HIV Stigma, Health, and Violence: A Longitudinal Study among Adolescent Boys with HIV in Soweto, South Africa.

There are over 1.4 million adolescents living with HIV in sub-Saharan Africa, the majority of whom acquired the virus through perinatal transmission (PHIV). HIV stigma is particularly high among adolescents living with HIV and is associated with several outcomes that worsen health and increase the risk of onward HIV transmission. We tested associations between internalized HIV stigma and four of these outcomes over a one-year period among a sample of adolescent boys living with PHIV in Soweto, South Africa. Participants (N = 241) answered questions about internalized HIV stigma at baseline. They completed weekly mobile surveys over the following year to answer questions about their experiences with depression, binge drinking, medication adherence, and violence victimization. Using generalized linear mixed models, we found that baseline internalized HIV stigma was associated with increased odds of depression (OR 1.74), alcohol misuse (OR 2.09), and violence victimization (OR 1.44) and decreased odds of medication adherence (OR 0.60) over the course of a year. These outcomes negatively impact the health and wellbeing of adolescents living with PHIV and increase their risk of transmitting HIV to their partners in the future. Our findings provide novel, longitudinal evidence for the deleterious effects of HIV stigma. To improve health outcomes for adolescents with PHIV, it will be crucial to develop effective HIV stigma reduction interventions that address specific developmental, gendered, and cultural experiences.

Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network.

BACKGROUND: Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters. OBJECTIVE: To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters. DESIGN: 3-arm pragmatic randomized controlled trial. PARTICIPANTS: Current smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record (n = 5225) and recruited using automated phone calls. INTERVENTIONS: One intervention group involved engagement with a health system-based tobacco coach (internal care coordination), and the other connected patients to a national quitline (external community referral). MEASUREMENTS: Proportion of smokers with documentation of any evidence-based cessation treatment in the 6 months after enrollment. KEY RESULTS: Of 639 individuals who responded to the proactive treatment offer, 233 consented and were randomized 1:1:1 to study arm. At 6-month follow-up, the pooled intervention group, compared with usual care, had higher documentation of any smoking cessation treatment (63% vs. 34%, p < 0.001), cessation medication prescription (52% vs. 30%, p = 0.002), and counseling (47% vs. 9%, p < 0.001). Internal care coordination was more effective than external community referral at connecting smokers to any cessation treatment (76% vs. 50%, p = 0.001) and at providing cessation medication (66% vs. 39%, p < 0.001), but comparable at linking smokers to cessation counseling resources. CONCLUSIONS: Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system-based or community-based program compared with usual care. The health system-based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates. TRIAL REGISTRATION: ClinicalTrials.gov NCT03612895.

Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey.

Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.

Self-silencing Mediates the Relationship Between Rejection Sensitivity and Intimate Partner Violence.

Intimate partner violence, including physical, psychological, and sexual violence, affects over one-third of Americans and is particularly common among college students. Previous work has found links between rejection sensitivity and aggressive or hostile behavior (i.e., perpetration) in intimate relationships, but this construct has only been tested as a predictor of violence in an all-male sample. A related body of work has found relationships between self-silencing and rejection sensitivity, and between self-silencing and both hostile and ingratiating behavior. The purpose of this study was to bridge these related literatures and examine the relationship between rejection sensitivity and intimate partner violence experiences and the role of self-silencing as a possible mediator. To test these relationships, we collected survey data from a sample of college students (N = 410) at a large university in the northeast United States. Using mediation analyses, we found that rejection sensitivity predicted intimate partner violence victimization (i.e., being the target of violence) through self-silencing. Similarly, rejection sensitivity predicted intimate partner violence perpetration (i.e., being violent toward one's partner) through self-silencing. Neither gender nor race significantly moderated either path of the models. Implications of this study include incorporating individual difference variables in intimate partner violence research and programming.

Contributions of psychology to research, treatment, and care of pregnant women with opioid use disorder.

The number of women with opioid use disorder (OUD) in the United States has risen precipitously. Pregnant women with OUD are a particularly vulnerable subset of addicted women with unique characteristics and needs. Many of them are impoverished, have strenuous life circumstances, are affected by past and current trauma, and have high rates of psychiatric comorbidities. Their addiction can compromise their and their infant's health, particularly without sufficient treatment including prenatal care, medication-assisted treatment (MAT), and social and behavioral care. Furthermore, these women's needs are often undetected and untreated: They may not seek appropriate prenatal and addiction care, or if they do, may face barriers to comprehensive, evidence-based treatment. Theories, methods, tools, and existing knowledge from the field of psychology are needed to improve research, prevention, and treatment for pregnant women with OUD. Although a number of psychologists have made critical contributions to research on pregnant women with OUD, we demonstrate by a scoping review of scientific literature and by examining American Psychological Association (APA) Annual Convention proceedings that much research on this population has been communicated in areas and journals outside psychology and among audiences other than psychologists. We identify relevant theoretical frameworks and methods to facilitate psychological investigation as well as evidence-based intervention and care for this population. Our field is well positioned to examine, identify, and alleviate the needs of pregnant women with OUD to improve their health and the health of their children. (PsycInfo Database Record (c) 2020 APA, all rights reserved).