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Chakrapani V, Kaur M, Tsai AC, Newman PA, Kumar R. The impact of a syndemic theory-based intervention on HIV transmission risk behaviour among men who have sex with men in India: Pretest-posttest non-equivalent comparison group trial. Soc Sci Med 2020; 295:112817. [PMID: 32033868 DOI: 10.1016/j.socscimed.2020.112817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/13/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomless anal intercourse among men who have sex with men (MSM) in India. In 2016/17, a pre- and post-test comparison group design was used to implement a syndemic theory-based intervention among 459 MSM (229, intervention; 230, standard-of-care comparison) recruited through non-governmental organizations in Chandigarh, India. The intervention group received two-session peer-delivered motivational interviewing-based HIV risk reduction counselling and skills training to improve sexual communication/negotiation and condom use self-efficacy, and screening/management of psychosocial health problems. The intervention's effect on consistent condom use was estimated using difference-in-differences (DiD) approach. Mediation analysis assessed the extent to which intervention effects on the outcome were mediated by changes in psychosocial health problems and condom use self-efficacy. A process evaluation assessed implementation fidelity and intervention acceptability. Baseline consistent condom use was 43% in the intervention group and 46% in the standard-of-care group. Baseline survey findings demonstrated that a psychosocial syndemic of problematic alcohol use, internalised homonegativity and violence victimisation synergistically increased condomless anal intercourse. Using DiD, we estimated that the intervention increased consistent condom use with male partners by 16.4% (95% CI: 7.1, 25.7) and with female partners by 28.2% (95% CI: 11.9, 44.4), and decreased problematic alcohol use by 24.3% (95%CI: -33.4, -15.3), depression by 20.0% (95% CI: -27.6, -12.3) and internalised homonegativity by 34.7% (95% CI: -43.6%, -25.8%). The mediation analysis findings suggested that the intervention might have improved consistent condom use by decreasing internalised homonegativity and by increasing condom use self-efficacy. The process evaluation showed high levels of acceptability/satisfaction among participants and high levels of implementation fidelity. A syndemic theory-based intervention tailored for MSM in India is feasible, acceptable, and can reduce HIV transmission risk behaviour as well as problematic alcohol use, depression and internalised homonegativity.
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Affiliation(s)
- Venkatesan Chakrapani
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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van Luenen S, Garnefski N, Spinhoven P, Spaan P, Dusseldorp E, Kraaij V. The Benefits of Psychosocial Interventions for Mental Health in People Living with HIV: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:9-42. [PMID: 28361453 PMCID: PMC5758656 DOI: 10.1007/s10461-017-1757-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this systematic review and meta-analysis we investigated the effectiveness of different psychosocial treatments for people living with HIV (PLWH) and mental health problems. Additionally, characteristics that may influence the effectiveness of a treatment (e.g., treatment duration) were studied. PubMed, PsycINFO and Embase were searched for randomized controlled trials on psychosocial interventions for PLWH. Depression, anxiety, quality of life, and psychological well-being were investigated as treatment outcome measures. Sixty-two studies were included in the meta-analysis. It was found that psychosocial interventions for PLWH had a small positive effect on mental health (ĝ = 0.19, 95% CI [0.13, 0.25]). Furthermore, there was evidence for publication bias. Six characteristics influenced the effectiveness of a treatment for depression. For example, larger effects were found for studies with psychologists as treatment providers. To conclude, this systematic review and meta-analysis suggests that psychosocial interventions have a beneficial effect for PLWH with mental health problems.
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Affiliation(s)
- Sanne van Luenen
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Nadia Garnefski
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
| | - Philip Spinhoven
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Pascalle Spaan
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
| | - Elise Dusseldorp
- Section of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
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El-Bassel N, Jemmott JB, Bellamy SL, Pequegnat W, Wingood GM, Wyatt GE, Richard Landis J, Remien RH. Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples. AIDS Behav 2016; 20:1197-207. [PMID: 26577402 DOI: 10.1007/s10461-015-1249-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.
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Huebner DM, Perry NS. Do behavioral scientists really understand HIV-related sexual risk behavior? A systematic review of longitudinal and experimental studies predicting sexual behavior. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1915-1936. [PMID: 26123067 DOI: 10.1007/s10508-015-0482-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/27/2014] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
Behavioral interventions to reduce sexual risk behavior depend on strong health behavior theory. By identifying the psychosocial variables that lead causally to sexual risk, theories provide interventionists with a guide for how to change behavior. However, empirical research is critical to determining whether a particular theory adequately explains sexual risk behavior. A large body of cross-sectional evidence, which has been reviewed elsewhere, supports the notion that certain theory-based constructs (e.g., self-efficacy) are correlates of sexual behavior. However, given the limitations of inferring causality from correlational research, it is essential that we review the evidence from more methodologically rigorous studies (i.e., longitudinal and experimental designs). This systematic review identified 44 longitudinal studies in which investigators attempted to predict sexual risk from psychosocial variables over time. We also found 134 experimental studies (i.e., randomized controlled trials of HIV interventions), but of these only 9 (6.7 %) report the results of mediation analyses that might provide evidence for the validity of health behavior theories in predicting sexual behavior. Results show little convergent support across both types of studies for most traditional, theoretical predictors of sexual behavior. This suggests that the field must expand the body of empirical work that utilizes the most rigorous study designs to test our theoretical assumptions. The inconsistent results of existing research would indicate that current theoretical models of sexual risk behavior are inadequate, and may require expansion or adaptation.
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Affiliation(s)
- David M Huebner
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84102, USA,
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O'Leary A, Jemmott JB, Jemmott LS, Bellamy S, Icard LD, Ngwane Z. Mediation of an efficacious HIV risk reduction intervention for South African men. AIDS Behav 2015; 19:1842-9. [PMID: 25969177 DOI: 10.1007/s10461-015-1042-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.
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Affiliation(s)
- Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 8 Corporate Square Blvd., Atlanta, GA, 30329, USA.
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Jemmott III JB, Jemmott LS, O’Leary A, Icard LD, Rutledge SE, Stevens R, Hsu J, Stephens AJ. On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial. AIDS Behav 2015; 19:1247-62. [PMID: 25449552 PMCID: PMC4503868 DOI: 10.1007/s10461-014-0961-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM’s condom use are discussed.
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Martin AM, Benotsch EG, Cejka A, Luckman D. Social responsibility, substance use, and sexual risk behavior in men who have sex with men. JOURNAL OF HOMOSEXUALITY 2014; 61:251-269. [PMID: 24383857 DOI: 10.1080/00918369.2013.839908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status-a behavior that helps men protect their partners but does not protect themselves from the virus-also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.
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Affiliation(s)
- Aaron M Martin
- a Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
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Lam CB, Lefkowitz ES. Risky sexual behaviors in emerging adults: longitudinal changes and within-person variations. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:523-532. [PMID: 22576250 DOI: 10.1007/s10508-012-9959-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 12/05/2011] [Accepted: 12/15/2011] [Indexed: 05/31/2023]
Abstract
This study examined longitudinal changes in condom use inconsistency and sexual encounters involving alcohol use and the within-person associations of these two risky sexual behaviors with other personal and contextual factors. Data were drawn from a sample of college students who completed surveys on four occasions across 3 years and included 317 participants (48 % male; 32 % African American, 28 % Latino American, and 40 % European American) who reported recent penetrative sexual activities on at least one of the occasions. Multilevel models revealed that, although condom use inconsistency increased and then leveled off over time, sexual encounters involving alcohol use showed a linear increase. Moreover, at times when students held more negative attitudes toward condoms than usual, they used condoms less consistently than usual; at times when students felt more anxious about HIV/AIDS than usual, they had more sexual encounters involving alcohol use than usual; and at times when students were involved in a serious relationship, they used condoms less consistently and had fewer sexual encounters involving alcohol use than usual. Findings demonstrate the utility of a developmental perspective in understanding sexual behaviors, the importance of examining the unique correlates of different risky sexual behaviors, and the distinctiveness between within-person versus between-person associations.
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Affiliation(s)
- Chun Bun Lam
- Department of Human Development and Family Studies, The Pennsylvania State University, 211 South Henderson Building, University Park, PA 16802, USA.
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Kapadia F, Latka MH, Wu Y, Strathdee SA, Mackesy-Amiti ME, Hudson SM, Thiede H, Garfein RS. Longitudinal determinants of consistent condom use by partner type among young injection drug users: the role of personal and partner characteristics. AIDS Behav 2011; 15:1309-18. [PMID: 19449099 PMCID: PMC3180628 DOI: 10.1007/s10461-009-9569-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 05/04/2009] [Indexed: 12/04/2022]
Abstract
We investigated the longitudinal influence of individual-, relationship- and social-level factors on condom use by partner type among young injections drug users (IDUs) enrolled in the Collaborative Injection Drug Users Study-III/Drug Users Intervention Trial (CIDUS-III/DUIT) from 2002 to 2004. Based on longitudinal analysis using generalized estimating equations (GEE), consistent condom use with main partners was more commonly reported among males and those with greater self-efficacy for condom use; main partner’s desire for pregnancy and needle sharing were negatively associated with consistent condom use. Among those with casual partners, having fewer sex partners was associated with consistent condom use. Positive attitudes toward condom use and partner norms supporting condom use were associated with greater consistent condom use with both partner types. These findings suggest that intervention strategies targeting individual- and partner-level factors may provide avenues for intervening upon sexual risks among young IDUs.
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Affiliation(s)
- F Kapadia
- Department of Nutrition, Food Studies & Public Health, New York University, New York, 10012, USA.
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Nöstlinger C, Nideröst S, Platteau T, Müller MC, Staneková D, Gredig D, Roulin C, Rickenbach M, Colebunders R. Sexual protection behavior in HIV-positive gay men: testing a modified information-motivation-behavioral skills model. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:817-827. [PMID: 20878223 DOI: 10.1007/s10508-010-9682-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 08/04/2010] [Accepted: 08/04/2010] [Indexed: 05/29/2023]
Abstract
This study on determinants of sexual protection behavior among HIV-positive gay men used the empirically tested information-motivation-behavioral skills (IMB) model. HIV-specific variables were added to the model to determine factors decisive for condom use with steady and casual partners. Data were collected using an anonymous, standardized self-administered questionnaire. Study participants were recruited at HIV outpatient clinics associated with the Eurosupport Study Group and the Swiss HIV Cohort Study. To identify factors associated with condom use, backward elimination regression analyses were performed. Overall, 838 HIV-infected gay men from 14 European countries were included in this analysis. About 53% of them reported at least one sexual contact with a steady partner; 62.5% had sex with a casual partner during the last 6 months. Forty-three percent always used condoms with steady partners and 44% with casual partners. High self-efficacy and subjective norms in favor of condom-use were associated with increased condom use with casual and steady partners, whereas feeling depressed was associated with decreased condom use with casual partners. Condoms were used less often with HIV-positive partners. Self-efficacy as an important behavioral skill to perform protection behavior was influenced by lower perceived vulnerability, higher subjective norms, and more positive safer sex attitudes. The IMB-model constructs appeared to be valid; however, not all the model predictors could be determined as hypothesized. Besides the original IMB constructs, HIV-specific variables, including sexual partners' serostatus and mental health, explained condom use. Such factors should be considered in clinical interventions to promote "positive prevention."
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Affiliation(s)
- Christiana Nöstlinger
- Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
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Schmiege SJ, Feldstein Ewing SW, Hendershot CS, Bryan AD. Positive outlook as a moderator of the effectiveness of an HIV/STI intervention with adolescents in detention. HEALTH EDUCATION RESEARCH 2011; 26:432-42. [PMID: 20926554 PMCID: PMC3099182 DOI: 10.1093/her/cyq060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Justice-involved adolescents engage in high levels of risky sexual behavior, underscoring the need for targeted, effective, prevention interventions geared toward this population. In a randomized controlled trial, 484 detained adolescents received a theory-based intervention or an information-only control. We have previously demonstrated that the theory-based intervention was superior to the control condition in changing theoretical mediators and in producing longitudinal decreases in risky sexual behavior. In the present study, we examined differential response to the intervention based on the adolescents' level of positive outlook (composed of self-esteem, perceived control over the future and optimism toward the future). Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy and intentions) were measured immediately post-intervention, and behavioral data were obtained 3, 6, 9 and 12 months later. Positive outlook significantly moderated program effects both in the context of the mediational path model and in the context of the longitudinal growth model. Specifically, intervention effects were strongest for those scoring relatively lower on the positive outlook dimension, whereas adolescents high in positive outlook demonstrated greater attitudes and self-efficacy and decreased risky sexual behavior, regardless of condition. Findings are discussed in terms of targeting and tailoring of intervention content.
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Affiliation(s)
- Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado--Denver, Aurora, CO 80045, USA.
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McKirnan DJ, Tolou-Shams M, Courtenay-Quirk C. The Treatment Advocacy Program: a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men. J Consult Clin Psychol 2011; 78:952-63. [PMID: 20919760 DOI: 10.1037/a0020759] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM "peer advocates" in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). METHOD We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period. RESULTS At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, χ2(2, N = 249) = 6.6, p = .04. Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months: Transmission risk ranged from 23% to 25% among comparison participants. CONCLUSIONS TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP-computer-based and individually tailored session content, delivered by peers, in the primary care setting-warrant further exploration.
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Affiliation(s)
- David J McKirnan
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60607, USA.
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Is sexual serosorting occurring among HIV-positive injection drug users? Comparison between those with HIV-positive partners only, HIV-negative partners only, and those with any partners of unknown status. AIDS Behav 2010; 14:92-102. [PMID: 19308717 DOI: 10.1007/s10461-009-9548-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
Abstract
Using baseline data from a multi-site, randomized controlled study (INSPIRE), we categorized 999 HIV-positive IDUs into three groups based on serostatus of their sex partners. Our data provide some evidence for serosorting occurring in our sample; about 40% of the sample had sex exclusively with HIV-positive partners, and about half of them reported having unprotected sex with these partners. Twenty per cent had sex exclusively with HIV-negative partners; their sexual behaviors tended to be least risky with about two-thirds reporting their sex was protected. However, we also found that another 40% had at least one partner of unknown HIV status and sexual and drug risk was the highest among them. They were also least empowered, showing attributes that may undermine HIV prevention. Some of these findings are consistent with findings from MSM studies, suggesting that partner selection practices are similar between primarily heterosexual IDUs and MSM.
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Hardnett FP, Pals SL, Borkowf CB, Parsons J, Gomez C, O'Leary A. Assessing mediation in HIV intervention studies. Public Health Rep 2009; 124:288-94. [PMID: 19320371 DOI: 10.1177/003335490912400217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A mediator is a psychosocial construct that is targeted by an intervention to bring about behavior change. Recent literature suggests that a widely used approach for assessing mediation, namely the causal steps method, can be severely statistically underpowered. This article describes three standard methods for assessing mediation: causal steps, difference in coefficients, and product of coefficients. We also demonstrate the use of asymmetric confidence limits (ACLs) in testing mediation. METHODS We compared the results obtained by ACL construction with results obtained based on the causal steps and product of coefficients approaches to analyze data from the Seropositive Urban Men's Intervention Trial. RESULTS ACL construction uncovered previously unidentified mediating factors. We also identified a marginally significant suppressor, which means that, with regard to this factor, the intervention had effects that were opposite from the desired direction. CONCLUSIONS ACLs are preferred for this type of analysis because of their statistical power and because they are informative regardless of whether the intervention has a significant effect on the outcome. Furthermore, ACLs present the size of the mediating effect rather than just a binary decision regarding significance.
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Affiliation(s)
- Felicia P Hardnett
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Quantitative Sciences and Data Management Branch, Atlanta, USA.
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15
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O'Dell BL, Rosser BRS, Miner MH, Jacoby SM. HIV prevention altruism and sexual risk behavior in HIV-positive men who have sex with men. AIDS Behav 2008; 12:713-20. [PMID: 17985229 PMCID: PMC3433852 DOI: 10.1007/s10461-007-9321-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
An understanding of men's motivations to avoid risk behavior is needed to create efficacious HIV prevention programs for HIV-positive men who have sex with men (MSM). This study investigates the relationship between sexual risk behavior and HIV prevention altruism, which is defined as the values, motivations, and practices of caretaking towards one's sexual partners to prevent the transmission of HIV. In a sample of 637 HIV-positive MSM, HIV prevention altruism significantly protects against serodiscordant unprotected anal intercourse (SDUAI) in crude analysis, but not after adjustment for drug use and compulsive sexual behavior. HIV prevention altruism is also related to not engaging in anal intercourse, but is not related to serodisclosure to secondary partners. Lack of altruism appears related to sexual risk behavior in HIV-positive MSM, although other psychological and contextual factors play significant roles. The promotion of HIV prevention altruism may provide a formidable new direction for HIV prevention programs.
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Affiliation(s)
- Brennan L O'Dell
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN 55454, USA.
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Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: a review of randomized controlled trials. Psychosom Med 2008; 70:575-84. [PMID: 18541907 PMCID: PMC2737587 DOI: 10.1097/psy.0b013e31817a5d30] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We reviewed randomized controlled trials (RCTs) that examined the effects of psychological interventions on HIV disease markers including neuroendocrine hormone regulation and immune status. Utilizing both PubMed and PsycINFO, we searched for RCTs published over the past 20 years (1987-2007). Of the 31 RCTs identified, 14 tested effects of psychological interventions on neuroendocrine regulation or immune status. Despite the fact that there are significant methodological limitations of RCTs that have been conducted to date, psychological interventions for HIV-positive persons have been shown to be efficacious in improving psychological adjustment compared with wait-list or treatment as usual control conditions. However, there is little support for differential efficacy of group-based interventions that have been tested to date, even in comparison with semistructured social support groups. Irrespective of the treatment modality, it seems that interventions that are successful in improving psychological adjustment are more likely to have salutary effects on neuroendocrine regulation and immune status. Psychological interventions represent a viable adjuvant treatment that can assist patients with improving psychological adjustment and potentially enhancing immune status. To inform the development of innovative treatments with potentially superior efficacy, deconstruction trials are necessary to examine the effects of distinct components of multimodal psychological interventions compared with nonspecific social support effects. Effectiveness trials of promising psychological interventions with more representative samples of HIV-positive persons are also needed to provide more definitive information on the clinical utility and potential cost-effectiveness of treatments that have been developed to date.
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Are feelings of responsibility to limit the sexual transmission of HIV associated with safer sex among HIV-positive injection drug users? J Acquir Immune Defic Syndr 2008; 46 Suppl 2:S88-95. [PMID: 18089989 DOI: 10.1097/qai.0b013e31815767b3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We developed a scale among HIV-positive injection drug users (IDUs) to measure self-perceived responsibility to limit HIV transmission during sex. We describe the characteristics of HIV-positive IDUs (n=1114, 62% male, HIV-positive for 9 years on average) who felt responsible for protecting their sexual partners from HIV and evaluated whether such feelings were associated with safer sexual practices. Using this scale (Cronbach alpha=0.83) and audio computer-assisted self-interviewing technology, 75% of this sample felt responsible for protecting their sexual partners from HIV. In cross-sectional multivariate analysis, HIV-positive IDUs who felt responsible were those with greater HIV knowledge (adjusted odds ratio [95% confidence interval]: 1.74 [1.26 to 2.40]), perceived social support (1.77 [1.28 to 2.44]), self-efficacy for safely injecting (1.41 [1.02 to 1.94]), and self-efficacy for using condoms (1.92 [1.38 to 2.68]). Feeling responsible was associated with having relatively fewer sex partners (<10 vs. >or=10, 0.57 [0.34 to 0.96]) and a lower odds of unprotected sex (0.63 [0.45 to 0.89]) but was not associated with safer injection practices. Feelings of responsibility did not vary by demographic characteristics, suggesting that prevention messages that encourage HIV-positive people to play a role in curbing HIV transmission may be acceptable to many HIV-positive IDUs. Working with HIV-positive IDUs to increase or reinforce feelings of responsibility may reduce the sexual transmission of HIV.
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What we can learn from the INSPIRE Study about improving prevention and clinical care for injection drug users living with HIV. J Acquir Immune Defic Syndr 2008; 46 Suppl 2:S31-4. [PMID: 18089982 DOI: 10.1097/qai.0b013e318157892d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wolitski RJ, Flores SA, O'Leary A, Bimbi DS, Gómez CA. Beliefs about personal and partner responsibility among HIV-seropositive men who have sex with men: measurement and association with transmission risk behavior. AIDS Behav 2007; 11:676-86. [PMID: 17103125 DOI: 10.1007/s10461-006-9183-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 09/27/2006] [Indexed: 11/26/2022]
Abstract
Beliefs of people living with HIV about their own responsibility for preventing HIV transmission (personal responsibility) and their sex partners' responsibility for protecting themselves (partner responsibility) are poorly understood. A sample of 1163 HIV-seropositive men who have sex with men (MSM; 55% men of color) completed an A-CASI assessment of sexual behavior and psychosocial measures. A two-dimensional model that represents four orientations toward responsibility was tested: (1) self-high personal and low partner responsibility, (2) other-low personal and high partner responsibility, (3) shared-high personal and high partner responsibility, and (4) diminished-low personal and low partner responsibility. As predicted, the self-responsibility group demonstrated the lowest risk of HIV transmission; the other responsibility group had the highest risk. Intermediate risk was observed in the shared and diminished responsibility groups. Implications for future research and HIV prevention efforts are discussed.
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Mizuno Y, Purcell DW, Latka MH, Metsch LR, Gomez CA, Latkin CA. Beliefs that condoms reduce sexual pleasure-gender differences in correlates among heterosexual HIV-positive injection drug users (IDUs). J Urban Health 2007; 84:523-36. [PMID: 17447147 PMCID: PMC2219572 DOI: 10.1007/s11524-007-9162-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Studies consistently find that negative condom beliefs or attitudes are significantly associated with less condom use in various populations, including HIV-positive injection drug users (IDUs). As part of efforts to reduce sexual risk among HIV-positive IDUs, one of the goals of HIV interventions should be the promotion of positive condom beliefs. In this paper we sought to identify the correlates of negative condom beliefs and examined whether such correlates varied by gender, using a subsample (those with an opposite-sex main partner; n = 348) of baseline data collected as part of a randomized controlled study of HIV-positive IDUs. In multivariate analyses, we found more significant correlates for women than for men. With men, perception that their sex partner is not supportive of condom use (negative partner norm) was the only significant correlate (Beta = -0.30; p < 0.01; R (2) = 0.18). Among women, negative partner norm (Beta = -0.18; p < 0.05); having less knowledge about HIV, STD, and hepatitis (Beta = -0.16; p < 0.05); lower self-efficacy for using a condom (Beta = -0.40; p < 0.01); and more episodes of partner violence (Beta = 0.15; p < 0.05) were significantly associated with negative condom beliefs (R (2) = 0.36). These findings suggest important gender-specific factors to consider in interventions that seek to promote positive condom beliefs among HIV-positive IDUs.
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Affiliation(s)
- Yuko Mizuno
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/STD/TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop E37, Atlanta, GA 30333, USA.
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Purcell DW, Mizuno Y, Metsch LR, Garfein R, Tobin K, Knight K, Latka MH. Unprotected sexual behavior among heterosexual HIV-positive injection drug using men: associations by partner type and partner serostatus. J Urban Health 2006; 83:656-68. [PMID: 16736116 PMCID: PMC2430482 DOI: 10.1007/s11524-006-9066-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Few studies have examined sexual risk behaviors of HIV-positive, heterosexual, injection drug using (IDU) men. We investigated such behaviors and associations with risk among sexually active, HIV-positive IDU men who reported only female sex partners in the 3 months prior to baseline interview. We examined associations separately for four non-exclusive groups of men by crossing partner type (main or casual) and partner serostatus (HIV-positive or HIV-negative/unknown). Of 732 male participants, 469 (64%) were sexually active with only female partners. Of these 469 men, 155 (33%) reported sex with HIV-positive main partners, 127 (27%) with HIV-negative or unknown serostatus main partners, 145 (31%) with HIV-positive casual partners, and 192 (41%) with HIV-negative/unknown serostatus casual partners. Significant multivariate associations for unprotected sex with HIV-negative or unknown serostatus main partners were less self-efficacy to use condoms, weaker partner norms supporting condoms, and more negative condom beliefs. Similar correlates were found for unprotected sex with HIV-positive main and casual partners. In addition, alcohol or drug use during sex was a significant correlate of unprotected sex with HIV-positive main partners, while depression was significant for HIV-positive casual partners. For unprotected sex with HIV-negative/unknown status casual partners, self-efficacy for condom use, sex trade, and education were significant multivariate correlates. A combination of broad and tailored intervention strategies based on the relationship pattern of men's lives may provide the most benefit for reducing unprotected sex with female partners.
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Affiliation(s)
- David W Purcell
- Centers for Disease Control and Prevention, NCHSTP/DHAP/PRB, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA.
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Wolitski RJ, Parsons JT, Gómez CA, Purcell DW, Hoff CC, Halkitis PN. Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men's Intervention Trial (SUMIT). AIDS 2005; 19 Suppl 1:S1-11. [PMID: 15838188 DOI: 10.1097/01.aids.0000167347.77632.cd] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To provide a public health rationale for prevention with HIV-seropositive gay and bisexual men and to describe the methods of the Seropositive Urban Men's Intervention Trial (SUMIT). DESIGN A randomized intervention trial. METHODS Self-identified HIV-positive gay and bisexual men were recruited from community-based venues in New York City and San Francisco. Eligible participants completed an A-CASI baseline assessment, were asked to provide samples for sexually transmitted infection (STI) testing, and were randomly assigned to either a single-session intervention or a six-session enhanced intervention designed to reduce HIV transmission risk and promote serostatus disclosure. Participants who attended the first intervention session were assessed 3 and 6 months post-intervention. STI testing was offered at the 6-month assessment. RESULTS A total of 1168 self-identified HIV-seropositive gay and bisexual men completed the baseline assessment, and 1110 of these (95%) opted for STI testing. A total of 811 attended the first intervention session, of which 85% were assessed at 3 months and 90% were assessed at 6 months. Of those assessed at 6 months, 92% (670/729) provided a blood or urine sample for STI testing. CONCLUSION SUMIT demonstrates the feasibility and acceptability of prevention research with HIV-seropositive gay and bisexual men. The study provides new information about the sexual behavior, serostatus disclosure practices, and the efficacy of an intervention to reduce HIV transmission risk.
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Affiliation(s)
- Richard J Wolitski
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road (E-37), Atlanta, GA 30333, USA.
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Stall R, van Griensven F. New directions in research regarding prevention for positive individuals: questions raised by the Seropositive Urban Men's Intervention Trial. AIDS 2005; 19 Suppl 1:S123-7. [PMID: 15838190 DOI: 10.1097/01.aids.0000167358.32783.ca] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ron Stall
- Divisions of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA.
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