Evidence for spatial clines and mixed geographic modes of speciation for North American cherry-infesting Rhagoletis (Diptera: Tephritidae) flies.

An important criterion for understanding speciation is the geographic context of population divergence. Three major modes of allopatric, parapatric, and sympatric speciation define the extent of spatial overlap and gene flow between diverging populations. However, mixed modes of speciation are also possible, whereby populations experience periods of allopatry, parapatry, and/or sympatry at different times as they diverge. Here, we report clinal patterns of variation for 21 nuclear-encoded microsatellites and a wing spot phenotype for cherry-infesting Rhagoletis (Diptera: Tephritidae) across North America consistent with these flies having initially diverged in parapatry followed by a period of allopatric differentiation in the early Holocene. However, mitochondrial DNA (mtDNA) displays a different pattern; cherry flies at the ends of the clines in the eastern USA and Pacific Northwest share identical haplotypes, while centrally located populations in the southwestern USA and Mexico possess a different haplotype. We hypothesize that the mitochondrial difference could be due to lineage sorting but more likely reflects a selective sweep of a favorable mtDNA variant or the spread of an endosymbiont. The estimated divergence time for mtDNA suggests possible past allopatry, secondary contact, and subsequent isolation between USA and Mexican fly populations initiated before the Wisconsin glaciation. Thus, the current genetics of cherry flies may involve different mixed modes of divergence occurring in different portions of the fly's range. We discuss the need for additional DNA sequencing and quantification of prezygotic and postzygotic reproductive isolation to verify the multiple mixed-mode hypothesis for cherry flies and draw parallels from other systems to assess the generality that speciation may commonly involve complex biogeographies of varying combinations of allopatric, parapatric, and sympatric divergence.

The Continuing Challenge of Reducing HIV Risk among Haitian Youth: The Need for Intervention.

There is a dire need for interventions that will address the multiple factors--poverty, substance use, early sexual debut, and violence--that influence Haitian youth's engagement in risky behaviors. The deteriorating socioeconomic and political state of the country has had a deleterious effect on the sociocultural milieu and on the boundaries that have heretofore kept risky behaviors in check. Historically, the lakou system, a community-based approach that supports the family unit, has disintegrated, leading to the disruption of traditional parenting patterns. The unstable economic system has also led to the increasing use of children from poor families, who through the restavek system, are sent to work as servants in other households. The breakdown of traditional systems, coupled with the increasing economic and political instability, has had a significant effect on Haitian adolescents. Among boys, increased levels of substance use have been associated with multiple sex partnerships and very early sexual debut. Among girls, extremely high rates of sexual abuse and forced sex have led to relatively high levels of HIV. While the majority of them have been exposed to behavior change messages, behavior change itself has lagged because many adolescents do not accurately perceive their risk exposure. This review explores the risks of HIV transmission among Haitian youth, with a focus on vulnerability factors, including substance use, culture, and the socioeconomic context, and provides recommendations for intervention. An ecosystemic approach, designed specifically for Haitian youth and that takes environmental context and culture into account, is needed.

Post-traumatic stress disorder symptomatology and alcohol use among HIV-seropositive adults in Haiti.

Psychological trauma resulting from natural disasters can negatively affect the health of persons living with HIV/AIDS (PLWH). This study examined relationships of alcohol use and exposure to the 2010 Haiti earthquake on symptoms of posttraumatic stress disorder (PTSD) among HIV-positive adults enrolled in an intervention study. Baseline data were collected from male and female PLWH, 19-56 years old on: alcohol consumption and related harms; anxiety; and coping strategies used to deal with HIV. Two to three months postearthquake, data were collected from 104 of the study participants on PTSD and earthquake-related impacts. Most participants had less than a secondary education (66%) and very low income (92% ≤ H$10,000 or ≤ US$1250/year). Over two-thirds of participants felt at some point that they should cut down on drinking. Fifty-two (50.5%) met criteria for PTSD. More than 83% lost their belongings and 64% had someone close to them hurt or killed during the earthquake. Bivariate analysis showed that women, younger participants, those who lost all belongings, and those with greater overall alcohol impact were more likely to report PTSD symptoms. In the multivariate model, participants more likely to meet PTSD criteria (p<0.05) were those who reported feeling a need to cut down on drinking (OR = 3.14, [CI = 1.16, 8.49]) and participants who used behavioral disengagement as a coping mechanism (OR = 1.49, [CI = 1.15, 1.92]). Following a natural disaster, it is important to address trauma-related mental health needs of PLWH - particularly women and individuals who abuse alcohol.

Impact of a secondary prevention intervention among HIV-positive older women.

Despite the fact that older women represent a growing risk group for HIV, they have been rarely targeted by public health campaigns designed to prevent HIV/AIDS and are often excluded from many prevention studies. This unique cohort may be often overlooked due to beliefs that older women are not sexually active and do not engage in high risk sexual activity. Data suggest a need for increased attention to this unique cohort. Risk reduction interventions tailored to the special needs of people living with HIV/AIDS have begun to demonstrate promising results. In this manuscript, we report the 6 month outcomes for female participants in Project ROADMAP, a secondary prevention intervention designed to reduce high risk sexual behavior in older adults living with HIV/AIDS. Our results indicate that female participants in the intervention group were more likely to report a reduction in high risk sexual behavior than women in the control condition. Our findings also suggest that the intervention succeeded in increasing the HIV-related knowledge of the participants and decreasing their stigma vis-à-vis the HIV condition. The study findings suggest that Project ROADMAP is an effective secondary prevention intervention for sexually active older HIV positive women.

Substance Abuse, Acculturation, and HIV Risk among Caribbean-Born Immigrants in the United States.

US immigrants of Caribbean origin are overrepresented in the HIV/AIDS prevalence statistics. Bidirectional travel between the United States and the Caribbean region by providing opportunities for sexual mixing may contribute to these high HIV rates. Caribbean immigrants face further risk because of limited health care access, social isolation, and stigma. Additionally, although substance abuse may not represent a major health issue in their countries of origin, Caribbean immigrants are composed disproportionately of adolescents who are at greatest risk of substance abuse. There is little information on the health care characteristics of these migrants, especially regarding HIV care. This article describes how the social and economic circumstances that surround the lives of people from the Caribbean and the challenges of the acculturation process have placed these individuals at risk of substance abuse and HIV infection. The article draws on findings from the literature and analysis of data from several sources.

Use of HIV primary care by HIV-positive Haitian immigrants in Miami, Florida.

Little is known about the use of HIV primary care among Haitian immigrants in the USA. The present study utilizes data from a survey of HIV-positive Haitians recruited from an HIV primary care clinic in Miami, Florida, to examine barriers and facilitators of regular use of HIV care by this population. Selection of measures was guided by the Andersen Model of Health Services Utilization for Vulnerable Populations. The dependent variable, regular use of HIV primary care, was operationalized as completion of four or more HIV primary care visits during the previous 12 months. Of the 96 participants surveyed, approximately three-fourths did not graduate from high school and reported an annual income of up to $5000. Seventy-nine percent of participants completed four or more visits in the past year. On univariate as well as multivariate analyses, participants without formal education or those with high psychological distress were significantly less likely to have used HIV primary care regularly than those who attended school or who were less distressed, respectively. The findings emphasize the need for health care practitioners to pay close attention to the education level and the mental health status of their Haitian HIV patients. The data also suggest that once these individuals are linked to care and offered assistance with their daily challenges, they are very likely to stay connected to care and to take their antiretroviral medicines.

Gender Differences in the salience of psychosocial mediators of the impact of acculturation on substance abuse among Hispanic youth in Florida.

OBJECTIVES: A number of psychosocial factors have been identified as mediators of the impact that acculturation exerts on adolescent drug use. We sought to evaluate gender differences in mediators of the impact of acculturation on substance abuse. METHODS: We used t-test and logistic regression to analyze data collected from 8,200 adolescent students who self-identified as Hispanic during the 2004 Florida Youth Substance Abuse. The dependent variable was past 30 day use of marijuana and the key independent variable was language spoken at home. The covariates were 32 risk and protective (R/P) factors for drug use as defined by the Social Development Strategy framework. RESULTS: For boys, the ORs associated with language changed significantly with the addition of any of the R/P factors to their basic model, while for girls only the addition of the Individual domain factors significantly changed the ORs. DISCUSSION AND CONCLUSION: These findings suggest that among boys the interventions that target any or all of the R/P factors may be able to positively alter the drug using behaviors among boys. In contrast, only the interventions that reinforce girls' innate strengths may succeed in dissuading them from initiating and perpetuating drug use. This information can be used to develop policies and interventions geared toward preventing drug problems among the growing group of adolescent of immigrant descent.

Drinking alcohol before age 13 and negative outcomes in late adolescence.

BACKGROUND: Research has shown that adolescents who begin drinking at an early stage in life are at greater risk of developing alcohol dependency, as well as a variety of negative outcomes, for instance, delinquent behavior. Most of these studies have focused on those who begin drinking in middle adolescence, but little attention has been paid to youth who initiate drinking under the age of 13. Twenty percent of adolescents have begun using alcohol by the age of 13. The purpose of the study is to examine whether initiating alcohol use before the age of 13 exacerbates negative outcomes in late adolescence. METHODS: Data for the study were derived from 2 school-based statewide surveys conducted in Florida: the 2005 YRBS and the 2006 FYSAS. The sample included 12,352 11th and 12th grade students divided into 3 groups: students who initiated alcohol use under the age of 13, students who initiated alcohol use at age 13 or later, and students who never used alcohol. RESULTS: Results showed that after adjusting for gender, ethnicity/race, and grade, adolescents who initiated alcohol use before age 13 were more likely to report problems with school performance and display delinquent behaviors (carrying a gun, carrying a weapon to school, and recent marijuana use). CONCLUSION: Although no temporal relationships can be determined between drinking alcohol before age 13 and delinquent behavior outcomes, the results suggested that adolescents under the age of 13 need to be included in national epidemiological surveys on alcohol use and more efforts need to be directed toward the implementation of prevention programs early in elementary and middle schools.

Knowledge, attitudes, and behaviors among a sample of HIV-positive and HIV-negative females visiting an urban VCT center in Haiti.

The knowledge, attitudes, and behaviors of over 43,000 women attending the Groupe Hatien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centers in Haiti between 1999-2004 were examined. Comparative analyses were conducted for several sub-samples. Analyses revealed that across the entire sample, HIV-positive women appeared to engage in more risky behaviors than HIV-negative women (p< .01); however, as a group, pregnant HIV-positive women reported safer behaviors than non-pregnant HIV-positive women (p<.01). Women from all groups were generally knowledgeable about the risk of HIV transmission through dirty needles and mother to child. However, inaccurate information about transmission through supernatural means and mosquitoes was very common. These results suggest that knowledge and education are negatively associated with HIV status in this sample. Addressing gaps in knowledge and behavior and reducing the risky behaviors of HIV-positive individuals are important directions for future programs.

Prevention of mother-to-child transmission of HIV in Haiti.

OBJECTIVES: To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT) of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS: All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3% received zidovudine (AZT), 2.9% received nevirapine (NVP), and 10.1% received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8% received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS: Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2% (95% CI: 6.14-12.24), in contrast to the historical mother-to-child transmission rate of 27% in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (chi(2) = 19.06, P < .001, log rank test). Infant survival improved with early pediatric diagnosis and antiretroviral treatment. CONCLUSIONS: The MTCT prevention program described proved to be feasible and effective in reducing vertical HIV transmission in Haiti. The authors emphasize the need to expand testing, extend services to rural areas, and implement early HIV diagnosis to reduce infant mortality.

Prevention of mother-to-child transmission of HIV in Haiti / Prevención de la transmisión del VIH de madre a hijo en Haití

OBJECTIVES: To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT) of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS: All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3 percent received zidovudine (AZT), 2.9 percent received nevirapine (NVP), and 10.1 percent received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8 percent received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS: Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2 percent (95 percent CI: 6.14-12.24), in contrast to the historical mother-to-child transmission rate of 27 percent in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (χ2 = 19.06, P < .001, log rank test). Infant survival improved with early pediatric diagnosis and antiretroviral treatment. CONCLUSIONS: The MTCT prevention program described proved to be feasible and effective in reducing vertical HIV transmission in Haiti. The authors emphasize the need to expand testing, extend services to rural areas, and implement early HIV diagnosis to reduce infant mortality.

OBJETIVOS: Describir la eficacia de un programa diseñado para reducir la tasa de transmisión del VIH de madre a hijo (TMH) en el principal centro de diagnóstico y tratamiento de esa infección en Haití entre 1999 y 2004. MÉTODOS: Se invitó a participar en un programa para la prevención de la TMH a todas las embarazadas positivas al VIH que asistían a la clínica principal de diagnóstico y tratamiento de la infección por el VIH en Puerto Príncipe, Haití, entre marzo de 1999 y diciembre de 2004. De las 650 mujeres que participaron, 73,3 por ciento recibieron zidovudina (AZT), 2,9 por ciento nervirapine (NVP) y 10,1 por ciento tripleterapia cuando esta se hizo disponible en 2003 y cumplían los indicadores clínicos y de laboratorio requeridos. Aproximadamente 13,8 por ciento no recibió medicamentos antirretrovirales. Todas las participantes recibieron el tratamiento profiláctico con cotrimoxazole y fórmula infantil para sus hijos. Para evaluar el impacto del programa sobre la supervivencia infantil se aplicó el análisis de supervivencia de Kaplan-Meier y la prueba de rangos logarítmicos. RESULTADOS: Se obtuvieron los datos completos de 348 parejas madre-hijo que terminaron el programa de prevención de la TMH del VIH. La tasa de TMH en el estudio fue de 9,2 por ciento (intervalo de confianza de 95 por ciento: 6,14 a 12,24), frente a una tasa de TMH histórica en Haití de 27 por ciento. A los 18 meses de seguimiento, los niños positivos al VIH presentaron una menor probabilidad de supervivencia que los negativos (χ2 = 19,06; P < 0,001; prueba de rangos logarítmicos). La supervivencia de los niños aumentó con el diagnóstico y el tratamiento antirretroviral pediátricos tempranos. CONCLUSIONES: El programa de prevención de la TMH descrito demostró su factibilidad y eficacia para reducir la transmisión vertical del VIH en Haití. Los autores sub rayan la necesidad de extender el tamizaje y los servicios a áreas rurales, así como de implementar...

Prevention of mother-to-child transmission of HIV in Haiti

OBJECTIVES: To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT) of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS: All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3% received zidovudine (AZT), 2.9% received nevirapine (NVP), and 10.1% received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8% received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS: Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2% (95% CI: 6.14-12.24), in contrast to the historical mother-to-child transmission rate of 27% in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (chi(2) = 19.06, P < .001, log rank test). Infant survival improved with early pediatric diagnosis and antiretroviral treatment. CONCLUSIONS: The MTCT prevention program described proved to be feasible and effective in reducing vertical HIV transmission in Haiti. The authors emphasize the need to expand testing, extend services to rural areas, and implement early HIV diagnosis to reduce infant mortality.

A feeding education program to prevent mother-to-child transmission of HIV in Haiti.

In Haiti, as in most of the developing world, vertical transmission of HIV from infected mother to infant through postpartum breastfeeding remains a significant mode of transmission. As part of their prevention of mother-to-child transmission program, the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centers developed a feeding education program in which over 83% of the HIV-positive pregnant women who were eligible to participate, enrolled. Bivariate and adjusted multivariate logistic regression analyses were used to compare feeding choices of the 290 women who participated in the feeding education program to 58 who did not. Of those who participated, 91.7% chose to use replacement formulas for their newborns, while 75.9% of those who did not participate chose replacement feeding. After adjustment for socio-demographic variables, analyses revealed that the no education group was less likely to adopt replacement feeding and more likely to use mixed feeding (OR=0.31, p=0.004; and OR=2.74, p=0.05, respectively). This suggests that a targeted and culturally appropriate education program can be effective in encouraging replacement feeding, even in those countries where breastfeeding is the norm.

Sexual risk behaviors in late middle age and older HIV seropositive adults.

Little is known about the sexual behaviors of older adults, although the prevalence of HIV/AIDS is rapidly increasing in this population. As part of a larger multi-site study examining secondary HIV prevention, we recruited from an HIV primary care clinic 210 sexually active HIV positive individuals aged 45 and over (125 men, 85 women) who had engaged in vaginal or anal sex within the past six months. Twenty percent of the participants reported inconsistent use of condoms and 33% had multiple sexual partners during the previous six months. Negative mood and perceived HIV stigma were associated with inconsistent condom use. In addition, multiple sex partners and higher level of education were related to inconsistent condom use during sex with partners of negative or unknown serostatus. These findings indicate that contrary to current beliefs, sexually active older adults, similar to younger ones, may be engaging in high risk transmission behaviors.

Psychosocial mediators of the impact of acculturation on adolescent substance abuse.

To identify and evaluate socio-psychological factors that are associated with differences in substance abuse prevalence between non-acculturated and acculturated Florida youth, we employed t-test and logistic regression to analyze self-reported data from 63,000 middle and high school student participants in the 2004 Florida Youth Substance Abuse Survey. Questionnaire items covered socio-demographics, tobacco, alcohol, and illicit substance use; and perceptions and attitudes toward drug use. The outcome variables were past 30 day use of "any illicit drug." The key independent variable was language used at home (English/Another language). The covariates were 32 socio-psychological factors that are considered risk and protective factors for adolescent drug abuse. Findings support the growing body of evidence suggesting that acculturation status is a strong predictor of substance use among adolescents. This effect may be mediated principally through the family and peer/individual psychosocial domains. The findings may have important implications for the design and implementation of drug prevention programs targeting teenagers.

A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation.

Healthy People 2010 made it a priority to eliminate health disparities. We used a rapid assessment response and evaluation (RARE) to launch a program of participatory action research focused on health disparities in an urban, disadvantaged Black community serviced by a major south Florida health center. We formed partnerships with community members, identified local health disparities, and guided interventions targeting health disparities. We describe the RARE structure used to triangulate data sources and guide intervention plans as well as findings and conclusions drawn from scientific literature and epidemiological, historic, planning, clinical, and ethnographic data. Disenfranchisement and socioeconomic deprivation emerged as the principal determinants of local health disparities and the most appropriate targets for intervention.

Differences in HIV-related hospitalization trends between Haitian-born blacks and US-born blacks.

OBJECTIVES: To examine the HIV care needs and hospital admission patterns of HIV-positive Haitian-born blacks (Haitians) and compare them with those of US-born blacks (Blacks). METHODS: We abstracted the medical records of 635 Blacks and Haitians consecutively admitted to the adult HIV Service at Jackson Memorial Hospital during 2004 for information on demographics, use of antiretroviral therapy, CD4 cell counts, primary and secondary diagnoses at admission, and substance use. The probability of being prescribed highly active antiretroviral therapy (HAART) was examined by country of origin. RESULTS: There was no statistically significant difference between the groups in likelihood to be prescribed HAART. In controlled analyses, however, Haitians were 76% more likely than Blacks to have a CD4 count <51 cells/mm3 and tended to be more recently diagnosed with HIV Moreover, tuberculosis was the most prevalent opportunistic infection for Haitians compared with candidiasis for Blacks. CONCLUSIONS: Findings suggest that barriers to medical care may exist for Haitians at an early stage of the access continuum and that prevention efforts among the Haitian HIV-positive population should be directed at promoting the need for timely use of health services.

Detection of carcinogenic human papillomavirus in specimens collected with a novel self-sampling device.

We compared the detection of carcinogenic human papillomavirus DNA in cervicovaginal specimens self-collected using a novel device to the detection in physician-collected cervical specimens from 137 women. The kappa value was 0.66 (95% confidence interval, 0.53 to 0.78), with an 83% overall test agreement and a 68% positive test agreement.

Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.