School of Public Health

Permanent URI for this communityhttp://hdl.handle.net/1903/1633

The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Subject: search.filters.subject.HIV/AIDS

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Now showing 1 - 4 of 4
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    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.
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    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.
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    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.
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    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.