Psychology
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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 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 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 Work adjustment in persons living with HIV/AIDS (PLWHA): A biopsychosocial perspective(2004-11-15) Baker, Lisa; Hoffman, Mary Ann; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)While there is evidence that Persons Living with HIV/AIDS (PLHWA) have unique and changing needs and concerns in their workplaces, such as changes in health status, high medical costs, emotional consequences of the disease, and concerns about discrimination, no previous studies could be found on work adjustment (e.g., job satisfaction) in PLWHA. However, past research has linked employment disruption and decisions to disease progression, cognitive impairment, physical symptoms, depression/anxiety, concern about discrimination, and medical costs (e.g., Ezzy et al., 1999; Heaton et al., 1994; Martin, Brooks, Ortiz, & Veniegas, 2003). Therefore, this study tested a biopsychosocial model of work adjustment in employed PLWHA (N = 57), based on Hoffman and Driscoll's (2002) Concentric Biopsychosocial Model. It was hypothesized that physical health (fatigue and pain), psychological adjustment, and work support/environment would uniquely predict work adjustment (e.g., job satisfaction), where psychosocial variables were expected to account for the most of the variance explained. With the exception of pain symptoms, the predictor variables in the model were found to correlate with the primary outcome, job satisfaction. A hierarchical block-wise regression was then utilized to test the model, where the physical health variable (i.e. energy/fatigue) was entered first, followed by the entry of the psychological adjustment variable in the second block. The work environment variables (i.e., perceived supervisor support, perceived discrimination) were entered in the third and final block. Results partially supported the proposed model with 25% of the variance in job satisfaction explained in the third step, where perceived supervisor support and workplace discrimination accounted for a statistically significant amount of the variance. These findings support the importance of examining perceptions of workplace environment when addressing work adjustment and employment concerns of PLWHA.