Attached are the 1st 2 articles summarized below (Malow et al & Nakimuli-Mpungu et al), which are recent epubs on HIV & mental health factors from the journal, AIDS & Behav. This is followed by summaries of other recent epubs/articles on HIV/mental health factors (e.g., depression, alcohol stigma, distress) from AIDS & Behav. & then from other journals. Below these are summaries of the 27 articles in the Jan 2012 issue of AIDS & Behav. Concluding this posting are summaries of articles from the Jan-Feb 2012 issue of Women’s Health Issues, with a focus on HIV/STI & mental health factors.
NOTE: My graduate assistant, Jennifer Attonito, will be assisting me in preparing the Lserv and responding to individual email requests. Any questions concerning the Lserv (e.g. content that may be valuable to post, literature queries) should be initially directed to Jennifer at firstname.lastname@example.org.
Cognitive Behavioral HIV Risk Reduction in Those Receiving Psychiatric Treatment: A Clinical Trial
Robert M. Malow, Robert C. McMahon, Jessy Dévieux, Rhonda Rosenberg, Anne Frankel, Vaughn Bryant, Brenda Lerner and Maria Jose Miguez
Florida International University. Miami, Fl email@example.com
AIDS & Behavior, Jan 2011 epubs
Among severely mentally ill (SMI) substance abusers, HIV rates are elevated and HIV risk reduction interventions have been shown to be less effective. An enhanced cognitive behavioral HIV risk reduction intervention (E-CB) for SMI was compared to a health promotion condition (HPC) in 222 psychiatric outpatients at 6 months postintervention. Compared to females, males in the E-CB improved on intention to practice safer sex and in condom use skills and in unprotected vaginal sex, but did not differ in HIV knowledge, perceived susceptibility, anxiety, condom attitudes, safer sex self-efficacy, unprotected vaginal sex acts, or sex partners. Across intervention groups, there were improvements in all areas except self-efficacy and number of partners. Risk reduction among SMI may be facilitated by increasing awareness of health related behaviors and HIV-targeted content. However, meaningful changes in critical risk reduction skills and intentions may require a more focused intervention and may vary by gender.
AIDS Behav. 2011 Nov 25. [Epub ahead of print]
Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review.
Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, Katabira E, Nachega JB.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Hampton House, Baltimore, MD, 21205, USA, firstname.lastname@example.org
Abstract/1st page image http://www.springerlink.com/content/1839156555306637/
This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5-38.2%, Tau(2) = 0.23) and 18% (95% CI 12.3-25.8%, Tau(2) = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31-0.66, Tau(2) = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa
43. Mother’s CD4(+) Count Moderates the Risk Associated with Higher Parity for Late Postnatal HIV-Free Survival of Breastfed Children: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials.
HIV & mental health factors (e.g., depression, stigma, distress) article suumaries in journal, AIDS & Behavior
AIDS Behav. 2011 Oct 11. [Epub ahead of print]
Depression in the Pathway of HIV Antiretroviral Effects on Sexual Risk Behavior Among Patients in Uganda.
Wagner GJ, Ghosh-Dastidar B, Holloway IW, Kityo C, Mugyenyi P.
RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA, email@example.com.
HIV antiretroviral therapy (ART) can increase safe sex or lead to disinhibition and less condom use. We conducted one of the first controlled studies of ART effects on sexual risk behavior in sub-Saharan Africa, and the potential explanatory roles of physical and mental health. Participants (302 non-ART, 300 ART) were followed for the first 12 months of HIV care in Uganda. Multivariate intention-to-treat regression analysis showed that frequency of sex increased significantly in both groups, but more among ART patients; when added to the model in separate analyses, changes in physical health functioning and depression were both significant predictors, as was time in HIV care, but there was no longer an ART effect. Both ART and non-ART groups had similar dramatic increases in consistent condom use over time; however, change in depression, unlike physical health functioning, was a significant predictor of consistent condom use when added to this model, and there remained a similar level of increased condom use among ART and non-ART patients. HIV care and ART increase sexual activity and condom use, but depression undercuts the prevention benefits of ART, highlighting the need to integrate mental health services into HIV care.
AIDS Behav. 2011 Dec 25. [Epub ahead of print]
HIV Stigma and Depressive Symptoms are Related to Adherence and Virological Response to Antiretroviral Treatment Among Immigrant and Indigenous HIV Infected Patients.
Sumari-de Boer IM, Sprangers MA, Prins JM, Nieuwkerk PT.
Department of Medical Psychology, Academic Medical Center, P. O. Box 22660, 1100 AD, Amsterdam, The Netherlands.
Abstract/1st page image http://www.springerlink.com/content/glg60017h225v47k/
We compared adherence to cART and virological response between indigenous and immigrant HIV-infected patients in the Netherlands, and investigated if a possible difference was related to a difference in the psychosocial variables: HIV-stigma, quality-of-life, depression and beliefs about medications. Psychosocial variables were assessed using validated questionnaires administered during a face-to-face interview. Adherence was assessed trough pharmacy-refill monitoring. We assessed associations between psychosocial variables and non-adherence and having detectable plasma viral load using logistic regression analyses. Two-hundred-two patients participated of whom 112 (55%) were immigrants. Viral load was detectable in 6% of indigenous patients and in 15% of the immigrants (P < 0.01). In multivariate analyses, higher HIV-stigma and prior virological failure were associated with non-adherence, and depressive symptoms, prior virological failure and non-adherence with detectable viral load. Our findings suggest that HIV-stigma and depressive symptoms may be targets for interventions aimed at improving adherence and virological response among indigenous and immigrant HIV-infected patients.
AIDS Behav. 2011 Dec 15. [Epub ahead of print]
Blocking the Benefit of Group-Based HIV-Prevention Efforts during Adolescence: The Problem of HIV-Related Stigma.
Barker DH, Swenson RR, Brown LK, Stanton BF, Vanable PA, Carey MP, Valois RF, Diclemente RJ, Salazar LF, Romer D.
Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, Coro West Building, Suite 204, One Hoppin Street, Providence, RI, firstname.lastname@example.org
Abstract/1st page image http://www.springerlink.com/content/e851168647v073p7/
HIV-related stigma has been shown to impede HIV-antibody testing and safer sexual practices in adults. Less is known about its effects on prevention programs among at-risk youth. This study examined the longitudinal relationships between HIV-stigma and HIV-knowledge following completion of a validated group-based intervention. Data were provided by 1,654 African-American adolescents who participated in a large multi-city prevention trial (Project iMPACCS). Participants were randomly assigned to an empirically-validated skill-based intervention or a general health promotion control group. Both stigma and knowledge were assessed at baseline and post-intervention. Results suggested that adolescents participating in the intervention showed improvements in knowledge and decreases in stigma when compared to controls. Improvements in stigma appeared to be partly driven by improvements in knowledge. Higher baseline stigma was shown to reduce gains in knowledge in both the treatment and control groups. Results suggest that HIV-stigma can interfere with how youth identify with and internalize messages from group-based prevention trials.
AIDS Behav. 2012 Jan 11. [Epub ahead of print]
Efficacy of HIV/STI Behavioral Interventions for Heterosexual African American Men in the United States: A Meta-Analysis.
Henny KD, Crepaz N, Lyles CM, Marshall KJ, Aupont LW, Jacobs ED, Liau A, Rama S, Kay LS, Willis LA, Charania MR.
Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-37, Atlanta, GA, 30333, USA, email@example.com.
This meta-analysis estimates the overall efficacy of HIV prevention interventions to reduce HIV sexual risk behaviors and sexually transmitted infections (STIs) among heterosexual African American men. A comprehensive search of the literature published during 1988-2008 yielded 44 relevant studies. Interventions significantly reduced HIV sexual risk behaviors and STIs. The stratified analysis for HIV sexual risk behaviors indicated that interventions were efficacious for studies specifically targeting African American men and men with incarceration history. In addition, interventions that had provision/referral of medical services, male facilitators, shorter follow-up periods, or emphasized the importance of protecting family and significant others were associated with reductions in HIV sexual risk behaviors. Meta-regression analyses indicated that the most robust intervention component is the provision/referral of medical services. Findings indicate that HIV interventions for heterosexual African American men might be more efficacious if they incorporated a range of health care services rather than HIV/STI-related services alone.
AIDS Behav. 2011 Oct 30. [Epub ahead of print]
HIV-Infected Individuals with Co-occurring Bipolar Disorder Evidence Poor Antiretroviral and Psychiatric Medication Adherence.
Moore DJ, Posada C, Parikh M, Arce M, Vaida F, Riggs PK, Gouaux B, Ellis RJ, Letendre SL, Grant I, Atkinson JH; The HIV Neurobahavioral Research Program (HNRP).
Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA, firstname.lastname@example.org.
The contribution of bipolar disorder (BD), a prevalent serious mental illness characterized by impulsivity and mood instability, to antiretroviral (ART) and psychiatric medication adherence among HIV-infected (HIV+) individuals is unknown. We examined medication adherence among 44 HIV+/BD+ persons as compared to 33 demographically- and medically-comparable HIV+/BD- persons. Classification of adherent (≥90%) or non-adherent (<90%) based on proportion of correctly taken doses over 30 days was determined using electronic medication monitoring devices. HIV+/BD+ persons were significantly less likely to be ART adherent (47.7%) as compared to HIV+/BD- (90.9%) persons. Within the HIV+/BD+ group, mean psychiatric medication adherence was significantly worse than ART medication adherence, although there was a significant correlation between ART and psychiatric adherence levels. Importantly, 30-day ART adherence was associated with plasma virologic response among HIV+/BD+ individuals. Given the high overlap of HIV and BD, and the observed medication adherence difficulties for these persons, specialized adherence improvement interventions are needed.
AIDS Behav. 2011 Oct 20. [Epub ahead of print]
The Impact of Prolonged Exposure on PTSD Symptoms and Associated Psychopathology in People Living with HIV: A Randomized Test of Concept.
Pacella ML, Armelie A, Boarts J, Wagner G, Jones T, Feeny N, Delahanty DL.
Department of Psychology, Kent State University, 118 Kent Hall, Kent, OH, 44242, USA.
People living with HIV (PLWH) report elevated levels of posttraumatic stress disorder symptoms (PTSS) and associated comorbidities. The present study tested the efficacy of prolonged exposure (PE) at reducing PTSS, depression, negative posttraumatic cognitions, and substance use in PLWH. Participants were randomly assigned to receive PE (n = 40) or to a weekly monitoring control group (n = 25). Assessments occurred at baseline, post-intervention and 3-months post-treatment. Following the 3-month assessment, controls were offered the intervention. All PE recipients (whether originally from the PE or control group) completed a 6-month assessment. Intent-to-treat mixed model repeated measures ANOVAs were conducted through 3-months post-treatment; within group analyses were conducted through 6-months. PE recipients reported fewer PTSS and negative posttraumatic cognitions and were more likely to achieve good end-state functioning; gains were maintained at 6-months. No between-group differences emerged for substance use. Overall, results support the efficacy of PE in PLWH.
Lay Adherence Counsellor Administered Substance Abuse and Mental Illness Symptoms Screener (SAMISS) and the International HIV Dementia Scale (IHDS) in a Primary care HIV Clinic in Cape Town, South Africa.
Breuer E, Stoloff K, Myer L, Seedat S, Stein DJ, Joska J.
Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa, email@example.com.
AIDS Behav. 2011 Oct 11. [Epub ahead of print]
Urban Farming: A Non-Traditional Intervention for HIV-Related Distress.
Shacham E, Donovan MF, Connolly S, Mayrose A, Scheuermann M, Overton ET.
Department of Behavioral Sciences and Health Education, School of Public Health, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA, firstname.lastname@example.org.
As individuals with HIV are living longer with less morbidity, developing interventions that address co-morbidities are essential. Psychological distress symptoms fluctuate throughout HIV infection and interrupt self-care practices. This pilot study was conducted to test the implementation of a clinic-recruited sample to participate in a community-based urban farming intervention, and assess the efficacy of reducing psychological distress symptoms. While the changes were not statistically significant, participants reported less distress symptoms, improved overall general health, and reduced frequency of illicit drug use. These findings support the development of a larger scale study to examine the impact of this nontraditional intervention.
HIV infection is associated with an increased prevalence of common mental disorders and with the development of HIV associated neurological disorders (HAND). The aim of this research was to determine the reliability of lay adherence counsellors in the administration of the substance abuse and mental illness symptom screener (SAMISS) for common mental disorders and International HIV Dementia Scale (IHDS) for HAND in a South African sample of 269 people living with HIV/AIDS and on HAART in a primary healthcare setting. We used a cross-sectional design with each patient assessed by a mental health nurse and counsellor, 1 week apart. Reliability was fair for the SAMISS overall (κ = 0.39, CI(95) 0.29-0.49, P < 0.01), but was higher for the substance abuse component compared to the mental illness component. Reliability for the IHDS between counsellors and nurses was slight (κ = 0.11, CI(95) 0.00-0.27, P < 0.02). Counsellors tended not to miss symptoms, and detected symptoms more often than nurses for the both the SAMISS and IHDS. Strategies to improve the ability of primary healthcare providers to screen for neurocognitive disorders as well as avoiding over-detection of mental illness and substance abuse symptoms need to be developed and implemented for the primary healthcare setting.
AIDS Behav. 2011 Oct 8. [Epub ahead of print]
Blashill AJ, O’Cleirigh C, Mayer KH, Goshe BM, Safren SA.
Massachusettes General Hospital, Harvard Medical School, 1 Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA, email@example.com.
Depression has been shown to be a risk factor for serodiscordant unprotected anal intercourse (SDUAI) in some studies, but not others. Body mass index (BMI) has recently been associated with SDUAI; however, to date, no published study has investigated the interactive effect of depression and BMI on SDUAI. The current study assessed the association between depression, BMI, and SDUAI among HIV-positive MSM. Participants were 430 HIV-positive MSM recruited in a Boston community health center where they received primary care. Participants completed audio computer-assisted self interview (ACASI) measures. Objective height and weight and other clinical variables were accessed through participants’ electronic medical records. Depression was positively associated with SDUAI. This association was significantly moderated by BMI. Elevated levels of depression were only associated with SDUAI for underweight participants. These findings suggest that underweight, depressed HIV-positive MSM may be particularly likely to engage in SDUAI.
AIDS Behav. 2011 Sep 29. [Epub ahead of print]
Coping with HIV Stigma: Do Proactive Coping and Spiritual Peace Buffer the Effect of Stigma on Depression?
Chaudoir SR, Norton WE, Earnshaw VA, Moneyham L, Mugavero MJ, Hiers KM.
Department of Psychology, Bradley University, 1501 W. Bradley Ave, Peoria, IL, 61625, USA, firstname.lastname@example.org.
Although HIV stigma is a significant predictor of depression, little is known about which factors might most effectively buffer, or attenuate, this effect. We examined whether two coping-related factors-proactive coping and spiritual peace-modified the effect of HIV stigma on likelihood of depression among a sample of 465 people living with HIV/AIDS (PLWHA). In a cross-sectional analysis, we conducted hierarchical logistic regressions to examine the effect of HIV stigma, proactive coping, spiritual peace, and their interactions on likelihood of significant depressive symptoms. Spiritual peace moderated the effect of HIV stigma on depression at high-but not low-levels of HIV stigma. No such effect was observed for proactive coping. Findings suggest that spiritual peace may help counteract the negative effect of HIV stigma on depression. Intervention components that enhance spiritual peace, therefore, may potentially be effective strategies for helping PLWHA cope with HIV stigma.
HIV & Mental Health factors (e.g., depression, stigma, distress, psychopathology) article summaries from other journals
Psychiatr Serv. 2011 Nov 1;62(11):1318-24.
A Randomized Trial of a Nursing Intervention for HIV Disease Management Among Persons With Serious Mental Illness.
Blank MB, Hanrahan NP, Fishbein M, Wu ES, Tennille JA, Ten Have TR, Kutney-Lee AM, Gross R, Hines JM, Coyne JC, Aiken LH.
Objective:The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens.
Methods:Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients’ medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months.
Results:Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=-.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant.
Conclusions:This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced.
J Interpers Violence. 2011 Dec 26. [Epub ahead of print]
Associations Between Intimate Partner Violence and Emotional Distress Among Pregnant Women in Durban, South Africa.
Groves AK, Kagee A, Maman S, Moodley D, Rouse P.
University of North Carolina at Chapel Hill, NC.
Intimate partner violence (IPV) during pregnancy has been associated with multiple negative health outcomes including emotional distress during pregnancy. However, little is known about IPV during pregnancy and its association with emotional distress among South African women. The objectives of this study were to determine the prevalence of both emotional distress and IPV during pregnancy, to identify whether different exposures of violence were associated with emotional distress and to assess whether social support attenuated the relationship between IPV and emotional distress. Pregnant women enrolled in the South Africa HIV Antenatal and Posttest Support Study (SAHAPS) who completed the baseline survey were included in this cross sectional analysis. We used logistic regression models to explore bivariate and multivariate relationships between the proposed covariates and emotional distress. Nearly a quarter of women experienced some type of IPV during the current pregnancy, with psychological violence being the most prevalent. The odds of emotional distress was 1.41 times (95% CI: [1.26, 1.57]) higher for each additional episode of psychological violence and 2.01 times (95% CI: [1.16, 3.77]) higher for each additional episode of sexual violence during pregnancy, adjusting for other covariates. Physical violence was only marginally associated with increased odds of emotional distress. Finally, social support was marginally significant as a main effect but did not attenuate the relationship between IPV and emotional distress. The high prevalence of IPV among South African women and its association with emotional distress during pregnancy suggest that interventions that reduce violence during or prior to pregnancy are needed.
Journal of LGBT Youth, Volume 8, Issue 2, 2011 pages 103-115
Arnold H. Grossman, Anthony R. D’augelli & John A. Frank
Free PDF/HTML/Abstract http://www.tandfonline.com/doi/abs/10.1080/19361653.2011.541347
Fifty-five transgender youth described their gender development and some of the stressful life experiences related to their gender identity and gender expression. More than two-thirds of youth reported past verbal abuse by their parents or peers related to their gender identity and nonconformity, and approximately one-fifth to one-third reported past physical abuse. The more gender non-conforming the youth were, the more abuse they reported. Four aspects of psychological resilience were examined: a sense of personal mastery, self-esteem, perceived social support, and emotion-oriented coping. A regression model of the selected aspects of resilience accounted for 40%–55% of the variance in relation to depression, trauma symptoms, mental health symptoms, and internalizing and externalizing problems. Emotion-oriented coping was a significant predictor of negative mental health as determined by each of the mental health variables.
BMC Psychiatry. 2011 Dec 30;11(1):205. [Epub ahead of print]
Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district, Uganda.
Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V.
BACKGROUND: Not much is known about the risk factors of major depressive disorder (MDD) in HIV/AIDS in the African socio-cultural context. Therefore a study was undertaken to examine the prevalence and risk factors of MDD in HIV/AIDS in semi-urban Uganda.
METHODS: A cross-sectional study was undertaken among 618 respondents attending two HIV clinics in Uganda.
RESULTS: Prevalence of MDD was 8.1%. Factors associated with MDD at univariate analysis only were female gender, family history of mental illness, negative coping style, alcohol dependency disorder, food insecurity and stress; not associated with MDD were social support, neurocognitive impairment, CD4 counts and BMI. Factors independently associated with MDD were psychosocial impairment, adverse life events, post traumatic stress disorder, generalised anxiety disorder and life-time attempted suicide.
CONCLUSION: Psychological and social factors were the main risk factors of MDD among ambulatory HIV positive persons with no evidence for the role of the neurotoxic effects of HIV. Treatment approaches for MDD in this patient group should be modeled on those used among non-HIV groups.
J Affect Disord. 2011 May;130(3):421-8.
Psychiatric context of human immunodeficiency virus infection among former plasma donors in rural China.
Atkinson JH, Jin H, Shi C, Yu X, Duarte NA, Casey CY, Franklin DR Jr, Vigil O, Cysique L, Wolfson T, Riggs PK, Gupta S, Letendre S, Marcotte TD, Grant I, Wu Z, Heaton RK; HIV Neurobehavioral Research Center Group. Collaborators (42)
HIV Neurobehavioral Research Center, University of California, San Diego, 220 Dickinson St., San Diego, CA 92103, USA. email@example.com
Abstract/1st page image http://www.springerlink.com/content/v8374637k0448642/
China’s HIV epidemic commenced in its agrarian provinces through contaminated commercial plasma donation centers and is now becoming a public health concern nationwide. Little is known of the psychiatric and substance use disorder characteristics of this population, or their impact on everyday function, employment, and life quality.
HIV-infected (HIV+) former plasma donors (N=203) and HIV-negative (HIV-) donor controls (N=198) completed the World Mental Health Survey Composite International Diagnostic Interview to determine lifetime major depressive disorder (MDD), substance use disorders, and suicidality. Current mood and suicidality were assessed with the Beck Depression Inventory-II. Everyday function was measured by an Activity of Daily Living questionnaire; life quality was evaluated by the Medical Outcomes Study-HIV.
HIV+ participants had known their infected status for 2 years on average. Most were taking antiretroviral treatment and had frank AIDS. Rates of current MDD were similar across groups (1-2%), but HIV+ had a higher frequency of lifetime MDD (14% vs. 5%, p<.05). Its onset preceded date of known infection in one-third of cases. Alcoholism was the only substance use disorder detected; HIV+ had a higher proportion of lifetime substance use diagnoses (14% vs. 6%, p<.05). Depression and AIDS independently predicted worse daily functioning and life quality, and unemployment.
The epicenter of China HIV has moved into urban injection drug users, limiting the representativeness of this sample.
High rates of MDD and its impact suggest that in China, as elsewhere, comprehensive care requires detection and treatment of mood disorder.
AIDS Care. 2011 Nov 15.
HIV risk among female sex workers in Miami: the impact of violent victimization and untreated mental illness.
Surratt HL, Kurtz SP, Chen M, Mooss A.
Center for Research on Substance Use & Health Disparities , Nova Southeastern University , Coral Gables , FL.
Street-based female sex workers constitute a vulnerable population for HIV, as they are often enmeshed in chronic patterns of substance use, sexual risk, homelessness, and violent victimization. This study examined the specific contributions of victimization history and abuse-related traumagenic factors to mental health functioning and sexual risk behaviors, while considering the impact of environmental risk factors as well. Using targeted sampling strategies, we enrolled 562 Miami-based female sex workers into an intervention trial testing the relative effectiveness of two alternative case management conditions in establishing linkages with health services and reducing risk for HIV. Lifetime prevalence of abuse was extremely elevated at 88%. Nearly half reported abuse before the age of 18, while 34% reported violent encounters with “dates” or clients in the past 90 days. Serious mental illness (SMI) was quite common, with 74% reporting severe symptoms of depression, anxiety, or traumatic stress. For those with histories of abuse, SMI appeared to mediate the association between abuse-related trauma and unprotected sex behaviors. Mental health treatment would appear to be an important component of effective HIV prevention among this vulnerable group, and should form part of a compendium of services offered to female sex workers.
The Impact of Depressive Symptoms on Neuropsychological Performance Tests in HIV-Infected Individuals: A Study of the Hawaii Aging with HIV Cohort
Sheri M. Shimizu, Dominic C. Chow, Victor Valcour, Kamal Masaki et al.
World Journal of AIDS, Vol. 1, No. 4, December, 2011, pp. 139-145
Background: The frequency of neurocognitive impairment (NCI) in human immunodeficiency virus (HIV) -infected individuals remains high despite the availability of potent antiretroviral therapy (ART). The concurrence of depression among HIV-infected patients with NCI is common, especially among older individuals. Depression has been implicated as a risk factor for impaired neuropsychological performance (NP). This study explored the relationship between depressive symptoms and NP testing in HIV-infected individuals.
Methods: A cross-sectional analysis was performed within the Hawaii Aging with HIV Cohort, a large prospective study of cognition of older (50 or more years old) compared to younger (20 to 39 years old) HIV-infected individuals.
Results: Two hundred and eighty-five HIV infected participants (157 older and 128 younger) were administered a battery of NP tests to measure performance in major cognitive domains. Depressive symptoms were measured using the Beck Depression Inventory (BDI). The rates of depressive symptoms and neuropsychological impairment were similar in older and younger groups. Multivariate analyses revealed depressive symptoms were associated with NP test impairment in the younger group. In the older group, depressive symptoms were not associated with NP.
Conclusion: This study suggests that depressive symptoms are associated with NP test impairment in younger HIV-infected individuals, but not in older individuals.
J Trauma Dissociation. 2012 Jan;13(1):102-14.
Relationships Among Childhood Trauma, Posttraumatic Stress Disorder, and Dissociation in Men Living with HIV/AIDS.
Kamen C, Bergstrom J, Koopman C, Lee S, Gore-Felton C.
Stanford University School of Medicine, Stanford, CA
This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r = .20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r = .69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.
The Impact of Depressive Symptoms on Neuropsychological Performance Tests in HIV-Infected Individuals: A Study of the Hawaii Aging with HIV Cohort
Sheri M. Shimizu, Dominic C. Chow, Victor Valcour, Kamal Masaki et al.
World Journal of AIDS, December, 2011 Volume 1, Number 4, p. 139-145
Background: The frequency of neurocognitive impairment (NCI) in human immunodeficiency virus (HIV) -infected individuals remains high despite the availability of potent antiretroviral therapy (ART). The concurrence of depression among HIV-infected patients with NCI is common, especially among older individuals. Depression has been implicated as a risk factor for impaired neuropsychological performance (NP). This study explored the relationship between depressive symptoms and NP testing in HIV-infected individuals. Methods: A cross-sectional analysis was performed within the Hawaii Aging with HIV Cohort, a large prospective study of cognition of older (50 or more years old) compared to younger (20 to 39 years old) HIV-infected individuals. Results: Two hundred and eighty-five HIV infected participants (157 older and 128 younger) were administered a battery of NP tests to measure performance in major cognitive domains. Depressive symptoms were measured using the Beck Depression Inventory (BDI). The rates of depressive symptoms and neuropsychological impairment were similar in older and younger groups. Multivariate analyses revealed depressive symptoms were associated with NP test impairment in the younger group. In the older group, depressive symptoms were not associated with NP. Conclusion: This study suggests that depressive symptoms are associated with NP test impairment in younger HIV-infected individuals, but not in older individuals.
Afr J Psychiatry (Johannesbg). 2011 Sep;14(4):259-61.
Bakelaar SY, Rosenstein D, Kagee A, Seedat S.
Department of Psychiatry, Faculty of Health Sciences, Tygerberg Campus, Stellenbosch University, Stellenbosch, South Africa.
HIV / AIDS carries a heavy burden for society, with between 31.4 and 35.3 million people infected and / or living with HIV / AIDS globally in 2009 and the largest proportion of these individuals living in Sub-Saharan Africa (22.5 million). At an individual level, the disease is associated with significant physical and psychiatric sequelae.
Qual Life Res. 2011 Oct 26.
Kamen C, Taniguchi S, Student A, Kienitz E, Giles K, Khan C, Lee S, Gore-Felton C, Koopman C.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, firstname.lastname@example.org.
BACKGROUND/PURPOSE: The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS.
METHODS: In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12 months, including denial as a predictor and gender as a moderator.
RESULTS: The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men’s baseline mental health-related QOL was more negatively affected by denial coping than women’s. Women tended to increase in QOL more slowly over time compared to men.
CONCLUSION: Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.
AIDS Care, Apr. 2011, Vol. 23,4, p. 417-25
Das S, Leibowitz GS.
School of Health Systems Studies, Mumbai, India email@example.com
We describe the global conditions associated with the AIDS pandemic and its socioeconomic and psychological impacts. A systematic review was performed to investigate the literature on the mental health needs of people living with HIV/AIDS (PLHA) in India. The focus is on the prevalence, nature, and sociocultural factors of the epidemic in India. A conceptual framework is offered and the findings of this study are presented across three major domains: (a) prevalence of mental health disorders among the HIV-infected population; (b) mental health needs of PLHA; and (c) gaps in policies and programs addressing these issues. Experiences of HIV stigma and discrimination are also noted in this population. We conclude with implications for future research, interventions, and public policy.
Community Ment Health J. 2011 Dec;47(6):668-71.
Treatment of HIV in outpatients with schizophrenia, schizoaffective disorder and bipolar disease at two county clinics.
Murphy K, Edelstein H, Smith L, Clanon K, Schweitzer B, Reynolds L, Wheeler P.
Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO
Abstract/1st page image http://www.springerlink.com/content/b6490jk715t22431/
Despite a high prevalence of HIV in patients with serious mental health disorders, there is little information in the literature regarding details of their HIV treatment. The objective of this paper is to assess factors associated with the success of HIV therapy in people with schizophrenia, schizoaffective, and bipolar disease. The methods used are retrospective, post-study chart review, and clinician questionnaire at two HIV county clinics. Forty-nine (4.8%) study patients were identified, 51% of whom achieved an undetectable HIV viral load. These patients tended to have less drug use (42% vs. 68%), more ongoing psychiatric visits (70% vs. 58%) and were more apt to take psychiatric medicines (70% vs. 40%) than patients with detectable HIV viral loads. Both groups had many missed appointments. We were surprised to find that many patients were successful with HIV treatment despite substance abuse, uncontrolled psychiatric symptoms, and lack of psychiatric care. Missing clinic appointments had little influence on treatment outcome.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 1-4.
Use of a Rapid HIV Home Test to Screen Sexual Partners: A Commentary on Ventuneac, Carballo-Diéguez, Leu et al. 2009.
Leu CS, Ventuneac A, Levin B, Carballo-Diéguez A.
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/d701w63836745554/
Previously, we estimated the HIV risk reduction that men who have sex with men could attain using a rapid HIV home test to screen sexual partners versus using condoms inconsistently. Here, we clarify the assumptions of our published formulas. Using models that more closely resemble our study population, our results show a difference from that presented in the original article in the magnitude of the relative advantage (i.e., lower risk of HIV infection) for HIV home test use versus inconsistent condom use. We present a general formula that can accommodate different types of partnerships in estimating risk of HIV infection.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 5-12.
Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, Awuondo KK, Mutinda MN, Molyneux CS, Berkley JA.
Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
Abstract/1st page image: http://www.springerlink.com/content/n4667240667x0766/
A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 13-22.
HIV Testing, Gay Community Involvement and Internet USE: Social and Behavioural Correlates of HIV Testing Among Australian Men Who have Sex with Men.
Holt M, Rawstorne P, Wilkinson J, Worth H, Bittman M, Kippax S.
National Centre in HIV Social Research, The University of New South Wales, Sydney, NSW, Australia, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/663k5225n180k673/
A significant minority of Australian men who have sex with men (MSM) have never been tested for HIV and many men do not test as often as recommended. Using data from 1770 HIV-negative and untested MSM collected in a national, online survey, we compared men who had never tested for HIV with those who had tested over 12 months ago and men who had tested over 12 months ago with those that had tested in the past year. Two multivariate logistic regression models were constructed. Compared with men tested over 12 months ago, untested men were younger, less educated, less likely to have unprotected anal intercourse with a regular male partner, less likely to have sought advice from a doctor, nurse or community organisation, more likely to expect HIV-negative disclosure, had fewer gay friends and spent more time using social networking websites. Compared with men who had tested over 12 months ago, men who had tested within the last year were younger, more likely to expect HIV-negative disclosure and disclose to casual partners, more likely to have sought advice from a doctor or nurse, had attended gay pools, gyms or beaches and had more gay friends and more male sex partners. Our findings suggest that the Internet and sex education in schools are important ways to promote HIV testing to untested MSM. Testing reinforcement messages delivered through gay community outreach and primary care will reach previously tested MSM.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 23-9.
‘Never Testing for HIV’ Among Men Who Have Sex with Men Recruited from a Sexual Networking Website, United States.
Margolis AD, Joseph H, Belcher L, Hirshfield S, Chiasson MA.
Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, AMargolis@cdc.gov.
Abstract/1st page image: http://www.springerlink.com/content/1u82170q2716n054/
HIV testing was assessed online among men accessing a sexual networking website for men who have sex with men. Most of the 8,040 participants reported HIV testing (58.2% ≤ 1 year; 33.1% > 1 year) and 17.1% were HIV-positive. Overall, 8.6% of men including 24% of those 18-24 years of age had never been tested. Among never testers, 25% did not know where to get tested. Predictors of never being tested included younger age (18-24), bisexual or heterosexual orientation, living outside of large metropolitan areas, and not having a healthcare provider. Increasing access to and knowledge of HIV testing sites is needed.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 30-5.
Reluctance to Do Blood Testing Limits HIV Diagnosis and Appropriate Health Care of Sub-Saharan African Migrants Living in Spain.
Navaza B, Guionnet A, Navarro M, Estévez L, Pérez-Molina JA, López-Vélez R.
Tropical Medicine and Clinical Parasitology Unit, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/q08hx6mm68162815/
This study investigates the reasons why sub-Saharan African migrants (SSAM) living in Spain may be unwilling to have their blood tested. A qualitative study was developed for 3 years (2006-2009) with the participation of 1338 SSAM. Cultural differences along with lack of information about Spanish health care system and health-related rights produced a feeling of mistrust towards medical staff. Reluctance to do blood testing may prevent SSAM from having a prompt HIV diagnosis and an appropriate health care. Linguistically and culturally adapted information is essential to overcome these barriers and achieve an equal access to health care services and HIV testing.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 36-43.
Hall HI, Walker F, Shah D, Belle E.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/5755m10q4vk1020p/
The Centers for Disease Control and Prevention recommends routine HIV screening in health care settings. Using national surveillance data, we assessed trends in HIV diagnoses and testing frequency in youth aged 13-24 diagnosed with HIV in 2005-2008. Diagnosis rates increased among black (17.0% per year), Hispanic (13.5%), and white males (8.8%), with increases driven by men who have sex with men (MSM). A higher percentage of white males and MSM had previously been tested than their counterparts. No increases in diagnoses or differences in testing were observed among females. Intensified interventions are needed to reduce HIV infections and racial/ethnic disparities.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 44-52.
Hong Y, Zhang C, Li X, Fang X, Lin X, Zhou Y, Liu W.
Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/y07lv813n5762414/
Despite the recognized importance of HIV testing in prevention, care and treatment, HIV testing remains low in China. Millions of female sex workers (FSW) play a critical role in China’s escalating HIV epidemic. Limited data are available regarding HIV testing behavior among this at-risk population. This study, based on a cross-sectional survey of 1,022 FSW recruited from communities in Southwest China, attempted to address the literature gap. Our data revealed that 48% of FSW ever took HIV testing; older age, less education, working in higher-income commercial sex venues and better HIV knowledge were associated with HIV testing. Those who never took HIV testing were more likely to engage in high-risk behaviors including inconsistent condom use with clients and stable partners. A number of psychological and structural barriers to testing were also reported. We call for culturally appropriate interventions to reduce HIV risks and promote HIV testing for vulnerable FSW in China.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 53-62.
Correlates of HIV Testing Uptake among Kothi-Identified Men who have Sex with Men in Public Sex Environments in Chennai, India.
Woodford MR, Newman PA, Chakrapani V, Shunmugam M, Kakinami L.
School of Social Work, University of Michigan, Ann Arbor, MI, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/7k4525u324127671/
Kothi-identified men who have sex with men in India are highly marginalized and are at high-risk for HIV. This study examines HIV testing among 132 self-reported HIV-negative and unknown serostatus kothis recruited from public sex environments in Chennai, India. Using logistic regression we identified variables associated with HIV testing uptake (i.e., being tested and knowing the result). Sixty-one percent reported HIV testing uptake. At the bivariate level, married men, those with low HIV transmission knowledge, those who engaged in unprotected anal sex and unprotected receptive anal sex were at lower odds of reporting testing uptake. In multivariate analysis, married men and those with low levels of HIV transmission knowledge were at decreased odds of being tested, as were kothis who experienced forced sex. Culturally competent programs engaging married kothis are needed. Interventions to facilitate HIV prevention education and systemic interventions to combat sexual violence may facilitate HIV testing uptake among kothis.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 63-8.
Negin J, Nemser B, Cumming R, Lelerai E, Ben Amor Y, Pronyk P.
Sydney School of Public Health, University of Sydney, Sydney, Australia, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/5k00034763254428/
In Africa, older adults aged 50 and older are still sexually active and play a critical role as caregivers, yet little is known about their attitudes towards HIV and awareness of services. In this study, surveys were conducted in nine African sites. A multilevel model was fitted to evaluate the relationship between age and outcome variables. The study reveals that people aged 50 years and older have lower levels of HIV-related knowledge and awareness than those aged 25-49. Older adults were less likely to have been tested for HIV and women aged 50 and older showed particularly low levels of awareness.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 69-78.
High Pregnancy Intentions and Missed Opportunities for Patient-Provider Communication About Fertility in a South African Cohort of HIV-Positive Women on Antiretroviral Therapy.
Schwartz SR, Mehta SH, Taha TE, Rees HV, Venter F, Black V.
Wits Reproductive Health & HIV Institute, Hillbrow Health Precinct, University of the Witwatersrand, Johannesburg, South Africa, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/e310h87734262755/
High fertility intentions amongst HIV-positive women have been reported elsewhere. Less is known about how clinical and HIV treatment characteristics correlate with fertility intentions. We use cross-sectional baseline data from a prospective cohort study to assess pregnancy intentions and patient-provider communication around fertility. Non-pregnant, HIV-positive women aged 18-35 on ART were recruited through convenience sampling at Johannesburg antiretroviral (ART) treatment facilities. Among the 850 women in this analysis, those on efavirenz had similar fertility intentions over the next year as women on nevirapine-based regimens (33% vs. 38%). In multivariate analysis, recent ART initiation was associated with higher current fertility intentions; there was no association with CD4 cell count. Forty-one percent of women had communicated with providers about future pregnancy options. Women on ART may choose to conceive at times that are sub-optimal for maternal, child and partner health outcomes and should be routinely counseled around safer pregnancy options.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 79-85.
Mother’s CD4(+) Count Moderates the Risk Associated with Higher Parity for Late Postnatal HIV-Free Survival of Breastfed Children: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials.
Division of Cancer Epidemiology & Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, firstname.lastname@example.org
Abstract/1st page image: http://www.springerlink.com/content/w138651w7661365k/
Risk association studies of late postnatal outcomes for children breastfed by HIV-1 positive mothers have had inconsistent findings and have not explored interactions among risk factors. This study addresses these limitations through an individual patient data (IPD) meta-analysis of HIV-free survival outcomes of nine randomized controlled trials to prevent early mother-to-child transmission of HIV-1. The pooled sample consisted of 3,324 African children in resource-limited settings who survived to age 28 days and were at-risk of acquiring HIV through breast milk. Based on a proportional hazards mixed effects meta-analysis, the composite endpoint of HIV-1 infection and all-cause mortality was found to be significantly associated with maternal immune status (CD4(+) ≥350 cells/mm(3), HR 0.59 95% CI (0.39, 0.87)), infant preterm delivery (gestational age <37 weeks, 1.40 (1.03, 1.89)), infant oral candidiasis infection (1.87, (1.53, 2.29)), and occurrence of breast abnormality before breastfeeding cessation (2.56 (1.90, 3.46)). A significant interaction between mother’s parity (any previous pregnancy) and CD4(+) count ≥350 (HR 0.63 (0.40, 0.99), P-value = 0.045) suggested that higher CD4(+) count offsets the risk associated with higher parity. Further research is needed to elucidate the moderating effect of immune status on the risk associated with high parity and adverse late postnatal outcomes for infants breastfed by HIV-infected mothers in the absence of antiretroviral treatment.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 86-90.
HIV Seroprevalence among High-Risk Groups in Kohgiloyeh and Boyerahmad Province, Southwest of Iran, a Behavioral Surveillance Survey.
Ilami O, Sarkari B, Khosravani A, Akbartabar Tori M, Hosseini Z.
Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
Abstract/1st page image: http://www.springerlink.com/content/q2w248100704q50r/
We conducted a survey to assess the seroprevalence and risk behaviors for HIV infection in 2,009 individuals in Kohgiloyeh and Boyerahmad province, in Southwest of Iran. Blood samples were drawn from each participant and tested for anti-HIV1/2 antibodies. HIV antibodies were detected in 36 (1.8%) blood samples among a total of 2,009 participants. The rate of infection in inmates was 2.7% while this rate was 9.9% in injection drug users. Correlation between HIV infection and sex, age, marital status, history of imprisonment, injection drug use, and place of residence were significant. Improving of the surveillance in this community through supervision and monitoring of infected people is needed.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 91-8.
Conversations With Mothers: Exploring Reasons for Prevention of Mother-to-Child Transmission (PMTCT) Failures in the Era of Programmatic Scale-Up in Soweto, South Africa.
Laher F, Cescon A, Lazarus E, Kaida A, Makongoza M, Hogg RS, Soon CN, Miller CL, Gray G.
Perinatal HIV Research Unit, University of the Witwatersrand, Diepkloof, Soweto, Johannesburg, South Africa, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/x010821745727w5q/
Reasons for incident cases of vertical HIV transmission in the era of free access to PMTCT in South Africa were investigated. This mixed-methods study was conducted in Soweto, South Africa from June-August, 2009. Birthmothers of HIV-infected infants born after 1 December 2008 were eligible. All participants completed an interviewer-administered questionnaire. Women also participated in a focus group (n = 10) or individual structured interview (n = 35). Mean age of participants (n = 45) was 28.7 years (SD = 5.4). Major findings are: (i) failure of per-guideline prescription of ARV strategies for infants (31%) and/or mothers (57%); (ii) maternal refusal of treatment (n = 5); (iii) preterm delivery (31%); (iv) delayed ANC attendance because of facility-related barriers and maternal apprehension around HIV testing; (v) fear of stigma; (vi) maternal difficulty with administering infant AZT (n = 9) and (vii) maternal confusion about infant feeding. A variety of individual, social, and structural factors must be addressed to optimize PMTCT service delivery in South Africa.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 99-107.
Discussing Childbearing with HIV-infected Women of Reproductive Age in Clinical Care: A Comparison of Brazil and the US.
Finocchario-Kessler S, Bastos FI, Malta M, Anderson J, Goggin K, Sweat M, Dariotis J, Bertoni N, Kerrigan D; The Rio Collaborative Group.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/h7247310061w1742/
Despite long term access to highly active antiretroviral therapy in Brazil and the US, little is known about women’s communication with their HIV provider regarding childbearing or the unmet need for reproductive counseling. We utilized identical survey questions to collect data from HIV-infected women of reproductive age in Rio de Janeiro (n = 180) and Baltimore (n = 181). We conducted univariate analyses to compare findings between samples of women and multivariate logistic regression to determine factors associated with childbearing desires, childbearing intentions, and provider communication among the combined sample of women (n = 361). Over one-third of women in Rio de Janeiro and nearly one-half of women in Baltimore reported the desire for future childbearing. Nevertheless, the majority of women in clinical care had not discussed future childbearing with their HIV provider. Even in countries with an advanced approach to HIV care, we found low and inadequate communication between providers and female patients about childbearing.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 108-20.
Catz SL, Thibodeau L, Bluespruce J, Yard SS, Seal DW, Amico KR, Bogart LM, Mahoney C, Balderson BH, Sosman JM.
Group Health Research Institute, Seattle, WA, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/e04rpr3kx785215l/
Greater understanding of barriers to risk reduction among incarcerated HIV+ persons reentering the community is needed to inform culturally tailored interventions. This qualitative study elicited HIV prevention-related information, motivation and behavioral skills (IMB) needs of 30 incarcerated HIV+ men and women awaiting release from state prison. Unmet information needs included risk questions about viral loads, positive sexual partners, and transmission through casual contact. Social motivational barriers to risk reduction included partner perceptions that prison release increases sexual desirability, partners’ negative condom attitudes, and HIV disclosure-related fears of rejection. Personal motivational barriers included depression and strong desires for sex or substance use upon release. Behavioral skills needs included initiating safer behaviors with partners with whom condoms had not been used prior to incarceration, disclosing HIV status, and acquiring clean needles or condoms upon release. Stigma and privacy concerns were prominent prison context barriers to delivering HIV prevention services during incarceration.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 121-31.
Behavior, Intention or Chance? A Longitudinal Study of HIV Seroadaptive Behaviors, Abstinence and Condom Use.
McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, Colfax G, Robertson T, Truong HH, Raymond HF.
HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, Willi_McFarland@hotmail.com.
Abstract/1st page image: http://www.springerlink.com/content/e705272h7x518533/
Seroadaptive behaviors have been widely described as preventive strategies among men who have sex with men (MSM) and other populations worldwide. However, causal links between intentions to adopt seroadaptive behaviors and subsequent behavior have not been established. We conducted a longitudinal study of 732 MSM in San Francisco to assess consistency and adherence to multiple seroadaptive behaviors, abstinence and condom use, whether prior intentions predict future seroadaptive behaviors and the likelihood that observed behavioral patterns are the result of chance. Pure serosorting (i.e., having only HIV-negative partners) among HIV-negative MSM and seropositioning (i.e., assuming the receptive position during unprotected anal sex) among HIV-positive MSM were more common, more successfully adhered to and more strongly associated with prior intentions than consistent condom use. Seroconcordant partnerships occurred significantly more often than expected by chance, reducing the prevalence of serodiscordant partnerships. Having no sex was intended by the fewest MSM, yet half of HIV-positive MSM who abstained from sex at baseline also did so at 12 month follow-up. Nonetheless, no preventive strategy was consistently used by more than one-third of MSM overall and none was adhered to by more than half from baseline to follow-up. The effectiveness of seroadaptive strategies should be improved and used as efficacy endpoints in trials of behavioral prevention interventions.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 132-8.
Disclosure of HIV Status to Sex Partners Among HIV-Infected Men and Women in Cape Town, South Africa.
Vu L, Andrinopoulos K, Mathews C, Chopra M, Kendall C, Eisele TP.
HIV and AIDS Program, Population Council, Washington, DC, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/02h8602053730410/
This study examines factors influencing HIV sero-status disclosure to sex partners among a sample of 630 HIV-infected men and women with recent sexual contact attending anti-retroviral therapy (ART) clinics in Cape Town, South Africa, with a focus on sex partner type, HIV-related stigma, and ART as potential correlates. About 20% of the sample had not disclosed their HIV status to their most recent sex partners. HIV disclosure to sex partner was more likely among participants who had a steady sex partner [Adjusted odds ratio (AOR) = 2.7; 95% CI: 1.6-4.6], had a partner with known-HIV status [AOR = 7.8; 95% CI: 3.2-18.7]; perceived less stigma [AOR = 1.9; 95% CI: 1.2-2.9]; and were on ART [AOR = 1.6; 95% CI: 1.1-2.3]. Stratified analyses by the type of sex partner further reveals that stigma and ART were significantly associated with HIV disclosure within steady relationships but were not significant correlates of HIV disclosure with casual sex partners. The findings support a positive prevention strategy that emphasizes increased access to ART, and behavioral interventions to reduce casual sex partnerships for persons who are HIV-positive. Mitigating the influence of HIV stigma on HIV status disclosure particularly within steady sex partnerships is also important and may be accomplished through individual and couple counseling.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 139-50.
Sexual Risk Behaviors Among HIV-Infected South African Men and Women with Their Partners in a Primary Care Program: Implications for Couples-Based Prevention.
Venkatesh KK, de Bruyn G, Lurie MN, Modisenyane T, Triche EW, Gray GE, Welte A, Martinson NA.
Department of Community Health, Alpert Medical School, Brown University, Providence, RI, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/551268624m1un846/
We studied 1163 sexually-active HIV-infected South African men and women in an urban primary care program to understand patterns of sexual behaviors and whether these behaviors differed by partner HIV status. Overall, 40% reported a HIV-positive partner and 60% a HIV-negative or status unknown partner; and 17.5% reported >2 sex acts in the last 2 weeks, 16.4% unprotected sex in the last 6 months, and 3.7% >1 sex partner in the last 6 months. Antiretroviral therapy (ART) was consistently associated with decreased sexual risk behaviors, as well as with reporting a HIV-negative or status unknown partner. The odds of sexual risk behaviors differed by sex; and were generally higher among participants reporting a HIV-positive partner, but continued among those with a HIV-negative or status unknown partner. These data support ART as a means of HIV prevention. Engaging in sexual risk behaviors primarily with HIV-positive partners was not widely practiced in this setting, emphasizing the need for couples-based prevention.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 151-8.
Changes in Stimulant Drug Use Over Time in the MACS: Evidence for Resilience Against Stimulant Drug Use Among Men Who Have Sex with Men.
Lim SH, Ostrow D, Stall R, Chmiel J, Herrick A, Shoptaw S, Kao U, Carrico A, Plankey M.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Abstract/1st page image: http://www.springerlink.com/content/u86247j28712h65u/
Stimulant drug use is associated with numerous health problems among men who have sex with men (MSM). This paper describes how stimulant drug use changes over a four and one-half year period from 2003 until 2008. Participants were 2,389 men (17,222 person-visits) from The Multicenter AIDS Cohort Study (MACS)-an ongoing, prospective study of HIV infection among MSM. Group-based trajectory analyses of data from these men over the study period yielded a four groups solution: consistent users (9.8%), men whose use increased (5.4%), men whose use declined (6.9%), and abstinent or rarely-using men (77.9%). There were significant differences between groups in terms of demographic, behavioral risk and HIV serostatus. Men who increased or decreased stimulant drug use over time reported congruent changes in sexual risk taking. The fact that sexual risk levels parallel stimulant drug use over time suggests that finding ways to lower rates of stimulant drug use among MSM could be a tool in HIV prevention.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 159-67.
Darbes LA, Chakravarty D, Beougher SC, Neilands TB, Hoff CC.
Center for AIDS Prevention Studies, University of California, San Francisco, CA, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/a5n4p730j556127t/
We investigated the influence of partner-provided HIV-specific and general social support on the sexual risk behavior of gay male couples with concordant, discordant, or serostatus-unknown outside partners. Participants were 566 gay male couples from the San Francisco Bay Area. HIV-specific social support was a consistent predictor for reduced unprotected anal intercourse (UAI) with both concordant outside partners (all couple types) and outside partners of discordant or unknown serostatus (concordant negative and discordant couples). General social support was associated with increased UAI with concordant outside partners for concordant negative and concordant positive couples (i.e., serosorting). Our findings suggest that prevention efforts should target couples and identify the level of HIV-specific support that partners provide. Partner-provided support for HIV-related behaviors could be an additional construct to consider in gay male relationships, akin to relationship satisfaction and commitment, as well as an important component of future HIV prevention interventions.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 168-78.
German D, Latkin CA.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/r76375516955pt04/
This study evaluated a cumulative and syndromic relationship among commonly co-occurring vulnerabilites (homelessness, incarceration, low-income, residential transition) in association with HIV-related risk behaviors among 635 low-income women in Baltimore. Analysis included descriptive statistics, logistic regression, latent class analysis and latent class regression. Both methods of assessing multidimensional instability showed significant associations with risk indicators. Risk of multiple partners, sex exchange, and drug use decreased significantly with each additional domain. Higher stability class membership (77%) was associated with decreased likelihood of multiple partners, exchange partners, recent drug use, and recent STI. Multidimensional social vulnerabilities were cumulatively and synergistically linked to HIV risk behavior. Independent instability measures may miss important contextual determinants of risk. Social stability offers a useful framework to understand the synergy of social vulnerabilities that shape sexual risk behavior. Social policies and programs aiming to enhance housing and overall social stability are likely to be beneficial for HIV prevention.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 179-88.
Gender Power Control, Sexual Experiences, Safer Sex Practices, and Potential HIV Risk Behaviors Among Young Asian-American Women.
Hahm HC, Lee J, Rough K, Strathdee SA.
School of Social Work, Boston University, Boston, MA, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/8326475777614506/
We examined the prevalence of three domains of sexual behaviors among young Asian-American women: sexual experiences, safer sex practices, and potential HIV risk behaviors. We also investigated the impact of gender power control on these domains. Among sexually experienced women, 51% reported using condoms during their most recent sex act, 63% reported inconsistent condom use, and 18% reported ever having forced sex. Multiple logistic regression analyses revealed that women’s perceived lower relationship power control was not associated with vaginal sex or safer sex practices, but it was powerfully associated with forced sex and all three potential HIV risk behaviors. This study demonstrates that control within young Asian-American women’s intimate relationships exerts different associations depending on the type of sexual behavior. The application of the Theory of Gender and Power should be employed with prudence when designing HIV interventions for this population.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 189-98.
Choice-Disability and HIV Infection: A Cross Sectional Study of HIV Status in Botswana, Namibia and Swaziland.
Andersson N, Cockcroft A.
Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Calle Pino, El Roble, Acapulco, Mexico, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/w4w3361157122250/
Interpersonal power gradients may prevent people implementing HIV prevention decisions. Among 7,464 youth aged 15-29 years in Botswana, Namibia and Swaziland we documented indicators of choice-disability (low education, educational disparity with partner, experience of sexual violence, experience of intimate partner violence (IPV), poverty, partner income disparity, willingness to have sex without a condom despite believing partner at risk of HIV), and risk behaviours like inconsistent use of condoms and multiple partners. In Botswana, Namibia and Swaziland, 22.9, 9.1, and 26.1% women, and 8.3, 2.8, and 9.3% men, were HIV positive. Among both women and men, experience of IPV, IPV interacted with age, and partner income disparity interacted with age were associated with HIV positivity in multivariate analysis. Additional factors were low education (for women) and poverty (for men). Choice disability may be an important driver of the AIDS epidemic. New strategies are needed that favour the choice-disabled.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 199-213.
Kissinger P, Kovacs S, Anderson-Smits C, Schmidt N, Salinas O, Hembling J, Beaulieu A, Longfellow L, Liddon N, Rice J, Shedlin M.
Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/44q6v424365085ku/
The purpose of this study was to examine patterns and predictors of HIV/STI risk over time among Latino migrant men in a new receiving community. Latino men (N = 125) were interviewed quarterly for 18 months and HIV/STI tested annually. Selected individual, environmental and cultural factors by partner type and condom use were explored longitudinally and in a cross-section. Sex with female sex workers (FSWs) and multiple partners decreased, sex with main partners and abstinence increased, while the number of casual partners remained stable. Consistent condom use was highest with FSWs, lowest with main partners and midrange with casual partners with no trends over time. STI morbidity was low; no HIV was detected. Drug use and high mobility were associated with inconsistent condom use with FSW, whereas having family in the household was protective. HIV/STI prevention efforts should focus on drug using Latino migrants who are highly mobile and should foster healthy social connections.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 214-24.
Social Network Characteristics and HIV Vulnerability Among Transgender Persons in San Salvador: Identifying Opportunities for HIV Prevention Strategies.
Barrington C, Wejnert C, Guardado ME, Nieto AI, Bailey GP.
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/701512g70h386t0p/
The purpose of this study is to improve understanding of HIV vulnerability and opportunities for HIV prevention within the social networks of male-to-female transgender persons in San Salvador, El Salvador. We compare HIV prevalence and behavioral data from a sample of gay-identified men who have sex with men (MSM) (n = 279), heterosexual or bisexual identified MSM (n = 229) and transgender persons (n = 67) recruited using Respondent Driven Sampling. Transgender persons consistently reported higher rates of HIV risk behavior than the rest of the study population and were significantly more likely to be involved in sex work. While transgender persons reported the highest rates of exposure to HIV educational activities they had the lowest levels of HIV-related knowledge. Transgender respondents’ social networks were homophilous and efficient at recruiting other transgender persons. Findings suggest that transgender social networks could provide an effective and culturally relevant opportunity for HIV prevention efforts in this vulnerable population.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 225-230.
De Ryck I, Van Laeken D, Nöstlinger C, Platteau T, Colebunders R; The Eurosupport Study Group.
HIV AIDS Center, Institute of Tropical Medicine, Nationalestraat, Antwerp, Belgium, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/w37023832h628107/
This study determined risk factors for decreased sexual satisfaction among men living with HIV (MLHIV). Self-administered questionnaires were distributed consecutively to all MLHIV attending 17 European HIV treatment centres. The sample included 1,017 MLHIV, among whom 79.2% self-identified as homosexual or bisexual. Sexual satisfaction was measured for five domains of sexual functioning and 33.2% reported low satisfaction in at least one domain. Decreased sexual satisfaction was associated with psychosocial factors, i.e. depression (OR 2.77, P < 0.001), anxiety (OR 1.77, P < 0.001), stress (OR 2.27, P < 0.001) and social factors, such as low partner support (OR 2.28, P < 0.001) and experiences of HIV related discrimination (OR 1.69, P < 0.001). Discussing satisfaction with sexuality should be integrated in regular HIV care, considering patients’ personal and relationship-related resources next to medical treatment if indicated.
AIDS & Behavior, Jan 2012, Vol. 16, 1, p. 231-43.
Enhancing Labour Force Participation for People Living with HIV: A Multi-Perspective Summary of the Research Evidence.
Worthington C, O’Brien K, Zack E, McKee E, Oliver B.
Faculty of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/v5tk8603143jg18r/
Labour force participation has been identified as a critical social and health issue facing people living with HIV/AIDS (PHAs). We conducted a scoping study (a form of literature synthesis that summarizes research findings, research activity, and identifies literature strengths and gaps) on labour force participation for PHAs, guided by a community advisory committee. We summarized information from 243 peer-reviewed articles and 42 reports from the grey literature, and synthesized the evidence into a preliminary conceptual framework with five components: (1) the meaning of work, (2) key factors (barriers and facilitators) influencing labour force participation, (3) factors affecting vulnerable populations, (4) strategies and supports for returning to or sustaining work, and (5) outcomes (benefits and risks) of labour force participation for individuals and employers. The framework supports the development of labour force initiatives requiring collaborative efforts in multiple domains (health, employment, community) by PHAs, rehabilitation professionals, employers, insurers, and policy makers.
Women’s Health Issues, Volume 22, Issue 1 (January–February 2012) Pages e1-e7
Michael D. Stein, Celeste M. Caviness, Bradley J. Anderson
Introduction and Background: At the time of incarceration, women have a high prevalence of sexually transmitted infections (STI). In the months after community release, women remain at high risk for new infections. This study assessed the rates and predictors of incident chlamydia, gonorrhea, and trichomoniasis in a sample of hazardously drinking women after incarceration.
Methods: Self-reported behavioral data were collected from 245 incarcerated women. Vaginal swabs were collected at baseline, and 3- and 6-month time points and tested for chlamydia, gonorrhea, and trichomoniasis. Treatment was provided for all positive tests.
Results: Participants’ mean age was 34.1 years of age; 175 (71.4%) were Caucasian, 47 (19.2%) were African American, 17 (6.9%) were Hispanic, and 6 (2.4%) were of other ethnic origins. The STI incidence rate was estimated to be 30.5 (95% confidence interval, 21.3–43.5) new infections per 100 person-years. Number of male sex partners reported during follow-up was a significant (z = 2.16; p = .03) predictor of STI; each additional male sex partner increased the estimated hazard of STI by 1.26.
Conclusion: Incarcerated women who are hazardous drinkers are at high risk for STI in the months after their return to the community. In addition to testing and treatment during incarceration, post-release rescreening, education, partner treatment, and follow-up are recommended.
Women’s Health Issues, Volume 22, Issue 1 (January–February 2012) Pages e9-e18
Sexual Risk Behaviors among African-American and Hispanic Women in Five Counties in the Southeastern United States: 2008–2009
Eleanor McLellan-Lemal, Christine M. O’Daniels, Gary Marks, Olga Villar-Loubet, Irene A. Doherty, Cathy Simpson, Stephen Weiss, Barbara Hanna, Adaora A. Adimora, Becky L. White, John T. Wheeling, Craig B. Borkowf
Purpose: We examined sexual risk behaviors and unrecognized HIV infection among heterosexually active African-American and Hispanic women.
Methods: Women not previously diagnosed with HIV infection were recruited in rural counties in North Carolina (African American) and Alabama (African American), and an urban county in southern Florida (Hispanic) using multiple methods. They completed a computer-administered questionnaire and were tested for HIV infection.
Results: Between October 2008 and September 2009, 1,527 women (1,013 African American and 514 Hispanic) enrolled in the study. Median age was 35 years (range, 18–59), 33% were married or living as married, 50% had an annual household income of $12,000 or less, and 56% were employed full or part time. Two women (0.13%) tested positive for HIV. In the past 12 months, 19% had been diagnosed with a sexually transmitted infection (other than HIV), 87% engaged in unprotected vaginal intercourse (UVI), and 26% engaged in unprotected anal intercourse (UAI). In multivariate analysis, UAI was significantly (p < .05) more likely among those who reported ever being pregnant, binge drinking in the past 30 days, ever exchanging sex for things needed or wanted, engaging in UVI, or being of Hispanic ethnicity. UAI was also more likely to occur with partners with whom women had a current or past relationship as opposed to casual partners.
Conclusion: A high percentage of our sample of heterosexually active women of color had recently engaged in sexual risk behaviors, particularly UAI. More research is needed to elucidate the interpersonal dynamics that may promote this high-risk behavior. Educational messages that explicitly address the risks of heterosexual anal intercourse need to be developed for heterosexually active women and their male partners.
Women’s Health Issues, Volume 22, Issue 1 (January–February 2012) Pages e19-e26
Appalachian and Non-Appalachian Pediatricians’ Encouragement of the Human Papillomavirus Vaccine: Implications for Health Disparities
Janice L. Krieger, Mira L. Katz, Jennifer A. Kam, Anthony Roberto
Background: In medically underserved regions such as Appalachia, cervical cancer incidence and mortality are higher than the general U.S. population; therefore, it is important for pediatricians to encourage parents to have their daughters vaccinated against the human papillomavirus (HPV). Unfortunately, little is known about the predictors of pediatricians’ encouragement of the HPV vaccine among medically underserved populations. The current study compared attitudes and behaviors of pediatricians with practices in Appalachia with those in non-Appalachia to identify potential strategies for reducing health disparities.
Methods: A survey was conducted with 334 pediatricians located in Appalachia and non-Appalachia counties to examine how prior behavior, perceived susceptibility, severity, self-efficacy, response-efficacy, and behavioral intentions are related to self-reported vaccine encouragement.
Results: Pediatricians in Appalachia perceived their patients to be less susceptible to HPV and reported lower rates of HPV encouragement than pediatricians in non-Appalachia. In addition, self-efficacy had a significant indirect association with vaccine encouragement for pediatricians in non-Appalachia.
Conclusion: This study’s findings emphasize the importance of increasing Appalachian pediatricians’ awareness of their patients’ susceptibility to HPV. Broader efforts to increase encouragement of the HPV vaccine among pediatricians should focus on promoting self-efficacy to encourage the HPV vaccine to parents of young females.
Women’s Health Issues, Volume 22, Issue 1 (January–February 2012) Pages e27-e33
Allison R. Webel, Patricia A. Higgins
Background: The social roles that women perform can be complicated and may affect their health. While there is some evidence describing traditional social roles of women, there is little evidence exploring the impact of those roles on how a woman manages a chronic condition. The purpose of this paper is to identify and examine the main social roles of 48 HIV infected women, and to explore how these roles relate to their self-management of HIV/AIDS.
Methods: Forty-eight HIV infected, adult women were recruited from HIV clinics and AIDS service organizations in Northeast Ohio. All participants participated in one of 12 digitally recorded focus groups. All data were analyzed using qualitative description methodology.
Results: The participants were predominantly middle-aged (mean = 42 years), African American (69%), and single (58%). Analysis revealed six social roles that these women experience and which affect their self-management. These social roles are: Mother/Grandmother, Believer, Advocate, Stigmatized Patient, Pet Owner, and Employee. These roles had both a positive and negative effect on a woman’s self-management of her HIV disease and varied by age and time living with HIV.
Conclusion: Women living with HIV/AIDS struggle to manage the many daily tasks required to live well with this disease. The social context in which this self-management happens is important, and the various social roles that women perform can facilitate or hinder them from completing these tasks. Healthcare and social service providers should learn about these roles in their individual patients, particularly how these roles can be developed to increase HIV/AIDS self-management.
Women’s Health Issues, Volume 22, Issue 1 (January–February 2012) Pages e35-e43
Do Asian-American Women Who Were Maltreated as Children Have a Higher Likelihood for HIV Risk Behaviors and Adverse Mental Health Outcomes?
Hyeouk Chris Hahm, Eric Kolaczyk, Yookyong Lee, Jisun Jang, Lisa Ng
Objectives: This study is the first to systematically investigate whether multiple child maltreatment is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women.
Methods: We conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women (n = 400), aged 18 to 35, who are identified as children of immigrants, using computer-assisted survey interviews.
Results: Approximately 7 in 10 women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Only 15% of our sample reported having sex at age 16 or before, yet almost 60% had ever engaged with potentially risky sexual partners. Contrary to the findings from previous studies of White and Black women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors among Asian-American women. However, it was associated with a marked increase in depression, lifetime suicidal ideation, and suicide attempts. A higher education level was associated with increased odds of HIV risk behaviors, including ever having had anal sex and ever having potentially risky sexual partners.
Conclusion: There was no evidence indicating that multiple child maltreatment was linked with HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. These empirical patterns of internalizing trauma, suffering alone, and staying silent are in accord with Asian-cultural norms of saving face and maintaining family harmony. The prevention of multiple child maltreatment may reduce high levels of depression and suicidal behaviors in this population. It is urgent to identify victims of multiple child maltreatment and provide culturally appropriate interventions.
Women’s Health Issues, Volume 22, Issue 1 (January–February 2012) Pages e45-e52
Joanne Klevens, Laura Sadowski, Romina Kee, William Trick, Diana Garcia
Background: Although under debate, routine screening for intimate partner violence (IPV) is recommended in health care settings. This study explored the utility of different screening and referral strategies for women exposed to IPV in primary health care.
Methods: Using a randomized controlled trial design we compared two screening strategies (health care providers [HCP] versus audio computer-assisted self-interviews [A-CASI]) and three referral strategies (HCP alone, A-CASI referral with HCP endorsement, and A-CASI alone). English-speaking women who were 18 years and older and were attending women’s health clinics at a public hospital were eligible to participate. Participants were randomly assigned to one of three study groups (HCP screen and referral, A-CASI screen and referral with HCP referral endorsement, and A-CASI screen and referral). Women were reinterviewed by telephone 1 week later. The primary outcome was rate of IPV disclosure; secondary outcomes were screening mode preference, reactions to IPV screening, and use of referral resources.
Results: Of the 129 eligible women, 126 women were enrolled (98%); 102 women (81% of those enrolled) completed the follow-up telephone interview. Disclosure rates were higher for women screened with A-CASI compared with HCP-screened women (21% vs. 9%; p = .07). Screening mode preference, impact of screening (positive and negative reactions), and rates of use of referral resources were similar between study groups.
Conclusion: A-CASI tended to yield higher rates of IPV disclosure and similar rates of use of referral resources. A-CASI technology may be a practical way to screen for IPV.