***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Among severely mentally ill ( SMI ) substance abusers , HIV rates are elevated and HIV risk reduction interventions have been shown to be less effective . An enhanced cognitive behavioral HIV risk reduction intervention ( E-CB ) for SMI was compared to a health promotion condition ( HPC ) in 222 psychiatric out patients at 6 months postintervention . Compared to females , males in the E-CB improved on intention to practice safer sex and in condom use skills and in unprotected vaginal sex , but did not differ in HIV knowledge , perceived susceptibility , anxiety , condom attitudes , safer sex self-efficacy , unprotected vaginal sex acts , or sex partners . Across intervention groups , there were improvements in all areas except self-efficacy and number of partners . Risk reduction among SMI may be facilitated by increasing awareness of health related behaviors and HIV-targeted content . However , meaningful changes in critical risk reduction skills and intentions may require a more focused intervention and may vary by gender Objective : The objective of this study was to assess the validity of women ’s reports of recent unprotected sex by testing for prostate-specific antigen ( PSA ) in vaginal sample s. Study Design : The authors conducted prospect i ve research with 332 female sex workers attending 2 public dispensaries in Madagascar . Results : Among women who reported no sex or protected sex only within the past 48 hours , 21 % and 39 % , respectively , tested positive for PSA . Among those testing positive for PSA , no differences in PSA concentrations were found among those reporting no sex , protected sex only , or at least one unprotected act . Conclusions : The substantial disagreement between self-reports and measurement of a biologic marker of semen exposure in vaginal specimens substantiates that self-reports of sexual behavior can not be assumed to be valid measures . Future sexually transmitted infection/HIV and pregnancy prevention studies should confirm the validity of self-reports or use end points that do not rely on self-reported data In a pilot study , young people in slums in Kampala , Ug and a received an  HIV prevention program ( Street Smart ) and were r and omized to receive vocational training immediately ( Immediate ) or four months later ( Delayed ) . Youth were monitored at recruitment , 4 months ( 85 % retention ) , and 24 months ( 74 % retention ) . Employment increased dramatically : Only 48 % had ever been employed at recruitment , 86 % were employed from months 21 to 24 post recruitment . Over two years , decreases were recorded in the number of sexual partners , mental health symptoms , delinquent acts , and drug use ; condom use increased . Providing employment in low income countries , in conjunction with HIV prevention , may provide sustained support to young people to prevent HIV acquisition . ResumenEn un estudio piloto , los jóvenes en los barrios bajos de Kampala , Ug and a recibieron un programa de prevención del VIH ( Street Smart ) y fueron aleatorizados para recibir la formación profesional inmediatamente ( inmediato ) o cuatro meses más tarde ( en diferido ) . La juventud fue vigilada en el reclutamiento , 4 meses ( 85 % de retención ) , y 24 meses ( 74 % de retención ) . El empleo aumentó dramáticamente : sólo el 48 % había sido empleado en la contratación , el 86 % fue empleado de 21 a 24 meses después de la contratación . Más de dos años , se registraron disminuciones en el número de parejas sexuales , los síntomas de la salud mental , los actos delictivos y el consumo de drogas ; el uso del condón aumentó . La creación de empleo en los países de bajos ingresos , en conjunción con la prevención del VIH , puede proporcionar un apoyo sostenido a los jóvenes para prevenir la adquisición del VIH Challenges in the accurate measurement of sexual behavior in human immunodeficiency virus ( HIV ) prevention research are well documented and have prompted discussion about whether valid assessment s are possible . Audio computer-assisted self-interviewing ( ACASI ) may increase the validity of self-reported behavioral data . In 2006 - 2007 , Zimbabwean women participated in a r and omized , cross-sectional study that compared self-reports of recent vaginal sex and condom use collected through ACASI or face-to-face interviewing ( FTFI ) with a vali date d objective biomarker of recent semen exposure ( prostate-specific antigen ( PSA ) levels ) . Of 910 study participants , 196 ( 21.5 % ) tested positive for PSA , an indication of semen exposure during the previous 2 days . Of these 196 participants , 23 ( 11.7 % ) reported no sex in the previous 2 days , with no difference in reported sexual activity between interview modes ( 12.5 % ACASI vs. 10.9 % FTFI ; Fisher 's exact test : P = 0.72 ) . In addition , 71 PSA-positive participants ( 36.2 % ) reported condom-protected vaginal sex only ; their reports also indicated no difference between interview modes ( 33.7 % ACASI vs. 39.1 % FTFI ; P = 0.26 ) . Only 52 % of PSA-positive participants reported unprotected sex during the previous 2 days . Self-report was a poor predictor of recent sexual activity and condom use in this study , regardless of interview mode , providing evidence that such data should be interpreted cautiously A partner study was conducted in northern Thail and between March 1992 and June 1996 which included data that allowed an assessment of the reliability of self-reports of sexual behavior and contraceptive use among heterosexual couples . The authors enrolled 529 couples among whom all male subjects were human immunodeficiency virus ( HIV ) seropositive voluntary blood donors and their female sexual partners were either HIV infected ( n=246 ) or HIV seronegative ( n=283 ) . The levels of agreement within couples were assessed for recency of last sexual intercourse , sexual activity in the prior year , and contraceptive practice s. For HIV discordant couples , a prospect i ve study was conducted to examine risk factors for HIV transmission , the primary goal of the study . This allowed assessment of reliability of inter-partner reports over 6 - 12 months . Overall , agreement among couples was good for common sexual practice s , especially vaginal intercourse and time since last intercourse , but was lower for condom use . Anal and oral sex were infrequently reported by these couples and there was greater disagreement for the occurrence of these practice s. Partner agreement for contraceptive histories was good to excellent . Prospect i ve data showed less frequent intercourse and more condom use but reliability remained good . Common sexual practice s may be reliable for both HIV concordant and discordant couples in studies estimating prevalent infection . Estimates of incident heterosexually transmitted HIV may be made with greater reliability by studies which include assessment of reports of risk behavior by each member of a couple than studies of individuals This r and omized , controlled trial , conducted among out-of-treatment heroin/cocaine users at an emergency department visit , tests the impact on sexual risk of adding brief motivational intervention ( B-MI ) to point-of-service testing , counseling and drug treatment referral .  1,030 enrollees aged 18–54 received either voluntary counseling/testing ( VC/T ) with drug treatment referral , or VC/T , referral , and B-MI , delivered by an outreach worker . We measured number and proportion of non-protected sex acts ( last 30 days ) at 6 and 12 months ( n = 802 ) . At baseline , 70 % of past-30-days sex acts were non-protected ; 35 % of sex acts occurred while high ; 64 % of sexual acts involved main , 24 % casual and 12 % transactional sex partners ; 1.7 % tested positive for an STI , and 8.8 % for HIV . At six or 12 month follow-up , 20 enrollees tested positive for Chlamydia and /or Gonorrhea , and 6 enrollees HIV sero-converted . Self-reported high-risk behaviors declined in both groups with no significant between-group differences in behaviors or STI/HIV incidence Abstract This study assessed and compared the efficacy of culturally tailored behavioral interventions to increase use and acceptability of sexual barrier products among HIV-positive women in Zambia . It also sought to evaluate cultural preferences as facilitators or impediments to potential use of vaginal chemical barriers for sexual risk reduction within the Zambian context . Women ( N=240 ) , recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center , were r and omized into group or individual intervention arms . Participants attended a baseline assessment , three intervention sessions and follow up assessment s at six and 12 months . All participants increased use and acceptability of female condoms and vaginal products and maintained male condom use at six and 12 months . Preliminary data indicated that group participants increased male condom use at six months and trial use and acceptability of female condoms and lubricants predicted their use in the group condition . Results support group interventions to increase sexual barrier use and acceptability in HIV-positive women within the Zambian context . From a public health st and point , groups may represent a cost-effective and culturally congruent intervention This article compares cross-sectional measures of condom use among 2,269 female sex workers in Cameroon r and omly assigned to receive one of five different question naires  measuring  condom use . We found that the level of reported condom use varied depending on the type of survey questions used . Measures based on 2-week coital logs or the past 10 acts categorized more women as " 100 % " or " 0 % " users than always-to-never scales categorized women as " always " or " never " users . Consistency of use also varied by type of partner . Internal consistency of responses was high . Future studies should assess differences in prospect i ve measures of condom use and the level of association between various measures and infection with sexually transmitted disease Research has established that voluntary medical male circumcision ( VMMC ) reduces HIV acquisition in heterosexual men by approximately 60 % ; however , engaging in sexual activity before the wound is healed may attenuate this protective effect . This prospect i ve study included  VMMC clients who were circumcised in Kenya between November , 2008 and March , 2010 , aged ≥18 years , and r and omly selected for an interview and genital examination 28–45 days post-VMMC ( N = 1,344 ) . At the time of the interview , 91.3 % participants were healed . Overall , 30.7 % reported engaging in early sexual activity , usually 3–4 weeks post-VMMC . In a multivariable analysis , being married or cohabitating was the strongest predictor of engaging in early sexual activity . Strategies to reduce engaging in sexual activity during the recommended 42-day abstinence period following VMMC should be explored including re-energizing the effort to include female partners in counseling , mass education campaigns , and targeted text messaging programs for VMMC clients Culturally-specific  HIV risk reduction interventions for Hispanic women are needed . SEPA ( Salud/Health , Educación/Education , Promoción/Promotion , y/ and Autocuidado/Self-care ) is a culturally-specific and theoretically-based group intervention for Hispanic women . The SEPA intervention consists of five sessions covering STI and HIV prevention ; communication , condom negotiation  and  condom use  ; and  violence prevention .  A r and omized trial tested the efficacy of SEPA with 548 adult U.S. Hispanic women ( SEPA n = 274 ; delayed intervention control n = 274 ) who completed structured interviews at baseline and 3 , 6 , and 12 months post-baseline . Intent-to-treat analyses indicated that SEPA decreased positive urine sample s for Chlamydia ; improved condom use , decreased substance abuse and IPV ; improved communication with partner , improved HIV-related knowledge , improved intentions to use condoms , decreased barriers to condom use , and increased community prevention attitudes . Culturally-specific interventions have promise for preventing HIV for Hispanic women in the U.S. The effectiveness of SEPA should be tested in a translational community trial . ResumenIntervenciones culturalmente específicas son necesarias para la reducción de riesgo de contraer VIH en las mujeres hispanas .  SEPA ( Salud/Health , Educación/Education , Promoción/Promotion , y Autocuidado/Self-care ) es una intervención grupal culturalmente específica con bases teóricas diseñada para mujeres Hispanas . La intervención SEPA consiste en cinco sesiones que cubren temas relacionados con la prevención de ITS - VIH , comunicación , negociación y uso del condón ; y prevención de la violencia . Utiliz and o un estudio r and omizado se probó la eficacia de SEPA con una muestra de 548 mujeres hispanas que viven en los Estados Unidos de Norteamérica ( SEPA n = 274 ; grupo control n = 274 ) . Las participantes respondieron una entrevistas estructuradas al inicio del estudio y a los 3 , 6 , y 12 meses posteriores a la intervención . Los result ados del análisis señalan que las mujeres que participaron en SEPA disminuyeron las muestras positivas de Chlamydia en orina , aumentaron el uso del condón , disminuyeron el abuso de sustancias y los episodios de violencia de pareja , mejoraron la comunicación de pareja , aumentaron el conocimiento sobre VIH , mejoraron la intención de utilizar condón , percibieron menores barreras para uso del condón , y mejoraron las actividades de preven 
    Output:
    
Desarrollar y utilizar normas para medición del uso de condón ampliaría comparabilidad de result ados a través de estudios y beneficiaría investigación de la prevención de VIH .