HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States

Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative cross-sectional survey. Among NSHBC participants, 522 were women and 347 (69.0%) reported HIV risk factors. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The HIV-Related Medical Mistrust Scale item: "there is a cure for HIV, but the government is withholding it from the poor" was independently associated with higher PrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention.

African born women living with HIV in the United States: unmet needs and opportunities for intervention

Africa born (immigrant) women comprise a disproportionate number of Black women living with HIV in the United States. Though they are at risk for mental health disorders, including psychological distress and depression, little is known about their experience with these important predictors of quality of life, retention in care and adherence to antiretroviral therapy. In this qualitative study, we used constructivist grounded theory to explore the psychosocial and mental health challenges of African born women living with HIV in Boston and New York City. We conducted one-on-one semi-structured interviews with 45 women. Major themes contributing to psychological distress and depressive symptoms included (1) pre-immigration HIV-related stigma; (2) persistent HIV-related stigma post-immigration, (3) undocumented immigration status, (4) economic insecurity, and (5) intimate partner violence (IPV). Many participants described ongoing depressive symptoms or histories of depressive episodes. Yet, most had not been formally diagnosed or treated for depression. Prayer, consultation with faith leadership, and support groups were described most frequently as useful interventions. Future research should explore these thematic areas among a larger, more representative sample of African born women living with HIV to determine differences by country of origin across thematic areas. These data would be useful to inform development of innovative and culturally appropriate interventions.

Treatment motivation among caregivers and adolescents with substance use disorders

Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (N_Dyads=15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent competence and repair relationships, and adolescents saw rules as indicating care rather than control. Adolescents with intrinsic motivations were the most engaged in treatment. Results suggest the importance of intrinsically motivated treatment, and highlight autonomy support and relatedness as mechanisms that might facilitate treatment engagement.

Perceived Benefits and Barriers Associated with the Female Condom among African-American Adults

This study examined perceived benefits and barriers associated with intentions to use the female condom among a sample of 143 African-American adults in Milwaukee, USA. Participants completed a self-report questionnaire. Aesthetics and contraceptive efficacy predicted women's intentions to use the female condom with a main sex partner. For men, intentions to use the device with a main partner were predicted by beliefs that the female condom is affordable, would prevent STDs, that their partner would not be angry about female condom use, and knowing how to use the device. Interventions to promote this device need to be tailored differently for men and women.

Psychosocial Issues in the Era of New AIDS Treatments from the Perspective of Persons Living with HIV

In the past, HIV disease meant an almost invariably downward health course. New highly active antiretroviral therapy (HAART) regimens have improved the health outlook for many persons living with HIV/AIDS but may create new psychological and coping challenges. In this study, open-ended, in-depth interviews were undertaken with an ethnically diverse sample of 44 purposively selected men and women with HIV disease who were on HAART regimens. The interviews were transcribed and qualitatively coded to identify major themes. While patients responding well to the regimens held optimistic views for their future, some who continued to have detectable viral load exhibited depression and feelings of hopelessness. Many patients reported stress associated with the demands of adhering to complex HAART regimens. Other common themes emerging in the interviews involved concerns about employment, romantic and non-romantic relationship formation, sexual behavior and serostatus disclosure, whether to plan families, and experiences of AIDS-related discrimination. There continue to be critical roles for psychological services in the care of persons living with HIV.

Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals

Previous research has reported rates of posttraumatic stress disorder (PTSD) following diagnosis with a life-threatening disease ranging from 5 to 42%. However, few studies have examined the impact of PTSD symptoms on disease markers or adherence to medical regimens. The present study represents an initial examination of the relationships among self-reported PTSD symptoms stemming from diagnosis with HIV, CD4 cell counts, salivary cortisol levels and adherence to highly active antiretroviral therapy (HAART) in 110 African-American and Caucasian individuals with HIV. Results revealed that the relationship between PTSD and disease progression is multifaceted: PTSD symptoms were related to worse adherence to HAART therapy, but were also associated with lower morning salivary cortisol levels and higher CD4 cell counts.

Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers

OBJECTIVE

The purpose of this study was to: 1) examine whether African Americans perceive race-based and socioeconomic status(SES)-based discrimination in their interactions with health care providers; 2) explore the relationship between perceived discrimination and health care utilization; and 3) examine the interrelationships among education, stigma consciousness, and perceived discrimination.

DESIGN

Cross-sectional.

METHODS

Seventy-six African-American adults (59 women and 17 men) completed self-report questionnaires regarding their experiences with and attitudes toward health care providers.

RESULTS

Almost two thirds (63%) of participants perceived discrimination in their interactions with health care providers based on their race or color, and 58.9% perceived discrimination based on their socioeconomic status or social class. Some experiences of perceived discrimination were correlated with measures of health care utilization. Education and stigma consciousness were positively correlated with perceptions of both race-based and SES-based discrimination. Stigma consciousness was not significantly correlated with education, suggesting that expectations that one will be stereotyped by doctors do not account for the relationship between education and reports of perceived discrimination in interactions with health care providers.

CONCLUSION

Further research is needed to assess the prevalence, frequency, and consequences of perceived discrimination in health care interactions.

Relationship of stereotypic beliefs about physicians to health care-relevant behaviors and cognitions among African American women

A great deal of basic social psychological research has demonstrated that stereotypes affect judgments, behaviors, and decisions with respect to individual group members. However, almost no research has applied social psychological theories of stereotypes to understanding health behavior. The purpose of the present study was to examine the relationship between stereotypic beliefs about physicians and health care-relevant behaviors and cognitions. Fifty-nine African American women were recruited from community venues to complete self-report, anonymous questionnaires measuring beliefs about physicians and health care utilization, satisfaction, and intentions. Participants who perceived physicians positively overall, and as competent and warm, reported greater health care utilization and higher satisfaction with their current health care, controlling for perceived general health status. These results suggest that interpersonal social cognitive expectancies play a role in health care-related behaviors and cognitions.

Factors influencing physicians' judgments of adherence and treatment decisions for patients with HIV disease

New medications for HIV reduce mortality and morbidity but require strict adherence. Thus, physicians treating HIV-positive patients must weigh both disease severity and likelihood of adherence when deciding whether to start patients on treatment. A national sample of 495 physicians surveyed via mail responded to clinical scenarios depicting HIV-positive patients and indicated whether they would start patients on medication (response rate = 53%). Scenarios varied on the patient characteristics of gender, disease severity, ethnicity, and risk group. Physicians predicted that patients with less severe disease, former injection drug users, and African American men would be less likely to adhere. Perceived adherence and disease severity influenced treatment decisions. Results are discussed in the context of attitudes about minority groups and injection drug users, which may influence adherence judgments in practice settings. Psychological research to identify better methods of predicting medication adherence may serve to inform medical decision making.

Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment

To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly active antiretroviral therapy (HAART), we sent a survey to a random sample of 995 infectious disease physicians who treat patients with HIV/AIDS in the United States in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral treatment and the extent to which each of three medical and 17 nonmedical factors would influence them for or against prescribing HAART to a hypothetical HIV-positive patient. Most reported initiating HAART with findings of low CD4+ cell counts and high viral loads, and weighing CD4+ cell counts, viral load, and opportunistic infection heavily in their decisions to prescribe HAART. Patients' prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injection drug use, and prior psychiatric hospitalization were cited by most physicians as weighing against HAART initiation. Thus, most physicians in this sample follow guidelines for the use of HAART, and nonmedical factors related to patients' life situations are weighed as heavily as disease severity in treatment decisions. As HIV increasingly becomes a disease associated with economic disadvantage and other social health problems, it will be essential to develop interventions and care support systems to enable patients experiencing these problems to benefit from HIV treatment advances.

Hispanic adults' beliefs, attitudes, and intentions regarding the female condom

The present study used the theory of planned behavior (TPB) (Ajzen, 1985) augmented by AIDS knowledge to investigate factors influencing intentions of Hispanic adults to use the female condom. A total of 146 persons (75 women and 71 men; mean age, 27 years) recruited from community-based organizations completed an anonymous survey regarding intentions to use the female condom with their main sex partner. The TPB model had greater predictive utility for women's, than for men's, female condom use intentions. For men, attitudes and norms did not predict female condom use intentions, but greater AIDS knowledge was related to lower intentions to use the female condom, above and beyond the TPB constructs. Perceived behavioral control, operationalized as self-efficacy, significantly increased the predictive utility of the TPB model for women's female condom use intentions but not for men's. Behavior change strategies to increase female condom use are discussed in light of these findings.

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed.

HIV risk differences between African-American and white men who have sex with men

African-American men who have sex with men remain at disproportionately greater risk for contracting human immunodeficiency virus (HIV) infection. While high HIV seroincidence has been documented among homosexual African-American men, behavioral research has rarely studied the HIV risk issues confronting these men. This study assessed a sample of 253 men who have sex with men to determine if African-American (n = 79) and white (n = 174) men report different rates of HIV risk behaviors and differ in characteristics indicative of risk. African-American men who have sex with men were more likely to be HIV-seropositive, to report past treatment for gonorrhea and syphilis, and to have a recent unprotected sex partner known or believed to be HIV-seropositive. Multivariate analyses of covariance, controlling for group differences in age, education, and income, revealed that African-American men who have sex with men were less open about their sexual orientation, scored lower in HIV risk behavior knowledge, had more female sexual partners, and more frequently used cocaine in association with sex relative to white men who have sex with men. Human immunodeficiency virus prevention programs tailored to the needs and risk issues of African-American men who have sex with men are needed.

Development of new group members' in-group and out-group stereotypes: changes in perceived group variability and ethnocentrism

Changes in new members' in-group and out-group stereotypes were examined, distinguishing among three stereotype components: stereotypicality, dispersion, and ethnocentrism. Pledges in 4 sororities judged their in-group and out-groups 4 times during their 8-month induction. Overall, out-groups were judged more stereotypically than in-groups at every wave. Although out-groups were initially perceived as more dispersed than in-groups, decreased out-group dispersion resulted in a shift toward out-group homogeneity. Ethnocentrism was present at every wave but decreased because of decreased in-group positivity. The authors discuss implications of these results for existing explanations of stereotype development. It is suggested that other aspects of group socialization (R.L. Moreland & J.M. Levine, 1982) are needed to explain fully the development of intergroup perceptions for new group members.

Patterns of services and consumer outcome in an intensive case management program

This study examined the patterns of services provided to individuals with serious and persistent mental illness during their first year in an intensive case management program. Services in 10 content areas were examined, and patterns for more versus less "successful" individuals were compared. Differences emerged for services focusing on family and housing, suggesting that the need for community support services influences the need for continued intensive case management. Linear reductions in rehabilitation services suggest that such services may indeed be effective early in the treatment process. Finally, differences among case managers in service patterns for 5 of the 10 content areas suggest that case managers play an important role in determining the course of treatment.

Patterns of services and consumer outcome in an intensive case management program

This study examined the patterns of services provided to individuals with serious and persistent mental illness during their first year in an intensive case management program. Services in 10 content areas were examined, and patterns for more versus less "successful" individuals were compared. Differences emerged for services focusing on family and housing, suggesting that the need for community support services influences the need for continued intensive case management. Linear reductions in rehabilitation services suggest that such services may indeed be effective early in the treatment process. Finally, differences among case managers in service patterns for 5 of the 10 content areas suggest that case managers play an important role in determining the course of treatment.