Behavioral & Community Health Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2802
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Item DISPARITIES IN PRE-EXPOSURE PROPHYLAXIS AWARENESS AMONG WOMEN: A SYSTEMATIC REVIEW OF THE LITERATURE AND LATENT CLASS ANALYSIS OF SYNDEMIC RISK FACTORS(2020) Stubbs, Leandra Nicole; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)While rates of HIV infection have declined among women in recent years, women still account for 19% of all new infections each year in the United States (US). Sociodemographic disparities remain with much of the burden falling on Black adult women aged 25-44. Ongoing transmission of HIV in this population has mostly resulted from heterosexual contact and prior studies have identified interpersonal and sociocultural factors that impede a woman’s choice to engage in safe sex and prevent HIV acquisition. With the debut of pre-exposure prophylaxis (PrEP), an FDA-approved once-daily pill to prevent HIV transmission, researchers believed that this user-controlled method would be an innovative method in reducing HIV in this subpopulation. However, since its release in 2012, there has been insufficient knowledge of PrEP among women in the U.S, resulting in slow and disproportionate uptake of PrEP in this population. While we know the clinical efficacy of PrEP, more understanding of the behavioral, social, and structural factors that impede PrEP awareness among women is important in the dissemination of PrEP-related information and subsequent use.In this dissertation, I took an exploratory approach to: a) identify awareness, knowledge, barriers and facilitators of PrEP use among US-based women through a systematic review; b) identify factors associated with PrEP awareness among female participants in the 2018 Community Health Survey; and c) explore how the presence of multiple deleterious factors can create distinct subgroups of women and further exacerbate disparities in PrEP awareness. In Paper 1, the systematic review of PrEP knowledge among Black/African American women identified 12 articles with findings disaggregated by both race and gender. Primary findings included gaps in PrEP knowledge; acceptability and willingness to use once informed of PrEP; perceived disadvantages as a result of exclusion in clinical trials and early dissemination; and social, structural, and institutional barriers to engagement in the PrEP care continuum. Papers 2 and 3 leveraged data from the 2018 Community Health Survey, a cross-sectional telephone survey of randomly selected adults aged 18 and older from all five boroughs of New York City. In Paper 2, 36% of a female subsample (N=2,295) were aware of PrEP at time of survey. As a result of multinomial linear regression, nine variables were significantly associated with PrEP awareness: nativity, education level, recent HIV test, number of sex partners, IPV, age, race/ethnicity, general health, and prior incarceration. In Paper 3, latent class analysis was used to identify distinct classes of women with varied responses to behavioral and structural variables. The adjusted item-response probabilities resulted in three distinct profiles of women: high resource and low risk group (39%), low resource and moderate risk group (33%), and moderate resource and high-risk group (28%). Key differences between groups include PrEP awareness, perceived health, count of sexual partners, and neighborhood poverty level. These findings have key implications for the way in which PrEP is marketed to women. Future studies should consider the importance of intersectionality and the social and structural context through which women engage with HIV prevention materials and promotional campaigns.Item A DESCRIPTIVE STUDY OF PROGRAM IMPLEMENTATION AMONG A GROUP OF HIGH ACHIEVING COALITIONS IN THE DRUG-FREE COMMUNITIES SUPPORT PROGRAM(2015) Perper, Emily; Beck, Kenneth H; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Substance abuse is a pervasive public health problem that affects all people and communities, regardless of socioeconomic status, race and ethnicity. Substance abuse can particularly devastate youth, as it correlates with many negative health outcomes including damage to the developing brain, dependence, delinquency, decreased academic potential, DUIs, and death. A potential solution to address these problems is the development and implementation of community coalitions. At the federal level, The Office of National Drug Control Policy's (ONDCP) Drug-Free Communities (DFC) Support Program does this through distributing competitive grants to eligible community coalitions that organize to prevent youth substance abuse. This descriptive study examines the degree of agreement between activities of 12 high achieving DFC coalitions to determine best practices. The analysis of the similarities and differences between the program implementation activities determined that 6 activities were universally present among high achieving coalitions, 10 activities has high agreement, and 33 activities to have low agreement among the coalitions. This paper aims to increase the knowledge about high achieving DFCs to help inform policies and practices for communities to reduce youth substance use.Item Barriers and Facilitators to Needle Exchange Implementation: Perceptions of Community Stakeholders In Prince George's County, MD(2013) Paleau, Natasha; Garza, Mary A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Prince George's County, MD has the second highest incidence of HIV in both the Washington, D.C. metropolitan region and the state of Maryland. Approximately 14% of the living cases of HIV/AIDS in Prince George's County in 2009 were attributable to injection drug use. In the 1990's, Prince George's County was one of only two jurisdictions in the state of Maryland to be granted an exemption to the state's drug paraphernalia law to operate a needle exchange program, a harm reduction intervention shown to be effective in lowering incidence rates of HIV in injection drug user populations. However, Prince George's County has yet to implement a needle exchange program to reduce the spread of HIV among injection drug users. This study examined the perceptions of key community stakeholders on what possible barriers and facilitators to the implementation of a needle exchange program exist in Prince George's County. Qualitative, in-depth interviews were conducted with stakeholders from the community sectors of elected officials, law enforcement, public health professionals, drug treatment counselors, neighborhood associations, and religious institutions from two legislative districts within the county. Themes and sub-themes emerged naturally using the Grounded Theory Model of qualitative data analysis. The themes that emerged in connection to barriers and facilitators to needle exchange program implementation included the image of Prince George's County, stigma, needle exchange as a political issue, benefits and harms of needle exchange programs, funding, injection drug use as a declining problem in the county, a need to raise awareness about HIV transmission in injection drug users, and differences between inner-beltway and outer-beltway areas in Prince George's County. Based on analysis of these themes, the barriers and facilitators to needle exchange program implementation in Prince George's County were identified and described, the feasibility of implementation was assessed, and recommendations were developed for local policy makers to aid in the implementation. Overall, barriers outweighed facilitators by more than 3 to 1, and the assessment concluded that implementation of a needle exchange program is unlikely at this time. However, this research sheds light on the history of needle exchange for HIV prevention in Prince George's County, and can be used to inform future research on harm reduction efforts.