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Carmack C, Nganga S, Ahmed E, Coleman T. Concept Mapping STI/HIV Prevention and Condom Use among Young African American Adults. Behav Sci (Basel) 2024; 14:501. [PMID: 38920833 PMCID: PMC11201233 DOI: 10.3390/bs14060501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 06/27/2024] Open
Abstract
Theory-based HIV prevention programs have resulted in increased condom use, which remains the best method for the prevention of sexually transmitted infections (STIs) among sexually active heterosexual individuals. Particularly, the integrative model of behavior prediction theorizes that attitudes, norms, self-efficacy, and socioenvironmental factors influence intention and behavior and has been useful in understanding STI risk among adolescents. However, more research is needed regarding young African American adults. Given the increased freedom and decision-making independence afforded to young adults compared to adolescents, it is important to consider the STI/human immunodeficiency virus (HIV) prevention messages that would resonate with them, particularly regarding condom use. The present study sought to explore how attitudes, subjective norms, self-efficacies, and socioenvironmental factors may influence condom use and STI/HIV prevention, as conceptualized by the participants. We conducted a group-based concept map, a systems-thinking mixed methodology that resulted in a geospatial map reflecting the conceptualizations of the participants. Self-identified young heterosexual African American adults (N = 43) aged 20-26 engaged in an interactive concept mapping procedure in order to "map out" their overarching concepts about STI/HIV risk and condom use. Seven overall conceptual domains emerged: self-efficacy for partner communication, condom use self-efficacy, social media/sociocultural influences, condom use/STI knowledge, condom use cons, condom use pros, and subjective and social norms about condom use. We presented the concept map and discussed the conceptual interpretations and the relationships among the overarching concepts. We also discussed how the social environment, including the social media environment, was conceptualized regarding STI/HIV risk and prevention among young African American adults. Concept mapping can be viewed as a way to determine worthwhile messages for intervention development. The findings may provide information for prevention programs aimed at reducing the incidence of STIs among young adult heterosexual persons within African American communities.
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Affiliation(s)
- Chakema Carmack
- Psychological Health and Learning Sciences Department, University of Houston, Houston, TX 77204, USA; (E.A.); (T.C.)
- Health Research Institute—Research Center in Minority Institution (HRI-RCMI), University of Houston, Houston, TX 77204, USA
- Center for Health Equity and Evaluation Research (CHEER), Texas A&M University, College Station, TX 77843, USA
| | - Sarah Nganga
- Legacy Community Health, Houston, TX 77009, USA;
| | - Eisha Ahmed
- Psychological Health and Learning Sciences Department, University of Houston, Houston, TX 77204, USA; (E.A.); (T.C.)
| | - Taylor Coleman
- Psychological Health and Learning Sciences Department, University of Houston, Houston, TX 77204, USA; (E.A.); (T.C.)
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2
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Pichon LC, Rossi KR, Chapple-McGruder T, Krull LJ, Kmet J, Carswell AL. A Pilot Outreach HIV Testing Project Among Homeless Adults. Front Public Health 2021; 9:703659. [PMID: 34395372 PMCID: PMC8356944 DOI: 10.3389/fpubh.2021.703659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Memphis metropolitan statistical area (MSA) represents a Deep Southern U.S. city disproportionally affected by the ongoing transmission of new HIV cases as well as those diagnosed in late-stage disease. This region is a subset of nine states, including Memphis, Tennessee (project site), driving the epidemic in the United States. Memphis ranks 4th among all U.S. MSAs for new HIV infections and has been identified in the CDC's Ending the HIV Epidemic Initiative as a high HIV burden geographic focus area. The Memphis Ryan White Part A Program conducted a pilot project among adults seeking services in Memphis emergency and transitional housing shelters to offer on-site, rapid HIV testing. In this paper we describe the results from this aforementioned pilot study, including the rate of HIV test acceptance and potential factors associated with a history of HIV testing in Memphis. Methods: Community-engaged research approaches were employed via a partnership between the local health department, a federally qualified faith-based health center, and an academic university. An interviewer-administered survey to measure potential factors associated with HIV testing history and voluntary HIV testing services were offered to adults living in transitional housing establishments. Bivariate chi-square analyses were performed to determine the association between predisposing, enabling, and need variables with HIV testing history in the past 12 months. Results: Survey respondents (n = 109) were mostly cisgender male (n = 96; 88.1%), African American (n = 79; 72.5%) and reported engaging in condomless sex in the past 12 months (n = 55; 50.5%). Acceptability and uptake of HIV testing was high (n = 97; 89.0%). Conclusions: Implementing rapid HIV testing programs outside of traditional health care settings is a strategy that can be used to engage high-risk individuals and those unaware of their HIV status to get tested. To our knowledge, this study represents the first that documents HIV testing acceptance rates offered outside of traditional health care settings for homeless and transitionally housed adults in a Deep Southern state.
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Affiliation(s)
- Latrice C Pichon
- School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Kristen Rae Rossi
- Battelle Formerly Shelby County Health Department, Memphis, TN, United States
| | | | - Lisa Jane Krull
- School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Jennifer Kmet
- Shelby County Health Department, Bureau of Epidemiology and Infectious Diseases, Memphis, TN, United States
| | - April L Carswell
- School of Public Health, The University of Memphis, Memphis, TN, United States
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3
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Serier KN, Venner KL, Hernandez-Vallant A. The Condom Use Self-Efficacy Scale in Substance Use Disorder Treatment-Seeking American Indian Adults. Subst Use Misuse 2021; 56:2066-2073. [PMID: 34590538 DOI: 10.1080/10826084.2021.1963988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American Indians (AIs) experience substance use disorder and sexual risk related inequities with elevated rates of sexually transmitted infections, unintended pregnancy, and fetal alcohol spectrum disorders. Substance misuse is associated with risky sexual behaviors including condomless sex. Objectives: The current study aimed to test the validity of the Condom Use Self-Efficacy Scale (CUSES) and the relationship between self-efficacy and condom use behaviors in AI individuals with substance use disorders (SUDs). Exploratory analyses also examined changes in condom use self-efficacy across SUD treatment. Methods: As part of a larger randomized controlled trial, AI individuals (N = 79) seeking SUD treatment completed baseline measures of condom use self-efficacy and sexual risk behaviors. Results: Confirmatory factor analysis (CFA) indicated that a 3-factor, 10-item version of the CUSES was a reliable and valid measure in this population. Condom use self-efficacy was associated with condom use behavior and increased during SUD treatment. Conclusions: Overall, it appears that the CUSES is a valid measure in AI individuals, is related to condom use behavior, and increases with SUD treatment. There is a need for future research to integrate these findings into AI cultural values. Addressing sexual risk behaviors in SUD treatment may be an important target and future research is needed to understand predictors of condom use self-efficacy and determine potential intervention targets to reduce sexual risk behaviors and related health inequities.
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Affiliation(s)
- Kelsey N Serier
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcohol, Substance use, & Addiction, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcohol, Substance use, & Addiction, University of New Mexico, Albuquerque, New Mexico, USA
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4
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Padilla M, Frazier EL, Carree T, Luke Shouse R, Fagan J. Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States - Medical Monitoring Project, 2009-2015. AIDS Care 2019; 32:594-599. [PMID: 31650855 DOI: 10.1080/09540121.2019.1683808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homelessness is a challenge to retention in HIV care and adherence to antiretroviral therapy. We describe the sociodemographic and behavioral characteristics of HIV-positive adults who reported recent homelessness. The Medical Monitoring Project is a complex sample survey of HIV-positive adults receiving medical care in the United States. We used weighted interview and medical record data collected from June 2009 to May 2015 to estimate the prevalence of depression, substance use, and HIV risk behaviors among adults experiencing recent homelessness. From 2009 to 2015, 8.3% of HIV-positive adults experienced recent homelessness. Homeless adults were more likely than housed adults to have major depression, to binge drink, use non-injection drugs, use injection drugs, and smoke. Over 60% of homeless adults were sexually active during the past year, with homeless adults reporting more condomless sex with an HIV-negative or unknown status sex partner than housed adults. Programs attempting to improve the health outcomes of HIV-positive homeless persons and reduce ongoing HIV transmission can focus on providing basic needs, such as housing, and ancillary services, such as mental health counseling or substance abuse treatment and counseling.
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Affiliation(s)
- Mabel Padilla
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma L Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamara Carree
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,ICF International, Atlanta, GA, USA
| | - R Luke Shouse
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fagan
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Schumacher A, Marzell M, Toepp AJ, Schweizer ML. Association Between Marijuana Use and Condom Use: A Meta-Analysis of Between-Subject Event-Based Studies. J Stud Alcohol Drugs 2019; 79:361-369. [PMID: 29885143 DOI: 10.15288/jsad.2018.79.361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With the current public health burden of sexually transmitted infections, it is important to identify factors affecting condom use. The association between marijuana use and condom use is especially important because of the increasing number of U.S. states legalizing marijuana; however, relevant research findings are mixed. The goal of this study was to perform a meta-analysis assessing the relationship between marijuana and condom use at instances of sexual intercourse. METHOD A systematic search of four databases was performed. Data were extracted and pooled estimates were calculated using random-effects models with inverse variance weighting. Heterogeneity was evaluated using the Cochran Q chi-square test. RESULTS Eleven studies were included. There was a statistically significant relationship between marijuana and condom use in the overall pooled analysis (odds ratio [OR] = 0.71, 95% CI [0.56, 0.89]), and studies were homogeneous, I2 = 12%, χ2(10) = 11.37, p = .33. Stratified analyses showed that although the pooled OR was not significant for adults (OR = 0.92, 95% CI [0.64, 1.33]), there was a significant relationship between condom use and marijuana use for adolescents (OR = 0.62, 95% CI [0.47, 0.82]). CONCLUSIONS This meta-analysis found that the odds of condom use were lower for those who used marijuana around the time of intercourse than for those who did not, with this effect only significant for adolescents in a subgroup analysis. As the adolescent populations in this analysis were not representative of a general population of adolescents, future research should focus not only on those considered high risk.
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Affiliation(s)
- Amy Schumacher
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Miesha Marzell
- Department of Social Work, College of Community and Public Affairs, Binghamton University, Binghamton, New York
| | - Angela J Toepp
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Marin L Schweizer
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Taylor JEB, Surey J, MacLellan J, Francis M, Abubakar I, Stagg HR. Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study. BMC Infect Dis 2019; 19:372. [PMID: 31046683 PMCID: PMC6498651 DOI: 10.1186/s12879-019-3926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed ‘hard-to-reach’ by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20–0.92]); 70.1% coverage with two or more factors, 0.19 [0.09–0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24–4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration ISRCTN24707359, Registered 19th October 2012. Electronic supplementary material The online version of this article (10.1186/s12879-019-3926-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josephine E B Taylor
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Julian Surey
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Jennifer MacLellan
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Marie Francis
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.
| | - Helen R Stagg
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.,Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
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7
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Green SM, Turner D, Baldwin JA, Walsh-Buhi ER, Vamos CA, Dagne G, Marhefka SL. Towards an Information Motivation and Behavioral Skills Model for New Sex Partners: Results of a Study of Condom Use as an HIV Prevention Method for Emerging Adults Who Met Partners on Dating and Sex-Seeking Platforms or Offline. AIDS Behav 2019; 23:1115-1134. [PMID: 30506475 DOI: 10.1007/s10461-018-2349-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants' IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners.
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Begun S, Combs KM, Torrie M, Bender K. "It seems kinda like a different language to us": Homeless youths' attitudes and experiences pertaining to condoms and contraceptives. SOCIAL WORK IN HEALTH CARE 2019; 58:237-257. [PMID: 30407128 DOI: 10.1080/00981389.2018.1544961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 06/08/2023]
Abstract
Homeless youth become pregnant or involved in pregnancies at high rates. There are many ways by which unintended pregnancies may be prevented, including the use of condoms and other contraceptives. However, there is a dearth of research regarding contraceptive use among this vulnerable youth population, and especially through lenses that consider homeless youths' diverse gender identities, expressions, and sexualities. This study qualitatively explores homeless youths' attitudes and experiences regarding condom and other contraceptive use. Data were obtained from interviews with 30 youth experiencing homelessness, ages 18-21. Youth reported inconsistent use of condoms and other contraceptives, which youth often attributed to their perceptions of contraceptive inaccessibility and exorbitant cost. Most youth also did not know where to obtain contraceptive information and services, and reported transportation barriers and fear of being stigmatized in health care settings, particularly in relation to their gender identities and sexualities. Findings suggest that reproductive and sexual health information and services are urgently needed by all homeless young people, and from low-barrier, non-judgmental, and empathetic sources.
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Affiliation(s)
- Stephanie Begun
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Katie Massey Combs
- b Graduate School of Social Work , University of Denver , Denver , CO USA
| | - Michaela Torrie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kimberly Bender
- b Graduate School of Social Work , University of Denver , Denver , CO USA
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Yoshioka-Maxwell A, Rice E. Exploring the Relationship Between Foster Care Experiences and HIV Risk Behaviors Among a Sample of Homeless Former Foster Youth. AIDS Behav 2019; 23:792-801. [PMID: 30715636 PMCID: PMC6497403 DOI: 10.1007/s10461-019-02417-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent research shows high rates of poor behavioral health outcomes among homeless former foster youth, including increased risk for HIV-risk behaviors. In the current study, data were collected from 184 youth at drop-in centers in Los Angeles using behavioral health questionnaires to explore the relationships between specific aspects of foster care experiences and engagement in HIV-risk behaviors. Results indicated that youth whose first homelessness experience occurred before leaving foster care were significantly more likely to engage in drug use with sex and exchange sex than those whose first homelessness experience occurred after leaving foster care. Intervention services targeting HIV-risk behaviors should consider the aspects of foster care placements that may increase the risk of these behaviors, such as long periods of placement or experiencing homelessness before exiting foster care, as well as those that may decrease the risk of these behaviors, such as exiting placement at an older age.
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Affiliation(s)
- Amanda Yoshioka-Maxwell
- Myron B. Thompson School of Social Work, University of Hawaii at Manoa, 2430 Campus Rd., Gartley Hall, 201E, Honolulu, HI, 96822, USA.
| | - Eric Rice
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
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10
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Wenzel SL, Rhoades H, La Motte-Kerr W, Duan L, Harris T, Rice E, Henwood BF. Do HIV risk and prevention behaviors change over time among adults in permanent supportive housing? AIDS Care 2019; 31:1172-1177. [PMID: 30724581 DOI: 10.1080/09540121.2019.1576849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Persons experiencing homelessness have a disproportionate burden of HIV infection and high rates of HIV risk behavior. Permanent supportive housing (PSH) has been identified as a primary solution to homelessness, but little is known about HIV sexual risk behavior among persons in PSH, nor about how HIV risk and prevention behavior may change as persons move from homelessness into PSH. Utilizing longitudinal data from 421 persons prior to moving in and over their first year living in PSH, this study assesses change over time in HIV risk and prevention behavior utilizing generalized linear mixed models. Results reveal changes in sexual risk behavior over time, including an overall increase in the rate of sexual activity, but a decrease in rates of some sexual risk behaviors, including condomless sex and multiple partners. While decreasing overall, the prevalence of condomless sex remains high (63%) at 12-months. Combined with a precipitous drop in HIV prevention programming exposure (from 56% at baseline to 23% at 12-months), only two-thirds of those sexually active reporting a past year HIV test at 12-months post-housing, and rare use of PrEP, these findings suggest a need for additional attention to promotion of sexual health behaviors and HIV prevention within PSH.
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Affiliation(s)
- Suzanne L Wenzel
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Harmony Rhoades
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Wichada La Motte-Kerr
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Lei Duan
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Taylor Harris
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Eric Rice
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Benjamin F Henwood
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
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11
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Fleisch SB, Nash R. Medical Care of the Homeless. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Santa Maria D, Hernandez DC, Arlinghaus KR, Gallardo KR, Maness SB, Kendzor DE, Reitzel LR, Businelle MS. Current Age, Age at First Sex, Age at First Homelessness, and HIV Risk Perceptions Predict Sexual Risk Behaviors among Sexually Active Homeless Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E218. [PMID: 29373568 PMCID: PMC5858287 DOI: 10.3390/ijerph15020218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/13/2018] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually active homeless adults from a cross-sectional study of participants (n = 610) recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s), and multiple sexual partners (≥4 sexual partners) in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness.
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Affiliation(s)
- Diane Santa Maria
- Department of Nursing Systems, School of Nursing, University of Texas Health Science Center, Houston, TX 77030, USA.
| | - Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA.
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA.
| | - Katherine R Arlinghaus
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA.
- Department of Health Promotion and Behavioral Sciences School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA.
| | - Kathryn R Gallardo
- Department of Health Promotion and Behavioral Sciences School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA.
| | - Sarah B Maness
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73019, USA.
| | - Darla E Kendzor
- Health Sciences Center, University of Oklahoma, Oklahoma City, OK 73104, USA.
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA.
| | - Michael S Businelle
- Health Sciences Center, University of Oklahoma, Oklahoma City, OK 73104, USA.
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13
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Barman-Adhikari A, Hsu HT, Begun S, Portillo AP, Rice E. Condomless Sex Among Homeless Youth: The Role of Multidimensional Social Norms and Gender. AIDS Behav 2017; 21:688-702. [PMID: 27885551 DOI: 10.1007/s10461-016-1624-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.
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Affiliation(s)
- Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Stephanie Begun
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA
| | - Andrea Perez Portillo
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, USA
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Abstract
Homeless persons die significantly younger than their housed counterparts. In many cases, relatively straightforward primary care issues escalate into life-threatening, expensive emergencies. Poor health outcomes driven by negative interactions between comorbid symptoms meet the definition of a health syndemic in this population. Successful primary care of patients struggling with homelessness may result in long-term lifesaving measures along with decreased expenditure to hospital systems. This primary prevention requires patience, creativity, and acknowledgment that the source of many confounders may lay outside the control of these patients.
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Affiliation(s)
- Sheryl B Fleisch
- Vanderbilt University School of Medicine, 2215 Garland Avenue, Light Hall, Nashville, TN 37232, USA
| | - Robertson Nash
- Vanderbilt Comprehensive Care Clinic, Vanderbilt Health at One Hundred Oaks, 719 Thompson Lane, Suite 37189, Nashville, TN 37204, USA.
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15
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Klein H, Sterk CE, Elifson KW. Knowledge about HIV in a Community Sample of Urban African Americans in the South. ACTA ACUST UNITED AC 2016; 7. [PMID: 27891291 PMCID: PMC5123594 DOI: 10.4172/2155-6113.1000622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Race and HIV are intertwined in complex ways. African Americans, particularly those residing in the southern United States, are at great risk for contracting and subsequently transmitting HIV. Research on the extent to which members of this population understand the risks associated with engaging in specific behaviors is limited. This paper examines HIV knowledge among at-risk adult African American men and women and the factors associated with levels of HIV knowledge. METHODS Based on a conceptual model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2011. Questionnaire-based interviews were conducted with 1,864 respondents from 80 strategically-chosen census block groups in Atlanta, Georgia. An innovative approach to assessing amount of HIV knowledge was implemented, to derive better estimates of the extent of knowledge. RESULTS Overall, HIV knowledge was low (average=43.5% correct answers). Seven factors were identified as contributing uniquely to having higher levels of knowledge about HIV transmission: (1) younger age, (2) being educated beyond the high school level, (3) being gay, lesbian or bisexual, (4) experiencing sexual abuse during childhood and/or adolescence, (5) drinking alcohol less frequently, (6) knowing a larger number of HIV-infected persons and (7) knowing anyone currently living with "full blown" AIDS. CONCLUSION HIV educational and intervention programs targeting at-risk African American adults need to develop effective ways of bolstering a solid understanding of how HIV is/not transmitted. In particular, efforts need to be targeted toward older adults, those with lower levels of educational attainment and persons who are not acquainted with anyone who is HIV-infected.
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Affiliation(s)
- H Klein
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University Atlanta, Georgia
| | - C E Sterk
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University Atlanta, Georgia
| | - K W Elifson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University Atlanta, Georgia
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16
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Nehl EJ, Elifson K, DePadilla L, Sterk C. Sex Partner Type, Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender? JOURNAL OF SEX RESEARCH 2016; 53:805-815. [PMID: 26580813 PMCID: PMC5006675 DOI: 10.1080/00224499.2015.1092018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.
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Affiliation(s)
- Eric J. Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
| | - Kirk Elifson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
| | - Lara DePadilla
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
| | - Claire Sterk
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
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17
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Hsu HT, Wenzel S, Rice E, Gilreath TD, Kurzban S, Unger J. Understanding Consistent Condom Use Among Homeless Men Who Have Sex with Women and Engage in Multiple Sexual Partnerships: A Path Analysis. AIDS Behav 2015; 19:1676-88. [PMID: 25845531 DOI: 10.1007/s10461-015-1051-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Consistent condom use is the main strategy aimed at preventing individuals from acquiring HIV through sexual intercourse. The mechanism of consistent condom use among a high-risk homeless subpopulation-homeless men who have sex with women and also engage in multiple sexual partnerships-remains unclear. This study identified 182 homeless men who engaged in multiple sexual partnerships from a representative sample of homeless men, who self-identified as heterosexual, using meal line services in Downtown Los Angeles' Skid Row area. Information such as participants' condom use psychosocial correlates, sexual risk behaviors, and social network characteristics were collected. Results suggested that condom efficacy is a potential intervening mechanism through which condom attitudes (β = -0.199; p = 0.005) and depression (β = -0.156; p = 0.029) are associated with an individual's consistent condom use. Having more network members with whom participants talked about HIV prevention (β = 0.051; p = 0.006) was also found to be associated with an individual's consistent condom use. HIV prevention programs should focus on increasing their condom efficacy to help reduce HIV risks among this vulnerable homeless subpopulation.
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18
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Song A, Wenzel SL. The association of social networks with substance use among homeless men in Los Angeles who have unprotected sex with women. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2013.875075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Tucker JS, Wenzel SL, Kennedy DP, Golinelli D, Ewing B. Sex trade behavior among heterosexually active homeless men. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1535-44. [PMID: 23720137 PMCID: PMC3773285 DOI: 10.1007/s10508-013-0122-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 06/19/2012] [Accepted: 03/31/2013] [Indexed: 06/02/2023]
Abstract
Sex trade behavior is fairly common among homeless adults and may contribute to higher rates of HIV/AIDS in this population. This study provides a detailed examination of the sex trade-related attitudes and behaviors of homeless men by: (1) determining the prevalence of sex trade-related behaviors, including sex with female sex workers (FSWs); (2) identifying risk factors for having sex with FSWs; and (3) comparing men's relationships with FSWs and non-FSWs in terms of relationship qualities and HIV-related risk behaviors, such as condom use. Structured interviews were conducted with a probability sample of 305 heterosexually active homeless men recruited from meal lines in Los Angeles. Recent sex with a FSW was reported by 26 % of men, and more likely among those who were older, used crack cocaine, had more sex partners, believed that sometimes men just need to have sex no matter what, and were embedded in networks that were denser and where risky sex was more normative. Compared to non-FSW partners, men with FSW partners felt less emotionally close to them, were more likely to believe the partner had never been tested for HIV, and were more likely to have sex with them under the influence of drugs or alcohol; however, they were not more likely to talk about using condoms or to use condoms with FSWs. Whether the relationship was considered "serious" was a stronger correlate of condom use than whether the partner was a FSW. Implications of these findings for HIV prevention efforts among homeless adults are discussed.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90407-2138, USA,
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20
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Brown RA, Kennedy DP, Tucker JS, Golinelli D, Wenzel SL. Monogamy on the Street: A Mixed-Methods Study of Homeless Men. JOURNAL OF MIXED METHODS RESEARCH 2013; 7:10.1177/1558689813480000. [PMID: 24327811 PMCID: PMC3856210 DOI: 10.1177/1558689813480000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In this study, we used a mixed methods approach to explore the determinants of relationship patterns and risky sex among homeless men living in downtown Los Angeles. This involved analysis of qualitative interviews focused on gender ideology and sexual events ( n = 30) as well as structured interviews ( n = 305) focused on homeless men’s sexual partners, sexual behaviors, and social networks. We found that men valued committed relationships but were frustrated by their lack of access to female partners (accentuated by the stigma attached to homeless males) and also by structural and logistical barriers to relationships. Some men reported monogamous relationships; such relationships were less likely with homeless or substance-using partners and more likely with partners central to men’s social networks.
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Affiliation(s)
- Ryan A. Brown
- RAND Corporation – RAND Health, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90402, T. 310 393 0411 x.6234, F. 310 392 4818
| | - David P. Kennedy
- RAND Corporation – RAND Health, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90402, T. 310 393 0411 x.6234, F. 310 392 4818
| | - Joan S. Tucker
- RAND Corporation – RAND Health, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90402, T. 310 393 0411 x.6234, F. 310 392 4818
| | - Daniela Golinelli
- RAND Corporation – RAND Health, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90402, T. 310 393 0411 x.6234, F. 310 392 4818
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21
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Kennedy DP, Wenzel SL, Brown R, Tucker JS, Golinelli D. Unprotected sex among heterosexually active homeless men: results from a multi-level dyadic analysis. AIDS Behav 2013; 17:1655-67. [PMID: 23212852 DOI: 10.1007/s10461-012-0366-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV is a serious public health problem for homeless populations. Homeless men who have sex with women have received less attention in the HIV risk literature than other homeless populations. This research uses multi-level modeling to investigate the context of unprotected sex among heterosexually active homeless men in the Skid Row area of Los Angeles. Based on interviews with 305 randomly selected men who discussed 665 of their recent female sexual relationships, this project investigates the correlates of unprotected sex during the past 6 months at the partnership, individual, and social network levels. Several different measures of relationship closeness and lack of communication about HIV/condoms were associated with unprotected sex. Controlling for relationship factors, men's negative attitudes towards condoms, mental health, and higher number of male sex partners also were associated with having unprotected sex with female partners. We discuss the implications of these findings for health interventions.
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