Effectiveness of a Cognitive Behavioral Randomized Controlled Trial for People Living with HIV Who are Heavy Drinkers: The Holistic Health Recovery Program (HHRP) Trial in Miami.

This study evaluates the impact of an intervention targeting high-risk behaviors among diverse, alcohol-using adults living with HIV (N = 267) from 2009 to 2013 in Miami, FL. The intervention took place in a group setting for eight sessions over 4 weeks and was compared to a didactic health promotion group. Assessments were conducted pre-intervention, post-intervention, and at 3, 6, and 12 months follow-up. Intervention participants (48% of sample) evidenced greater knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms after participation. This was particularly noteworthy because associations among knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms were negatively associated with intervention status at baseline. Participants also reported fewer heavy drinking days after participating in the intervention than those in the control group. Greater HIV knowledge, more condom self-efficacy and intentions to use condoms predicted more condom assertiveness; greater intentions to use condoms predicted fewer unprotected sexual behaviors. These findings underscore the importance of taking a comprehensive, multi-systemic approach to address risky behaviors in high-risk, diverse populations.

The impact of COVID-19 on African American communities in the United States.

IMPORTANCE: The novel Coronavirus Disease 2019 (COVID-19), declared a pandemic in March 2020, may present with disproportionately higher rates in underrepresented racial/ethnic minority populations in the United States, including African American communities who have traditionally been over-represented in negative health outcomes. STUDY OBJECTIVE: To understand the impact of the density of African American communities (defined as the percentage of African Americans in a county) on COVID-19 prevalence and death rate within the three most populous counties in each U.S. state and territory (n=152). Design: An ecological study using linear regression was employed for the study. SETTING: The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n=152 counties. PARTICIPANTS: Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. MAIN OUTCOME MEASURES: Linear regression was used to determine the association between African American density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. RESULTS: There was a direct association between African American density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density (p<.01). There was also an association between county AA density and COVID-19 deaths, such; the death rate increased 2 per 100,000 for every percentage increase in county AA density (p=.02). CONCLUSION: These study findings indicate that communities with a high African American density have been disproportionately burdened with COVID-19. Further study is needed to indicate if this burden is related to environmental factors or individual factors such as types of employment or comorbidities that members of these community have.

Substance-abusing adolescents at varying levels of HIV risk: psychosocial characteristics, drug use, and sexual behavior.

PURPOSE: To evaluate the relationship of various psychosocial factors on HIV sexual risk behavior in a sample of 169 "inner city" male and female adolescents mandated into in court-ordered substance abuse treatment. METHOD: The Millon Adolescent Clinical Inventory (MACI) and measures of sexual behavior, condom attitudes and skills, HIV knowledge, and substance abuse were administered. Data were evaluated according to five HIV risk groups: abstinent (n = 37); monogamous and practicing only protected sex (n = 19); monogamous and practicing unprotected sex (n = 45); multiple partners and practicing only protected sex (n = 11); and multiple partners and having only unprotected sex (n = 57). RESULTS: Significant main effects were found for impulsive propensity, submissiveness, marijuana and alcohol use, condom attitudes, and intentions to engage in safer sex. Protective behavior was directly associated with submissiveness and inversely associated with impulsive personality profiles, with increased marijuana use emerging as a significant predictive factor in the choice for sexual activity vs. abstinence. More alcohol use was predictive of choosing multiple partners vs. monogamy. IMPLICATIONS: Factoring risk variation into the design of HIV psychosocial research may enhance the tailoring of effective prevention strategies.

Measuring perceived barriers to condom use: psychometric evaluation of the Condom Barriers Scale.

A programmatic series of three studies developed and evaluated the Condom Barriers Scale (CBS), an instrument measuring women s perceived barriers to condom use for prevention of HIV and other sexually transmitted diseases. Following item generation and selection, Study 1 evaluated the CBS in a sample of minority women (N = 178), reduced the number of items, assessed the factor structure, evaluated the internal consistency, and explored the convergent validity of the CBS. In Study 2, the CBS was administered to a cross-validation sample (N = 278). Confirmatory factor analysis and internal consistency were compared against the original sample and construct, criterion, and discriminant validity were assessed. In Study 3 (N = 30), temporal stability of the CBS was evaluated. The resulting instrument appears to have sound psychometric properties and can be used to measure a key construct in the leading theoretical models of health behavior for which a measure with known psychometric properties previously has not been available.