RESUMO
In contrast to intervention studies that assess psychosocial factors only as mediators or moderators of HIV risk, the present study assessed the effects of an Mpowerment-based community-level intervention on psychosocial determinants (e.g., depressive symptoms, sexual stigma) of HIV risk behavior among young black MSM. Approximately 330 respondents were surveyed annually for 4 years in each of two sites. General linear models examined change across time between the intervention and comparison communities, and participation effects in the intervention site. Social diffusion (spreading information within networks) of safer sex messages (p < 0.01) and comfort with being gay (p < 0.05) increased with time in intervention versus control. Cross-sectionally, intervention participants responded more favorably (p < 0.05) on social diffusion and depressive symptoms, but less favorably (p < 0.01) on sex in difficult situations and attitudes toward condom use. Findings suggest a need to address broader health issues of MSM as well as sexual risk.
Assuntos
Negro ou Afro-Americano/psicologia , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Poder Psicológico , Comportamento de Redução do Risco , Estigma Social , Adolescente , Adulto , Estudos Transversais , HIV , Infecções por HIV/psicologia , Promoção da Saúde , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Assunção de Riscos , Sexo Seguro , Autoeficácia , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero , Adulto JovemRESUMO
The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV.
Assuntos
Antirretrovirais/uso terapêutico , População Negra/psicologia , Negro ou Afro-Americano/psicologia , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina , Adesão à Medicação , Parceiros Sexuais , Adulto , HIV , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Soropositividade para HIV/epidemiologia , Pessoal de Saúde , Humanos , MasculinoRESUMO
HIV affects African American gay and bisexual men (AAGBM) more disproportionately than any other group in the USA. The Black Church, which has been a historic mainstay for African American empowerment and well-being, has the potential to be a public health partner for HIV prevention with AAGBM. Public health partnerships with the Black Church can strengthen HIV prevention efforts with AAGBM by [1] adapting church-based prevention strategies developed for other African American subgroups [2], providing prevention and referral services [3], considering how scripture supports prevention efforts, and [4] emphasizing the tenets of liberation theology. Public health should consider how thoughtful engagement, research, and interventions can support these approaches. Developing partnerships with the Black Church and African American clergy can promote effective HIV prevention efforts for AAGBM.
Assuntos
Bissexualidade/psicologia , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Religião e Sexo , Comportamento Sexual/psicologia , Adulto , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Spirituality and religiosity may serve as both a resource and a barrier to HIV prevention with young black men who have sex with men (YBMSM). We examined indices of spirituality/religiosity as correlates of binge drinking, stimulant use, and recent HIV testing in a sample of YBMSM. METHODS: From 2011-2013, annual venue-based surveys of sexually active YBMSM ages 18-29 were conducted in Dallas and Houston, Texas. Binge drinking and stimulant use were assessed in the past two months. Participants recently tested for HIV (i.e., within the past six months) were compared to those without recent HIV testing (i.e., never tested or tested more than six months ago). RESULTS: Among the 1565 HIV-negative or HIV-unknown YBMSM enrolled, more engagement in spiritual and religious activities was associated with greater odds of reporting stimulant use (Adjusted Odds Ratio [AOR]=1.20; 95% CI=1.04-1.40) while higher spiritual coping was associated with lower odds of reporting stimulant use (AOR=0.66; 95% CI=0.56-0.78). Binge drinking was independently associated with 29% lower odds of recent HIV testing (AOR=0.71; 95% CI=0.55-0.92), but lower odds of binge drinking did not mediate the association of engagement in spiritual and religious activities with 27% greater odds of recent HIV testing (AOR=1.27; 95% CI=1.11-1.46). CONCLUSIONS: Among YBMSM, culturally tailored approaches addressing spirituality/religiosity could support prevention of stimulant use and increase HIV testing. In particular, expanded efforts are needed to promote HIV testing in binge drinkers.
Assuntos
Negro ou Afro-Americano , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Espiritualidade , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Sexo sem Proteção , Adaptação Psicológica , Adolescente , Adulto , Humanos , Masculino , Programas de Rastreamento , Religião , Texas , Adulto JovemRESUMO
In September 2010, CDC launched the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy (NHAS). Twelve health departments in cities with high AIDS burden participated. These 12 grantees submitted plans detailing jurisdiction-level goals, strategies, and objectives for HIV prevention and care activities. We reviewed plans to identify themes in the planning process and initial implementation. Planning themes included data integration, broad engagement of partners, and resource allocation modeling. Implementation themes included organizational change, building partnerships, enhancing data use, developing protocols and policies, and providing training and technical assistance for new and expanded activities. Pilot programs also allowed grantees to assess the feasibility of large-scale implementation. These findings indicate that health departments in areas hardest hit by HIV are shifting their HIV prevention and care programs to increase local impact. Examples from ECHPP will be of interest to other health departments as they work toward meeting the NHAS goals.
Assuntos
Infecções por HIV/prevenção & controle , Planejamento em Saúde , Política de Saúde , Recursos em Saúde/organização & administração , Centers for Disease Control and Prevention, U.S./organização & administração , Infecções por HIV/epidemiologia , Planejamento em Saúde/métodos , Planejamento em Saúde/organização & administração , Humanos , Objetivos Organizacionais , Alocação de Recursos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Young Black men who have sex with men (YBMSM) are at extraordinarily high risk for HIV infection. Given their dual minority identity, they experience multiple forms of social oppression-racism, homophobia, and poverty. This study tested a model for how these forces contribute to their sexual risk behavior. METHOD: YBMSM (n = 1,289) from 2 Texas cities completed a 1-time assessment of sexual behaviors and psychosocial variables. Structural equation modeling was used to characterize relationships among variables. RESULTS: Experiences of racism, homophobia, and socioeconomic distress were all associated with unprotected anal intercourse (UAI) either directly or indirectly in a manner largely consistent with Díaz's (1997, 1998) model of the effects of social oppression. Racism, homophobia, and socioeconomic distress were each associated with specific psychological vulnerabilities, which were in turn associated with participation in difficult sexual situations (e.g., in a public setting), and then UAI. The effects of racism were largely mediated by depressive symptoms and participation in difficult sexual situations. Homophobia was mediated by depressive symptoms, social support, and internalized homophobia. The effects of socioeconomic distress were partially mediated by decreased social support and greater participation in difficult sexual situations. Socioeconomic distress also had a significant direct effect on UAI not explained by the proposed mediators. CONCLUSIONS: Social oppression contributes to YBMSM's psychological vulnerabilities, participation in difficult sexual situations, and their UAI. Interventions to reduce sexual risk in YBMSM should address socioeconomic disadvantage, homophobia, and racism, as well as the psychological challenges that social oppression creates for them.
Assuntos
Negro ou Afro-Americano/psicologia , Homofobia/etnologia , Homossexualidade Masculina/etnologia , Pobreza/etnologia , Racismo/etnologia , Sexo sem Proteção/etnologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Depressão/etnologia , Depressão/psicologia , Infecções por HIV/etnologia , Homofobia/psicologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Modelos Psicológicos , Pobreza/psicologia , Racismo/psicologia , Assunção de Riscos , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Apoio Social , Texas , Sexo sem Proteção/psicologia , Adulto JovemRESUMO
INTRODUCTION: Microenterprise programs are widely used to improve health outcomes among women internationally. However, there is little information on applicability to American women living in poverty. We conducted formative research to identify activities that are viable and attractive, that may produce income to address some proportion of economic need and could be incorporated in the development of a micro-enterprise HIV-prevention intervention to reduce HIV/STD transmission among unemployed or underemployed African American women at risk for HIV. METHODS: Focus groups were convened with young African American women and community leaders in two southern states. Interviews with women participating in the focus groups were also convened. RESULTS: Findings suggest an intervention should incorporate activities to increase self-esteem, enhance employability and job sustainability to decrease financial dependence. This research serves as the foundation for developing a novel approach to HIV prevention in the U.S. that may directly address poverty as a social determinant of health.
Assuntos
População Negra , Comércio/educação , Emprego , Infecções por HIV/prevenção & controle , Pobreza , Desemprego , Adolescente , Adulto , Feminino , Florida , Grupos Focais , Humanos , North Carolina , Adulto JovemRESUMO
PURPOSE: To examine adolescent-level correlates of HIV-related risk behaviors among urban African American adolescents whose mothers use crack cocaine. METHODS: Interviews were conducted with 208 African American adolescents (aged 12-17 years) to assess psychosocial, behavioral, and perceived environment correlates of HIV-related risk behavior. Adolescents were children of community-recruited African American women not currently in drug treatment who reported crack cocaine use (in last 6 months). Bivariate and multivariate regression models were used to evaluate associations among adolescent-level factors, sexual experience, and substance use. RESULTS: Of the adolescents, 30% reported being sexually experienced, and 23% reported alcohol or drug use in the past month. Older age and lower school satisfaction were associated with both sexual experience and substance use, but no other factors were associated with both risk behaviors. Male gender, current substance use, high HIV/AIDS knowledge, and high risk perception were associated with being sexual experienced. Sexual experience and lower expectations for future life outcomes were associated with substance use. A general pattern of protective factors related to attitudes about future goals, help-seeking behavior, and positive feelings about school emerged for substance use. CONCLUSIONS: These results suggest that the patterns of adolescent-level risk and protective factors for sexual experience and substance use may be unique in African American adolescents from substance-abusing families. Instead of an increase in problem behaviors associated with using substances, protective factors were evident, suggesting these adolescents may have resiliency for dealing with environmental stressors related to substance use. Implications for HIV prevention programs involving mentoring and goal development are discussed.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Assunção de Riscos , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Comportamento do Adolescente , Fatores Etários , Criança , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Modelos Logísticos , Masculino , Análise Multivariada , Relações Pais-Filho , Probabilidade , Psicologia , Medição de Risco , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To examine relationships between parenting behaviors, parent-child relationship, and moderating effects of age on youth substance use among a community sample of African-American mothers who use crack cocaine and their children (12-17 years). METHODS: Maternal-child dyads (n = 208) were recruited through street outreach and snowball sampling and completed interviews about substance use and parenting. RESULTS: Regression analyses found significant main effects of youth age, family conflict, warmth, and disapproval of youth substance use on children's substance use. Age x Parenting interactions were significant for conflict and disapproval. Higher family conflict increased older youths' risk, while higher perceived maternal disapproval protected against substance use for older youth. CONCLUSIONS: Family influences may offer risk and protective effects for adolescent children of maternal drug users. Outreach and family-focused interventions that address family conflict and communication of disapproval of substance use may help reduce intergenerational risk transmission. However, longitudinal research with comprehensive parenting assessments is needed.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Transtornos Relacionados ao Uso de Cocaína/etnologia , Cocaína Crack , Relações Mãe-Filho , Mães/estatística & dados numéricos , Poder Familiar , Adolescente , Adulto , Criança , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos Transversais , Feminino , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
The likelihood of prevention providers and consumers adopting and implementing evidence-based HIV prevention interventions depends on the strategies employed in translating, packaging, and disseminating the findings from research to practice. Lessons from the Centers for Disease Control and Prevention's Replicating Effective Programs project have shown that to smoothly transfer HIV prevention technology from research to practice, researchers need to prepare for possible transfer during research trials. Preparation should include documenting details of the intervention beyond what is published in journals, including important details regarding what the intervention was about, how preparations for it were made, and how it was delivered. Researchers should also ensure that all relevant stakeholders are integrally involved in all aspects of the research and technology transfer process. Such collaborations encourage exchange of ideas and can make certain that interventions are designed to be relevant and acceptable to community agencies and feasible for them to implement.
Assuntos
Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Pesquisadores , Medicina Baseada em Evidências , Humanos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Pesquisa , Comportamento de Redução do Risco , Papel (figurativo) , Estados UnidosRESUMO
Although HIV prevention researchers have conducted numerous controlled outcome studies to evaluate the effectiveness of theory-based interventions aimed at reducing HIV risk behaviors, many HIV risk reduction interventions are conducted not by researchers but by staff in local health departments or community-based organizations (CBOs). Despite their widely recognized role in slowing the spread of HIV, very few attempts have been geared toward understanding the programmatic and organizational characteristics of their HIV prevention efforts. The Centers for Disease Control and Prevention's Characteristics of Reputationally Strong Programs project identified and profiled 18 innovative, community-based, HIV prevention programs viewed by community partners as successful. The aim was to determine common features of the programs that could be widely applied to improve HIV prevention research and programs. Results indicated that several common intervention characteristics and organizational characteristics, including agency support and staff commitment, played significant roles in the success of reputationally strong programs.
Assuntos
Infecções por HIV/prevenção & controle , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Promoção da Saúde/métodos , Humanos , Modelos Teóricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Assunção de Riscos , Sexo Seguro , Estados UnidosRESUMO
We describe 99 (experimental and certain quasi-experimental) U.S.-based trials, reported or published since 1988, of behavioral and social interventions that measured prespecified behavioral and biologic outcomes and aimed to reduce risk for HIV infection. Studies identified through June 1998 by the HIV/AIDS Prevention Research Synthesis project were grouped into 4 risk behavior areas: drug-related (k [number of studies] = 48), heterosexual youth (k = 24), heterosexual adult (k = 17), and same-sex (k = 10). We compared the studies in the 4 areas by variables key to the development, evaluation, and transfer of interventions. Participants comprised injection drug users (43% of studies), drug users out of treatment (29%), African Americans (18%), clinic patients (18%), youth in schools (10%), and drug users in treatment (10%). Most studies were randomized (85%), provided another intervention to the control or comparison groups (71%), and evaluated behavioral interventions (92%). On average, interventions were conducted in 5 sessions (total, 8 hours) during 3 months. The theoretical basis of the intervention was not noted in 57% of the reports. At least one variable from each of the 3 outcome classifications was measured in 8% of the studies: behavioral, biologic, and psychosocial. Distinct profiles exist for the 4 risk areas. Addressing gaps in research and reporting would be helpful for analytical and program activities. This sizable portfolio of evaluated interventions contributes to effectiveness reviews and to considerations of transfer to program practice.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Terapia Comportamental/métodos , Projetos de Pesquisa Epidemiológica , Assunção de Riscos , Adolescente , Adulto , Terapia Comportamental/normas , Feminino , Heterossexualidade , Homossexualidade , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Saúde Pública/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias , Estados UnidosRESUMO
In response to the HIV/AIDS epidemic, many governments and nongovernmental organizations have supported numerous HIV prevention intervention studies in both the United States and in other countries. To understand which intervention approaches have worked outside the United States, the Centers for Disease Control and Prevention extended the scope of its HIV/AIDS Prevention Research Synthesis (PRS) project to include non-U.S.-based studies. We describe briefly the PRS experience with the challenges of acquiring and reviewing those studies, and some of the specialized efforts to find them. The ultimate goals of the PRS project related to international prevention research are to include all available reports of non-U.S.-based studies in the PRS database and to provide comprehensive reviews of those studies. The findings of the reviews would not only highlight common themes of effectiveness or research gaps in the international arena but could also be useful for improving prevention research and programs in the United States.