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Jaffe AE, Blayney JA, Jones HR, Stappenbeck CA, George WH, Davis KC. Sexual Decision Making When Intoxicated: Women's Reasons for and Against Having Sex in a Laboratory-Based Scenario. JOURNAL OF SEX RESEARCH 2024; 61:767-782. [PMID: 37651745 PMCID: PMC10902182 DOI: 10.1080/00224499.2023.2249774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Young adult women report high condom use intentions, but inconsistent condom use. Cognitive appraisals during sexual encounters are important determinants of condom use decisions, but a nuanced understanding of what cognitions emerge during women's "hot states" (e.g., sexual arousal, alcohol intoxication) remains lacking. To address this gap, we examined women's heat of the moment cognitions in their own words using mixed methods. Young adult women (N = 503; Mage = 25.01, SDage = 2.66) were randomized to a beverage condition (alcohol or control), then read and responded to questions about an eroticized sexual scenario. The nature and strength of reasons for and against having sex were reported before and after learning no condom was available. Multilevel models revealed intoxicated participants were more likely to let the partner decide how far to go sexually than sober participants at both timepoints, but the strength of cognitive appraisals (reasons for, reasons against, and feeling conflicted) only differed between beverage conditions after knowledge of no condom. These results suggest alcohol myopia was evident in the presence of inhibition conflict. Content analysis of these reasons revealed multifaceted cognitions that changed upon learning there was no condom. Findings highlight cognitions to target through interventions and underscore the importance of both alcohol and situational context in decision making.
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Affiliation(s)
- Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Harper R Jones
- Department of Psychology, University of Nebraska-Lincoln
| | | | | | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University
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2
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Menza TW, Jensen A, Hixson LK. Predictors of Viral Suppression Among People Living with HIV in Rural Oregon. AIDS Behav 2024; 28:154-163. [PMID: 37610534 DOI: 10.1007/s10461-023-04145-6] [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: 07/19/2023] [Indexed: 08/24/2023]
Abstract
With recent outbreaks of HIV in rural areas of the United States, it has become increasingly important to understand the factors affecting health outcomes of people with HIV living in rural areas. We assessed predictors of durable HIV viral suppression among rural participants using a pooled 7-year dataset from the Medical Monitoring Project (MMP), a cross-sectional, representative sample of individuals receiving HIV medical care in Oregon. Only 77.3% of rural participants achieved durable HIV viral suppression, while 22.7% had at least one detectable HIV viral load measurement within the past 12 months. The primary predictors of viral suppression were ARV adherence, poverty, and reported heavy drinking in the past 30 days. These results highlight the influence of social factors on health outcomes for persons with HIV living in rural areas and inform areas for policy and program change.
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Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA.
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Ann Jensen
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, OR, USA
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O'Leary A, Willis LA, Henny KD, Madden M, Koenig LJ. Development of a Video-Delivered Serial Drama Designed to Reduce Community Homophobia and HIV Stigma, Decrease Sexual Risk Behavior, and Increase HIV Testing Among Black Youth. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:439-451. [PMID: 38096457 PMCID: PMC10877481 DOI: 10.1521/aeap.2023.35.6.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This article describes the development of a video serial drama intervention that was designed to address factors that influence HIV in the United States among Black youth. These include HIV testing, sexual behaviors not protected by condoms, negative attitudes towards sexual minorities, and HIV stigma. Behavior-change principles (social learning theory and education-entertainment) and input from members of the priority audience formed the basis of this 27-episode (3 minutes each) drama for dissemination on multiple platforms, including in public spaces or privately online. The developmental process, specifically involving members of the population of interest and use of behavioral theory, enriched the narrative elements and likely ensured intervention acceptability, enhancing effectiveness. Public health practitioners and prevention programmers may want to consider using this intervention and/or the narrative communication approach when intervening to change behavior.
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Affiliation(s)
| | - Leigh A Willis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kirk D Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Linda J Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Robbins T, Szucs LE, Trujillo L, Young E. AIDS or HIV Education and Sexual Behaviors Among Adolescent Sexual Minority Males: National HIV Behavioral Surveillance, 3 U.S. Cities, 2015. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:201-212. [PMID: 37410370 PMCID: PMC11057022 DOI: 10.1521/aeap.2023.35.3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
In the U.S., HIV transmission rates have increased among male-male sexual contacts. Sex education reduces HIV-related risks; yet impacts for adolescent sexual minority males (ASMM) are less known. Data from a sample (n = 556) of ASMM (aged 13-18) in three U.S cities were used to examined associations between HIV education in school and sexual behaviors. Outcomes of interest included: sexually transmitted infection (STI), multiple sex partners, and condomless anal intercourse (CAI) with a male (all past 12 months). Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were calculated. Of 556 ASMM, 84% reported received HIV education. Among sexually active ASMM (n = 440) who received HIV education, fewer reported an STI (10% vs. 21%, aPR: 0.45, CI [0.26, 0.76]) and CAI (48% vs. 64%, aPR: 0.71, CI [0.58, 0.87]) than ASMM who did not receive HIV education. Protective effects of school HIV education on sexual behaviors are promising and suggest prevention education is vital to reducing HIV- and STI-related risks among ASMM.
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Affiliation(s)
- Taylor Robbins
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leigh E Szucs
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta
| | - Lindsay Trujillo
- ICF International, Fairfax, Virginia. Emily Young is also affiliated with the Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Emily Young
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta
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Adeyeba MO, Montazeri Q, Bivens-Davis T, Schrode KM, Harawa NT. Reducing Human Immunodeficiency Virus and Sexually Transmitted Infections Risk in African American Women with At-Risk Male Partners: A Randomized Trial. J Womens Health (Larchmt) 2023; 32:311-322. [PMID: 36520613 PMCID: PMC9993165 DOI: 10.1089/jwh.2022.0194] [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] [Indexed: 12/23/2022] Open
Abstract
Background: We examined the efficacy of the Females of African American Legacy Empowering Self (FemAALES) intervention in a cohort of 203 publicly insured Black women in Los Angeles. Materials and Methods: Women who reported recent sex with a male partner who was at increased risk for infection by human immunodeficiency virus (HIV) and sexually transmitted infections (STI) were randomized to the six-session FemAALES intervention or to a single client-centered family planning and STI/HIV counseling session. Participants were followed at 3 and 9 months post-intervention. To investigate between-group behavioral changes in condomless sex in the prior 90 days and other HIV/STI risks, we used generalized estimating equations that accounted for repeated observations in individuals. Results: Most participants (mean age 34 ± 11 standard deviation) were low-income and unemployed, despite three-quarters having completed high school or the equivalent. The most common HIV/STI risk factors among recent male partners were incarceration (58.8%) and concurrent sex with other women (72.2%). At 3 months, the FemAALEs group showed a larger increase in the odds of asking their partner to test (adjusted odds ratio = 2.14; 95% confidence interval [CI], 1.02-4.47; p = 0.0431) and in sexual health self-efficacy scores (adjβ = 1.82; 95% CI, 0.02-3.62; p = 0.0471) compared to the control group, although these changes did not hold at 9 months. Both groups showed statistically significant declines in the frequency of several sexual risk factors between baseline and 9 months. Conclusion: Although we did not find evidence that the FemAALES intervention was more efficacious than the less-intensive control condition in reducing sexual risk behaviors, the overall declines in risk behaviors we observed warrant further research. ClinicalTrials.gov (Identifier: NCT02189876).
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Affiliation(s)
- Mariam O. Adeyeba
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Qiana Montazeri
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
| | - Traci Bivens-Davis
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
| | - Katrina M. Schrode
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
| | - Nina T. Harawa
- Department of Psychiatry, Charles R. Drew University of Science and Medicine, Los Angels, California, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angels, California, USA
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Setty E, Dobson E. Department for Education Statutory Guidance for Relationships and Sex Education in England: A Rights-Based Approach? ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:79-93. [PMID: 36171488 PMCID: PMC9859846 DOI: 10.1007/s10508-022-02340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/03/2022] [Accepted: 04/13/2022] [Indexed: 06/16/2023]
Abstract
In England, the Children and Social Work Act (HMSO, 2017) bestowed compulsory status on relationships and sex education (RSE), which means that young people's right to receive RSE has been codified in law. This paper analyzes how this right is upheld and enacted within the Department for Education (DfE) (2019) statutory guidance on RSE for schools in England. The analysis suggests that the guidance features contradictory discourses in which young people's rights are ostensibly advanced, but remain structured by adult-centric, heteronormative understandings of sex and relationships. It upholds a decontextualized and legalistic approach to rights, responsibilities, informed choice, and decision making. A narrow conception of rights is particularly evident regarding young people's digital sexual cultures, which are predominantly framed in terms of risk and harm. We argue that scholars should investigate how educators are designing and delivering RSE in light of the guidance, and the opportunities for and obstacles to a genuinely "rights-based" approach to RSE. While the policy discussed in this article is specific to England, the discussion has wider relevance for practitioners and policymakers across cultural and geographic contexts as it draws upon a model for analyzing how young people's sexuality is presented and addressed in legislative and curricular documentation.
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Affiliation(s)
- Emily Setty
- Department of Sociology, University of Surrey, 11 AD 03, Guildford, GU2 7XH, Surrey, UK.
| | - Emma Dobson
- School of Education, University of Durham, Durham, UK
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Smyth HL, Pitpitan EV, MacKinnon DP, Booth RE. Assessing Potential Outcomes Mediation in HIV Interventions. AIDS Behav 2021; 25:2441-2454. [PMID: 33740215 DOI: 10.1007/s10461-021-03207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
Knowledge of causal processes through mediation analysis can help improve the effectiveness and reduce costs of public health programs, like HIV prevention and treatment interventions. Advancements in mediation using the potential outcomes framework provide a method for estimating the causal effect of interventions on outcomes via a mediating variable. The purpose of this paper is to provide practical information about mediation and the potential outcomes framework that can enhance data analysis and causal inference for intervention studies. Causal mediation effects are defined and then estimated using data from an HIV intervention randomized trial among people who inject drugs (PWID) in Ukraine. Results from a potential outcomes mediation analysis show that the intervention had a total causal effect on incident HIV infection such that participants in the experimental group were 36% less likely to become infected during the 12-month study than those in the control arm, but that neither self-efficacy nor network communication mediated this effect. Because neither putative mediator was significant, measurement and confounding issues should be investigated to rule out these mediators. Other putative mediators, such as injection frequency, route of administration, or HIV knowledge can be considered. Future research is underway to examine additional, multiple mediators explaining efficacy of the current intervention and sensitivity to confounding effects.
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8
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Noar SM, Willoughby JF, Crosby R, Webb EM, Van Stee SK, Feist-Price S, Davis E. Acceptability of a Computer-Tailored Safer Sex Intervention for Heterosexually Active African Americans Attending an STI Clinic. J Prim Prev 2021; 41:211-227. [PMID: 32157623 DOI: 10.1007/s10935-020-00585-1] [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: 10/24/2022]
Abstract
Since African Americans are disproportionately affected by HIV/AIDS, interventions that increase correct and consistent condom use are urgently needed. We report baseline acceptability data from a randomized controlled trial (RCT) testing the Tailored Information Program for Safer Sex, a computer-tailored intervention designed to increase correct and consistent condom use among low income, heterosexually active African Americans attending an urban sexually transmitted infection (STI) clinic. We enrolled 274 participants at baseline in an RCT-147 in the intervention group. The intervention had high acceptability, with a mean acceptability of 4.35 on a 5-point scale. We conducted a multiple regression analysis examining demographic, structural, and sexual risk characteristics that revealed only sex to be significantly (p < .01) associated with intervention acceptability. While women were more likely than men to find the intervention acceptable, overall the results indicated broad acceptability of this intervention to the target audience. eHealth interventions are a viable option for HIV prevention among African Americans visiting a publicly-funded STI clinic. We discuss implications of these results for the future application of such programs.
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Affiliation(s)
- Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, 382 Carroll Hall, Campus Box 3365, Chapel Hill, NC, 27599-3365, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | - Richard Crosby
- College of Public Health, University of Kentucky, Lexington, USA
| | - Elizabeth M Webb
- Department of Communication, University of South Carolina Aiken, Aiken, USA
| | - Stephanie K Van Stee
- Department of Communication and Media, University of Missouri-St. Louis, St. Louis, USA
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9
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Ramos SR, Nelson LE, Jones SG, Ni Z, Turpin RE, Portillo CJ. A State of the Science on HIV Prevention Over 40 Years Among Black and Hispanic/Latinx Communities. J Assoc Nurses AIDS Care 2021; 32:253-263. [PMID: 33929978 PMCID: PMC8223201 DOI: 10.1097/jnc.0000000000000266] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We present a state of the science on HIV behavioral prevention interventions in Black and Hispanic/Latinx communities. The purpose of this article is threefold: (a) highlight the early documented underlying social and political barriers that constrained interventions to prevent new HIV infections; (b) address the structural inequities in HIV prevention and treatment; and (c) describe the need for increasing HIV multilevel prevention interventions that support greater HIV testing and pre-exposure prophylaxis uptake. To address HIV prevention, multilevel interventions that address individual, structural, and social level components have demonstrated more sustainable outcomes. Implications for research and clinical practice include (a) updating antiquated curricula in nursing, medicine, and public health that perpetuate racial, structural-level inequities and (b) increasing the pipeline for Black and Hispanic/Latinx persons to pursue research or clinical-focused doctorate degrees.
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Affiliation(s)
- S. Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | | | - Sandra Gracia Jones
- Chronic Disease Prevention and Care, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida, USA
| | - Zhao Ni
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rodman E. Turpin
- Department of Epidemiology and Biostatistics, University of Maryland College Park, School of Public Health, College Park, Maryland, USA
| | - Carmen J. Portillo
- Yale University School of Nursing, Yale University, New Haven, Connecticut, USA
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10
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Walter AW, Morocho C. HIV Related Knowledge, HIV Testing Decision-Making, and Perceptions of Alcohol Use as a Risk Factor for HIV among Black and African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4535. [PMID: 33923339 PMCID: PMC8123126 DOI: 10.3390/ijerph18094535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
The HIV/AIDS epidemic disproportionately affects Black and African American women in the United States. This study examined the extent of HIV related knowledge, HIV testing decision-making, and perceptions of alcohol use as a risk factor for HIV among Black and African American women in urban and suburban communities. Seven focus groups were conducted with 37 women aged 18 to 49 residing in the Commonwealth of Massachusetts. Women participating in focus groups had a wide breadth of HIV related knowledge. Findings suggest the influence of interpersonal relationships and provider-patient interactions on HIV testing, the need for building community capacity and leveraging community resources towards HIV prevention, and the influence of alcohol outlet density on HIV vulnerability and exposure in communities of color. Comprehensive multifaceted evidence informed interventions that are culturally relevant and gender responsive are needed to reduce HIV/AIDS disparities.
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Affiliation(s)
- Angela Wangari Walter
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Cesar Morocho
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell, Lowell, MA 01854, USA;
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Koenig LJ, Lyles CM, Higa D, Mullins MM, Sipe TA. Research Synthesis, HIV Prevention Response, and Public Health: CDC's HIV/AIDS Prevention Research Synthesis Project. Public Health Rep 2021; 137:32-47. [PMID: 33635724 PMCID: PMC8721762 DOI: 10.1177/0033354920988871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Research synthesis, through qualitative or quantitative systematic reviews, allows for integrating results of primary research to improve public health. We examined more than 2 decades of work in HIV prevention by the Centers for Disease Control and Prevention's (CDC's) HIV/AIDS Prevention Research Synthesis (PRS) Project. We describe the context and contributions of research synthesis, including systematic reviews and meta-analyses, through the experience of the PRS Project. METHODS We reviewed PRS Project publications and products and summarized PRS contributions from 1996 to July 2020 in 4 areas: synthesis of interventions and epidemiologic studies, synthesis methods, prevention programs, and prevention policy. RESULTS PRS Project publications summarized risk behaviors and effects of prevention interventions (eg, changing one's perception of risk, teaching condom negotiation skills) across populations at risk for HIV infection and intervention approaches (eg, one-on-one or group meetings) as the HIV/AIDS epidemic and science evolved. We used the PRS Project cumulative database and intervention efficacy reviews to contribute to prevention programs and policies through identification of evidence-based interventions and development of program guidance. Subject matter experts and scientific evidence informed PRS Project products and contributions, which were implemented through strategic programmatic partnerships. CONCLUSIONS The contributions of the PRS Project to HIV prevention and public health efforts in the United States can be credited to CDC's long-standing support of the project and its context within a federal prevention agency, where HIV programs and policies were developed and implemented. The effect of the PRS Project was likely facilitated by opportunities to directly influence program and policy because of connections with other research translation activities and program and policy decision making within CDC.
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Affiliation(s)
- Linda J. Koenig
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia M. Lyles
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Darrel Higa
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M. Mullins
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Theresa A. Sipe
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA,Theresa A. Sipe, PhD, MPH, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Prevention Research Branch, 1600 Clifton Rd NE, MS US8-5, Atlanta, GA 30329, USA.
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Wang L, Huai P, Jiao K, Liu Y, Hua Y, Liu X, Wei C, Ma W. Awareness of and barriers to using non-occupational post-exposure prophylaxis among male clients of female sex workers in two cities of China: a qualitative study. Sex Health 2021; 18:239-247. [PMID: 34148566 DOI: 10.1071/sh20203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
Background Male clients of female sex workers ('clients' hereafter) are considered high-risk and potentially a bridge population in the HIV epidemic. Non-occupational post-exposure prophylaxis (nPEP) is a safe and effective but under-utilised public health intervention to prevent HIV transmission. This study aims to explore clients' awareness of nPEP, intention of uptake, potential barriers to nPEP uptake and adherence, and suggestions for nPEP promotion in China. METHODS We conducted semi-structured in-depth interviews with 20 clients in two Chinese cities in 2018. Participants were recruited through purposive sampling. The content of the interviews was analysed using thematic content analysis in ATLAS.ti. RESULTS Overall, just a minority of participants were aware of nPEP. A majority expressed willingness to use nPEP. Potential barriers to nPEP uptake and adherence included adverse drug reactions, price, concerns of drug efficacy, privacy issues, and forgetting to take the drugs. Almost all participants expressed the need to promote nPEP among clients. Participants suggested that the promotion of nPEP should be at hospitals, online, and be integrated with HIV/AIDS health education. CONCLUSIONS Our findings suggested that nPEP guidelines should be formulated and implementation strategies should be developed to address barriers to uptake and adherence in order to successfully tap into the potential of nPEP as an effective HIV prevention tool.
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Affiliation(s)
- Lin Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China
| | - Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yicong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yumeng Hua
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Xueyuan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Chongyi Wei
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA; and Corresponding authors. Emails: ;
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China; and Corresponding authors. Emails: ;
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Poku OB, Ho-Foster AR, Entaile P, Misra S, Mehta H, Rampa S, Goodman M, Arscott-Mills T, Eschliman E, Jackson V, Melese T, Becker TD, Eisenberg M, Link B, Go V, Opondo PR, Blank MB, Yang LH. 'Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial. Trials 2020; 21:832. [PMID: 33028387 PMCID: PMC7542742 DOI: 10.1186/s13063-020-04676-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. METHODS This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status). DISCUSSION Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana. TRIAL REGISTRATION ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.
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Affiliation(s)
- Ohemaa B Poku
- Johns Hopkins University, Baltimore, MD, United States.
| | - Ari R Ho-Foster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | | | | | | | | | - Tonya Arscott-Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | - Valerie Jackson
- University of California San Francisco, San Francisco, CA, United States
| | | | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Bruce Link
- University of California Riverside, Riverside, CA, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill, Chapel Hil, NC, USA
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States
- Columbia University Mailman School of Public Health, New York, NY, USA
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Are Sexually Transmitted Infection/HIV Behavioral Interventions for Women of Color Culturally Grounded? A Review of the Literature. J Assoc Nurses AIDS Care 2020; 30:e64-e81. [PMID: 31461740 DOI: 10.1097/jnc.0000000000000008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although behavioral interventions for women of color have been shown to be effective in reducing sexually transmitted infections (STIs), STI/HIV rates continue to increase. To alleviate sexual health disparities, it is necessary to understand the cultural behaviors of the target population to design culturally grounded interventions. The purposes of our review were to examine the current state of STI/HIV behavioral interventions for women of color, determine how culture has been incorporated into interventions, and identify gaps in the literature. We reviewed 17 articles targeting women of color between the ages of 13 and 65 years. Findings suggest the need for interventions that are culturally grounded, group based, and delivered face-to-face and in multiple sessions to reduce STI/HIV risk behaviors. Although many of the studies were effective, we found three major gaps: (a) the need to examine intervention sustainability, (b) limitations in the adaption of theoretical frameworks, and (c) clarity in how to infuse culture into interventions.
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Carmack C, Roncancio AM, Gerecht L, Ansari M. Perceived partner beliefs about condoms and self-efficacy communication within the context of the theory of gender and power. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1424-1437. [PMID: 32168397 DOI: 10.1002/jcop.22337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 05/25/2023]
Abstract
The theory of gender and power provides a unique framework for understanding condom use by accounting for distinct challenges faced by minority women in particular. This study examined whether self-efficacy about condom use communication (SECC) and perceived partner's beliefs about condom (PPBC) use had an influence on condom use frequency; and whether these associations varied by gender. A sample of 252 African-American college students (101 males and 151 females) completed a confidential online survey assessing SECC, PPBC, and condom use behavior. SECC and PPBC showed significant associations with condom use behavior. Furthermore, there was a gender interaction effect with PPBC on condom use behavior. As PPBC increases toward positive associations about condom use, condom use behavior increased significantly more for females (B = 0.42; p = .02) as compared to males (B = 0.26; p = .19). This study supports the need to teach young women effective communication skills in order for them to accurately assess what their partner thinks about condom-related behaviors; and ultimately not allow partner discouragement to influence their decisions to use condoms. Interventions aimed at reducing risky sexual behavior on predominantly Black college campuses, in particular, may benefit from directly addressing relationship power and focusing on building self-efficacy in communicating condom use.
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Affiliation(s)
- Chakema Carmack
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas
| | - Angelica M Roncancio
- Health and Behavioral Science, College of Humanities and Social Sciences, Houston, Texas
| | - Lena Gerecht
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas
| | - Mohammed Ansari
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, Texas
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Carey MP, Rich C, Norris AL, Krieger N, Gavarkovs AG, Kaplan C, Guthrie KM, Carey KB. A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1231-1250. [PMID: 32189096 PMCID: PMC7150639 DOI: 10.1007/s10508-020-01635-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.
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Affiliation(s)
- Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA.
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Alyssa L Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Naomi Krieger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Adam G Gavarkovs
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | - Clair Kaplan
- Department of Clinical Research, Planned Parenthood of Southern New England, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | - Kate B Carey
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Chiaramonte D, Miller RL, Lee K, Santiago Rivera OJ, Acevedo-Polakovich ID, McGirr S, Porter JL, Ellen JM, Boyer CB. Gendered powerlessness in at-risk adolescent and young women: an empirical model. AIDS Care 2020; 32:1333-1342. [PMID: 32008352 DOI: 10.1080/09540121.2020.1724252] [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: 10/25/2022]
Abstract
In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connell's Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young women's health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.
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Affiliation(s)
| | - Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - KyungSook Lee
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | | | - Sara McGirr
- Michigan Public Health Institute, Okemos, MI, USA
| | | | - Jonathan M Ellen
- All Children's Hospital Johns Hopkins Medicine, Baltimore, MD, USA
| | - Cherrie B Boyer
- School of Medicine, University of California, San Francisco, CA, USA
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- Department of Psychology, Michigan State University, East Lansing, MI, USA
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18
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Gursahaney PR, Cordes S, Ofotokun I, Wall KM, Jamieson DJ, Haddad LB. Factors associated with condom use among HIV-positive women living in Atlanta, Georgia. PLoS One 2019; 14:e0225406. [PMID: 31834885 PMCID: PMC6910822 DOI: 10.1371/journal.pone.0225406] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Consistent condom use is essential to reducing heterosexual transmission of HIV. African Americans are disproportionately affected by HIV in the United States despite comprising a small percentage of the population. Our objectives were to evaluate factors associated with self-reported condom use in a cohort of predominantly African American women receiving HIV care in Atlanta, Georgia. Methods A cross-sectional study of reproductive knowledge, attitudes, and practices among adult, sexually-active, HIV-positive women attending the Grady Infectious Disease Clinic in Atlanta, Georgia was conducted from July, 2013 to November, 2014 to evaluate factors associated with self-reported condom use. Primary outcomes included: condom use at last vaginal intercourse and consistent condom use with vaginal intercourse over the last six months. Descriptive, bivariable, and multivariable logistic regression analyses were performed. Results Of 187 women enrolled, 170 reported having vaginal intercourse in the last six months. Seventy-four percent used condoms at last vaginal intercourse, whereas 53% reported consistent condom use over the last six months. In adjusted analyses, factors associated with condom use at last intercourse included decreased frequency of sex, no history of drug use, and confidence to discuss condom use with sexual partners (p<0.05). Factors associated with consistent condom use in the past six months were older age, being single/dating, and confidence to discuss condom use with sexual partners. History of drug use, having HIV-positive partners, and unprotected anal intercourse were associated with inconsistent use (p<0.05). Conclusions Improved strategies are needed to educate women on the importance of safe sexual practices and condom negotiation. Healthcare providers should strive to have an open dialogue with patients about condom use, whether they engage in anal sex, and its risks.
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Affiliation(s)
- Priya R. Gursahaney
- University of Cincinnati College of Medicine, Department of Obstetrics and Gynecology, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Sarah Cordes
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, Georgia, United States of America
| | - Kristin M. Wall
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, United States of America
| | - Denise J. Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Lisa B. Haddad
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
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Sabri B, Gielen A. Integrated Multicomponent Interventions for Safety and Health Risks Among Black Female Survivors of Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2019; 20:720-731. [PMID: 29334001 PMCID: PMC5771976 DOI: 10.1177/1524838017730647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The epidemic of violence disproportionately affects women, including Black women. Black women survivors of violence have been found to face multiple safety and health issues such as depression, post-traumatic stress disorder, HIV, and poor reproductive health. Many health issues co-occur, and this co-occurrence can be associated with additional safety and health-related challenges for survivors. Consequently, there is a need for multicomponent interventions that are designed to concurrently address multiple health issues commonly faced by Black survivors of violence. This systematic review of literature determines the efficacy of various strategies used in the existing evidence-based multicomponent interventions on violence reduction, promotion of reproductive health, reduction in risk for HIV, reduction in levels of stress, and improvement in mental health. Sixteen intervention studies were identified. Examples of components found to be efficacious in the studies were safety planning for violence, skill building in self-care for mental health, education and self-regulatory skills for HIV, mindfulness-based stress reduction for reducing stress, and individual counseling for reproductive health. Although some strategies were found to be efficacious in improving outcomes for survivors, the limitations in designs and methods, and exclusive focus on intimate partner violence calls for more rigorous research for this population, particularly for Black survivors of all forms of violence. There is also need for culturally responsive multicomponent interventions that account for diversity among Black survivors.
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Affiliation(s)
- Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea Gielen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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20
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Collins CB, Baack BN, Tomlinson H, Lyles C, Cleveland JC, Purcell DW, Ortiz-Ricard A, Mermin J. Selecting Evidence-Based HIV Prevention Behavioral Interventions for HIV-Negative Persons for National Dissemination. AIDS Behav 2019; 23:2226-2237. [PMID: 30798460 DOI: 10.1007/s10461-019-02433-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper describes the development of a formula to determine which evidence-based behavioral interventions (EBIs) targeting HIV-negative persons would be cost-saving in comparison to the lifetime cost of HIV treatment and the process by which this formula was used to prioritize those with greatest potential impact for continued dissemination. We developed a prevention benefit index (PBI) to rank risk-reduction EBIs for HIV-negative persons based on their estimated cost for achieving the behavior change per one would-be incident infection of HIV. Inputs for calculating the PBI included the mean estimated cost-per-client served, EBI effect size for the behavior change, and the HIV incidence per 100,000 persons in the target population. EBIs for which the PBI was ≤ $402,000, the estimated lifetime cost of HIV care, were considered cost-saving. We were able to calculate a PBI for 35 EBI and target population combinations. Ten EBIs were cost-saving having a PBI below $402,000. One EBI did not move forward for dissemination due to high start-up dissemination costs. DHAP now supports the dissemination of 9 unique EBIs targeting 13 populations of HIV-negative persons. The application of a process, such as the PBI, may assist other health-field policymakers when making decisions about how to select and fund implementation of EBIs.
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Affiliation(s)
- Charles B Collins
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA.
| | - Brittney N Baack
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Hank Tomlinson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Cindy Lyles
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Janet C Cleveland
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - David W Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Angel Ortiz-Ricard
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Mailstop E-40, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Jonathan Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
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Johnson K, Gilbert L, Hunt T, Wu E, Metsch L, Goddard-Eckrich D, Richards S, Tibbetts R, Rowe JC, Wainberg ML, El-Bassel N. The effectiveness of a group-based computerized HIV/STI prevention intervention for black women who use drugs in the criminal justice system: study protocol for E-WORTH (Empowering African-American Women on the Road to Health), a Hybrid Type 1 randomized controlled trial. Trials 2018; 19:486. [PMID: 30201039 PMCID: PMC6131955 DOI: 10.1186/s13063-018-2792-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the study protocol of a hybrid type I randomized controlled trial that evaluates the effectiveness and cost-effectiveness of implementing Empowering African-American Women on the Road to Health (E-WORTH), an Afrocentric, group-based, computerized human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention intervention for controlled substance-using black women in community corrections settings in New York City. METHODS/DESIGN We provide an overview of E-WORTH's hybrid type I design, which is guided by the Consolidated Framework for Implementation Research (CFIR). E-WORTH combines HIV/STI and intimate partner violence (IPV) prevention components and tests the comparative effectiveness of E-WORTH and streamlined HIV testing versus streamlined HIV testing alone in decreasing biologically confirmed HIV and STI incidence, sexual risk, and IPV, as well as in improving access to HIV and STI prevention services and care. DISCUSSION This paper provides an overview of E-WORTH's intervention protocol and serves as a framework for using hybrid type I designs, guided by the CFIR conceptual framework, to evaluate HIV/STI and IPV prevention interventions in community corrections settings. We discuss how E-WORTH's hybrid type I design advances implementation science through its effectiveness and cost-effectiveness aims as well as through a mixed-methods study that evaluates multilevel theory-driven factors (structural, organizational, staffing, and client) guided by the CFIR that influences the implementation of E-WORTH in a criminal justice setting. This study also addresses the novel challenges and opportunities of implementing an intervention that targets specific racial subgroup(s) in a community corrections setting that services all populations, implementing a group-based intervention with technological components in such settings, and employing community-based participatory research strategies to guide recruitment and retention efforts. TRIAL REGISTRATION ClinicalTrials.gov, NCT02391233 . Registered on 17 March 2015.
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Affiliation(s)
- Karen Johnson
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
- Columbia University School of Social Work, Social Intervention Group, 1255 Amsterdam Avenue, New York, NY 10027 USA
| | - Louisa Gilbert
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
| | - Timothy Hunt
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
| | - Elwin Wu
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Dawn Goddard-Eckrich
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
- Social Intervention Group, Columbia University Teacher’s College, 1255 Amsterdam Avenue, New York, NY 10027 USA
| | - Stanley Richards
- The Fortune Society, 625 West 140th Street, New York, NY 10031 USA
| | - Rick Tibbetts
- New York City Department of Probation, 210 Joralemon Street, Brooklyn, NY 11201 USA
| | - Jessica C. Rowe
- Center for Teaching and Learning, Columbia University, Lewisohn Hall, 2970 Broadway #603, New York, NY 10027 USA
| | - Milton L. Wainberg
- Columbia University / New York State Psychiatric Institute, 1051 Riverside Drive, #24, New York, NY 10032 USA
| | - Nabila El-Bassel
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
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Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
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Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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O'Leary A. Women and HIV in the Twenty-First Century: How Can We Reach the UN 2030 Goal? AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:213-224. [PMID: 29969306 DOI: 10.1521/aeap.2018.30.3.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Women have always been part of the HIV/AIDS epidemic. As with other populations affected by HIV, for many years the only prevention strategy available was behavior change. Behavioral interventions for women were developed and evaluated, with some success. Because women did not control the use of male condoms, efficacious interventions needed to build skills for partner negotiation. Woman-controlled technologies such as the female condom and vaginal spermicide were unable to solve the problem of male control of the condom and enable the development of safe methods for women to protect themselves. The modern era of HIV prevention has produced biomedical solutions based on highly active retroviral chemoprophylaxis, which can be hidden from the male partner and thus eliminate his possible negative reactions. Pre-exposure prophylaxis holds promise for HIV prevention among women. This article reviews the literature on HIV prevention for women, including both successes and challenges.
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Affiliation(s)
- Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mwangi M, Waruru A, Waruiru W, Gichangi A, Toroitich-Ruto C, Kim AA. Factors associated with unsafe sex among Kenyan youth: Results from a nationally representative population-based survey. EAST AFRICAN JOURNAL OF APPLIED HEALTH MONITORING AND EVALUATION 2018; 2:25-37. [PMID: 31149660 PMCID: PMC6537612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Understanding sexual risk among youth can inform the design of effective HIV prevention interventions. METHODS The 2012 Kenya AIDS Indicator Survey was a nationally representative population-based survey. We administered a questionnaire and collected blood samples for HIV testing. We examined factors associated with unsafe sex among unmarried youth aged 15-19 and 20-24 years. RESULTS Of 2,090 unmarried youth aged 15-19 years, 33.3% (95% confidence interval [CI] 30.6-36.1) had ever had sex. Among those, 66.0% (95% CI 61.3-70.7) had sex in the past year (sexually active), and of these, 38.7% (95% 33.4 -44.0) reported unsafe sex. No differences were observed in unsafe sex by sex. Factors associated with increased adjusted odds of unsafe sex among youth aged 15-19 years were residence in Central province; having primary or lower education; sexual debut before age 15 years; ever receiving money, gifts or favours for sex (transactional sex); multiple sexual partners in the past year; and low self-perceived risk of HIV. Of the 1,079 unmarried youth aged 20-24 years, 77.2% (95% CI 74.2-80.2) had ever had sex. Of these, 73.1% (95% CI69.8-76.3) were sexually active, and 24.1% (95% CI 18.1-30.1) of women and 31.9% (95% CI 26.4-37.5) of men reported unsafe sex in the past year. Factors associated with increased adjusted odds of unsafe sex among youth aged 20-24 years were primary or lower education, transactional sex and multiple partners in the past year. CONCLUSION Unsafe sex is common among Kenyan youth, especially those aged 15-19 years. HIV prevention efforts need to target youth, support educational progression and economic empowerment.
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Affiliation(s)
- Mary Mwangi
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Anthony Waruru
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Wanjiru Waruiru
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Anthony Gichangi
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Cathy Toroitich-Ruto
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Hill MJ, Holt M, Hanscom B, Wang Z, Cardenas-Turanzas M, Latkin C. Gender and race as correlates of high risk sex behaviors among injection drug users at risk for HIV enrolled in the HPTN 037 study. Drug Alcohol Depend 2018; 183:267-274. [PMID: 29316523 PMCID: PMC5803307 DOI: 10.1016/j.drugalcdep.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sexual contact has been shown to be a major mode of HIV transmission among people who inject drugs (PWID). This study examined gender and racial differences among PWID' sexual risk behaviors from the perspective of sexual scripts. METHODS 696 PWID enrolled from Philadelphia on HPTN 037 were classified as engaging in high-risk sex behaviors if they reported having sex in the past 30 days and condomless sex with a non-primary partner, giving/receiving sex for money, or multiple partners. A multivariable logistic regression model was used to assess associations between demographic factors and high risk sex. RESULTS Findings of the multivariable regression analysis demonstrated that being White (OR = 0.52, p < 0.001) and male (OR = 0.59, p = 0.002) were protective of high risk sex, while homelessness (OR = 1.7, p = 0.005), and being single (OR = 1.83, p = 0.006) were positively associated with high risk sex. African American (AA) women were 1.7 times more likely to report high-risk sex than AA men (p = 0.002), 3.28 times more likely than White men (p < 0.001), and 1.93 times more likely than White women (p < 0.001). CONCLUSIONS Since AA women report high-risk sex behaviors more than other demographic groups, behavioral interventions for HIV risk reduction among PWID may benefit from focusing on sex-risk reduction among AA women.
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Affiliation(s)
- Mandy J. Hill
- McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Michael Holt
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Brett Hanscom
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Zhe Wang
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | | | - Carl Latkin
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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26
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Williams SP, Myles RL, Sperling CC, Carey D. An Intervention for Reducing the Sexual Risk of Men Released From Jails. JOURNAL OF CORRECTIONAL HEALTH CARE 2018; 24:71-83. [PMID: 29303039 DOI: 10.1177/1078345817745537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Incarceration history can affect sexual health behaviors. A randomized controlled trial of a prevention intervention tailored for post-incarcerated men was administered in a reentry setting. Men ≤45 days post release were recruited into a five-session intervention study. Participants ( N = 255) were assessed and tested for three sexually transmitted diseases (STDs) and HIV at baseline and 3 months post-intervention and followed up for 3 more months. The intervention group's STD risks knowledge ( p < .001), partner communication about condoms ( p < .001), and condom application skills ( p < .001) improved. Although fewer men tested positive for an STD at 3 months post-intervention (10% vs. 8%) and no new HIV cases were found, the finding was not significant. A tailored risk reduction intervention for men with incarceration histories can affect sexual risk behaviors.
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Affiliation(s)
- Samantha P Williams
- 1 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ranell L Myles
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles C Sperling
- 3 Standing to Achieve New Directions, Inc. (STAND, Inc.), Decatur, GA, USA
| | - Delicia Carey
- 1 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,4 Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Farnham A, Ziegler S, Blanke U, Stone E, Hatz C, Puhan MA. Does the DOSPERT scale predict risk-taking behaviour during travel? A study using smartphones. J Travel Med 2018; 25:5069446. [PMID: 30107438 DOI: 10.1093/jtm/tay064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/08/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite the continuing growth of international tourism, very little research has been done on the link between individual risk attitudes and health behaviours during travel. Our study uses a validated risk-taking questionnaire Domain-Specific Risk-Taking Scale (DOSPERT) and data from a smartphone application to study the association between pre-travel risk attitudes and the occurrence of behaviours during travel. METHODS A prospective cohort of travellers to Thailand used a smartphone application to answer a daily questionnaire about health behaviours and events. Prior to travel, participants completed the DOSPERT, a validated 30-item scale that assesses risk-taking and perception in five content domains: financial decisions, health/safety, recreational, ethical and social decisions. Multiple linear regression models were used to model the relationship between DOSPERT risk-taking subdomain score and health behaviour. RESULTS Of the 75 travellers that completed the study, 70 (93.3%) completed the DOSPERT pre-travel. Men, backpackers and young travellers reported a higher willingness to take recreational risks than women, luxury travellers and older travellers. Incidence of drug and alcohol risk behaviours during travel, itching from mosquitoes, smoking and failing to use a seatbelt in automobiles while at home were all significantly associated with an individual's score on the health and safety DOSPERT subdomain. CONCLUSIONS In our study, individual scores on risk-taking in the health and safety subdomain of the DOSPERT questionnaire seem to be predictive of health behaviours both during travel and at home. By pairing new methods of data collection with questionnaires such as DOSPERT that identify key traveller characteristics to intervene on, travel medicine doctors will be able to provide more specialised health advice, ensuring that all travellers receive well-rounded advice about the full range of health challenges they will face during travel.
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Affiliation(s)
- Andrea Farnham
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Travel Clinic, University of Zurich, 8001 Zurich, Switzerland
| | - Sarah Ziegler
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Ulf Blanke
- Wearable Computing Laboratory, ETH Zurich, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Emily Stone
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christoph Hatz
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Travel Clinic, University of Zurich, 8001 Zurich, Switzerland.,Medical Services and Diagnostic Department, University of Basel, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Infectious Diseases, Cantonal Hospital, 9007 St. Gallen, Switzerland
| | - Milo A Puhan
- Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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28
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Sangaramoorthy T, Jamison A, Dyer T. Intersectional stigma among midlife and older Black women living with HIV. CULTURE, HEALTH & SEXUALITY 2017; 19:1329-1343. [PMID: 28418279 PMCID: PMC5647221 DOI: 10.1080/13691058.2017.1312530] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
HIV-related stigma is a barrier to the prevention and treatment of HIV. For midlife and older Black women, the nature and intensity of HIV-related stigma may be compounded by their multiple marginalised social status based on gender, race, and age. We examined the perceptions and experiences of HIV-related stigma among midlife and older Black women living in Prince George's County, Maryland, USA. Between 2014 and 2015, we conducted semi-structured interviews with a sample of 35 midlife and older Black women living with HIV. Using a modified grounded theory approach, we explored emergent themes related to the manifestation and experience of intersectional stigma and changes in stigma experience over time. Our findings suggest that intersectional stigma is a central feature in midlife and older Black women's lives, with women reporting experiences of intersectional stigma at the interpersonal/familial, community, and institutional/structural levels. Although women acknowledged gradual acceptance of their HIV-positive status over time, they continued to experience negative responses related to gender, race, age, and disease. Our findings indicate that a more robust understanding of the impact of HIV-related stigma requires work to consider the complex manifestations of intersectional stigma among an increasingly aging population of Black women in the USA.
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Affiliation(s)
| | - Amelia Jamison
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland at College Park, MD, USA
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland at College Park, MD, USA
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29
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Painter JE, Temple BS, Woods LA, Cwiak C, Haddad LB, Mulligan MJ, DiClemente RJ. Theory-Based Analysis of Interest in an HIV Vaccine for Reasons Indicative of Risk Compensation Among African American Women. HEALTH EDUCATION & BEHAVIOR 2017; 45:444-453. [PMID: 29073834 DOI: 10.1177/1090198117736860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Licensure of an HIV vaccine could reduce or eliminate HIV among vulnerable populations. However, vaccine effectiveness could be undermined by risk compensation (RC), defined by an increase in risky behavior due to a belief that the vaccine will confer protection. Interest in an HIV vaccine for reasons indicative of RC may serve as an indicator of actual RC in a postlicensure era. This study assessed factors associated with interest in an HIV vaccine for reasons indicative of RC among African American women aged 18 to 55 years, recruited from a hospital-based family planning clinic in Atlanta, Georgia ( N = 321). Data were collected using audio-computer-assisted surveys. Survey items were guided by risk homeostasis theory and social cognitive theory. Multivariable logistic regression was used to assess determinants of interest in an HIV vaccine for reasons indicative of RC. Thirty-eight percent of the sample expressed interest in an HIV vaccine for at least one reason indicative of RC. In the final model, interest in an HIV vaccine for reasons indicative of RC was positively associated with higher impulsivity, perceived benefits of sexual risk behaviors, and perceived benefits of HIV vaccination; it was negatively associated with having at least some college education, positive future orientation, and self-efficacy for sex refusal. Results suggest that demographic, personality, and theory-based psychosocial factors are salient to wanting an HIV vaccine for reasons indicative of RC, and underscore the need for risk-reduction counseling alongside vaccination during the eventual rollout of an HIV vaccine.
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30
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Camacho-Gonzalez AF, Chernoff MC, Williams PL, Chahroudi A, Oleske JM, Traite S, Chakraborty R, Purswani MU, Abzug MJ. Sexually Transmitted Infections in Youth With Controlled and Uncontrolled Human Immunodeficiency Virus Infection. J Pediatric Infect Dis Soc 2017; 6:e22-e29. [PMID: 27440505 PMCID: PMC5907850 DOI: 10.1093/jpids/piw039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/16/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), disproportionately affect adolescents and young adults (AYAs) ages 13-24 years. Sexually transmitted infections likewise are a risk factor for HIV acquisition and transmission; however, there is a lack of data on STI acquisition in HIV-infected AYAs. METHODS We determined the incidence of STIs in HIV-infected AYAs 12.5 <25 years of age in the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1074 observational cohort study. Univariate and multivariable logistic regression models were used to evaluate the association of HIV control (mean viral load <500 copies/mL and CD4+ T cells >500 cells/mm3 in the year preceding STI diagnosis) and other risk factors with STI occurrence. RESULTS Of 1201 enrolled subjects, 1042 participants met age criteria and were included (49% male, 61% black, 88% perinatally infected; mean age 18.3 years). One hundred twenty participants had at least 1 STI on study, of whom 93 had their first lifetime STI (incidence rate = 2.8/100 person-years). For individual STI categories, 155 incident category-specific events were reported; human papillomavirus (HPV) and chlamydial infections were the most common. In the multivariable model, having an STI was associated with older age (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 1.05-1.22), female sex (aOR = 2.65; 95% CI, 1.67-4.21), nonperinatal HIV acquisition (aOR = 2.33; 95% CI, 1.29-4.22), and uncontrolled HIV infection (aOR = 2.05; 95% CI, 1.29-3.25). CONCLUSIONS Sexually transmitted infection acquisition in HIV-infected AYAs is associated with older age, female sex, nonperinatal HIV acquisition, and poorly controlled HIV infection. Substantial rates of STIs among HIV-infected AYAs support enhanced preventive interventions, including safe-sex practices and HPV vaccination, and antiretroviral adherence strategies.
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Affiliation(s)
- Andres F Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Division of Pediatric Infectious Diseases,,Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia,,Correspondence: A. F. Camacho-Gonzalez, MD, MSc, Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, 2015 Uppergate Dr, Ste 500, Atlanta, GA 30322 ()
| | - Miriam C Chernoff
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paige L Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Division of Pediatric Infectious Diseases,,Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia,
| | - James M Oleske
- Department of Pediatrics, Division of Allergy, Immunology, Infectious Diseases and Pulmonology, Rutgers New Jersey Medical School, Newark;
| | - Shirley Traite
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rana Chakraborty
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Division of Pediatric Infectious Diseases,,Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia,
| | - Murli U Purswani
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, and
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Division of Pediatric Infectious Diseases, Aurora
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31
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Rabani-Bavojdan M, Rabani-Bavojdan M, Rajabizadeh G, Kaviani N, Bahramnejad A, Ghaffari Z, Shafiei-Bafti M. The Effectiveness of the Harm Reduction Group Therapy Based on Bandura's Self-Efficacy Theory on Risky Behaviors of Drug-Dependent Sex Worker Women. ADDICTION & HEALTH 2017; 9:175-182. [PMID: 29657698 PMCID: PMC5894797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/19/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effectiveness of the harm reduction group therapy based on Bandura's self-efficacy theory on risky behaviors of sex workers in Kerman, Iran. METHODS A quasi-experimental two-group design (a random selection with pre-test and post-test) was used. A risky behaviors questionnaire was used to collect. The sample was selected among sex workers referring to drop-in centers in Kerman. Subjects were allocated to two groups and were randomly classified into two experimental and control groups. The sample group consisted of 56 subjects. The experimental design was carried out during 12 sessions, and the post-test was performed one month and two weeks after the completion of the sessions. The results were analyzed statistically. FINDINGS By reducing harm based on Bandura's self-efficacy theory, the risky behaviors of the experimental group, including injection behavior, sexual behavior, violence, and damage to the skin, were significantly reduced in the pre-test compared to the post-test (P < 0.010). CONCLUSION The harm reduction group therapy based on Bandura's self-efficacy theory can reduce the risky behaviors of sex workers.
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Affiliation(s)
| | | | - Ghodratollah Rajabizadeh
- Associate Professor, Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Kaviani
- Health Deputy, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Bahramnejad
- PhD Candidate, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mehdi Shafiei-Bafti
- General Practitioner, Deputy for Health, Kerman University of Medical Sciences, Kerman, Iran
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32
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Aholou TM, McCree DH, Oraka E, Jeffries WL, Rose CE, DiNenno E, Sutton MY. Sexual Risk and Protective Behaviors Among Reproductive-Aged Women in the United States. J Womens Health (Larchmt) 2017; 26:1150-1160. [PMID: 28557545 DOI: 10.1089/jwh.2016.6224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2014, women represented 19% of HIV diagnoses in the United States. Of these, 78% were among black women and Latinas. Sexual risk behaviors-for example concurrent sex partnerships, nonmonogamous sex partners, and inconsistent condom use-are associated with increased HIV transmission and prevalence; these behaviors have been understudied, collectively, in women. METHODS To examine HIV-related sexual risk behaviors among sexually active women aged 18-44 years by race/ethnicity and over time, we used data from the 2006-2008, 2008-2010, and 2011-2013 cycles of the National Survey of Family Growth. We estimated weighted percentages and performed logistic regression to measure adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between selected behaviors and sociodemographic covariates. RESULTS Among 13,588 women, 1.1% reported concurrent sex partnerships, 10.3% reported male partners whom they perceived were nonmonogamous, and 21.1% reported using a condom at either last vaginal or anal sex. Black women (aPR = 1.52; CI = 1.36-1.71) and Latinas (aPR = 1.29; CI = 1.14-1.47) were more likely to report condom use at either last vaginal or anal sex compared with white women. However, black women were also more likely to report concurrent opposite-sex partnerships (aPR = 2.44; CI = 1.57-3.78) and perceived nonmonogamous sex partners (aPR = 1.33; CI = 1.14-1.56) compared with white women. CONCLUSIONS Improved HIV behavioral risk-reduction strategies are needed for women. Black women could benefit from interventions that address partnership concurrency. For black women and Latinas, who are more likely to use condoms, further examination of broader social and structural factors as contributors to racial/ethnic gaps are warranted and vital for understanding and decreasing HIV-related disparities.
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Affiliation(s)
- Tiffiany M Aholou
- 1 Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donna Hubbard McCree
- 1 Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emeka Oraka
- 2 ICF International at the Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William L Jeffries
- 1 Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles E Rose
- 1 Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth DiNenno
- 1 Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y Sutton
- 1 Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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33
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Robillard A, Padi A, Lewis K, Julious C, Troutman J. Advice for prevention from HIV-positive African-American women: 'My story is not just a story'. CULTURE, HEALTH & SEXUALITY 2017; 19:630-642. [PMID: 27796161 DOI: 10.1080/13691058.2016.1243732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Large disparities in HIV incidence, prevalence and mortality exist for African-American women, especially in the southern region of the USA. Based on the culture-centric health promotion model, HIV-positive African American women can use their stories to support primary prevention. The purpose of this study was to document advice from HIV-positive African-American women (n = 25) to young African-American women, as described in their own cultural narratives collected through qualitative interviews. Content analysis of women's advice identified five common themes revolving broadly around: (1) advice for prevention, (2) support systems for prevention, (3) education, (4) empowerment/self-care and (5) potential barriers to prevention. Advice reflected recommendations based on personal experience and highlighted social determinants linked to HIV, such as stigma, access to education and healthcare, social support, and gender and power dynamics. Women also offered advice for coping with an HIV-positive diagnosis. Communication with parents, family and friends regarding education and social support emerged as an important interpersonal factor for participants, as were interactions with sexual/romantic partners. Stigma, at the community level, was consistently discussed as a hindrance to prevention. Narratives of HIV-positive women as community health agents of change can enhance the effectiveness of HIV prevention interventions for young US African-American women.
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Affiliation(s)
- Alyssa Robillard
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
| | - Akhila Padi
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
| | - Kaleea Lewis
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
| | - Carmen Julious
- b Palmetto AIDS Life Support Services Inc , Columbia , USA
| | - Jamie Troutman
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
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Barman-Adhikari A, Hsu HT, Begun S, Portillo AP, Rice E. Condomless Sex Among Homeless Youth: The Role of Multidimensional Social Norms and Gender. AIDS Behav 2017; 21:688-702. [PMID: 27885551 DOI: 10.1007/s10461-016-1624-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.
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Affiliation(s)
- Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Stephanie Begun
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA
| | - Andrea Perez Portillo
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, USA
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Theoretical Implications of Gender, Power, and Sexual Scripts for HIV Prevention Programs Aimed at Young, Substance-Using African-American Women. J Racial Ethn Health Disparities 2016; 4:1175-1180. [PMID: 27981501 DOI: 10.1007/s40615-016-0323-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
HIV continues to be a major public health problem for African-American (AA) women, and the burden of new cases to our society is significant because each case is at risk of infecting others. Substance use worsens the risk of HIV transmission to AA women. We provide specific recommendations to move the concept of tailoring HIV prevention interventions for substance users forward by focusing on young, sexually active, substance-using AA women and applying a culturally relevant revision to existing theoretical frameworks to include the Sexual Script Theory and the Theory of Gender and Power. We encourage use of these theories to guide adaptation of interventions to demonstrate efficacy within this hard-to-reach population. Consistent use of theories designed to exploit powerlessness and sexual scripts as barriers to adoption of protective sexual behaviors has potential to permeate sexual and substance use networks among African-Americans. This recommendation is being made because this theoretical framework has not been used in HIV prevention interventions targeting young, sexually active, substance-using AA women.
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Partnership-Level Analysis of African American Women's Risky Sexual Behavior in Main and Non-Main Partnerships. AIDS Behav 2016; 20:2893-2903. [PMID: 26992394 DOI: 10.1007/s10461-016-1351-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The majority of research on risky sexual behavior in African American women has examined global associations between individual-level predictors and behavior. However, this method obscures the potentially significant impact of the specific relationship or relationship partner on risky sexual behavior. To address this gap, we conducted partnership-level analysis of risky sexual behavior among 718 African American women recruited from HIV counseling, testing, and referral sites in four states. Using mixed model regressions, we tested relationships between condomless vaginal intercourse with men and variables drawn from the Theory of Planned Behavior, Theory of Gender and Power, and previous research specifically on sexual risks among African American women. Significant associations with risky sexual behavior indicate the need for continued emphasis on condom attitudes, condom negotiation behaviors, and overcoming partner resistance to condoms within both main and non-main partnerships when implementing interventions designed to address HIV and sexually transmitted infection risks among African American women.
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Wenzel SL, Cederbaum JA, Song A, Hsu HT, Craddock JB, Hantanachaikul W, Tucker JS. Pilot Test of an Adapted, Evidence-Based HIV Sexual Risk Reduction Intervention for Homeless Women. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:112-21. [PMID: 26103921 DOI: 10.1007/s11121-015-0575-6] [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: 12/24/2022]
Abstract
Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.
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Affiliation(s)
- Suzanne L Wenzel
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Julie A Cederbaum
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Ahyoung Song
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Hsun-Ta Hsu
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Jaih B Craddock
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Wichada Hantanachaikul
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kalibala S, Woelk GB, Gloyd S, Jani N, Kay L, Sarna A, Okal J, Ndwiga C, Haberland N, Sinai I. Experiences in implementation and publication of operations research interventions: gaps and a way forward. J Int AIDS Soc 2016; 19:20842. [PMID: 27443272 PMCID: PMC4956737 DOI: 10.7448/ias.19.5.20842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION According to UNAIDS, the world currently has an adequate collection of proven HIV prevention, treatment and diagnostic tools, which, if scaled up, can lay the foundation for ending the AIDS epidemic. HIV operations research (OR) tests and promotes the use of interventions that can increase the demand for and supply of these tools. However, current publications of OR mainly focus on outcomes, leaving gaps in reporting of intervention characteristics, which are essential to address for the utilization of OR findings. This has prompted WHO and other international public health agencies to issue reporting requirements for OR studies. The objective of this commentary is to review experiences in HIV OR intervention design, implementation, process data collection and publication in order to identify gaps, contribute to the body of knowledge and propose a way forward to improve the focus on "implementation" in implementation research. DISCUSSION Interventions in OR, like ordinary service delivery programmes, are subject to the programme cycle, which continually uses insights from implementation and the local context to modify service delivery modalities. Given that some of these modifications in the intervention may influence study outcomes, the documentation of process data becomes vital in OR. However, a key challenge is that study resources tend to be skewed towards documentation and the reporting of study outcomes to the detriment of process data, even though process data is vital for understanding factors influencing the outcomes. CONCLUSIONS Interventions in OR should be viewed using the lens of programme evaluation, which includes formative assessment (to determine concept and design), followed by process evaluation (to monitor inputs and outputs) and effectiveness evaluation (to assess outcomes and effectiveness). Study resources should be equitably used between process evaluation and outcome measurement to facilitate inclusion of data about fidelity and dose in publications in order to enable explanation of the relationship between dosing and study outcomes for purposes of scaling up and further refinement through research.
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Affiliation(s)
| | - Godfrey B Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nrupa Jani
- HIVCore/Population Council, Washington, DC, USA
| | | | - Avina Sarna
- HIVCore/Population Council, Washington, DC, USA
| | - Jerry Okal
- HIVCore/Population Council, Washington, DC, USA
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Lessons learned and study results from HIVCore, an HIV implementation science initiative. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.5.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Klein H, Elifson KW, Sterk CE. How the Interaction of Childhood Sexual Abuse and Gender Relates to HIV Risk Practices among Urban-Dwelling African Americans. ACTA ACUST UNITED AC 2016; 2. [PMID: 30197963 DOI: 10.15744/2454-499x.2.105] [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: 11/05/2022]
Abstract
Purpose Previous research has demonstrated that HIV risk practices often differ based on gender and on whether or not people experienced sexual abuse during their formative (i.e., childhood and adolescence) years. The interaction of these two factors, which is the focus of this paper, has received limited attention. Methods Based on a model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2012 with 1,864 African American adults residing in Atlanta, Georgia in 80 strategically-chosen consensus block groups. Results Based on multiple regression and structural equation analyses, the interaction of sexual abuse and gender was found to be a significant predictor of involvement in (un)protected sex. The interaction of sexual abuse and gender also was related to condom use self-efficacy, which was one of the strongest factors underlying (un)protected sex. Conclusion The relationship of sexual abuse history and gender is relevant in the understanding of HIV risk practices. The interaction of these factors with one another and with other relevant influences that shape people's HIV risk profiles is complex. The Syndemics Theory approach used to conceptualize the relationships among relevant variables in this study is an effective way of trying to understand and address HIV risk practices.
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Affiliation(s)
- H Klein
- Kensington Research Institute, Kensington MD and Rollins School of Public Health, Emory University, Atlanta GA, United States
| | - K W Elifson
- Rollins School of Public Health, Emory University, Atlanta GA, United States
| | - C E Sterk
- Rollins School of Public Health, Emory University, Atlanta GA, United States
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Individual and Partner-Level Factors Associated with Condom Non-Use Among African American STI Clinic Attendees in the Deep South: An Event-Level Analysis. AIDS Behav 2016; 20:1334-42. [PMID: 26683032 DOI: 10.1007/s10461-015-1266-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The US HIV/AIDS epidemic is concentrated in the Deep South, yet factors contributing to HIV transmission are not fully understood. We examined relationships between substance use, sexual partnership characteristics, and condom non-use in an African American sample of STI clinic attendees in Jackson, Mississippi. We assessed condom non-use at last intercourse with up to three recent sexual partners reported by participants between January and June 2011. Participant- and partner-level correlates of condom non-use were examined using generalized estimating equations. The 1295 participants reported 2880 intercourse events, of which 1490 (51.7 %) involved condom non-use. Older age, lower educational attainment, reporting financial or material dependence on a sex partner, sex with a primary partner, and higher frequency of sex were associated with increased odds of condomless sex. HIV prevention efforts in the South should address underlying socioeconomic disparities and structural determinants that result in partner dependency and sexual risk behavior.
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Covey J, Rosenthal-Stott HES, Howell SJ. A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs. J Behav Med 2016; 39:371-85. [PMID: 26831053 PMCID: PMC4853449 DOI: 10.1007/s10865-016-9714-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022]
Abstract
To identify the mode of delivery, communicator, and content dimensions that make STI/HIV prevention interventions most successful at increasing condom use/protected sex or reducing STI/HIV incidence. A literature search for published meta-analyses of STI/HIV prevention interventions yielded 37 meta-analyses that had statistically tested the moderating effects of the dimensions. Significant and non-significant moderators from the coded dimensions were extracted from each meta-analysis. The most consistently significant moderators included matching the gender or ethnicity of the communicator to the intervention recipients, group targeting or tailoring of the intervention, use of a theory to underpin intervention design, providing factual information, presenting arguments designed to change attitudes, and providing condom skills and intrapersonal skills training. The absence of significant effects for intervention duration and expert delivery are also notable. The success of HIV/STI prevention interventions may be enhanced not only by providing skills training and information designed to change attitudes, but also by ensuring that the content is tailored to the target group and delivered by individuals of the same gender and ethnicity as the recipients.
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Affiliation(s)
- Judith Covey
- Department of Psychology, Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK.
| | - Harriet E S Rosenthal-Stott
- Department of Psychology, Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK
| | - Stephanie J Howell
- Department of Psychology, University of York, Heslington, York, YO10 5DD, UK
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Macaya Pascual A, Ferreres Riera J, Campoy Sánchez A. Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.adengl.2016.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nehl EJ, Klein H, Sterk CE, Elifson KW. Prediction of HIV Sexual Risk Behaviors Among Disadvantaged African American Adults Using a Syndemic Conceptual Framework. AIDS Behav 2016; 20:449-60. [PMID: 26188618 DOI: 10.1007/s10461-015-1134-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.
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Lotfi R, Ramezani Tehrani F, Salehifar D, Dworkin SL. Predictors of Condom Use Among Iranian Women at Risk of HIV. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:429-437. [PMID: 26450127 DOI: 10.1007/s10508-015-0603-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 06/05/2023]
Abstract
Sexual transmission of HIV/AIDS is increasing in Iran and is the main route of infection among women. In order to foster the development of future HIV prevention interventions for women, researchers need to understand the factors that influence sexual risk reduction behaviors in this group. The aim of this study was to explore the predictors of condom use among women at risk of HIV and develop a model of condom use in a sample of women at risk of HIV. We cross-sectionally examined predictors of condom use among 200 women at risk of HIV. Women were recruited from drop-in centers and voluntary counseling and testing centers in Tehran. Condom use among women at risk of HIV was examined using path analysis, and fit indices showed a good fit for the model. Condom use self-efficacy, social support, and less stereotypic gender roles influenced sexually protective behaviors of women at risk of HIV. Our results can provide a basis for future gender-specific intervention programs among women at risk of HIV. Researchers, practitioners, and organizations that play a central role in protecting the health of this population can make use of these results for the benefit of sexual and reproductive health programs.
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Affiliation(s)
- Razieh Lotfi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Delara Salehifar
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Shari L Dworkin
- Department of Social and Behavioral Sciences, University of California, San Francisco School of Nursing, San Francisco, CA, USA
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Macaya Pascual A, Ferreres Riera JR, Campoy Sánchez A. Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:301-17. [PMID: 26801866 DOI: 10.1016/j.ad.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies. OBJECTIVE To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies. METHODS We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared. RESULTS We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables. CONCLUSIONS There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated.
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Affiliation(s)
- A Macaya Pascual
- Universitat Internacional de Catalunya, Barcelona, España; Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España.
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Rowell-Cunsolo TL, El-Bassel N, Hart CL. Black Americans and Incarceration: A Neglected Public Health Opportunity for HIV Risk Reduction. J Health Care Poor Underserved 2016; 27:114-130. [PMID: 27763462 PMCID: PMC5111428 DOI: 10.1353/hpu.2016.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Black Americans are incarcerated at disproportionate rates, largely due to racial differences in the application of drug laws. Human immunodeficiency virus (HIV) prevalence rates among Black Americans are also disproportionately high. Moreover, availability of and access to HIV prevention services in correctional settings are limited. Recognizing that Blacks are at an elevated risk of contracting HIV, and that incarceration worsens health outcomes, this paper addresses the importance of implementing comprehensive prison-based HIV programs and prevention interventions to improve the health of this vulnerable population. In the absence of a vaccine, prevention interventions can serve as an effective method of systematically addressing HIV-related health disparities. Prevention strategies offered within correctional settings provide a unique opportunity to engage a high-risk population when its members may be receptive to behavior modification.
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Affiliation(s)
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY
| | - Carl L. Hart
- Departments of Psychology and Psychiatry, Columbia University, New York, NY
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Rohrbach LA, Berglas NF, Jerman P, Angulo-Olaiz F, Chou CP, Constantine NA. A Rights-Based Sexuality Education Curriculum for Adolescents: 1-Year Outcomes From a Cluster-Randomized Trial. J Adolesc Health 2015; 57:399-406. [PMID: 26403840 DOI: 10.1016/j.jadohealth.2015.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of a rights-based sexuality education curriculum on adolescents' sexual health behaviors and psychosocial outcomes 1 year after participation. METHODS Within 10 urban high schools, ninth-grade classrooms were randomized to receive a rights-based curriculum or a basic sex education (control) curriculum. The intervention was delivered across two school years (2011-2012, 2012-2013). Surveys were completed by 1,447 students at pretest and 1-year follow-up. Multilevel analyses examined curriculum effects on behavioral and psychosocial outcomes, including four primary outcomes: pregnancy risk, sexually transmitted infection risk, multiple sexual partners, and use of sexual health services. RESULTS Students receiving the rights-based curriculum had higher scores than control curriculum students on six of nine psychosocial outcomes, including sexual health knowledge, attitudes about relationship rights, partner communication, protection self-efficacy, access to health information, and awareness of sexual health services. These students also were more likely to report use of sexual health services (odds ratio, 1.37; 95% confidence interval, 1.05-1.78) and more likely to be carrying a condom (odds ratio, 1.97; 95% confidence interval, 1.39-2.80) relative to those receiving the control curriculum. No effects were found for other sexual health behaviors, possibly because of low prevalence of sexual activity in the sample. CONCLUSIONS The curriculum had significant, positive effects on psychosocial and some behavioral outcomes 1 year later, but it might not be sufficient to change future sexual behaviors among younger adolescents, most of whom are not yet sexually active. Booster education sessions might be required throughout adolescence as youth initiate sexual relationships.
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Affiliation(s)
- Louise A Rohrbach
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nancy F Berglas
- Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California
| | - Petra Jerman
- Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California
| | - Francisca Angulo-Olaiz
- Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California
| | - Chih-Ping Chou
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Norman A Constantine
- Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California; Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, California.
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Ballester-Arnal R, Gil-Llario MD, Giménez-García C, Kalichman SC. What Works Well in HIV Prevention Among Spanish Young People? An Analysis of Differential Effectiveness Among Six Intervention Techniques. AIDS Behav 2015; 19:1157-69. [PMID: 25085080 DOI: 10.1007/s10461-014-0863-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The AIDS epidemic remains a concern of public health among young people and adolescents. Prevention programs have revealed diverse deficiencies to attain their main goal: preventing risky behaviors. This experimental study evaluates the differential effectiveness of six intervention techniques for preventing HIV/AIDS based on informational-motivational-behavioral Model (talk, website, attitudinal discussion, participation of a seropositive person, fear induction and role play). 239 Spanish young people took part in an experimental design to evaluate six intervention techniques and a non-intervention condition, through changes in their knowledge, attitudes and protective sex behavior. Our findings support a general effectiveness of preventive intervention techniques comparing non-intervention. In particular, the motivational techniques reveal more effectiveness for these Spanish young people. Therefore, it is required identifying a differential impact of the intervention techniques when implementing HIV behavioral interventions.
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Towner SL, Dolcini MM, Harper GW. Romantic Relationship Dynamics of Urban African American Adolescents: Patterns of Monogamy, Commitment, and Trust. YOUTH & SOCIETY 2015; 47:343-373. [PMID: 26691404 PMCID: PMC4681523 DOI: 10.1177/0044118x12462591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Relationship dynamics develop early in life and are influenced by social environments. STI/HIV prevention programs need to consider romantic relationship dynamics that contribute to sexual health. The aim of this study was to examine monogamous patterns, commitment, and trust in African American adolescent romantic relationships. The authors also focused on the differences in these dynamics between and within gender. The way that such dynamics interplay in romantic relationships has the potential to influence STI/HIV acquisition risk. In-depth interviews were conducted with 28 African American adolescents aged 14 to 21 living in San Francisco. Our results discuss data related to monogamous behaviors, expectations, and values; trust and respect in romantic relationships; commitment to romantic relationships; and outcomes of mismatched relationship expectations. Incorporating gender-specific romantic relationships dynamics can enhance the effectiveness of prevention programs.
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