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Kalichman SC. Commentary on Whittle et al. (2019): Food insecurity, substance use and women living with/or at risk for HIV-temporal relations and underlying mechanisms. Addiction 2019; 114:137-138. [PMID: 30537425 DOI: 10.1111/add.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, USA
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Kalichman SC, Mathews C, Banas E, Kalichman MO. Stigma management intervention to improve antiretroviral therapy adherence: Phase-I test of concept trial, Cape Town South Africa. Glob Public Health 2018; 14:1059-1074. [PMID: 30500309 DOI: 10.1080/17441692.2018.1552307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Combination antiretroviral therapy (cART) has transformed HIV infection from a universally fatal disease to a medically manageable chronic illness. We conducted a Phase-I test of concept intervention trial to examine feasibility and potential efficacy of behavioural self-regulation counselling designed to improve care retention and cART adherence. The intervention was culturally adapted from client-centered evidence-based interventions that are grounded in behavioural self-regulation theory and available in the US. The intervention adaptation included enhancements to directly address HIV stigma and alcohol-related sources of nonadherence. Fifty patients receiving cART in Cape Town, South Africa were randomised to receive either: (a) five weekly cellphone-delivered sessions of stigma and alcohol-enhanced behavioural self-regulation counselling or (b) a contact matched control condition. Participants were baseline assessed and followed for two weeks post-intervention, with 94% of participants retained throughout the study. Participants receiving the intervention significantly improved cART adherence from baseline-to-follow up and improvement was significantly greater than the control condition. Behaviours related to stigma and alcohol use that impede cART adherence were significantly reduced, and there was uptake of adherence improvement strategies. The current study supports the potential efficacy of relatively brief behavioural self-regulation counselling delivered by cellphone in a context of differentiated care in South Africa.
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Affiliation(s)
- Seth C Kalichman
- a Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, CT , USA
| | - Catherine Mathews
- b Health Systems Research Unit, South African Medical Research Council , Cape Town , South Africa
| | - Ellen Banas
- b Health Systems Research Unit, South African Medical Research Council , Cape Town , South Africa
| | - Moira O Kalichman
- a Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, CT , USA
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Kalichman SC, Mathews C, Banas E, Kalichman MO. Treatment adherence in HIV stigmatized environments in South Africa: stigma avoidance and medication management. Int J STD AIDS 2018; 30:362-370. [PMID: 30501366 DOI: 10.1177/0956462418813047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stigmatization of HIV infection undermines antiretroviral therapy (ART) adherence. The current study examined strategies that people living with HIV employ to manage their ART in stigmatized environments. We conducted an anonymous survey with 439 patients receiving ART at a community clinic in Cape Town, South Africa. Measures included demographic and health characteristics, ART adherence, stigma experiences, efforts to conceal ART to avoid stigma (stigma-medication management strategies), and beliefs that ART nonadherence itself is stigmatizing. One in four participants had forgone taking their ART in social settings to avoid stigmatization, a behavior associated with younger age, experiencing greater stigma, and poorer ART adherence. Regression models found stigma-medication management strategies significantly predicted ART nonadherence over and above age, gender, alcohol use, and HIV stigma experiences. We also found that a significant majority of participants believed that having unsuppressed HIV and ART nonadherence are irresponsible and should be reprimanded by clinicians. Results show that the behavioral effects of stigma directly impede ART adherence. The behaviors that patients may employ to avoid stigma are amenable to interventions to directly improve ART adherence while managing stigma concerns.
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Affiliation(s)
- Seth C Kalichman
- 1 Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Ellen Banas
- 1 Department of Psychology, University of Connecticut, Storrs, CT, USA.,2 South African Medical Research Council, Tygerberg, South Africa
| | - Moira O Kalichman
- 1 Department of Psychology, University of Connecticut, Storrs, CT, USA
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Carey KB, Walsh JL, Merrill JE, Lust SA, Reid AE, Scott-Sheldon LAJ, Kalichman SC, Carey MP. Using e-mail boosters to maintain change after brief alcohol interventions for mandated college students: A randomized controlled trial. J Consult Clin Psychol 2018; 86:787-798. [PMID: 30138017 DOI: 10.1037/ccp0000339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Brief motivational interventions (BMIs) reduce drinking in the short term, but these initial effects often decay. We tested the hypothesis that theory-based e-mail boosters would promote maintenance of change after a BMI. METHOD Participants were students (N = 568; 72% male) who violated campus alcohol policy and were mandated to participate in an alcohol-risk-reduction program. Participants provided baseline data, received a BMI, and then completed a 1-month post-BMI survey. Next, they were randomized to receive 12 booster e-mails that contained either (a) alcohol norms or (b) structurally equivalent general health information (control). Alcohol consumption and alcohol-related consequences were assessed at baseline, 1, 3, 5, 8, and 12 months. RESULTS As expected, we observed significant reductions in both consumption and consequences after the BMI (ps < .01), and groups were equivalent at baseline and at 1-month post-BMI, prior to randomization (ps > .05). Latent growth curve models revealed no condition effects on changes in the latent consumption variable from 1- to 12-month follow-ups (b = .01, SE = .01, p > .05). Unexpectedly, a main effect of the condition emerged for self-reported consequences (b = .03, SE = .01, p = .01); we observed more consequences after boosters containing alcohol norms than general health information. Outcomes were not moderated by sex, consumption at baseline or 1 month, or e-mail exposure, and there was no mediation by descriptive norms, injunctive norms, or peer communication. CONCLUSIONS Contrary to predictions, e-mail boosters with corrective norms content did not improve outcomes after a BMI. (PsycINFO Database Record
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Affiliation(s)
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Medical College of Wisconsin
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | | | | | | | | | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital
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Pellowski JA, Huedo-Medina TB, Kalichman SC. Food Insecurity, Substance Use, and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis. Arch Sex Behav 2018; 47:1899-1907. [PMID: 28429158 PMCID: PMC5650554 DOI: 10.1007/s10508-017-0942-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/02/2023]
Abstract
People living with HIV in poverty have limited tangible and mental resources coupled with competing demands for these resources. Competing demands require individuals to make choices that may be beneficial to them in the short term but not in the long term. Past research has shown that food insecurity is related to sexual risk behaviors among people living with HIV. Individuals who are food insecure may sell sex in order to obtain food or lack of food may lead to a depletion of mental resources to negotiate safe sex. Substance use may also create additional constraints on these already limited resources. The current study tested the relation between food insecurity and day-level sexual risk behavior and the possible mediating role that alcohol/substance use may play. Men and women living with HIV were enrolled in a 28-day prospective study between October 2012 and April 2014 in which they completed daily text message surveys regarding their sex behaviors and substance/alcohol use in the context of sex. A total of 796 participants reported sex on 3894 days. On days in which sex occurred, baseline food insecurity was negatively associated with daily condom use. There was also a significant effect of substance use in the context of sex on the rates of change in condom use over time, and this interaction between substance use and time was a partial mediator of the relation between food insecurity and condom use. Gender did not moderate this mediation. Situation-specific alcohol and drug use should be integrated into interventions that target food insecurity and HIV prevention.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, 2nd Floor, Providence, RI, 02903, USA.
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences and Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Abstract
HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.
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Affiliation(s)
- Andrew C Cortopassi
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
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Kalichman SC, Mathews C, Kalichman M, Lurie MN, Dewing S. Perceived barriers to partner notification among sexually transmitted infection clinic patients, Cape Town, South Africa. J Public Health (Oxf) 2018; 39:407-414. [PMID: 27222237 DOI: 10.1093/pubmed/fdw051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Public health approaches to sexually transmitted infection (STI) prevention in resource-limited countries rely on patients to self-notify sex partners of their STI. However, a majority of partners go uninformed and remain untreated and infectious. Methods Anonymous surveys collected from 776 men and women receiving STI clinic services in Cape Town, South Africa. Results Half of patients surveyed intended to inform their partners, while half did not intend to notify partners. Women were more likely than men to intend to notify their partners. Patients who completed formal education were also more likely to indicate intentions to notify partners. There were no associations between numbers of partners patients had or partner types with intentions to notify partners. Among both men and women, concerns about adverse partner reactions were associated with intentions not to notify partners. Multivariable analyses stratified by gender and controlling for confounds showed that intentions to notify partners were significantly related to men's concerns that their partner could react violently against them and women's concerns that their partner may leave them and refuse to see them again. Conclusions Interventions that assist patients to develop strategies to safely inform their partners are needed to increase patient-initiated partner notification.
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Affiliation(s)
| | | | | | - Mark N Lurie
- Brown University School of Public Health, Providence, RI, USA
| | - Sarah Dewing
- South African Medical Research Council, Cape Town, South Africa
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Kalichman SC, Cherry C, Kalichman MO, Eaton LA, Kohler J, Montero C, Schinazi RF. Mobile Health Intervention to Reduce HIV Transmission: A Randomized Trial of Behaviorally Enhanced HIV Treatment as Prevention (B-TasP). J Acquir Immune Defic Syndr 2018; 78:34-42. [PMID: 29406429 PMCID: PMC5889341 DOI: 10.1097/qai.0000000000001637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We conducted a randomized clinical trial to test a mobile health behavioral intervention designed to enhance HIV treatment as prevention (B-TasP) by simultaneously increasing combination antiretroviral therapies (cART) adherence and improving the sexual health of people living with HIV. METHODS A cohort of sexually active men (n = 383) and women (n = 117) living with HIV were enrolled. Participants were baseline assessed and randomized to either (1) B-TasP adherence and sexual health intervention or (2) general health control intervention. Outcome measures included HIV RNA viral load, cART adherence monitored by unannounced pill counts, indicators of genital tract inflammation, and sexual behaviors assessed over 12 months. RESULTS Eighty-six percent of the cohort was retained for 12-month follow-up. The B-TasP intervention demonstrated significantly lower HIV RNA, OR = 0.56, P = 0.01, greater cART adherence, Wald χ = 33.9, P = 0.01, and fewer indicators of genital tract inflammation, Wald χ = 9.36, P = 0.05, over the follow-up period. Changes in sexual behavior varied, with the B-TasP intervention showing lower rates of substance use in sexual contexts, but higher rates of condomless sex with non-HIV positive partners occurred in the context of significantly greater beliefs that cART reduces HIV transmission. CONCLUSIONS Theory-based mobile health behavioral interventions can simultaneously improve cART adherence and sexual health in people living with HIV. Programs aimed to eliminate HIV transmission by reducing HIV infectiousness should be bundled with behavioral interventions to maximize their impact and increase their chances of success.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Moira O. Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - James Kohler
- Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine
| | - Catherine Montero
- Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine
| | - Raymond F. Schinazi
- Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine
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Kalichman SC, Kalichman MO. HIV-Related Stress and Life Chaos Mediate the Association Between Poverty and Medication Adherence Among People Living with HIV/AIDS. J Clin Psychol Med Settings 2018; 23:420-430. [PMID: 27873055 DOI: 10.1007/s10880-016-9481-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV treatment depends on high-levels of antiretroviral therapy (ART) adherence, which is severely impeded by poverty. Men and women living with HIV infection (N = 92) completed computerized interviews of demographic and health characteristics, poverty markers, stressful life events, and life chaos, as well as unannounced pill counts to determine prospective medication adherence and medical record chart abstractions for HIV viral load. Poverty markers were associated with both stressors and chaos, and the direct effects of all three factors predicted ART non-adherence. The multiple mediation model showed that accounting for stressors and chaos resulted in a non-significant association between poverty markers and ART adherence. The indirect effect of poverty markers on adherence through life chaos was significant, whereas the indirect effect of poverty markers on adherence through stressors was not significant. Factors that render HIV-related stress and create chaos offer intervention targets that are more amenable to change than poverty itself.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Moira O Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Cruess DG, Burnham KE, Finitsis DJ, Goshe BM, Strainge L, Kalichman M, Grebler T, Cherry C, Kalichman SC. A Randomized Clinical Trial of a Brief Internet-based Group Intervention to Reduce Sexual Transmission Risk Behavior Among HIV-Positive Gay and Bisexual Men. Ann Behav Med 2018; 52:116-129. [PMID: 29538626 PMCID: PMC6361295 DOI: 10.1093/abm/kax031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background HIV disproportionately affects sexual minority men, and developing strategies to reduce transmission risk is a public health priority. Purpose The goal was to empirically test a newly developed, Information, Motivation, Behavioral skills (IMB) theoretically derived, online HIV sexual risk reduction intervention (called HINTS) among a sample of sexual minority men living with HIV. Methods Participants were 167 men randomized to either the four-session online HINTS intervention or to a time-matched, online control condition. Participants were assessed at baseline and at 6-month follow-up for demographic, medical and psychosocial factors, and sexual risk behavior. Analyses examined group differences in incidence rates of condomless anal sex (CAS) at follow-up with all male sex partners and by partner serostatus, either seroconcordant or serodiscordant for HIV infection. Results Men assigned to the HINTS intervention reported decreased CAS with serodiscordant partners, a behavior that confers high risk of HIV transmission, compared to the control group. Men assigned to the HINTS intervention also reported increased CAS with seroconcordant partners, a behavior indicative of serosorting. Although the IMB model did not appear to mediate these intervention effects, some IMB components were associated with behavioral outcomes at 6-month follow-up. Conclusions A new group-based sexual risk reduction intervention conducted exclusively online was successful in reducing HIV transmission risk behavior in a sample of gay and bisexual men living with HIV. Future work should consider utilizing this intervention with other groups living with HIV, perhaps in combination with biomedical HIV prevention strategies.
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Affiliation(s)
- Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Kaylee E Burnham
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - David J Finitsis
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Brett M Goshe
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Lauren Strainge
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Tamar Grebler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
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Carey KB, Merrill JE, Walsh JL, Lust SA, Kalichman SC, Carey MP. Predictors of short-term change after a brief alcohol intervention for mandated college drinkers. Addict Behav 2018; 77:152-159. [PMID: 29032317 DOI: 10.1016/j.addbeh.2017.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/05/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Brief motivational interventions (BMIs) reduce problematic drinking for some, but not all, college students. Identifying those students who are less responsive can help to guide intervention refinement. Therefore, we examined demographic, personality, and cognitive factors hypothesized to influence change after a BMI. METHOD Students mandated for intervention following a campus alcohol violation (N=568; 28% female, 38% freshmen) completed a baseline assessment, then received a BMI, and then completed a 1-month follow-up. At both assessments, alcohol use (i.e., drinks per week, typical BAC, binge frequency) and alcohol-related problems were measured. RESULTS Latent change score analyses revealed significant decrease in both alcohol use and problems 1month after the BMI. In the final model that predicted change in alcohol use, four factors (male sex, a "fun seeking" disposition, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in alcohol use over time. In the final model that predicted change in alcohol-related problems, three factors (stronger beliefs about the centrality of alcohol to college life, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in problems over time. CONCLUSIONS Participation in a BMI reduced alcohol use and problems among mandated college students at 1-month follow-up. We identified predictors of these outcomes, which suggest the need to tailor the BMI to improve its efficacy among males and those students expressing motives (pro and cons, and fun seeking) and beliefs about the centrality of drinking in college.
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Affiliation(s)
- Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sarah A Lust
- Department of Social Sciences, Maryville University, St. Louis, MO, United States
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, United States; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
| | - Michael P Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States; Centers for Preventive and Behavioral Medicine, The Miriam Hospital, Providence, RI, United States
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Hernandez D, Kalichman SC, Katner HP, Burnham K, Kalichman MO, Hill M. Psychosocial complications of HIV/AIDS-metabolic disorder comorbidities among patients in a rural area of southeastern United States. J Behav Med 2018; 41:441-449. [PMID: 29383534 DOI: 10.1007/s10865-018-9912-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 01/13/2018] [Indexed: 02/05/2023]
Abstract
As people living with HIV experience longer life-expectancies resulting from antiretroviral therapy, comorbid conditions are increasing, particularly metabolic disorders. There is potential for psychosocial factors such as stigma experiences, depression, and alcohol use to complicate both HIV infection and metabolic disorders, including diabetes mellitus and hyperlipidemia. While the impact of these psychosocial factors on HIV infection alone are widely studied, their role in potentially complicating HIV co-morbid metabolic conditions has received little attention. This study examined the association between HIV-related stigma and depression, and the potential role of alcohol use as a mediating factor in a clinical sample of patients with comorbid HIV infection and metabolic conditions. Results demonstrated that HIV stigma is associated with depression and this relationship is in part accounted for by alcohol use. Our results indicate that interventions aiming to improve the health of people living with HIV and co-morbid metabolic disorders should prioritize addressing alcohol use as it is related to sources of stress, such as stigma, and depression.
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Affiliation(s)
- Dominica Hernandez
- University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA.
| | - Seth C Kalichman
- University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | | | - Kaylee Burnham
- University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Moira O Kalichman
- University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Marnie Hill
- Mercer University Medical School, Macon, GA, USA
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63
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Pellowski JA, Kalichman SC, Cherry S, Conway-Washington C, Cherry C, Grebler T, Krug L. The Daily Relationship Between Aspects of Food Insecurity and Medication Adherence Among People Living with HIV with Recent Experiences of Hunger. Ann Behav Med 2017; 50:844-853. [PMID: 27333898 DOI: 10.1007/s12160-016-9812-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Limited access to resources can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between lacking access to nutritious food and antiretroviral (ARV) medication non-adherence in a variety of social contexts. PURPOSE This study aims to determine if several aspects of food insecurity co-occur with missed doses of medication on a daily basis among a sample of people living with HIV who have recently experienced hunger. METHODS The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Participants were followed for 45 days and completed daily assessments of food insecurity and alcohol use via interactive text message surveys and electronic medication adherence monitoring using the Wisepill. RESULTS Fifty-nine men and women living with HIV contributed a total of 2,655 days of data. Results showed that severe food insecurity (i.e., hunger), but not less severe food insecurity (i.e., worrying about having food), significantly predicted missed doses of medication on a daily level. Daily alcohol use moderated this relationship in an unexpected way; when individuals were hungry and drank alcohol on a given day, they were less likely to miss a dose of medication. CONCLUSIONS Among people living with HIV with recent experiences of hunger, this study demonstrates that there is a daily relationship between hunger and non-adherence to antiretroviral therapy. Future research is needed to test interventions designed to directly address the daily relationship between food insecurity and medication non-adherence.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Sabrina Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Larissa Krug
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Mathews C, Kalichman MO, Laubscher R, Hutchison C, Nkoko K, Lurie M, Kalichman SC. Sexual relationships, intimate partner violence and STI partner notification in Cape Town, South Africa: an observational study. Sex Transm Infect 2017; 94:144-150. [PMID: 29191815 PMCID: PMC5870461 DOI: 10.1136/sextrans-2017-053434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/11/2017] [Indexed: 11/10/2022] Open
Abstract
Objectives We aimed to identify individual and sexual partnership characteristics associated with partner notification (PN) among people with STI. We hypothesised that PN would be less likely in more casual sexual partnerships and in partnerships with intimate partner violence (IPV). Methods We conducted an observational study among the first 330 patients with STI enrolled in a trial of a behavioural intervention to reduce STI incidence, at a clinic in a poor, Cape Town community. We included 195 index patients (those reporting STI symptoms), and conducted longitudinal analyses using participant-completed questionnaires on the day of diagnosis and 2 weeks later. Using partnership data for five recent sexual partners, we assessed factors associated with reported PN with logistic regressions, adjusting for repeated measurements on the same participant for each partner. Results The sample included 99 males with 303 partners and 96 females with 158 partners. Males reported perpetrating IPV in 46.2% of partnerships. Females reported being IPV victims in 53.2% of partnerships. Males notified 58.1%, females 75.4% of partners during the 2 weeks following diagnosis. Type of partner was an independent correlate of PN for males and females, with the odds of PN lower in more casual partnerships. For males, reporting physical IPV perpetration in the partnership was an independent correlate of PN. For females, there was no association between IPV victimisation in a partnership and PN. Conclusions Efforts to decrease the pool of infectious partners need to have a strong focus on the promotion of PN in casual relationships and one-night stands. IPV was not identified as a barrier to PN. In future, we need to investigate the association between IPV with an objective measure of PN success such as partner testing or treatment, or index patient reinfection. Clinical trial registration PACTR201606001682364; Pre-results.
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Affiliation(s)
- Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Cameron Hutchison
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Koena Nkoko
- City of Cape Town Health Department, Cape Town, South Africa
| | - Mark Lurie
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
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Kalichman SC, Cherry C. Male polyurethane condoms do not enhance brief HIV-STD risk reduction interventions for heterosexually active men: results from a randomized test of concept. Int J STD AIDS 2017. [DOI: 10.1177/095646249901000811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current study examined the effects of a brief HIV risk reduction intervention for men. Participants were recruited (n=108) from an urban public health clinic and randomly assigned to one of 3 experimental intervention conditions: (1) 3 h HIV-STD risk reduction behavioural skills building latex condom intervention; (2) the same 3 h skills workshop but focused on male polyurethane condoms; or (3) a 3 h HIV education workshop. Results showed all 3 interventions increased AIDS knowledge and positively influenced attitudes, but men who received the polyurethane condom skills intervention were more likely to request condoms at follow ups. In addition, men who received either of the 2 skills interventions evidenced increased condom use at the one-month follow up, with no differences at 3-month follow up. This study is among the first to test a brief HIV risk reduction intervention for men and is the first to test whether polyurethane male condoms enhance HIV risk reduction efforts.
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Affiliation(s)
- Seth C Kalichman
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin
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Kiene SM, Kalichman SC, Sileo KM, Menzies NA, Naigino R, Lin CD, Bateganya MH, Lule H, Wanyenze RK. Efficacy of an enhanced linkage to HIV care intervention at improving linkage to HIV care and achieving viral suppression following home-based HIV testing in rural Uganda: study protocol for the Ekkubo/PATH cluster randomized controlled trial. BMC Infect Dis 2017; 17:460. [PMID: 28673251 PMCID: PMC5494823 DOI: 10.1186/s12879-017-2537-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/09/2017] [Indexed: 01/05/2023] Open
Abstract
Background Though home-based human immunodeficiency virus (HIV) counseling and testing (HBHCT) is implemented in many sub-Saharan African countries as part of their HIV programs, linkage to HIV care remains a challenge. The purpose of this study is to test an intervention to enhance linkage to HIV care and improve HIV viral suppression among individuals testing HIV positive during HBHCT in rural Uganda. Methods The PATH (Providing Access To HIV Care)/Ekkubo Study is a cluster-randomized controlled trial which compares the efficacy of an enhanced linkage to HIV care intervention vs. standard-of-care (paper-based referrals) at achieving individual and population-level HIV viral suppression, and intermediate outcomes of linkage to care, receipt of opportunistic infection prophylaxis, and antiretroviral therapy initiation following HBHCT. Approximately 600 men and women aged 18-59 who test HIV positive during district-wide HBHCT in rural Uganda will be enrolled in this study. Villages (clusters) are pair matched by population size and then randomly assigned to the intervention or standard-of-care arm. Study teams visit households and participants complete a baseline questionnaire, receive HIV counseling and testing, and have blood drawn for HIV viral load and CD4 testing. At baseline, standard-of-care arm participants receive referrals to HIV care including a paper-based referral and then receive their CD4 results via home visit 2 weeks later. Intervention arm participants receive an intervention counseling session at baseline, up to three follow-up counseling sessions at home, and a booster session at the HIV clinic if they present for care. These sessions each last approximately 30 min and consist of counseling to help clients: identify and reduce barriers to HIV care engagement, disclose their HIV status, identify a treatment supporter, and overcome HIV-related stigma through links to social support resources in the community. Participants in both arms complete interviewer-administered questionnaires at six and 12 months follow-up, HIV viral load and CD4 testing at 12 months follow-up, and allow access to their medical records. Discussion The findings of this study can inform the integration of a potentially cost-effective approach to improving rates of linkage to care and HIV viral suppression in HBHCT. If effective, this intervention can improve treatment outcomes, reduce mortality, and through its effect on individual and population-level HIV viral load, and decrease HIV incidence. Trial registration NCT02545673
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Affiliation(s)
- Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rose Naigino
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Chii-Dean Lin
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA
| | - Moses H Bateganya
- Formerly: Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Kalichman SC, Kalichman MO, Cherry C, Grebler T. HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men. AIDS Patient Care STDS 2017; 30:221-8. [PMID: 27158850 DOI: 10.1089/apc.2015.0333] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. Results showed that 166 (30%) men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. Men who engaged in nondisclosed condomless sex were less adherent to their HIV treatment, more likely to have unsuppressed HIV, demonstrated poorer disclosure self-efficacy, enacted fewer risk reduction communication skills, and held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.
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Affiliation(s)
- Seth C. Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Moira O. Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, Connecticut
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Pellowski JA, Price DM, Allen AM, Eaton LA, Kalichman SC. The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV. Psychol Health 2017; 32:1127-1139. [PMID: 28475365 DOI: 10.1080/08870446.2017.1324969] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV. DESIGN A total of 458 HIV positive African-Americans completed a cross-sectional survey. MAIN OUTCOME MEASURES Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs. RESULTS All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = -.339 to -.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence. CONCLUSION Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.
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Affiliation(s)
- Jennifer A Pellowski
- a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
| | - Devon M Price
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Aerielle M Allen
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Lisa A Eaton
- c Department of Human Development and Family Sturdies , University of Connecticut , Storrs , CT , USA
| | - Seth C Kalichman
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
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Kalichman SC, Price D, Eaton LA, Burnham K, Sullivan M, Finneran S, Cornelius T, Allen A. Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997-2015. Arch Sex Behav 2017; 46:895-902. [PMID: 28168543 PMCID: PMC5967889 DOI: 10.1007/s10508-016-0934-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/13/2016] [Accepted: 12/28/2016] [Indexed: 05/15/2023]
Abstract
Community-wide awareness that antiretroviral therapies (ART) provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005-2006 (the 2006 survey over-sampled African-Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA.
| | - Devon Price
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Lisa A Eaton
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Kaylee Burnham
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Matthew Sullivan
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Stephanie Finneran
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Talea Cornelius
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Aerielle Allen
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
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Cruess DG, Burnham KE, Finitsis DJ, Cherry C, Grebler T, Goshe BM, Strainge L, Kalichman MO, Kalichman SC. Online Partner Seeking and Sexual Risk Among HIV+ Gay and Bisexual Men: A Dialectical Perspective. Arch Sex Behav 2017; 46:1079-1087. [PMID: 27671781 DOI: 10.1007/s10508-016-0833-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/09/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
For almost two decades, researchers have explored the relationship between online partner seeking (OPS) and HIV/STI transmission risk behavior among men who have sex with men (MSM), including gay- and bisexual-identified men. A dichotomy has emerged with some findings that OPS is associated with greater sexual risk behavior, and a sparser but emerging literature that men may use OPS for sexual risk reduction. This study examined the association between proportion of partners met online and sexual risk behavior in a sample of 170 HIV-positive gay- and bisexual-identified men. Participants completed assessments including psychosocial factors and a comprehensive assessment of sexual behavior, including total number of male partners, and condomless insertive and receptive anal sex with HIV-negative/unknown serostatus partners or HIV-positive male partners. Our findings support taking a dialectical stance and indicate that OPS may impact risk differently given different individual and contextual circumstances.
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Affiliation(s)
- Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA.
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA.
| | - Kaylee E Burnham
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - David J Finitsis
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Tamar Grebler
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Brett M Goshe
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Lauren Strainge
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
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Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men. AIDS Behav 2017; 21:1236-1246. [PMID: 28108878 DOI: 10.1007/s10461-017-1690-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The HIV/AIDS epidemic in the US continues to persist, in particular, among race, sexual orientation, and gender minority populations. Pre-exposure prophylaxis (PrEP), or using antiretroviral medications for HIV prevention, is an effective option, but uptake of PrEP has been slow. Sociocultural barriers to using PrEP have been largely underemphasized, yet have the potential to stall uptake and, therefore, warrant further understanding. In order to assess the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs), and interest in PrEP, Black men and transgender women who have sex with men (BMTW, N = 85) and White MTW (WMTW, N = 179) were surveyed at a gay pride event in 2015 in a large southeastern US city. Bivariate and multivariate logistic regression analyses were completed to examine factors associated with PrEP interest. Among the full sample, moderate levels of PrEP awareness (63%) and low levels of use (9%) were observed. Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behavior. Conspiracy beliefs related to PrEP were reported among a large minority of the sample (42%) and were more frequently reported among BMTW than WMTW. Given the strong emphasis on the use of biomedical strategies for HIV prevention, addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, CT, USA.
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Devon Price
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Stephanie Finneran
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Aerielle Allen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica Maksut
- Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
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Eaton LA, Kalichman SC, Kalichman MO, Driffin DD, Baldwin R, Zohren L, Conway-Washington C. Randomised controlled trial of a sexual risk reduction intervention for STI prevention among men who have sex with men in the USA. Sex Transm Infect 2017; 94:40-45. [PMID: 28404766 DOI: 10.1136/sextrans-2016-052835] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/08/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Novel interventions to address sexual risk taking and slow rates of STIs are urgently needed, in particular among black men who have sex with men (MSM) in the USA. Serosorting, or limiting condomless sex acts to partners of the same HIV status, is commonly practised among MSM, yet can lead to STI and remains largely unaddressed by public health agencies. METHODS A two-arm, randomised controlled trial was conducted from 2012 to 2015. This trial assessed the effects of a single-session, sexual partner selection and risk decision intervention (experimental arm) versus a single-session, Centers for Disease Control and Prevention-based, sexual risk reduction intervention (control arm) on psychosocial measures, sexual risk taking and STI. RESULTS At study follow-ups, multiple beneficial changes were observed on sexual risk beliefs measures (ie, changes in serosorting and condom use beliefs, and HIV risk perceptions) and sexual risk taking among the experimental arm relative to the control arm. Overall main effects, however, of the intervention on STI outcomes on year-long follow-ups were non-significant. There was evidence for short-term effects on STI outcomes, and self-report of multiple STIs and STI symptoms demonstrated positive effects over the follow-up period. CONCLUSIONS Brief interventions to address sexual risk taking can result in short-term beneficial outcomes and can be incorporated into currently existing infrastructure at healthcare agencies. Additional intervention will be necessary for demonstrating long-term results. TRIAL REGISTRATION NUMBER NCT02128594.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Moira O Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Daniel D Driffin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Robert Baldwin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Larissa Zohren
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Pitpitan EV, Kalichman SC, Eaton LA, Sikkema KJ, Watt MH, Skinner D, Pieterse D. Men's Behavior Predicts Women's Risks for HIV/AIDS: Multilevel Analysis of Alcohol-Serving Venues in South Africa. Prev Sci 2016; 17:472-82. [PMID: 26768432 DOI: 10.1007/s11121-015-0629-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South Africa has among the highest rates of HIV infection in the world, with women disproportionately affected. Alcohol-serving venues, where alcohol use and sexual risk often intersect, play an important role in HIV risk. Previous studies indicate alcohol use and gender inequity as drivers of this epidemic, yet these factors have largely been examined using person-level predictors. We sought to advance upon this literature by examining venue-level predictors, namely men's gender attitudes, alcohol, and sex behavior, to predict women's risks for HIV. We recruited a cohort of 554 women from 12 alcohol venues (6 primarily Black African, and 6 primarily Coloured [i.e., mixed race] venues) in Cape Town, who were followed for 1 year across four time points. In each of these venues, men's (N = 2216) attitudes, alcohol use, and sexual behaviors were also assessed. Men's attitudes and behaviors at the venue level were modeled using multilevel modeling to predict women's unprotected sex over time. We stratified analyses by venue race. As predicted, venue-level characteristics were significantly associated with women's unprotected sex. Stratified results varied between Black and Coloured venues. Among Black venues where men reported drinking alcohol more frequently, and among Coloured venues where men reported meeting sex partners more frequently, women reported more unprotected sex. This study adds to the growing literature on venues, context, and HIV risk. The results demonstrate that men's behavior at alcohol drinking venues relate to women's risks for HIV. This novel finding suggests a need for social-structural interventions that target both men and women to reduce women's risks.
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Affiliation(s)
- Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA. .,Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA. .,Department of Psychology, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT, 06269-1020, USA.
| | - Seth C Kalichman
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA. .,Department of Psychology, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT, 06269-1020, USA.
| | - Lisa A Eaton
- Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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Cornelius T, Jones M, Merly C, Welles B, Kalichman MO, Kalichman SC. Impact of food, housing, and transportation insecurity on ART adherence: a hierarchical resources approach. AIDS Care 2016; 29:449-457. [PMID: 27846730 DOI: 10.1080/09540121.2016.1258451] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Antiretroviral therapy (ART) has transformed HIV into a manageable illness. However, high levels of adherence must be maintained. Lack of access to basic resources (food, transportation, and housing) has been consistently associated with suboptimal ART adherence. Moving beyond such direct effects, this study takes a hierarchical resources approach in which the effects of access to basic resources on ART adherence are mediated through interpersonal resources (social support and care services) and personal resources (self-efficacy). Participants were 915 HIV-positive men and women living in Atlanta, GA, recruited from community centers and infectious disease clinics. Participants answered baseline questionnaires, and provided prospective data on ART adherence. Across a series of nested models, a consistent pattern emerged whereby lack of access to basic resources had indirect, negative effects on adherence, mediated through both lack of access to social support and services, and through lower treatment self-efficacy. There was also a significant direct effect of lack of access to transportation on adherence. Lack of access to basic resources negatively impacts ART adherence. Effects for housing instability and food insecurity were fully mediated through social support, access to services, and self-efficacy, highlighting these as important targets for intervention. Targeting service supports could be especially beneficial due to the potential to both promote adherence and to link clients with other services to supplement food, housing, and transportation. Inability to access transportation had a direct negative effect on adherence, suggesting that free or reduced cost transportation could positively impact ART adherence among disadvantaged populations.
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Affiliation(s)
- Talea Cornelius
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA.,b Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs , CT , USA
| | - Maranda Jones
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Cynthia Merly
- b Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs , CT , USA
| | - Brandi Welles
- b Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs , CT , USA
| | - Moira O Kalichman
- b Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs , CT , USA
| | - Seth C Kalichman
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA.,b Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs , CT , USA
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Choi KW, Watt MH, Skinner D, Kalichman SC, Sikkema KJ. "Wine you get every day, but a child you can't replace": The perceived impact of parental drinking on child outcomes in a South African township. J Child Adolesc Ment Health 2016; 27:173-87. [PMID: 26890399 DOI: 10.2989/17280583.2015.1113974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study explored the perceived impact of parental drinking on children in a South African township where alcohol abuse is prevalent and high levels of existing poverty and violence may exacerbate potential consequences on children. METHOD Qualitative in-depth interviews were conducted with 92 male and female participants recruited from alcohol-serving venues in Cape Town, South Africa. RESULTS Grounded theory analyses revealed three major aspects of parental drinking - intoxication, venue attendance and expenditures on alcohol - which participants linked to negative proximal outcomes (e.g., child neglect, abuse and exposure to alcohol culture) and long-term outcomes (e.g., fractured parent-child relationships and problematic youth behaviours). In addition, preliminary accounts from some participants suggested that parents may experience tensions between desires to reduce drinking for child-related reasons and complex factors maintaining their drinking behaviour, including the use of alcohol to cope with stressors and trauma. CONCLUSIONS This study provides novel insights into the consequences and motivations of parental drinking in a high-risk context. Contextual risks (e.g., poverty and violence) that exacerbate the impact of parental drinking on children may be the same factors that continue to shape intergenerational alcohol use in this community. Findings highlight opportunities for further research and interventions to support child protection in South Africa.
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Affiliation(s)
- Karmel W Choi
- a Duke University , Department of Psychology and Neuroscience , Durham , North Carolina , USA.,b Duke University , Duke Global Health Institute , Durham , North Carolina , USA
| | - Melissa H Watt
- b Duke University , Duke Global Health Institute , Durham , North Carolina , USA
| | - Donald Skinner
- c Stellenbosch University , Unit for Research on Health and Society , Tygerberg , South Africa
| | - Seth C Kalichman
- d University of Connecticut , Department of Psychology , Storrs , Connecticut , USA
| | - Kathleen J Sikkema
- a Duke University , Department of Psychology and Neuroscience , Durham , North Carolina , USA.,b Duke University , Duke Global Health Institute , Durham , North Carolina , USA
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76
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Watt MH, Eaton LA, Dennis AC, Choi KW, Kalichman SC, Skinner D, Sikkema KJ. Alcohol Use During Pregnancy in a South African Community: Reconciling Knowledge, Norms, and Personal Experience. Matern Child Health J 2016. [PMID: 26197733 DOI: 10.1007/s10995-015-1800-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Due to high rates of fetal alcohol spectrum disorder (FASD) in South Africa, reducing alcohol use during pregnancy is a pressing public health priority. The aim of this study was to qualitatively explore knowledge and attitudes about maternal alcohol consumption among women who reported alcohol use during pregnancy. METHODS The study was conducted in Cape Town, South Africa. Participants were pregnant or within 1 year postpartum and self-reported alcohol use during pregnancy. In-depth interviews explored personal experiences with drinking during pregnancy, community norms and attitudes towards maternal drinking, and knowledge about FASD. Transcripts were analyzed using a content analytic approach, including narrative memos and data display matrices. RESULTS Interviews revealed competing attitudes. Women received anti-drinking messages from several sources, but these sources were not highly valued and the messages often contradicted social norms. Women were largely unfamiliar with FASD, and their knowledge of impacts of fetal alcohol exposure was often inaccurate. Participants' personal experiences influenced their attitudes about the effects of alcohol during pregnancy, which led to internalization of misinformation. The data revealed a moral conflict that confronted women in this setting, leaving women feeling judged, ambivalent, or defensive about their behaviors, and ultimately creating uncertainty about their alcohol use behaviors. CONCLUSIONS Data revealed the need to deliver accurate information about the harms of fetal alcohol exposure through sources perceived as trusted and reliable. Individual-level interventions to help women reconcile competing attitudes and identify motivations for reducing alcohol use during pregnancy would be beneficial.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - Alexis C Dennis
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Karmel W Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Donald Skinner
- Unit for Research on Health and Society, Stellenbosch University, Cape Town, South Africa
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Carey KB, Lust SA, Reid AE, Kalichman SC, Carey MP. How Mandated College Students Talk About Alcohol: Peer Communication Factors Associated with Drinking. Health Commun 2016; 31:1127-34. [PMID: 26861808 PMCID: PMC4927376 DOI: 10.1080/10410236.2015.1045238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Relatively little research has examined how peer communication influences alcohol consumption. In a sample of mandated college students, we differentiate conversations about drinking from conversations about harm prevention and provide evidence for the validity of these communication constructs. Students who violated campus alcohol policies and were referred for alcohol sanctions (N = 345) reported on drinking patterns, use of protective behavioral strategies, perceived descriptive norms for close friends, and serving as social leader among their friends; they also reported on the frequency of conversations about drinking, about drinking safety, and about risk reduction efforts. Predicted correlations were found among types of communication and conceptually related variables. General communication was related to consumption but not protective behavioral strategies, whereas safety/risk reduction conversations correlated positively with all protective behavioral strategies. Both types of communication were associated with social leadership. Safety communication moderated the relationship between peer descriptive norms and drinks per week; more frequent talking about safety attenuated the norms-consumption relationship. Peer communication about both drinking and safety may serve as targets for change in risk reduction interventions for mandated college students.
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Affiliation(s)
- Kate B. Carey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Sarah A. Lust
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Center for Health Intervention and Prevention, University of Connecticut
| | - Allecia E. Reid
- Department of Behavioral and Social Sciences, Brown University School of Public Health
- Department of Psychology, Colby College
| | - Seth C. Kalichman
- Center for Health Intervention and Prevention, University of Connecticut
- Department of Psychology, University of Connecticut
| | - Michael P. Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health
- Department of Psychiatry and Human Behavior, Alpert Medical School
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital
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78
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Abstract
A paper-and-pencil Piagetian water-level task was administered to 250 undergraduate students within 5 college majors: engineering, natural sciences, social sciences, business, and language arts. Analysis showed significant differences between sexes and college majors. Men were significantly more accurate than women within each college major, and science majors were more accurate than liberal arts majors within each sex. Caution against treating college students as a homogeneous population in research using a water-level task is suggested.
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79
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Abstract
HIV infection is now clinically manageable with antiretroviral therapy (ART). However, a significant number of people with HIV do not benefit from ART because of non-adherence. This study examined the use of adherence strategies and barriers to adherence among persons at substantial risk for developing resistant virus (less than 75% adherent). People living with HIV (n = 556) who were less than 95% adherent to ART completed computerized interviews, were screened for active drug use, provided medical records for HIV viral load, and completed unannounced pill counts to monitor ART adherence and an assessment of adherence barriers. Based on pill counts, participants were defined as severely non-adherent (≤75% medications taken) and moderately non-adherent (>75% and <95% adherent). Results showed a broad array of memory devices were used to no avail across non-adherence groups. Individuals who were severely non-adherent were significantly more likely to attribute missing medications due to substance use and structural barriers, including running out of medications, inability to get to pharmacy, and inability to afford medications. Results suggest that interventions focused on memory lapses will be insufficient and should rather concentrate on substance use treatment and providing case management to resolve structural barriers to adherence.
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Affiliation(s)
- Seth C Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Moira O Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Chauncey Cherry
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
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80
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Kalichman SC, Cherry C, Kalichman MO, Washington C, Grebler T, Hoyt G, Merely C, Welles B. Sexual Behaviors and Transmission Risks Among People Living with HIV: Beliefs, Perceptions, and Challenges to Using Treatments as Prevention. Arch Sex Behav 2016; 45:1421-30. [PMID: 26292837 PMCID: PMC4761529 DOI: 10.1007/s10508-015-0559-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 05/15/2023]
Abstract
Antiretroviral therapy (ART) improves the health of people living with HIV and can reduce infectiousness, preventing HIV transmission. The potential preventive benefits of ART are undermined by beliefs that it is safe to have condomless sex when viral load is below levels of detection (infectiousness beliefs and risk perceptions). In this study, we hypothesized that infectiousness beliefs and HIV transmission risk perceptions would prospectively predict people living with HIV engaging in more condomless sex with HIV-negative and unknown HIV status sex partners. Sexually active HIV-positive men (n = 538, 76 %) and women (n = 166, 24 %) completed computerized interviews of sexually transmitted infection (STI) symptoms and diagnoses, unannounced pill counts for medication adherence, medical chart-abstracted HIV viral load, and 28 daily cell-phone-delivered prospective sexual behavior assessments. Results showed that a total of 313 (44 %) participants had engaged in condomless sex with HIV-negative/unknown status sex partners, and these individuals demonstrated higher rates of STI symptoms and diagnoses. Two-thirds of participants who had condomless sex with HIV-negative/unknown status partners had not disclosed their HIV status. Multivariable logistic regression models showed that beliefs regarding viral load and HIV infectiousness and perceptions of lower risk of HIV transmission resulting from HIV viral suppression predicted condomless sex with potentially uninfected partners over and above sex behaviors with HIV-positive partners and STI symptoms/diagnoses. Interventions that address HIV status disclosure and aggressively treat STI in sexually active people living with HIV should routinely accompany the use of HIV treatments as prevention.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Chauncey Cherry
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Christopher Washington
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Ginger Hoyt
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Cindy Merely
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Brandi Welles
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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81
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Abstract
Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the intervention development and intervention content of the social cognitive risk reduction intervention for HIV-positive persons. The effective five group session intervention focused on enhancing motivation through self-reflection and developing coping efficacy skills for HIV disclosure decision making, active listening, assertiveness, and problem solving for disclosure and transmission risk reduction behaviors. Intervention components were tailored for gender and sexual orientation and integrated skills practice sessions used role-plays couched within scenes from popular films. This intervention was demonstrated to be effective in a community-service delivery setting and can be adapted for implementation in HIV-related services delivered within support groups.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs 06269, USA.
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82
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Kalichman SC, Eaton L, Kalichman MO, Cherry C. Medication beliefs mediate the association between medical mistrust and antiretroviral adherence among African Americans living with HIV/AIDS. J Health Psychol 2016; 22:269-279. [PMID: 26311814 DOI: 10.1177/1359105315600239] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Medical mistrust is a significant barrier to medication adherence among African Americans living with HIV. In this study 380 African American people receiving antiretroviral therapy (ART) in a southern US city completed computerized measures at a community-based research site. Multiple mediation modeling showed that medical provider mistrust was associated with medication beliefs and ART adherence. Also, medication beliefs predicted adherence. The indirect effects of medical mistrust on adherence via medication beliefs was significant; the indirect effect was significant for medication concerns beliefs, but not medication necessity beliefs. Medication concerns beliefs therefore mediate the association between medical mistrust and ART adherence.
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83
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Kalichman SC, Eaton L, Kalichman MO, Grebler T, Merely C, Welles B. Race-based medical mistrust, medication beliefs and HIV treatment adherence: test of a mediation model in people living with HIV/AIDS. J Behav Med 2016; 39:1056-1064. [PMID: 27392477 DOI: 10.1007/s10865-016-9767-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
Race-based medical mistrust significantly predicts non-adherence to antiretroviral therapy (ART) in people living with HIV. The current study builds on previous research that shows beliefs about medication necessity (i.e., "My medicines protect me from becoming worse") and concerns (i.e., "Having to take my medicines worries me") mediate the association between race-based medical mistrust and medication adherence. Racial and ethnic minority men and women living with HIV and receiving ART (N = 178) in a southern US city completed computerized measures of demographic and health characteristics, telephone interviews of race-based medical mistrust and medication beliefs, and unannounced phone-based pill counts for ART adherence. Multiple mediation modeling showed that medical mistrust is related to medication necessity and concerns beliefs and ART adherence. Furthermore, medication necessity beliefs predicted ART adherence. The indirect effect of medical mistrust on adherence through medication necessity beliefs was also significant. Results confirm that medication necessity beliefs, although not concerns beliefs, mediate the association between medical mistrust and ART adherence. Medication necessity beliefs offer a viable target for interventions to improve ART adherence in the context of mistrust that patients may have for medical providers and health care systems.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Lisa Eaton
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Tama Grebler
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Cynthia Merely
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Brandi Welles
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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84
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Pellowski J, Mathews C, Kalichman MO, Dewing S, Lurie MN, Kalichman SC. Advancing Partner Notification Through Electronic Communication Technology: A Review of Acceptability and Utilization Research. J Health Commun 2016; 21:629-637. [PMID: 27144318 PMCID: PMC4948177 DOI: 10.1080/10810730.2015.1128020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A cornerstone of sexually transmitted infection (STI) prevention is the identification, tracing, and notification of sex partners of index patients. Although partner notification reduces disease burden and prevents new infections as well as reinfections, studies show that only a limited number of partners are ever notified. Electronic communication technologies, namely, the Internet, text messaging, and phone calls (i.e., e-notification), have the potential to expand partner services. We conducted a systematic review of studies that have investigated the acceptability and utility of e-notification. We identified 23 studies that met the following criteria: (a) 9 studies presented data on the acceptability of technology-based communications for contacting sex partner(s), and (b) 14 studies reported on the utilization of communication technologies for partner notification. Studies found high levels of interest in and acceptability of e-notification; however, there was little evidence for actual use of e-notification. Taken together, results suggest that electronic communications could have their greatest impact in notifying less committed partners who would otherwise be uninformed of their STI exposure. In addition, all studies to date have been conducted in resource-rich countries, although the low cost of e-notification may have its greatest impact in resource-constrained settings. Research is needed to determine the best practices for exploiting the opportunities afforded by electronic communications for expanding STI partner services.
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Affiliation(s)
- Jennifer Pellowski
- a Department of Psychology , University of Connecticut , Storrs , Connecticut , USA
- c Brown University School of Public Health , Providence , Rhode Island , USA
| | - Catherine Mathews
- b Health Systems Research Unit , South African Medical Research Council , Cape Town , South Africa
| | - Moira O Kalichman
- a Department of Psychology , University of Connecticut , Storrs , Connecticut , USA
| | - Sarah Dewing
- b Health Systems Research Unit , South African Medical Research Council , Cape Town , South Africa
| | - Mark N Lurie
- c Brown University School of Public Health , Providence , Rhode Island , USA
| | - Seth C Kalichman
- a Department of Psychology , University of Connecticut , Storrs , Connecticut , USA
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85
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Pellowski JA, Kalichman SC, Kalichman MO, Cherry C. Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication adherence and alcohol use among people living with HIV. AIDS Care 2016; 28:963-70. [PMID: 26964014 DOI: 10.1080/09540121.2016.1154134] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol-antiretroviral therapy (ART) interactive toxicity beliefs reflect perceived adverse outcomes of mixing alcohol and ART. Previous research has shown a significant relationship between alcohol-ART interactive toxicity beliefs and ART non-adherence, over and above other correlates of non-adherence such as human immunodeficiency virus (HIV)symptoms and frequency of alcohol use. Most past studies have collected data over extended periods and have not determined if alcohol use and missed medications occur at the day-level among people holding interactive toxicity beliefs. Previous daily analyses, however, have been limited by self-reported adherence and relatively short periods of observation. To address these gaps in the literature, men and women living with HIV in Atlanta, GA, were enrolled in a 45-day observational cohort study. Daily alcohol use was collected using two-way interactive text message surveys and daily adherence was collected via the Wisepill device. Fifty-seven participants completed a measure of alcohol-ART interactive toxicity beliefs and contributed 2565 days of daily data. Participants who endorsed high levels of interactive toxicity beliefs had significantly more days when they missed doses of medication. Alcohol-antiretroviral toxicity beliefs predicted missing doses of medication on days when participants were drinking and on days when they were not drinking. Multilevel multivariate regressions showed that these toxicity beliefs predicted daily missed doses of medication over and above quantity of alcohol consumed, depression and general medication concerns. This study replicates and extends previous literature and indicates the necessity of addressing alcohol-ART toxicity beliefs within adherence interventions.
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Affiliation(s)
- Jennifer A Pellowski
- a Department of Psychiatry and Human Behavior , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Seth C Kalichman
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Moira O Kalichman
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Chauncey Cherry
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
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86
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Glasman LR, Skinner D, Bogart LM, Kalichman SC, McAuliffe T, Sitzler CA, Toefy Y, Weinhardt LS. Do Assessments of HIV Risk Behaviors Change Behaviors and Prevention Intervention Efficacy? An Experimental Examination of the Influence of Type of Assessment and Risk Perceptions. Ann Behav Med 2016; 49:358-70. [PMID: 25385202 DOI: 10.1007/s12160-014-9659-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Behavioral assessments may change behaviors and responses to behavioral interventions, depending on assessment type and respondents' motivations. PURPOSE We observed effects on sexual behavior and human immunodeficiency virus (HIV) prevention intervention efficacy of interviews assessing recent HIV risk behavior frequency or HIV risk behavior events among respondents with different perceptions of their risk for HIV. METHODS Young South African sexually transmitted infection (STI) clinic clients (N=1,728) participated in a 3 (event-based vs. frequency-based vs. no interview) by 2 (evidence-based vs. standard of care risk-reduction session) RCT. RESULTS The interviews increased reported safer sexual behavior among youth with higher but not lower risk perceptions. The intervention session was less effective when combined with interviews, particularly among lower risk perception youth. Patterns replicated for both interviews. CONCLUSIONS HIV risk behavior assessments may increase resistance to interventions among unmotivated youth and enhance safer sexual behavior among motivated youth. Behavioral assessments may reduce HIV risk among motivated individuals.
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Affiliation(s)
- Laura R Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA,
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87
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Abstract
Limited health literacy has been shown to contribute to poor adherence to antiretroviral therapy (ART) in people living with HIV/AIDS. Given the mixed results of previous interventions for people with HIV and low health literacy, investigating possible targets for improved adherence is warranted. The present study aims to identify the correlates of optimal and suboptimal outcomes among participants of a recent skills-based medication adherence intervention. This secondary analysis included 188 men and women living with HIV who had low health literacy and who had complete viral load data. Adherence was assessed by unannounced pill count and follow-up viral loads were assessed by blood draw. Results showed that higher levels of health literacy and lower levels of alcohol use were the strongest predictors of achieving HIV viral load optimal outcomes. The interplay between lower health literacy and alcohol use on adherence should be the focus of future research.
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Affiliation(s)
- Jennifer A. Pellowski
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut
| | - Seth C. Kalichman
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut
| | - Tamar Grebler
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut
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88
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Abstract
Apart from individual alcohol drinking behavior, the context or places where people drink play a significant role in HIV transmission risk. In this paper, we review the research that has been conducted on alcohol venues to identify the social and structural factors (e.g., social norms, sexual behavior) that are associated with HIV risk in these places, to review HIV prevention interventions based in alcohol venues, and to discuss appropriate methodologies for alcohol venue research. Alcohol venues are defined here as places that sell or serve alcohol for onsite consumption, including bars, bottle stores, nightclubs, wine shops, and informal shebeens. Despite the many established HIV risk factors at play in alcohol venues, limited prevention strategies have been implemented in such places. A total of 11 HIV prevention interventions or programs were identified. HIV prevention interventions in alcohol venues may be conducted at the individual, social, or structural level. However, multilevel interventions that target more than one level appear to lead to the most sustainable behavior change. Strategies to incorporate alcohol venues in biomedical prevention strategies including antiretroviral therapy for alcohol users are also discussed.
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89
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Burnham KE, Cruess DG, Kalichman MO, Grebler T, Cherry C, Kalichman SC. Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online. AIDS Care 2015; 28:347-53. [PMID: 26461452 DOI: 10.1080/09540121.2015.1096894] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.
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Affiliation(s)
- Kaylee E Burnham
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Dean G Cruess
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Moira O Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Tamar Grebler
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Chauncey Cherry
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Seth C Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
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90
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Velloza J, Watt MH, Choi KW, Abler L, Kalichman SC, Skinner D, Pieterse D, Sikkema KJ. HIV/AIDS-related stigma in South African alcohol-serving venues and its potential impact on HIV disclosure, testing and treatment-seeking behaviours. Glob Public Health 2015; 10:1092-106. [PMID: 25630531 PMCID: PMC4519431 DOI: 10.1080/17441692.2014.1001767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Alcohol-serving venues in South Africa are sites for high-risk behaviours that may lead to HIV transmission. Prevention and treatment interventions are sorely needed in these settings, but HIV-related stigma may limit their effectiveness. This study explored expressions of stigma among alcohol-serving venue patrons in Cape Town and examined the potential impact of stigma on HIV disclosure, testing and treatment-seeking behaviours. A total of 92 in-depth interviews with male and female, black and coloured patrons were conducted. Transcripts were analysed via memo-writing and diagramming techniques. Many participants mentioned knowing other patrons living with HIV/AIDS (PLWH), and this visibility of HIV impacted expressions of HIV-related stigma. Participants discussed four forms of HIV-related stigma in the venues: fearing PLWH, fearing HIV acquisition, blaming others for spreading HIV and isolating PLWH. HIV visibility and expressions of HIV-related stigma, particularly fear of isolation, influenced participants' willingness to disclose their status. HIV-related stigma in the venues also appeared to indirectly influence testing and treatment-seeking behaviour outside the venue. Results suggest that efforts to change norms and reduce expressions of HIV-related stigma in alcohol-serving venues are necessary to successfully deliver tailored HIV prevention interventions and increase uptake of HIV testing and care in this important social setting.
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Affiliation(s)
| | - Melissa H. Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Karmel W. Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Laurie Abler
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Seth C. Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Donald Skinner
- Unit for Research on Health and Society, Stellenbosch University, Tygerberg, South Africa
| | - Desiree Pieterse
- Unit for Research on Health and Society, Stellenbosch University, Tygerberg, South Africa
| | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Kalichman SC, Grebler T, Amaral CM, McKerney M, White D, Kalichman MO, Cherry C, Eaton L. Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol. J Behav Med 2015; 37:1009-18. [PMID: 24022091 DOI: 10.1007/s10865-013-9536-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 08/25/2013] [Indexed: 11/30/2022]
Abstract
Food insecurity is associated with HIV treatment non-adherence and poor health outcomes for people living with HIV/AIDS. Given the poor nutritional status common to people who drink alcohol, food insecurity may be particularly problematic for HIV positive individuals who drink alcohol. To examine food insecurity among HIV positive men and women who drink alcohol and its association with antiretroviral therapy (ART) adherence, health outcomes and health service utilization. Adults living with HIV (N = 183) in Atlanta, Georgia who reported alcohol use in the previous week and were receiving ART participated in a 12-month cohort. Participants were recruited from infectious disease clinics and social services to complete computerized interviews, monthly-unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. Forty-three percent of participants experienced food insecurity during at least one month of the study period. Food insecurity was independently associated with suboptimal ART adherence and less suppressed HIV viral load over. Individuals who experienced food insecurity also had histories of more medical and psychiatric hospitalizations, and greater mental health problems. Food insecurity is prevalent among alcohol using people receiving ART and food insecurity is associated with treatment non-adherence, poor health outcomes, and increased medical and psychiatric hospitalizations.
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92
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Scott-Sheldon LA, Carey MP, Carey KB, Cain D, Simbayi LC, Mehlomakhulu V, Kalichman SC. HIV testing is associated with increased knowledge and reductions in sexual risk behaviours among men in Cape Town, South Africa. Afr J AIDS Res 2015; 12:195-201. [PMID: 25871481 DOI: 10.2989/16085906.2013.863219] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV testing benefits those who test positive, allowing them to receive treatment, but the benefits for those who test negative remain controversial. We evaluated the impact of testing on HIV knowledge and sexual risk among men in South Africa. Men were recruited from townships outside Cape Town and completed a survey that assessed testing history, knowledge, and sexual behaviours. Among the 820 participants, 516 (63%) reported being tested (82% tested negative, 6% tested positive, and 12% unknown). Compared to those who had never been tested for HIV, men who tested for HIV were more knowledgeable about HIV transmission, but did not differ on sexual risk behaviour. Knowledge moderated the effect of testing on sexual risk such that men reported fewer sexual partners (incidence rate ratio (IRR) = 0.91, 95% CI = 0.84, 0.98) and fewer unprotected anal sex events (IRR = 0.81, 95% CI = 0.66, 1.00) if they had been tested for HIV and were knowledgeable about HIV transmission. For men testing HIV-negative, knowledge predicted fewer sexual risk behaviours. Previous HIV testing is associated with enhanced knowledge, which moderates sexual risk behaviour among South African men living in Cape Town. Results suggest that HIV testing may increase knowledge and lead to reductions in sexual risk even when results are negative.
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Affiliation(s)
- Lori Aj Scott-Sheldon
- a Centers for Behavioral and Preventive Medicine , The Miriam Hospital , CORO West, Suite 309, 164 Summit Avenue, Providence , Rhode Island , USA
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93
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Kalichman SC, Grebler T, Amaral CM, McNerney M, White D, Kalichman MO, Cherry C, Eaton L. Viral suppression and antiretroviral medication adherence among alcohol using HIV-positive adults. Int J Behav Med 2015; 21:811-20. [PMID: 24085706 DOI: 10.1007/s12529-013-9353-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Substance use is a known predictor of poor adherence to antiretroviral therapies (ART) in people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Less studied is the association between substance use and treatment outcomes, namely, suppression of HIV replication. METHODS Adults living with HIV (N = 183) who reported alcohol use in the previous week and receiving ART were observed over a 12-month period. Participants completed computer interviews, monthly unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. HIV viral load was collected at baseline and 12-month follow-up from medical records. Analyses compared participants who had undetectable HIV viral loads at baseline and follow-up (sustained viral suppression) to those with unsustained viral suppression. Analyses also compared participants who were adherent to their medications (>85 % pills taken) over the year of observation to those who were nonadherent. RESULTS Fifty-two percent of participants had unsustained viral suppression; 47 % were ART nonadherent. Overall results failed to demonstrate alcohol use as a correlate of sustained viral suppression or treatment adherence. However, alcohol use was associated with nonadherence among participants who did not have sustained viral suppression; nonadherence in unsustained viral suppression patients was related to drinking on fewer days of assessment, missing medications when drinking, and drinking socially. CONCLUSIONS Poor HIV treatment outcomes and nonadherence were prevalent among adults treated for HIV infection who drink alcohol. Drinking in relation to missed medications and drinking in social settings are targets for interventions among alcohol drinkers at greatest risk for poor treatment outcomes.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA,
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94
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Watt MH, Sikkema KJ, Abler L, Velloza J, Eaton LA, Kalichman SC, Skinner D, Pieterse D. Experiences of forced sex among female patrons of alcohol-serving venues in a South African township. J Interpers Violence 2015; 30:1533-1552. [PMID: 24981006 PMCID: PMC4280349 DOI: 10.1177/0886260514540807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
South Africa has among the highest rates of forced sex worldwide, and alcohol use has consistently been associated with risk of forced sex in South Africa. However, methodological challenges affect the accuracy of forced sex measurements. This study explored the assessment of forced sex among South African women attending alcohol-serving venues and identified factors associated with reporting recent forced sex. Women (n = 785) were recruited from 12 alcohol-serving venues in a peri-urban township in Cape Town. Brief self-administered surveys included questions about lifetime and recent experiences of forced sex. Surveys included a single question about forced sex and detailed questions about sex by physical force, threats, verbal persuasion, trickery, and spiked drinks. We first compared the single question about forced sex to a composite variable of forced sex as unwanted sex by physical force, threats, or spiked drinks. We then examined potential predictors of recent forced sex (demographics, drinking behavior, relationship to the venue, abuse experiences). The single question about forced sex had low sensitivity (0.38); more than half of the respondents who reported on the detailed questions that they had experienced forced sex by physical force, threats, or spiked drinks reported on the single question item that they had not experienced forced sex. Using our composite variable, 18.6% of women reported lifetime and 10.8% reported recent experiences of forced sex. In our adjusted logistic regression model, recent forced sex using the composite variable was significantly associated with hazardous drinking (OR = 1.92), living farther from the venue (OR = 1.81), recent intimate partner violence (OR = 2.53), and a history of childhood sexual abuse (OR = 4.35). The findings support the need for additional work to refine the assessment of forced sex. Efforts to prevent forced sex should target alcohol-serving venues, where norms and behaviors may present particular risks for women who frequent these settings.
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95
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Abstract
AIDS is only one of several life threatening social problems facing people living in poverty. HIV/AIDS prevention messages and prevention programmes should be framed within the context of relevant social problems. The current study examined public perceptions of AIDS as a relative social problem and AIDS-related socio-political beliefs among South African men and women living in a Black township of Cape Town. Participants (224 men and 276 women) completed surveys that assessed perceptions of HIV/AIDS relative to nine other social problems: lack of housing, transportation, poor sanitation, sufficient food, unemployment, discrimination, poor education, violence and crime. Participants also responded to six items assessing socio-political views of AIDS. Results showed that AIDS was perceived as a serious social problem in the township, but was perceived as less serious than crime and not different from violence and unemployment. Principal components factor analyses showed that AIDS was associated with multiple social problems and that AIDS was most closely associated with crime and violence, representing social problems that directly cause death. Although AIDS perceptions were similar to those expressed by the South African government, there was evidence for some mistrust about both what the government was doing and what it was saying about AIDS. HIV prevention messages in South Africa should be tailored to fit the perceived social context of AIDS.
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Affiliation(s)
- Seth C Kalichman
- a Department of Psychology , University of Connecticut , 406 Babbidge Road , Storrs , CT , 06269 , USA
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Eaton LA, Cain DN, Pitpitan EV, Carey KB, Carey MP, Mehlomakulu V, Simbayi LC, Mwaba K, Kalichman SC. Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. J Prim Prev 2015; 35:255-65. [PMID: 24806889 DOI: 10.1007/s10935-014-0346-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
South African townships have among the highest rates of HIV infection in the world. Considerable research on understanding the high rates of HIV transmission in this country has identified alcohol use as a critical factor in driving the HIV epidemic. Although the relationship between alcohol use and sexual risk-taking is well documented, less is known about how other factors, such as food insecurity, might be important in understanding alcohol's role in sexual risk-taking. Furthermore, prior research has highlighted how patterns of alcohol use and sexual risk-taking tend to vary by gender. We examined how food insecurity is related to both alcohol use and sexual risk-taking. We administered anonymous community surveys to men (n = 1,137) and women (n = 458) residing within four contiguous Black African townships outside of Cape Town, South Africa. In multivariate linear regression, we found that food insecurity was related to having higher numbers of male sex partners and condom-protected sex acts among women only. These relationships, however, were fully mediated by women's alcohol use. Among men, we found that food insecurity was negatively related to unprotected sex; that is, men with greater food security reported more unprotected sex acts. Unlike the results found among women, this relationship was not mediated by alcohol use. Food insecurity appears to be an important factor in understanding patterns of sexual risk-taking in regards to gender and alcohol use, and may serve as an important point of intervention for reducing HIV transmission rates.
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Affiliation(s)
- Lisa A Eaton
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA,
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA,
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98
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Abstract
One particularly vulnerable population for HIV treatment non-adherence is persons with poor health literacy skills. For these individuals, it is important to simplify medication taking as much as possible by integrating medication adherence into other routine health behaviors. This study aims to ascertain the relationship between medication adherence and other health behaviors. Adults living with HIV (N = 422) completed intake measures and 3 months of unannounced pill counts. Endorsement of diet and exercise behaviors at intake predicted higher medication adherence, over and above other known predictors of medication adherence such as HIV symptoms, depression, social support, and stress. These results support integrating strategies for medication management into a constellation of routine health practices.
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99
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Affiliation(s)
- Seth C. Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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100
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Kalichman SC, Washington C, Grebler T, Hoyt G, Welles B, Kegler C, Kalichman MO, Cherry C. Medication Adherence and Health Outcomes of People Living with HIV Who Are Food Insecure and Prescribed Antiretrovirals That Should Be Taken with Food. Infect Dis Ther 2015; 4:79-91. [PMID: 25613643 PMCID: PMC4363219 DOI: 10.1007/s40121-015-0057-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Food insecurity is a well-established predictor of poor health outcomes. Antiretroviral therapies (ARTs) that should be taken with food to increase bioavailability may further challenge food insecure patients. This study examined factors associated with antiretroviral adherence and HIV viral suppression among people living with HIV who are food insecure and prescribed medications that require food. METHODS A community sample of 313 men and 105 women who experienced food insecurity in the previous month and were currently taking ART completed computerized interviews, urine screening for drug use, prospective biweekly unannounced pill count adherence assessments, and obtained their HIV viral load and CD4 cell counts from medical records. RESULTS Individuals taking ART regimens that should be taken with food were significantly more likely to be unemployed, were living longer with an HIV diagnosis, had lower CD4 cell counts, poorer HIV suppression, and endorsed more beliefs that taking medications was necessary for their health. Multivariable regression models controlling for potential confounding factors showed that receiving ART that requires food was significantly related to poorer ART adherence and unsuppressed HIV in this food insecure sample. CONCLUSION People living with HIV who are food insecure likely experience multiple facets of poverty that challenge their medication adherence, but food insecurity is the only such factor that is directly related to the pharmacokinetics of some antiretroviral medications. Achieving optimal treatment outcomes for HIV infection will require routine assessment of access to food when determining patient-tailored ART regimens.
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