Adverse Childhood Experiences among a Sample of Youth Living with HIV in the Deep South.

The southern region of the United States, often referred to as the Deep South, is disproportionately affected by HIV. In fact, the highest rates of new HIV infections occur in the Deep South. Approximately one in five new HIV infections are among youth. Youth living with HIV (YLWH) have several behavioral health risks, including co-occurring mental health and substance abuse disorders, which negatively affect medication adherence, contribute to less engagement in HIV care, and result in poor health outcomes. Research suggests that adverse childhood experiences (ACEs) contribute to HIV risk behaviors and that people living with HIV may be more vulnerable to the negative health outcomes and adverse effects of stressors. Using existing program evaluation data, we examined data from 41 YLWH aged 17-24 screened for ACEs in an integrated care setting. Most participants were Black/African American young men who identified as homosexual, bisexual, or questioning, and who acquired HIV behaviorally. Approximately, one-third of YLWH screened positive or in the high-risk range on an ACEs screener. Scores fell in the intermediate range for nearly half of the sample. Results did not reveal a significant relationship between ACEs and HIV biological indicators. In this paper, we describe these findings and the importance of incorporating trauma-informed approaches into HIV prevention and treatment programs targeting youth in the Deep South.

Bijou: Engaging Young MSM in HIV Care Using a Mobile Health Strategy.

Young men who have sex with men (YMSM) living with HIV experience challenges with retention in care, which negatively affects viral suppression. To address this, researchers piloted Bijou, a program designed to provide health education through electronically delivered behavior and risk reduction modules. Participants were 29 YMSM aged 19-24 living with HIV from the southeastern US. Participants completed pre, post, and 3-month follow-up (3MFU) surveys assessing knowledge, intervention acceptability, satisfaction, self-efficacy, ehealth literacy, and usability. Findings revealed significant improvement in knowledge and e-health literacy from pre-test to post-test but lost significance at 3MFU. Self-efficacy scores did not show significant differences from pre-test to post-test or 3MFU. Participants who completed all modules considered Bijou usable and acceptable; however, many did not complete the program. Findings suggest a need for adaptations to promote knowledge retention, e-health literacy, engagement over time, and research with a larger, more representative sample.

Gender Differences in Psychosocial Predictors of Sexual Activity and HIV Testing Among Youth in Kenya.

Sub-Saharan Africa (SSA) carries a disproportionate burden of HIV in the world relative to its population. Youth are at particular risk. Understanding HIV risk factors, as well as factors affecting HIV testing among SSA youth, is important given that HIV testing, linkage to care, and viral suppression are part of the global strategy to end HIV. Because young women face disparate sexual and reproductive health outcomes, exploring gender differences related to HIV risk, and testing is vital. Using existing program evaluation data from a larger project, the purpose of this study was to explore gender differences related to sexual activity and HIV testing among youth in SSA. Participant data from 581 youth ages 13-24 in Kenya was analyzed using descriptive statistics, analysis of covariance, and binomial logistic regression. Findings revealed that young men were more likely to report sexual activity than young women. Age was a predictor of sexual activity for all youth. However, among psychosocial variables, depression predicted sexual activity for young women while stress predicted sexual activity for young men. Although there were no gender differences in HIV testing after controlling for demographic and psychosocial variables, there were some differences between young women and young men with regard to predictors of HIV testing. Age and full-time self-employment predicted HIV testing among young women, while part-time self-employment, education, and substance abuse risk predicted HIV testing among young men. Findings suggest a need for gender and youth friendly strategies for addressing the HIV treatment cascade and care continuum.

Effects of a brief interpersonal conflict cognitive reappraisal intervention on improvements in access to emotion regulation strategies and depressive symptoms in college students.

Objective: Research has demonstrated relative success with brief interventions that utilize social psychological theory to target the root cause of unwanted behaviours. Given the intersections among anxious attachment, depression, and emotion dysregulation, the current research utilises an interpersonal conflict cognitive reappraisal intervention to evaluate improvements in depressive symptoms. We also evaluated mediation via improvements in emotion regulation and moderation by attachment anxiety. Design: Undergraduates (N = 260) completed a baseline assessment and were randomised to one of four writing conditions: An interpersonal conflict from (a) their own perspective; (b) the other party's perspective; or (c) a neutral, third-party perspective (primary experimental condition) or about their day (control condition). They also completed a follow-up survey online two weeks later. Main outcome measures included limited access to emotion regulation strategies and depressive symptoms. Results: Consistent with hypotheses, compared to control, participants who adopted the perspective of neutral third party reported improvements in access to emotion regulation strategies. There was also a significant indirect effect on depressive symptoms through changes in strategies. Finally, improving strategies led to a reduction in depressive symptoms, especially for those higher in attachment anxiety. Conclusion: We present promising emerging results for a single-session, conflict-focused, brief cognitive reappraisal intervention on changes in emotion regulation and depressive symptoms.

Preliminary Findings From the HIV SEERs Project: A Community-Based Participatory Research Program to Reduce HIV Stigma Among Youth in Kenya.

Worldwide, an estimated 4 million youth, ages 15-24 years, are living with HIV. Youth in Kenya experience a high HIV disease burden. HIV-related stigma is a known barrier to HIV prevention. We evaluated the HIV Stigma-reduction through Education, Empowerment, and Research (SEERs) Project, a conceptually driven program that emerged from community-based participatory research and was designed with and for youth ages 13-24 years in Kenya. We analyzed existing evaluation data from 641 SEERs participants who completed pre-, post-, and 3-month follow-up surveys to evaluate changes in HIV knowledge and stigma. Findings revealed a significant increase in HIV knowledge and a significant decrease in HIV-related stigma over time. Despite strong preliminary evidence, research is needed to refine the program and better determine its effectiveness using a randomized controlled trial. Programs such as SEERs can be used in Kenya and other low- to middle-income countries to improve HIV-related health outcomes.

Comparison of the utility of the PHQ and CES-D for depression screening among youth with HIV in an integrated care setting.

BACKGROUND: Depressive symptoms are well documented among people living with HIV and some evidence suggests that youth living with HIV (YLWH) are more affected than their adult counterparts. Therefore, screening for depression is imperative among YLWH to ensure optimal health. The objective of this study is to compare the utility of the Center for Epidemiological Studies-Depression (CES-D) and the Patient Health Questionnaire (PHQ) as depression screeners in an integrated care setting serving YLWH in the southeastern United States. METHODS: As a part of standard care, the CES-D and the PHQ were administered to YLWH. A Retrospective review of patient records was conducted. Using receiver operating characteristic (ROC) curve analysis and reports from mental health providers, researchers compared the utility of the screeners. RESULTS: The sample consisted of 121 cases from 2017. Youth ranged in age from 12-25 (M = 20.68, SD = 2.75). Most were Black/African American (59.5%) males (56.2%) who acquired HIV behaviorally (51.2%). Sexual orientation was nearly evenly split between heterosexual (37.2%) and homosexual (34.7%). The CES-D demonstrated higher specificity and sensitivity for identifying clinical depression, yet, this was not significantly different from the PHQ, p = .09. LIMITATIONS: Generalizability of findings may be limited as the study sample included youth from a single integrated care setting. CONCLUSION: Both the PHQ and the CES-D demonstrate utility for depression screening among YLWH. However, the PHQ may be preferable for use within a clinical setting.

The HIV SEERs Project: A Qualitative Analysis of Program Facilitators' Experience.

HIV-related stigma creates barriers to HIV testing, medication adherence, and retention in care. Guided by the principles of community-based participatory research (CBPR) and in collaboration with community health workers (CHWs), the Stigma-reduction through Education, Empowerment, and Research (SEERs) project was developed with and for youth living in Nakuru, Kenya to reduce HIV-related stigma. The purpose of this qualitative study was to examine the experiences of the CHWs serving as SEERs facilitators. To evaluate SEERs, 37 facilitators completed open-ended survey questions to gather their experiences and recommendations for future program implementation and sustainability. Participants' mean age was 30.58 (standard deviation = 9.62), ranging from ages 18 to 53. Thematic content analysis was used to categorize (a) facilitators' experiences and the community impact of the SEERs project, (b) lessons learned, and (c) challenges to sustainability. Recommendations will be used to modify the SEERs project, improve implementation and sustainability strategies, and may provide guidance for similar CBPR projects.