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A three-arm randomised controlled trial to evaluate the efficacy of a positive psychology and social networking intervention in promoting mental health among HIV-infected men who have sex with men in China. Epidemiol Psychiatr Sci 2021; 30:e24. [PMID: 33736740 PMCID: PMC8061281 DOI: 10.1017/s2045796021000081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS There is a lack of mental health promotion and treatment services targeting HIV-positive men who have sex with men (HIVMSM) in China. The aim of this study was to evaluate the mental health promotion efficacy of an online intervention that combined Three Good Things (TGT) with electronic social networking (TGT-SN) and an intervention that used TGT only (TGT-only), compared with a control group. METHODS We conducted a randomised controlled trial among HIVMSM in Chengdu, China. The participants were randomly assigned to the TGT-SN, TGT-only, and control groups. The participants in the TGT-SN group were divided into five social network groups and asked to post brief messages to the group about three good things that they had experienced and for which they felt grateful. The participants in the TGT-only group were only required to write down their three good things daily without sharing them with others. The control group received information about mental health promotion once a week for a month. The primary outcome was probable depression. Secondary outcomes were anxiety, positive and negative affect, gratitude, happiness and social support. These outcomes were assessed at baseline, 1, 3, 6 and 12 months after the intervention. Repeated-measures analyses were conducted using generalised estimation equations. The study was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-13003252). RESULTS Between June 2013 and May 2015, 404 participants were enrolled and randomly assigned to either the TGT-SN (n = 129), TGT-only (n = 139) or control group (n = 136). The main effects of TGT-SN (adjusted odds ratio (aOR) = 0.75, 95% CI 0.52-1.09; p = 0.131) and TGT-only (aOR = 0.83, 95% CI 0.57-1.21; p = 0.332) in reducing depression were statistically non-significant. The participants of the TGT-SN group showed significantly lower anxiety symptoms (aOR = 0.62, 95% CI 0.43-0.89; p = 0.009) and negative affect (β = -1.62, 95% CI 2.98 to -0.26; p = 0.019) over time compared with those of the control group. No significant main effect was found for any secondary outcomes for the TGT-only group. CONCLUSIONS The novel intervention combining the TGT exercise with electronic social networking was found effective in reducing anxiety and negative affect among HIVMSM.
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Mannes ZL, Dunne EM, Ferguson EG, Cook RL, Ennis N. Symptoms of generalized anxiety disorder as a risk factor for substance use among adults living with HIV. AIDS Care 2020; 33:623-632. [PMID: 32835502 DOI: 10.1080/09540121.2020.1808163] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study examined the association between symptoms of generalized anxiety disorder (GAD) and substance use among 932 people living with HIV (PLWH) in Florida. PLWH completed a 45-minute questionnaire assessing demographics, symptoms of GAD and depression, and use of substances including alcohol, cigarettes, marijuana, crack/cocaine, and injection drugs. The GAD-7 measured symptoms of anxiety and participants were categorized as experiencing none/mild anxiety (score 0-9) or moderate/severe symptoms (score ≥10). Adjusted binary logistic regressions assessed the association between moderate-severe GAD symptoms and substance use while controlling for covariates, including depressive symptoms. Approximately one-third (31.4%) of the sample reported experiencing moderate/severe symptoms of GAD. After controlling for covariates, PLWH with moderate/severe symptoms of GAD had greater odds of reporting current cigarette use (AOR = 1.70, 95% CI = 1.18-2.45 p = 0.004), past 30-day hazardous alcohol consumption (AOR = 1.50, 95% CI = 1.04-2.16, p = 0.028), and past 12-month non-injection crack/cocaine use (AOR = 1.75, 95% CI = 1.13-2.69, p = 0.011) compared to PLWH reporting none/mild symptoms. Findings demonstrate that moderate/severe GAD symptoms were common among this sample of PLWH in Florida and were associated with use of cigarettes, crack/cocaine, and hazardous alcohol consumption. Future studies should explore interventions to reduce comorbid anxiety and substance use.
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Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Alpert Medical School, Brown University, Providence, RI, United States
| | - Erin G Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, United States
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Center for Translational Behavioral Science, Tallahassee, FL, United States
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3
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Ramirez-Garcia MP, Leclerc-Loiselle J, Gagnon MP, Côté J, Brouillette MJ, Thomas R. A mixed-method randomized feasibility trial evaluating progressive muscle relaxation or autogenic training on depressive symptoms and quality of life in people living with human immunodeficiency virus (HIV) who have depressive symptoms. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 18:165-174. [PMID: 32621729 DOI: 10.1515/jcim-2019-0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/06/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive muscle relaxation (PMR) and autogenic training (AT) are effective relaxation techniques to reduce depressive symptoms. However, no studies on their effectiveness have been conducted among people living with HIV and depressive symptoms. The primary aim of this pilot study was to assess the feasibility and acceptability of PMR and AT interventions among people living with HIV who have depressive symptoms. A secondary aim was to assess the potential effectiveness of these interventions on depressive symptoms and quality of life. METHODS This study was a three-arm pilot randomized control trial with mixed methods. Participants were randomized to PMR, AT, or a control group (CG), with four assessments (baseline, and at one, three, and six months). The PMR and AT interventions consisted of six 1 h sessions of individual training over 12 weeks, plus home practice. Recruitment, attrition, and completion rates were calculated. Depressive symptoms and quality of life were assessed at all times. Participants' perceptions of the interventions were collected in semi-structured interviews. RESULTS Following the screening, 54/63 people met the inclusion criteria, and 42/54 were randomly allocated to the PMR group (n=14), AT group (n=14), and CG (n=14). Six participants (43%; 95% CI 18-71%) in the PMR group and 10 (71%; 95% CI 42-92%) in the AT group completed the intervention. Participants reported better emotion management and improvements in depressive symptoms and quality of life. CONCLUSIONS The pilot study suggests that a randomized trial to test the effectiveness of these interventions is feasible. TRIAL REGISTRATION ClinicalTrials.gov NCT01901016.
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Affiliation(s)
- Maria Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada.,Research Center of the Centre Hospitalier de l', Université de Montréal, Montréal, Quebec, Canada.,Quebec Nursing Intervention Research Network (RRISIQ), Quebec, Canada
| | - Jérôme Leclerc-Loiselle
- Faculté des sciences infirmières, Université de Montréal, Montréal, Quebec, Canada.,Centre de recherche du CHUM, Montréal, Quebec, Canada
| | - Marie-Pierre Gagnon
- Quebec Nursing Intervention Research Network (RRISIQ), Quebec, Canada.,Centre de recherche du CHUM, Montréal, Quebec, Canada.,Faculté des Sciences Infirmières de l'Université Laval, Quebec, Canada
| | - José Côté
- Quebec Nursing Intervention Research Network (RRISIQ), Quebec, Canada.,Faculté des sciences infirmières, Université de Montréal, Montréal, Quebec, Canada.,Centre de recherche du CHUM, Montréal, Quebec, Canada
| | - Marie-Josée Brouillette
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada.,AIDS and Infectious Disease Network (SIDA-MI), Quebec, Canada
| | - Réjean Thomas
- AIDS and Infectious Disease Network (SIDA-MI), Quebec, Canada.,Clinique médicale l'Actuel, Montréal, Quebec, Canada
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Yang X, Li X, Qiao S, Li L, Parker C, Shen Z, Zhou Y. Intersectional stigma and psychosocial well-being among MSM living with HIV in Guangxi, China. AIDS Care 2020; 32:5-13. [PMID: 32156159 DOI: 10.1080/09540121.2020.1739205] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The existing literature suggests a negative impact of intersectional stigma on multiple aspects of psychosocial well-being among individuals with multiple stigmatized identities. However, such impact remains poorly understood. This study aims to investigate the association between intersectional stigma and psychosocial well-being among 193 men who have sex with men (MSM) living with HIV. Based on their responses to measures of HIV-related stigma and sexual and gender minority (SGM) stigma, the participants were grouped into "high" vs "low" on each type of stigma. The General Linear Model (GLM) was used to analyze the main and interaction effect of two types of stigma on multiple psychosocial measures. Our results indicated a significant interaction effect of two types of stigma on depression, anxiety, quality of life, and psychological resilience after controlling for key socio-demographic covariates. The findings suggest that experiencing both HIV-related stigma and SGM stigma may synergistically lead to poor psychosocial well-being among MSM in a more profound manner than experiencing only one type of stigma. It is critical for researchers and clinicians to consider the patients' multiple stigmatized identities, develop effective intervention strategies, and improve the psychosocial well-being of MSM living with HIV in China and other cultural settings.
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Affiliation(s)
- Xueying Yang
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Linda Li
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Casey Parker
- School of Public Health, Brown University, Providence, RI, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
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5
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Swendeman D, Arnold EM, Harris D, Fournier J, Comulada WS, Reback C, Koussa M, Ocasio M, Lee SJ, Kozina L, Fernández MI, Rotheram MJ. Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11165. [PMID: 31400109 PMCID: PMC6707028 DOI: 10.2196/11165] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 01/12/2023] Open
Abstract
Background America’s increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. Objective This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. Methods Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). Results The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective. Trial Registration ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9) International Registered Report Identifier (IRRID) DERR1-10.2196/11165
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Affiliation(s)
- Dallas Swendeman
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Danielle Harris
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Jasmine Fournier
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States
| | - W Scott Comulada
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Cathy Reback
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Maryann Koussa
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Manuel Ocasio
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States
| | - Sung-Jae Lee
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Leslie Kozina
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States
| | - Maria Isabel Fernández
- Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, FL, United States
| | - Mary Jane Rotheram
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
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- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States.,Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States.,Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States.,Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, FL, United States
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6
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Wykowski J, Kemp CG, Velloza J, Rao D, Drain PK. Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:2059-2071. [PMID: 30659424 PMCID: PMC6639150 DOI: 10.1007/s10461-018-02390-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Untreated mental health disorders among people living with HIV (PLHIV) may prevent low- and middle-income countries (LMICs) from achieving the UNAIDS 90-90-90 targets. Anxiety disorders may be associated with decreased adherence to antiretroviral therapy (ART). We sought to review and meta-analyze studies estimating associations between anxiety and ART adherence in LMICs. We searched PubMed, PsychINFO, CINAHL and EMBASE for relevant studies published before July 18, 2018. We defined anxiety as reported anxiety scores from screening questionnaires or having a clinical diagnosis of an anxiety disorder, and poor ART adherence as missed doses, poor visit attendance, or scores from structured adherence questionnaires. We used a random effects model to conduct a meta-analysis for calculating a pooled odds ratio, and conducted sensitivity analyses by time on ART, anxiety evaluation method, and study region. From 472 screened manuscripts, thirteen studies met our inclusion criteria. Eleven studies were included in the meta-analysis. PLHIV who reported anxiety had 59% higher odds of poor ART adherence compared with those who did not report anxiety disorder (pooled odds ratio [pOR]: 1.59, 95% confidence interval [CI] 1.29-1.96, p < 0.001). When excluding PLHIV who initiated ART within 6 months, reported anxiety remained strongly associated with poor ART adherence (pOR: 1.61, 95% CI 1.18-2.20, p = 0.003). Among PLHIV in LMICs, reported anxiety was associated with poor ART adherence. This association persisted after the ART initiation period. Increased resources for mental health may be important for achieving virologic suppression in LMICs.
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Affiliation(s)
- James Wykowski
- Department of Medicine, School of Medicine, University of Washington, 325 Ninth Ave, UW, Box 359927, Seattle, WA, 98104-2420, USA.
| | - Christopher G Kemp
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
| | - Jennifer Velloza
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Deepa Rao
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Paul K Drain
- Department of Medicine, School of Medicine, University of Washington, 325 Ninth Ave, UW, Box 359927, Seattle, WA, 98104-2420, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
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7
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Arnold EM, Swendeman D, Harris D, Fournier J, Kozina L, Abdalian S, Rotheram MJ. The Stepped Care Intervention to Suppress Viral Load in Youth Living With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10791. [PMID: 30810536 PMCID: PMC6414817 DOI: 10.2196/10791] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background Among youth living with HIV (YLH) aged 12-24 years who have health care in the United States, only 30% to 40% are virally suppressed. YLH must achieve viral suppression in order to reduce the probability of infecting others as well as increasing the length and quality of their own life. Objective This randomized controlled trial aimed to evaluate the efficacy of an Enhanced Standard Care condition (n=110) compared to an Enhanced Stepped Care intervention condition (n=110) to increase viral suppression among YLH aged 12-24 years with established infection (not acutely infected). Methods YLH (N=220) who are not virally suppressed will be identified at homeless shelters, health clinics, and gay-identified community-based organizations in Los Angeles, CA, and New Orleans, LA. Informed consent will be obtained from all participants. YLH will be randomly assigned to one of two study conditions: Enhanced Standard Care, which includes standard clinical care plus an automated messaging and monitoring intervention (AMMI), or an Enhanced Stepped Care, which includes three levels of intervention (AMMI, Peer Support via social media plus AMMI, or Coaching plus Peer Support and AMMI). The primary outcome is viral suppression of HIV, and YLH will be assessed at 4-month intervals for 24 months. For the Enhanced Stepped Care intervention group, those who do not achieve viral suppression (via blood draw, viral load<200 copies/mL) at any 4-month assessment will “step up” to the next level of intervention. Secondary outcomes will be retention in care, antiretroviral therapy adherence, alcohol use, substance use, sexual behavior, and mental health symptoms. Results Recruitment for this study began in June 2017 and is ongoing. We estimate data collection to be completed by the end of 2020. Conclusions This is the first known application of an Enhanced Stepped Care intervention model for YLH. By providing the lowest level of intervention needed to achieve viral suppression, this model has the potential to be a cost-effective method of helping YLH achieve viral suppression and improve their quality of life. Trial Registration ClinicalTrials.gov NCT03109431; https://clinicaltrials.gov/ct2/show/NCT03109431 International Registered Report Identifier (IRRID) DERR1-10.2196/10791
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Affiliation(s)
- Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Harris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jasmine Fournier
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Leslie Kozina
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Susan Abdalian
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Mary Jane Rotheram
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Adams JW, Lurie MN, King MRF, Brady KA, Galea S, Friedman SR, Khan MR, Marshall BDL. Potential drivers of HIV acquisition in African-American women related to mass incarceration: an agent-based modelling study. BMC Public Health 2018; 18:1387. [PMID: 30563496 PMCID: PMC6299641 DOI: 10.1186/s12889-018-6304-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background The United States has the highest incarceration rate in the world. Incarceration can increase HIV risk behaviors for individuals involved with the criminal justice system and may be a driver of HIV acquisition within the community. Methods We used an agent-based model to simulate HIV transmission in a sexual-contact network representing heterosexual African American men and women in Philadelphia to identify factors influencing the impact of male mass incarceration on HIV acquisition in women. The model was calibrated using surveillance data and assumed incarceration increased the number of sexual contacts and decreased HIV care engagement for men post-release. Incarceration of a partner increased the number of sexual contacts for women. We compared a counterfactual scenario with no incarceration to scenarios varying key parameters to determine what factors drove HIV acquisition in women. Results Setting the duration of male high-risk sexual behavior to two years post-release increased the number of HIV transmissions to women by more than 20%. Decreasing post-release HIV care engagement and increasing HIV acquisition risk attributable to sexually transmitted infections (STIs) also increased the number of HIV transmissions to women. Changing the duration of risk behavior for women, the proportion of women engaging in higher risk behavior, and the relative risk of incarceration for HIV-infected men had minimal impact. Conclusion The mass incarceration of African American men can increase HIV acquisition in African American women on a population-level through factors including post-release high-risk behaviors, disruption of HIV care engagement among formerly incarcerated men, and increased STI prevalence. These findings suggest that the most influential points of intervention may be programs seeking to reduce male risk behaviors and promote HIV care engagement post-release, as well as STI testing and treatment programs for recently incarcerated men, as well as women with incarcerated partners. Electronic supplementary material The online version of this article (10.1186/s12889-018-6304-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joëlla W Adams
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Mark N Lurie
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Maximilian R F King
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Kathleen A Brady
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | - Samuel R Friedman
- National Development and Research Institutes, New York City, NY, USA
| | - Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University, New York City, NY, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
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9
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Bruce D, Bauermeister JA, Kahana SY, Mendoza E, Fernández MI. Correlates of Serodiscordant Condomless Anal Intercourse Among Virologically Detectable HIV-Positive Young Men Who Have Sex with Men. AIDS Behav 2018; 22:3535-3539. [PMID: 29876755 DOI: 10.1007/s10461-018-2183-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexual transmission risk occurs in the context of serodiscordant condomless anal intercourse (CAI) where the seropositive partner is virologically detectable (VL+) and/or seronegative partner is not on PrEP. We analyzed correlates of serodiscordant CAI among 688 VL+ young men who have sex with men (YMSM). In multivariable analyses, serodiscordant CAI was associated with a receiving a HIV diagnosis in the past 6 months, greater depressive symptoms, and cocaine use during the past 90 days. Although HIV+ YMSM currently experience disparities across the continuum of care, those new to care may need support adopting risk reduction strategies with their sexual partners.
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Affiliation(s)
- Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL, USA.
- Department of Health Sciences, DePaul University, 1110 W. Belden, Suite 411, Chicago, IL, 60614, USA.
| | | | | | - Eduardo Mendoza
- Department of Health Sciences, DePaul University, Chicago, IL, USA
| | - M Isabel Fernández
- College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
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10
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Babowitch JD, Vanable PA, Carey MP. Gender Moderates the Association of Depressive Symptoms to Sexual Risk Behavior Among HIV-Positive African-American Outpatients. AIDS Behav 2018; 22:1430-1434. [PMID: 29185079 DOI: 10.1007/s10461-017-1981-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous research has reported an association between depressive symptoms and sexual risk behavior. The purpose of this study was to explore whether gender moderates this association in a sample of HIV-positive African-Americans. Participants (N = 93) self-reported depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D), and sexual risk behavior for the past 4 months. Analyses revealed that the depressive symptoms-by-gender interaction was associated with condomless sex and substance use proximal to sex. When analyses were stratified by gender, depressive symptoms were associated with condomless sex and frequency of substance use only for women. We conclude that depressive symptoms may be a more powerful sexual risk factor among women relative to men.
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Affiliation(s)
- Jacklyn D Babowitch
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University, Providence, RI, USA
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Thai TT, Jones MK, Harris LM, Heard RC. The association between symptoms of mental disorders and health risk behaviours in Vietnamese HIV positive outpatients: a cross-sectional study. BMC Public Health 2017; 17:250. [PMID: 28288615 PMCID: PMC5348739 DOI: 10.1186/s12889-017-4162-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 03/02/2017] [Indexed: 11/11/2022] Open
Abstract
Background A high prevalence of symptoms of mental disorders (SOMD) has been found among people living with HIV/AIDS (PLHIV). Additionally, SOMD may impact on the prevalence of high-risk health behaviours (HRB). This study investigates the relationship between SOMD and HRB in a large sample of Vietnamese HIV positive outpatients. Methods A cross-sectional study was conducted with 400 outpatients at two HIV/AIDS clinics in Ho Chi Minh City, Vietnam, selected using a systematic sampling technique. Validated scales were used to measure SOMD, specifically symptoms of depression, anxiety, alcohol use disorder (AUD), substance use disorder (SUD) and HIV associated dementia (HAD). Participants completed a self-report questionnaire assessing HRB during the preceding 12 months including unsafe sexual practices and illicit drug use. Multivariable logistic regression models were used to evaluate associations between SOMD and HRB. Results The majority of participants (63.5%) were male and the median age was 34.0 years. Unsafe sexual practices and illicit drug use were reported by 13.8 and 5.5% of participants. The prevalences of HAD, depression, AUD, anxiety and SUD symptoms were 39.8, 36.5, 13.3 10.5, 3.3% respectively. There was no association between SOMD and HRB either with or without adjusting for correlates of HRB, except between symptoms of SUD and illicit drug use. PLHIV who had symptoms of SUD were more likely to use illicit drugs (adjusted Odds Ratio 81.14, 95% CI 12.55–524.47). Conclusions While the prevalence of SOMD among HIV positive outpatients was high, most SOMD were not associated with increased HRB. Only illicit drug use was predicted by symptoms of SUD. Screening PLHIV for symptoms of SUD may be useful for detecting people likely to be engaging in illicit drug use to reduce the risk of secondary disease transmission.
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Affiliation(s)
- Truc T Thai
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam. .,Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia.
| | - Mairwen K Jones
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia
| | - Lynne M Harris
- School of Psychological Sciences, Australian College of Applied Psychology, Level 11, 255 Elizabeth Street, Sydney, NSW, 2000, Australia
| | - Robert C Heard
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia
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12
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Brandt C, Zvolensky MJ, Woods SP, Gonzalez A, Safren SA, O'Cleirigh CM. Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature. Clin Psychol Rev 2017; 51:164-184. [PMID: 27939443 PMCID: PMC5195877 DOI: 10.1016/j.cpr.2016.11.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 09/09/2016] [Accepted: 11/04/2016] [Indexed: 12/21/2022]
Abstract
There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning.
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Affiliation(s)
- Charles Brandt
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd. Houston, Texas, 77030, United States
| | - Steven P Woods
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33124, United States
| | - Conall M O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 701, Boston Ma, 02114, United States
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13
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Li J, Mo PKH, Wu AMS, Lau JTF. Roles of Self-Stigma, Social Support, and Positive and Negative Affects as Determinants of Depressive Symptoms Among HIV Infected Men who have Sex with Men in China. AIDS Behav 2017; 21:261-273. [PMID: 26896120 DOI: 10.1007/s10461-016-1321-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Poor mental health was prevalent among HIV positive men who have sex with men (HIVMSM), and a tremendous burden extents on their families and society. The present study investigated the prevalence of depression and its relationship with social support, HIV self-stigma, positive affect and negative affect among 321 HIVMSM in Chengdu, China. The study was conducted during July 2013 through October 2013. Findings showed that 55.8 % of the participants had mild to severe depression. The results of structural equation modeling showed that social support and positive affect were negatively associated with depression, while HIV self-stigma and negative affect were positively associated with depression. Social support, positive affect, and negative affect mediated the association between HIV self-stigma and depression. The hypothesized model had a satisfactory fit. Interventions improving mental health among this population are warranted.
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Affiliation(s)
- Jinghua Li
- Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Anise M S Wu
- Department of Psychology, University of Macau, Macau, China
| | - Joseph T F Lau
- Division of Behavioral Health and Health Promotion, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China.
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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14
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Sullivan KM, Dawson Rose C, Phillips JC, Holzemer WL, Webel AR, Nicholas P, Corless IB, Kirksey K, Sanzero Eller L, Voss J, Tyer-Viola L, Portillo C, Johnson MO, Brion J, Sefcik E, Nokes K, Reid P, Rivero-Mendez M, Chen WT. Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory. J Adv Nurs 2016; 73:162-176. [PMID: 27485796 DOI: 10.1111/jan.13087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/19/2022]
Abstract
AIM Sexual risk behaviour was explored and described using Social Action Theory. BACKGROUND The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. DESIGN Cross-sectional survey. METHODS Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. FINDINGS Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. CONCLUSION Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.
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Affiliation(s)
- Kathleen M Sullivan
- University of Hawaii at Manoa School of Nursing and Dental Hygiene, Honolulu, Hawaii, USA
| | - Carol Dawson Rose
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - J Craig Phillips
- School of Nursing, University of Ottawa School of Nursing, Ottawa, Ontario, Canada
| | | | - Allison R Webel
- Case Western Reserve University School of Nursing, Cleveland, Ohio, USA
| | - Patrice Nicholas
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Inge B Corless
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Kenn Kirksey
- Nursing Strategic Initiatives Harris Health System, Houston, Texas, USA
| | | | - Joachim Voss
- Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Lynda Tyer-Viola
- Baylor College of Medicine and AVP Texas Children's Hospital, Houston, Texas, USA
| | - Carmen Portillo
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Mallory O Johnson
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - John Brion
- Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Elizabeth Sefcik
- Texas A&M University-Corpus Christi, Corpus, Christi, Texas, USA
| | - Kathleen Nokes
- Hunter College, CUNY School of Nursing, New York, New York, USA
| | - Paula Reid
- University of North Carolina at Wilmington, Wilmington, North Carolina, USA
| | | | - Wei-Ti Chen
- Yale University School of Nursing, New Haven, Connecticut, USA
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15
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Wagner GJ, Ghosh-Dastidar B, Slaughter ME, Akena D, Nakasujja N, Musisi S. Changes in condom use during the first year of HIV treatment in Uganda and the relationship to depression. Ann Behav Med 2015; 48:175-83. [PMID: 24504978 DOI: 10.1007/s12160-013-9586-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE We examined the effect of antiretroviral therapy (ART), and the predictive role of depression, on condom use with primary partners. METHODS Data from three studies in Uganda were combined into a sample of 750 patients with a primary sex partner, with 502 starting ART and 248 entering HIV care, and followed for 12 months. Random-effects logistic regression models were used to examine the impact of ART, and the influence of baseline level and change in depression, on condom use with primary partners. RESULTS At month 12, 61 % ART and 67 % non-ART patients were consistent condom users, compared to 44 and 41 % at baseline, respectively. Multivariate analysis revealed that consistent condom use increased similarly for ART and non-ART patients, and that minor depression at baseline and increased depression over time predicted inconsistent condom use. CONCLUSIONS Improved depression diagnosis and treatment could benefit HIV prevention.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA,
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16
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Comulada WS. Model specification and bootstrapping for multiply imputed data: An application to count models for the frequency of alcohol use. THE STATA JOURNAL 2015; 15:833-844. [PMID: 26973439 PMCID: PMC4782976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stata's mi commands provide powerful tools to conduct multiple imputation in the presence of ignorable missing data. In this article, I present Stata code to extend the capabilities of the mi commands to address two areas of statistical inference where results are not easily aggregated across imputed datasets. First, mi commands are restricted to covariate selection. I show how to address model fit to correctly specify a model. Second, the mi commands readily aggregate model-based standard errors. I show how standard errors can be bootstrapped for situations where model assumptions may not be met. I illustrate model specification and bootstrapping on frequency counts for the number of times that alcohol was consumed in data with missing observations from a behavioral intervention.
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Affiliation(s)
- W. Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
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17
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Miller CT, Solomon SE, Bunn JY, Varni SE, Hodge JJ. Psychological symptoms are associated with both abstinence and risky sex among men with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:453-65. [PMID: 25614050 PMCID: PMC4324502 DOI: 10.1007/s10508-014-0464-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/06/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
Sexual abstinence is often deemed the "safest behavior" in HIV prevention, but is sometimes associated with psychological symptoms (e.g., depression) just as sexually risky behavior is. This study explored whether sexual abstinence and risky sexual behavior among men with HIV were associated with similar constellations of psychological symptoms. Prior research has not addressed this issue because abstinent people often are not included in the sample or, when data are analyzed, researchers combine abstinent people with sexually active people who practice safer sex. Past research also neglects the co-morbidity of psychological symptoms. A latent class analysis of the psychological symptoms (assessed with the Symptom Check List 90-R; Derogatis, 1994) of 140 men with HIV, mostly from rural New England, revealed three latent classes: men who were asymptomatic on all symptom domains (28.8 %), men who were symptomatic on all domains (34.1 %), and men who were symptomatic on internalizing domains (37.1 %), but were asymptomatic on the externalizing symptoms of hostility and paranoid ideation. Logistic regression showed that sexual behavior during the past 90 days of men in the all symptom class and the internalizing symptoms class was similar, with abstinence and risky sex predominating, and safer sex being relatively uncommon for both classes. The sexual behavior of men in the asymptomatic class differed, with safer sex being relatively more likely to occur compared to the symptomatic classes. These findings suggest that the psychological symptom profile of sexually abstinent people places them at risk for inconsistent condom use should they engage in sexual behavior.
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Affiliation(s)
- Carol T Miller
- Department of Psychological Science, University of Vermont, 360 John Dewey Hall, 2 Colchester Ave., Burlington, VT, 05405, USA,
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18
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Comulada WS. Mobile Phone Assessment in Egocentric Networks: A Pilot Study on Gay Men and Their Peers. CONNECTIONS (TORONTO, ONT.) 2014; 34:43-51. [PMID: 25844003 PMCID: PMC4380161 DOI: 10.17266/34.1.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mobile phone-based data collection encompasses the richness of social network research. Both individual-level and network-level measures can be recorded. For example, health-related behaviors can be reported via mobile assessment. Social interactions can be assessed by phone-log data. Yet the potential of mobile phone data collection has largely been untapped. This is especially true of egocentric studies in public health settings where mobile phones can enhance both data collection and intervention delivery, e.g. mobile users can video chat with counselors. This is due in part to privacy issues and other barriers that are more difficult to address outside of academic settings where most mobile research to date has taken place. In this article, we aim to inform a broader discussion on mobile research. In particular, benefits and challenges to mobile phone-based data collection are highlighted through our mobile phone-based pilot study that was conducted on egocentric networks of 12 gay men (n = 44 total participants). HIV-transmission and general health behaviors were reported through a mobile phone-based daily assessment that was administered through study participants' own mobile phones. Phone log information was collected from gay men with Android phones. Benefits and challenges to mobile implementation are discussed, along with the application of multi-level models to the type of longitudinal egocentric data that we collected.
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Affiliation(s)
- W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles, California. He is also a Methods Core scientist for the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS; P30MH058107)
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19
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Meyer JP, Cepeda J, Springer SA, Wu J, Trestman RL, Altice FL. HIV in people reincarcerated in Connecticut prisons and jails: an observational cohort study. Lancet HIV 2014; 1:e77-e84. [PMID: 25473651 DOI: 10.1016/s2352-3018(14)70022-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reincarceration in prison or jail correlates with non-sustained HIV viral suppression, but HIV treatment outcomes in released prisoners who are reincarcerated have not recently been systematically assessed despite advances in antiretroviral treatment (ART) potency, simplicity, and tolerability. METHODS In a retrospective cohort of reincarcerated inmates with HIV in Connecticut (2005-12), we used longitudinally linked demographic, pharmacy, and laboratory databases to examine correlates of viral suppression. The primary outcome was viral suppression on reincarceration, defined as viral load lower than 400 RNA copies per mL. FINDINGS Of 497 prisoners and jail detainees with HIV, with 934 reincarcerations, individuals were mostly unmarried, uninsured, and black men prescribed a protease-inhibitor-based ART regimen. During the median 329 days (IQR 179-621) between prison release and reincarceration, the proportion of incarceration periods with viral suppression decreased significantly from 52% to 31% (mean HIV-RNA increased by 0·4 log10; p<0·0001), lower than Connecticut's HIV-infected prison population and those prescribed ART nationally. 158 (51%) of 307 individuals with viral suppression on release had viral suppression on reincarceration. Viral suppression on reincarceration was associated with increasing age (adjusted odds ratio [aOR] 1·04, 95% CI 1·01-1·07), being prescribed non-nucleoside reverse transcriptase inhibitor-based regimens (1·63, 1·14-2·34), and having higher levels of medical or psychiatric comorbidity (1·16, 1·03-1·30). INTERPRETATION Identification of individuals most at risk for recidivism and loss of viral suppression might mitigate the risk that repeated reincarceration poses to systems of public health and safety. FUNDING Bristol-Myers Squibb Virology, Patterson Trust, and National Institute on Drug Abuse.
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Affiliation(s)
- Jaimie P Meyer
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Javier Cepeda
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Sandra A Springer
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Johnny Wu
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Robert L Trestman
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
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Li L, Hien NT, Liang LJ, Lin C, Tuan NA. Correlated outcomes of a pilot intervention for people injecting drugs and their family members in Vietnam. Drug Alcohol Depend 2014; 134:348-354. [PMID: 24305572 PMCID: PMC3881285 DOI: 10.1016/j.drugalcdep.2013.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/01/2013] [Accepted: 11/02/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The interrelationship between the well-being of injecting drug users (IDUs) and their family environment has been widely documented. However, few intervention programs have addressed the needs of both IDUs and their family members. METHODS This study describes a randomized intervention pilot targeting 83 IDUs and 83 of their family members from four communes in Phú Thọ province, Vietnam. The IDUs and family members in the intervention condition received multiple group sessions, with the intent to improve psychological well-being and family relationships. The intervention outcomes (depressive symptoms and family relations) were evaluated at baseline, 3-month and 6-month follow-up assessments. RESULTS Depressive symptoms and family relations reported by IDUs were found to be correlated to those reported by their family members. Overall, significant intervention effects on depressive symptoms and family relations were observed for both IDUs and family members. A similar improvement pattern in family relations emerged for both the IDU and family member samples, although the intervention effect of reducing depressive symptoms was more sustainable for family members at the 6-month assessment when compared to the IDU sample. CONCLUSION The intervention pilot addressed challenges faced by IDUs and their family members and revealed correlated outcomes for the two groups. Findings suggest a vital need to include family members in future drug prevention and harm reduction intervention efforts.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Nguyen Tran Hien
- National Institute of Hygiene and Epidemiology, 1 Yersin, Hanoi 10000, Vietnam
| | - Li-Jung Liang
- Department of Medicine Statistics Core, University of California, 911 Broxton Ave., Los Angeles, CA 90095, U.S.A
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, U.S.A
| | - Nguyen Anh Tuan
- National Institute of Hygiene and Epidemiology, 1 Yersin, Hanoi 10000, Vietnam
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21
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Guimarães MDC, McKinnon K, Cournos F, Machado CJ, Melo APS, Campos LN, Wainberg ML. Correlates of HIV infection among patients with mental illness in Brazil. AIDS Care 2013; 26:505-13. [PMID: 23998905 DOI: 10.1080/09540121.2013.832722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
People living with mental illness are at increased risk for HIV. There are scarce data on correlates and prevalence of HIV infection, and none with a nationally representative sample. We report on correlates of HIV infection from a cross-sectional national sample of adults receiving care in 26 publicly funded mental health treatment settings throughout Brazil. Weighted prevalence rate ratios were obtained using multiple log-binomial regression modeling. History of homelessness, ever having an STD, early age of first sexual intercourse before 18 years old, having suffered sexual violence, previous HIV testing, self-perception of high risk of HIV infection and not knowing one's risk were statistically associated with HIV infection. Our study found an elevated HIV seroprevalence and correlates of infection were not found to include psychiatric diagnoses or hospitalizations but instead reflected marginalized living circumstances and HIV testing history. These adverse life circumstances (history of homelessness, having suffered sexual violence, reporting a sexually transmitted disease, and early sexual debut) may not be unique to people living with mental illness but nonetheless the mental health care system can serve as an important point of entry for HIV prevention in this population.
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Affiliation(s)
- Mark D C Guimarães
- a Department of Preventive and Social Medicine, School of Medicine , Federal University of Minas Gerais , Belo Horizonte , Brazil
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22
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Musisi S, Wagner GJ, Ghosh-Dastidar B, Nakasujja N, Dickens A, Okello E. Depression and sexual risk behaviour among clients about to start HIV antiretroviral therapy in Uganda. Int J STD AIDS 2013; 25:130-7. [PMID: 23970636 DOI: 10.1177/0956462413495186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated depression in relationship to sexual risk behaviour with primary partners among HIV-positive clients in Uganda. Baseline data were analyzed from a cohort of clients starting antiretroviral therapy. The Patient Health Questionnaire (PHQ-9) was used to classify depressive severity (none, minor and major depression) and symptom type (cognitive and somatic). Condom use was assessed over the past six months and during the last episode of sexual intercourse. A total of 386 participants had a primary sex partner, with whom 41.6% always used condoms during sex over the past six months, and 62.4% during last sex. Use of a condom during last sex was associated with having no depression and lower PHQ-9 total and cognitive and somatic subscale scores in bivariate analyses; most of these relationships were marginally significant for intercourse over the past six months. Controlling for demographics, HIV disclosure and partner HIV status, only minor depression was associated with unprotected sex. Depressive symptoms, even if not a clinical disorder, warrant early detection and treatment for promoting HIV prevention among HIV-affected couples.
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Affiliation(s)
- Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM, Schumacher JE, Mathews WC, Mayer KH. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Am J Public Health 2013; 103:1457-67. [PMID: 23763417 DOI: 10.2105/ajph.2012.301162] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The purpose of this study was to better understand substance use behaviors and deleterious health consequences among individuals with HIV. METHODS We examined a multicenter cohort of HIV-infected patients (n = 3,413) receiving care in 4 US cities (Seattle, Birmingham, San Diego, Boston) between December 2005 and April 2010 in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We used generalized estimating equations to model specific substance use outcomes. RESULTS Overall, 24% of patients reported recent use of marijuana; 9% reported amphetamine use, 9% reported crack-cocaine use, 2% reported opiate use, 3.8% reported injection drug use, and 10.3% reported polydrug use. In adjusted multivariable models, those who reported unprotected anal sex had higher odds of marijuana, amphetamine, injection drug, and polydrug use. An increased number of distinct vaginal sexual partners was associated with polydrug and crack-cocaine use. Nonadherence to antiretroviral therapy was associated with the use of all substances other than marijuana. CONCLUSIONS The co-occurrence of substance use, unprotected intercourse, and medication nonadherence could attenuate the public health benefits of test, treat, and link to care strategies. Prevention programs are needed that address these coprevalent conditions.
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Affiliation(s)
- Matthew J Mimiaga
- Harvard Medical School/Massachusetts General Hospital, 1 Bowdoin Square, 7th floor, Boston, MA 02114, USA.
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24
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Safran MA, Hoover KW, Tao G, Butler MO. Sexual behaviour and desire to discuss mental health as reported by HIV-infected men who have sex with men. Int J STD AIDS 2013; 24:93-9. [PMID: 23514829 DOI: 10.1177/0956462412472307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed sexually transmitted infection risk behaviours and desire to discuss mental health, as reported by 426 HIV-infected men who have sex with men receiving HIV care in eight urban clinics. Most of these patients (90%) had begun HIV care >1 year ago. In the past year, 74% had multiple sexual partners, 75% engaged in anal intercourse, 48% had >1 HIV-uninfected partner and 82% used illegal psychoactive drugs. Among those reporting anal intercourse, approximately 61% reported using a condom during the most recent episode. Among all patients, 70% wanted to talk with their clinicians about how they felt mentally or emotionally. Using a two-tailed chi-squared test, we found that patients who engaged in unprotected receptive anal sex were more likely to want such a conversation than those who did not (80% versus 62%, P < 0.01); and those who engaged in unprotected insertive anal sex were also more likely to want such a conversation (81% versus 63%, P < 0.01). The findings highlight the prevalence of risky sexual behaviour and of mental health concerns in the participating patient population. Patients reporting risky sexual behaviour were more likely to want to discuss how they felt mentally or emotionally than those not reporting such behaviour.
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Affiliation(s)
- M A Safran
- Centers for Disease Control and Prevention, Mail Stop E-44, 1600 Clifton Road, Atlanta, GA, 30333
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25
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De Santis JP, Gonzalez-Guarda RM, Vasquez EP. Psychosocial and cultural correlates of depression among Hispanic men with HIV infection: a pilot study. J Psychiatr Ment Health Nurs 2012; 19:860-9. [PMID: 22295937 PMCID: PMC3345319 DOI: 10.1111/j.1365-2850.2011.01865.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression is a common mental health condition among persons with human immunodeficiency virus (HIV) infection. Depression influences quality of life, social relationships and adherence to medication therapy. Little is known about depression among Hispanic men with HIV infection. The purpose of this pilot study was to describe the relationships of depression to other psychosocial factors (self-esteem, Hispanic stress, substance abuse and violence) and cultural factors (familism and Hispanic stress) among a sample of Hispanic men with HIV infection. Using a cross-sectional, descriptive research design a convenience sample of 46 Hispanic men with HIV infection was recruited and surveyed from the South Florida area of the USA. The majority of the participants (65%; n = 30) were depressed. In addition, the majority of participants reported high familism and self-esteem and low Hispanic stress. A history of substance abuse and childhood and adult violence were common. Significant relationships were noted between depression, and self-esteem, Hispanic stress, substance abuse, and adult physical violence. Healthcare providers need to be aware of the high rates of depression, substance abuse and violence that may occur among Hispanic men with HIV infection. More research is needed to further explore the relationship of these factors, as well as to determine the impact that these variables have on adherence to medication therapy among Hispanic men with HIV infection.
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Affiliation(s)
- J P De Santis
- University of Miami School of Nursing & Health Studies, Coral Gables, FL, USA.
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26
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Comulada WS, Muth SQ, Latkin CA. The analysis of multiple ties in longitudinal egocentric network data: A case study on bidirectional relationships between trust and drug use. SOCIAL NETWORKS 2012; 34:691-700. [PMID: 23243335 PMCID: PMC3519439 DOI: 10.1016/j.socnet.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We extend multi-level models to examine single egocentric network ties to the joint analysis of paired dynamic ties. Two analytic challenges are addressed. First, inference needs to account for multiple layers of nesting: ties are nested within pairs, pairs are nested within time points, and time points are nested within egos. Second, the focus is on the relationship between two dynamic ties; specification of outcome and predictor may be difficult. Instead, we treat both ties as outcomes. Our approach is used to analyze trust and reported drug use between egos and alters over time in a Bayesian framework.
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Affiliation(s)
- W. Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, United States;
| | | | - Carl A. Latkin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University, United States;
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27
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Wagner GJ, Ghosh-Dastidar B, Holloway IW, Kityo C, Mugyenyi P. Depression in the pathway of HIV antiretroviral effects on sexual risk behavior among patients in Uganda. AIDS Behav 2012; 16:1862-9. [PMID: 21986868 DOI: 10.1007/s10461-011-0051-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
HIV antiretroviral therapy (ART) can increase safe sex or lead to disinhibition and less condom use. We conducted one of the first controlled studies of ART effects on sexual risk behavior in sub-Saharan Africa, and the potential explanatory roles of physical and mental health. Participants (302 non-ART, 300 ART) were followed for the first 12 months of HIV care in Uganda. Multivariate intention-to-treat regression analysis showed that frequency of sex increased significantly in both groups, but more among ART patients; when added to the model in separate analyses, changes in physical health functioning and depression were both significant predictors, as was time in HIV care, but there was no longer an ART effect. Both ART and non-ART groups had similar dramatic increases in consistent condom use over time; however, change in depression, unlike physical health functioning, was a significant predictor of consistent condom use when added to this model, and there remained a similar level of increased condom use among ART and non-ART patients. HIV care and ART increase sexual activity and condom use, but depression undercuts the prevention benefits of ART, highlighting the need to integrate mental health services into HIV care.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407, USA.
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28
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Springer SA, Spaulding AC, Meyer JP, Altice FL. Public health implications for adequate transitional care for HIV-infected prisoners: five essential components. Clin Infect Dis 2012; 53:469-79. [PMID: 21844030 DOI: 10.1093/cid/cir446] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In the United States, 10 million inmates are released every year, and human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) prevalence is several-fold greater in criminal justice populations than in the community. Few effective linkage-to-the-community programs are currently available for prisoners infected with HIV. As a result, combination antiretroviral therapy (cART) is seldom continued after release, and virological and immunological outcomes worsen. Poor HIV treatment outcomes result from a myriad of obstacles that released prisoners face upon reentering the community, including homelessness, lack of medical insurance, relapse to drug and alcohol use, and mental illness. This article will focus on 5 distinct factors that contribute significantly to treatment outcomes for released prisoners infected with HIV and have profound individual and public health implications: (1) adaptation of case management services to facilitate linkage to care; (2) continuity of cART; (3) treatment of substance use disorders; (4) continuity of mental illness treatment; and (5) reducing HIV-associated risk-taking behaviors as part of secondary prevention.
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Affiliation(s)
- Sandra A Springer
- AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut 06511, USA.
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29
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Hutton VE, Misajon R, Collins FE. Subjective wellbeing and ‘felt’ stigma when living with HIV. Qual Life Res 2012; 22:65-73. [DOI: 10.1007/s11136-012-0125-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2012] [Indexed: 11/24/2022]
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30
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Wagner GJ, Ghosh-Dastidar B, Dickens A, Nakasujja N, Okello E, Luyirika E, Musisi S. Depression and its Relationship to Work Status and Income Among HIV Clients in Uganda. ACTA ACUST UNITED AC 2012; 2:126-134. [PMID: 24653946 DOI: 10.4236/wja.2012.23018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Despite high levels of depression among persons living with HIV (PLWHIV), little research has investigated the relationship of depression to work status and income in PLWHIV in sub-Saharan Africa, which was the focus of this analysis. METHODS Baseline data from a prospective longitudinal cohort of 798 HIV patients starting antiretroviral therapy in Kampala, Uganda were examined. In separate multivariate analyses, we examined whether depressive severity and symptom type [as measured by the Patient Health Questionnaire (PHQ-9)] and major depression [diagnosed with the Mini International Neuropsychiatric Interview (MINI)] were associated with work status and income, controlling for demographics, physical health functioning, work self-efficacy, social support and internalized HIV stigma. RESULTS 14% of the sample had Major Depression and 66% were currently working. Each measure of depression (PHQ-9 total score, somatic and cognitive subscales; Major Depression diagnosis) was associated with not working and lower average weekly income in bivariate analysis. However, none of the depression measures remained associated with work and income in multivariate analyses that controlled for other variables associated with these economic outcomes. CONCLUSIONS These findings suggest that while depression is related to work and income, its influence may only be indirect through its relationship to other factors such as work self-efficacy and physical health functioning.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA, USA 90407
| | | | - Akena Dickens
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Mulago Hill, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Mulago Hill, Kampala, Uganda
| | - Elialilia Okello
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Mulago Hill, Kampala, Uganda
| | | | - Seggane Musisi
- Department of Psychiatry, Makerere University, College of Health Sciences, P.O. Box 7072, Mulago Hill, Kampala, Uganda
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Kemppainen JK, Wantland D, Voss J, Nicholas P, Kirksey KM, Corless IB, Willard S, Holzemer WL, Robinson L, Hamilton MJ, Sefcik E, Eller LS, Huang E, Arudo J, Moezzi S, Rivero-Mendez M, Rosa M, Human S, Cuca Y, Lindgren T, Portillo CJ, Maryland M. Self-care behaviors and activities for managing HIV-related anxiety. J Assoc Nurses AIDS Care 2011; 23:111-23. [PMID: 21839652 DOI: 10.1016/j.jana.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/13/2011] [Indexed: 11/25/2022]
Abstract
The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.
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32
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Comulada WS, Weiss RE. Sample size and power calculations for correlations between bivariate longitudinal data. Stat Med 2010; 29:2811-24. [PMID: 20827714 DOI: 10.1002/sim.4064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The analysis of a baseline predictor with a longitudinally measured outcome is well established and sample size calculations are reasonably well understood. Analysis of bivariate longitudinally measured outcomes is gaining in popularity and methods to address design issues are required. The focus in a random effects model for bivariate longitudinal outcomes is on the correlations that arise between the random effects and between the bivariate residuals. In the bivariate random effects model, we estimate the asymptotic variances of the correlations and we propose power calculations for testing and estimating the correlations. We compare asymptotic variance estimates to variance estimates obtained from simulation studies and compare our proposed power calculations for correlations on bivariate longitudinal data to power calculations for correlations on cross-sectional data.
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Affiliation(s)
- W Scott Comulada
- UCLA Center for Community Health, 10920 Wilshire Blvd Suite 350, Los Angeles, CA 90024-6543, USA.
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