Combination methods for HIV prevention in men who have sex with men (MSM)

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    Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use секс more сокс to date browser or turn off compatibility mode in Internet Explorer.

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    Physicians секв with sexual dysfunction SD must consider the psychological and behavioral aspects of their patient's diagnosis and management, as well as organic causes and risk factors.

    Integrating sex therapy and other psychological techniques into their office practice will improve effectiveness in treating SD. This presentation provides information about the секс forces of patient and partner resistance, which impact patient compliance and sex lives beyond organic illness and mere комбинации anxiety.

    Successful treatment requires a supportive available sexual partner, yet partner cooperation may be independent of секс attendance during the office visit.

    Preliminary data from a survey of SMSNA members practice patterns, regarding partner issues, is presented and discussed. The секс of evoking комбинации support and cooperation independent of actual attendance during office visits комбинации emphasized. Correspondence to M A Perelman.

    Reprints and Permissions. Perelman, M. Sex coaching for physicians: combination treatment for patient and partner. Download citation. The Journal of Sexual Medicine Секс The World Journal of Men's Health Advanced search. Skip to main content. Abstract Physicians dealing комбинации sexual dysfunction SD must consider the psychological and behavioral aspects of their patient's diagnosis and management, as well as organic causes and risk комбинации.

    Access through your institution. Buy or subscribe. Download PDF. Rights and комбинации Reprints and Permissions. About this article Cite this article Perelman, M. ColsonB. CuzinA. FaixL. International Journal of Impotence Research menu. Nature Research menu. Еомбинации Article search Search.

    care: combination social protection and reduced unprotected sex among HiV-​positive adolescents in South africa, aidS and Behaviour,. doi. Lancet. Jan 3;() doi: /S(14) Epub Jul Combination HIV prevention for female sex workers: what is the. This review has been withdrawn. The reason for withdrawal and previous versions are archived and accessible within the withdrawn record in.

    AIDS and Behavior. Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited.

    This study quantitatively tests whether social protection is associated сокс reduced unprotected sex among ART-eligible adolescents from 53 government facilities in South Africa. Lower rates of unprotected sex were associated with access to school OR 0. Gender moderated the effect of adolescent-sensitive clinic care.

    Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls. There are an estimated 1. While rates of unprotected sex among HIV-positive adolescents are comparable to those among the general adolescent population [ 2 ], HIV-positive adolescents are a key population for reducing onwards HIV transmission to sexual partners and children.

    In addition, Комбирации adolescents experience a range of vulnerabilities that are likely to reduce the efficacy of HIV prevention programmes aimed at general populations, including cognitive and mental health issues [ 67 ], family-related challenges [ 89 ] and material deprivation [ 1011 ]. While notable research and resources are focused on supporting adolescent girls and young women to remain HIV-negative, there is a dearth of research and programming for HIV-positive комбинаици.

    HIV-positive adolescent girls face multiple potential risks: low rates of condom and contraceptive use, greater rates of unwanted pregnancies and related health complications, as well as lower enrollment, adherence to, and retention in prevention-of-mother-to-child transmission programmes, and, consequently, increased risk of transmitting HIV to their partners and children [ 1415161718 ]. Increasingly, social protection provisions are showing potential to reduce the negative impacts of structural deprivations faced by adolescents in high-prevalence комбинации, and to improve their long-term health outcomes [ 19 ].

    Most evidence to date has focused on impacts of social cash transfers in addressing structural vulnerabilities to HIV-infection among adolescents in Sub-Saharan Africa [ 13 ]. Two studies from South Africa and Kenya suggest that social protection may function differently for boys and girls [ 2325 ].

    The evaluation of the Kenya cash transfer programme for orphans and vulnerable children showed overall reductions in sexual debut with greater impact among girls compared to boys [ 25 ]. A recent review in Eastern and Southern Africa reported an increasing evidence base on how social protection can секс HIV infection among HIV-negative adolescents, еомбинации found no studies that investigate the role of social protection in preventing onwards HIV-transmission among HIV-positive adolescents [ 21 ].

    There is a need for evidence on whether social protection provisions alone or in combination can reduce HIV-risk behavior for HIV-positive adolescents, and to understand potential gender differences. To date, only a few programmes have tested any interventions to improve sexual and reproductive health among HIV-positive adolescents in Sub-Saharan Africa. Combination social protection may have cumulative effects, that is комбинации of two or more provisions may do better than those receiving each provision alone.

    These effects may be multiplicative or additive [ 23 ]. This study aims to address this essential research gap. It tests 1 associations of each social protection provisions with unprotected sex, 2 the effects of gender on social protection provisions significantly associated with unprotected sex, 3 potential interactive effects of significant social protection provisions, and 4 potential additive effects of combination social protection provisions.

    This was selected as a resource-limited setting with high HIV-prevalence rates [ секч ]. As the study progressed, комбпнации South African Department of Health implemented a primary healthcare reengineering programme, as a result of which the adolescents receiving care in the комбинации 39 facilities were transferred to a total of 53 healthcare facilities including hospitals, community healthcare centres, and primary healthcare секс.

    All 53 facilities were then included in the study. Adolescents were recruited at clinics where they were receiving antiretroviral treatment and care, or traced into their home communities for those not reachable at the clinics. Due to high HIV-stigma rates, the study was presented in participating communities as a general study on adolescent access to health and social services. Quantitative and qualitative research were combined iteratively during the study: qualitative research guided the design and комбинации of the quantitative data collection tools and processes, preliminary quantitative analysis provided themes to be further explored by qualitative комбмнации, and these in-depth explorations shaped quantitative analyses.

    Quantitative questionnaires used standardised scales and validated measures when available. Tools were translated into Xhosa and back-translated for improved conceptual validity [ 31 ], then piloted with 25 HIV-positive adolescents from rural and urban sites in the health district. Questionnaires included graphics, interactive games and vignettes to комбиннации questions around sensitive topics.

    Unprotected sex at last sexual intercourse was measured as no комбианции use at most recent sexual encounter. Секс pregnancy among girls was defined as комлинации having been pregnant before or during data collection, measured using an item from the National Survey of HIV and Risk Behaviour Amongst Young South Africans [ 33 ].

    Orphanhood status was coded as death of either mother or father or both [ 35 ]. Additional checks on adolescent knowledge of own HIV-status were уомбинации using a screening on recent health and medication-taking histories комбинации avoid unintentional disclosure. Past-week food security, defined as at least two meals daily for the past week, was measured through items from the National Food Consumption Survey [ 39 ]. Access to school was defined as access to free schooling or комбонации to afford school fees, uniform and equipment.

    School feeding referred to receiving at least one free meal at school daily. Sufficient clothing was measured using an item from комбинациии South African Social Attitudes Survey [ 40 ]. Attending an HIV-support group was measured секс past-month attendance at either a youth-focused or general HIV-support group.

    Adolescent-sensitive care at clinics was measured through two items asking adolescents about their experience obtaining contraception at the clinic: whether they felt disrespected or were scolded.

    Data analysis consisted of five steps: first, the included sample Descriptive statistics of socio-demographic characteristics, access to each social protection provision, and rates of unprotected sex were calculated for the full included sample and by gender. To check the extent of risk for onwards HIV-transmission, we tested whether unprotected sex was associated with virological failure, a marker of high HIV-transmission risk through unprotected sex [ 42 ].

    Second, validation checks for self-reported unprotected sex комбинации conducted by testing associations between a unprotected sex and STI symptomology full sample and b unprotected sex and комбинации females only. These used multivariate ы regression models controlling сс all potential covariates. Covariates entered included: adolescent age, gender, language, housing type, residential location, maternal and paternal orphanhood, living with biological caregiver, mode of infection, and knowledge of own HIV-positive status.

    Fourth, we tested whether gender acted as a moderator for each social protection provision. Moderator analyses were conducted using logistic regression models with two-way interaction terms of gender and each social protection provisions entered in separate models, controlling for covariates found significant in the above step.

    Subsequently, based on existing literature suggesting different social protection provisions may work for adolescent boys and girls, and because a moderator effect was found, multivariate logistic regressions were run separately for HIV-positive girls and boys. Fifth, effects of combinations of social protection provisions on unprotected sex were tested for the full and then gender-disaggregated samples.

    Step 1—all covariates significant from the model in stage 3, step 2—all significant social protection variables, step 3—all two-way interaction terms of significant social protection variables, step 4—all three-way and higher order interaction terms of significant social protection variables.

    Subsequently, marginal effect analysis in STATA tested potential additive effects of significant social protection provisions by computing predicted секс of unprotected sex under each potential combination of комбинациии social protection provisions, with all significant covariates held at mean values. Gender-disaggregated analyses were not possible due to small sub-sample sizes.

    Gender-disaggregated logistic regressions of social protection provisions and covariates. No social комбинации provisions were associated with unprotected sex amongst HIV-positive boys. Logistic regression models of all significant potential social protection factors, interaction terms, and covariates. Marginal effects model testing for additive effects of combination social protections on unprotected sex among HIV-positive adolescents. Findings from this study have several important implications.

    First, we found high rates of unprotected sex reported by HIV-positive adolescents, and significantly higher rates of virological failure amongst HIV-positive adolescents engaging in unprotected sex, suggesting greater transmission risk to uninfected peers. It is clear that effective programming to reduce sexual risk behavior for this vulnerable group is essential. Second, we identify three types of social protection provisions that are strongly associated with reduced unprotected sex among HIV-positive adolescents: access to schools, good parental supervision, and adolescent-sensitive sexual health care at clinics.

    These findings reflect emerging секс on combinations of social protection for reducing sexual risk-taking among general samples of adolescents [ 23 ]. They support recent calls for adolescent-sensitive HIV-inclusive social protection, that is social protection that reaches HIV-positive and HIV-affected adolescents without using HIV status as a targeting condition [ 21 ].

    Compared to those receiving none or one social protection provision, adolescents who receive two types of social комбнации reported секс rates of unprotected sex, with those receiving three types of social protection reporting the lowest rates.

    Additional research is needed to elucidate these potential mechanisms. Fourth, our findings highlight the importance of receiving social protection in three key locations for adolescents: school, home and clinic. This finding supports qualitative reports from South Africa on the negative комбинации of poor clinic care on adolescent sexual and reproductive health outcomes [ 43 ]. Further analyses, including in-depth qualitative research, are needed to better understand the mechanisms through which classroom- and clinic-level support is linked to reduced unprotected sex.

    Fifth, our gender-disaggregated analyses resulted in different significant social protection комбинации boys and girls, though this may also be due to reduced power and the lower rates of sexual activity reported by the HIV-positive adolescent boys in our sample [ 15 ]. Three of the social protection provisions we tested have significant effects on HIV-positive adolescent girls: access to schools, good parental supervision, and adolescent-sensitive sexual health clinic care.

    Supporting adolescent girls beyond the home setting, at school and clinics, will not only ensure they reach services critical to their long-term well-being, but also support them in engaging in safer sex. Notably, these three provisions are—when available—targeted at all adolescents, whether HIV-positive or not.

    This suggests that social protection that reaches at-risk populations such as adolescents, even when not targeted секс HIV-positive ones, can be effective to reduce their vulnerabilities. These findings resonate with advocacy for generalised social protection in the Sustainable Development Goals [ 13 ]. They also underline the importance of ensuring that HIV-positive adolescents are not excluded from accessing social protection.

    This study has several methodological limitations. Cross-sectional analyses always limit our ability to reach conclusions on the direction of the observed associations, due to potential reverse causality for significant associations. Future research can valuably test these associations in longitudinal quasi-experimental studies or randomised controlled trials. Second, self-reported sexual health секс contain комбинацим of social desirability bias.

    As a check for комбниации, we tested associations of self-reported unprotected sex with two other sexual and reproductive health outcomes. Unprotected sex was significantly associated with pregnancy and STI symptomology. However, comparison of the sample reached and those not reached showed no significant differences by age, gender and residential комбинации only information available to us.

    Despite this limitation, our study is the first and largest study of HIV-positive adolescents traced into their homes and communities, and thus may allow more representativity of the overall population than clinic-based samples that are thus restricted to those who attend healthcare services.

    Moreover, by including study sites with high HIV prevalence and секс poor resources, our findings may be applicable to contexts with similar socio-economic and epidemiological profiles. These coverage rates not only limited our ability to conduct sub-group analyses секс also precluded us from reaching any conclusions on whether they may be associated with sexual health outcomes among HIV-positive комбинации.

    However, given prior evidence from South Africa on the effectiveness комбинайии social cash transfers in reducing sexual risk-taking among AIDS-affected adolescents [ 2444 ], our findings suggest that the positive effect of additional social protection may extend gains from the social cash transfer and school feeding schemes documented by prior studies in the region. Despite the above limitations, the study provides key insights for sexual health programming among HIV-positive комбинпции in and out of clinical care.

    The interventions identified are available in real-life settings and have statistically and practically significant associations with reduced unprotected sex, particularly when accessed in combination. Increasing access to these social protection provisions among HIV-positive adolescents has the potential to support HIV-positive adolescents to reduce unprotected sex, and its related outcomes of unwanted pregnancies and onwards HIV-transmission.

    This study would not be possible without the experiences shared by over adolescents, their caregivers and healthcare providers, to whom we are immensely grateful. Elona Toska declares с they have no conflict of interest. Lucie Cluver declares that they have no conflict of interest. Mark Boyes declares that they have no conflict of interest. Maya Isaacsohn declares that they have секс conflict of interest. Rebecca Hodes declares that they have no conflict of interest.

    Lorraine Sherr declares that they have no conflict of interest. Informed consent was obtained from all individual participants included in the study. Skip to main content Skip to sections.

    Сес, effects of combinations of social protection provisions on unprotected sex were tested for the full and then gender-disaggregated комбинации. Preventive service needs of young people perinatally infected with Секс in Uganda. Experiences and challenges in sexual and reproductive health for adolescents living with HIV in Malawi, Mozambique, Zambia and Zimbabwe. sex dating

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    This review has been withdrawn. The reason for withdrawal and previous versions are archived and accessible within the withdrawn record in. Guidelines for Expanding Combination. Prevention and Treatment Options for Sex. Workers: Oral Pre-Exposure Prophylaxis. (PrEP) and Test. Sex therapy is useful as a monotherapy or an adjunctive treatment and is often the 'combination therapy' of choice when treating SD.

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    Combination methods for HIV prevention in men who have sex with men (MSM) | Cochrane

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