***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: Using a multiracial sample of 621 homeless women , we tested a latent variable causal model of personal , cognitive , behavioral , and demographic predictors of two coping mediators and the outcome variables of HIV testing and return for test results and a recent STD infection . HIV testing and return were predicted by more social support , greater AIDS knowledge , greater perceived risk for AIDS , and more problem-focused coping strategies . Recent STDs were predicted by more AIDS knowledge , emotion-focused coping strategies , and risky sexual behavior and one measured variable , crack cocaine use . Emotion-focused coping strategies were predicted by drug use , less self-esteem , more social support , and greater perceived risk for AIDS .  Hispanics reported less emotion-focused coping strategies than African-Americans . Predictors of problem-focused coping strategies included less drug use , more self-esteem , more social support , more AIDS knowledge , and less risky sexual behavior .  African-Americans reported less problem-focused coping strategies than Latinas . Indirect effects on the outcomes mediated through coping styles are also reported . Theoretical and practical implication s of results for community outreach are discussed OBJECTIVE This study assessed the impact of social ties on substance abuse treatment outcome . Two models which predict alternative hypotheses were evaluated . 1 ) Based on the self-medication model , it was hypothesized that social support would aid in coping with painful affect and decrease the need for drugs . 2 ) Based on a social learning model , it was hypothesized that drug use in the social network would threaten abstinence due to modeling and conditioning effects . METHOD Seventy methadone maintenance patients were given baseline measures of mood , stress , social support , and drug use in the network  and followed prospect ively for 3 months with weekly urine drug screens . RESULTS Social support was correlated with positive affect ( r = .59 , p < .001 ) , and stress with negative affect ( r = .46 , p < .001 ) , but no measures of social support , affect , or stress correlated with the proportion of drug positive urines . However , patients with at least one drug user among the closest significant others had 63 + /- 38 % positive urines versus 35 + /- 36 % positive among those without a drug-using significant other ( t = -3.2 , p < .002 ) . CONCLUSIONS Substance use in the social network had a substantial negative impact on treatment outcome . Consistent with the social learning model and the traditional " persons , places , and things , " this suggests interventions should get drug-using significant others into treatment and teach patients coping skills to reduce their negative influence Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health . Prospect i ve studies , which control for baseline health status , consistently show increased risk of death among persons with a low quantity , and sometimes low quality , of social relationships . Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes . The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored BACKGROUND HIV infection and intimate-partner violence share a common risk environment in much of southern Africa . The aim of the Intervention with Microfinance for AIDS and Gender Equity ( IMAGE ) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum . METHODS Villages in the rural Limpopo province of South Africa were pair-matched and r and omly allocated to receive the intervention at study onset ( intervention group , n=4 ) or 3 years later ( comparison group , n=4 ) . Loans were provided to poor women who enrolled in the intervention group . A participatory learning and action curriculum was integrated into loan meetings , which took place every 2 weeks . Both arms of the trial were divided into three groups :  direct programme participants or matched controls ( cohort one ) , r and omly selected 14 - 35-year-old household co-residents ( cohort two ) , and r and omly selected community members ( cohort three ) . Primary outcomes were experience of intimate-partner violence -- either physical or sexual -- in the past 12 months by a spouse or other sexual intimate ( cohort one ) , unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months ( cohorts two and three ) , and HIV incidence ( cohort three ) . Analyses were done on a per- protocol basis . This trial is registered with Clinical Trials.gov , number NCT00242957 . FINDINGS In cohort one , experience of intimate-partner violence was reduced by 55 % ( adjusted risk ratio [ aRR ] 0.45 , 95 % CI 0.23 - 0.91 ; adjusted risk difference -7.3 % , -16.2 to 1.5 ) . The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two ( aRR 1.02 , 0.85 - 1.23 ) , and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner ( 0.89 , 0.66 - 1.19 ) or HIV incidence ( 1.06 , 0.66 - 1.69 ) in cohort three . INTERPRETATION A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants . Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa The research ers sought to explore and describe the demographic , cognitive , psychosocial , and behavioral factors associated with the continued risky behavior of a convenience sample of homeless and drug-addicted women two to four weeks after they had completed an AIDS education program . The sample included 942 crack users and 767 women who had multiple sex partners . Analyses revealed that impoverished women who maintained multiple sexual partners were less likely to be in drug recovery programs than in homeless shelters . They were more likely to share needles and be involved sexually with male injection drug users compared with impoverished women who did not maintain multiple sexual partners . Persistent crack users were older than those who reported cessation of crack use , were more often African American , and were more likely to have sex partners who were injecting drug users . Women who demonstrated less improvement in depression and distress scores , concerns , use of affective coping , appraisal of threat , and social support were more likely to maintain crack use and multiple partners . The study 's implication s for the design of intervention programs aim ed at risk reduction based on ethnicity are discussed HIV/AIDS has emerged as a significant health threat for African American women with well-documented disparities . The purpose of this study was to assess the association between social network characteristics and high-risk sexual behaviors among a sample of urban African American women at risk of heterosexually acquired HIV/STIs . We performed a cross-sectional study of baseline data collected from the CHAT study , a r and omized HIV-prevention trial targeting urban HIV-at-risk women in Baltimore , MD . Our primary outcomes were risky sexual behaviors defined as either ( a ) two or more sexual partners or ( b ) having a risky sex partner within the past 90 days . Bivariable and multivariable logistic regression examining the associations between individual and social network factors and our two outcomes of interest were conducted . The study population included 513 sexually active African American women with a mean age of 41.1 years . High levels of unemployment ( 89.5 % ) , depressive symptoms ( 60.0 % ) , and drug use ( 68.8 % ) were present among this high-risk urban cohort . Controlling for individual factors including participant drug use , age , and depression , having two or more sex partners within the past 90 days was associated with having a larger personal network ( OR = 1.11 ; 95 % CI , 1.06 and 1.17 ) ; more network members who pitched in to help ( OR = 1.22 ; 95 % CI , 1.04 and 1.44 ) , provided financial support ( OR = 1.33 ; 95 % CI , 1.11 and 1.60 ) , or used heroin or cocaine ( OR = 1.26 ; 95 % CI , 1.14 and 1.40 ) . Having a risky sexual partner within the past 90 days was associated with having a larger social network ( OR = 1.06 ; 95 % CI , 1.00 and 1.12 ) and having more social networks who used heroin or cocaine ( OR = 1.30 ; 95 % CI , 1.14 and 1.49).In summary , social network characteristics are associated with HIV sexual risk behaviors among African American urban women .  Social-network-based interventions that promote norms pertaining to HIV risk reduction and provide social support are needed for African American women at risk of heterosexually acquired HIV/STIs One reason for difficulty in long-term maintenance of behavior changes by injection drug users ( IDUs ) is the concomitant support or distraction from the IDUs social environment . This study explored the relationship of social factors -- e.g . , encouragement from friends , beliefs about social norms  -- with drug injection behaviors .  Subjects were clients in a short-term residential detoxification program . Self-reports of drug and AIDS-protective behaviors were gathered at baseline and at least 6 months following a trial of enhanced vs. informational educational interventions . Results provide support both for the general hypothesis about the influence of peers and drug-use partners prior and subsequent to detoxification and for the greater effectiveness of the enhanced intervention on social factors . Particularly important to improved drug use behavior were decreased number of friends who inject drugs ( social network ) , increased number of people to talk with when upset ( social support ) , and increased argument skills about safe drug use ( social influence ) Background : Multilevel analytical techniques are being applied in condom use research to ensure the validity of investigation on environmental/structural influences and clustered data from venue-based sampling . The literature contains reports of consistent associations between perceived gatekeeper support and condom use among entertainments establishment-based female sex workers ( FSWs ) in Guangxi , China . However , the clustering inherent in the data ( FSWs being clustered within establishment ) has not been accounted in most of the analyses . We used multilevel analyses to examine perceived features of gatekeepers and individual correlates of consistent condom use among FSWs and to vali date the findings in the existing literature . Methods : We analyzed cross-sectional data from 318 FSWs from 29 entertainment establishments in Guangxi , China in 2004 , with a minimum of 5 FSWs per establishment . The Hierarchical Linear Models program with Laplace estimation was used to estimate the parameters in models containing r and om effects and binary outcomes . Results : About 11.6 % of women reported consistent condom use with clients . The intraclass correlation coefficient indicated 18.5 % of the variance in condom use could be attributed to their similarity between FSWs within the same establishments . Women 's perceived gatekeeper support and education remained positively associated with condom use ( P < 0.05 ) , after controlling for other individual characteristics and clustering . Conclusions : After adjusting for data clustering , perceived gatekeeper support remains associated with consistent condom use with clients among FSWs in China . The results imply that combined interventions to intervene both gatekeepers and individual FSW may effectively promote consistent condom use Associations between social support network  characteristics and sexual risk among racially/ethnically diverse young men who have sex with men ( YMSM ) were examined using  egocentric network data from a prospect i ve cohort study of YMSM ( n = 501 ) recruited in New York City . Bivariate and multivariable logistic regression analyses examined associations between  social support network characteristics and sexual risk taking behaviors in Black , Hispanic/Latino , and White YMSM . Bivariate analyses indicated key differences in network size , composition , communication frequency and average relationship duration by race/ethnicity . In multivariable analyses , controlling for individual level sociodemographic , psychosocial and relationship factors , having a sexual partner in one ’s social support network was associated with unprotected sexual behavior for both Hispanic/Latino ( AOR = 3.90 ) and White YMSM ( AOR = 4.93 ) . Further examination of key network characteristics across racial/ethnic groups are warranted in order to better underst and the extant mechanisms for provision of HIV prevention programming to racially/ethnically diverse YMSM at risk for HIV.ResumenLas asociaciones entre las características de las redes sociales de apoyo y el riesgo sexual entre hombres jóvenes que tienen sexo con otros hombres ( YMSM , por sus siglas en Inglés ) fueron examinadas us and o datos de las redes egocéntricas de un estudio de cohorte  prospect ivo de YMSM ( n = 501 ) reclutados en la ciudad de Nueva York . Los análisis de las regresiones logísticas bivariadas y multivariadas examinaron las asociaciones entre las características de las redes sociales de apoyo y los comportamientos de toma de riesgo sexual en YMSM Negros , Hispanos/Latinos , y Blancos . Los análisis bivariados indicaron diferencias claves en el tamaño de las redes , la composición , la frecuencia de la comunicación y el promedio de la duración de las relaciones por raza/origen étnico . En los análisis multivariados , control and o para los factores sociodemográficos a nivel individual , los factores psicosociales y de relaciones , tener un compañero sexual en la redes sociales de apoyo del individuo estuvo asociado con el comportamiento sexual sin protección para los YMSM Hispanos/Latinos ( AOR = 3.90 ) y Blancos ( AOR = 4.93 ) . Un examen más detallado de las características clave de las redes en los diferentes grupos raciales/étnicos se justifica con el fin de comprender mejor los mecanismos existentes para proveer program 
    Output:
    
The current review reveals a complex picture of this relationship across diverse population s. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general .
However , influences of social support on HIV-related risk behaviors are inconsistent within drug users , men who have sex with men and adolescents .