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Lechuga J, Ramos R, Dickson-Gomez J, Beachy S, Perez G, Nevola O, Varela A, Ramos ME, Sauceda J, Ludwig-Barrron N, Salazar J. Institutional violence from police militarization and drug cartel wars as a 'Big Event' and its influence on drug use harms and HIV risk in people who inject drugs on the U.S.-Mexico border. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104125. [PMID: 37499305 DOI: 10.1016/j.drugpo.2023.104125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Globally, the US-Mexico Border is one of the largest drug trafficking regions, with Ciudad Juarez (CJ) and El Paso (EP) making up the second-largest border crossing in the world. Border communities are places where the risk of drug use harm and infectious diseases such as HIV are augmented due to the confluence of factors operating across the physical, social, economic and policy environment. Although the two cities are economically, culturally, and socially intertwined, each has distinct criminal justice systems and policy practices aimed at curtailing substance use. Between 2008 and 2011, the CJ/EP region experienced an unprecedented level of violence that stemmed from the intersection of police militarization and drug cartel wars, which profoundly shaped every aspect of life. Little research has documented the impact of drug cartel wars on the drug use and health harms of people who inject drugs (PWID) living in CJ and EP. The purpose of the study is to understand the effect that the drug cartel war had on the drug use harms and HIV risk of PWID. METHODS We conducted 40 in-depth interviews with people who inject drugs who resided in CJ or EP and had used heroin or crack cocaine in the last 30 days, and asked how police militarization and drug cartel war affected their daily lives. The risk environment framework informed the analysis and interpretation of findings. RESULTS Findings indicated that the risk environment was profoundly altered as PWID residing in CJ experienced profound changes in their daily lives that promoted engagement in behaviors that increased drug use and health harms including HIV risk, exacerbated trauma, and prevented use of substance use treatment and harm reduction services. The risk environment was also altered in EP, where PWID experienced drug supply shortages, violent policing practices, and reduced availability of harm reduction services. Findings underscore the permeability of risk environments across geographical borders. CONCLUSION The intersection of law enforcement militarization and drug cartel wars can be conceptualized as a 'big event' because it disrupts the drug market economy, leads to drug shortages, promotes entrance into the drug market economy by people who use drugs, reshapes drug use sites, and constrains the provision of harm reduction services. The stability of the harm reduction system in CJ was negatively impacted and limited the ability of individuals to reduce harm. Our findings show that drug cartel wars render the CJ/EP region extremely susceptible to drug use and health harms, while also creating vulnerability by severely restricting its ability to respond. Traditional recommendations to intervene to limit the impact of risk environments on the drug use harms of PWID need to be reconsidered in the context of drug cartel wars.
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Affiliation(s)
- Julia Lechuga
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States.
| | - Rebeca Ramos
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | | | - Sara Beachy
- Lehigh University, Bethlehem PA, United States
| | - Gilberto Perez
- Texas State Health Department, Houston, TX, United States
| | | | - Alan Varela
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | | | - John Sauceda
- The University of California San Francisco, San Francisco, CA, United States
| | | | - Jorge Salazar
- The University of California San Francisco, San Francisco, CA, United States
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Rayanakorn A, Ong-artborirak P, Ademi Z, Chariyalertsak S. Predictors of Stigma and Health-Related Quality of Life Among People Living with HIV in Northern Thailand. AIDS Patient Care STDS 2022; 36:186-193. [PMID: 35507323 PMCID: PMC9125577 DOI: 10.1089/apc.2022.0035] [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] [Indexed: 11/12/2022] Open
Abstract
HIV-related stigma and discrimination have been a significant barrier to accessing health care, hence contributing to poor health outcomes. This study aimed to investigate factors associated with HIV-related stigma and discrimination and health-related quality of life (HRQoL) among people living with HIV in rural Thailand setting. A cross-sectional convenience sample of 161 HIV-positive Thai patients was recruited from a single rural district hospital using a self-administered questionnaire entailing sociodemographic information, the 12-item stigma scale, the Medical Outcomes Study HIV Health Survey (MOS-HIV), and the EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Linear regression and the multi-variable analyses were used to investigate factors associated with stigma and HRQoL, whereas the correlations between stigma and quality of life variables were tested by Pearson correlations. Being married and duration of antiretroviral therapy were negatively correlated with HIV stigma, while increased age was inversely associated with HRQoL. Being employed and having sufficient money for living contributed positively to predict HRQoL. HIV stigma was negatively associated with mental health summary (MHS) and visual analog scale (VAS) score, whereas duration diagnosed with HIV and the use of two nucleoside reverse transcriptase inhibitors in combination with protease inhibitor regimen were negative factors associated with VAS and health utility, respectively. The findings confirm complex and inseparable associations of factors relating to HIV-related stigma and HRQoL. The development of effective interventions tailored at individual level is warranted to address this gap.
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Affiliation(s)
- Ajaree Rayanakorn
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Epidemiology Research Group of Infectious Disease (ERGID), Chiang Mai University, Chiang Mai, Thailand
| | - Parichat Ong-artborirak
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
- Epidemiology Research Group of Infectious Disease (ERGID), Chiang Mai University, Chiang Mai, Thailand
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Bond KT, Gunn A, Williams P, Leonard NR. Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:180-193. [PMID: 35401855 PMCID: PMC8992539 DOI: 10.1007/s13178-021-00533-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). METHODS We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. RESULTS Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. CONCLUSIONS Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.
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Affiliation(s)
- Keosha T. Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York, United States
| | - Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois At Chicago, Chicago, Illinois, United States
| | - Porche Williams
- CUNY Lehman College, Bronx, New York, New York, United States
| | - Noelle R. Leonard
- Silver School of Social Work, New York University, New York, New York, United States
- Center for Drug Use and HIV Research, NYU School of Global Public Health, New York, New York, United States
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Phillips G, McCuskey D, Ruprecht MM, Curry CW, Felt D. Structural Interventions for HIV Prevention and Care Among US Men Who Have Sex with Men: A Systematic Review of Evidence, Gaps, and Future Priorities. AIDS Behav 2021; 25:2907-2919. [PMID: 33534056 PMCID: PMC7856612 DOI: 10.1007/s10461-021-03167-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/01/2022]
Abstract
The preponderance of HIV interventions have been behavioral, targeting individual, dyadic, or group dynamics. However, structural-level interventions are required to decrease HIV transmission and increase engagement in care, especially for men who have sex with men (MSM), particularly Black and Latinx MSM. A systematic literature review was conducted to assess the current state of structural interventions; only two studies detailing structural interventions related to HIV for Black and Latinx MSM in the US were identified. An additional 91 studies which discussed structural-level barriers to optimal HIV outcomes among MSM, yet which did not directly evaluate a structural intervention, were also identified. While this paucity of findings was discouraging, it was not unexpected. Results of the systematic review were used to inform guidelines for the implementation and evaluation of structural interventions to address HIV among MSM in the U.S. These include deploying specific interventions for multiply marginalized individuals, prioritizing the deconstruction of structural stigma, and expanding the capacity of researchers to evaluate “natural” policy-level structural interventions through a standardization of methods for rapid evaluative response, and through universal application of sex, sexual orientation, and gender identity demographic measures.
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Affiliation(s)
- Gregory Phillips
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David McCuskey
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan M Ruprecht
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caleb W Curry
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Case Western Reserve University Undergraduate Studies, Cleveland, OH, USA
| | - Dylan Felt
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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What Racism Has to Do with It: Understanding and Reducing Sexually Transmitted Diseases in Youth of Color. Healthcare (Basel) 2021; 9:healthcare9060673. [PMID: 34199974 PMCID: PMC8227416 DOI: 10.3390/healthcare9060673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 01/22/2023] Open
Abstract
Sexually transmitted diseases (STDs) are high in populations of color compared to Whites. High-risk sexual behaviors are widely viewed as the key contributors to the levels of STDs, especially in adolescents and young adults. This article situates the sexual risk behaviors of Black, Indigenous, and other young people of color within the framework of racism. It begins with an overview of racial inequities in common STDs and shows how racism gives rise to several risk factors for high-risk sexual behaviors. These risk factors for STDs identified in prior research are best understood as adaptations to the challenges and constraints faced by youth in socially disadvantaged environments. Both social adversity and the mental health problems that it triggers can lead to risky sexual behaviors. Drawing on findings from prior research with youth of color, this paper describes the needed interventions that can markedly reduce STDs and their risk factors. It also describes needed research on interventions that could contribute to the knowledge and understanding of the adverse conditions fueled by racism that affect youth of color, their health, and their communities.
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Opara I, Lardier DT, Durkee MI, Garcia-Reid P, Reid RJ. Ethnic Identity as a Moderator Between HIV Knowledge, Viral Hepatitis Knowledge, and Psychological Antecedents Among Racial-Ethnic Minority Youth Living in an Urban Community. J Racial Ethn Health Disparities 2021; 9:1298-1307. [PMID: 34041704 DOI: 10.1007/s40615-021-01069-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
Racial-ethnic minority youth between the ages of 13 and 24 in the USA are disproportionately impacted by HIV. Low HIV knowledge and psychological antecedents such as low perception of risk and low sexual negotiation skills have all been associated with HIV risk behaviors; however, the role of ethnic identity on these factors is unclear in the literature. Ethnic identity, which is a critical part of identity development among racial-ethnic minority youth, has been found to be a protective factor in risk-taking behaviors. However, limited research is available on the role of ethnic identity in HIV prevention research among youth. For this study, data were collected as part of a larger HIV prevention education program using a sample of 564 students of color (Meanage = 16.30, standard deviation [SD] = 1.26; 67.4% Hispanic, 29.5% Black) from an underserved northeastern US urban community. We examined whether ethnic identity moderated the relationship between psychological antecedents (e.g., perception of risk and sexual negotiation skills), gender, and viral hepatitis knowledge on HIV knowledge. Findings revealed that ethnic identity significantly moderated the relationship between psychological antecedent variables and HIV knowledge by strengthening these associations as ethnic identity increased. Female adolescents were also more likely to have higher levels of HIV knowledge than males. Findings provide support for cultural and gender-specific prevention programs for racial-ethnic minority youth that seek to reduce HIV risk behaviors by increasing ethnic identity, particularly in under-resourced communities.
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Affiliation(s)
- Ijeoma Opara
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
| | - David T Lardier
- Department of Individual, Family, and Community Studies, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Myles I Durkee
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Robert J Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
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Best AL, Wynn A, Ogbu CE, Nixon S. Improve the Quality of Life Related to HIV and the Black Community: HIV and AIDS Inequity in the Black Community: Proximal Solutions to Distal Determinants. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:25-33. [PMID: 36818206 PMCID: PMC9930518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This literature review describes the historical impact of HIV and AIDS among Black populations in United States (US), as well as the misalignment between root causes of HIV-related inequities and HIV prevention efforts. Specifically, we describe how distal factors (including structural racism) contribute to the disproportionate rates of HIV infection within Black communities. Further, we highlight consequences of focusing primarily on proximal determinants of acquiring HIV. Finally, we share some brief conclusions and recommendations to help move towards eliminating HIV and AIDS inequities among Black populations.
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Benbow ND, Aaby DA, Rosenberg ES, Brown CH. County-level factors affecting Latino HIV disparities in the United States. PLoS One 2020; 15:e0237269. [PMID: 32785252 PMCID: PMC7423131 DOI: 10.1371/journal.pone.0237269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine which county-level social, economic, demographic, epidemiologic and access to care factors are associated with Latino/non-Latino White disparities in prevalence of diagnosed HIV infection. METHODS AND FINDINGS We used 2016 county-level prevalence rates of diagnosed HIV infection rates for Latinos and non-Latino Whites obtained from the National HIV Surveillance System and factors obtained from multiple publicly available datasets. We used mixed effects Poisson modeling of observed HIV prevalence at the county-level to identify county-level factors that explained homogeneous effects across race/ethnicity and differential effects for Latinos and NL-Whites. Overall, the median Latinos disparity in HIV prevalence is 2.4; 94% of the counties have higher rates for Latinos than non-Latinos, and one-quarter of the counties' disparities exceeded 10. Of the 41 county-level factors examined, 24 showed significant effect modification when examined individually. In multi-variable modeling, 11 county-level factors were found that significantly affected disparities. Factors that increased disparity with higher, compared to lower values included proportion of HIV diagnoses due to injection drug use, percent Latino living in poverty, percent not English proficient, and percent Puerto Rican. Latino disparities increased with decreasing percent severe housing, drug overdose mortality rate, percent rural, female prevalence rate, social association rate, percent change in Latino population, and Latino to NL-White proportion of the population. These factors while significant had minimal effects on diminishing disparity, but did substantially reduce the variance in disparity rates. CONCLUSIONS Large differences in HIV prevalence rates persist across almost all counties even after controlling for county-level factors. Counties that are more rural, have fewer Latinos, or have lower NL-White prevalence rates tend to have higher disparities. There is also higher disparity when community risk is low.
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Affiliation(s)
- Nanette D. Benbow
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| | - David A. Aaby
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, United States of America
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Lanier Y, Campo A, Lavarin C, Toussaint A, Gwadz M, Guilamo-Ramos V. Methodological strategies to engage young black and Latino heterosexual couples in sexual and reproductive health research. BMC Health Serv Res 2020; 20:375. [PMID: 32366309 PMCID: PMC7199298 DOI: 10.1186/s12913-020-05202-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Approaches that move beyond individuals and target couples may be an effective strategy for reducing sexual and reproductive health (SRH) disparities among adolescents and young adults (AYA). However, few researchers have attempted to recruit couples due to feasibility and methodological issues. This study aims to enhance implementation and methodological approaches to successfully engage heterosexual Black and Latino adolescent and young adult (AYA) couples in sexual reproductive health (SRH) research. METHODS We developed a four-step approach to systematically engage AYA couples in a qualitative study examining factors that influence uptake of combination HIV prevention methods: 1) understanding barriers and facilitators to engaging AYA couples, (2) identifying AYAs living in geographic areas of HIV vulnerability, (3) recruiting and screening AYA couples, and (4) scheduling and completion of the interview session. RESULTS Black and Latino youth aged 16 to 24 and their opposite sex romantic were recruited in the South Bronx, New York from September 2017-May 2018. Three hundred and seventy-two men and women completed screening procedures to determine eligibility for the index participant; 125 were eligible and enrolled into the study. Forty-nine nominated partners (NPs) participated in screening procedures and enrolled into the study. A total of 49 couples enrolled into the study; 23 couples completed study activities. CONCLUSIONS Developing a systematic recruitment plan aided in successfully engaging Black and Latino heterosexual youth. Nevertheless, barriers to study enrollment remained including locating eligible IPs and screening of the NP. Targeting both young men and women was an effective recruitment strategy. Moreover, dyadic strategies that allow for simultaneous interaction with both couple members may be a beneficial strategy to couples' study enrollment and completion of study activities.
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Affiliation(s)
- Yzette Lanier
- New York University, Rory Meyers College of Nursing, New York, NY, USA.
| | - Alena Campo
- New York University, Rory Meyers College of Nursing, New York, NY, USA
| | - Claudine Lavarin
- New York University, College of Global Public Health, New York, NY, USA
| | - Ashley Toussaint
- New York University, College of Global Public Health, New York, NY, USA
| | - Marya Gwadz
- New York University, Silver School of Social Work, New York, NY, USA
| | - Vincent Guilamo-Ramos
- New York University, Silver School of Social Work, New York, NY, USA
- Center for Latino Adolescent and Family Health, CLAFH, New York, NY, USA
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Stein R, Xu S, Williams W, Marano M, Eke A, Finlayson T, Paz-Bailey G, Wejnert C. Factors Associated with HIV Antiretroviral Therapy among Men Who Have Sex with Men in 20 US Cities, 2014. J Urban Health 2019; 96:868-877. [PMID: 31512032 PMCID: PMC6904711 DOI: 10.1007/s11524-019-00386-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Reducing HIV among men who have sex with men (MSM) is a national goal, and early diagnosis, timely linkage to HIV medical care, and ongoing care and treatment are critical for improving health outcomes for MSM with HIV and preventing transmission to others. We assessed demographic, social, and economic factors associated with HIV antiretroviral treatment among HIV-infected MSM. Data are from the National HIV Behavioral Surveillance (NHBS) collected in 2014 among MSM. We estimated prevalence ratios and 95% confidence intervals using average marginal predictions from logistic regression. Overall, 89% of HIV-positive MSM reported currently taking antiretroviral therapy (ART). After controlling for other variables, we found that higher perceived community stigma and not having health insurance were significant risk factors for not taking ART. We also found that high socioeconomic status (SES) was associated with taking ART. Race/ethnicity was not significantly associated with taking ART in either the unadjusted or adjusted analyses. Findings suggest that to increase ART use for MSM with HIV, we need to move beyond individual-level approaches and move towards the development, dissemination, and evaluation of structural and policy interventions that respond to these important social and economic factors.
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Affiliation(s)
- Renee Stein
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA.
| | - Songli Xu
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA
| | - Weston Williams
- Public Health Analytic Consulting Services, Inc, Hillsborough, NC, USA
| | - Mariette Marano
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA
| | - Adanze Eke
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA
| | - Teresa Finlayson
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA
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11
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Diedricks T, Myburgh C, Poggenpoel M. Promoting mental health of students living with HIV using appreciative inquiry. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 17:163-174. [PMID: 30003845 DOI: 10.2989/16085906.2018.1478312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Living with HIV poses many challenges. This is especially true for students living with HIV (SLHIV) within a university setting. The challenges faced by SLHIV makes it difficult for them to see new possibilities in living with the virus. The purpose of the study was to describe the experiences of being a student living with HIV and being a practitioner caring for them by using Appreciative Inquiry which incorporated individual interviews. A qualitative, exploratory, descriptive and contextual research design was applied in this study. Purposeful sampling was utilised to select participants in accordance with specific criteria. Individual interviews using the 4-D model of Appreciative Inquiry, were conducted with SLHIV and practitioners caring for them. The individual interviews were transcribed verbatim and analysed into themes and categories which were verified separately by an independent coder, who is experienced in qualitative research, and further confirmed by research participants through member checking. Themes and categories derived from the data were discussed, and the findings were positioned in terms of relevant literature and the results of similar studies. The study concluded that when SLHIV and practitioners caring for them, embarked on a journey of discovering their strengths in living with HIV and dealing with SLHIV respectively, they start to see new possibilities and potential to effect change to help students manage their HIV infection more effectively.
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Affiliation(s)
- Teolene Diedricks
- a Department of Educational Psychology , University of Johannesburg , Johannesburg , South Africa
| | - Christoffel Myburgh
- a Department of Educational Psychology , University of Johannesburg , Johannesburg , South Africa
| | - Marie Poggenpoel
- a Department of Educational Psychology , University of Johannesburg , Johannesburg , South Africa
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De Jesus M, Williams DR. The Care and Prevention in the United States Demonstration Project: A Call for More Focus on the Social Determinants of HIV/AIDS. Public Health Rep 2019; 133:28S-33S. [PMID: 30457952 DOI: 10.1177/0033354918801353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Maria De Jesus
- 1 School of International Service and Center on Health, Risk, and Society, American University, Washington, DC, USA
| | - David R Williams
- 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,3 Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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Chiaramonte D, Strzyzykowski T, Acevedo-Polakovich I, Miller RL, Boyer CB, Ellen JM. Ecological Barriers to HIV Service Access among Young Men who have Sex with Men and High-Risk Young Women from Low-resourced Urban Communities. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2018; 17:313-333. [PMID: 31440119 PMCID: PMC6706082 DOI: 10.1080/15381501.2018.1502710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 06/02/2023]
Abstract
Using an ecological perspective, we sought to elucidate the perceived barriers preventing HIV service access among two groups of U.S. youth (ages 12-24) disproportionately affected by HIV, men who have sex with men and high-risk women. We content analyzed interviews with 318 key informants to identify distinct service barriers. The 29 barriers informants named were organized into six categories (service-seeking demands, stigmas, knowledge and awareness, service quality, powerful opposition, and negative emotions). Findings suggest that barriers impacting access to HIV prevention, testing, and linkage-to-care services are remarkably similar and point to the need for comprehensive approaches to improving youth's access services that address both individual-level barriers and extra-individual barriers simultaneously. Findings can be used to guide future research, programming and interventions to reduce the disproportionate spread of HIV among US youth.
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Affiliation(s)
| | | | | | - Robin Lin Miller
- Michigan State University, Department of Psychology, East Lansing, MI
| | - Cherrie B. Boyer
- University of California-San Francisco, Department of Pediatrics, San Francisco, CA
| | - Jonathan M. Ellen
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD
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Abstract
We proposed a multilevel model of structural influences on HIV-risky sexual partnerships in a diverse sample of 1793 youth residing in 23 states and the District of Columbia. We examined the influence of concentrated disadvantage, HIV stigma, and sexual and gender minority stigma on engagement in HIV risky sexual partnerships and whether youth's participation in opportunity structures, anticipation of HIV stigma, and perceptions of their community as youth-supportive settings mediated structural effects. After controlling for age, HIV status, and race, we found structural HIV stigma had deleterious indirect effects on youth's participation in HIV-risky sexual partnerships. Concentrated disadvantage and structural sexual and gender minority stigma had direct negative effects on youth's perceptions of their communities as supportive and on their participation in prosocial activity. Support perceptions had direct, protective effects on avoidance of HIV-risky sexual partnerships. Structural stigma undermines youth's belief that their communities invest in their safety and well-being.
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15
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Beach LB, Greene GJ, Lindeman P, Johnson AK, Adames CN, Thomann M, Washington PC, Phillips G. Barriers and Facilitators to Seeking HIV Services in Chicago Among Young Men Who Have Sex with Men: Perspectives of HIV Service Providers. AIDS Patient Care STDS 2018; 32:468-476. [PMID: 30398956 DOI: 10.1089/apc.2018.0094] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Young men who have sex with men (YMSM) are disproportionally impacted by HIV, and continue to lag behind other age groups in the receipt of HIV prevention and care services. To inform the development of interventions to improve pre-exposure prophylaxis and HIV care engagement outcomes among YMSM, a growing number of studies have reported the barriers and facilitators YMSM encounter when accessing HIV services. Few studies, however, have assessed how HIV service providers perceive these facilitators and barriers. In total, 21 interviews were conducted with HIV service providers in Chicago about barriers and facilitators they perceived affected YMSM's engagement in HIV services. Barriers included lack of comprehensive wraparound services, lack of trust of providers, unfamiliarity with seeking HIV services, feelings of invincibility, lack of knowledge of HIV service providers, intersectional and structural concerns (e.g., not thinking the site's services were for YMSM), geography and distance to clinic, and HIV stigma. Facilitators included presence of comprehensive wraparound services, high trust in providers, a clinic's willingness to serve uninsured patients, community engagement, word-of-mouth recommendations from lesbian, gay, bisexual, and transgender (LGBT) friends, intersectionality (e.g., offering LGBT-tailored services), geography and distance, lack of HIV stigma. Axial coding revealed that five conceptual themes cut across multiple barriers and facilitators, including health system characteristics, intersectionality, geography and transportation, community outreach, and stigma. These conceptual themes map closely onto Bronfenbrenner's ecological model. Overall, these findings highlight the importance of a multi-level approach to future intervention development to increase engagement in HIV services among YMSM.
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Affiliation(s)
- Lauren B. Beach
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - George J. Greene
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Peter Lindeman
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Amy K. Johnson
- Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
- AIDS Foundation of Chicago, Chicago, Illinois
| | - Christian N. Adames
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
| | - Matthew Thomann
- Department of Anthropology and Sociology, Kalamazoo College, Kalamazoo, Michigan
| | - Patrick C.T. Washington
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Sociology, University of Illinois at Chicago, Chicago, Illinois
| | - Gregory Phillips
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Evaluation, Data Integration, and Technical (EDIT) Assistance Program, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, Illinois
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16
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Brawner BM, Sutton MY. Sexual Health Research Among Youth Representing Minority Populations: To Waive or Not to Waive Parental Consent. ETHICS & BEHAVIOR 2017; 28:544-559. [DOI: 10.1080/10508422.2017.1365303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bridgette M. Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing
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17
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Miller RL, Lee KS, Chiaramonte D, Santiago-Rivera OJ, Acevedo-Polakovich I, Boyer CB, Ellen JM. Youth health outcomes from the Connect-to-Protect Coalitions to prevent adolescent HIV infections. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 13:142-157. [PMID: 29623100 PMCID: PMC5880542 DOI: 10.1080/17450128.2017.1371818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.
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18
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Miller RL, Reed SJ, Chiaramonte D, Strzyzykowski T, Spring H, Acevedo-Polakovich ID, Chutuape K, Cooper-Walker B, Boyer CB, Ellen JM. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:199-214. [PMID: 28851064 PMCID: PMC5678968 DOI: 10.1002/ajcp.12162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.
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Affiliation(s)
| | - Sarah J. Reed
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine
| | | | | | | | | | - Kate Chutuape
- Johns Hopkins University School of Medicine, Department of Pediatrics
| | | | - Cherrie B. Boyer
- University of California, San Francisco, Department of Pediatrics
| | - Jonathan M. Ellen
- Johns Hopkins University School of Medicine, Department of Pediatrics
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19
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Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, Schneider J. Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men. AIDS Behav 2017; 21:207-216. [PMID: 27233249 PMCID: PMC5124546 DOI: 10.1007/s10461-016-1439-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91-1.00 and OR 0.50, 95 % CI 0.25-1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20-3.94) and psychological distress (OR 5.02, 95 % CI 1.54-16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.
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Affiliation(s)
- Katherine Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Kate Jaffe
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Eavou
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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20
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Internalized HIV Stigma and Disclosure Concerns: Development and Validation of Two Scales in Spanish-Speaking Populations. AIDS Behav 2017; 21:93-105. [PMID: 26837625 DOI: 10.1007/s10461-016-1305-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Internalized stigma and disclosure concerns are key elements for the study of mental health in people living with HIV. Since no measures of these constructs were available for Spanish population, this study sought to develop such instruments, to analyze their reliability and validity and to provide a short version. A heterogeneous sample of 458 adults from different Spanish-speaking countries completed the HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale, along with the Hospital Anxiety and Depression Scale, Rosenberg's Self-esteem Scale and other socio-demographic variables. Reliability and correlation analyses, exploratory factor analyses, path analyses with latent variables, and ANOVAs were conducted to test the scales' psychometric properties. The scales showed good reliability in terms of internal consistency and temporal stability, as well as good sensitivity and factorial and criterion validity. The HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale are reliable and valid means to assess these variables in several contexts.
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21
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Garrido-Hernansaiz H, Heylen E, Bharat S, Ramakrishna J, Ekstrand ML. Stigmas, symptom severity and perceived social support predict quality of life for PLHIV in urban Indian context. Health Qual Life Outcomes 2016; 14:152. [PMID: 27809839 PMCID: PMC5094021 DOI: 10.1186/s12955-016-0556-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022] Open
Abstract
Background Multiple variables have been studied in relation to health-related quality of life (HRQoL), but research has not integrated the contributions of different variables in a single model that allows to compare them. This study, carried out with people living with HIV/AIDS in India, sought to develop a prediction model considering various predictors previously found to be related to HRQoL, namely sociodemographic factors, HIV symptoms, social support, stigmas and avoidant coping. Methods A sample of 961 HIV-positive persons from Bengaluru and Mumbai participated in this cross-sectional study, completing a sociodemographic questionnaire along with HRQoL, HIV symptoms, disclosure expectations, disclosure avoidance, social support and internalized, felt, vicarious and enacted stigma scales. Bivariate associations were obtained (correlations, ANOVAs and t tests) and a multiple regression analysis was performed. Results Results show that, when all variables are considered together, being married, widowed or deserted, symptom intensity, internalized stigma, disclosure avoidance and enacted stigma contribute negatively to predict HRQoL. On the other hand, being employed, good disclosure expectations and good social support contribute positively to predict HRQoL. Almost half of the variance in HRQoL was explained by this model. Conclusions Interventions seeking to increase HRQoL in people living with HIV/AIDS in India would benefit from addressing these aspects.
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Affiliation(s)
- Helena Garrido-Hernansaiz
- Department of Biological and Health Psychology, Psychology Faculty, Universidad Autónoma de Madrid, C/Ivan Pavlov, 6, 28049, Madrid, Spain
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA
| | - Shalini Bharat
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Chembur, Mumbai, Maharashtra, 400085, India
| | - Jayashree Ramakrishna
- Department of Mental Health Education, National Institute of Mental Health and Neurosciences, Post Bag 2900, Hosur Road, Bengaluru, 560 029, Karnataka, India
| | - Maria L Ekstrand
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA. .,St John's Research Institute, St John's National Academy of Health Sciences, 100 Feet Rd, Bengaluru, Karnataka, 560034, India.
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22
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Sutherland ME. An intersectional approach for understanding the vulnerabilities of English-speaking heterosexual Caribbean youth to HIV/AIDS and sexually transmitted infections: Prevention and intervention strategies. Health Psychol Open 2016; 3:2055102916679349. [PMID: 28070411 PMCID: PMC5193298 DOI: 10.1177/2055102916679349] [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: 01/08/2023] Open
Abstract
Caribbean youth comprise about 30 percent of the English-speaking Caribbean population, and about 81,000 Caribbean and Latin American youth are HIV infected. AIDS is the leading cause of death for 15- to 24-year-old English-speaking Caribbean youth. This article relies on intersectionality theory in the assessment of the macro-level, or structural variables, and micro-level, or individual level, variables that influence the risk-taking sexual behaviors of heterosexual English-speaking Caribbean youth and increase their vulnerability to HIV/sexually transmitted infections. This article offers macro- and micro-level prevention/intervention strategies for reducing the prevalence of sexually transmitted infections in English-speaking Caribbean youth, including the promotion of condom use, voluntary male circumcision, and HIV testing and counseling. Suggestions are offered for future research investigations to explore the contributing factors to youth's vulnerability to sexually transmitted infections and to empirically verify the relationship between and among variables that account for desired outcomes, including decreases in risky sexual behaviors.
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23
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Rowe CL, Alberga L, Dakof GA, Henderson CE, Ungaro R, Liddle HA. Family-Based HIV and Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes. FAMILY PROCESS 2016; 55:305-20. [PMID: 26879671 DOI: 10.1111/famp.12206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.
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Affiliation(s)
- Cynthia L Rowe
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Linda Alberga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Gayle A Dakof
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Craig E Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX
| | - Rocio Ungaro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Howard A Liddle
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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24
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Miller RL, Janulis PF, Reed SJ, Harper GW, Ellen J, Boyer CB. Creating Youth-Supportive Communities: Outcomes from the Connect-to-Protect® (C2P) Structural Change Approach to Youth HIV Prevention. J Youth Adolesc 2016; 45:301-15. [PMID: 26534775 PMCID: PMC4714586 DOI: 10.1007/s10964-015-0379-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/25/2015] [Indexed: 12/01/2022]
Abstract
Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.
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Affiliation(s)
| | | | - Sarah J Reed
- Michigan State University, East Lansing, MI, USA.
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25
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Homonegativity, Religiosity, and the Intersecting Identities of Young Black Men Who Have Sex with Men. AIDS Behav 2016; 20:51-64. [PMID: 26373283 DOI: 10.1007/s10461-015-1200-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV. Homonegativity, or the stigma associated with homosexuality, may be an important social factor influencing racial disparities in HIV. This research, conducted using an intersectional framework, examines experiences of homonegativity among YBMSM with a particular emphasis on the influence of the Black Church. We conducted 30 semi-structured interviews with YBMSM ages 16-24. Interview transcripts were analyzed in MAXQDA using thematic content analysis, guided by principles of grounded theory and constant comparative method. The Black Church is an integral aspect of YBMSM's identity, history, family, and community life. As such, the Church's construction of homosexuality dominated throughout YBMSM's lives. The expectations of masculinity facing YBMSM emphasize expectations of physical and sexual dominance, which are viewed as incompatible with homosexuality. Participants describe complex decision-making around whether to disclose their sexuality and to whom, and weigh the consequences of disclosure and non-disclosure. For many YBMSM, their multiple, intersecting identities significantly influenced their experiences with homonegativity and their decisions about disclosing their sexual orientation. Findings lend support for the need to develop community-, family-, and church-based stigma reduction interventions that address homonegativity among YBMSM.
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26
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Guilamo-Ramos V, Lee JJ, Kantor LM, Levine DS, Baum S, Johnsen J. Potential for using online and mobile education with parents and adolescents to impact sexual and reproductive health. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:53-60. [PMID: 24522898 DOI: 10.1007/s11121-014-0469-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research supports the central role of parents in the sexual health behaviors and outcomes of their adolescent children. Too often, parents and adolescents with the greatest sexual health disparities are difficult to reach and engage in preventative interventions. Online and mobile technologies (OMTs) represent an innovative opportunity to reach large numbers of youth and their parents. However, there is a dearth of information related to the feasibility and acceptability of OMT-delivered family interventions for reaching vulnerable youths--particularly, ethnic minority youths. The current manuscript addresses this gap in the empirical literature by examining the feasibility and acceptability of OMT-based parent-adolescent sexual health interventions for African American and Latino families. Focus groups were conducted with convenience samples of Latino and African Americans from six US cities. Fourteen focus groups (six parents and eight adolescents) with an average of 10-12 participants each provided data for the study. Researchers used inductive thematic analysis to evaluate data. The findings suggest that parents and adolescents were motivated to obtain sexual health information through OMTs due to their accessibility, widespread use, and ability to deliver large quantities of information. However, personalized and trustworthy information was viewed as less attainable through the Internet or similar digital means, presenting a potential barrier to delivering an adolescent sexual health intervention via OMTs. Sexual health interventions delivered through online and mobile mechanisms present a novel opportunity for reaching potentially at-risk ethnic minority adolescents and their parents. Feelings of discomfort surrounding OMT use with parents, generational differences, and parent-adolescent relationship quality must be considered when developing technology-based sexual health interventions for Latino and African American families.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, New York University Silver School of Social Work, 15 Washington Place, New York, NY, 10003, USA,
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27
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The dollars and sense of economic incentives to modify HIV-related behaviours. J Int AIDS Soc 2015; 18:20724. [PMID: 26480927 PMCID: PMC4610955 DOI: 10.7448/ias.18.1.20724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022] Open
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28
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Zeglin RJ. Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1979-1990. [PMID: 25917411 PMCID: PMC5502076 DOI: 10.1007/s10508-015-0501-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/24/2015] [Accepted: 01/28/2015] [Indexed: 05/31/2023]
Abstract
HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.
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Affiliation(s)
- Robert J Zeglin
- Department of Counseling and Human Development, George Washington University, 2134 G St. NW, 3rd Floor, Washington, DC, 20037, USA,
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29
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Perrino T, Beardslee W, Bernal G, Brincks A, Cruden G, Howe G, Murry V, Pantin H, Prado G, Sandler I, Brown CH. Toward scientific equity for the prevention of depression and depressive symptoms in vulnerable youth. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:642-51. [PMID: 25349137 PMCID: PMC4412755 DOI: 10.1007/s11121-014-0518-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Certain subgroups of youth are at high risk for depression and elevated depressive symptoms, and experience limited access to quality mental health care. Examples are socioeconomically disadvantaged, racial/ethnic minority, and sexual minority youth. Research shows that there are efficacious interventions to prevent youth depression and depressive symptoms. These preventive interventions have the potential to play a key role in addressing these mental health disparities by reducing youth risk factors and enhancing protective factors. However, there are comparatively few preventive interventions directed specifically to these vulnerable subgroups, and sample sizes of diverse subgroups in general prevention trials are often too low to assess whether preventive interventions work equally well for vulnerable youth compared to other youth. In this paper, we describe the importance and need for "scientific equity," or equality and fairness in the amount of scientific knowledge produced to understand the potential solutions to such health disparities. We highlight possible strategies for promoting scientific equity, including the following: increasing the number of prevention research participants from vulnerable subgroups, conducting more data synthesis analyses and implementation science research, disseminating preventive interventions that are efficacious for vulnerable youth, and increasing the diversity of the prevention science research workforce. These strategies can increase the availability of research evidence to determine the degree to which preventive interventions can help address mental health disparities. Although this paper utilizes the prevention of youth depression as an illustrative case example, the concepts are applicable to other health outcomes for which there are disparities, such as substance use and obesity.
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Affiliation(s)
- Tatiana Perrino
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, #1011 (R-669), Miami, FL, 33136, USA,
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Bacio GA, Estrada Y, Huang S, Martínez M, Sardinas K, Prado G. Ecodevelopmental predictors of early initiation of alcohol, tobacco, and drug use among Hispanic adolescents. J Sch Psychol 2015; 53:195-208. [PMID: 26054814 PMCID: PMC4461835 DOI: 10.1016/j.jsp.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/20/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this cross-sectional study was to test the transactional relationships of risk and protective factors that influence initiation of alcohol, tobacco, and drug use among Hispanic youth. Ecodevelopmental theory was used to identify factors at multiple ecological levels with a focus on four school-level characteristics (i.e. school socioeconomic status, school climate, school acculturation, and school ethnic composition). A sample of 741 Hispanic adolescents (M age=13.9, SD=.67) and their caregivers were recruited from 18 participating middle schools in Miami-Dade County, FL. Structural equation modeling was used to test the hypothesized ecodevelopmental model of early substance use, accounting for school clustering effects. Results provided strong support for the model (CFI=.95; RMSEA=.03). School SES was indirectly related to the likelihood of starting substance use through perceived peer use norms (β=.03, p<.02). Similarly, school climate had an indirect effect on substance use initiation through family functioning and perceptions of peer use norms (β=-.03, p<.01). Neither school ethnic composition nor school acculturation had indirect effects on initiation of substance use. Results highlight the importance of the interplay of risk and protective factors at multiple ecological levels that impact early substance use initiation. Further, findings underscore the key role of school level characteristics on the initiation of substance use and present opportunities for intervention.
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Affiliation(s)
| | - Yannine Estrada
- Department of Public Health Sciences, University of Miami, USA
| | - Shi Huang
- Department of Public Health Sciences, University of Miami, USA
| | | | | | - Guillermo Prado
- Department of Public Health Sciences, University of Miami, USA.
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Wilson EC, Chen YH, Arayasirikul S, Fisher M, Pomart WA, Le V, Raymond HF, McFarland W. Differential HIV risk for racial/ethnic minority trans*female youths and socioeconomic disparities in housing, residential stability, and education. Am J Public Health 2015; 105 Suppl 3:e41-7. [PMID: 25905826 DOI: 10.2105/ajph.2014.302443] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined HIV prevalence and risk behaviors of 282 trans*female youths aged 16 to 24 years participating in the San Francisco Bay Area, California, SHINE study from 2012 to 2013 to determine differences between racial/ethnic minority and White youths. METHODS We conducted the χ(2) test to determine distributional differences between racial/ethnic minority and White participants in sociodemographic factors, HIV-related risk behaviors, and syndemic factors. RESULTS Of the trans*female youths, 4.8% were HIV positive. Racial/ethnic minority and White trans*female youths differed significantly in gender identity and sexual orientation. Racial/ethnic minority youths also had significantly lower educational attainment, were less likely to have lived with their parents of origin as a child, and were significantly more likely to engage in recent condomless anal intercourse than were Whites. CONCLUSIONS Efforts to assess the impact of multiple-minority stress on racial/minority trans*female youths are needed imminently, and prevention efforts must address macrolevel disparities for trans*female youths, especially those from racial/ethnic minority groups, to reduce these disparities and prevent incident cases of HIV.
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Affiliation(s)
- Erin C Wilson
- All of the authors are with the San Francisco Department of Public Health, San Francisco, CA
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Chutuape KS, Muyeed AZ, Willard N, Greenberg L, Ellen JM. Adding to the HIV Prevention Portfolio - the Achievement of Structural Changes by 13 Connect to Protect ® Coalitions. GLOBAL JOURNAL OF COMMUNITY PSYCHOLOGY PRACTICE 2015; 5:1-8. [PMID: 25632407 PMCID: PMC4306189 DOI: 10.7728/0502201404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Opportunities to control risk factors that contribute to HIV transmission and acquisition extend far beyond individuals and include addressing social and structural determinants of HIV risk, such as inadequate housing, poor access to healthcare and economic insecurity. The infrastructure within communities, including the policies and practices that guide institutions and organizations, should be considered crucial targets for change. This paper examines the extent to which 13 community coalitions across the U.S. and Puerto Rico were able to achieve "structural change" objectives (i.e., new or modified practices or policies) as an intermediate step toward the long-term goal of reducing HIV risk among adolescents and young adults (12-24 years old). The study resulted in the completion of 245 objectives with 70% categorized as structural in nature. Coalitions targeted social services, education and government as primary community sectors to adopt structural changes. A median of 12 key actors and six new key actors contributed to accomplishing structural changes. Structural change objectives required a median of seven months to complete. The structural changes achieved offer new ideas for community health educators and practitioners seeking to bolster their HIV prevention agenda.
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Affiliation(s)
- Kate S Chutuape
- Project Director for Connect to Protect at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Adaline Z Muyeed
- Senior Epidemiologist and Project Director at Westat in Rockville, MD, USA
| | - Nancy Willard
- public health researcher at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - Jonathan M Ellen
- Protocol Chair and President of All Children's Hospital in St. Petersburg, FL, USA
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Newsome V, Davis Z, Dinac J. Re-Search: The Missing Pieces in Investigating African-American Relationship Dynamics and Implications for HIV Risk. ACTA ACUST UNITED AC 2015; 1:113-128. [PMID: 26594651 DOI: 10.1353/bsr.2015.0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Feldman MB, Silapaswan A, Schaefer N, Schermele D. Is there life after DEBI? Examining health behavior maintenance in the diffusion of effective behavioral interventions initiative. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2014; 53:286-313. [PMID: 24499926 DOI: 10.1007/s10464-014-9629-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The evidence-based interventions that are identified, packaged, and disseminated by the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention as part of the Diffusion of Effective Behavioral Interventions (DEBI) initiative-commonly referred to the "DEBIs"-currently represent a primary source of HIV prevention interventions for community-based providers. To date, little attention has focused on whether the intended outcomes of the DEBIs, i.e., reductions in HIV-related risk behaviors, are maintained over time. This review summarized evidence for the sustainability of the effects of the DEBIs on HIV sexual risk behavior and intravenous drug use from studies of original and adapted DEBIs. Evidence of intervention decay or a lack of any intervention effect was identified in several original and adapted versions of the DEBIs included in this review. Recommendations include modifications to current criteria for inclusion in the DEBI portfolio, in addition to the development of remediation strategies to address intervention decay. Further, theoretical models that specify the processes that underlie the maintenance of health behaviors over time should be used in developing HIV prevention interventions.
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