[Show abstract][Hide abstract] ABSTRACT: Osteopathic manipulative treatment (OMT) may provide added benefits to standard human immunodeficiency virus (HIV) and AIDS treatments. However, lack of access to trained OMT providers is a potential barrier to the widespread use of OMT in the management of HIV and AIDS.
To determine the best time to measure the short-term impact of a brief OMT protocol on white blood cell counts in individuals with HIV and AIDS. Also, to explore recruiting and training laypersons to administer select osteopathic manual techniques.
Participants were HIV-positive men aged between 18 and 65 years who had not undergone antiretroviral therapy in the past 12 months, had CD4(+) lymphocyte counts of 200 to 700 cells/mm(3), and had viral load levels of less than 100,000 copies/mL. Participants were randomly assigned to an OMT group or a control group; those in the OMT group recruited a layperson for training in osteopathic manual therapy. Participants in the OMT group received a 15-minute OMT protocol consisting of myofascial release of the thoracic inlet, pectoral traction, rib raising, thoracic pump, and abdominal pump. Participants in the control group engaged in conversation with the researcher for 15 minutes. Between-group differences for each white blood cell type were examined at varying time intervals after the protocols. Laypersons were trained to administer thoracic and abdominal pump techniques. They were tested by multiple choice examinations and by an independent rater for fidelity of administration.
Twenty-one participants met the eligibility criteria. Of those, 18 returned for their study visit (OMT group, n=9; control group, n=9). An optimal time interval for measurement of white blood cell changes across the 5 cell types was not determined. However, P values for the 30-minute interval were consistently below 0.18 for neutrophils, eosinophils, and monocytes. Nine laypersons were trained in osteopathic manual therapy, 5 of whom scored 100% on initial completion of the multiple-choice examination; the remaining 4 laypersons scored 80% on the first try and 100% on the second try. All laypersons appropriately administered the manual therapy protocol.
It is feasible to recruit and train laypersons to administer selected osteopathic manual therapy techniques with fidelity. Longitudinal studies on this concept are needed to examine patient outcomes and to evaluate the retention and fidelity of laypersons over time.
The Journal of the American Osteopathic Association 05/2011; 111(5):325-30.
[Show abstract][Hide abstract] ABSTRACT: Planning for end-of-life (EOL) care can result in better patient outcomes and lowered health care costs. We hypothesized that knowledge and experiences with EOL care would influence patients' EOL planning (i.e., health care decisions, hospice use). Using an observational, cross-sectional design, we recruited a community sample of 331 South Floridians aged 18 to 84 (M = 44 years, SD = 14.95) to complete a questionnaire examining knowledge and opinions on EOL issues. Regression analyses showed that prior knowledge of living wills and hospice services were associated with more favorable attitudes toward hospice care, preference for limited medical interventions at EOL, and more comfort in communicating about death and dying. Patient education on EOL care may increase hospice use, enhance EOL planning, and improve patient outcomes.
The American journal of hospice & palliative care 05/2011; 28(3):176-82. DOI:10.1177/1049909110382770 · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: an estimated 252,000 to 312,000 individuals have undiagnosed human immunodeficiency virus (HIV) infection in the United States. To date, little has been known about osteopathic physicians' attitudes and practices regarding routine HIV testing.
to understand osteopathic primary care physicians' attitudes and practices toward HIV testing and sexual history taking and to examine factors associated with osteopathic physicians' recommendations of HIV testing at the initial patient visit.
a cross-sectional survey of osteopathic physicians was conducted at the 106th Annual Convention of the Florida Osteopathic Medical Association in February 2009. Survey participants were asked 36 questions about osteopathic physician and patient sociodemographic factors and osteopathic physician attitudes and office practices regarding HIV testing and sexual history taking.
a total of 233 osteopathic physicians completed the survey, but only 160 respondents (69%) met inclusion criteria of working in primary care and spending more than 50% of their time with patients. Almost two-thirds of participants were men, 80% were white, and the age range was 28 to 83 years. Twenty-two percent of participants recommended HIV testing at the initial patient visit, and 18% recommended annual HIV testing for all patients. Eighty-seven percent obtained a separate consent form for HIV testing, and 19% included HIV testing in general consent forms. About two-thirds of participants recommended annual HIV testing for homosexual men. Three factors were associated with recommending HIV testing at the initial patient visit: (1) recommending an annual HIV test for sexually active patients (odds ratio [OR], 12.82; 95% confidence interval [CI], 3.97-41.67); (2) having an agree/strongly agree attitude toward HIV testing (OR, 5.59; 95% CI, 1.63-19.23); and (3) obtaining a general consent form that included permission for HIV testing (OR, 3.25; 95% CI, 1.07-9.90).
osteopathic physicians who practice primary care medicine can play a crucial role in reducing the number of individuals with undiagnosed HIV infection. More concerted efforts are needed to help osteopathic physicians incorporate HIV testing as part of routine care for all patients.
The Journal of the American Osteopathic Association 12/2010; 110(12):712-20.
[Show abstract][Hide abstract] ABSTRACT: The frequency of HIV infection is increasing in men who have sex with men (MSM) aged 40 and older yet little is known about factors that influence their risky sexual behavior, such as sexual positioning. The goal of this study was to examine multi-level factors associated with unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) in MSM aged 40 and older. A community-based sample of 802 self-identified MSM aged 40-94 years was recruited through targeted outreach from community venues (e.g., bars, social events) in South Florida and completed an anonymous pen-and-paper questionnaire. Logistic regression showed that younger age (i.e., aged 40-59; odds ratio [OR]=0.6; 95% confidence interval [CI]: 0.4, 0.9), HIV-positive status (OR=2.8; 95% CI: 1.9, 4.0), drug use (OR=2.6; 95% CI: 1.7, 3.7), a larger number of male sexual partners (OR=1.7; 95% CI: 1.3, 2.3), and lower scores on internalized homonegativity (OR=0.9; 95% CI: 1.0, 1.0) were associated with higher risk for URAI. Younger age (OR=0.4; 95% CI: 0.3, 0.6), HIV-positive status (OR=1.5; 95% CI: 1.0, 2.1), drug use (OR=1.6; 95% CI: 1.1, 22.3), Viagra use (OR=1.7; 95% CI: 1.2, 2.4), larger number of sexual partners (OR=2.1; 95% CI: 1.6, 2.9), and holding views more characterized by high optimism concerning the future (OR=1.1; 95% CI: 1.0, 1.1) were associated with higher risk for UIAI. These results provide useful information that may guide the development of tailored prevention interventions to reduce the growing rates of HIV among MSM aged 40 and older.
AIDS Care 03/2010; 22(10):1204-11. DOI:10.1080/09540121003615137 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite continued high HIV risk among Hispanic men who have sex with men (HMSM), culturally tailored, theoretically based interventions have yet to be developed and tested. As a first step toward intervention development, we collected quantitative and qualitative data on sociocultural and psychological factors associated with drug use and risky sex among 566 HMSM recruited from community and Internet venues. Participants reported high rates of drug use (43%), unprotected anal sex (45%), and multiple sex partners (median 4) in the past 6 months. In multivariate analyses, use of drugs was associated with HIV seropositivity, less orientation to the Hispanic community, stronger attachment to the gay community, lower levels of homophobia, higher numbers of sex partners and more unprotected anal sex. The need for acceptance and desire to please partners emerged as core drivers of HIV risk in the qualitative data. Findings were used to guide development of Proyecto SOL, a theoretically grounded intervention that targets core determinants of HIV risk, builds on protective cultural influences, and strengthens positive social connections.
AIDS education and prevention: official publication of the International Society for AIDS Education 10/2009; 21(5 Suppl):45-60. DOI:10.1521/aeap.2009.21.5_supp.45 · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Transmission of HIV in older men who have sex with men (OMSM) is increasing, yet little is known about their safer sex practices. In a cross-sectional analysis, we investigated demographic characteristics, safer sex practices (including serosorting and sexual positioning practices), condom use, HIV testing behaviors, and drug and alcohol use in OMSM with or at-risk for HIV infection.
METHODS: Data were collected from a community-based sample of 802 MSM self-identified MSM ages 40 to 94 (M = 55.9; SD = 10.8). Participants completed a 121-item, self-administered anonymous questionnaire. The men were recruited from community venues (i.e., LGBT community centers, gay pride festivals, bars, sporting events, gyms, and social clubs) where OMSM congregate.
RESULTS: The majority of the 802 men (n=693; 86.4%) reported having sex with men in the last 6 months. In that time frame, more than one-third (n=304; 37.9%) had met a new sex partner. The average number of sex partners was 9 (SD = 27.6; range 0-500); one fifth (n=152; 19%) reported having 21 or more partners. The most frequent places where participants met their sexual partners were through the Internet and in bars. One third (n=249; 31%) of the men indicated that they practiced receptive anal sex (bottoming) without a condom, and nearly 40% (n=307; 38.3%) indicated that they practiced insertive anal sex (topping) without a condom. One-third (n=242; 30.3%) reported difficulty in maintaining condom use, and 12.8% (n=103) had not used a condom due to difficulty with erections before or during sex. Nearly 40% (n=314; 39.2%) of the men reported that they sometimes or always do not use condoms if their partner says he is HIV-negative. Of the men who had sex in the last 6 months, the majority (n = 405; 50.5) never or only sometimes discussed the topic of HIV with their partners and (n=369; 46%) never or only sometimes told their sex partners about their HIV status.
Of the 802 respondents, 722 had been tested for HIV and knew their status. Forty percent of the men (n=315) reported that they did not test regularly, but nearly one-third of the men who had tested reported a positive result (n=232; 28.9%). Nearly one-fourth (n=185; 23.1%) of the men reported that they had put themselves at risk for HIV. Many of the men reported having taken alcohol and or drugs (i.e., GHB, Ketamine, Ecstasy) right before or during sex. The majority of the sample was non-Hispanic white (n=661; 82.4%), 67 (8.4%) were Hispanic/Latino, 44 (5.5%) were Black, and 22 (2.7%) were Asian, Native American, or of mixed race.
CONCLUSION: Older MSM continue to be sexually active and engage in unsafe sex practices. More research is needed to understand the how sexuality, sex practices, and age convene to create HIV risk and protective factors in this understudied and vulnerable population.
Research that Promotes Sustainability and (re)Builds Strengths; 01/2009
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND AND PURPOSE: This research explored the sexual practices of a multi-ethnic sample of 802 older men who have sex with men (OMSM) who may be at risk for HIV transmission/infection. The rates of HIV in OMSM have increased, yet little is known about the sexual decision making processes that place them at risk. The multiplicity of underlying factors and root causes of HIV infection helps account for the intensity of the epidemic among OMSM and their subpopulations. There are multiple HIV/AIDS epidemics, indicating that HIV prevention interventions, care, and treatment need to be tailored to risk behavior and population variations, including age differences in prevailing behavioral norms.
METHODS: We present the findings of the qualitative component of a community-based self-administered questionnaire (N = 802) of OMSM aged 40-94 (M = 55.9 years, SD = 10.8) and participatory inquiry with an audio-taped focus group of 10 OMSM (aged 43-75). Participants were recruited from community venues (i.e., LGBT centers, gay pride festivals, bars, sporting events, gyms, social clubs, and religious organizations) where OMSM congregate. Two open-ended qualitative questions (i.e., Thinking about when you have sex in general, what makes it easier to use condoms/protection with your partners? and Thinking about when you have sex in general, what are some of the reasons you haven't used condoms/protection?) were added to the 119 quantitative items. These questions were also asked of focus group participants to help elucidate some of the nuances that influence OMSM's safer sex and condom use decision-making processes. Using a grounded theory approach (Glaser & Strauss, 1967), data was divided by emergent themes and coded.
RESULTS: The study participants were sexually active, practiced high-risk behaviors, used serosorting and sexual positioning practices (receptive and/or penetrative anal sex), and testing as forms of HIV prevention. Emergent themes included (1) safer sex decision making with monogamous partners regarding sex outside the primary relationship, (2) trust issues regarding who is considered safe (i.e., HIV-negative), (3) condom use negotiation (i.e., who decides if a condom is used and under which circumstances), and (4) drug use as a factor for high-risk sexual behaviors, and (5) problems with condom use and maintaining erections. The findings elucidate about men's layers of decision-making for using condoms, defining safer sex practices from an older gay man's perspective, the intersections of age with the desire for partnership, optimism for the future, and internalized homophobia in their life experiences as it applies to their ability and desire to engage in both safer sex and in making decisions to take personal risk for HIV.
CONCLUSIONS AND IMPLICATIONS: Age, life optimism, internalized homophobia, and serostatus may play a role in attitudes toward safer sex practices and high-risk behaviors in older MSM. Understanding how older MSM differ or are viewed differently from their younger counterparts may be most beneficial in developing efficacious interventions to reduce HIV transmission in older MSM. The presentation concludes with realistic recommendations to inform for social work practice and prevention strategies to reduce the spread of HIV among older MSM populations.
Research that Promotes Sustainability and (re)Builds Strengths; 01/2009
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND AND PURPOSE. Men who have sex with men (MSM) continue to be the U.S. population most heavily impacted by the HIV epidemic. In 2007, MSM comprised 52% of HIV/AIDS
cases among older adults in Florida. Middle-aged and older MSM (OMSM) continue to engage in risky behavior thus placing themselves at risk for HIV infection/reinfection. While the rates of HIV in OMSM have increased, little is known about their sexual practices and risk behaviors. The goal of this study was to investigate the sexual practices and identify risks for unprotected anal intercourse (UAI) in MSM aged 40 and older.
METHODS: A multi‐ethnic sample of 802 self-identified MSM aged 40 years and older was recruited in South Florida from community venues (i.e., bars, sporting events, churches, gyms, LGBT community centers). The men were approached by the researcher and trained peer research assistants to complete an anonymous, self administered questionnaire using the paper‐and‐pencil survey format. The study used a cross‐sectional research design to determine the influence of selected psychosocial variables, drug use, and demographic variables (e.g., HIV serostatus, employment) that place OMSM at risk for unprotected anal intercourse (UAI). Data collected over a 5‐month period (December 2007 May 2008)were analyzed for this poster.
RESULTS: In ordinal logistic regression analysis to predict UAI using two models, one for insertive anal intercourse (top' position) and one for receptive anal intercourse (bottom' position) that adjusted for demographic and other variables, drug use, HIV serostatus, and not being employed were associated with increased odds of UAI in OMSM. For OMSM who bottom, the risk for UAI was associated with drug use (ketamine, GHB), not being employed, and serostatus (p = <0.0001, likelihood ratio test; Wald test, p<0.05). For OMSM who top, the risk for UAI was associated with stimulant drug use (p=0.0097,likelihood ratio test; Wald test, p<0.05). OMSM who top and use stimulants are 48% (odds ratio= 1.48, 95% CI= 1.09, 1.99) more likely to be at risk for UAI. OMSM who bottom' and use ketamine or GHB are almost 3 times more likely to be at risk for UAI (odds ratio = 2.55, 95% CI = 1.50, 4.33). OMSM who bottom and who are HIV‐positive are 2 times more likely to be at risk for UAI (odds ratio = 1.93, 95% CI = 1.31, 2.85). OMSM who bottom and are employed full‐time are 35% less likely to be at risk for UAI than OMSM who bottom and are not employed (odds ratio = 0.65, 95% CI = 0.46, 0.93). Having a full‐time job creates a protective effect against risk for UAI in OMSM who bottom.
CONCLUSIONS AND IMPLICATIONS: MSM aged 40 and older continue to be at increased risk for HIV infection. Findings suggest that age, HIV serostatus, drug use, and employment may be risk factors for unprotected anal intercourse in OMSM. The results provide impetus to influence practice and future research related to the development of age-appropriate risk reduction efforts to decrease the rates of HIV infection among this at-risk understudied population.
Research that Promotes Sustainability and (re)Builds Strengths; 01/2009
[Show abstract][Hide abstract] ABSTRACT: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida.
Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries.
In the previous 6 months, 44% of the sample engaged in UAI, and 41% used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months.
Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.
Revista Panamericana de Salud Pública 06/2008; 23(5):341-8. DOI:10.1590/S1020-49892008000500006 · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM).
We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users).
We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received 50 dollars.
In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance.
The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors.
Drug and Alcohol Dependence 02/2007; 86(2-3):245-52. DOI:10.1016/j.drugalcdep.2006.06.016 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Difficulties with recruitment of hidden populations, such as Hispanic men who have sex with men (MSM), have hampered HIV prevention research, leading researchers to explore alternative recruitment modalities such as the Internet. In this paper, we compare the efficiency and cost of recruiting HMSM from Internet chat rooms versus community venues and examine the differences between participants recruited from each type of venue. Internet recruitment was more efficient and somewhat less costly than community recruitment. Although the two groups were comparable in most demographic factors and HIV risk behaviors, Internet recruits were more likely to be bisexual, more likely to be HIV seropositive, had a higher level of education, and reported higher levels of psychological distress and lower levels of gay community attachment. Implications of our findings for using Internet chatrooms as recruitment venues are discussed.
Journal of Ethnicity in Substance Abuse 02/2007; 6(2):143-62. DOI:10.1300/J233v06n02_09 · 0.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this cross-sectional study the authors examine condom use attempts and condom use among 305 high-risk, low-income African American women who reported having a main partner. Women who had recently attempted to convince their main partner to use condoms were almost 10 times more likely to have recently used condoms with their partner than women who had not made an attempt. Among the subsample of 116 women who had recently made a condom use attempt with their main partner, having a history of childhood abuse and having one's main partner raise infidelity questions in response to the condom use attempt were negatively associated with recent condom use with this partner. Findings provide initial insights into the importance of women's condom use attempts, as well as subgroups of women who may encounter special challenges convincing their main partner to use condoms.
Cultural Diversity and Ethnic Minority Psychology 02/2006; 12(1):70-83. DOI:10.1037/1099-9809.12.1.70 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hispanic men who have sex with men (MSM) are at high risk of HIV infection. This study reports on the club drug use and sexual behaviors of two distinct samples (community and Internet) of Hispanic MSM living in the AIDS epicenter of Miami-Dade County. Both samples reported high rates of unprotected anal sex and high numbers of sex partners; rates of club drug use (cocaine, ecstasy, methamphetamines, GHB, amyl nitrites, and Viagra) were also high. Recent use of club drugs was associated with both unprotected receptive and insertive anal sex in the Internet sample, but not in the community sample. Implications for social work practice are discussed.
Journal of Social Work Practice in the Addictions 12/2005; 5(4):81-100. DOI:10.1300/J160v05n04_06
[Show abstract][Hide abstract] ABSTRACT: The Internet presents unique and growing opportunities for conducting HIV/ STD research. This article reports on the first 171 participants enrolled in an ongoing study examining use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in an AIDS epicenter to participate in community-based studies. First, it describes initial success with chatroom recruitment. Second, it compares the demographic, psychosocial, and sexual risk practices among HMSM recruited through the Internet who had used club drugs in the last 6 months and those who had not. In 2 months, 211 hours were spent recruiting in chatrooms; 735 chatroom users were engaged. Researchers used a scripted dialogue to describe the study and to invite chatroom users to visit the study's community sites for screening and enrollment. One hundred and seventy-six men came to the community sites; 172 (98%) were eligible and completed an audio-computer assisted self-interview. In the last 6 months, 48.5% of the sample had used club drugs [defined as cocaine, crystal methamphetamines (crystal), amyl nitrites (poppers), Ecstasy, gamma-hydroxybutyrate (GHB), ketamine (Special K), and Viagra]. The proportion of men reporting use of each drug was: cocaine (15.8%), crystal (11.7%), poppers (31.6%), Ecstasy (14%), GHB (3.5%), Special K (3.5%), and Viagra (19.3%). In multivariate analyses, having higher number of sex partners, having higher social isolation scores, and having engaged in unprotected receptive anal intercourse were significantly associated with club-drug use. These initial findings suggest that high-risk HMSM can be successfully recruited through chatroom dialogues to participate in community-based HIV studies. The alarmingly high rates of club-drug use and risky sexual practices among HMSM underscore the need for effective HIV preventive interventions for this population.
Journal of Urban Health 04/2005; 82(1 Suppl 1):i79-88. DOI:10.1093/jurban/jti027 · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: From a study of high-risk minority women, we examined data for a subgroup of 201 women who participated in a "male condom- focused" HIV prevention intervention, and who reported having attempted to convince their main partner to use condoms in the 3 months following intervention. Factors related to consistent condom use with a main partner post-intervention were not living with the partner, fewer sexual encounters, and no recent sexual encounter in which either partner was under the influence of drugs. At 3 months following intervention, factors related to women's future intentions to use condoms consistently with a main partner were no recent sex while either partner was under the influence of drugs, and the woman's desire to use condoms consistently with the partner. Main partner's resistance to condoms was unrelated to consistent condom use or future intentions to use condoms consistently. Findings identify barriers to consistent condom use within primary relationships, a critical yet challenging focal point for HIV prevention interventions.
Women & Health 02/2005; 42(3):37-56. DOI:10.1300/J013v42n03_03 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2=7.4, p=0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed.
[Show abstract][Hide abstract] ABSTRACT: Although use of the Internet as a vehicle for HIV/STI research is increasing, its viability to recruit at-risk populations such as Hispanic men who have sex with men (HMSM) to participate in community-based HIV studies is in its infancy. We report on the first 171 participants enrolled in an ongoing study exploring use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in Miami-Dade County, Florida to participate in community-based studies. We report our initial success with chat-room recruitment and describe the sexual and drug use practices of the initial set of participants who were recruited through the Internet. In addition, we describe the formative work conducted to develop the Internet recruitment procedures we are testing. In two months, we spent 211 hours recruiting in chat-rooms and engaged 735 chatters. One hundred and seventy-six men came to our community sites; 172 (98%) were eligible and completed an audio computer-assisted self-interview. In the previous six months, 94.7% of participants had anal sex; 48.9% did not use condoms for anal sex or used them inconsistently; and 48.5% had used club drugs. Six-month use rates for individual drugs were: poppers (31.6%), cocaine (15.8%), ecstasy (14%) and crystal methamphetamines (11.7%). Use of club drugs was significantly associated with unprotected insertive and unprotected receptive anal sex. These initial findings point to the Internet's potential as a tool for recruiting at-risk Hispanic MSM for community studies.
AIDS Care 11/2004; 16(8):953-63. DOI:10.1080/09540120412331292480 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined factors associated with being at risk of sexually acquiring HIV among a community sample of 244 Hispanic migrant and seasonal farm workers. Bilingual staff interviewed respondents anonymously at worksites, camps, and other public venues in South Florida during the 2002 winter/spring growing season. The following variables were positively associated with being at risk of sexually acquiring HIV in multivariable analyses: being female; being married; having "some" or "a lot" of knowledge about HIV transmission, having ever used marijuana, having two or more sex partners in the last 12 months, and having had a sexually transmitted infection. The findings heighten the importance of recognizing women's elevated risk of HIV infection and conducting further studies to examine the factors associated with this increased risk. The study is an important first step toward developing tailored HIV prevention interventions for this at-risk, understudied population.
AIDS and Behavior 07/2004; 8(2):165-74. DOI:10.1023/B:AIBE.0000030247.00140.62 · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The HIV epidemic has been the most significant public health crisis of the last 2 decades. Although Experimental Social Innovation and Dissemination (ESID) principles have been used by many HIV prevention researchers, the clearest application is the series of model-building and replication experiments conducted by Kelly and colleagues. The model mobilized, trained, and engaged key opinion leaders to serve as behavior change and safe-sex endorsers in their social networks. This paper illustrates how ESID principles were used to develop, test, and disseminate an innovative social model and discusses the challenges of applying ESID methodology in the midst of a public health emergency.
American Journal of Community Psychology 01/2004; 32(3-4):333-44. DOI:10.1023/B:AJCP.0000004752.42987.a1 · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined factors associated with HIV testing intentions among a community sample of 255 never-tested Hispanic men. It compared (1) men who intended to test in the next 6 months with those who did not and (2) men who intended to test only on the day of the interview with those who intended to test in the next 6 months. Eighty-four percent of men had never been offered testing. Yet, 86% would accept testing if recommended by their doctor. The strongest multivariate predictor of testing intention was willingness to accept a physician-endorsed test. Almost 49% of men who intended to test in the next 6 months would only do so if the test were offered on the interview day. These findings highlight the importance of encouraging physicians, particularly in high-prevalence areas, to routinely recommend testing. They also suggest that for some men, there is a window of opportunity for testing that does not endure.
AIDS and Behavior 10/2003; 7(3):253-62. DOI:10.1023/A:1025491602652 · 3.49 Impact Factor