Carla Dillard Smith

University of Oxford, Oxford, ENG, United Kingdom

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Publications (4)8.09 Total impact

  • Lena D Saleh · Don Operario · Carla Dillard Smith · Emily Arnold · Susan Kegeles
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    ABSTRACT: In the United States, there is an urgent need to provide HIV prevention services to African American men who have sex with men and women (MSMW) but who do not identify as gay or homosexual. Engaging these men in HIV prevention has historically been challenging. This study used qualitative methodology to explore the beliefs and experiences from community-based service providers (n = 21) and from African American MSMW (n = 21) regarding the provision of HIV prevention education and counseling to these men. Data analysis revealed that (a) African American MSMW who do not identify as gay can challenge service providers' assumptions about sexual behavior and sexual identity; (b) service providers' attitudes toward these men can be affected by ambivalent or negative beliefs that pervade the general community; (c) African American MSMW need safe and nonjudgmental spaces that offer HIV risk reduction, but they also might experience anxiety about disclosing same-sex behaviors to counselors. Findings highlighted the complexities related to culture, masculinity, and sexuality as determinants of HIV risk in African American MSMW, and findings also revealed tensions between these factors that may affect the quality of HIV prevention services. Service providers may need additional training to provide appropriate and non-judgmental HIV prevention counseling and education.
    AIDS education and prevention: official publication of the International Society for AIDS Education 12/2011; 23(6):521-32. DOI:10.1521/aeap.2011.23.6.521 · 1.51 Impact Factor
  • Don Operario · Carla Dillard Smith · Emily Arnold · Susan Kegeles
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    ABSTRACT: The Bruthas Project is a community-collaborative intervention to reduce HIV risk behavior among African American men who have sex with men and women (MSMW) but who do not form an identity around their same-sex behavior. The intervention was developed based on formative qualitative research with members of the population and involved four individualized risk reduction counseling sessions. Participants review general risk factors for HIV and are offered HIV testing and counseling (Session 1); discuss sexual dynamics and risk behaviors with female partners (Session 2); discuss sexual dynamics and risk behaviors with male partners (Session 3); review motivations and situational triggers for unsafe sex, and engage in role-play exercises that aim to reach personal risk reduction goals (Session 4). Community outreach and counseling are provided by African American men with whom participants can identify, and counseling is designed to respond to men's need for privacy, cultural affirmation, and masculine values. Thirty-six African American MSMW completed a pilot intervention, including baseline and 3-month follow-up assessments of sexual risk behaviors and psychosocial factors. Preanalysis and postanalysis found significant reductions in unprotected receptive and insertive anal sex with male partners, fewer numbers of female and male unsafe sex partners, and decreased sex while under the influence of drugs. Men also reported significantly increased social support, self-esteem, and reduced loneliness at follow-up. Positive outcomes suggest this is a promising approach for reducing HIV risk in this population.
    AIDS education and prevention: official publication of the International Society for AIDS Education 02/2010; 22(1):37-48. DOI:10.1521/aeap.2010.22.1.37 · 1.51 Impact Factor
  • Don Operario · Carla Dillard Smith · Emily Arnold · Susan Kegeles
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    ABSTRACT: African American men who have sex with men and women (MSMW), but who do not form a sexual identity around same-sex behavior, may experience risk for HIV infection and transmission. This paper reports cross-sectional survey findings on sexual behaviors and substance use of urban non-gay- or non-bisexual-identified African American MSMW (n = 68), who completed behavior assessment surveys using audio-computer assisted self-interviewing technology. Overall, 17.6% reported being HIV-positive. In the past 3 months, 70.6% had unprotected insertive sex with a female, 51.5% had unprotected insertive anal sex (UIAS) with a male, 33.8% had unprotected receptive anal sex (URAS) with a male, 25% had UIAS with a transgender female, and 10.3% had URAS with a transgender female. Findings indicated a bridging potential for HIV and sexually transmitted infections across groups, such that 38.2% reported concurrent unprotected sex with female and male partners and 17.6% reported concurrent unprotected sex with female and transgender female partners. In the past 3 months, 70.6% used alcohol before sex and 85% used drugs before sex. Men who used drugs before sex had a tenfold increased likelihood for unprotected sex with male partners, and men who injected drugs had a nearly fivefold increased likelihood for unprotected sex with a transgender female. Interventions to address sexual risk behaviors, especially partner concurrency, and substance use behavior for these men are warranted.
    AIDS and Behavior 08/2009; 15(3):576-83. DOI:10.1007/s10461-009-9588-0 · 3.49 Impact Factor
  • Don Operario · Carla Dillard Smith · Susan Kegeles
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    ABSTRACT: This study used qualitative methods to explore the social and psychological context of sexual behavior and HIV risk among African American non-gay-identified men who have sex with men. Analysis of men's narratives on their sexual behaviors revealed four social and psychological factors contributing to risk for HIV infection: (a) a tendency to compartmentalize and personally disengage from same-sex behavior, (b) traditional gender roles that reinforce men's adherence to masculine images and ambivalent attitudes toward women, (c) cultural norms that favor secrecy and privacy about any personal matters, and (d) spontaneous and unplanned sexual episodes with other men. Findings indicate that innovative HIV prevention and risk reduction strategies are necessary to reach this group and question the legitimacy of conventional sexual orientation categories for these men. Interventions must address social contextual determinants of risk, reinforce men's public identifications as straight/heterosexual, and maintain men's need for privacy about same-sex behaviors.
    AIDS Education and Prevention 09/2008; 20(4):347-59. DOI:10.1521/aeap.2008.20.4.347 · 1.59 Impact Factor