***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE The purpose of the study was to examine the association between adolescents ' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes .  METHOD Sexually active black adolescent females ( N = 522 ) completed , at baseline and again 6 months later , a self-administered question naire that assessed  sexual health attitudes  and  emotional distress symptoms ( using st and ardized measures , alpha = .84 ) , a structured interview that assessed STD/HIV-associated sexual risk behaviors , and a urine screen for pregnancy .  RESULTS In multivariate analyses , controlling for observed covariates , adolescents with significant distress at baseline were more likely than their peers , after 6 months , to be pregnant ( adjusted odds ratio [ AOR ] : = 2.0 ) , have had unprotected vaginal sex ( AOR = 2.1 ) , have nonmonogamous sex partners ( AOR = 1.7 ) , and not use any form of contraception ( AOR = 1.5 ) . Additionally , they were also more likely to : perceive barriers to condom use ( AOR = 2.2 ) , be fearful of the adverse consequences of negotiating condom use ( AOR = 2.0 ) , perceive less control in their relationship ( AOR = 2.0 ) , have experienced dating violence ( AOR = 2.4 ) , feel less efficacious in negotiating condom use with a new sex partner ( AOR = 1.6 ) , and have norms nonsupportive of a healthy sexual relationship ( AOR = 1.7 ) . DISCUSSION The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes . Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history , initiate STD/HIV-preventive counseling , and refer for comprehensive psychological assessment and appropriate treatment . Among adolescents receiving STD treatment , those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes . STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy OBJECTIVES The purpose of this study was to test the effects of an  education program in Tanzania  design ed to reduce children 's risk of human immunodeficiency virus ( HIV ) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome ( AIDS ) . METHODS A r and omized controlled community trial including baseline and 12-month follow-up surveys was employed . Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and r and omly assigned to intervention ( n = 6 ) or comparison ( n = 12 ) conditions . Of the 1063 sixth- grade students ( average age : 13.6 years ) who participated at baseline , 814 participated in the follow-up survey . RESULTS At follow-up , statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication , AIDS knowledge , attitudes toward people with AIDS , and subjective norms and behavioral intentions toward having sexual intercourse . A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year ( 7 % vs 17 % ) . CONCLUSIONS It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children OBJECTIVE This study seeks to advance our underst and ing of moderating influences on the relationship between alcohol and condom use by examining their association at both the global and event levels of analysis using a prospect i ve approach within a sample of high-risk adolescents . The following potential moderators were examined : sex-related alcohol expectancies , gender , relationship type , level of alcohol use , and impulsive sensation seeking . METHOD Criminally involved adolescents ( N = 300 ) completed measures of alcohol use , condom use , personality , and alcohol expectancies ; 267 ( 89 % ) participants completed a behavioral assessment 6 months later . RESULTS At the global level of analysis , there was a significant moderating effect of alcohol-related sexual-enhancement expectancies , such that the relationship between alcohol and condom use was negative and significant only among individuals with higher sexual-enhancement expectancies . At the time-limited global level , impulsive sensation seeking at baseline was negatively associated with condom use at 6-month follow-up . At the event level , there was a Gender x Alcohol interaction such that alcohol use was unrelated to condom use among males but was strongly and negatively related among females . CONCLUSIONS This study makes a contribution to the underst and ing of the relationship between alcohol use and condom use by looking beyond main effects and conducting an empirically driven and multilevel examination of moderating variables . Results support the inclusion of situation-specific alcohol risk-reduction content in human immunodeficiency virus/sexually transmitted disease-prevention activities Mediation analysis is a statistical technique that can be used to identify mechanisms by which intervention programs achieve their effects . This paper presents the results of a mediation analysis of Ngao , an acquired immunodeficiency syndrome ( AIDS ) education program that was implemented with school children in Grade s 6 and 7 in Tanzania in the mid-1990s and evaluated using a controlled , group-r and omized trial . The study examined which variables mediated the effect Ngao had in regard to ( i ) fostering positive attitudes towards people living with AIDS and ( ii ) decreasing intentions to be sexually active in the near future . Data from students who participated in a baseline and 12-month follow-up survey ( n = 814 ) were analyzed . Results indicate that increasing exposure to AIDS information and increasing knowledge about human immunodeficiency virus transmission/prevention were significant mediators of the intervention 's effect on alleviating the stigma associated with people living with AIDS . Moreover , encouraging more restrictive social norms about sexual intercourse was a significant mediator of the intervention 's effect on decreasing students ' intentions to be sexually active in the near future . Implication s for future AIDS education programs for school children in this part of Africa design ed to achieve similar goals are discussed Purpose We examined the effect of antiretroviral therapy ( ART ) , and the predictive role of depression , on condom use with primary partners . Methods Data from three studies in Ug and a were combined into a sample of 750 patients with a primary sex partner , with 502 starting ART and 248 entering HIV care , and followed for 12 months . R and om-effects logistic regression models were used to examine the impact of ART , and the influence of baseline level and change in depression , on condom use with primary partners . Results At month 12 , 61 % ART and 67 % non-ART patients were consistent condom users , compared to 44 and 41 % at baseline , respectively . Multivariate analysis revealed that consistent condom use increased similarly for ART and non-ART patients , and that minor depression at baseline and increased depression over time predicted inconsistent condom use . Conclusions Improved depression diagnosis and treatment could benefit HIV prevention Background “ Let Us Protect Our Future ” is a sexual risk-reduction intervention for sixth- grade adolescents in South Africa . Tested in a cluster-r and omized controlled trial , the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period . Purpose The present analyses were conducted to identify moderators of the intervention ’s efficacy as well as , which theory-based variables mediated the intervention ’s effects . Methods Intervention efficacy over the 3- , 6- , and 12-month follow-up was tested using generalized estimating equation models . Results Living with their father in the home , parental strictness , and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse . Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse , derived from Social Cognitive Theory , significantly mediated the intervention ’s effect on abstinence . Conclusions This is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents Findings have been inconsistent regarding the association of obesity and sexual risk behaviors . The purpose of the current study was to assess the prospect i ve nature of body mass index ( BMI ) , depression , and their interaction in predicting condom use during anal intercourse among HIV-infected men who have sex with men ( MSM ) . The sample ( N = 490 ) was obtained from a large , HIV clinical cohort from four sites across the U.S. The following inclusion criteria were employed : identification as MSM and had completed at least one wave of patient-reported measures ( e.g. , depression , as measured by the PHQ-9 ) in the clinical cohort study . Longitudinal linear mixed-effects modeling revealed a significant BMI by depression interaction . Depressive symptoms were predictive of less frequent condom use for obese but not overweight men . Analogous results were found in regard to comparisons between normal weight and overweight men . Obesity , in the context of depression , is a risk factor for unprotected anal intercourse among HIV-infected MSM .  Cognitive behavioral interventions to reduce HIV transmission risk behaviors among HIV-infected MSM should adopt an integrated perspective , combining sexual risk reduction with treatment for depression and body-related concerns Objectives : To evaluate the effects of an enhanced peer-led intervention on transmission risk behavior and serostatus disclosure of HIV-seropositive gay and bisexual men . Design : A r and omized intervention trial . Methods : HIV-seropositive gay and bisexual men were recruited from New York City and San Francisco and were r and omly assigned to either a st and ard or an enhanced intervention . The st and ard intervention consisted of one session that provided safer sex information . The enhanced intervention consisted of six sessions and included safer sex information , interactive learning activities , and discussion groups that were facilitated by HIV-seropositive peers . Participants completed audio computer-assisted self interview ( A-CASI ) assessment s at baseline and 3 and 6-month follow-ups . Optional testing for sexually transmitted infections was offered at baseline and the 6-month follow-up . Results : A total of 811 participants met the inclusion criteria for outcome analyses . Of these , 85 and 90 % were retained for the 3 and 6-month follow-ups , respectively . Compared with the st and ard intervention , fewer men assigned to the enhanced intervention reported unprotected receptive anal intercourse with a negative or unknown-serostatus partner at 3 months ( 21 versus 26 % , P < 0.05 ) . However , there were no other significant differences in transmission risk or serostatus disclosure at 3 or 6 months . Conclusion : The enhanced intervention was associated with only a limited reduction in transmission risk at 3 months relative to the st and ard intervention . The characteristics of the intervention that may have reduced its efficacy are identified and directions for future research are suggested Research is needed to identify culturally relevant factors that may contribute to sexual risk among African Americans . We investigated HIV-specific medical mistrust as one such cultural factor , often exhibited as conspiracy beliefs about HIV ( e.g. , “ AIDS was produced in a government laboratory ” ) , which may be indicative of general suspicion of HIV treatment and prevention messages . Over a 6-month time-period , we measured endorsement of  HIV conspiracy beliefs  three times and frequency of condom use monthly among 181 HIV-positive African American males . A hierarchical multivariate repeated- measures logistic r and om effects model indicated that greater belief in HIV conspiracies was associated with a higher likelihood of reporting unprotected intercourse across all time-points . An average of 54 % of participants who endorsed conspiracies reported unprotected intercourse , versus 39 % who did not endorse conspiracies . Secondary prevention interventions may need to address medical mistrust as a contributor to sexual risk among African Americans living with HIV OBJECTIVE To test the efficacy of a school-based human immunodeficiency virus/sexually transmitted disease ( HIV/STD ) risk-reduction intervention for South African adolescents . DESIGN A cluster-r and omized , controlled design with assessment s of self-reported sexual behavior collected before intervention and 3 , 6 , and 12 months after intervention . SETTING Primary schools in a large , black township and a neighboring rural settlement in Eastern Cape Province , South Africa . PARTICIPANTS Nine of 17 matched pairs of schools were r and omly selected . Sixth- grade students with parent or guardian consent were eligible . INTERVENTIONS Two 6-session interventions based on behavior-change theories and qualitative research . The HIV/STD risk-reduction intervention targeted sexual risk behaviors ; the attention-matched health promotion control intervention targeted health issues unrelated to sexual behavior . OUTCOME MEASURES The primary outcome was self report of unprotected vaginal intercourse in the previous 3 months averaged over the 3 follow-ups . Secondary outcomes were other sexual behaviors . RESULTS A total of 1057 ( 94.5 % ) of 1118 eligible students ( mean age , 12.4 years ) participated , with 96.7 % retained at the 12-month follow-up . Generalized estimating equation analyses adjusted for clustering from 18 schools revealed that , averaged over the 3 follow-ups , a significantly smaller percentage of HIV/STD risk-reduction intervention participants reported having unprotected vaginal intercourse ( odds ratio [ OR ] , 0.51 ; 95 % confidence interval [ CI ] , 0.30 - 0.85 ) , vaginal intercourse ( OR , 0.62 ; 95 % CI , 0.42 - 0.94 ) , and multiple 
    Output:
    
Results show little convergent support across both types of studies for most traditional , theoretical predictors of sexual behavior .