Recent Publications -- Winter 2011-2012
Below is a listing, with abstracts, of articles by HIV Center investigators recently published in peer-reviewed journals. Note that below, authors who are based at the HIV Center are underlined .
Each title is hyperlinked to a full-text version whenever possible. However, due to copyright protections, the full text of articles is available only to users whose institutions subscribe to the journal in which the article was published. If the hypertext link does not work, you can click here to link to the PubMed database (separate log-in may be required).
For a listing of the full archive of HIV Center publications (1987-2011), click here.
Progress and challenges to male and female condom use in South Africa
Authors:
Beksinska M, Smit JA, Mantell JE.
Journal:
Sexual Health, 9 (1): 51-58 (2012)
Abstract:
South Africa has responded to the sexually transmissible infection and HIV epidemic with a rapid expansion ofits national-level public sector condom program. Male condoms are available widely at no cost in the public sector, with expanded access via social marketing and the private sector. The female condom program is one of the largest and best established globally. National surveys show progressive increases in rates of condom use at last sex. However, inconsistent
and incorrect condom use and the likelihood that condoms are discontinued in longer-term partnerships are some of the challenges impeding the condom program’s successes in the fight against sexually transmissible infections and HIV. This article reviews the current condom program, related guidelines and policies, and the existing data on male and female condom use, including distribution and uptake. We discuss the main challenges to condom use, including both user and service-related issues and finally how these challenges could be addressed.
Occupational safety and HIV risk among female sex workers in China: A mixed-methods analysis of sex-work harms and mommies
Authors:
Yi H, Zheng T, Wan Y, Mantell JE, Park M, Csete J.
Journal:
Global Public Health (Available online: 01 March 2012)
Abstract:
Female sex workers (FSWs) in China are exposed to multiple work-related harms that increase HIV vulnerability. Using mixed-methods, we explored the social-ecological aspects of sexual risk among 348 FSWs in Beijing. Sex-work harms were assessed by property stolen, being underpaid or not paid at all, verbal and sexual abuse, forced drinking; and forced sex more than once. The majority (90%)reported at least one type of harm, 38% received harm protection from ‘mommies’ (i.e., managers) and 32% reported unprotected sex with clients. In multivariate models, unprotected sex was significantly associated with longer involvement in sex work, greater exposure to harms, and no protection from mommies. Mommies’ protection moderated the effect of sex-work harms on unprotected sex with clients. Our ethnography indicated that mommies played a core role in sex-work networks. Such networks provide a basis for social capital ;they are not only profitable economically, but also protect FSWs from sex-work harms. Effective HIV prevention interventions for FSWs in China must address the occupational safety and health of FSWs by facilitating social capital and protection agency (e.g., mommies) in the sex-work industry.
Variations in microbicide gel acceptability among young women in the USA and Puerto Rico
Authors:
Giguere R, Carballo-Diéguez A, Ventuneac A, Mabragaña M, Dolezal C, Chen BA, Kahn J, Zimet G, McGowan I
Journal:
Culture, Health and Sexuality; 14(2):151-66 (2012)
Abstract:
In a multi-site study of vaginal microbicide acceptability conducted with sexually active young women, quantitative assessments revealed significant differences in acceptability by site. Participants in Puerto Rico rated the gel more favourably than mainland US participants in terms of liking the gel and likelihood of future use. To explain these differences, we examined responses to qualitative behavioural assessments. Young women in mainland USA associated gel leakage with uncomfortable sensations experienced during menstruation, while young women in Puerto Rico had positive associations of gel use with douching. These negative or positive associations affected assessments of the gel's physical qualities. In addition, young women's perceptions of primary partners' support for microbicide use influenced sexual satisfaction with the gel and, ultimately, product acceptability. Finally, geographic HIV-risk context contributed to heightened HIV-risk perception, which influenced likelihood of future microbicide use, even for women in stated monogamous relationships. Future microbicide acceptability studies should take into account potential differences in acceptability by site such as HIV-risk perception based on local HIV prevalence, popularity of vaginal hygiene products in a specific area and male attitudes in different cultures concerning women's use of HIV protection strategies.
Are HIV-negative men who have sex with men and who bareback concerned about HIV infection? Implications for HIV risk reduction interventions
Authors:
Balán I, Carballo-Diéguez A, Ventuneac A, Remien RH, Dolezal C, Ford J:
Journal:
Archives of Sexual Behavior. Epub ahead of print Jan 5 (2012)
Abstract:
The emergence of barebacking (intentional unprotected anal intercourse in situations where there is risk of HIV infection) among men who have sex with men (MSM) has been partially attributed to a decrease in HIV-related concerns due to improved anti-retroviral treatment. It is important to understand the level of concern these men have regarding HIV infection because it can affect their interest in risk reduction behaviors as well as their possible engagement in risk reduction interventions. As part of a study on MSM who use the Internet to seek sexual partners, 89 ethnic and racially diverse men who reported never having an HIV-positive test result completed an in-depth qualitative interview and a computer-based quantitative assessment. Of the 82 men who were asked about concerns of HIV infection during the qualitative interviews, 30 expressed "significant concern" about acquiring HIV, 42 expressed "moderate concern," and 10 expressed "minimal concern." Themes that emerged across the different levels of concern were their perceptions of the severity of HIV infection, having friends who were HIV positive, and their own vulnerability to HIV infection. However, these themes differed depending on the level of concern. Among the most frequently mentioned approaches to decrease risk of HIV infection, participants mentioned avoiding HIV-positive sex partners, limiting the number of partners with whom they barebacked, and not allowing partners to ejaculate inside their rectum. Findings suggest that many MSM who bareback would be amenable to HIV prevention efforts that do not depend solely on condom use.
Intergroup contact, attitudes toward homosexuality, and the role of acceptance of gender non-conformity in young adolescents
Authors:
Collier KL, Bos HM, Sandfort TGM.
Journal:
Journal of Adolescence. Epub ahead of print Jan 11 (2012)
Abstract:
This study explored how contact with gay and lesbian persons affects adolescents' attitudes toward them, and whether this association is mediated or moderated by one's acceptance of gender non-conformity. We analyzed survey responses from 456 Dutch adolescents aged 12-15 who reported having no same-sex attractions. Data were collected in 2008 at 8 schools in Amsterdam, the Netherlands. Preliminary analyses showed that contact with lesbian/gay persons outside of school was positively associated with attitudes toward lesbians and gay men. Multilevel analyses showed that acceptance of gender non-conformity mediated rather than moderated the relationship between intergroup contact and sexual prejudice in males. The effect of intergroup contact on females' attitudes toward lesbian women was no longer significant in multilevel analyses. The findings suggest that attention to both intergroup contact and acceptance of gender non-conformity would enhance our understanding of attitudes toward homosexuality in adolescents.
Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners?
Authors:
Carballo-Diéguez A, Frasca T, DolezalC & Balan I
Journal:
Journal of Sex Research. Epub ahead of print Jan 21 (2012)
Abstract:
The Food and Drug Administration may license OraQuick™, a rapid HIV test, for over-the-counter (OTC) sale. This study investigated whether HIV-uninfected, non-monogamous, gay and bisexual men who never or rarely use condoms would use the test with partners as a harm-reduction approach. Sixty participants responded to two computer-assisted self-interviews, underwent an in-depth interview, and chose whether to test themselves with OraQuick. Over 80% of the men said they would use the kit to test sexual partners or themselves if it became available OTC. Most participants understood that antibody tests have a window period in which the virus is undetectable, yet saw advantages to using the test to screen partners; 74% tested themselves in our offices. Participants offered several possible strategies to introduce the home-test idea to partners, frequently endorsed mutual testing, and highlighted that home testing could stimulate greater honesty in serostatus disclosure. Participants drew distinctions between testing regular versus occasional partners. Non-monogamous men who have sex with men, who never or rarely use condoms, may nevertheless seek to avoid HIV. Technologies that do not interfere with sexual pleasure are likely to be used when available. Studies are needed to evaluate the advantages and disadvantages of using OTC rapid HIV tests as one additional harm-reduction tool.
Gender, peer and partner influences on adolescent HIV risk in rural South Africa
Authors:
Harrison, A., Smit, J., Hoffman, S., Nzama, T., Mantell, J., Stein, Z., & Exner, T.
Journal:
Sexual Health. May;9(2):178-86. (2012)
Abstract:
Background and methods: In preparation for a school-based intervention in KwaZulu-Natal, South Africa, a cross-sectional survey of potential HIV risk factors in youth aged 14–17 (n = 983) was conducted. Results: Boys were significantly more likely than girls to report lifetime sexual activity (37.7% v. 13.8%, P < 0.01). Among boys and girls, 46.1% reported condom use at last sex. Discussion of condom use with a partner was the strongest predictor of condom use (boys, odds ratio (OR) = 7.39; girls, OR= 5.58, P < 0.0001). Age was independently associated with sexual activity for boys (OR = 1.49, P < 0.0001) and girls (OR = 1.74, P = 0.02). For boys, perceptions of male peer behavior were associated with both ever having participated in sexual activity (OR = 1.48, P < 0.01) and condom use at last sex (OR = 1.79, P < 0.01). Girls who equated condom use with having numerous partners were more likely to use them. Among boys, results challenged some expected gender beliefs: support for girls’ initiative in relationship formation and refusal of sex were significant predictors of sexual activity. Among girls, higher pregnancy risk perception (OR = 1.32,P = 0.02) and knowledge (OR = 4.85, P = 0.055) were associated with sexual activity. Conclusions: Creating more gender equitable norms can reduce HIV risk behaviours. HIV prevention interventions should build on existing gender equitable beliefs, and work to promote others, including sexual communication and negotiation skills, and modelling of positive peer norms.
2011 ARTICLES
Conflicts between conservative Christian institutions and secular groups in sub-Saharan Africa: Ideological discourses on sexualities, reproduction, and HIV/AIDS
Authors:
Mantell, J., Correale, J., Adams-Skinner, J., & Stein, Z. (2011)
Journal:
Global Public Health. Global Public Health, 6:sup2, S192-S209
Abstract:
Religious and secular institutions advocate strategies that represent all points on the continuum to reduce the spread of HIV/AIDS. Drawing on an extensive literature review of studies conducted in sub-Saharan Africa, we focus on those secular institutions that support all effective methods of reducing HIV/AIDS transmission and those conservative religious institutions that support a limited set of prevention methods. We conclude by identifying topics for dialogue between these viewpoints that should facilitate cooperation by expanding the generally acceptable HIV/AIDS prevention methods, especially the use of condoms.
“Everywhere you go, everyone is saying condom, condom.” But are they being used consistently? Views of South African male students about male and female condom use
Authors:
Mantell, J., Smit, J., Beksinska, M., Scorgie, F., Milford, C., Balch, E., Mabude, Z., Smith, E., Adams-Skinner, J., Exner, T., Hoffman, S., & Stein, Z.
Journal:
Health Education Research. Oct;26(5):859-71(2011)
Abstract:
Young men in South Africa can play a critical role in preventing new human immunodeficiency virus (HIV) infections, yet are seldom targeted for HIV prevention. While reported condom use at last sex has increased considerably among young people, consistent condom use remains a challenge. In this study, 74 male higher education students gave their perspectives on male and female condoms in 10 focus group discussions. All believed that condoms should be used when wanting to prevent conception and protect against HIV, although many indicated that consistent condom use was seldom attained, if at all. Three possible situations for not using condoms were noted: (i) when sex happens in the heat of the moment and condoms are unavailable, (ii) when sexual partnerships have matured and (iii) when female partners implicitly accept unprotected sex. Men viewed it as their responsibility to have male condoms available, but attitudes about whose decision it was to initiate condom use were mixed. Almost all sexually active men had male condom experience; however, very few had used female condoms. Prevention initiatives should challenge traditional gendered norms that underpin poor condom uptake and continued use and build on the apparent shifts in these norms that are allowing women greater sexual agency.
Safer conception interventions for HIV-affected couples: implications for resource-constrained settings
Authors:
Chadwick RJ, Mantell JE, Moodley J, Harries J, Zweigenthal V, Cooper D.
Journal:
Topics in Antiviral Medicine. Nov;19(4):148-55.(2011)
Abstract:
Developing and testing safer conception methods that reduce HIV transmission to HIV-seronegative partners in serodiscordant couples and reduce superinfection in HIV-seroconcordant couples is a crucial but often unaddressed component of HIV prevention programs. Most research has focused on developed-world settings, where "high-technology" assisted reproduction techniques are used for HIV-serodiscordant couples in which the male is HIV-infected. There is a dearth of research on safer conception methods for HIV-seropositive women and "low-technology" harm-reduction strategies for HIV-affected couples, including vaginal insemination for HIV-seropositive women and natural conception methods for HIV-seroconcordant and -serodiscordant couples. This review summarizes international studies of safer conception interventions for HIV-affected couples, with a focus on feasibility in public-sector health settings where assisted reproductive technology is not readily available. Given that such low-technology options are feasible in most settings, well-designed, prospective interventions offering low-technology safer conception methods need to be developed and tested.
Mental health in youth infected with and affected by HIV: The role of caregiver HIV
Authors:
Elkington, K. S., Robbins, R. N., Bauermeister, J. A., Abrams, E. J., McKay, M., & Mellins, C. A.
Journal:
Journal of Pediatric Psychology, 36, 360-373 (2011)
Abstract:
OBJECTIVE: To examine the association of youth and caregiver HIV status, and other contextual and social regulation factors with youth mental health.
METHOD: Data were from two longitudinal studies of urban youth perinatally infected, affected, and unaffected by HIV (N = 545; 36% PHIV+ youth; 45.7% HIV+ caregivers). Youth mental health was measured using the Child Behavior Checklist, the Child Depression Inventory, and the State-Trait Anxiety Inventory for Children.
RESULTS: HIV+ youth reported elevated scores on the CDI compared with HIV- youth. HIV+ caregivers reported fewer symptoms and were less likely to report scores in the clinical range for their children on the CBCL compared with HIV- caregivers. Caregiver mental health and parent-child communication and involvement were also associated with youth mental health.
CONCLUSIONS: Youth who resided with HIV+ caregivers had better mental health. Future research needs to further explore the role of caregiver HIV infection in youth mental health. Understanding and building upon strengths of HIV-affected families may be an effective focus of interventions for this population.
Project REACH: A provider-delivered dual protection intervention for women using family planning services in New York City
Authors:
Exner, T. M., Mantell, J. E., Hoffman, S., Adams-Skinner, J., & Leu, C.-S.
Journal:
AIDS Care, 23, 467-475 (2011)
Abstract:
High rates of unintended pregnancies and sexually transmitted infection (STI), including HIV, highlight the importance of promoting dual protection (DP) - i.e., methods that offer concurrent protection against unintended pregnancies and STI - during contraceptive counseling. Using a Phase II quasi-experimental design, this study compared an individualized, clinic-based, nurse-delivered intervention designed to increase DP against standard of care among 101 HIV negative women accessing contraceptive services in medically under-served areas of New York City. Participants were evaluated at baseline, post-counseling, and six months later. Findings indicated that the intervention has possible benefit. At six-month follow-up, there was greater perceived susceptibility to STI and fewer condom-unprotected vaginal sex occasions in the intervention arm. Women in the intervention also had five times the odds of reporting female condom use. Results suggest that this intervention has the potential for a larger population impact and should be more rigorously evaluated in a Phase III trial.
Sexual pleasure and intimacy among men who engage in "bareback sex"
Authors:
Carballo-Diéguez, A., Ventuneac, A., Dowsett, G. W., Balan, I., Bauermeister, J., Remien, R. H., Dolezal, C., Giguere, R., & Mabragaña, M.
Journal:
AIDS and Behavior, 15 Suppl 1, S57-65 (2011)
Abstract:
An ethnically diverse sample of 120 mostly gay-identified men who engaged in "bareback" intercourse was recruited via the Internet in New York City. By study design three quarters of participants were HIV-uninfected and engaged in condomless receptive anal intercourse. In the course of face-to-face in-depth interviews, participants were asked what led them to have their first bareback experience as well as to continue with the behavior. Qualitative analysis identified the pivotal role that sexual pleasure and intimacy have in this population and how drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations. Men interested in bareback sex use a variety of defense mechanisms to account for, justify, and exonerate their behavior. HIV-prevention interventions have paid insufficient attention to libidinal drives, a crucial element of psychological functioning.
Depressive symptoms among MSM who engage in bareback sex: Does mood matter?
Authors:
Houston, E., Sandfort, T., Dolezal, C., & Carballo-Diéguez, A.
Journal:
AIDS and Behavior, 16, 245-290 (2012)
Abstract:
Much research has examined the relationship between depressive symptoms and unprotected sex among men who have sex with men (MSM), but little is known about how depression is related to the sexual behavior of men who intentionally engage in unprotected anal intercourse, or bareback sex. In this study, we explored the extent to which depressive symptoms were associated with rates of unprotected sex among barebackers, and whether this relationship was dependent upon HIV serostatus. Using a sample of 120 MSM who engage in intentional condomless sex, we found that for HIV-negative participants, depressive symptoms were associated with the overall frequency of unprotected anal intercourse as well as unprotected anal intercourse with a serodiscordant partner. For HIV-positive participants, depressive symptoms were not associated unprotected intercourse. Additional research is needed to better understand depression among men who bareback and how interventions could be designed to address depression and reduce sexual risk behaviors.
The Internet profiles of men who have sex with men within bareback websites
Authors:
Nodin, N., Valera, P., Ventuneac, A., Maynard, E., Wilson, P., & Carballo-Diéguez, A.
Journal:
Culture, Health and Sexuality; 13(9):1015-1029 (2011)
Abstract:
The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men ('bareback' sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixed-methods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualized in accordance with group norms perceived and reinforced by the websites' design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances.
Recalled sexual experiences in childhood with older partners: A study of Brazilian men who have sex with men and male-to-female transgender persons
Authors:
Carballo-Diéguez, A., Balan, I., Dolezal, C., Brito de Mello, M., & Leu, C.-S.
Journal:
Archives of Sexual Behavior.PMC in process. (2011)
Abstract:
This study assessed the prevalence of recalled childhood sexual experiences with an older partner among men who have sex with men (MSM) and/o rmale-to-female transgender persons recruited in Campinas, Brazil. It also analyzed associations between such recalled experiences and sexual risk behavior in adulthood. Participants recruited using respondent driven sampling completed a self-administered, computer-based questionnaire, and underwent HIV testing. For data analysis, raw scores were weighted based on participants' reported network size. Of 575 participants (85% men and 15% transgender), 32% reported childhood sexual experiences with an older partner. Mean age at first experience was 9 years, partners being, on average, 19 years old, and mostly men. Most frequent behaviors were partners exposing their genitals, mutual fondling, child masturbating partner, child performing oral sex on partner, and child being anally penetrated. Only 29% of the participants who had had such childhood sexual experiences considered it abuse; 57% reported liking, 29% being indifferent and only 14% not liking the sexual experience at the time it happened. Transgender participants were significantly more likely to report such experiences and, compared with men, had less negative feelings about the experience at the time of the interview. No significant associations were found between sexual experiences in childhood and unprotected receptive or insertive anal intercourse in adulthood. Results highlight the importance of assessing participants' perception of abuse, regardless of researchers' pre-determined criteria to identify abuse. MSM and transgender people may experience childhood sexual experiences with older partners differently from other populations (e.g., heterosexuals), particularly in countries with different cultural norms concerning sexuality than those prevalent in Europe and the U.S.
Contexts of risk and networks of protection: NYC West Indian immigrants’ perceptions of migration and vulnerability to sexually transmitted diseases
Authors:
Hoffman, S., Higgins, J., Beckford-Jarrett, S., Augenbraun, M., Bylander, K., Mantell, J., & Wilson, T.
Journal:
Culture, Health, and Sexuality, 13, 513-528 (2011)
Abstract:
To generate insights into how migration shapes sexual risk and protection, we interviewed 36 female and 20 male West Indian immigrants attending a public sexually transmitted disease clinic in Brooklyn, New York, between 2004 and 2005. Migration theory suggests that shifts in sexual partnership patterns, bi-directional travel and changes in sexual norms may alter risk. We found evidence of sexual mixing across ethnic groups: a large proportion of participants' partners were not born in the West Indies, despite what is expected among first generation immigrants. Recent travel 'home', another potential source of risk, was uncommon. In open-ended interviews, two themes around sexual and social networks emerged. First, immigrants believed that access to wider, more anonymous sexual networks in New York City (NYC) and the weakening of social controls that limit multiple partnerships (especially for women) promoted greater risk. Second, immigrants experienced greater opportunities for protection in NYC, both through exposure to safer sex messages and availability of condoms. Reported changes in their own condom use, however, were not attributed to migration. West Indian immigrants' risk in NYC may be driven by access to wider sexual networks but failure to alter reliance on 'networks of knowledge' for protection.
How local IRBs view central IRBs in the US
Author:
Klitzman, R.
Journal:
BMC Medical Ethics, 12. (2011).
Abstract:
BACKGROUND: Centralization of IRB reviews have been increasing in the US and elsewhere, but many questions about it remain. In the US, a few centralized IRBs (CIRBs) have been established, but how they do and could operate remain unclear.
METHODS: I contacted 60 IRBs (every fourth one in the list of the top 240 institutions by NIH funding), and interviewed leaders from 34 (response rate = 55%) and an additional 12 members and administrators.
RESULTS: These interviewees had often interacted with CIRBs, but supported local reviews, and offered advantages and disadvantages of each. Interviewees argued that local IRBs can provide "local knowledge" of subjects and PIs, and "curbside consults" with PIs, facilitating mutual trust. PIs may interact more fully and informally, and hence effectively with local IRBs. IRBs also felt additional responsibility to protect "their own" subjects. Respondents mentioned a few advantages of CIRBs (e.g., CIRBs may streamline reviews), though far more rarely and cursorily. Overall, interviewees were wary of CIRBs, which they saw as varying widely in quality, depending on who happened to be members. Both local and centralized IRBs appear to have unintended consequences. For instance, discrepancies arose between IRBs that appeared to reflect differences in institutional culture and history, and personalities of chairs and/or vocal members, more than in local community values per se, and thus do not seem to be the intent of the regulations. While some critics see CIRBs as solutions to many IRB problems, critical tradeoffs and uncertainties emerge.
CONCLUSIONS: These data have critical implications for future policy and research. Debates need to evolve beyond simply a binary discussion of whether CIRBs should replace local IRBs, to examine how and to what degree different models might operate, and what the relative advantages and disadvantages of each are. While some critics see CIRBs as panaceas, certain problems appear likely to continue. Careful consideration needs to be given to whether the advantages of local IRBs outweigh the problems that result, and whether a system can be developed that provides these benefits, while avoiding the disadvantages of local IRBs.
"Tell Juliana": Acceptability of the candidate microbicideVivaGel® and two placebo gels among ethnicallydiverse, sexually active young women participating in a Phase 1 microbicide study
Authors:
Carballo-Diéguez, A., Giguere, R., Dolezal, C., Chen, B. A., Kahn, J., Zimet, G., Mabragaña, M., Leu, C.-S., & McGowan, I.
Journal:
AIDS and Behavior (2011)
Abstract:
This study assessed acceptability of the candidate microbicide VivaGel(®) and two placebo gels among 61 sexually active young US and Puerto Rican women at three sites. Participants were randomly assigned to use one of the gels twice per day for 14 days. At trial completion, 59% of the women in the VivaGel(®) group reported being likely to use the gel in the future, whereas 23% were unlikely to use it and 18% were undecided. Participants reported problems with all three gels, including the "universal" placebo containing hydroxyethyl cellulose (HEC). The most frequent complaints were leakage, interference with sexual behavior, and decreased sexual satisfaction. Some of the complaints are not new but remain unresolved. Women's perceived risk of HIV infection may determine whether the gels are used. Users also may want a choice of viscosity. Poor acceptability of vaginal microbicide formulations may result in poor adherence to gel use during efficacy trials and compromise validity of results.
Assessing treatment motivation among patients receiving antiretroviral therapy: A multidimensional approach
Authors:
Houston, E., McKirnan, D., Cervone, D., Johnson, M.S., & Sandfort, T.G.M.
Journal:
Psychology and Health, 1 (2011)
Abstract:
Using multidimensional scaling (MDS) analysis, this study examined how patient conceptualisations of treatment motivation compare with theoretically based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n = 39) rated for similarity between all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivations often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivations. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.
Behavioral health risks in perinatally HIV-infected youth: Co-occurrence of mental health problems, sexual and drug use behavior, and non-adherence
Authors:
Mellins, C., Tassiopoulos, K., Malee, K., Moscicki, B., Patton, D., Smith, R., Usitalo, A., Allison, S., Van Dyke, R.,& Seage, G.
Journal:
AIDS Patient Care and STDs, 25 (2011).
Abstract:
In a sample of perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, uninfected (PHEU) adolescents, we examined the co-occurrence of behavioral health risks including mental health problems, onset of sexual and drug use behaviors, and (in PHIV+ youth) nonadherence to antiretroviral therapy (ART). Participants, recruited from 2007 to 2010, included 349 youth, ages 10-16 years, enrolled in a cohort study examining the impact of HIV infection and ART. Measures of the above behavioral health risks were administered to participants and primary caregivers. Nearly half the participants met study criteria for at least one behavioral health risk, most frequently, mental health problems (28%), with the onset of sexual activity and substance use each reported by an average of 16%. Among the sexually active, 65% of PHIV+ and 50% of PHEU youth reported unprotected sex. For PHIV +youth, 34% reported recent ART nonadherence, of whom 45% had detectable HIV RNA levels. Between 16% (PHIV+) and 11% (PHEU) of youth reported at least two behavioral health risks. Older age, but not HIV status, was associated with having two or more behavioral health risks versus none. Among PHIV+ youth, living with a birth mother (versus other caregivers) and detectable viral load were associated with co-occurrence of behavioral health risks. In conclusion, this study suggests that for both PHIV+ and PHEU youth, there are multiple behavioral health risks, particularly mental health problems, which should be targeted by service systems that can integrate prevention and treatment efforts.
Modafinil and armodafinil treatment for fatigue for HIV-positive patients with and without chronic hepatitis C
Authors:
Rabkin JG, McElhiney MC, Rabkin R.
Journal:
International Journal of STD & AIDS, 22, 95-101 (2011)
Abstract:
Fatigue is prevalent among patients with hepatitis C virus (HCV) and with HIV/AIDS but there are no established fatigue treatments for either condition or their combination. We analysed data from three trials of modafinil or armodafinil for HIV-positive patients with fatigue, including 36 co-infected with HCV, to compare treatment response and safety parameters related to HCV status. One hundred and twenty patients received active drug and 70 were randomized to placebo. Fatigue response rate to modafinil/armodafinil was 100% for patients with HCV (18/18) and 73% (74/102) for patients without HCV. Placebo response rate was 28% (5/18) and 29% (15/52), respectively. Depressive symptoms improved only when energy improved. Viral load declined from baseline after 12 and 26 weeks of active medication. CD4 cell count did not change, nor did alanine transaminase and aspartate aminotransferase for patients with HCV. Patients with haematocrit below the reference range responded, as well as patients whose values were within the reference range. Modafinil and armodafinil appear effective and well tolerated for treating fatigue among both HCV-positive and HCV-negative patients with HIV/AIDS, suggesting that they may hold promise for HIV-positive patients considering alpha interferon/ribavirin treatment for HCV. Further investigation in a focused trial is warranted.
Treatment of HIV-Related Fatigue with Armodafinil: A Placebo-Controlled Randomized Trial
Authors:
Rabkin, J. G., McElhiney, M., & Rabkin, R. (2011).
Journal:
Psychosomatics, 52, 328-336.PMC in process.
Abstract:
OBJECTIVE: To evaluate the efficacy and safety of armodafinil in the treatment of fatigue in HIV+ patients, and to assess its effect on depressive symptoms and behavior once fatigue remitted.
METHOD: HIV+ patients with clinically significant fatigue were treated in a placebo-controlled randomized double-blind trial for 4 weeks. Armodafinil responders and placebo non-responders or relapsers were treated openly for a total of 16 weeks with armodafinil. The primary outcome measure for fatigue and depression was the Clinical Global Impressions-Improvement Scale, supplemented by the Fatigue Severity Scale, the Hamilton Depression Rating Scale, and the Beck Depression Inventory. Safety was assessed with assays of CD4 cell count and HIV RNA viral load and the SAFTEE side effects rating scale. Maximum trial dose of armodafinil was 250 mg/d.
RESULTS: Seventy patients were enrolled. Attrition was 9%. In intention-to-treat analyses, fatigue response rate to armodafinil was 75% and to placebo, 26%. Armodafinil did not reduce depressive symptoms in the absence of improved energy, but of those patients with an Axis I depressive disorder at study entry whose energy improved, 82% experienced improved mood as well. Markers of immunologic suppression did not change during treatment. At 6 months, those still taking armodafinil had more energy and fewer depressive symptoms than those who were no longer taking it.
CONCLUSIONS: As we found in our RCT of modafinil, armodafinil appears effective and well tolerated in treating fatigue in HIV+ patients. Side effects were minimal and most patients reported substantially improved energy and mood.
Psychosocial implications of HIV serostatus disclosure to youth with perinatally-acquired HIV
Authors:
Santamaria, E. K., Dolezal, C., Marhefka, S. L., Hoffman, S., Ahmed, Y., Elkington, K., & Mellins, C. A.
Journal:
AIDS Patient Care STDs, 25, 257-264 (2011)
Abstract:
Recommendations suggest that older children and adolescents perinatally infected with HIV (PHIV+) be informed of their HIV diagnosis; however, delayed disclosure is commonly reported. This study examined the prevalence and timing of HIV disclosure to PHIV+ adolescents and the associations between the timing of disclosure and psychological functioning and other behavioral outcomes. Recruitment took place at four medical centers in New York City between December 2003 and December 2008. This sample included data from 196 PHIV+ youth and their caregivers: 50% of youth were male, 58% African American, 42% Hispanic, with a mean age of 12.71 years. According to caregiver reports, 70% of the PHIV+ youth knew their HIV diagnosis. Youths who had been told were more likely to be older; youths with a Spanish-speaking Latino caregiver and whose caregivers had a grade school education were told at an older age. Youths who had been told their HIV status were significantly less anxious than those who had not been told; there were no other differences in psychological functioning. Youths who knew their status for longer reported higher intentions to self-disclose to potential sex partners. In multivariate analyses only demographic differences associated with timing of disclosure remained. In summary, PHIV+ youth who had been told their HIV status did not show an increase of psychological problems and were more likely to have intentions to self-disclose to sexual partners. Yet, almost one third was entering puberty without important information regarding their illness. Caregivers need support to address factors impeding HIV disclosure.
First phase 1 double-blind, placebo-controlled, randomized rectal microbicide trial using UC781 gel with a Novel Index of ex vivo efficacy
Authors:
Anton PA, Saunders T, Elliott J, Khanukhova E, Dennis R, Adler A, Cortina G, Tanner
K, Boscardin J, Cumberland WG, Zhou Y, Ventuneac A, Carballo-Diéguez A, Rabe L,
McCormick T, Gabelnick H, Mauck C, McGowan I
Journal:
PLoS ONE 2011; 6(9): e23243. (2011)
Abstract:
OBJECTIVES: Successful control of the HIV/AIDS pandemic requires reduction of HIV-1 transmission at sexually-exposed mucosae. No prevention studies of the higher-risk rectal compartment exist. We report the first-in-field Phase 1 trial of a rectally-applied, vaginally-formulated microbicide gel with the RT-inhibitor UC781 measuring clinical and mucosal safety, acceptability and plasma drug levels. A first-in-Phase 1 assessment of preliminary pharmacodynamics was included by measuring changes in ex vivo HIV-1 suppression in rectal biopsy tissue after exposure to product in vivo.
METHODS: HIV-1 seronegative, sexually-abstinent men and women (N = 36) were randomized in a double-blind, placebo-controlled trial comparing UC781 gel at two concentrations (0.1%, 0.25%) with placebo gel (1∶1∶1). Baseline, single-dose exposure and a separate, 7-day at-home dosing were assessed. Safety and acceptability were primary endpoints. Changes in colorectal mucosal markers and UC781 plasma drug levels were secondary endpoints; ex vivo biopsy infectibility was an ancillary endpoint.
RESULTS: All 36 subjects enrolled completed the 7-14 week trial (100% retention) including 3 flexible sigmoidoscopies, each with 28 biopsies (14 at 10 cm; 14 at 30 cm). There were 81 Grade 1 adverse events (AEs) and 8 Grade 2; no Grade 3, 4 or procedure-related AEs were reported. Acceptability was high, including likelihood of future use. No changes in mucosal immunoinflammatory markers were identified. Plasma levels of UC781 were not detected. Ex vivo infection of biopsies using two titers of HIV-1(BaL) showed marked suppression of p24 in tissues exposed in vivo to 0.25% UC781; strong trends of suppression were seen with the lower 0.1% UC781 concentration.
CONCLUSIONS: Single and 7-day topical rectal exposure to both concentrations of UC781 were safe with no significant AEs, high acceptability, no detected plasma drug levels and no significant mucosal changes. Ex vivo biopsy infections demonstrated marked suppression of HIV infectibility, identifying a potential early biomarker of efficacy.
Use of respondent driven sampling (RDS) generates a highly diverse sample of men who have sex with men (MSM) in Buenos Aires, Argentina
Authors:
Carballo-Dieguez A, Balan I, Marone R, Pando M, Dolezal C, Barreda V, Leu C, Avila MM
Journal:
PLoS ONE 2011; 6(11): e27447 (2011)
Abstract:
BACKGROUND: Prior research focusing on men who have sex with men (MSM) conducted in Buenos Aires, Argentina, used convenience samples that included mainly gay identified men. To increase MSM sample representativeness, we used Respondent Driven Sampling (RDS) for the first time in Argentina. Using RDS, under certain specified conditions, the observed estimates for the percentage of the population with a specific trait are asymptotically unbiased. We describe, the diversity of the recruited sample, from the point of view of sexual orientation, and contrast the different subgroups in terms of their HIV sexual risk behavior.
METHODOLOGY: 500 MSM were recruited using RDS. Behavioral data were collected through face-to-face interviews and Web-based CASI.
CONCLUSION: In contrast with prior studies, RDS generated a very diverse sample of MSM from a sexual identity perspective. Only 24.5% of participants identified as gay; 36.2% identified as bisexual, 21.9% as heterosexual, and 17.4% were grouped as "other." Gay and non-gay identified MSM differed significantly in their sexual behavior, the former having higher numbers of partners, more frequent sexual contacts and less frequency of condom use. One third of the men (gay, 3%; bisexual, 34%, heterosexual, 51%; other, 49%) reported having had sex with men, women and transvestites in the two months prior to the interview. This population requires further study and, potentially, HIV prevention strategies tailored to such diversity of partnerships. Our results highlight the potential effectiveness of using RDS to reach non-gay identified MSM. They also present lessons learned in the implementation of RDS to recruit MSM concerning both the importance and limitations of formative work, the need to tailor incentives to circumstances of the less affluent potential participants, the need to prevent masking, and the challenge of assessing network size.
Beyond faith-based organizations: Using comparative institutional ethnography to understand religious responses to HIV and AIDS in Brazil
Authors:
Muñoz-Laboy, M., Murray, L., Wittlin, N., Garcia, J., Terto Jr, V., & Parker, R.
Journal:
American Journal of Public Health, 101, 972-978 (2011)
Abstract:
Religious institutions, which contribute to understanding of and mobilization in response to illness, play a major role in structuring social, political, and cultural responses to HIV and AIDS. We used institutional ethnography to explore how religious traditions--Catholic, Evangelical, and Afro-Brazilian--in Brazil have influenced HIV prevention, treatment, and care at the local and national levels over time. We present a typology of Brazil's division of labor and uncover overlapping foci grounded in religious ideology and tradition: care of people living with HIV among Catholics and Afro-Brazilians, abstinence education among Catholics and Evangelicals, prevention within marginalized communities among Evangelicals and Afro-Brazilians, and access to treatment among all traditions. We conclude that institutional ethnography, which allows for multilevel and interlevel analysis, is a useful methodology.
Aceptabilidad del diagnóstico rápido casero para HIV entre hombres gay y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires. [Acceptability of Rapid Home HIV Testing Among MSM in Buenos Aires, Argentina]
Authors:
Balán, I., Carballo-Diéguez, A., Marone, R., Pando, M., Barreda, V., & Avila, M.
Journal:
Actualizaciones en SIDA, 19, 26-32. (2011)
Abstract [in English translation]:
The use of rapid HIV testing in Latin America has been limited and efforts to broaden its use unsuccessful. We report on the acceptability of rapid HIV home testing among gay and other men who have sex with men in Buenos Aires, Argentina. We conducted focus groups with 73 participants and asked about perceived advantages and disadvantages of rapid HIV home testing. Responses were coded using NVivo qualitative analysis software and then thematically analyzed. Participants perceived numerous advantages to rapid HIV home testing, but some expressed significant concerns about impulsive suicidal behavior if someone received a positive result at-home, alone. There was strong support for rapid HIV testing conducted by trained personnel in community settings. Findings are discussed in the context of HIV-related stigma and its impact on HIV testing and public health policy.
Presentación del estudio “Links” de hombres que tienen sexo con hombres en Buenos Aires, Argentina. [Overview of the LINKS study on men who have sex with men in Argentina]
Authors:
Carballo-Diéguez, A., Ávila, M., Balán, I., Marone, R., Pando, M., & Barreda, V.
Journal:
Actualizaciones en SIDA, 19, 21-25 (2011)
Abstract [in English translation]:
Previous studies conducted in Buenos Aires reported high HIV prevalence rates among MSM, which varied from 9 to 14% for 10 years of continuous testing. The main objective of the study was to evaluate the factors associated to high risk behavior for HIV transmission among MSM based on their knowledge as well as emotional, socio-cultural and environmental factors. On the other hand, HIV prevalence and incidence studies were performed by RDS (Respondent Driven Sampling) as well as the presence of other STIs. Finally, we evaluated the habits of HIV testing regarding the factors that facilitate or hinder its performance. The study was divided into two phases: firstly, a qualitative phase and secondly a quantitative phase for 4.5 years. During the qualitative phase, 44 individual in-depth interviews, 8 focal groups (including 73 participants) and 10 ethnographic observations were conducted (hotels, public toilets (“teteras”), x-rat¬ed cinemas, private parties, dark rooms and discos). The quantitative phase involved the recruitment of 500 partici¬pants from the Autonomous City of Buenos Aires as well as Great Buenos Aires. The recruitment started with 16 participants called seeds. The following diagnoses were performed: HIV-infection, Hepatitis B and C (HBV and HCV), Treponema pallidum, Human Papiloma Virus (HPV) and Chlamidiae. The collaboration set by the work-groups focused on different areas allowed to address unprecedented joint research strategies in Argentina.
A practical framework for navigating ethical challenges in collaborative community research
Authors:
Hunter, J., Lounsbury, D., Rapkin, B., & Remien, R.
Journal:
Global Journal of Community Psychology Practice, 1.(2011)
Abstract:
To effectively mobilize community-based organizations (CBOs) and international non-governmental organizations (NGOs) in research, important ethical issues must be addressed. A memorandum of understanding (MOU) approach, providing a framework and a tool to be used for establishing effective community-research partnerships, was developed by the Community Collaboration Core (CCC) of the HIV Center for Clinical and Behavioral Studies. Aims of the CCC include: (1) Initiating and sustaining successful partnerships in HIV prevention research in areas of sexuality, gender, mental health, and of mutual benefit to communities; (2) Advancing the science of collaboration among researchers, practitioners, and government in HIV prevention. Developed and assessed over a two-year period by researchers, CBO/NGO and public health representatives, this MOU can be used by potential research and community partners to address the most important issues early in a collaborative research project. Clarifying essential roles, responsibilities, and relationships, establishing trust and transparency in that process, can guide collaborators in planning the important steps for beginning and sustaining an ethical and successful research project.
“Members of the Same Club”: Challenges and decisions faced by US IRBs in identifying and managing conflicts of interest
Author:
Klitzman, R.
Journal:
PLoS ONE, 6, e22796. epub July 29, 2011.
Abstract:
Conflicts of interest (COIs) in research have received increasing attention, but many questions arise about how Institutional Review Boards (IRBs) view and approach these.
METHODS: I conducted in-depth interviews of 2 hours each with 46 US IRB chairs, administrators, and members, exploring COI and other issues related to research integrity. I contacted leaders of 60 IRBs (every fourth one among the top 240 institutions by NIH funding), and interviewed IRB leaders from 34 of these institutions (response rate=55%). Data were analyzed using standard qualitative methods, informed by Grounded Theory.
RESULTS: IRBs confront financial and non-financial COIs of PIs, institutions, and IRBs themselves. IRB members may seek to help, or compete with, principal investigators (PIs). Non-financial COI also often appear to be "indirect financial" conflicts based on gain (or loss) not to oneself, but to one's colleagues or larger institution. IRBs faced challenges identifying and managing these COI, and often felt that they could be more effective. IRBs' management of their own potential COI vary, and conflicted members may observe, participate, and/or vote in discussions. Individual IRB members frequently judge for themselves whether to recuse themselves. Challenges arise in addressing these issues, since institutions and PIs need funding, financial information is considered confidential, and COI can be unconscious.
CONCLUSIONS: This study, the first to explore qualitatively how IRBs confront COIs and probe how IRBs confront non-financial COIs, suggests that IRBs face several types of financial and non-financial COIs, involving themselves, PIs, and institutions, and respond varyingly. These data have critical implications for practice and policy. Disclosure of indirect and non-financial COIs to subjects may not be feasible, partly since IRBs, not PIs, are conflicted. Needs exist to consider guidelines and clarifications concerning when and how, in protocol reviews, IRB members should recuse themselves from participating, observing, and/or voting.
HIV/STI risk by migration status among workers in an urban high-end entertainment centre in Eastern China
Authors:
Mantell, J., Kelvin, E., Sun, X., Zhou, J., Exner, T., Hoffman, S., Zhou, F., Sandfort, T., & Leu, C.-S.
Journal:
Health Education Research, 26, 283-295 (2011)
Abstract:
Large-scale internal migration in China may be an important mechanism for the spread of HIV/sexually transmitted infections (STIs) because of the risk behaviours of migrants. We conducted a self-administered survey among 724 employees of a high-end entertainment centre in Kunshan, Jiangsu Province, China. Using logistic regression, we examined the association of hometown of origin (Kunshan city, elsewhere in Jiangsu Province, or another province in China) and consecutive years living in Kunshan with measures of HIV/STI risk behaviour. We found that increased time living in Kunshan was associated with lower odds of using condoms as contraception [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.95] and consistent condom use with a casual partner (OR = 0.66, 95% CI: 0.47-0.93), after controlling for gender, marital status age and income. The odds of having had an STI were significantly lower for Kunshan natives than those originally from outside provinces (OR = 0.25, 95% CI: 0.07-0.96), but increasing years living in Kunshan was not related to lower risk for an STI. Our findings do not support the hypothesis that migrants living far from home participate in higher risk behaviour than locals. Findings suggest that adaptation to local culture over time may increase HIV/STI risk behaviours, a troublesome finding.
Health care providers: A missing link in understanding acceptability of the female condom
Authors:
Mantell, J. E., West, B., Sue, K., Hoffman, S., Exner, T. M., Kelvin, E. A., & Stein, Z. A.
Journal:
AIDS Education and Prevention, 23, 65-77 (2011)
Abstract:
Health care providers can play a key role in influencing clients to initiate and maintain use of the female condom, an underused method for HIV/STI and pregnancy prevention. In 2001-2002, based on semistructured interviews with 78 health care providers from four types of settings in New York City, we found that most providers had seen the female condom, but they had not used it and did not propose the method to clients. They lacked details about the method-when to insert it, where it can be obtained, and its cost. Gender of provider, provider level of training, and setting appeared to influence their attitudes. Unless and until provider training on the female condom is greatly improved, broader acceptance of this significant public health contribution to preventing HIV/AIDS and unwanted pregnancy will not be achieved.
Divine targets: Youth at the centre of Catholic and Pentecostal responses to HIV and AIDS in Brazil
Authors:
Muñoz-Laboy, M., Murray, L., Wittlin, N., Wilson, P., Terto, V., & Parker, R.
Journal:
Culture, Health & Sexuality, 13, 657-668 (2011)
Abstract:
This study explored the focus on youth in Catholic and Evangelical Pentecostal discussions about and responses to HIV and AIDS in Brazil. Key informant, oral history and in-depth interviews revealed a disconnect between young people's views of themselves as leaders in their religious institutions' responses to HIV and other social problems, and adult religious leaders' views of young people as vulnerable and in need of being 'saved'. Religious leaders presented young people as institutional commodities, emphasizing their symbolic value as signs of the health and future of their churches. We explore the unofficial exchange between religious institutions and young people, who benefited from the leadership opportunities and communities provided by their churches and youth groups. We discuss the political economy of youth in religious institutions' responses to HIV and AIDS within the context of Brazil's high levels of religious mobility as well as the broader, global commodification of spirituality and religion.
Psychiatric risk factors for HIV disease progression: The role of inconsistent patterns of antiretroviral therapy utilization
Authors:
Carrico, A. W., Riley, E. D., Johnson, M. O., Charlebois, E. D., Neilands, T. B., Remien, R. H., Lightfoot, M. A., Steward, W. T., Weinhardt, L. S., Kelly, J. A., Rotheram-Borus, M. J., Morin, S. F., & Chesney, M. A.
Journal:
Journal of Acquired Immune Deficiency Syndromes. Feb;56(2):146-50 (2011)
Abstract:
BACKGROUND: In the era of antiretroviral therapy (ART), depression and substance use predict hastened HIV disease progression, but the underlying biological or behavioral mechanisms that explain these effects are not fully understood.
METHODS: Using outcome data from 603 participants enrolled in a randomized controlled trial of a behavioral intervention, binary logistic and linear regression were employed to examine whether inconsistent patterns of ART utilization partially mediated the effects of depression and substance use on higher HIV viral load over a 25-month follow-up.
RESULTS: Elevated affective symptoms of depression independently predicted ART discontinuation [adjusted odds ratio = 1.39, 95% confidence interval (CI) = 1.08 to 1.78], and use of stimulants at least weekly independently predicted intermittent ART utilization (adjusted odds ratio = 2.62, 95% CI = 1.45 to 4.73). After controlling for the average self-reported percentage of ART doses taken and baseline T-helper (CD4) count, elevated depressive symptoms predicted a 50% higher mean viral load, and weekly stimulant use predicted a 137% higher mean viral load. These effects became nonsignificant after accounting for inconsistent patterns of ART utilization, providing evidence of partial mediation.
CONCLUSIONS: Inconsistent patterns of ART utilization may partially explain the effects of depression and stimulant use on hastened HIV disease progression.
Intervention to influence behaviors linked to risk of chronic diseases: a multisite randomized controlled trial with African-American HIV-serodiscordant heterosexual couples
Authors:
El-Bassel, N., Jemmot, J., Landis, J., Pequegnat, W., GM, W., Wyatt, G., Bellamy, S., & the National Institute of Mental Health Multisite HIV/STD Prevention Trial for African-American Couples Group [including Remien, R.H.]
Journal:
Archives of Internal Medicine, 171, 728-736.
Abstract:
BACKGROUND: The high morbidity and mortality in African Americans associated with behavior-linked chronic diseases are well documented.
METHODS: We tested the efficacy of an intervention to increase multiple health-related behaviors in African Americans. In a multisite cluster-randomized controlled trial, groups of African American human immunodeficiency virus (HIV)-serodiscordant heterosexual couples in Atlanta (Georgia), Los Angeles (California), New York (New York), and Philadelphia (Pennsylvania) were allocated to an individual-focused health promotion that addressed multiple health-related behaviors or to a couple-focused HIV/sexually transmitted disease (STD) risk reduction intervention. Primary outcomes were adherence to fruit and vegetable consumption and physical activity guidelines assessed preintervention, immediately postintervention, and 6 and 12 months postintervention. Secondary outcomes included fatty food consumption, prostate and breast cancer screening, and alcohol use. Generalized estimating equations tested the efficacy of the health promotion intervention over the postintervention assessments.
RESULTS: Health promotion intervention participants were more likely to report consuming 5 or more servings of fruits and vegetables daily (rate ratio [RR], 1.38; 95% confidence interval [CI], 1.18 to 1.62) and adhering to physical activity guidelines (1.39; 1.22 to 1.59) compared with HIV/STD intervention participants. In the health promotion intervention compared with the HIV/STD intervention, participants consumed fatty foods less frequently (mean difference, -0.18; 95% CI, -0.30 to -0.07), more men received prostate cancer screening (RR, 1.51; 95% CI, 1.21 to 1.88), and more women received a mammogram (RR, 1.26; 95% CI, 1.06 to 1.50). Alcohol use did not differ between the intervention groups.
CONCLUSION: This trial demonstrates the efficacy of interventions targeting multiple health-related behaviors in African American HIV-seropositive and HIV-seronegative men and women. Trial Registration clinicaltrials.gov Identifier: NCT00644163.
"I feel like I'm carrying a weapon." Information and motivations related to sexual risk among girls with perinatally acquired HIV
Authors:
Marhefka, S. L., Valentin, C., Pinto, R. M., Demetriou, N. K., Wiznia, A., & Mellins, C. A.
Journal:
AIDS Care, 3(1-8). Mar 3:1-8 (2011)
Abstract:
Some adolescent girls perinatally infected with HIV (PIH) engage in sexual behavior that poses risks to their own well-being and that of sexual partners. Interventions to promote condom use among girls PIH may be most effective if provided prior to first sexual intercourse. With in-depth interviews, we explored gender- and HIV-specific informational and motivational factors that might be important for sexual risk reduction interventions designed to reach US girls PIH before they first engage in sexual intercourse. Open-ended interview questions and vignettes were employed. The information-motivation-behavioral skills (IMB) model guided descriptive qualitative analyses. Participants (20 girls PIH ages 12-16 years) had experienced kissing (n=12), genital touching (n=6), and oral (n=3), vaginal (n=2), and anal sex (n=1). Most knew sex poses transmission risks but not all knew anal sex is risky. Motivations for and against condom use included concerns about: sexual transmission, psychological barriers, and partners' awareness of the girl's HIV+ status. Girls were highly motivated to prevent transmission, but challenged by lack of condom negotiation skills as well as negative potential consequences of unsafe sex refusal and HIV status disclosure. Perhaps most critical for intervention development is the finding that some girls believe disclosing one's HIV status to a male partner shifts the responsibility of preventing transmission to that partner. These results suggest a modified IMB model that highlights the role of disclosure in affecting condom use among girls PIH and their partners. Implications for cognitive-behavioral interventions are discussed.
Strange bedfellows: the Catholic Church and Brazilian National AIDS Program in the response to HIV/AIDS in Brazil
Authors:
Murray, L., Garcia, J., Muñoz-Laboy, M., & Parker, R.
Journal:
Social Science and Medicine, 72, 945-952. (2011)
Abstract:
The HIV epidemic has raised important tensions in the relationship between Church and State in many parts of Latin America where government policies frequently negotiate secularity with religious belief and doctrine. Brazil represents a unique country in the region due to the presence of a national religious response to HIV/AIDS articulated through the formal structures of the Catholic Church. As part of an institutional ethnography on religion and HIV/AIDS in Brazil, we conducted an extended, multi-site ethnography from October 2005 through March of 2009 to explore the relationship between the Catholic Church and the Brazilian National AIDS Program. This case study links a national, macro-level response of governmental and religious institutions with the enactment of these politics and dogmas on a local level. Shared values in solidarity and citizenship, similar organizational structures, and complex interests in forming mutually beneficial alliances were the factors that emerged as the bases for the strong partnership between the two institutions. Dichotomies of Church and State and micro and macro forces were often blurred as social actors responded to the epidemic while also upholding the ideologies of the institutions they represented. We argue that the relationship between the Catholic Church and the National AIDS Program was formalized in networks mediated through personal relationships and political opportunity structures that provided incentives for both institutions to collaborate.
Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, black men who have sex with men
Authors:
Wu, E., El-Bassel, N., McVinney, L., Hess, L., Remien, R., Charania, M., & Mansergh, G. (2011).
Journal:
AIDS and Behavior 2011 Nov;15(8):1745-54.
Abstract:
Accumulating evidence supports couple-based approaches for HIV/STI preventive interventions. Yet, to date, no studies have examined couple-based sexual risk reductions intervention specifically for men who have sex with men (MSM) from populations with elevated rates of HIV/STI transmission, such as black MSM and methamphetamine-involved MSM. We pilot tested-using a pre-/post-test design-a seven-session couple-based intervention for black, methamphetamine-using, black MSM couples engaging in sexual risk. Feasibility was assessed via recruitment and retention rates; potential efficacy relied on self-reported sexual risk and drug use prior to and two months following intervention delivery. We enrolled 34 couples (N = 68 men). Over 80% attended all seven intervention sessions, and retention exceeded 95% at two-month follow-up. At follow-up, participants reported significantly fewer sexual partners, fewer episodes of unprotected anal sex, and greater condom use with their main partner; participants also reported significantly less methamphetamine use, any illicit drug use, and number of illicit drugs used. These findings indicate that couple-based HIV/STI intervention is feasible and promising for at-risk black MSM couples.
Assessing maladaptive responses to the stress of being at-risk of HIV infection among HIV-negative gay men in New York City
Authors:
Yi H, Shidlo A, & Sandfort T.
Journal:
Journal of Sex Research, 48, 62-73 (2011)
Abstract:
The aim of this study was to examine the psychometric properties and preliminary validity of a newly developed 16-item measure to assess maladaptive responses to the stress of being at risk for HIV infection among HIV-negative gay men. The measure consisted of three factors: (a) fatalistic beliefs about maintaining an HIV-negative serostatus, (b) reduced perceived severity of HIV infection due to advances in medical treatment of HIV and AIDS, and (c) negative affective states associated with the risk of HIV infection. A total of 285 HIV-negative gay men at a counseling program in New York City participated in the study. Confirmatory factor analyses supported the three-factor model as an acceptable model fit: non-normed fit index = .91, comparative fit index = .92, goodness-of-fit index = .90, and root mean square error of approximation = .07. The measure and its subscales obtained in this sample achieved adequate internal consistency coefficients. Construct validity was supported by significant and positive associations with internalized homophobia, depression, self-justifications for the last unprotected anal intercourse (UAI), and actual UAI with casual sex partners. Understanding the dynamics of maladaptive responses to the epidemic and intense anxieties elicited by HIV risk among HIV-negative gay men living in a place of high seroprevalence provides useful information to guide psychosocial interventions in the population.
ABSTRACTS ON THIS PAGE
Progress and challenges to male and female condom use in South Africa (M. Bekinska et al)
2011 ARTICLES
Sexual pleasure and intimacy among men who engage in "bareback sex" (A. Carballo-Diéguez et al.)
Depressive symptoms among MSM who engage in bareback sex: Does mood matter? (E. Houston et al.)
How local IRBs view central IRBs in the US (R. Klitzman)
