College of Behavioral & Social Sciences
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Item Patient and provider perceptions of a peer-delivered intervention (‘Khanya’) to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis(Cambridge University Press, 2022-08-26) Rose, Alexandra L.; Belus, Jennifer M.; Hines, Abigail C.; Barrie, Issmatu; Regenauer, Kristen S.; Andersen, Lena S.; Joska, John A.; Ciya, Nonceba; Ndamase, Sibabalwe; Myers, Bronwyn; Safren, Steven A.; Magidson, Jessica F.Background. Despite a high prevalence of problematic substance use among people living with HIV in South Africa, there remains limited access to substance use services within the HIV care system. To address this gap, our team previously developed and adapted a six-session, peer-delivered problem-solving and behavioral activation-based intervention (Khanya) to improve HIV medication adherence and reduce substance use in Cape Town. This study evaluated patient and provider perspectives on the intervention to inform implementation and future adaptation. Methods. Following intervention completion, we conducted semi-structured individual interviews with patients (n = 23) and providers (n = 9) to understand perspectives on the feasibility, acceptability, and appropriateness of Khanya and its implementation by a peer. Patients also quantitatively ranked the usefulness of individual intervention components (problem solving for medication adherence ‘Life-Steps’, behavioral activation, mindfulness training, and relapse prevention) at post-treatment and six months follow-up, which we triangulated with qualitative feedback to examine convergence and divergence across methods. Results. Patients and providers reported high overall acceptability, feasibility, and appropriateness of Khanya, although there were several feasibility challenges. Mindfulness and Life-Steps were identified as particularly acceptable, feasible, and appropriate components by patients across methods, whereas relapse prevention strategies were less salient. Behavioral activation results were less consistent across methods. Conclusions. Findings underscore the importance of examining patients’ perspectives on specific intervention components within intervention packages. While mindfulness training and peer delivery models were positively perceived by consumers, they are rarely used within taskshared behavioral interventions in low- and middle-income countries.Item EFFECTS OF INTERSECTING STIGMAS ON HIV AND ALCOHOL-RELATED HEALTH BEHAVIORS(2021) Regenauer, Kristen S; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)South Africa (SA) has a high burden of HIV and problematic alcohol use. However, associations between HIV stigma and alcohol-outcomes, and alcohol stigma and HIV-outcomes are largely unknown. Further, limited research has examined the role of avoidance in these associations. Therefore, as part of a larger clinical trial, we explored these associations among people living with HIV (PLWH) and problem drinking in SA (N=64). Patients had blood drawn for biomarker-verified measures of outcome variables, and completed self-report measures for all variables. A significant interaction was found between internalized HIV stigma and avoidance in predicting self-report problematic alcohol use (b(SE)=.24(.09), p=.01) such that at low levels of avoidance, higher HIV stigma was associated with less problematic alcohol use (b(SE)=-1.92(.85), p=.03). A matching nonsignificant pattern was observed for biomarker-verified alcohol consumption, suggesting that the relationship between internalized HIV stigma and problematic alcohol use may be moderated by avoidance.Item Female partners of opioid-injecting men in the Republic of Georgia: an initial characterization(Springer Nature, 2012-11-16) Lund, Ingunn O; Kirtadze, Irma; Otiashvili, David; O’Grady, Kevin E; Jones, Hendrée EHIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners. In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake. The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship. The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial “Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)”. ClinicalTrials.gov Identifier: NCT00496990.]Item Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 – 2011: a retrospective cohort study(Springer Nature, 2014-12-17) Mee, Paul; Wagner, Ryan G; Gómez-Olivé, Francesc Xavier; Kabudula, Chodziwadziwa; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Byass, Peter; Tollman, Stephen MIn 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.Item Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa(Springer Nature, 2020-03-04) Magidson, Jessica F.; Joska, John A.; Myers, Bronwyn; Belus, Jennifer M.; Regenauer, Kristen S.; Andersen, Lena S.; Majokweni, Sybil; O’Cleirigh, Conall; Safren, Steven A.Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population.Item WHAT IS BEAUTIFUL IS SAFE: PHYSICAL ATTRACTIVENSS AND PERCEPTIONS OF STI RISK AMONG MEN WHO HAVE SEX WITH MEN(2018) Sarno, Elissa Louise; Mohr, Jonathan J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Men who have sex with men (MSM) are the group most severely impacted by HIV in the United States (CDC, 2015). Many MSM, however, still engage in sex without condoms (Smith, Herbst, Zhang, & Rose, 2015). One factor influencing a lack of condom use among MSM may be an assumption of low risk of contracting HIV or another STI from physically attractive partners. This assumption may be particularly dangerous for MSM who use geosocial networking applications (GSN) to find sexual partners. Previous researchers have suggested that this assumption could be based on two theoretical mechanisms: implicit personality theory and motivated reasoning. The present study tested two hypothesized models of the associations between physical attractiveness, perceived HIV/STI risk, and condom use intentions, based on these proposed theories. Participants were 197 MSM who completed an online survey in which they viewed photos of physically attractive and unattractive men and responded to items on perception of positive partner personality characteristics, intention to have sex with the partner, perceived risk for HIV/STIs, and condom use intentions. Results supported both theories. Specifically, physical attractiveness was negatively associated with perceived risk for HIV/STIs and condom use intentions, and these relations were mediated by intentions to have sex and positive partner personality. Implications of these findings for further research and practice are discussed.Item Experimentally Testing the Effect of Parent-Adolescent Conflict on HIV Risk, and Investigation of a Neurobiological Moderator of This Effect(2015) Thomas, Sarah Ann; De Los Reyes, Andres; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Human immunodeficiency virus (HIV) is a condition in which immune cells become destroyed such that the body may become unable to fight off infections. Engaging in risk-taking behaviors (e.g., substance use) puts people at heightened risk for HIV infection, with mid-to-late adolescents at increasing risk (Leigh & Stall, 1993). Environmental and neurological reasons have been suggested for increased risk-taking among adolescents. First, family-level precursors such as parent-adolescent conflict have been significantly associated with and may pose risk for engaging in substance use and risk-taking (Duncan, Duncan, Biglan, & Ary, 1998). Thus, parent-adolescent conflict may be an important proximal influence on HIV risk behaviors (Lester et al., 2010; Rowe, Wang, Greenbaum, & Liddle, 2008). Yet, the temporal relation between parent-adolescent conflict and adolescent HIV risk-taking behaviors is still unknown. Second, at-risk adolescents may carry a neurobiological predisposition for engaging in trait-like expressions of disinhibited behavior and other risk-taking behaviors (Iacono, Malone, & McGue, 2008). When exposed to interpersonally stressful situations, their likelihood of engagement in HIV risk behaviors may increase. To investigate the role of parent-adolescent conflict in adolescent HIV risk-taking behaviors, 49 adolescents ages 14-17 and their parent were randomly assigned to complete a standardized discussion task to discuss a control topic or a conflict topic. Immediately after the discussion, adolescents completed a laboratory risk-taking measure. In a follow-up visit, eligible adolescents underwent electrophysiological (EEG) recording while completing a task designed to assess the presence of a neurobiological marker for behavioral disinhibition which I hypothesized would moderate the links between conflict and risk-taking. First, findings indicated that during the discussion task, adolescents in the conflict condition evidenced a significantly greater psychophysiological stress response relative to adolescents in the control condition. Second, a neurobiological marker of behavioral disinhibition moderated the relation between discussion condition and adolescent risk-taking, such that adolescents evidencing relatively high levels of a neurobiological marker related to sensation-seeking evidenced greater levels of risk-taking following the conflict condition, relative to the control condition. Lastly, I observed no significant relation between parent-adolescent conflict, the neurobiological marker of behavioral disinhibition and adolescent engagement in real-world risk-taking behavior.Item Prevalence of dysphagia and cognitive impairments in adults with HIV/AIDS in the acute care setting: An epidemiological study(2011) Walker, Theresa; Sonies, Barbara; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are life-threatening conditions. This virus causes the suppression of the immune system, allowing opportunistic infections and diseases to attack the body. Due to these opportunistic infections, individuals with HIV/AIDS are susceptible to conditions such as dysphagia (difficulty swallowing), odynophagia (painful swallowing), and cognitive impairment (e.g., HIV dementia). The co-morbidity of these conditions is not clearly documented in the literature. Therefore, in this study, the prevalence of dysphagia (with and without cognitive impairment) in the HIV/AIDS population was determined by a review of 300 medical charts from patients admitted to a metropolitan hospital. Possible associations between the conditions and several demographic variables (e.g., age, CD4 cell count, recommended diet) were also explored. Twenty-one percent of the charts of patients with HIV/AIDS reported confirmed dysphagia and/or complaints of odynophagia. Of that 21%, only about five percent also had a documented cognitive impairment. This study supports previous prevalence estimates of dysphagia and odynophagia and reports prevalence of concurrent dysphagia and cognitive impairment, a potentially challenging complex. Lower CD4 counts were associated with the presence of dysphagia in this population. Individuals with dysphagia and cognitive impairments were more likely to be older and were more likely to be recommended a restrictive diet consistency. Implications and recommendations for future study of this population are discussed.Item The Intersection of HIV Infection with HIV/AIDS Beliefs among African Americans(2007-08-02) Walton, Heather M.; Fassinger, Ruth E.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This dissertation describes a qualitative study of 15 African American, HIV-positive individuals who were clients in a day treatment program at an HIV clinic in the Washington, DC, area. Data were collected through semistructured interviews; grounded theory methodology was used to generate a theory of how the participants gave meaning to HIV. The theoretical model included Personal Context, Support and Education, Socio-cultural Meaning, and Personal Meaning, all of which related to the formation of a global meaning regarding HIV. The emergent theoretical model and its components are presented, and the implications of the study for research, practice, and advocacy are discussed.Item Nonrandom Mixing Models of HIV Transmission(Springer-Verlag, 1989) Kaplan, Edward H.; Cramton, Peter; Paltiel, A. DavidModels of HIV transmission and the AIDS epidemic generally assume random mixing among those infected with HIV and those who are not. For sexually transmitted HIV, this implies that individuals select sex partners without regard to attributes such as familiarity, attractiveness, or risk of infection. This paper formulates a model for examining the impact of nonrandom mixing on HIV transmission. We present threshold conditions that determine when HIV epidemics can occur within the framework of this model. Nonrandom mixing is introduced by assuming that sexually active individuals select sex partners to minimize the risk of infection. In addition to variability in risky sex rates, some versions of our model allow for error (or noise) in information exchanged between prospective partners. We investigate several models including random partner selection (or proportionate mixing), segregation of the population by risky sex rates, a probabilistic combination of segregation and random selection induced by imperfect information (or preferred mixing), and a model of costly search with perfect information. We develop examples which show that nonrandom mixing can lead to epidemics that are more severe or less severe than random mixing. For reasonable parameter choices describing the AIDS epidemic, however, the results suggest that random mixing models overstate the number of HIV infections that will occur.