UMD Theses and Dissertations
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Item “WHAT’S SPANISH FOR AIDS?”: LATINO ACTIVISM AGAINST RACIALLY EXCLUSIVE HIV/AIDS HEALTHCARE OUTREACH IN WASHINGTON, D.C., 1981-1995(2019) Brandli, Elizabeth Jane; Rosemblatt, Karin A; History; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This research examines the racially exclusive health outreach practices in Washington, D.C. during the HIV/AIDS crisis that created barriers to healthcare for Latino residents. After analyzing the ways in which mainstream organizations failed to disseminate educational materials within Latino communities, this thesis turns to the ways in which Latino activists combatted exclusion and performed healthcare outreach within their communities. Finally, this research considers the national significance of the D.C. region on Latino HIV/AIDS outreach and the importance of immigrants and transregional migrants to the nation’s capital.Item BLACK SURVIVAL POLITICS: ORGANIZED MOBILIZATION STRATEGIES IN AFRICAN AMERICAN COMMUNITIES TO END THE HIV/AIDS EPIDEMIC(2016) Beadle Holder, Michelle; Collins, Patricia H; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this study is to examine organizational patterns of African American activism in response the HIV/AIDS epidemic. Given their political, economic, and social disenfranchisement, African Americans have historically developed protest and survival strategies to respond to the devaluation of their lives, health, and well-being. While Black protest strategies are typically regarded as oppositional and transformative, Black survival strategies have generally been conceptualized as accepting inequality. In the case of HIV/AIDS, African American religious and non-religious organizations were less likely to deploy protest strategies to ensure the survival and well-being of groups most at risk for HIV/AIDS—such as African American gay men and substance abusers. This study employs a multiple qualitative case study analysis of four African American organizations that were among the early mobilizers to respond to HIV/AIDS in Washington D.C. These organizations include two secular or community-based organizations and two Black churches or faith-based organizations. Given the association of HIV/AIDS with sexual sin and social deviance, I postulated that Black community-based organizations would be more responsive to the HIV/AIDS-related needs and interests of African Americans than their religious counterparts. More specifically, I expected that Black churches would be more conservative (i.e. maintain paternalistic heteronormative sexual standards) than the community-based organizations. Yet findings indicate that the Black churches in this study were more similar than different than the community-based organizations in their strategic responses to HIV/AIDS. Both the community-based organizations and Black churches drew upon three main strategies in ways that politicalize the struggle for Black survival—or what I regard as Black survival politics. First, Black survival strategies for HIV/AIDS include coalition building at the intersection of multiple systems of inequality, as well as on the levels of identity and community. Second, Black survival politics include altering aspects of religious norms and practices related to sex and sexuality. Third, Black survival politics relies on the resources of the government to provide HIV/AIDS related programs and initiatives that are, in large part, based on the gains made from collective action.Item The Relation between Substance Use and Medication Adherence among HIV Positive Substance Users in Residential Treatment(2015) Hoffman, Elana Michelle; MacPherson, Laura; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Poor medication adherence is problematic among HIV positive, low-income African-American substance users. Substance use has been shown to be associated with poor medication adherence, though we do not know the mechanism that underlies this relationship. Lack of positive environmental rewards and the propensity to discount delayed rewards may be possible mechanisms to explain this relationship. Using baseline data from a randomized controlled trial, we examined the relationships between substance use and medication adherence, testing both environmental rewards and delay discounting as independent mediators. There was a main effect of substance use on adherence, such that high frequency of substance use predicted poor adherence. There was also a main effect of environmental rewards on adherence, such that a lack of environmental reinforcement predicted poor adherence. This study shed light on the processes that contribute to low adherence, namely substance use and lack of environmental contingencies, and suggests important targets for intervention.Item THE ROLE OF DENIAL AND PERCEIVED HIV STIGMA AS BARRIERS TO ENGAGING IN HIV MEDICAL CARE AMONG HIV POSITIVE AFRICAN AMERICANS IN THE WASHINGTON, DC AREA(2015) Geiger, Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)HIV is a potentially fatal and highly stigmatized disease such that diagnosis with the disease is often met with high anxiety. Many people who test positive for HIV may not receive sufficient linkage to HIV care or do not remain engaged in continuous HIV medical care once they have entered care. While a considerable amount of research exists on referral, access, personal characteristics, and mental illness barriers associated with engagement in HIV medical care, far less attention has been given to psychosocial factors, specifically denial and perceived HIV stigma as important barriers to engaging in HIV medical care. The purpose of this study was to determine whether denial and/or perceived HIV stigma are associated with engagement in HIV medical care for African-American people living with HIV/AIDS (PLWHA). Data were collected as part of a peer-based community health worker program (CHW), based in Washington DC, designed to link PLWHA to HIV medical care and services. Logistic regression analyses were performed to determine whether the psychosocial variables were predictors of engagement in HIV medical care.Results indicated that disclosure is a major issue for this population, as 46% of the participants had not disclosed their HIV status to others. Separate analyses were conducted for the total sample (n=262) and with the disclosed sample (n=120). Results in the total sample revealed that disclosure of HIV status was associated with engagement in HIV status. PLWHA who disclosed HIV status to others were 2.2 times more likely to engage in HIV medical care than persons who had not disclosed HIV status. In the disclosed sample, gender, educational level and employment status were also associated with engagement in HIV medical care. Women and persons with low educational level and unemployed were less likely to engage in HIV medical care. Denial and perceived HIV stigma were not found to be independent predictors of engagement in HIV medical care when other covariates were included in the model. Disclosure of HIV status, gender and educational level were predictors of engagement in HIV medical care for this population. These obstacles to care may be amenable to disclosure and gender-specific interventions; and, therefore, warrant better understanding to improve outreach interventions to PLWHA who are not engaged in HIV medical care.Item Mediators of the Relationship between Depression and Medication Adherence among HIV Positive Substance Users(2012) Magidson, Jessica F; Lejuez, Carl W; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Medication adherence is of utmost importance in predicting health outcomes across numerous chronic conditions, particularly HIV/AIDS. Highly active antiretroviral therapy (HAART) to treat HIV/AIDS requires high levels of adherence to maintain viral suppression, which is crucial for optimal HIV treatment and prevention. One of the most significant patient-level barriers to medication adherence is depressive symptoms. Even at subclinical levels, depressive symptoms predict nonadherence above and beyond other relevant psychosocial factors. Despite the focus on depressive symptoms as a reliable and powerful predictor of nonadherence, few studies have sought to test potential mechanisms underlying this relationship, which is an important step to advance our understanding of how depression affects adherence to inform intervention efforts. The current study utilized early behavioral theories of depression (Lewinsohn, 1974; Ferster, 1973) to select potential mediators that may be relevant to both depression and adherence. Specifically, we tested the key components of these models, (1) goal-directed activation, (2) positive reinforcement, and (3) punishment in one's environment as potential mediators of the relationship between depressive symptoms and medication adherence among HIV positive individuals in substance abuse treatment (n = 73). We examined adherence to HAART as well as adherence to other daily medications using a combination of self-report assessments (% of doses missed over past four days, frequency of doses missed across common reasons for nonadherence) and viral load. Greater levels of punishment mediated a positive relationship between clinician-rated depressive symptoms and greater frequency of missed doses across common reasons for nonadherence. Activation and positive reinforcement were unrelated to adherence or viral load in this sample. Findings suggest the importance of punishment in explaining the relationship between depression and medication nonadherence. Individuals with elevated depressive symptoms may perceive greater negative consequences related to medications (e.g., side effects, stigma) and may be less likely to overcome barriers necessary for optimal adherence. If findings continue to replicate, this may suggest a need to target punishment in HIV prevention and treatment, for instance in the context of integrated cognitive behavior therapy interventions that target depression and adherence among substance users.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.Item WHAT DOES IT MEAN TO CARE AND PROVIDE SCHOOLING FOR A CHILD ORPHANED DUE TO HIV/AIDS IN CÔTE D'IVOIRE?: A QUALITATIVE STUDY(2012) Briggs, Liza EA; Klees, Steven; Education Policy, and Leadership; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This is a qualitative study about how a family describes what it means to care for and provide schooling for a child orphaned due to HIV/AIDS. The study offers a perspective beyond the lens of a family through the inclusion of interview data from representatives of the Ivorian Ministry of Health, and non-governmental organizations (NGOs) located in Côte d'Ivoire. Descriptive data reveal how care and schooling are nearly synonymous constructs in the family at the center of this study. To care for a child means to provide schooling. The form of care and schooling are ordered through practices linked to established matrilineal and ethnic family system practices. The child, orphaned due to HIV/AIDS, offers rich descriptive insights about how the loss of his parents affected his care needs, how he negotiated the matrilineal system and how he embraced school achievement and religion to manage his sense of loss and the stigma attached to his status as an orphaned child. This study also offers descriptions that explore the complexity of the political dynamics, support mechanisms, and psychosocial constructs that delineate care and schooling practices in this family and, more broadly, in Côte d'Ivoire. This study contributes to existing scholarly literature by offering a nuanced depiction of the impact of HIV/AIDS from a variety of perspectives. This contrasts with studies that converge on demographic and statistical analysis. This study also places a great deal of emphasis on the inclusion of the perspective of Ivorians. Ivorian representation allows for Ivorian-centered depictions and responses to the research questions and reflects concerns about post-development critiques on discourse and representation.Item Predictors of Abstinence, Safer Sex & Higher Risk Sexual Behaviors At A Historically Black College & University(2009) Saunders, Darlene Renee; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this cross sectional study, purposive sampling was used to examine the sexual behaviors and practices of African American college age students (n=681) attending a Mid-Atlantic HBCU. The majority of participants were women (72%) and sexually attracted to men (69%); the mean age was 20 (SD=1.3). The primary purpose of this research was to explore specific factors that may contribute to African American college students' decisions to practice abstinence, engage in safer sex or higher risk sexual practices. The Theory of Planned Behavior loosely guided the selection of variables, specifically normative beliefs, attitudes and behavioral control constructs were used to examine the sexual behaviors of African American college students. Binge drinking, marijuana use, the number of hours per day students' listened to rap music and viewed rap music videos, and the extent rap music or rap music videos influenced their sexual attitudes were variables examined using backward logistic regression. Additionally, the investigator examined religiosity and students' perceptions of whether peers and parents would approve of their engagement in specific sexual behaviors, using valid and reliable scales developed by other researchers. Demographic variables explored included age, gender and the students' sexual orientation. Results from research question one (predicting whether students would be abstinent or sexually active) indicated age, marijuana use, and binge drinking were the best predictors, accounting for 22% of the variance. Students who reported binge drinking or marijuana use were more liked to report being sexually active than students not engaging in these behaviors. Research question two (distinguishing between sexually active students who engage in safer vs. riskier sexual behaviors) found that sexual orientation was the only significant predictor. The study documented greater sexual risk-taking behaviors among heterosexual women when compared to heterosexual males. This exploratory study helps fill the void in the literature about the sexual behaviors of African American college students.Item The Impact of Formal Social Support on Outpatient Care Among a Sample of Adults Living with HIV/AIDS in the United States(2007-11-19) Matoff-Stepp, Sabrina A; Boekeloo, Ph.D., Bradley O.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background The HIV Cost and Services Utilization Study and HIV Research Network (HIVRN) clinical studies showed disparities among HIV-positive men and women in outpatient care use in the U.S. Formal social support provided by case managers may help patients access outpatient care. The primary purpose of this study was to determine if having case managers is associated with levels of outpatient care visits among 797 individuals living with HIV/AIDS, and whether this association varies by patient sex. Other aims were to determine if the number of in-person case management visits and the type of formal social support are associated with these same outcomes. Outpatient visit levels were defined as 2-5 (average) or 6+ (high). Based on Andersen's (1995) Behavioral Model of Health Services Use, a conceptual model was developed as a framework for examining the study's hypothesized relationships. Methods The HIVRN is a convenience sample of 17 U.S. clinical sites serving more than 15,000 people living with HIV/AIDS. In 2003, interviews were conducted with a stratified sample of 951 clients at 14 HIVRN sites. The current study sample consisted of 797 adult respondents (543 males and 254 females). Logistic regression was used to identify significant predictors of outpatient care visit levels. Results Patients who had one or two case managers versus no case managers were significantly more likely to have 6+ outpatient visits, while patients who were employed and had higher self-reported perceptions of their health were significantly less likely to have 6+ outpatient visits. These relationships did not vary by patient sex. Level of outpatient visits also did not vary by patient sex. No significant associations were found between the number of in-person case management visits or the type of formal social support and level of outpatient visits. In sub-analyses that separated patients with one case manager from those with two case managers, no new predictors emerged. Conclusion Case management was associated with higher levels of outpatient visits for both male and female patients in this study. This finding suggests that utilization of HIV-related outpatient care may be increased among both men and women with case management.Item Black women's meaning-making of HIV/AIDS campaigns: A Black feminist approach to the impact of race on the reception of targeted health communication(2007-05-09) Curry, Tiphane' Patrice; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this exploratory study was to understand how Black women make meaning of HIV/AIDS communication. This study combines Black feminist epistemology with the situational theory of publics in an examination of Black females' meaning making of HIV/AIDS communication. Twenty in-depth interviews were conducted with Black women under the age of 35. Findings suggest targeted publics may choose not to process messages because they feel the messages inaccurately represent their identity, or not to seek information because they do not want to face judgment from others who associate their identity with a health problem because of targeted messages. This study added to the situational theory of publics by proposing an emerging model describing the relationship between identity and the variables of the situational theory.