ABSTRACT: Policies of name-based HIV reporting, partner notification (PN), and criminalization of non-disclosure of HIV positive status
to sexual partners remain controversial. The views of people living with HIV (PLH) are critical to the success of these three
initiatives, but have been understudied. Thus, we interviewed 76 PLH about these policies. Themes arose of potential public
health benefits (e.g., epidemiological surveillance and notification of possible exposure) and costs (e.g., deterrence of
testing); threats to privacy, civil rights and relationships; government mistrust; and beliefs that prevention is an individual,
not governmental responsibility. Misperceptions about the intent, content and scope of these policies, and past experiences
of discrimination, shaped these attitudes. To enhance development and implementation of HIV prevention strategies, the views
of PLH must be taken into account, and education campaigns need to address misperceptions and mistrust. These data shed light
on difficulties in developing and implementing policies that may affect sexual behavior, and have critical implications for
Sexuality Research and Social Policy: Journal of NSRC 04/2012; 1(3):38-57. · 0.72 Impact Factor
ABSTRACT: To examine the predictors of transmission risk among HIV-infected men who have sex with men (MSM) in 4 US cities.
Individual computer-assisted interviews assessing psychologic measures and sexual behavior with the 5 most recent male and female partners were conducted with a diverse sample of 1910 HIV-infected MSM recruited from community and clinic settings in San Francisco, New York, Los Angeles, and Milwaukee. Transmission-risk events were defined as unprotected vaginal or anal sex with a partner who was HIV negative or of unknown status.
A small but not insignificant proportion of MSM (12.7%) reported at least 1 transmission-risk event in the previous 3 months, with 57% of those events taking place with casual as opposed to steady partners. Multivariate predictors of transmission risk with casual partners were stimulant (eg, crystal methamphetamine) and other drug use, having low coping self-efficacy, and not having disclosed one's HIV serostatus to all partners. Stimulant use and failing to disclosing one's serostatus to all partners were associated with risk in primary relationships.
Responding to HIV transmission risk in MSM requires different strategies for primary and casual partners.
JAIDS Journal of Acquired Immune Deficiency Syndromes 11/2005; 40(2):226-35. · 4.43 Impact Factor
ABSTRACT: Adverse effects from antiretroviral therapy (ARV) for HIV are associated with medication nonadherence. The purposes of this study were to explore group differences in the reporting of adverse effects, identify individual adverse effects that are linked to nonadherence, and to explore the role of coping in the relationship between adverse effects and adherence. Cross-sectional interviews of 2,765 HIV-positive adults on ARV therapies in four U.S. cities were performed using a computerized assessment of self-reported adverse effects, coping self-efficacy, and adherence. There were no gender differences in the rate or severity of adverse effects reported. Latino respondents reported more adverse effects than either White or African Americans. Those taking a protease inhibitor (PI) reported a higher rate and greater severity of adverse effects. Older participants reported fewer adverse effects despite being more likely to be on a regimen containing a PI. Respondents with less than 90% adherence reported greater numbers and severity of adverse effects overall. In multivariate analyses, nausea, skin problems, vomiting, and memory adverse effects were independently related to less than 90% adherence over the prior three days. Coping moderated the relationship between nausea and adherence such that individuals who reported lower coping self-efficacy and experienced nausea were at increased risk for nonadherence, regardless of the length of time on the current ARV regimen. Women and men are similar in their overall reports of adverse effects, and Latinos report more adverse effects to ARVs than White or African American patients. Specific adverse effects (skin problems, memory problems, vomiting, and nausea) are more likely than others to be associated with missing ARV medications. Increasing adaptive coping self-efficacy among patients experiencing nausea may be a particularly effective strategy in increasing medication adherence.
Journal of Pain and Symptom Management 03/2005; 29(2):193-205. · 2.50 Impact Factor
ABSTRACT: To examine predictors of the current level of substance use and reductions in seriousness of substance use among adults living with HIV.
Cross-sectional survey. Setting: Four major metropolitan areas of the United States.
Three thousand eight hundred six adults living with HIV.
Self-reported substance use, depression, and quality of life from audio computer assisted self-interviewing and computer assisted personal interviewing structured assessments.
Recent substance use of persons living with HIV was classified as frequent (40%), occasional (32%), or abstinent (28%). Participants using drugs at a frequent level identified as heterosexual, had public insurance, and had higher levels of depression. Participants who reduced from a lifetime high seriousness in substance use were female, older, and knew their HIV status for a longer period of time.
Screening and identification of substance use should be included in all treatment settings and community-based organizations serving adults living with HIV.
Drug and Alcohol Dependence 03/2005; 77(2):129-38. · 3.38 Impact Factor
ABSTRACT: Being a parent, especially a custodial parent, living with HIV was anticipated to increase psychological distress and challenges to self-care.
Mental health symptoms, substance use, and health care utilization were assessed among 3818 HIV-infected adults, including custodial parents, noncustodial parents, and nonparents, in 4 AIDS epicenters.
Custodial parents demonstrated significantly poorer medication adherence and attendance at medical appointments but were similar to nonparents and noncustodial parents in mental health symptoms and treatment utilization for mental health and substance use problems. Noncustodial parents demonstrated the highest levels of recent substance use and substance abuse treatment. Other markers of risk, such as African American ethnicity, lack of current employment income, and injection drug use moderated many of the apparent psychosocial disadvantages exhibited by parents.
Interventions specific to the psychosocial stressors facing families living with HIV are needed.
The Journal of the American Board of Family Practice / American Board of Family Practice 18(5):362-73.