted in the included studies were the use of products that:


 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Protect against behavior-related disease or injury (i.e., condoms, child safety seats, recreational safety helmets, sun-protection products).

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Because results were positive across these behaviors evaluated, these findings are likely to apply to a broader range of health-related products that meet the review’s product eligibility criteria in the intervention definition. The effectiveness of interventions promoting the use of health-related products other than those distributed in the reviewed studies should be assessed to ensure applicability.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The systematic review focused only on interventions that included a mass media component; therefore, this recommendation is specific to such interventions. The results may or may not apply to campaigns that do not include a mass media component, which were outside of the scope of the review.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Comprehensive risk reduction (CRR)**

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Comprehensive risk reduction (CRR) (Community Preventive Services, 2011B) promotes behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). These interventions may:
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Suggest a hierarchy of recommended behaviors that identifies abstinence as the best or preferred method but also provides information about sexual risk reduction strategies
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Promote abstinence and sexual risk reduction without placing one approach above another
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Promote sexual risk reduction strategies, primarily or solely
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">This review evaluated CRR interventions delivered in school or community settings to groups of adolescents (10–19 years old). These interventions may also include other components such as condom distribution and STI testing.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Summary of Task Force Recommendations & Findings**

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The Community Preventive Services Task Force recommends group-based comprehensive risk reduction (CRR) delivered to adolescents to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). The recommendation is based on sufficient evidence of effectiveness in:


 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Reducing a number of self-reported risk behaviors, including:
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Engagement in any sexual activity
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Frequency of sexual activity
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Number of partners, and
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Frequency of unprotected sexual activity
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Increasing the self-reported use of protection against pregnancy and STIs
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Reducing the incidence of self-reported or clinically-documented sexually transmitted infections.
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">There is limited direct evidence of effectiveness, however, for reducing pregnancy and HIV.

<span style="color: #000099; font-family: Verdana,Geneva,sans-serif;">Discussion of Intervention Efficacy »
<span style="font-family: 'Verdana','sans-serif'; font-size: 17px;">The CDC recommendations reflect the United States Preventive Services Task Force (USPSTF) updated definitions of the grades it assigns to recommendations and includes "suggestions for practice" associated with each grade. The CDC recomendations would be considered Grade A or B recommendations. The USPSTF included levels of certainty regarding net benefit of the recommendation. The USPSFT grades differ from the SORT criteria, because the SORT criteria rates the quality, quantity and consistency of evidence. The USPSFT grades recommend or do not recommend the intervention be used in practice based on the certainty of achieving the desired outcomes. Certainty regarding benefit relates to the efficacy of the intervention to acheive the desired outcomes. The updated definitions are below,

> **Suggestions for Practice:** Offer or provide this service. >
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Grade A.** The USPSTF recommends the service. There is high certainty that the net benefit is substantial.
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Grade B.** The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Suggestions for Practice:** Offer or provide this service


 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Grade C.** The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small..
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Suggestions for Practice:** Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Grade D.** The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Suggestions for Practice:** Discourage the use of this service.


 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Grade I.** The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
 * <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">**Suggestions for Practice:** Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

<span style="color: #000099; font-family: Verdana,Geneva,sans-serif;">D2L Discussion Prompt »
<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">A primary HIV prevention strategy for women who are sexually active is to use condoms consistently and correctly during sexual intercourse. Although condoms are an efficacious method for prohibiting transmission of sexually transmitted disease (STD) pathogens including HIV, their effectiveness as a risk reduction strategy is dependent on consistent and proper use. Unfortunately, many economically disadvantaged African American women encounter numerous socioeconomic, behavioral, cultural, and gender-related obstacles that make practicing consistent condom use a formidable challenge.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The Integrated Behavioral Model provides guidance in the design and implementation phases of HIV prevention programs. The Integrated Behavioral Model is particularly useful as a foundation for developing risk reduction behavior change interventions, especially for women and ethnic minority populations (Montano & Kasprzyk, 2008). Integrated Behavioral Model is a social psychological model that examines social, environmental, behavioral, and personal influences on an individual’s behavior. According to Integrated Behavioral Model, providing information alone to individuals might not be sufficient to influence their adoption or maintenance of HIV-preventive behavior (e.g., condom use during sexual intercourse). Changing an individual’s behavior requires assessing and modifying attitudes, norms and self-efficacy related to condom use. Successful behavior change, therefore, requires an intention to use condoms, no serious environmental constraints; salience of behavior, and the person previously performed the behavior.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">The most important component of using the Integrated Behavioral Model is to conduct in-depth, open-ended interviews with the target population whom interventions will be designed for. Elicitation interviews identify the behavioral outcomes, normative referents, and barriers and facilitators that are relevant to the particular behavior and population under investigation. The elicitation interviews drive the design of interventions, such as persuasive messages, to modify attitudes, norms, personal agency, self-efficacy, and environmental conditions affecting the desired behavior.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Use the Integrated Behavioral Model as a guide to develop elicitation questions for female African American clients between 17-29 years old relate to their;


 * 1) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">behavioral beliefs about consistent use of condoms
 * 2) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">efficacy beliefs about consistent use of condoms
 * 3) <span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">normative beliefs about consistent use of comments

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">//Provide a succinct// explanation for why your questions will elicit African American women’s behavioral, normative, and efficacy beliefs about consistent use of condoms.

<span style="font-family: Verdana,Geneva,sans-serif; font-size: 110%;">Each student critiques at least 2 other student’s questions and state what is good about the question in context of the Integrated Behavioral Model, how the questions could be improved.