Living with COVID-19 and preparing for future pandemics: revisiting lessons from the HIV pandemic

In April, 2020, just months into the COVID-19 pandemic, an international group of public health researchers published three lessons learned from the HIV pandemic for the response to COVID-19, which were to: anticipate health inequalities, create an enabling environment to support behavioural change, and engage a multidisciplinary effort. We revisit these lessons in light of more than 2 years' experience with the COVID-19 pandemic. With specific examples, we detail how inequalities have played out within and between countries, highlight factors that support or impede the creation of enabling environments, and note ongoing issues with the scarcity of integrated science and health system approaches. We argue that to better apply lessons learned as the COVID-19 pandemic matures and other infectious disease outbreaks emerge, it will be imperative to create dialogue among polarised perspectives, identify shared priorities, and draw on multidisciplinary evidence.

University of California Cannabis Research Workshop, May 2021: Meeting Summary

This meeting report describes the University of California's (UC) Cannabis Research Workshop on May 26-27, 2021, which was organized by the UC Office of the President (UCOP) in partnership with the University of California, Davis (UCD). The event was designed to explore ways to strengthen research collaborations within and between campuses, discuss federal and state regulations and scientific priorities, and provide updates on current or recent cannabis and cannabinoid research studies. Topical areas were highlighted in four breakout sessions, including: 1) agronomy and environmental impacts; 2) biomedicine and public health; 3) economics, law, public policy, and social science; and 4) administrative considerations for supporting university research on cannabis and cannabinoids.

A State-Level Analysis of Social and Structural Factors and HIV Outcomes Among Men Who Have Sex With Men in the United States

We apply a social determinants of health model to examine the association of select social and structural influences on AIDS diagnosis rates among men who have sex with men (MSM) in the U.S. states. Secondary data for key social and structural variables were acquired and analyzed. Standard descriptive and inferential statistics were used to examine bivariate and multivariate associations of selected social and structural variables with estimated rate of Stage 3 HIV infection (AIDS) per 100,000 MSM in 2010. We found that living in states with a higher demographic density of lesbian, gay, bisexual, and transgender persons is independently associated with lower AIDS diagnosis rates among MSM. In addition, we found that greater income inequality and higher syphilis rates among men were associated with greater AIDS diagnosis rates among MSM, which may be attributable to state policy environments that underinvest in social goods that benefit population health, and to the fact that ulcerative sexually-transmitted infections increase biological risk of HIV transmission and acquisition. To end the epidemic in the U.S., it will be critical to identify and address state-level social and structural factors that may be associated with adverse HIV outcomes for MSM.

Key issues in mentoring in HIV prevention and mental health for new investigators from underrepresented racial/ethnic groups

We examine the challenges and barriers to quality mentoring for new investigators from underrepresented racial/ethnic groups and propose solutions for establishing a robust pipeline of early-career scientists who are well equipped to conduct research on disparities in HIV and mental health. In addition, we review contributions to this special supplement on mentoring and advocate a multilevel strategy that targets funding agencies, academic and research institutions, mentors, and mentees to enhance the diversity of the nation's scientific workforce and ensure that the public health system benefits from innovations derived from the optimal use of existing human capital.

Prevention interventions with persons living with HIV/AIDS: state of the science and future directions

The National Institutes of Health (NIH/NIMH), the Centers for Disease Control and Prevention (CDC), and the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) support the CDC's Serostatus Approach to Fighting the HIV Epidemic (SAFE; Janssen et al., 2001). One aim of the strategy is to help individuals living with HIV (and their partners) adopt and sustain HIV and STD risk reduction, treatment adherence, and effective strategies for coping with HIV/AIDS. Efficacious interventions are needed by community organizations and clinics that provide evidence-based services. To expedite translation from research to practice, we convened scientist-practitioners, HIV treatment and prevention providers, and community/consumer members. In this article, we include an overview of prevention trials with HIV-positive persons presented at the meeting, discuss strengths and limitations, recommendations for future research, and discuss sponsoring agencies' plans for advancing prevention tailored for persons living with HIV.

HIV infection and pregnancy status among adults attending voluntary counseling and testing in 2 developing countries

OBJECTIVES

This study investigated the impact of HIV voluntary counseling and testing (VCT) on reproduction planning among 1634 adults in 2 sub-Saharan countries.

METHODS

Data were obtained from a multisite randomized controlled trial.

RESULTS

At 6 months post-VCT, the women more likely to be pregnant were younger (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.0, 6.5), not using contraceptives (OR = 0.1; 95% CI = 0.1, 0.3), and HIV infected (OR = 3.0; 95% CI = 1.3, 7.0). An interaction emerged linking pregnancy intention at baseline and HIV serostatus with pregnancy at follow-up (OR = 0.1; 95% CI =.0, 0.4) Partner pregnancy rates did not differ by HIV serostatus among men.

CONCLUSIONS

HIV diagnosis may influence reproduction planning for women but not for men.

Using information, motivational enhancement, and skills training to reduce the risk of HIV infection for low-income urban women: a second randomized clinical trial

This randomized clinical trial evaluated an HIV-risk reduction (HIV-RR) intervention based on the information-motivation-behavioral skills model. At baseline, 102 women (M age = 29 years; 88% African American) completed a survey regarding HIV-related knowledge, risk perceptions, behavioral intentions, and risk behavior. Participants were then assigned to either the HIV-RR intervention or a health-promotion control group. Postintervention and follow-up data indicated that women in the HIV-RR program enhanced their knowledge and strengthened their risk reduction intentions relative to controls. Moreover, HIV-RR women who expressed "imperfect" intentions also increased their condom use, talked more with partners about condom use and HIV testing, and were more likely to have refused unprotected sex.

Using information, motivational enhancement, and skills training to reduce the risk of HIV infection for low-income urban women: a second randomized clinical trial

This randomized clinical trial evaluated an HIV-risk reduction (HIV-RR) intervention based on the information-motivation-behavioral skills model. At baseline, 102 women (M age = 29 years; 88% African American) completed a survey regarding HIV-related knowledge, risk perceptions, behavioral intentions, and risk behavior. Participants were then assigned to either the HIV-RR intervention or a health-promotion control group. Postintervention and follow-up data indicated that women in the HIV-RR program enhanced their knowledge and strengthened their risk reduction intentions relative to controls. Moreover, HIV-RR women who expressed "imperfect" intentions also increased their condom use, talked more with partners about condom use and HIV testing, and were more likely to have refused unprotected sex.

HIV and AIDS relative to other health, social, and relationship concerns among low-income urban women: a brief report

Our objective was to determine the priorities of low-income women regarding health, relationship, and social concerns. Street-intercept surveys were conducted with 161 low-income urban women (mean = 27 years, 85% African American, 80% single mothers) regarding their perceptions of the threat associated with 48 health and social problems. Women rated acquired immune deficiency syndrome (AIDS) as their most important health, social, or relationship concern. Nearly one half of all women indicated that they would attend risk reduction programs to learn how to avoid infection with human immunodeficiency virus (HIV). AIDS is perceived as a serious threat to women's health, and interventions to reduce risk are welcomed.

Measuring self-efficacy in the context of HIV risk reduction: research challenges and recommendations

Self-efficacy theory has had considerable influence in studies of health-related behaviors, including the prevention of sexual transmission of HIV. However, imprecise operationalization of self-efficacy theory in HIV prevention research is common and has important implications for the prediction of risk-reducing behavior from self-efficacy beliefs. In many instances, constructs other than self-efficacy have been assessed. In this article, the operationalization and measurement of self-efficacy in the context of HIV-risk-reduction research are reviewed and challenges inherent to such efforts are identified. Recommendations for enhancing the prediction of risk-reducing behavior from self-efficacy beliefs are also provided.

Measuring self-efficacy in the context of HIV risk reduction: research challenges and recommendations

Self-efficacy theory has had considerable influence in studies of health-related behaviors, including the prevention of sexual transmission of HIV. However, imprecise operationalization of self-efficacy theory in HIV prevention research is common and has important implications for the prediction of risk-reducing behavior from self-efficacy beliefs. In many instances, constructs other than self-efficacy have been assessed. In this article, the operationalization and measurement of self-efficacy in the context of HIV-risk-reduction research are reviewed and challenges inherent to such efforts are identified. Recommendations for enhancing the prediction of risk-reducing behavior from self-efficacy beliefs are also provided.

Reliability and validity of self-report measures of HIV-related sexual behavior: progress since 1990 and recommendations for research and practice

The trustworthiness of self-reported sexual behavior data has been questioned since Kinsey's pioneering surveys of sexuality in the United States (Kinsey et al., 1948, 1953). In the era of HIV and AIDS, researchers and practitioners have employed a diversity of assessment techniques but they have not escaped the fundamental problem of measurement error. We review the empirical literature produced since Catania et al.'s (1990) review regarding reliability and validity of self-administered and automated questionnaires, face-to-face interviews, telephone interviews, and self-monitoring approaches. We also provide specific recommendations for improving sexual behavior assessment. It is imperative that standardized self-report instruments be developed and used for sexual risk-behavior assessment.

Evaluation of the validity of the condom use self-efficacy scale (CUSES) in young men using two behavioral simulations

Assessment of behavioral skills remains critical to the evaluation of HIV prevention interventions; however, investigators often rely upon participant reports of self-efficacy to estimate such skills. We evaluated the relationship between self-efficacy beliefs for condom use and behavioral performance. Forty-three men completed the Condom Use Self-Efficacy Scale (CUSES) and participated in 2 behavioral assessments. Regression analyses indicated that the CUSES subscales relevant to negotiation of condom use did not account for a significant amount of variability in interpersonal skills; similarly, the CUSES subscale relevant to technical condom use skill did not account for variability in the condom application scores. We caution investigators against the assumption that higher self-efficacy reflects behavioral competence for HIV-risk reduction.

Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women

This research evaluated a motivation-based HIV risk reduction intervention for economically disadvantaged urban women. Participants completed a survey that assessed HIV-related knowledge, risk perceptions, behavioral intentions, sexual communication, substance use, and risk behavior. A total of 102 at-risk women (76% African American) were randomly assigned to either the risk reduction intervention or to a waiting list. Women were reassessed at 3 and 12 weeks. Results indicated that treated women increased their knowledge and risk awareness, strengthened their intentions to adopt safer sexual practices, communicated their intentions with partners, reduced substance use proximal to sexual activities, and engaged in fewer acts of unprotected vaginal intercourse. These effects were observed immediately, and most were maintained at follow-up.

Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women

This research evaluated a motivation-based HIV risk reduction intervention for economically disadvantaged urban women. Participants completed a survey that assessed HIV-related knowledge, risk perceptions, behavioral intentions, sexual communication, substance use, and risk behavior. A total of 102 at-risk women (76% African American) were randomly assigned to either the risk reduction intervention or to a waiting list. Women were reassessed at 3 and 12 weeks. Results indicated that treated women increased their knowledge and risk awareness, strengthened their intentions to adopt safer sexual practices, communicated their intentions with partners, reduced substance use proximal to sexual activities, and engaged in fewer acts of unprotected vaginal intercourse. These effects were observed immediately, and most were maintained at follow-up.

Evaluation of the validity of the condom use self-efficacy scale (CUSES) in young men using two behavioral simulations

Assessment of behavioral skills remains critical to the evaluation of HIV prevention interventions; however, investigators often rely upon participant reports of self-efficacy to estimate such skills. We evaluated the relationship between self-efficacy beliefs for condom use and behavioral performance. Forty-three men completed the Condom Use Self-Efficacy Scale (CUSES) and participated in 2 behavioral assessments. Regression analyses indicated that the CUSES subscales relevant to negotiation of condom use did not account for a significant amount of variability in interpersonal skills; similarly, the CUSES subscale relevant to technical condom use skill did not account for variability in the condom application scores. We caution investigators against the assumption that higher self-efficacy reflects behavioral competence for HIV-risk reduction.