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Mitchell MM, Tseng TY, Rubin LH, Cruz-Oliver D, Catanzarite Z, Clair CA, Moore DJ, Knowlton AR. Social support network factors associated with verbal fluency among vulnerable persons living with HIV. AIDS Care 2024; 36:358-367. [PMID: 37345842 PMCID: PMC10739652 DOI: 10.1080/09540121.2023.2216925] [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: 03/18/2022] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
Vulnerable persons living with HIV (PLWH) are at high risk of cognitive impairment and challenges accessing quality social support in later life. Impaired verbal fluency (VF), a cognitive domain linked to HIV, could impede social support associated with health and well-being for already vulnerable PLWH. We examined the structure of social support, using latent class analysis, and the associations among quantity, specific forms and quality of social support and VF among PLWH. Participants enrolled in the BEACON study (n = 383) completed the Controlled Oral Word Association test (COWAT) and a social support network inventory. Latent class analysis with count variables was used to determine the number of classes of PLWH based on their social network characteristics. The majority of PLWH were male (61.4%) and African American (85.9%). Two distinct latent classes, with a major distinction in the number of network members who were female, knew participants' HIV status and HIV medication usage. Fewer support network members (β = -.13, p < 0.01), greater negative interactions (β = -.16, p < 0.01), and less positive interactions with network members (β = .15, p < 0.05) were significantly associated with lower COWAT scores. Comprehensive screening of high-risk PLWH and early intervention with those with cognitive impairment are important for addressing social support needs.
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Affiliation(s)
- Mary M. Mitchell
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Tuo-Yen Tseng
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Leah H. Rubin
- Departments of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Dulce Cruz-Oliver
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zachary Catanzarite
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Catherine A. Clair
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Amy R. Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
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Tam C, Wesseling T, Wang L, Salters K, Moore DM, Dawydiuk N, Zhu J, Grieve S, Bingham B, McLinden T, Hogg R, Barrios R. It's all about connection: Determinants of social support and the influence on HIV treatment interruptions among people living with HIV in British Columbia, Canada. BMC Public Health 2023; 23:2524. [PMID: 38104090 PMCID: PMC10725596 DOI: 10.1186/s12889-023-17416-7] [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: 10/17/2022] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Social support has previously been found to be associated with improved health outcomes of individuals managing chronic illnesses, including amongst people living with HIV (PLWH). For women and people who use injection drugs who continue to experience treatment disparities in comparison to other PLWH, social support may have potential in facilitating better treatment engagement and retention. In this analysis, we examined determinants of social support as measured by the Medical Outcomes Study - Social Support Survey (MOS-SSS) scale, and quantified the relationship between MOS-SSS and HIV treatment interruptions (TIs) among PLWH in British Columbia, Canada. METHODS Between January 2016 and September 2018, we used purposive sampling to enroll PLWH, 19 years of age or older living in British Columbia into the STOP HIV/AIDS Program Evaluation study. Participants completed a baseline survey at enrolment which included the MOS-SSS scale, where higher MOS-SSS scores indicated greater social support. Multivariable linear regression modeled the association between key explanatory variables and MOS-SSS scores, whereas multivariable logistic regression modeled the association between MOS-SSS scores and experiencing TIs while controlling for confounders. RESULTS Among 644 PLWH, we found that having a history of injection drug use more than 12 months ago but not within the last 12 months, self-identifying as Indigenous, and sexual activity in the last 12 months were positively associated with MOS-SSS, while being single, divorced, or dating (vs. married), experiences of lifetime violence, and diagnosis of a mental health disorder were inversely associated. In a separate multivariable model adjusted for gender, ethnicity, recent homelessness, sexual activity in the last 12 months, and recent injection drug use, we found that higher MOS-SSS scores, indicating more social support, were associated with a lower likelihood of HIV treatment interruptions (adjusted odds ratio: 0.90 per 10-unit increase, 95% confidence interval: 0.83, 0.99). CONCLUSIONS Social support may be an important protective factor in ensuring HIV treatment continuity among PLWH. Future research should examine effective means to build social support among communities that have potential to promote increased treatment engagement.
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Affiliation(s)
- Clara Tam
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada.
| | - Tim Wesseling
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nicole Dawydiuk
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Julia Zhu
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Sean Grieve
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Indigenous Health, Vancouver Coastal Health, Vancouver, Canada
| | - Taylor McLinden
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert Hogg
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Armoon B, Griffiths MD, Mohammadi R, Ahounbar E, Fleury MJ. Acute care utilization and its associated determinants among patients with substance-related disorders: A worldwide systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2023; 30:1096-1113. [PMID: 37211655 DOI: 10.1111/jpm.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Identifying determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRDs) can improve health services to address unmet health needs. AIM The present study aimed to identify the prevalence rates of ED use and hospitalization, and their associated determinants among patients with SRDs. METHODS Studies in English published from January 1, 1995, to December 1, 2022, were searched on PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies. RESULTS The pooled prevalence rates of ED use and hospitalization among patients with SRDs were 36% and 41%, respectively. Patients with SRDs who were the most at risk of being both ED users and hospitalized were those (i) having medical insurance, (ii) having other drug and alcohol use disorders, (iii) having mental health disorders, and (iv) having chronic physical illnesses. A lower level of education increased the risk of ED use only. DISCUSSION To decrease ED use and hospitalization, more comprehensive services may be offered to these vulnerable patients with diversified needs. IMPLICATIONS FOR PRACTICE Chronic care integrating outreach interventions could be more provided for patients with SRDs after discharge from acute care units or hospitals.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Collins CB, Higa D, Taylor J, Wright C, Murray KH, Pitasi M, Greene Y, Lyles C, Edwards A, Andia J, Stallworth J, Alvarez J. Prioritization of Evidence-Based and Evidence-Informed Interventions for Retention in Medical Care for Persons with HIV. AIDS Behav 2023; 27:2285-2297. [PMID: 36580166 PMCID: PMC10225340 DOI: 10.1007/s10461-022-03958-1] [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] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
Up to 50% of those diagnosed with HIV in the U.S. are not retained in medical care. Care retention provides opportunity to monitor benefits of HIV therapy and enable viral suppression. To increase retention, there is a need to prioritize best practices appropriate for translation and dissemination for real-world implementation. Eighteen interventions from CDC's Compendium of Evidence-Based Interventions were scored using the RE-AIM framework to determine those most suitable for dissemination. A CDC Division of HIV Prevention workgroup developed a RE-AIM scale with emphasis on the Implementation and Maintenance dimensions and less emphasis on the Efficacy dimension since all 18 interventions were already identified as evidence-based or evidence-informed. Raters referenced primary efficacy publications and scores were averaged for a ranked RE-AIM score for interventions. Of 18 interventions, four included care linkage and 7 included viral suppression outcomes. Interventions received between 20.6 and 35.3 points (45 maximum). Scores were converted into a percentage of the total possible with ranges between 45.8 and 78.4%. Top four interventions were ARTAS (78.4%); Routine Screening for HIV (RUSH) (73.2%); Optn4Life (67.4%) and Virology Fast Track (65.9%). All four scored high on Implementation and Maintenance dimensions. Select items within the scale were applicable to health equity, covering topics such as reaching under-served focus populations and acceptability to that population. Navigation-enhanced Case Management (NAV) scored highest on the health equity subscale. RE-AIM prioritization scores will inform dissemination and translation efforts, help clinical staff select feasible interventions for implementation, and support sustainability for those interventions.
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Affiliation(s)
- Charles B Collins
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA.
| | - Darrel Higa
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jocelyn Taylor
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Carolyn Wright
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Kimberly H Murray
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Marc Pitasi
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Yvonne Greene
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Cynthia Lyles
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Arlene Edwards
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jonny Andia
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - JoAna Stallworth
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jorge Alvarez
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
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Liu Y, Yang Y, Fu C, Lin H, Wang T, Wang S, Kuang J, Chen X, Wang J. Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study. Front Psychiatry 2023; 14:1179703. [PMID: 37091698 PMCID: PMC10117785 DOI: 10.3389/fpsyt.2023.1179703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness. Methods A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects. Results Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem. Conclusion Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.
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Affiliation(s)
- Yuhan Liu
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Yuting Yang
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Chaowei Fu
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Haijiang Lin
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Tingting Wang
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Shanling Wang
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Jiawen Kuang
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
- Xiaoxiao Chen,
| | - Jingyi Wang
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
- *Correspondence: Jingyi Wang,
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Constructing Taxonomies: Identifying Distinctive Class of HIV Support and Risk Networks among People Who Use Drugs (PWID) and Their Network Members in the HPTN 037 Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127205. [PMID: 35742460 PMCID: PMC9223677 DOI: 10.3390/ijerph19127205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
Injection drug use is a significant mode of HIV transmission. Social networks are potential avenues for behavior change among high-risk populations. Increasing knowledge should include a classification or taxonomy system of networks’ attributes, risks, and needs. The current study employed 232 networks comprising 232 indexes, with 464 network members enrolled in Philadelphia. LCA revealed a three-class solution, Low-Risk, Paraphernalia Risk, and High Sex/Moderate Paraphernalia Risk class, among participants. The analysis found receiving money or drugs for sex and employment status increased the odds of belonging to PR and PSR classes. Homelessness and incarceration increased the odds of belonging to the PR class when compared to the LR class. Our findings suggest that classes of risk among PWID comprise clusters of information concerning their members. These findings add depth to our understanding while extending our knowledge of the contextual environment that nurtures or exacerbates the problem.
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Rudolph AE, Dembo RS, Tobin K, Latkin C. Perceived HIV Treatment Norms Modify the Association Between HIV-Related Stigma and Adherence to Antiretroviral Therapy Among Persons Living with HIV in Baltimore, Maryland. AIDS Behav 2022; 26:537-548. [PMID: 34338899 PMCID: PMC8807774 DOI: 10.1007/s10461-021-03409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014-2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15-0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65-1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA.
| | - Robert S Dembo
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Stigma in a Collectivistic Culture: Social Network of Female Sex Workers in China. AIDS Behav 2022; 26:297-309. [PMID: 34312739 DOI: 10.1007/s10461-021-03383-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
In this egocentric network study, we explored Chinese collectivism in relation to social network characteristics and sex work-related stigma among mid-age female sex workers (FSWs). Respondent-driven sampling was used to recruit 1245 mid-age FSWs from three cities in China. We found that a one standard deviation (SD) increase in FSWs' collectivism was associated with a 0.18 SD decrease in social support (95% CI - 0.32, - 0.04), a 0.20 SD decrease in network effective size (i.e., the diversity of a social network; 95% CI - 0.30, - 0.10), and a 0.21 SD decrease in network betweenness (i.e., the "bridging potential" of egos within their networks; 95% CI - 0.33, - 0.09). Among participants who perceived more sex work stigma, the association between collectivism and FSWs' network betweenness was attenuated. In a collective culture emphasizing group values and honor, belonging to a less interconnected social network may give FSWs a structural advantage to cope with stigma and secure social support.
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The Impact of a Peer Social Support Network from the Perspective of Women with Fibromyalgia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312801. [PMID: 34886527 PMCID: PMC8657284 DOI: 10.3390/ijerph182312801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022]
Abstract
Background: Fibromyalgia is a chronic and complex disease whose management by patients requires a high level of commitment. Patient empowerment therefore represents an important milestone in chronic disease treatment and control. We explored the impact of a peer social support network from the perspective of women with fibromyalgia. Methods: A generic qualitative design was proposed for the study, for which women who had been diagnosed with fibromyalgia were purposefully selected. Six semi-structured interviews were conducted, and the collected data were thematically analysed. Results: Three key themes emerged regarding the peer social support network: (1) empowerment (facilitating acceptance of the diagnosis and acting as a source of information); (2) effects on well-being and quality of life (attenuated the stigma, improved physical well-being, provided emotional support and was a socialization medium); and (3), valuable aspects (transmitted feelings of being understood and listened to and increased personal feelings of satisfaction). Conclusions: A peer social support network for women with fibromyalgia exerts positive effects on their physical, mental, and social well-being and empowers them to better manage their disease. Healthcare for women with fibromyalgia should include strategies that connect them through peer social support networks.
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Davey-Rothwellh M, Owczarzak J, Collins K, Dolcini MM, Tobin K, Mitchell F, Jones A, Latkin C. Lessons Learned from Implementing the SHIELD Intervention: A Peer Education Intervention for People Who Use Drugs. AIDS Behav 2021; 25:3472-3481. [PMID: 33913060 DOI: 10.1007/s10461-021-03275-z] [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] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
HIV prevention and care peer education interventions have demonstrated effectiveness at changing HIV risk and care behaviors among a variety of at-risk populations in different settings. However, little is known about the implementation of this type of intervention in community-based settings. Further, there is limited information available regarding the facilitators and barriers to implementing peer education interventions in community-based settings. In this study, we explore implementation facilitators, barriers, and strategies to overcome these barriers among 12 organizations that implemented the SHIELD intervention, an evidenced-based peer education intervention for people who use drugs. Guided by the Consolidated Framework for Implementation Research, we identified several facilitators and barriers at the outer, inner individuals, and intervention level of the implementation process. Future evidence-based public health programs should, in addition to addressing effectiveness, be relevant to the needs and lives of clients.
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Affiliation(s)
- Melissa Davey-Rothwellh
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA.
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21212, USA.
| | - Jill Owczarzak
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA
| | - Karina Collins
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA
| | - M Margaret Dolcini
- Oregon State University, College of Public Health and Health Sciences, School of Social and Behavioral Health Sciences, Corvallis, OR, USA
| | - Karin Tobin
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA
| | - Frances Mitchell
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA
| | - Abenea Jones
- Pennsylvania State University, College of Health and Human Development, Health and Family Studies, University Park, PA, USA
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA
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Gordon KS, Chiasson MA, Hoover DR, Martins SS, Wilson PA, Lewis CF. Difference in HIV testing behavior by injection status, among users of illicit drugs. AIDS Care 2021; 34:776-783. [PMID: 33856945 DOI: 10.1080/09540121.2021.1913716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Human Immunodeficiency Virus (HIV) infection remains prevalent among the marginalized and drug using population in the United States. Testing for HIV is an important and cost-effective way to reduce HIV prevalence. Our objective was to determine if there is a difference in the number of HIV testing by injection status among users of illicit drugs and if a person's social network characteristics is a contributing factor. Using a cross-sectional design and negative binomial regression models, we assessed HIV testing behavior of people who use non-injected drugs (PWND) compared to people who use injected drugs (PWID). In an analytic sample of 539 participants, PWND tested for HIV 19% less compared to PWID, PR (95% CI) = 0.81 (0.66, 0.98), p = 0.03. Other contributing factors of testing were education, condomless sex, STIs, heroin use, and participant's sex network. The interaction term between PWND and emotional support in relation to HIV testing was significant, 1.33 (1.03, 1.69), p=0.03. These findings suggest HIV testing behavior differed by injection status, and this relationship may be dependent on emotional support. To exert a greater impact on the HIV epidemic, interventions and policies encouraging HIV testing in PWND, an understudied at-risk sub-population, are warranted.
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Affiliation(s)
- Kirsha S Gordon
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA.,Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Mary Ann Chiasson
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA.,Public Health Solutions, Research and Evaluation Unit, New York, NY, USA
| | - Donald R Hoover
- Department of Statistics & Biostatistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, USA
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | - Patrick A Wilson
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY, USA
| | - Crystal Fuller Lewis
- Division of Social Solutions and Services Research, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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12
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Semá Baltazar C, Kellogg TA, Boothe M, Loarec A, de Abreu E, Condula M, Fazito E, Raymond HF, Temmerman M, Luchters S. Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs: Results from the implementation of the first drop-in-center in Mozambique. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103095. [PMID: 33429163 DOI: 10.1016/j.drugpo.2020.103095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND People who use drugs (PWUD) which includes both people who inject drugs (PWID) and non-injection drug users (NIDU) are marginalized, experience high levels of stigma and discrimination, and are likely to have challenges with accessing health services. Mozambique implemented the first drop-in center (DIC) for PWUD in Maputo City in 2018. This analysis aims to assess the prevalence of HIV, viral hepatitis B (HBV) and C (HCV) and tuberculosis (TB) among PWUD, and assess their linkage to care and associated correlates. METHODS We conducted a cross-sectional retrospective analysis of routine screening data collected from the first visit at the drop-in center (DIC) during the period of May 2018 to November 2019 (18 months). Descriptive and multivariable logistic regression analysis were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of HIV, HBV, HCV and TB infections among PWID and NIDU. Cox proportional hazards models of determinants were used to estimate time from HIV diagnosis to linkage to care for PWUD. RESULTS A total of 1,818 PWUD were screened at the DIC, of whom 92.6% were male. The median age was 27 years (range:14-63). Heroin was the most consumed drug (93.8%), and among people who used it, 15.5% injected it. Prevalence of HIV (43.9%), HCV (22.6%) and HBV (5.9%) was higher among PWID (p<0.001). Linkage to HIV care was observed in 40.5% of newly diagnosed PWID. Factors associated with shorter time to linkage to care included drug injection (aHR=1.6) and confirmed TB infection (aHR=2.9). CONCLUSION This was the first analysis conducted on the implementation of the DIC in Mozambique and highlights the importance of targeted services for this high-risk population. Our analysis confirmed a high prevalence of HIV, HBV and HCV, and highlight the challenges with linkage to care among PWID. The expansion of DIC locations to other high-risk localities to enhance HIV testing, treatment services and linkage to care to reduce ongoing transmission of HIV, HBV, HCV and TB and improve health outcomes.
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Affiliation(s)
- Cynthia Semá Baltazar
- Instituto Nacional de Saúde (INS), Maputo, Mozambique; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Makini Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anne Loarec
- Médecins Sans Frontières, Maputo, Mozambique
| | | | | | - Erika Fazito
- International Center Aids Program (ICAP), Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco (UCSF), USA; School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of OBGYN, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Population Health, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Burnet Institute, Melbourne, Australia
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13
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Dong ZL, Gao GF, Lyu F. Advances in research of HIV transmission networks. Chin Med J (Engl) 2020; 133:2850-2858. [PMID: 33273335 PMCID: PMC10631577 DOI: 10.1097/cm9.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
Transmission network analysis is a crucial evaluation tool aiming to explore the characteristics of the human immunodeficiency virus epidemic, develop evidence-based prevention strategies, and contribute to various areas of human immunodeficiency virus/acquired immunodeficiency syndrome prevention and control. Over recent decades, transmission networks have made tremendous strides in terms of modes, methods, applications, and various other aspects. Transmission network methods, including social, sexual, and molecular transmission networks, have played a pivotal role. Each transmission network research method has its advantages, as well as its limitations. In this study, we established a systematic review of these aforementioned transmission networks with respect to their definitions, applications, limitations, recent progress, and synthetic applications.
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Affiliation(s)
- Zhi-Long Dong
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - George Fu Gao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Fan Lyu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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14
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Falade-Nwulia O, Ward KM, McCormick S, Mehta SH, Pitts SR, Katz S, Chander G, Thomas DL, Sulkowski M, Latkin CA. Network-based recruitment of people who inject drugs for hepatitis C testing and linkage to care. J Viral Hepat 2020; 27:663-670. [PMID: 32045086 PMCID: PMC7299737 DOI: 10.1111/jvh.13274] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Although oral direct-acting agent (DAA) therapies have the potential to reduce the burden of hepatitis C virus (HCV) infection, treatment uptake remains low, particularly among people who inject drugs (PWID). This study examined the feasibility of an innovative peer-based recruitment strategy to engage PWID in HCV testing and treatment. We interviewed an initial set of HCV antibody-positive PWID as 'primary indexes' to gather demographic, drug use, health information and drug network characteristics. Primary indexes were then briefly educated on HCV and its treatment and encouraged to recruit their injection drug 'network members' for HCV testing and linkage to care. Eligible network members were enrolled as 'secondary indexes' and completed the same index study procedures. In sum, 17 of 36 primary indexes initiated the recruitment of 64 network members who were HCV antibody positive and eligible to become indexes. In multivariable analysis, successful recruitment of at least one network member was positively associated with prior HCV treatment (OR 2.80; CI [1.01, 7.72]), daily or more injection drug use (OR 2.38; CI [1.04, 5.47]), and a higher number of injection drug network members (OR 1.20; CI [1.01, 1.42]). Among the 69 participants with chronic HCV not previously linked to HCV care at enrolment, 91% (n = 63) completed a linkage to HCV care appointment, 45% (n = 31) scheduled an appointment with an HCV provider, and 20% (n = 14) initiated HCV therapy. These findings suggest a potential benefit for peer-driven, network-based interventions focused on HCV treatment-experienced PWID as a mechanism to increase HCV linkage to care.
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Affiliation(s)
| | | | - Sean McCormick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H. Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Stephanie Katz
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - David L. Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl A. Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Marziali ME, Armstrong HL, Closson K, McLinden T, Wang L, Barath J, Harris M, Roth EA, Moore DM, Lachowsky NJ, Hogg RS, Sang JM, Card KG. Loneliness and self-rated physical health among gay, bisexual and other men who have sex with men in Vancouver, Canada. J Epidemiol Community Health 2020; 74:553-559. [PMID: 32269083 PMCID: PMC7527030 DOI: 10.1136/jech-2019-213566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/02/2020] [Accepted: 03/04/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Due to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression. METHODS Participants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012-February 2015) with follow-up visits occurring every 6 months till February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale. RESULTS Of the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health who reported feeling lonely. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship. CONCLUSION There may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.
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Affiliation(s)
- Megan E. Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Mailman School of Public Health, Columbia University, New York City, United States
| | - Heather L. Armstrong
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Psychology, University of Southampton, Southampton, England
| | - Kalysha Closson
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Taylor McLinden
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Marianne Harris
- AIDS Research Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eric A. Roth
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - David M. Moore
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J. Lachowsky
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | - Robert S. Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jordan M. Sang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G. Card
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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16
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Messer LC, Quinlivan EB, Adimora A, Roytburd K. Self-reported depression and social support are associated with egocentric network characteristics of HIV-infected women of color. BMC WOMENS HEALTH 2020; 20:80. [PMID: 32326922 PMCID: PMC7181511 DOI: 10.1186/s12905-020-00937-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
Abstract
Background We explore the social network characteristics associated with depressive symptoms and social support among HIV-infected women of color (WOC). Methods Network data were collected from 87 HIV-infected WOC at an academic Infectious Disease clinic in the United States (US) south. With validated instruments, interviewers also asked about depressive symptoms, social support, and treatment-specific social support. Linear regression models resulted in beta coefficients and 95% confidence intervals for the relationships among network characteristics, depression, and support provision. Results Financial support provision was associated with lower reported depressive symptoms while emotional support provision was associated with increased reported social support. Talking less than daily to the first person named in her network, the primary alter, was associated with a nearly 3-point decrease in reported social support for respondents. Having people in their social network who knew their HIV status was also important. Conclusions We found that both functional and structural social network characteristics contributed to perceptions of support by HIV-infected WOC.
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Affiliation(s)
- Lynne C Messer
- OHSU-PSU School of Public Health, 506 SW Mill St, Portland, OR, 97201, USA.
| | - E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adaora Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katya Roytburd
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Kalichman SC, Banas E, Katner H, Hill M, Kalichman MO. Individual Social Capital and the HIV Continuum of Care in a Rural Setting of the Southeast United States. ACTA ACUST UNITED AC 2020; 44:75-86. [PMID: 34017364 DOI: 10.1037/rmh0000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social capital is associated with the health of people living with HIV, and yet few studies have examined social capital in relation to the HIV continuum of care in the United States. The current study assessed individual social capital within social networks of 251 people living with HIV and residing in a rural area of the southeastern United States. Participants completed computerized self-administered measures that included markers of social capital and disclosure of HIV status to network members. We estimated individual social capital for each relationship identified in the social network interviews and tested regression models at three points along the HIV continuum of care: receiving ART, ART adherence, and HIV viral suppression. Results indicated that one in four participants had not disclosed their HIV status to at least one member of their social network and disclosure was not associated with social capital. Regression models showed that participants with larger social networks and less social capital were more likely to be receiving ART and more likely to have HIV suppressed viral loads. Alcohol use, not social capital, was related to ART non-adherence. Participant's depressive symptomatology was unrelated to any HIV care continuum metrics assessed in this study. We conclude that social capital is drawn upon at critical points along the HIV continuum of care. Interventions should focus on building social capital within social networks and provide support to key network members when patients are transitioning into care, initiating ART and experiencing HIV unsuppressed viral loads.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School
| | - Harold Katner
- Department of Medicine, Mercer University Medical School
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut
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18
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Falade-Nwulia O, Sacamano P, McCormick SD, Yang C, Kirk G, Thomas D, Sulkowski M, Latkin C, Mehta SH. Individual and network factors associated with HCV treatment uptake among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102714. [PMID: 32135398 DOI: 10.1016/j.drugpo.2020.102714] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/15/2020] [Accepted: 02/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWID), a population with disproportionately high rates of HCV, remains low. Peers have been shown to positively impact a broad range of health outcomes for PWID. There is, however, limited data on the impact of PWID social network members on HCV treatment. METHODS HCV-infected PWID enrolled in an ongoing community-based cohort were recruited as "indexes" to complete an egocentric social network survey. The survey elicited from the index PWID a list of their network members and the index's perception of network member characteristics. Logistic regression analyses were conducted to compare individual and network factors associated with HCV treatment in the index PWID. RESULTS Among 540 HCV-infected PWID, the mean age was 55.7 years and the majority were black (87.2%) and male (69.8%). PWID reported a mean of 4.4 (standard deviation [SD] 3.2) network members, most of whom were relatives (mean 2.2 [SD 1.5]). In multivariable analysis, increasing index age and HIV infection were positively associated with HCV treatment, while drug use and homelessness in the preceding 6 months were negatively associated with HCV treatment. From a network perspective, having at least one network member who regularly talked with the index about seeing their doctor for HIV care was associated with HCV treatment (Adjusted Odds Ratio [AOR] 2.7; 95% Confidence Interval (CI) [1.3, 5.6]). Conversely, PWID who had at least one network member who helped them understand their HCV care were less likely to have been HCV treated (AOR 0.2; CI [0.1, 0.6). CONCLUSION HCV treatment uptake in this group of PWID appeared to be positively influenced by discussions with network members living with HIV who were in care and negatively influenced by HCV information sharing within PWID networks. These findings underscore the influence of peers on health seeking behaviors of their network members and emphasizes the importance of well-informed peers.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA.
| | - Paul Sacamano
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean D McCormick
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Cui Yang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Greg Kirk
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Thomas
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shruti H Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Moitra E, Anderson BJ, Herman DS, Hayaki J, Pinkston MM, Kim HN, Stein MD. Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C. AIDS Care 2020; 32:1238-1245. [PMID: 32098484 DOI: 10.1080/09540121.2020.1734177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Lifespan Physicians Group, Providence RI, USA
| | - H Nina Kim
- Department of Global Health, University of Washington, Seattle WA, USA.,Department of Medicine, University of Washington, Seattle WA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
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20
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Sacamano PL, Mehta SH, Latkin C, Falade-Nwulia O, Kirk GD, Rudolph AE. Characterizing latent classes of social support among persons who inject drugs. Drug Alcohol Depend 2020; 207:107816. [PMID: 31923777 PMCID: PMC7532840 DOI: 10.1016/j.drugalcdep.2019.107816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/16/2019] [Accepted: 12/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Social network members influence risk and health behaviors, yet little is known about the support that persons who inject drugs (PWID) receive from their closest ties. METHODS 970 participants from the AIDS Linked to the IntraVenous Experience (ALIVE) study completed a social network survey between April 2016 and June 2017 about their five closest ties. Our analysis: 1) identified latent classes of support received by participants; 2) determined whether class membership differed by current (≤12 months) vs. former (>12 months) injection drug use; 3) compared classes of support by individual and network characteristics. RESULTS 970 participants listed 3,388 network members. We identified three support classes: (1) Moderate (n = 249): probabilities of support <0.40; (2) High (n = 366): probabilities of support 0.58-0.82; (3) Very high (n = 355): probabilities of support 0.91-0.99. In adjusted analysis compared to moderate support, the odds of high and very high support increased as the mean age of network members increased (Adjusted Odds Ratio [AOR]:1.03; 95 % CI: 1.01, 1.05) and as the number of network members with whom they interacted daily increased (AOR-high: 1.33; 95 % CI:1.14, 1.56 and AOR-very high: 1.54; 95 % CI: 1.30, 1.83). While current injection drug use was associated with lower unadjusted odds of high and very high support, the associations were not statistically significant in adjusted analysis. CONCLUSIONS Support was higher among networks of older ties and more frequent interaction, but differences did not appear to be driven by injection drug use status. Findings point to the importance of the closest social ties.
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Affiliation(s)
- Paul L Sacamano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, Baltimore, MD 21205, United States
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 737, Baltimore, MD 21205, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins Department of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, United States
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6533, Baltimore, MD 21205, United States
| | - Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA 19122, United States
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21
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Sohler N, Slawek D, Earnshaw V, Jost J, Lee A, Mancini J, Mompremier A, Cunningham CO. Drug use and HIV medication adherence in people living with HIV. Subst Abus 2020; 42:310-316. [PMID: 31951807 DOI: 10.1080/08897077.2019.1706695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioid and cocaine use epidemics continue to be substantial in the United States and intersect with the HIV epidemic. Antiretroviral medication (ARV) adherence is critical for optimum HIV outcomes. While previous research explored harm reduction strategies to prevent HIV spread for people who use drugs (PWUD), little is known about strategies used by PWUD living with HIV to maintain ARV adherence. Methods: We explored whether PWUD modify their drug use explicitly to maintain ARV adherence, and identified factors associated with this process. We conducted 23 semi-structured interviews. Data were analyzed using a modified framework analysis approach. Results: Participants had a mean age of 54 years and were predominantly male (70%) and non-Hispanic black (65%). Most described periods of being able to adhere to ARVs while still using drugs, difficulty adhering to ARVs while using drugs, and abstinence/near abstinence from drug use. In exploring factors that influenced changes in drug use and ARV adherence behaviors, we noted consistent acknowledgment of the roles of family, partners, or providers. Conclusions: PWUD living with HIV often modify their drug use to improve ARV adherence. Providers caring for this population might consider family or group education models to encourage harm reduction to improve outcomes.
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Affiliation(s)
- Nancy Sohler
- CUNY School of Medicine, City College of New York, New York, NY, USA
| | - Deepika Slawek
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - John Jost
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Alice Lee
- CUNY School of Medicine, City College of New York, New York, NY, USA
| | - John Mancini
- CUNY School of Medicine, City College of New York, New York, NY, USA
| | | | - Chinazo O Cunningham
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Falade-Nwulia O, Irvin R, Merkow A, Sulkowski M, Niculescu A, Olsen Y, Stoller K, Thomas DL, Latkin C, Mehta SH. Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore. J Subst Abuse Treat 2019; 100:45-51. [PMID: 30898327 DOI: 10.1016/j.jsat.2019.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major public health issue among people who inject drugs (PWID) with prevalence of 50-80% in the United States. Effective, simple, oral direct acting agents (DAA) of short duration with minimal side effects have been associated with cure rates > 95%. However, HCV treatment uptake among PWID remains low. We characterized the HCV care continuum, HCV treatment knowledge, as well as barriers and facilitators to HCV treatment uptake among PWID enrolled in two opioid treatment programs (OTPs) in Baltimore, Maryland, USA. METHODS Between July and November 2016, 124 HCV infected PWID were recruited from two opioid treatment programs in Baltimore through convenience sampling. Participants completed a 50-item questionnaire to assess HCV treatment knowledge, attitudes, and practices. Progress through the HCV care continuum was assessed based on a series of questions assessing evaluation for HCV treatment, recommendation for HCV treatment by a provider, and HCV treatment initiation. HCV status was assessed based on participant self-report. RESULTS The median age was 52 years (IQR 44-58), 56% were male, the majority were African American (69%), and 19% reported HIV coinfection. Participants had been tested for HCV at their primary care provider's (PCP's) office (34%), drug treatment center (20%), emergency room (11%), or prison (9%), and most (60%) had been diagnosed with HCV over 5 years prior. The majority reported that HCV was a major health concern for them (91%), were aware there were new treatments for HCV (89%), and that the new treatments cure most people (69%). More than half (60%) had seen a health professional who could treat HCV, 40% had HCV therapy recommended by their HCV specialist, and 20% had started or completed treatment. In univariable analysis, PWID were significantly more likely to have been treated if they were HIV co-infected (OR 3.4 (95% CI 1.3-9.2)) or had a partner or friend concerned about their HCV (OR 3.4 (95% CI 1.2-9.7)), and were significantly less likely to have been treated if they had used any illicit drugs in the preceding 6 months (OR 0.4 (95% CI 0.2-0.99). In multivariable analysis, having a friend or partner concerned about their HCV remained significantly associated with HCV treatment (OR 5.0 (95% CI 1.4-17.7)). When questioned about what would facilitate HCV treatment, the majority (85%) reported that a friend telling them that HCV treatment had helped them and having HCV treatment provided at their opioid treatment program would make them more likely to engage in HCV treatment. CONCLUSION Despite a high prevalence of HCV among opioid treatment program patients and the availability of effective treatments, uptake remains low. We identified several key barriers and facilitators that can affect HCV treatment uptake.
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Affiliation(s)
| | - Risha Irvin
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Alana Merkow
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Alexander Niculescu
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Yngvild Olsen
- Institute for Behavior Resources, Inc, REACH Health Services, Baltimore, MD, United States of America
| | - Kenneth Stoller
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Cortopassi AC, Driver R, Eaton LA, Kalichman SC. A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious). Annu Rev Psychol 2018; 70:673-701. [PMID: 30256719 DOI: 10.1146/annurev-psych-010418-102927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.
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Affiliation(s)
- Andrew C Cortopassi
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
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24
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Kim SJ, Glassgow AE, Watson KS, Molina Y, Calhoun EA. Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis. Cancer 2018; 124:4350-4357. [PMID: 30246241 DOI: 10.1002/cncr.31636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. METHODS Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. RESULTS Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. CONCLUSIONS Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.
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Affiliation(s)
- Sage J Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- College of Medicine, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | | | - Yamile Molina
- Division of Community Health Science, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Elizabeth A Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, Arizona
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25
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Shen L, Assanangkornchai S, Liu W, Cai L, Li F, Tang S, Shen J, McNeil EB, Chongsuvivatwong V. Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China. PLoS One 2018; 13:e0200105. [PMID: 29969481 PMCID: PMC6029801 DOI: 10.1371/journal.pone.0200105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
AIMS To examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients' social network characteristics. DESIGN Cross-sectional study. SETTING Four MMT clinics in Kunming, Yunnan province, China. PARTICIPANTS 324 consecutive MMT clients. MEASUREMENTS A structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites. ANALYSIS The association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations. FINDINGS MMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use. CONCLUSION Social networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients.
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Affiliation(s)
- Ling Shen
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- School of Public Health, Kunming Medical University, Kunming, China
| | | | - Wei Liu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Le Cai
- School of Public Health, Kunming Medical University, Kunming, China
| | - Fei Li
- School of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Songyuan Tang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jiucheng Shen
- Yunnan Institute for Drug Abuse, Xi Shan District, Kunming, China
| | - Edward B. McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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26
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Friedman SR, Williams L, Young AM, Teubl J, Paraskevis D, Kostaki E, Latkin C, German D, Mateu-Gelabert P, Guarino H, Vasylyeva TI, Skaathun B, Schneider J, Korobchuk A, Smyrnov P, Nikolopoulos G. Network Research Experiences in New York and Eastern Europe: Lessons for the Southern US in Understanding HIV Transmission Dynamics. Curr HIV/AIDS Rep 2018; 15:283-292. [PMID: 29905915 PMCID: PMC6010197 DOI: 10.1007/s11904-018-0403-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE This paper presents an overview of different kinds of risk and social network methods and the kinds of research questions each can address. RECENT FINDINGS It also reviews what network research has discovered about how network characteristics are associated with HIV and other infections, risk behaviors, preventive behaviors, and care, and discusses some ways in which network-based public health interventions have been conducted. Based on this, risk and social network research and interventions seem both feasible and valuable for addressing the many public health and social problems raised by the widespread use of opioids in the US South.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institutes, Inc., New York, NY, USA.
| | - Leslie Williams
- National Development and Research Institutes, Inc., New York, NY, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Jennifer Teubl
- National Development and Research Institutes, Inc., New York, NY, USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Honoria Guarino
- National Development and Research Institutes, Inc., New York, NY, USA
| | | | - Britt Skaathun
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - John Schneider
- Department of Medicine and Center for HIV Elimination, University of Chicago, Chicago, IL, USA
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Mitchell MM, Isenberg SR, Maragh-Bass AC, Knowlton AR. Chronic Pain Predicting Reciprocity of Support Among Vulnerable, Predominantly African-American Persons Living with HIV/AIDS. AIDS Behav 2018; 22:2002-2007. [PMID: 28451889 DOI: 10.1007/s10461-017-1775-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Among persons living with HIV/AIDS (PLHIV), approximately two-thirds report moderate to severe pain. Chronic pain can negatively affect PLHIVs' health behaviors and outcomes by interfering with their reciprocity (mutual exchange) of support in their caregiving relationships, which has been found to be associated with PLHIVs' antiretroviral adherence and viral suppression. Data were longitudinal (baseline, 6- and 12-month follow-up) from 383 PLHIV who were formerly or currently using drugs. Utilizing a longitudinal lagged fixed effects structural equation model, we found that never having pain in the past 6 months was predictive of increased reciprocity of support. Sub-analyses by care relationship type revealed never having pain was a significant predictor of greater reciprocity for sexual partner caregiving dyads, but not for kin or friend caregiving dyads. Our study emphasizes the importance of pain management in quality caregiving relationships characterized by reciprocity, which has consistently been found to be associated with stronger, more supportive caregiving relationships and better quality of life. Our findings suggest the importance of pain management intervention for improving reciprocity between vulnerable PLHIVs and their primary caregivers, especially between PLHIVs and caregivers who are current or former sexual partners.
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Affiliation(s)
- Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA.
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
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Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10(1500) copies/ml among illicit drug users. AIDS 2018; 32:1059-1067. [PMID: 29424782 DOI: 10.1097/qad.0000000000001777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log10(1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. DESIGN Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. METHODS We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log10(1500) copies/ml plasma in the previous 180 days. RESULTS Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log10(1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log10(1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). CONCLUSION Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.
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29
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Pilot Randomized Controlled Trial of Acceptance-Based Behavior Therapy to Promote HIV Acceptance, HIV Disclosure, and Retention in Medical Care. AIDS Behav 2017; 21:2641-2649. [PMID: 28451891 DOI: 10.1007/s10461-017-1780-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
HIV patients who are not retained in medical care risk viral resistance, disease progression to AIDS, and mortality. Numerous interventions have been tested to improve retention, but they are limited by their resource-intensive approaches and lack of focus on new patients, who are at highest risk for drop-out. Data show that acceptance and disclosure of HIV status might impact retention, yet these variables have not been targeted in previous interventions. In this pilot randomized controlled trial, we assessed feasibility, acceptability, and preliminary efficacy of a brief, 2-session acceptance based behavior therapy (ABBT), relative to treatment-as-usual (TAU), in 34 new-to-care HIV patients. ABBT attendance was high and patient feedback was positive. Relative to TAU, ABBT had significant positive effects on retention, as well as putative mechanisms of action, including experiential avoidance of HIV, willingness to make and actual disclosures of HIV status, and perceived social support. Further testing of ABBT is warranted. Trial registered at clinicaltrials.gov; Clinical Trial #NCT02004457.
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30
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Barman-Adhikari A, Craddock J, Bowen E, Das R, Rice E. The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617726080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data ( N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.
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Affiliation(s)
| | | | | | - Rohan Das
- Creighton University, Lincoln, NE, USA
| | - Eric Rice
- University of Southern California, Los Angeles, USA
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31
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Zhao Q, Mao Y, Li X, Zhou Y, Shen Z. Social support and amphetamine-type stimulant use among female sex workers in China. AIDS Care 2017; 29:1324-1330. [PMID: 28514866 DOI: 10.1080/09540121.2017.1328101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Existing research has suggested a positive role of social support in reducing drug use among female sex workers (FSWs). However, there is limited research on the role of social support in amphetamine-type stimulant (ATS) use among FSWs in China. This study explored the present situation of ATS use among FSWs in Guangxi, China and examined the associations of different types of social support from different sources with ATS use. METHOD A sample of 1022 FSWs was recruited from 56 commercial sex venues in Guangxi Autonomous Region in China. Bivariate comparison was used to compare demographic characteristics and source of emotional or tangible social support across frequency of ATS use among FSWs. The relationship between social support and ATS use was examined using multiple ordinal logistic regression models controlling for the potential confounding effects of demographic variables. RESULTS The multiple ordinal logistic regression indicated that FSWs who were from younger age groups (aOR = 10.88 for age group <20; aOR = 2.80 for age group 20-23), and from all higher-income venues (aOR = 1.96 for venue level 1; aOR = 2.28 for venue level 2; aOR = 1.81 for venue level 3) tended to use ATS more frequently. They also tended to use ATS more frequently when they depended on their boyfriends (aOR = 1.08) for emotional support or on their co-workers for tangible support (aOR = 1.17). CONCLUSIONS Different types of social support from different sources can be either positively or negatively associated with ATS use among FSWs, therefore, the future intervention efforts should differentiate and target different types and different sources of social support in response to the living and work conditions of FSWs.
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Affiliation(s)
- Qun Zhao
- a School of Public Administration , Nanjing University of Information Science & Technology , Nanjing , China
| | - Yuchen Mao
- b Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , SC , USA
| | - Xiaoming Li
- a School of Public Administration , Nanjing University of Information Science & Technology , Nanjing , China
| | - Yuejiao Zhou
- c Institute of HIV/AIDS Control and Prevention , Guangxi CDC , Nanning , China
| | - Zhiyong Shen
- c Institute of HIV/AIDS Control and Prevention , Guangxi CDC , Nanning , China
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32
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Ghosh D, Krishnan A, Gibson B, Brown SE, Latkin CA, Altice FL. Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review. AIDS Behav 2017; 21:1183-1207. [PMID: 27125244 DOI: 10.1007/s10461-016-1413-y] [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: 01/12/2023]
Abstract
Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.
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Affiliation(s)
- Debarchana Ghosh
- Department of Geography and Institute for Collaboration on Health Intervention and Prevention, University of Connecticut, 215 Glenbrook Road, AUST 421, U-4148, Storrs, CT, 06269, USA.
| | - Archana Krishnan
- Department of Communication, University at Albany, SUNY, Albany, NY, USA
| | - Britton Gibson
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Shan-Estelle Brown
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Epidemiology, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frederick L Altice
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Barman-Adhikari A, Al Tayyib A, Begun S, Bowen E, Rice E. Descriptive and injunctive network norms associated with nonmedical use of prescription drugs among homeless youth. Addict Behav 2017; 64:70-77. [PMID: 27563741 DOI: 10.1016/j.addbeh.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/12/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nonmedical use of prescription drugs (NMUPD) among youth and young adults is being increasingly recognized as a significant public health problem. Homeless youth in particular are more likely to engage in NMUPD compared to housed youth. Studies suggest that network norms are strongly associated with a range of substance use behaviors. However, evidence regarding the association between network norms and NMUPD is scarce. We sought to understand whether social network norms of NMUPD are associated with engagement in NMUPD among homeless youth. METHODS 1046 homeless youth were recruited from three drop-in centers in Los Angeles, CA and were interviewed regarding their individual and social network characteristics. Multivariate logistic regression was employed to evaluate the significance of associations between social norms (descriptive and injunctive) and self-reported NMUPD. RESULTS Approximately 25% of youth reported past 30-day NMUPD. However, more youth (32.28%) of youth believed that their network members engage in NMUPD, perhaps suggesting some pluralistic ignorance bias. Both descriptive and injunctive norms were associated with self-reported NMUPD among homeless youth. However, these varied by network type, with presence of NMUPD engaged street-based and home-based peers (descriptive norm) increasing the likelihood of NMUPD, while objections from family-members (injunctive norm) decreasing that likelihood. CONCLUSIONS Our findings suggest that, like other substance use behaviors, NMUPD is also influenced by youths' perceptions of the behaviors of their social network members. Therefore, prevention and interventions programs designed to influence NMUPD might benefit from taking a social network norms approach.
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Latkin CA, Smith MK, Ha TV, Mo TT, Zelaya C, Sripaipan T, Le Minh N, Quan VM, Go VF. Roles and Functions of Social Networks Among Men Who Use Drugs in ART Initiation in Vietnam. AIDS Behav 2016; 20:2782-2789. [PMID: 27125243 DOI: 10.1007/s10461-016-1408-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Support from social network members may help to facilitate access to HIV medical care, especially in low resourced communities. As part of a randomized clinical trial of a community-level stigma and risk reduction intervention in Thai Nguyen, Vietnam for people living with HIV who inject drugs (PWID), 341 participants were administered a baseline social network inventory. Network predictors of antiretroviral therapy (ART) initiation at the 6-month follow-up were assessed. The social networks of PWID were sparse. Few participants who reported injectors in their networks also reported family members, whereas those who did not have injectors were more likely to report family members and network members providing emotional support and medical advice. In multivariate models, having at least one network member who provided medical advice predicted ART initiation at 6 months (OR 2.74, CI 1.20-6.28). These results suggest the importance of functional social support and network support mobilization for ART initiation among PWID.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - M Kumi Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tran Viet Ha
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Tran Thi Mo
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Teerada Sripaipan
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Nguyen Le Minh
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Vu Minh Quan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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Zhang C, Li X, Liu Y, Qiao S, Zhang L, Zhou Y, Tang Z, Shen Z, Chen Y. Stigma against People Living with HIV/AIDS in China: Does the Route of Infection Matter? PLoS One 2016; 11:e0151078. [PMID: 26981636 PMCID: PMC4794244 DOI: 10.1371/journal.pone.0151078] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
In the current study, we tested the hypothesis that people who contracted HIV from “blameless” routes (e.g., blood transfusion, sex with stable partners) are less stigmatized compared to people who contracted HIV from “blamable” routes (e.g., injection drug use, sex with sex workers). A cross-sectional study was conducted among 2,987 participants in Guangxi province, China, between 2012 and 2013. We employed both explanatory and predictive modeling strategy by using multivariate linear regression models. In the explanatory models, we assessed the association between routes of infection and three types of stigma (perceived, internalized, and enacted). From identified routes of infection that significantly contributed to higher stigma, we employed predictive modeling to explore predictors for the specific type of stigma. Multiple-imputation was employed for sensitivity analyses. Of the total sample, 63% were male and the average age was 42.9 years (ranged between 18 and 88). Multivariate regression models revealed that contraction from commercial sex increased the perceived (β = 0.46, 95%CI = 0.02, 0.90) and internalized stigma (β = 0.60, 95%CI = 0.09, 1.10), while injecting drug use increased the perceived (β = 0.65, 95%CI = 0.07, 1.22) and enacted stigma (β = 0.09, 95%CI = 0.02, 0.16) after controlling for confounders. Among PLWHA who were infected via commercial sex partners, social support was negatively associated with perceived (β = -0.47, 95%CI = -0.79, -0.14) and internalized stigma (β = -0.80, 95%CI = -1.24, -0.35). Among PLWHA who were infected via injecting drugs, no adherence to antiretroviral treatment (β = 0.41, 95%CI = 0.01, 0.82) was positively associated with perceived stigma, and disclosure of serostatus to others was negatively associated with enacted stigma (β = -0.20, 95%CI = -0.34, -0.05). Knowledge of the association between routes of infection and stigma can guide health professionals and policy makers to develop tailored intervention strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China.
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Affiliation(s)
- Chen Zhang
- Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America
- * E-mail:
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America
| | - Yu Liu
- Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America
| | - Liying Zhang
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United State of America
| | - Yuejiao Zhou
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Zhenzhu Tang
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Zhiyong Shen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Yi Chen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
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Knowlton AR, Mitchell MM, Robinson AC, Nguyen TQ, Isenberg S, Denison J. Informal HIV Caregiver Proxy Reports of Care Recipients' Treatment Adherence: Relationship Factors Associated with Concordance with Recipients' Viral Suppression. AIDS Behav 2015; 19:2123-9. [PMID: 26036463 DOI: 10.1007/s10461-015-1092-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the role of informal caregivers in adherence, we compared adherence reports by caregivers to those of care recipients. We identified individual-level and relationship factors associated with agreement between caregivers' reports of recipients' adherence and assessed viral suppression. Participants were care recipients, who were on ART and had ever injected drugs, and their caregivers (N = 258 dyads). Nearly three-fourths of caregivers' reports of recipients' ART adherence agreed with recipients' viral suppression status. Agreement was associated with recipient age and expressing affection or gratitude to the caregiver, caregiver's having been close to someone who died of HIV/AIDS, and caregiver's fear of caregiving-related HIV (re)infection, while it was negatively associated with recipient's limited physical functioning. Our findings support the utility of caregiver proxy reports of care recipients' ART adherence and suggest ways to identify and promote HIV caregiver attention to and support of this vulnerable population's ART adherence.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA.
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Allysha C Robinson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Trang Q Nguyen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Sarina Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Julie Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
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A qualitative analysis of peer recruitment pressures in respondent driven sampling: Are risks above the ethical limit? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:832-42. [PMID: 26141164 DOI: 10.1016/j.drugpo.2015.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 04/12/2015] [Accepted: 05/31/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND This paper examines peer recruitment dynamics through respondent driven sampling (RDS) with a sample of injection drug users in Hartford, CT to understand the strategies participants use to recruit peers into a study and the extent to which these strategies may introduce risks above the ethical limit despite safeguards in RDS. METHODS Out of 526 injection drug users who participated in a mixed-method RDS methodology evaluation study, a nested sample of 61 participants completed an in-depth semi-structured interview at a 2-month follow-up to explore their experiences with the recruitment process. RESULTS Findings revealed that participants used a variety of strategies to recruit peers, ranging from one-time interactions to more persistent strategies to encourage participation (e.g., selecting peers that can easily be found and contacted later, following up with peers to remind them of their appointment, accompanying peers to the study site, etc.). Some participants described the more persistent strategies as helpful, while some others experienced these strategies as minor peer pressure, creating a feeling of obligation to participate. Narratives revealed that overall, the probability of experiencing study-related risks remains relatively low for most participants; however, a disconcerting finding was that higher study-related risks (e.g., relationship conflict, loss of relationship, physical fights, violence) were seen for recruits who participated but switched coupons or for recruits who decided not to participate in the study and did not return the coupon to the recruiter. CONCLUSIONS Findings indicate that peer recruitment practices in RDS generally pose minimal risk, but that peer recruitment may occasionally exceed the ethical limit, and that enhanced safeguards for studies using peer recruitment methods are recommended. Suggestions for possible enhancements are described.
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Hao C, Guida J, Morisky DE, Liu H. Family Network, Workplace Network, and Their Influence on Condom Use: A Qualitative Study Among Older Female Sex Workers in China. JOURNAL OF SEX RESEARCH 2014; 52:924-935. [PMID: 25411685 PMCID: PMC4439380 DOI: 10.1080/00224499.2014.973101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to qualitatively explore the components of social networks and their influence on condom use among female sex workers (FSWs) aged 35 years and older in China. In-depth interviews with 63 older FSWs and 6 focus group interviews with pimps and owners of roadside salons and hotels were conducted in 3 Chinese cities. The mean age of participants was 42.6 years old (SD = 6.9 years) and the mean age of starting sex work was 38.6 years old (SD = 6.6 years). Two types of networks that influenced condom use were identified: family networks (relationship with children and husbands) and workplace networks (relationship with peers, clients, pimps, and owners). Relationships between older FSWs and their children negatively influenced condom use. Low levels of network support and norms regarding condom use were observed in the relationship between older FSWs and their clients, whereas positive social support and norms were prevalent among older FSWs who had frequent contact with peers. Norms for condom use existed among pimps and owners but were counterbalanced by monetary gains. Future human immunodeficiency virus (HIV) interventions for older FSWs should take the different features of social network components into consideration.
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Affiliation(s)
- Chun Hao
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park
| | - Jennifer Guida
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park
| | - Donald E Morisky
- b Department of Community Health Sciences, School of Public Health , University of California , Los Angeles
| | - Hongjie Liu
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park
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Mitchell MM, Robinson AC, Nguyen TQ, Smith TJ, Knowlton AR. Preferences for professional versus informal care at end of life amongst African-American drug users with HIV/AIDS. AIDS Care 2014; 27:218-22. [PMID: 25196174 DOI: 10.1080/09540121.2014.951307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
With the advent of antiretroviral therapies, persons living with HIV/AIDS (PLHIVs) are living longer but with increased impairment and care needs. The purpose of this study was to assess whether a vulnerable population of PLHIVs preferred informal versus professional care when unable to care for themselves, and individual and support network factors associated with preference for informal care. The findings have potential implications for facilitating the population's informal care at end of life. Data were from the BEACON study, which examined social factors associated with health outcomes among former or current drug-using PLHIVs in Baltimore, MD. Structural equation modeling was used to identify individual and support network characteristics associated with PLHIVs' preference for informal (family or friends) compared to professional care. The structural equation model indicated preference for informal care was associated with female sex, greater informal care receipt, reporting one's main partner (i.e., boy/girlfriend or spouse) as the primary source of informal care, and a support network comprised greater numbers of female kin and persons supportive of the participant's HIV treatment adherence. Not asking for needed help to avoid owing favors was associated with preferring professional care. Findings suggest that interventions to promote informal end of life care should bolster supportive others' resources and skills for care provision and treatment adherence support, and should address perceived norms of reciprocity. Such intervention will help ensure community caregiving in a population with high needs for long-term care.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Barman-Adhikari A, Rice E. Social networks as the context for understanding employment services utilization among homeless youth. EVALUATION AND PROGRAM PLANNING 2014; 45:90-101. [PMID: 24780279 PMCID: PMC4069330 DOI: 10.1016/j.evalprogplan.2014.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/05/2014] [Accepted: 03/09/2014] [Indexed: 05/27/2023]
Abstract
Little is known about the factors associated with use of employment services among homeless youth. Social network characteristics have been known to be influential in motivating people's decision to seek services. Traditional theoretical frameworks applied to studies of service use emphasize individual factors over social contexts and interactions. Using key social network, social capital, and social influence theories, this paper developed an integrated theoretical framework that capture the social network processes that act as barriers or facilitators of use of employment services by homeless youth, and understand empirically, the salience of each of these constructs in influencing the use of employment services among homeless youth. We used the "Event based-approach" strategy to recruit a sample of 136 homeless youth at one drop-in agency serving homeless youth in Los Angeles, California in 2008. The participants were queried regarding their individual and network characteristics. Data were entered into NetDraw 2.090 and the spring embedder routine was used to generate the network visualizations. Logistic regression was used to assess the influence of the network characteristics on use of employment services. The study findings suggest that social capital is more significant in understanding why homeless youth use employment services, relative to network structure and network influence. In particular, bonding and bridging social capital were found to have differential effects on use of employment services among this population. The results from this study provide specific directions for interventions aimed to increase use of employment services among homeless youth.
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Affiliation(s)
- Anamika Barman-Adhikari
- School of Social Work, California State University, Fresno, CA, United States; School of Social Work, University of Southern California, Los Angeles, CA, United States.
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, United States
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Woodall D, Boeri M. "When You Got Friends in Low Places, You Stay Low:" Social Networks and Access to Resources for Female Methamphetamine Users in Low-Income Suburban Communities. JOURNAL OF DRUG ISSUES 2014; 44:321-339. [PMID: 25346549 PMCID: PMC4204334 DOI: 10.1177/0022042613511440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To examine access to needed resources among low-income methamphetamine-using females, we conducted interviews with 30 women living in poor suburban communities of a large southeastern metropolis. As an invisible population in the suburbs, underserved by social services, the women remain geographically and socially anchored to their poor suburban enclaves as transit, treatment and education remain out of reach. The longitudinal study included three interviews over a two-year period. Resources needed by the women were identified in the first interview and a list of available services was provided to them. In subsequent interviews we asked how they accessed the services or barriers encountered and discussed these further in focus groups. Using a social capital framework in our qualitative analysis, we identified three processes for accessing needed resources: formal, informal and mediated. Implications for policymakers and social service providers are suggested, and models for future development proposed.
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Sapra KJ, Crawford ND, Rudolph AE, Jones KC, Benjamin EO, Fuller CM. Social network members' roles and use of mental health services among drug users in New York City. J Behav Health Serv Res 2014; 40:476-87. [PMID: 23897001 DOI: 10.1007/s11414-013-9355-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression is more common among drug users (15-63 %) than the general population (5-16 %). Lack of social support network members may be associated with low mental health service (MHS) use rates observed among drug users. We investigated the relationship between social network members' roles and MHS use among frequent drug users using Social Ties Associated with Risk of Transition into Injection Drug Use data (NYC 2006-2009). Surveys assessed depression, MHS use, demographics, drug use and treatment, and social network members' roles. Participants reporting lifetime depressive episode with start/end dates and information on social/risk network members were included (n = 152). Adjusting for emotional support and HIV status, having one or more informational support network members remained associated with MHS use at last depressive episode (adjusted odds ratio (AOR) 3.37, 95 % confidence interval (CI) 1.38-8.19), as did history of drug treatment (AOR 2.75, 95 % CI 1.02-7.41) and no legal income (AOR 0.23, 95 % CI 0.08-0.64). These data suggest that informational support is associated with MHS utilization among depressed drug users.
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Affiliation(s)
- Katherine J Sapra
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Knowlton A, Weir BW, Hughes BS, Southerland RJH, Schultz CW, Sarpatwari R, Wissow L, Links J, Fields J, McWilliams J, Gaasch W. Patient demographic and health factors associated with frequent use of emergency medical services in a midsized city. Acad Emerg Med 2013; 20:1101-11. [PMID: 24238312 DOI: 10.1111/acem.12253] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 05/10/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To optimize health care utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of health care and may be indicative of challenges accessing, or poor outcomes of, health care. Patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a midsized city were identified. Study findings will aid in the development of targeted interventions to improve population health. METHODS The authors reviewed 9-1-1 call dispatch data and Baltimore City Fire Department (BCFD) EMS records from 2008 through 2010. Frequent use was defined as six or more EMS incidents in the 23-month period. Analyses used census data to compare demographics of EMS users to their population distribution and examined differences in demographics and health problems of frequent EMS users compared to nonfrequent users. RESULTS Frequent EMS users (n = 1,969) had a range of six to 199 EMS incidents (mean = 11.2) during the observation period, and although they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, compared to nonfrequent users and to the population, were more likely to be male, African American, and 45 years of age or older. Of frequent users, the modal age group was 45 to 54 years, accounting for 29.7% of frequent users, which represented twice this age group's population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users) and was the peak age group for incidents related to substance abuse (28.0% of frequent users' incidents in this age group). Frequent users, compared to nonfrequent users, had lower levels of incidents related to trauma (5.1% vs. 16.7%) and higher levels of medical incidents (94.8% vs. 82.9%). As proportions of EMS incidents among frequent versus nonfrequent users, respiratory, mental health, and seizure-related incidents were highest in the youngest age groups; substance abuse-related incidents were highest in those middle-aged (35 to 44 and 45 to 54 years). Of health problems, behavioral health (mental health or substance use) contributed most to frequent EMS use (23.4% of frequent users' incidents). Across all incidents, 65.8% of frequent users had indications of behavioral health problems, representing 6.6-fold higher odds than nonfrequent users (22.5%). Frequent compared to nonfrequent users also had higher levels of select chronic conditions (diabetes, 39.9% vs. 14.6%; asthma, 40.9% vs. 13.4%; and HIV, 9.1% vs. 2.4%), with unadjusted odds almost four to seven times higher. CONCLUSIONS The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use and that rates of frequent use were highest among those middle-aged, African American, and male. These results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to improve access and use of preventive services, with implications for health outcomes and costs. This study demonstrates the value of EMS patient data in identifying at-risk populations and informing novel, targeted approaches to public health interventions.
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Affiliation(s)
- Amy Knowlton
- Department of Health; Behavior & Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
| | - Brian W. Weir
- Department of Health; Behavior & Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
| | - Brenna S. Hughes
- Goucher College; Post-Baccalaureate Premedical Program; Baltimore MD
| | | | - Cody W. Schultz
- Goucher College; Post-Baccalaureate Premedical Program; Baltimore MD
| | - Ravi Sarpatwari
- Goucher College; Post-Baccalaureate Premedical Program; Baltimore MD
| | - Lawrence Wissow
- Department of Health; Behavior & Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
- The Departments of Psychiatry and Pediatrics; Johns Hopkins School of Medicine; Baltimore MD
| | - Jonathan Links
- The Department of Environmental Health Sciences; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
- The Department of Emergency Medicine; Johns Hopkins School of Medicine; Baltimore MD
| | - Julie Fields
- Department of Health; Behavior & Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
- The Department of Emergency Medicine; Johns Hopkins School of Medicine; Baltimore MD
| | - Junette McWilliams
- Department of Health; Behavior & Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
| | - Wade Gaasch
- The Department of Emergency Medicine; University of Maryland School of Medicine; Baltimore MD
- The Baltimore City Fire Department; Baltimore MD
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Toth M, Messer LC, Quinlivan EB. Barriers to HIV care for women of color living in the Southeastern US are associated with physical symptoms, social environment, and self-determination. AIDS Patient Care STDS 2013; 27:613-20. [PMID: 24138485 DOI: 10.1089/apc.2013.0030] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-infected women of color (WOC) face particular barriers to accessing HIV medical care. To understand the impact of physical symptoms, social support, and self-determination on barriers to care, we interviewed HIV-infected women of color. HIV-infected WOC (N=141), attending an academic infectious disease clinic for HIV care in North Carolina, completed the Barriers to Care scale and were categorized as reporting a history of low (less than four of eleven barriers) or high (five or more) barriers to care. Binomial regression was used to estimate prevalence ratios and risk differences of reported barriers to care and its correlates such as depression, anxiety, illness-severity, psychological abuse, social support, treatment-specific social support, and self-determination (autonomy, relatedness, competency). A lower risk of reporting five or more barriers to care was associated with higher levels of autonomy (PR=0.93, 95% CI: 0.89, 0.96), relatedness (PR=0.92, 95% CI: 0.89, 0.94), competency (PR=0.93, 95% CI: 0.87, 0.98), and social support (PR=0.24, 95% CI: 0.81, 0.81). Depression, illness severity, and psychological abuse were associated with a greater risk of having five or more barriers to care. There are multiple social and psychological factors that contribute to perceived barriers to HIV care among WOC in the southeastern USA. Interventions that promote social support and increase individual self-determination have the potential to improve access to HIV care for WOC.
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Affiliation(s)
- Matthew Toth
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, North Carolina
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina
| | - Lynne C. Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon
| | - E. Byrd Quinlivan
- Center for Infectious Diseases, University of North Carolina-Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina-Chapel Hill, North Carolina
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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McCree DH, Millett G, Baytop C, Royal S, Ellen J, Halkitis PN, Kupprat SA, Gillen S. Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men. Am J Public Health 2013; 103:1851-6. [PMID: 23948017 PMCID: PMC3780728 DOI: 10.2105/ajph.2013.301260] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). METHODS The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. RESULTS Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. CONCLUSIONS SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies.
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Affiliation(s)
- Donna H McCree
- Donna H. McCree is with the Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. Gregorio Millett is with Centers for Disease Control and Prevention, Washington, DC. Chanza Baytop and Scott Royal are with Abt Associates, Bethesda, MD. Jonathan Ellen is with the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Perry N. Halkitis and Sandra A. Kupprat are with the Center for Health, Identity, Behavior and Prevention Studies, Steinhardt School of Culture and Human Development, New York University, New York, NY. Sara Gillen is with Community Health Services, Harlem United, New York, NY
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Black SR, Schmiege S, Bull S. Actual versus perceived peer sexual risk behavior in online youth social networks. Transl Behav Med 2013; 3:312-9. [PMID: 24073183 DOI: 10.1007/s13142-013-0227-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Perception of peer behaviors is an important predictor of actual risk behaviors among youth. However, we lack understanding of peer influence through social media and of actual and perceived peer behavior concordance. The purpose of this research is to document the relationship between individual perception of and actual peer sexual risk behavior using online social networks. The data are a result of a secondary analysis of baseline self-reported and peer-reported sexual risk behavior from a cluster randomized trial including 1,029 persons from 162 virtual networks. Individuals (seeds) recruited up to three friends who then recruited additional friends, extending three waves from the seed. ANOVA models compared network means of actual participant behavior across categories of perceived behavior. Concordance varied between reported and perceived behavior, with higher concordance between perceived and reported condom use, multiple partners, concurrent partners, sexual pressure, and drug and alcohol use during sex. Individuals significantly over-reported risk and under-reported protective peer behaviors related to sex.
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Latkin CA, Davey-Rothwell MA, Knowlton AR, Alexander KA, Williams CT, Boodram B. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S54-8. [PMID: 23673888 DOI: 10.1097/qai.0b013e3182928e2a] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Johns Hopkins Bloomberg School of Public Health, University of Pennsylvania, Baltimore, MD, USA.
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48
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Messer LC, Quinlivan EB, Parnell H, Roytburd K, Adimora AA, Bowditch N, DeSousa N. Barriers and facilitators to testing, treatment entry, and engagement in care by HIV-positive women of color. AIDS Patient Care STDS 2013; 27:398-407. [PMID: 23829330 PMCID: PMC3704120 DOI: 10.1089/apc.2012.0435] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development.
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Affiliation(s)
- Lynne C Messer
- School of Community Health, Portland State University, Portland, OR 97207, USA.
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49
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Gaston GB, Alleyne-Green B. The impact of African Americans' beliefs about HIV medical care on treatment adherence: a systematic review and recommendations for interventions. AIDS Behav 2013; 17:31-40. [PMID: 23010941 DOI: 10.1007/s10461-012-0323-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disparities in access to and retention of regular HIV medical treatment persist among African Americans living with HIV. Many scholars believe that the mistrust of health care held by many African Americans stems from a legacy of abuse, from medical experimentation on slaves to the unethical practices with patients in the Tuskegee Syphilis study. We performed a systematic appraisal of the literature, using several key terms, in order to understand how attitudes about HIV-related health care influence African Americans' engagement in care. We examined peer-reviewed studies published during the period January 2001 through May 2012. An initial search generated 326 studies. Sixteen descriptive studies met our inclusion criteria. Experiences of racism, conspiracy beliefs and the quality of provider relationships appeared to impact engagement. Providers should openly investigate personal beliefs that adversely affect their treatment decisions, listen to patient narratives, and share treatment decisions in order to create a transparent environment.
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Affiliation(s)
- Gina B Gaston
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 West Harrison Street (MC 309), Chicago, IL 60607, USA.
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50
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Wolfe H, Haller DL, Benoit E, Bolger KW, Cancienne JC, Ingersoll KS, Sharp V. Developing PeerLink to engage out-of-care HIV+ substance users: training peers to deliver a peer-led motivational intervention with fidelity. AIDS Care 2012; 25:888-94. [PMID: 23230862 DOI: 10.1080/09540121.2012.748169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Substance use among HIV+ individuals can be a barrier to HIV care, resulting in poor health outcomes. Motivational interviewing (MI) is an effective intervention to reduce substance abuse and increase HIV-related health. Healthcare workers from various backgrounds can be effectively trained in delivering MI interventions; however, there has been limited evidence that peers can effectively deliver MI interventions with fidelity. Peers have traditionally worked in HIV care settings and represent a valid context for a peer-delivered intervention focused on motivational issues. We trained four peers in MI. In this paper, we describe the intervention, explain the MI training methods, and investigate whether peers can be trained in MI with fidelity. The MI training included didactic instruction, group workshops, and individual feedback sessions. Two of four peers achieved MI treatment fidelity as measured by the Motivational Interviewing Treatment Integrity Code Version 3.0. Overall, peers had difficulty using open-ended questions and querying pros and cons, skills thought necessary to elicit change talk. They also tended to give too much direct advice where reflections would have been appropriate. A challenge was training peers to change familiar ways of communicating. Nonetheless, they did well at assessing and highlighting motivation to change. The total training hours (40 h) was long compared with other published MI studies. However, the intervention included several components with two targeted change behaviors. It is likely that peers can be trained in MI with fidelity in less time given a more streamlined intervention. When working with peers who have life stressors similar to the target group, it is important to be flexible in the training.
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Affiliation(s)
- Hannah Wolfe
- St. Luke's-Roosevelt Hospital Center, Center for Comprehensive Care, NY, USA
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