RESUMEN
High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.
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Evaluación de Programas y Proyectos de Salud , HumanosRESUMEN
CONTEXT: Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic-government relationships. METHODS: We conducted in-depth interviews with 52 faculty at one school of public health and 24 government decision-makers at city, state, federal and global levels. Interviews were transcribed and coded deductively and inductively using Atlas.Ti. Responses across codes and respondents were extracted into an Excel matrix and compared in order to identify key themes. FINDINGS: Eight key drivers to engagement were identified, namely (1) decision-maker research needs, (2) learning, (3) access to resources, (4) student opportunities, (5) capacity strengthening, (6) strategic positioning, (7) institutional conditionalities, and (8) funder conditionalities. There were several elements that enabled initiation of relationships, including the role of faculty members in the decision-making process, individual attributes and reputation, institutional reputation, social capital, and the role of funders. Maintenance of partnerships was dependent on factors such as synergistic collaboration (i.e. both benefit), mutual trust, contractual issues and funding. Dissolution of relationships resulted from champions changing/leaving positions, engagement in transactional relationships, or limited mutual trust and respect. CONCLUSIONS: As universities and government agencies establish relationships and utilise opportunities to share ideas, envision change together, and leverage their collaborations to use evidence to inform decision-making, a new modus operandi becomes possible. Embracing the individual, institutional, networked and systems dynamics of relationships can lead to new practices, alternate approaches and transformative change. Government agencies, schools of public health and higher education institutions more broadly, should pay deliberate attention to identifying and managing the various drivers, enablers and disablers for relationship initiation and resilience in order to promote more evidence-informed decision-making.
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Personal Administrativo/organización & administración , Educación en Salud Pública Profesional/organización & administración , Agencias Gubernamentales/organización & administración , Relaciones Interinstitucionales , Investigadores/organización & administración , Creación de Capacidad , Femenino , Política de Salud , Humanos , Entrevistas como Asunto , Aprendizaje , Masculino , Salud Pública , Universidades/organización & administración , Compromiso LaboralRESUMEN
BACKGROUND: Little is known regarding the possible role of social network members and peer attitudes on emergency department (ED) patients' willingness to be tested for HIV. METHODS: We conducted mixed methods in-depth interview and quantitative survey with ED patients from November 2013 to June 2014 to assess peer and personal perceptions of ED-based HIV testing. Patients enrolled were asked about their own attitudes toward HIV testing as well as those of their friends. Interviews were transcribed and categories that captured free responses in the verbatim were independently coded by two reviewers. RESULTS: Overall, 86 patients were enrolled including 22 HIV known positive. Among 64 HIV-negative participants, 50 were tested during the past 12 months and 4 had never been tested. The majority (82.5%) of participants thought that their friends were likely to accept HIV testing in EDs. Participants discussed their perceptions of friends' attitudes toward HIV testing: the majority (60%) believed their friends held positive attitudes about HIV testing. The majority of participants believed that their friends had positive feelings about HIV testing and were likely to accept testing in ED settings. CONCLUSIONS: Interventions utilizing peer networks to promote HIV testing and increase testing acceptance could be designed and explored.
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Servicio de Urgencia en Hospital , Amigos/psicología , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Tamizaje Masivo/psicología , Adolescente , Adulto , Anciano , Baltimore , Femenino , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Aceptación de la Atención de Salud , Pruebas Serológicas , Encuestas y Cuestionarios , Población Urbana , Adulto JovenRESUMEN
BACKGROUND: Evaluations of overdose response programs suggest effectiveness in preventing overdose-related death and individual willingness to respond to an overdose. However, knowledge of and confidence in performing response behaviors is necessary for individuals to intervene. This study assessed overdose responding self-efficacy among adults who reported lifetime opioid use. METHODS: Data come from a cross-sectional survey, part of a randomized controlled trial designed for adults living with hepatitis C. Participants were 18 years old or older, and reported lifetime opioid use. Overdose responding self-efficacy was assessed by perceived knowledge and/or need for additional training to have confidence responding to an overdose. Univariate statistics were calculated for overdose responding self-efficacy, and individual characteristics and experiences. Adjusted logistic regression was used to identify variables associated with low overdose responding self-efficacy. RESULTS: Of the 424 participants, 67.2% reported low overdose responding self-efficacy. Sixty percent witnessed and 30.4% experienced an overdose in the past year. Witnessing an overdose in the past year, experience with naloxone training, and receiving and using naloxone were associated with high overdose responding self-efficacy. While, apprehension with particular response behaviors (e.g. rescue breathing) was associated with low overdose responding self-efficacy. CONCLUSIONS: A large proportion of adults who reported lifetime opioid use did not feel confident or knowledgeable responding to an overdose. This could be influenced by overdose exposure, specific response behaviors, and response trainings.
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Sobredosis de Droga/tratamiento farmacológico , Sobredosis de Droga/psicología , Trastornos Relacionados con Opioides/psicología , Autoeficacia , Adulto , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hepatitis C/complicaciones , Hepatitis C/psicología , Humanos , Masculino , Persona de Mediana Edad , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Abuso de Sustancias por Vía Intravenosa , Encuestas y CuestionariosRESUMEN
BACKGROUND: Fentanyl-related mortality has skyrocketed among people who use opioids (PWUO) in North America. The current study of PWUO aims to examine the perceived fentanyl risk and training needs; fatal overdose prevention behaviors; and, feasibility of a peer education approach to reducing fentanyl-related fatal overdoses in Baltimore, Maryland, USA. METHODS: 316 street-recruited PWUO were interviewed about fentanyl in Baltimore, MD. RESULTS: Most participants (56%) reported that "all" or "almost all" heroin in Baltimore was adulterated with fentanyl and were worried (75%) about their drug buddies overdosing on fentanyl. Half (54%) the participants felt that they needed more training to respond to an overdose. Many participants (66%) reported receiving naloxone or a prescription for it, yet only 17% carried naloxone with them "often" or "always." Among people who inject drugs (PWID) only 13% had naloxone available "often" or "always" when they injected with others, and 51% "often" or "always" injected alone. Almost half of participants (47%) were "very willing" to talk with people in their neighborhood about fentanyl. CONCLUSIONS: The majority of PWUO perceived that most heroin in Baltimore was adulterated with fentanyl, yet most did not carry naloxone and PWID often did so alone. Given the high perceived risk of fentanyl and relatively low uptake of fatal overdose prevention behaviors, there is an urgency for safe injection facilities, access to medically assisted treatment, and programs that work with the drug-using community to deliver overdose prevention training as well as promote behaviors to carry naloxone and not use drugs alone.
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Sobredosis de Droga/prevención & control , Fentanilo/efectos adversos , Conocimientos, Actitudes y Práctica en Salud , Trastornos Relacionados con Opioides/psicología , Asunción de Riesgos , Adulto , Baltimore , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Depression and substance use are highly comorbid, and stigmatized, mental health conditions influenced by social network factors. The objective of this study was to explore the role of perceived depression and perceived mental health stigma among friends on self-reported depression over time. Between 2009 and 2012, 527 participants who used drugs completed baseline and 6-month follow-up surveys in Baltimore, Maryland. Logistic regression was used to assess whether perceived depression and stigma among friends were associated with personal depressive status before and after accounting for depressive status at baseline. A total of 309 participants (58.6%) had depressive symptoms at baseline, while 207 participants (39.3%) had depressive symptoms at follow-up. Not accounting for baseline depression, perceiving friends as being depressed (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI] [1.12, 1.56]) and as having stigmatizing attitudes toward mental health conditions (AOR = 1.92, 95% CI [1.31, 2.79]) were associated with increased odds of personal depression. After accounting for baseline depression, the relationship between personal depression and perceived stigma was marginally significant, while the relationship between personal depression and perceived depression among friends was attenuated. These results suggest that baseline depression is the largest predictor of follow-up depression. Future research should explore whether specific aspects of perceived stigma independently account for personal depression.
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Depresión/psicología , Consumidores de Drogas/psicología , Amigos/psicología , Estigma Social , Adulto , Baltimore , Estudios Transversales , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Percepción , AutoinformeRESUMEN
BACKGROUND: There has been a dramatic increase in drug overdose deaths in the United States. In the current study, the authors examined factors associated with witnessing a drug overdose. METHODS: A sample of 450 substance users in Baltimore, Maryland, were recruited for a behavioral intervention and were administered a survey. Multinomial logistic regression models were used to compare participants who never witnessed a drug overdose with those who witnessed one in the prior 6 months and those who witnessed an overdose over 6 months ago. RESULTS: Most (58%) participants were male, 40% experienced homelessness in the prior 6 months, 63% reported a history of heroin injecting, 84% had snorted heroin, 75% reported witnessing a drug overdose, and 38% experienced an overdose. In multinomial logistic regression models, witnessing an overdose in the past 6 months was associated with number of different types of places where drugs were used (adjusted odds ratio [aOR] = 1.34), history of experiencing an overdose (aOR = 1.80), injecting heroin and/or speedball (aOR = 1.78), and snorting heroin (aOR = 1.54). Witnessing an overdose more than 6 months ago was associated with number of different places where drugs were used (aOR = 1.25), history of experiencing an overdose (aOR = 1.61), snorting heroin (aOR = 1.42), and injecting heroin or speedball (aOR = 1.47). CONCLUSIONS: These data suggest that people who engage in more public and frequent drug use, and hence are more likely to witness an overdose, should be targeted for interventions to prevent and treat drug overdose.
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Sobredosis de Droga , Consumidores de Drogas/psicología , Observación , Adolescente , Adulto , Baltimore , Sobredosis de Droga/prevención & control , Sobredosis de Droga/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
Introduction: Economic disparities in rates of smoking have been well documented in many countries. These disparities exist on an individual and geographic or neighborhood level. This cross-sectional study examined the relationship between neighborhood physical and social disorder and barriers to smoking cessation among an impoverished urban sample. Methods: A sample of current smokers were recruited through street outreach, posted advertisements, and word of mouth from impoverished neighborhoods in Baltimore, Maryland, USA for a study of psychosocial factors and smoking behaviors. Neighborhood disorder was assessed with a 10-item scale from the Block Environmental Inventory and barriers to cessation with a 9-item scale. Results: In the multiple logistic regression model, perceived stress (aOR = 1.60, 95% CI = 1.32 to 1.95), neighborhood disorder (aOR= 1.34, 95% CI = 1.11 to 1.63), and level of nicotine dependence (aOR = 1.97), 95% CI = 1.62 to 2.40) were all strongly associated with barriers to cessation. Conclusion: The results of this study suggest that neighborhood disorder may lead to barriers to cessation among low-income populations. The findings also indicate that tobacco control interventions should examine and address social and physical aspects of impoverished neighborhoods. Implications: In many countries, tobacco control programs and policies have been less effective among low-income populations as compared to more affluent populations. Little is known about how neighborhood factors influence smoking cessation. This study examined the relationship between neighborhood disorder and barriers to cessation among a low-income population. We recruited a convenience sample of hard-to-reach cigarette smokers from low-income neighborhoods. Even after controlling for level of nicotine dependence and stress, neighborhood disorder was found to be associated with barriers to cessation. The findings suggest the important role of neighborhood disorder as a barrier to smoking cessation.
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Pobreza/economía , Características de la Residencia , Fumadores , Cese del Hábito de Fumar/economía , Fumar/economía , Fumar/terapia , Adulto , Baltimore/epidemiología , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Pobreza/psicología , Fumadores/psicología , Fumar/epidemiología , Fumar/psicología , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Medio Social , Estados Unidos/epidemiologíaRESUMEN
Depression and depressive symptoms mediate the association between drug use and HIV risk. Yet, there are few interventions that target depressive symptoms and HIV risk for people who use drugs (PWUD). This study was a randomized controlled trial of an integrated cognitive behavioral therapy and HIV prevention intervention to reduce depressive symptoms, injection risk behaviors and increase condom use in a sample of urban people who used heroin or cocaine in the prior 6 months. A total of 315 individuals aged 18-55, who self-reported at least one HIV drug and sex risk behavior and scored ≥16 and <40 on the Centers for Epidemiologic Studies-Depression (CES-D) scale were randomized using a two-block design, stratified by sex to ensure equivalent numbers, to a 10 session intervention arm (n = 162) or a single session control arm (n = 153). The outcomes of interest were decreases in CES-D score and injection risk behaviors and increases in condom use. The sample was majority African American (85%) and unemployed (94%). Nearly half (47%) reported injection in the prior 6 months and only 19% were taking medication for depression. Follow-up assessments were conducted at 6 and 12 months. Retention at 12 months was 94%. Intervention arm was associated with statistically significantly lower CES-D score at 12 month compared to control. No differences were observed between arms in injection risk. At 6 month, intervention was associated with greater odds of condom use with non-main partner. These findings suggest the potential role of the integrated intervention in reducing depressive symptoms, but weak impact on HIV risk. This trial is registered with ClinicalTrials.gov under the title "Neighborhoods, Networks, Depression, and HIV Risk" number NCT01380613.
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Terapia Cognitivo-Conductual , Depresión/terapia , Infecciones por VIH/psicología , Adolescente , Adulto , Condones , Femenino , Infecciones por VIH/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa , Adulto JovenRESUMEN
BACKGROUND: Social desirability response bias may lead to inaccurate self-reports and erroneous study conclusions. The present study examined the relationship between social desirability response bias and self-reports of mental health, substance use, and social network factors among a community sample of inner-city substance users. METHODS: The study was conducted in a sample of 591 opiate and cocaine users in Baltimore, Maryland from 2009 to 2013. Modified items from the Marlowe-Crowne Social Desirability Scale were included in the survey, which was conducted face-to-face and using Audio Computer Self Administering Interview (ACASI) methods. RESULTS: There were highly statistically significant differences in levels of social desirability response bias by levels of depressive symptoms, drug use stigma, physical health status, recent opiate and cocaine use, Alcohol Use Disorders Identification Test (AUDIT) scores, and size of social networks. There were no associations between health service utilization measures and social desirability bias. In multiple logistic regression models, even after including the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomology, social desirability bias was associated with recent drug use and drug user stigma. Social desirability bias was not associated with enrollment in prior research studies. CONCLUSIONS: These findings suggest that social desirability bias is associated with key health measures and that the associations are not primarily due to depressive symptoms. Methods are needed to reduce social desirability bias. Such methods may include the wording and prefacing of questions, clearly defining the role of "study participant," and assessing and addressing motivations for socially desirable responses.
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Trastornos Relacionados con Cocaína/psicología , Trastornos Relacionados con Opioides/psicología , Deseabilidad Social , Adolescente , Adulto , Baltimore , Femenino , Estado de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Autoinforme , Apoyo Social , Salud Urbana , Adulto JovenRESUMEN
Scarce research has explored how sex partners and their provision of social support impact depression among women. The purpose of this study is to examine the role of social support (overall and specific types of support) provided by a sex partner on depressive symptoms among a sample of women (n = 295). We assessed depression using the Centers for Epidemiological Studies Depression Scale and used a social network inventory to evaluate partner characteristics and types of support provided. Overall 76% (n = 225) of the sample experienced depressive symptoms in the past 90 days. Approximately one-third of the sample had a partner who provided emotional support (33.9%), financial support (36.6%), or socialization support (40.0%). About 41% of women said their partner offered no support while 16.3% had a partner who gave all three types of support. These findings demonstrate that partners and the level and types of support provided should not be discounted in mental health assessments.
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Depresión/psicología , Parejas Sexuales , Apoyo Social , Adulto , Depresión/epidemiología , Depresión/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
BACKGROUND: Neighborhood disorder, signs of physical and social disorganization, has been related to a range of poor mental and physical health outcomes. Although individual factors have been widely associated with getting a mammogram, little is known about the impact of the neighborhood environment on a woman's decision to get a mammogram. METHODS: In a sample of women at risk for human immunodeficiency virus and sexually transmitted infections, we explored the role of perceptions of one's neighborhood on getting a mammogram. The study included two samples: women 40 to 49 years (n = 233) and women 50 years and older (n = 83). Data were collected from May 2006 through June 2008. RESULTS: Women age 50 years and older who lived in a neighborhood with disorder were 72% less likely to get a mammogram compared with women who lived in neighborhoods without disorder. There was no relationship for women age 40 to 49 years. CONCLUSIONS: Interventions are needed to increase awareness and encourage women living in neighborhoods with disorder to get a mammogram. In addition to interventions to increase mammography, programs are needed to decrease neighborhood disorder. Increasing neighborhood cohesion, social control, and empowerment could integrate health promotion programs to both reduce disorder and increase health behaviors.
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Conductas Relacionadas con la Salud , Mamografía/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza , Características de la Residencia , Adulto , Femenino , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Mamografía/psicología , Tamizaje Masivo/psicología , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Percepción , Enfermedades de Transmisión Sexual/epidemiología , Factores SocioeconómicosRESUMEN
Data from a social network-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention study with a total of 330 men and women at high risk for HIV/STIs were used to examine the relationships between substance use, depressive symptoms, general health, cardiovascular disease risk factors, sociodemographic characteristics, and systolic/diastolic blood pressure (SBP/DBP). Approximately 60% of the participants had prehypertension to stage 2 hypertension. In the base model, older patients (P<.0001), men (P=.003), and patients with poorer self-reported health (P=.029) were significantly associated with high SBP, whereas older age (P<.001) and higher body mass index (P<.001) were significantly associated with higher DBP. After adjusting for the base model, high frequency of alcohol drinking and high frequency of binge drinking remained significant for high SBP and DBP. These data suggest that future cardiovascular disease programs should target moderate alcohol consumption to improve blood pressure among individuals at high risk for HIV/STIs.
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Infecciones por VIH/epidemiología , Hipertensión/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Baltimore/epidemiología , Índice de Masa Corporal , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Autoinforme , Enfermedades de Transmisión Sexual/psicologíaRESUMEN
A large literature suggests that social norms contribute to HIV and substance use related behaviors. Less attention has been given to neighborhood factors that may contribute to the development of norms about risky behaviors. We examined the cross-sectional associations between perceptions of one's neighborhood and norms of perceived prevalence of, and peer support for sex exchange and risky injection behaviors. The sample consisted of 719 people who reported injecting heroin and cocaine and did not move in the past 6 months in Baltimore, MD. Living in a neighborhood with disorder was associated with believing that others exchanged sex, practiced risky injection behaviors (descriptive norms) and approved of risky injection behavior (injunctive norms).
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Características de la Residencia/estadística & datos numéricos , Normas Sociales , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Negro o Afroamericano , Baltimore/epidemiología , Trastornos Relacionados con Cocaína/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/transmisión , Dependencia de Heroína/epidemiología , Humanos , Masculino , Asunción de Riesgos , Conducta Sexual/etnología , Conducta Sexual/psicología , Abuso de Sustancias por Vía Intravenosa/psicologíaRESUMEN
One out of nine African-American men between the ages of 20 and 34 is behind bars, resulting in many African-American women losing their primary romantic partners to incarceration. Research suggests that partner incarceration may contribute to increased risk of sexually transmitted infections (STIs)/human immunodeficiency virus (HIV); however, factors associated with women's decisions to begin new sexual partnerships following partner incarceration (i.e., separational concurrency) have not been well studied. This study examined the social context relevant to initiating separational concurrency, following incarceration of a primary male partner. Cross-sectional secondary data analysis of 6-month follow-up data from the CHAT Project, a social-network based HIV/sexually transmitted disease (STD) prevention study in Baltimore, MD, USA. Participants were N = 196 African-American women, who reported ever having had a partner who was incarcerated for at least 6 months during the relationship. The majority (81.5%) of women were unemployed with a mean age of 41.7 years. Over half of the sample (59.5%) reported having used crack or heroin at least once in the previous 12 months; 48.5% of the women had experienced physical abuse, with over half of the sample reporting a lifetime history of emotional abuse (54.6%). Separational concurrency, defined as answering yes to the item, "While [your] partner was incarcerated, did you have any other sexual partners?," was the primary outcome measure. After adjusting for age, drug use and unemployment the multiple logistic regression model found that women who reported a history of physical or emotional abuse were over two times as likely to report separational concurrency than women without an abuse history [adjusted odds ratio (AOR), 2.24; 95% CI, 1.24, 4.05; p = .007 and AOR, 2.44; 95% CI, 1.33, 4.46; p = .004, respectively]. Individuals who reported a higher number of drug-using sex partners (AOR, 2.49; 95% CI, 1.4, 4.5; p = .002), sex exchange partners (AOR, 4.0; 95% CI, 1.8 8.9; p = .001), and sexual partners who engaged in concurrency (AOR: 2.67; 95% CI: 1.5, 4.8; p = .001) were significantly more likely to report separational concurrency. Conversely, participants who reported more female kin in their social networks (AOR, .808; 95% CI, .67, .97; p = .025), having known network members a longer time (AOR, .997; 95% CI, .993, .999; p = .043), and higher levels of trust for network members (AOR, .761; 95% CI, .63, .92; p = .005) were significantly less likely to report separational concurrency. Results of this study demonstrate that social network characteristics may be crucial to understanding separational concurrency among African-American urban women who have lost a partner to incarceration. Social network and other resource-based interventions, which provide instrumental, social, and economic resources to women who have experienced the loss of a partner to incarceration, may be important tools in empowering women and helping to reduce the disproportionate burden of STIs/HIV among low income, African-American women.
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Negro o Afroamericano/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Prisioneros/estadística & datos numéricos , Apoyo Social , Adolescente , Adulto , Baltimore/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Adulto JovenRESUMEN
Food insecurity has been linked to poor physical and mental health as well as HIV risk behaviors. While prior research has shown that drug users are prone to food insecurity it is unclear if drug use exacerbates the physical and psychosocial consequences. A sample of women who used drugs (DU) (specifically heroin and cocaine) and women who did not use drugs (NDU) were examined to determine if the relationship between food insecurity and depression varied by drug use status. Approximately 29% (n=128) of the total sample experienced food insecurity. DU women were more likely to be food insecure. There were no differences in receiving food stamps. After controlling for demographics and receiving food stamps, a significant association between food insecurity and depression existed for both DU and NDU women. The strength of this association was approximately double for NDU women. The study results suggest that it is critical to integrate mental health, food assistance, and other services.
RESUMEN
This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.
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Infecciones por VIH/prevención & control , VIH , Cumplimiento de la Medicación , Selección de Paciente , Apoyo Social , Infecciones por VIH/terapia , HumanosRESUMEN
Incarceration has been extensively linked with HIV and sexually transmitted infections (STIs). While a great deal of attention has been given to the risk behaviors of people who have been incarcerated, examination of the behaviors of partners of incarcerated individuals is also needed to understand the direct and indirect links between incarceration and HIV and to identify prevention avenues. In the present study, we hypothesize that incarceration is associated with risk behavior through attitudes and norms. The purpose of this paper is: (1) to describe the attitudes and norms about sexual behaviors that women have when a sexual partner is incarcerated; and (2) to examine the association between attitudes and norms with the behavior of having other sex partners while a main partner is incarcerated. In our sample (n = 175), 50 % of women reported having other sex partners while their partner was incarcerated. Our findings show that attitudes, descriptive norms (i.e., norms about what other people do), and injunctive norms (i.e., norms about what others think is appropriate) were associated with having other partners. Interventions designed for couples at pre- and post-release from prison are needed to develop risk reduction plans and encourage HIV/STI testing prior to their reunion.
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Actitud/etnología , Prisioneros , Conducta Sexual/etnología , Parejas Sexuales , Enfermedades de Transmisión Sexual/prevención & control , Medio Social , Adulto , Negro o Afroamericano , Condones/estadística & datos numéricos , Estudios Transversales , Femenino , Infecciones por VIH/prevención & control , Humanos , Persona de Mediana Edad , Asunción de Riesgos , Autoeficacia , Conducta Sexual/psicología , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/etnología , Salud UrbanaRESUMEN
We examined the relationship between sources of income and sex behaviors among a sample of low-income, sexually active women in Baltimore, MD (n = 517). Data were collected through interviews administered by a trained interviewer and audio computer-assisted self-interviewing (ACASI). The study assessed four categories of income: government payments, money from other people, selling items, and irregular jobs (i.e., odds jobs). Having multiple sex partners was associated with receiving income from other people [AOR: 2.60, 95% CI: 1.66-4.09], selling items [AOR: 2.67, 95% CI: 1.64-4.36], and irregular jobs [AOR: 1.57, 95% CI: 1.08, 2.29]. Women who exchanged sex were more likely to acquire income through these sources but less likely to receive government assistance [AOR: 0.62, 95% CI: 0.39-0.97]. Sexual behaviors are associated with multiple sources of personal income. HIV prevention interventions should address the role that economic factors play in risk behaviors.
Asunto(s)
Infecciones por VIH , Renta , Asunción de Riesgos , Conducta Sexual , Adolescente , Adulto , Baltimore , Estudios Transversales , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Heterosexualidad , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Análisis Multivariante , Encuestas y Cuestionarios , Sexo Inseguro , Población Urbana , Adulto JovenRESUMEN
OBJECTIVE: Social networks can either negatively or positively influence a variety of behaviors, including alcohol use. This study examined social network characteristics that are risk factors for and protective factors against heavy episodic drinking among a sample of women at risk for HIV/sexually transmitted infections. METHOD: This was a cross-sectional study using baseline data from 567 impoverished women participating in an HIV prevention study in Baltimore, MD. Data were collected through face-to-face interviews at a community-based research clinic. Heavy episodic drinking was defined as six or more drinks per drinking episode on at least a weekly basis. We examined network characteristics, including structure and function and their association with heavy episodic drinking. Multivariate logistic regression was used, adjusting for individual-level factors, such as drug use, demographics, and depression. RESULTS: Approximately 21% of the sample engaged in heavy episodic drinking at least weekly. Controlling for individual-level factors, women who engaged in heavy episodic drinking had fewer social network members (a) who were in drug treatment, adjusted odds ratio (AOR) = 0.65, 95% CI [0.49, 0.88]; (b) who were employed, AOR = 0.89, 95% CI [0.79, 0.99]; and (c) with whom the participant socialized, AOR = 0.74, 95% CI [0.63, 0.96]. Women who engaged in heavy episodic drinking had a significantly higher number of social network members with whom they drank alcohol, AOR = 1.71, 95% CI [1.43, 2.03]. CONCLUSIONS: Social network characteristics are both protective and risk factors for heavy episodic drinking among women. Interpersonal interventions, such as peer education, may be a useful strategy to decrease heavy episodic drinking and its subsequent outcomes among women.