Partnerships between Black Women and Behaviorally Bisexual Men: Implications for HIV Risk and Prevention.

Although an estimated 87% of new HIV infections in Black/African American women are attributed to sex with men, many women are unaware of their male partners' HIV risk factors. Research on women who are aware of a high-risk male partner may inform HIV prevention. We analyzed transcripts from semi-structured interviews with 20 Black women who reported sex with at least one man who had sex with men and women (MSMW) in the prior 5 years. We applied Choice and Sexual Network theories to the interpretation. The majority described their partnerships as committed and involving emotional or instrumental support. Substance abuse was a common component of the relationships and very few involved consistent condom use. Although nearly all respondents described it as alarming to learn of their partners' involvement with other men and several ended the relationships, many continued the relationships without protective changes in their sex behavior. These narratives indicate that although many leave, many other women remain in relationships after learning of a male partners' high-risk activity. Substance abuse, financial instability, and a desire to remain in intimate partnerships may discourage preventive actions in these women.

HIV risk behaviors among Black/African American and Hispanic/Latina Female partners of men who have sex with men and women.

We examined the frequencies of HIV-related risk factors among women reporting and not reporting sex with a man who has sex with men and women (MSMW).We used data from 15,625 visits of Black and Hispanic/Latina females, ages 15­64 years, to Los Angeles County HIV testing sites (2007­2008). The following risk factors were associated with reporting an MSMW partner: number of sex partners, use of party drugs, anal sex, and sexual partners with other risk factors. Overall, females who reported an MSMW partner differed little in their likelihood of testing HIV positive (0.93%) compared to those who did not (0.58%, p value = 0.19). Among females reporting one male sex partner, having an MSMW partner was strongly associated with HIV (2.8 vs. 0.63%, p = 0.03). Interventions targeting women who report other risky behaviors may reach many who have been with MSMW. Women with one partner are an important focus of such efforts.

Stigma and Family Relationships of Middle-Aged Gay Men in Recovery.

The primary objective of this study was to explore how middle-aged gay men in recovery cope with stigma and family relationships. For gay men, perceptions of acceptance of their sexual orientation and degree of social connectedness can play a role in their recovery from alcohol and substance use disorders. Yet gay men may have a more difficult time accessing certain family-level health resources because their families of origin may stigmatize, reject or silence them on account of their sexual orientation. Semi-structured interviews were used to explore how participants in recovery constructed and coped with their experiences of stigma, family relationships, and alcohol and substance use. Participants (30 gay men aged 50-64) completed a questionnaire and interview. We used constructivist Grounded Theory method and Minority Stress Theory as a theoretical framework to interpret the data. We identified the following themes: Internalization of Stigma, Changes in Coping Strategies, and Ongoing Stigma. Future research should explore how to incorporate familial support into gay men's recovery, address ongoing internalized stigma, and develop a social response to stigma, rather than leaving it to individuals to confront on their own.

Facilitators of HIV Medical Care Engagement Among Former Prisoners.

Linkage to and retention in medical care is a concern for HIV-positive individuals leaving custody settings in the United States. The minimal existing research points to low rates of entry into care in the months following release and lapsed viral control among releasees who are subsequently reincarcerated. We conducted seven small focus group discussions with 27 HIVpositive individuals who were recently incarcerated in a California State prison to understand those factors that facilitated linkage to and retention in HIV care following their release. We used a consensual approach to code and analyze the focus group transcripts. Four main themes emerged from the analysis: (1) interpersonal relationships, (2) professional relationships, (3) coping strategies and resources, and (4) individual attitudes. Improving HIV-related outcomes among individuals after their release from prison requires strengthening supportive relationships, fostering the appropriate attitudes and skills, and ensuring access to resources that stabilize daily living and facilitate the process of accessing care.

The associations of social self-control, personality disorders, and demographics with drug use among high-risk youth.

A 10-item self-report measure of social self-control was examined for its association with substance use, controlling for its associations with 12 personality disorder indices and 4 demographic variables among a sample of 1050 high-risk youth. Social self-control was found to be associated with 30-day cigarette smoking, alcohol use, marijuana use, and hard drug use, controlling for these other variables. The most consistent concurrent predictors of substance use were male gender, antisocial personality disorder, and social self-control. These results highlight the importance of social self-control as a unique concurrent predictor of substance use and suggest that social self-control skill training is relevant in substance abuse prevention programming.

Tracking procedures for locating high-risk youth.

Few published works are available that provide a comprehensive description of tracking procedures. This article describes the data collection tracking protocol that was used in Project Towards No Drug Abuse (Project TND), to follow high-risk youth over a 5 1/2 year period. Youth were followed from 1994 through 2000. A total of 35% of these youth were assessed 5 1/2 years later. Collapsing across the last two waves, 46% of these youth were followed an average of 5 years later. These procedures may be helpful in tracking highly mobile youth.

A Condom Distribution Program in the Los Angeles Men's Central Jail: Sheriff Deputies' Attitudes and Opinions.

The K6G unit of Los Angeles Men's Central Jail is comprised of males who have sex with males (MSM), whether gay, bisexual, or transgender. Within this unit, condoms are distributed to inmates, one condom per week. The current study was conducted to better understand the experiences and opinions of jail staff as they pertain to the condom distribution program's effectiveness and impact on jail safety and management. A total of 10 staff interviews were conducted with the unit's line staff (n = 8) and administrative personnel (n = 2). Findings suggest that despite the contradictory "mixed message" that jail staff felt the program sent, it causes few operational or safety concerns and is perceived to be beneficial to public health.

Negotiating Emotional Support: Sober Gay Latinos and their Families.

This study explores how sober gay Latino men obtain support from their families. Familial ties can be a protective health factor, yet many gay Latinos experience rejection from family members because of their sexuality. There are very few studies that examine the extent and quality of emotional support from kin for this population. Understanding family dynamics within the context of recovery and sexuality can increase our understanding of how to leverage family ties to develop alcohol abuse interventions. The study was conducted semi-structured interviews with 30 sober gay Latinos using a grounded theory approach. Analyses of the qualitative data identified the following themes: Family values shaped the participants' perception of their range of choices and emotional responses; participants reported feeling loved and supported even when sexuality was not discussed with parents; and family support for sobriety is essential. Findings suggest that familial ties shape perceptions of support and importance of disclosing sexual identity. Family support often results from agreements about sexual identity disclosure, and some families can overcome cultural and religious taboos on sexuality. Future studies should investigate families that negotiate acceptance with their gay members, and whether they exhibit heterosexual biases that may influence the psychological stress of gay Latino men who wish to be sober.

HIV prevention among incarcerated male adolescents in an alternative school setting.

This pilot project tested the feasibility of an evidence-based HIV Intervention Program (HIP) program among 64 male youth, most of whom were African American or Hispanic, in Los Angeles County probation camps. Comparisons were made between adolescents who participated in HIP and a control group on changes in (a) condom use, (b) sexual intercourse under the influence of drugs, (c) knowledge of HIV prevention behaviors, and (d) attitudes toward condom use. Compared to the control group, the intervention group demonstrated significant increases in condom use and significant decreases in their endorsement of the attitude, ''If you want to use a condom, your boy-friend or girlfriend might think you don't trust them.'' These preliminary findings suggest that the HIP program influences key HIV-related constructs among male juvenile offenders.

Development and immediate impact of a self-instruction curriculum for an adolescent indicated drug abuse prevention trial.

This article describes the development and immediate impact of a self-instruction indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse to complete their high school education, and is a method of choice among educators at alternative high schools. This article describes the justification for the self-instruction program, keys to good programmed self-learning, and how a 12-session health educator delivered program was converted to a self-instruction format. In addition, the immediate impact of a 3-group experimental trial is presented. Health educator led, self-instruction, and standard care control conditions are compared on knowledge change, and the two program conditions are compared on process ratings. Self-instruction programming can be successfully adapted from a health educator-led format, though the lack of student group interaction in this modality may limit its receptivity among students.

Project Towards No Drug Abuse: two-year outcomes of a trial that compares health educator delivery to self-instruction.

OBJECTIVES: This paper describes the 2-year follow-up of a 12-session version of an indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse to complete their high school education. However, a health educator-led program is much more interactive. METHODS: The effects of self-instruction versus health educator-led versions of this curriculum were examined. Eighteen schools were randomly assigned by block to one of three conditions--standard care (control), health educator-led classroom program, and self-instruction classroom program. Subjects were followed up 1 and 2 years later. Two-year results are reported here. RESULTS: The self-instruction program produced no behavioral effects relative to the standard care control condition. The 2-year follow-up results indicated maintenance of program effects on cigarette smoking and hard drug use in the health educator-led version. CONCLUSIONS: Project TND shows maintenance of effects on some drugs 2 years after program implementation, when most youth were young adults. More work is needed to learn how to maintain effects across substances. Continued exploration of modalities of implementation may be helpful.

Project EX: A Program of Empirical Research on Adolescent Tobacco Use Cessation.

This paper presents the Project EX research program. The historical background for Project EX is presented, including a brief summary of reasons youth fail to quit tobacco use, the disappointing status of previous cessation research, and the teen cessation trial that provided the template for the current project (Project TNT). Next, program development studies for Project EX are described. Through use of focus groups, a theme study (concept evaluation of written activity descriptions), a component study, and pilot studies, an eight-session program was developed. This program involves novel activities (e.g., "talk show enactments," games, and alternative medicine-type activities such as yoga and meditation) in combination with motivation enhancement and cognitive-behavioral strategies to motivate and instruct in cessation initiation and maintenance efforts. The outcomes of the first experimental trial of Project EX, a school-based clinic program, are described, followed by a posthoc analysis of its effects mediation. A second EX study, a multiple baseline single group pilot study design in Wuhan, China, is described next. Description of a second experimental trial follows, which tested EX with nicotine gum versus a natural herb. A third experimental trial that tests a classroom prevention/cessation version of EX is then introduced. Finally, the implications of this work are discussed. The intent-to-treat quit rate for Project EX is approximately 15% across studies, double that of a standard care comparison. Effects last up to a six-month post-program at regular and alternative high schools. Through a systematic protocol of empirical program development and field trials, an effective and replicable model teen tobacco use cessation program is established. Future cessation work might expand on this work.