Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV.

People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.

Reframing school-based restorative justice as a structural population health intervention.

School-based restorative justice has gained national prominence as an effective approach to interrupting the school-to-prison pipeline. Remarkably, despite its simultaneous positive association with academic success, school safety, and school connectedness, most scholars and practitioners do not associate restorative justice with health. Using ecosocial theory, we conceptualize school-based restorative justice as a structural population health intervention. Our findings indicate that students attending schools using restorative justice have lower odds of missing school due to adverse health and better academic outcomes compared to students who do not. Restorative justice shows promise as a structural intervention that can contribute to improving population health.

Advancing Social Work Education for Health Impact.

Social work education plays a critical role in preparing social workers to lead efforts that improve health. Because of the dynamic health care landscape, schools of social work must educate students to facilitate health care system improvements, enhance population health, and reduce medical costs. We reviewed the existing contributions of social work education and provided recommendations for improving the education of social workers in 6 key areas: aging, behavioral health, community health, global health, health reform, and health policy. We argue for systemic improvement in the curriculum at every level of education, including substantive increases in content in health, health care, health care ethics, and evaluating practice outcomes in health settings. Schools of social work can further increase the impact of the profession by enhancing the curricular focus on broad content areas such as prevention, health equity, population and community health, and health advocacy.

The Influence of Violence Victimization on Sexual Health Behaviors and Outcomes.

This study examines the implications of a history of personal violence on health and health behaviors. A secondary analysis of cross-sectional data involving adults (n = 214) from a semirural area in southern Louisiana between October 2008 and December 2010 was conducted to ascertain the association between a personal history of violence victimization and indicators of sexual health behaviors and outcomes: communication with sexual partners about HIV status, consistent condom use, and sexually transmitted infection (STI). While violence victimization is widely accepted as a risk factor for high-risk sex behavior, the mechanisms underlying violence victimization's influence on sexual health outcomes remain unclear. Bivariate analyses demonstrated a significant positive association between experience of physical abuse and lifetime history of STI. Surprisingly, respondents reporting lifetime physical violence were more than two times more likely to ask sexual partners about HIV status [odds ratio (OR) for physical attack = 2.23, 95% confidence intervals (CI) = 1.00-4.97; OR for physical injury = 4.60, 95% CI = 1.79-11.85]. Consistent condom use was not significantly associated with violence exposure in adjusted models. There was no evidence that communication with sexual partners mediated the relationship between experiences of violence and condom use. The link between personal history of violence and condom use may be mediated through alternative pathways beyond communication.

HIV-Testing Rates and Testing Locations Among Women Who Have Experienced Intimate Partner Violence: Data From the Centers for Disease Control Behavioral Risk Factor Surveillance System, 2006.

Data from the Centers for Disease Control and Prevention's (CDC) 2006 Behavioral Risk Factor Surveillance System were analyzed to report the HIV-testing rates and locations of women who have experienced intimate partner violence (IPV). Of the 18,917 women in the sample, 19.8% reported experiencing IPV. Over half of the women who experienced IPV reported testing rates of 52.4%, compared with 35.5% of the overall sample. Testing rates and locations significantly differed by race/ethnicity. Findings and their implications are explored, with an emphasis on increasing access to HIV testing and treatment for women who have experienced IPV and providing sexual safety planning for women accessing HIV-testing services.

Racial Discrimination and HIV-related Risk Behaviors in Southeast Louisiana.

OBJECTIVES: We examined the relationship between cumulative experiences of racial discrimination and HIV-related risk taking, and whether these relationships are mediated through alcohol use among African Americans in semi-rural southeast Louisiana. METHODS: Participants (N = 214) reported on experiences of discrimination, HIV sexual risk-taking, history of sexually transmitted infection (STI), and health behaviors including alcohol use in the previous 90 days. Experiences of discrimination (scaled both by frequency of occurrence and situational counts) as a predictor of a sexual risk composite score as well as a history of STI was assessed using multivariate linear and logistic regression, respectively, including tests for mediation by alcohol use. RESULTS: Discrimination was common in this cohort, with respondents confirming their experience on average 7 of the 9 potential situations and on more than 34 separate occasions. After adjustment, discrimination was significantly associated with increasing sexual risk-taking and lifetime history of STI when measured either by frequency of occurrence or number of situations, although there was no evidence that these relationships were mediated through alcohol use. CONCLUSIONS: Cumulative experiences of discrimination may play a significant role in sexual risk behavior and consequently increase vulnerability to HIV and other STIs.

Promotion of Latina Health: Intersectionality of IPV and Risk for HIV/AIDS.

Latina women in the United States are vulnerable to two intersecting public health concerns: intimate partner violence (IPV) and subsequent risk for HIV/AIDS infection. Examination of the cultural and contextual life factors of this understudied population is crucial to developing culturally relevant HIV interventions. Focus groups with Latinas (15 monolingual; 10 bilingual) who have experienced IPV were conducted. Monolingual and bilingual Latinas endorsed that they were concerned about HIV infection, naming partner infidelity and experiences of forced and coerced sex as primary reasons for their concern. However, monolingual participants had lower levels of HIV knowledge, spending much time discussing myths of HIV infection, whereas bilingual participants spent more time discussing specific prevention techniques, including challenges related to the violence in their relationships. These findings suggest that HIV/AIDS prevention programs for Latinas need to pay close attention to the different historical, contextual, and cultural experiences of this at-risk group of women.

HIV/AIDS Risk Reduction Intervention for Women who have Experienced Intimate Partner Violence.

A growing body of literature highlights the association between women who have experienced intimate partner abuse (IPA) and their heightened risk for HIV/AIDS (human immune deficiency syndrome/ acquired immune deficiency syndrome) infection. Finding HIV risk reduction strategies that are contextually relevant for this population is an important public policy priority. This qualitative study researched women who have experienced intimate partner abuse in order to develop a HIV/AIDS risk reduction intervention unique to their circumstances. This pilot study explored the critical components of such an intervention among a racially/ethnically stratified (African-American, Mexican-American and Anglo) sample of women (n=43) who have experienced IPA. Focus groups were conducted and transcribed, and a content analysis was used to identify major themes. In all five focus groups, participants viewed the research as interesting, good, beneficial, and/or important based on their perceptions of risk for infection. Respondents felt that they knew of ways to protect themselves from infection in non-abusive relationships; however, acknowledged the difficulties of doing so given the context of their abusive relationships. Examining the racial/ethnic differences across focus groups showed that the language used by women is quite variable. The ways in which survivors define rape, sexual abuse, and their own experiences are all unique; however, their actual experiences have many similarities. Discussed at length are the topics participants shared as critical in informing the design of an intervention and the relevance of the findings to social work clinical practice is explained.

Exploring the meaning and role of spirituality for women survivors of intimate partner abuse.

Literature on trauma, coping and spirituality has introduced new questions about protective factors in the healing process for intimate partner abuse survivors (IPA). This qualitative study explores the relationship between spirituality and IPA with three focus groups of twenty-two women IPA survivors residing in a shelter. A content analysis revealed central themes that explicate the meaning and role spirituality plays for participants. Viewed as a salient dimension, spirituality provides strength, influences outcomes and assists in the regulation of behavioral responses in a positive manner in terms of participants' traumatic IPA victimization. Practice implications are discussed.

HIV testing rates and testing locations, by race and ethnicity.

The purpose of this study is to report the HIV testing rates among white Americans, African Americans, and Hispanic Americans and to identify the frequency of use of HIV testing locations according to a variety of sociodemographic variables. Data for this study came from the 2005 Behavioral Risk Factor Surveillance System (BRFSS). Participants in the BRFSS were recruited from residential households in the United States through an ongoing, random-digit-dial telephone survey. Results showed that 40 percent of all participants had been tested for HIV and that HIV testing rates significantly differed by racial-ethnic group. Gender and income were not significant factors for HIV testing rates among African Americans. Marital status was not a significant factor for Hispanics. Overall, 41 percent of the sample had been tested at a private doctor's office or HMO facility, and 24 percent had been tested at a clinic. Hispanics were the only group more likely to have been tested at a clinic. Recommendations for increasing rates of testing among all racial-ethnic groups based on testing locations are explored. Implications of the findings that certain racial-ethnic groups are reporting higher rates of HIV testing and higher rates of new HIV infections are discussed.

Exploring the meaning and role of spirituality for women survivors of intimate partner abuse.

Literature on trauma, coping and spirituality has introduced new questions about protective factors in the healing process for intimate partner abuse survivors (IPA). This qualitative study explores the relationship between spirituality and IPA with three focus groups of twenty-two women IPA survivors residing in a shelter. A content analysis revealed central themes that explicate the meaning and role spirituality plays for participants. Viewed as a salient dimension, spirituality provides strength, influences outcomes and assists in the regulation of behavioral responses in a positive manner in terms of participants' traumatic IPA victimization. Practice implications are discussed.

Domestic violence shelters as prevention agents for HIV/AIDS?

The article reports findings from a pilot study of 21 domestic violence shelters in a southwestern state in the United States. The survey instrument included descriptive information on shelter service delivery. Specifically, questions were asked about the practice of assessing a client's risk of HIV/AIDS, the provision of HIV/AIDS educational and prevention programs within shelters, and information about organizational characteristics that facilitate or impede the existence of these services. The findings suggest that shelters lacked sufficient HIV/AIDS policies and programs to respond to their client's heightened risk of infection. Although 19 (90.5 percent) of the shelters reported that they routinely ask about their clients' sexual abuse histories, there was no link between a woman's disclosure of sexual abuse and a subsequent provision of appropriate HIV/AIDS services (referrals for testing, treatment) by the shelter. HIV/AIDS awareness was high among the shelter staffwho responded to the survey, but HIV/AIDS prevention and education were practically nonexistent. Implications for social work practice are discussed.