-
Nabila El-Bassel, Louisa Gilbert,
Assel Terlikbayeva,
Elwin Wu,
Chris Beyrer,
Stacey Shaw,
Tim Hunt,
Xin Ma,
Mingway Chang,
Leyla Ismayilova,
Marat Tukeyev,
Baurzhan Zhussupov,
Yelena Rozental
[show abstract]
[hide abstract]
ABSTRACT: This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug users (IDUs) and their heterosexual intimate partners (N = 728) from Almaty, Kazakhstan. The study uses baseline data from Project Renaissance, a couple-based HIV prevention intervention delivered to a couple where one or both partners are IDUs. HIV prevalence rates among female and male IDUs were 28 %. Among the full sample, 75 % had HCV, and 13 % tested positive for the syphilis antibody test. Only 10 % of the sample ever visited a needle exchange program. One-fourth (25.3 %) had never been tested for HIV. One-quarter of those who tested positive were unaware of their status. Being HIV positive was associated with a history of incarceration, being an IDU, and having access to needle exchange programs. The findings call for increasing efforts to improve access to HIV testing, prevention, treatment, and care for IDUs in Almaty, Kazakhstan.
AIDS and Behavior 04/2013; · 3.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Delivered a relationship- based HIV intervention, Project Connect, to 217 African American and Latino heterosexual couples recruited from primary healthcare settings. The mean age of participants was 38 yrs. The intervention takes into account relationship dynamics and communication patterns needed to enable women to initiate or sustain condom use with their main steady partners. The intervention is manualized and consists of an orientation session and five relationship-based sessions combining safe sex education, joint HIV testing, and communication and negotiation skills. The authors present lessons learned in the implementation of the project with regard to involving research participants as consultants, working with an ethnically diverse sample, and involving hospital staff as collaborators. Also, implications of Project Connect for future practice and policy making for HIV interventcons for heterosexual couples are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Families Systems & Health 10/2012; 19(4):379-395. · 1.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those
reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment
suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence;
however, little is known about the mechanisms of risk between these two public health concerns among this population of women.
To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships
between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment.
In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month
prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest
that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and
that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner
violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence
reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention
strategies.
Journal of Family Violence 04/2012; 23(7):605-617. · 1.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Traumatic experiences and their biopsychosocial sequelae present complex challenges in substance use treatment. For women with substance use problems, childhood sexual abuse (CSA), intimate partner violence exposure (IPV), posttraumatic stress disorder (PTSD), and overall psychological distress are often co-occurring concerns. To address gaps in knowledge and to strengthen practice regarding these critical issues in substance use treatment, we drew upon cross-sectional and longitudinal data from baseline and 12-month interviews with a random sample of 416 women in methadone treatment to examine relationships between CSA characteristics, particularly the presence of force and involvement of family, IPV, and mental health concerns. Although CSA involving force and family was not associated with IPV as hypothesized, it was associated with increased risk of PTSD and overall psychological distress. The multivariate findings underscore the psychological vulnerabilities associated with CSA involving force and family and suggest that drug use and financial circumstances may be important targets to reduce IPV risk.
Journal of substance abuse treatment 03/2012; 43(3):366-76. · 2.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The high levels of health and psychosocial needs among correctional populations strongly shape the well-being of the urban communities from which a large number of criminal justice-involved individuals come or to which they return. The benefits of providing services to correction-involved individuals and linking them to providers such as with alternative to incarceration (ATI) programs may be limited if they encounter difficulties accessing such services. This study identified the types of barriers that have prevented entrants into ATI programs from receiving health and psychosocial services. We then tested the association between number of prior incarcerations and number of barriers by gender. From a random sample of adults (N = 322; 83 women and 239 men) entering ATI programs in New York City, data were collected via structured interviews that elicited self-reported sociodemographics, substance use, prior incarcerations, and barriers that had actually prevented a participant from visiting or returning to a service provider. Participants reported an average of 3.0 barriers that have prevented them from receiving health and psychosocial services. The most prevalent barriers predominantly concerned service providers' inability to accommodate constraints on participants' time availability or flexibility, transportation, and money. Compared to women, men had a significantly different association that was in the adverse direction--i.e., more prior incarcerations was associated with more barriers--between prior incarcerations and encountering service barriers. Findings indicate that ATI program entrants experience many barriers that have prevented them from receiving health and/or psychosocial services. Furthermore, men with more extensive incarceration histories particularly are disadvantaged. ATI programs can improve the public health of urban communities if such programs are prepared and resourced to facilitate the receipt of services among program participants, especially men who have more extensive incarceration histories.
Journal of Urban Health 03/2012; 89(2):384-95. · 2.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is increasing excitement about multimedia sexually transmitted infection (STI) and HIV prevention interventions, yet there has been limited discussion of how use of multimedia technology may improve STI/HIV prevention efforts. The purpose of this paper is to describe the mechanisms through which multimedia technology may work to improve the delivery and uptake of intervention material. We present conceptual frameworks describing how multimedia technology may improve intervention delivery by increasing standardization and fidelity to the intervention material and the participant's ability to learn by improving attention, cognition, emotional engagement, skills-building, and uptake of sensitive material about sexual and drug risks. In addition, we describe how the non-multimedia behavioral STI/HIV prevention intervention, Project WORTH, was adapted into a multimedia format for women involved in the criminal justice system and provide examples of how multimedia activities can more effectively target key mediators of behavioral change in this intervention.
AIDS and Behavior 01/2012; 16(7):1949-60. · 3.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Growing evidence suggests intimate partner violence (IPV) and substance misuse are co-occurring problems that disproportionately affect low income urban women seeking care in emergency departments (EDs) and represent leading causes of injuries that result in ED visits. This paper examines temporal bidirectional associations between different types of drug and alcohol use and different types of IPV in a longitudinal study of a representative sample of 241 low-income urban women receiving emergency care from an ED in the Bronx, New York. After adjusting and matching for sociodemographics and potentially confounding multilevel risk and protective covariates, women who reported using heroin in the prior 6 months at Wave 1 were twice as likely as nonheroin-using women to indicate any physical, injurious, or sexual IPV at subsequent waves and were 2.7 times more likely to indicate experiencing an injury from IPV at subsequent waves. Crack or cocaine use in the past 6 months at Wave 1 was associated with an increased likelihood of injurious IPV and severe verbal abuse at subsequent waves. Findings also suggested that sexual IPV was significantly associated with subsequent use of crack or cocaine. The multiple bidirectional associations found linking these problems underscore the need for conducting routine screening for IPV and substance misuse among women in low-income urban EDs, and for improving linkages to services that will ultimately reduce the risk of morbidity, disability, and mortality related to these co-occurring problems.
Psychology of Addictive Behaviors 10/2011; 26(2):226-35. · 2.09 Impact Factor
-
Susan S Witte,
Batsukh Altantsetseg,
Toivgoo Aira,
Marion Riedel,
Jiehua Chen,
Katie Potocnik,
Nabila El-Bassel,
Elwin Wu, Louisa Gilbert,
Catherine Carlson,
Hanfei Yao
[show abstract]
[hide abstract]
ABSTRACT: This study examined the efficacy of an enhanced intervention to reduce sexual risk of HIV/STI and harmful alcohol use among female sex workers in Mongolia. Women (n = 166) were recruited and randomized to either (1) a relationship-based HIV sexual risk reduction intervention; (2) the same sexual risk reduction intervention plus motivational interviewing; or (3) a control condition focused on wellness promotion. At three and six month follow-up, both treatment interventions and the wellness promotion condition were effective in reducing the percentage and the number of unprotected acts of vaginal sex with paying partners in the past 90 days. All three conditions demonstrated efficacy in reducing harmful alcohol use. No significant differences in effects were observed between conditions. Findings suggest that even low impact behavioral interventions can achieve considerable reductions of HIV/STI risk and harmful alcohol use with a highly vulnerable population in a low resourced setting.
AIDS and Behavior 07/2011; 15(8):1785-94. · 3.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Dual threats of injection drug use and risky sexual practices continue to increase transmission of HIV and other sexually transmitted Infections (STIs) among drug-using couples in low-income communities in the United States. Two hypotheses were tested: (1) "intervention effect"-whether the HIV risk-reduction intervention provided to the couple or individual partners would be more efficacious in decreasing number of unprotected sexual acts and having a lower cumulative incidence of biologically confirmed STIs over the 12-month follow-up period compared with the attention control condition; and (2) "modality effect"-whether the HIV risk-reduction intervention would be more likely to decrease the number of unprotected sexual acts and have a lower cumulative STI incidence when delivered to a couple compared with the same intervention delivered to an individual.
Using a randomized controlled trial, 282 HIV-negative drug-using couples (564 individuals) were randomly assigned to receive either of the following: (1) couple-based risk reduction; (2) individual-based HIV risk reduction, or (3) couple-based wellness promotion, which served as an attention control condition.
Over 12-month follow-up, there was a 30% reduction in the incidence rate of unprotected acts of intercourse with the study partners compared with participants in the attention control arm. Moreover, over 12-month follow-up there was a 29% reduction in the same outcome in the couple arm compared with the individual arm with a 41% reduction at the 12-month follow-up.
A couple-based approach that addresses drug and sexual risks and targets low-income active drug users may help curb the HIV epidemic.
JAIDS Journal of Acquired Immune Deficiency Syndromes 06/2011; 58(2):198-206. · 4.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We examined the relationships between mobility characteristics and sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan.
Participants completed a structured interview covering sociodemographics, mobility characteristics, sexual behaviors, and biomarkers for HIV, HCV, and syphilis. We used multivariate analyses to examine associations between mobility patterns and HIV risks after adjusting for sociodemographics.
Longer duration of a participant's last trip outside Almaty increased the odds of reporting multiple sexual partners. More frequent travel to visit family or friends was associated with multiple sexual partners and unprotected sex with steady partners. More frequent travel to buy goods in the past year was associated with multiple sexual partners. Men who traveled more often to buy goods were more likely to have purchased sex within the previous 90 days.
Relationships between mobility patterns and sexual risk behaviors underscore the need for HIV-prevention strategies targeting the specific transmission dynamics that migrant vendors are likely to present.
American Journal of Public Health 06/2011; 101(6):1075-81. · 3.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study is to examine the extent to which drug-involved men who perpetrate male-to-female intimate partner violence (IPV) are engaged with various formal service systems as well as whether adherence to traditional male ideologies-thought to drive perpetration of male-to-female IPV-affects help-seeking behavior. This study also seeks to redress a gap in the research literature stemming from the general reliance on batterers intervention programs to acquire samples of IPV perpetrators. A sample of 126 men receiving methadone maintenance treatment who reported perpetrating IPV against a female partner participated in this longitudinal study. A large majority (88%) of participants reported use of additional services beyond methadone treatment (e.g., medical, employment/ vocational, etc.). Using generalized linear modeling, we found that greater endorsement of traditional male ideologies significantly predicted lower subsequent service utilization overall, except for legal services, for which there was a significant positive association. These findings suggest targeted assessment and engagement strategies may be required to involve a greater number of drug-involved men who perpetrate IPV with a wider spectrum of health and social services.
Journal of Interpersonal Violence 05/2011; 26(8):1646-63. · 1.64 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study examines the longitudinal relationship between personal and sexual partner incarceration and subsequent HIV risk behaviors among drug-involved men and their primary female sexual partners. A random sample of 356 men in methadone treatment in New York City were interviewed at baseline, 6 and 12 months; these men also reported information on their primary female sexual partners. Female partner recent incarceration was associated with subsequent increase in multiple partnerships for the male participants (AOR: 3.31; 95% C.I.: 1.26-8.72, P < .05). Female partner incarceration was also associated with reduced likelihood of subsequent unprotected sex between primary partners (AOR: .13; 95% C.I.: .05-.40, P < .01); this finding is somewhat unique and warrants further investigation. Findings support the notion of mutual influence in the case of female partner incarceration, which is associated with both female partner and male partner risk behaviors. HIV prevention implications are discussed, including the need for couple-based HIV prevention interventions targeting couples affected by incarceration.
AIDS and Behavior 02/2011; 15(2):347-55. · 3.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.
Substance Use & Misuse 01/2011; 46(2-3):295-306. · 1.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This article presents an overview of couple-based HIV prevention research to date, advantages of using and core components of couple-based interventions, gaps in the current understanding of couple-based HIV prevention, status of dissemination research and the transportability of effective couple-based HIV prevention and treatment to real-world settings, and recommendations for future directions in couple-based prevention and treatment. Couple-based studies conducted among several populations-heterosexuals, men who have sex with men, and drug users-reported in the research literature were reviewed. Commonalities and limitations were noted in customary focus areas of the couple-based approaches: sexual and drug risk reduction, HIV testing behaviors, adherence to HIV treatment, and prevention of mother-to-child transmission. Couple-based intervention strategies have been rigorously tested and are a valuable addition to the arsenal of HIV prevention strategies. Immediate needs and opportunities include couple-based intervention strategies for prevention of HIV and other sexually transmitted infections among serodiscordant couples, couples who do not know their HIV status, and couples in whom both partners are HIV negative but at risk of HIV infection. There is a particular need to develop couple-based intervention strategies for men who have sex with men and for drug-involved couples.
JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2010; 55 Suppl 2:S98-101. · 4.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We examined the associations between posttraumatic stress disorder (PTSD) and HIV risk behaviors among a random sample of 241 low-income women receiving care in an urban emergency department.
We recruited participants from the emergency department waiting room during randomly selected 6-hour blocks of time. Multivariate analyses and propensity score weighting were used to examine the associations between PTSD and HIV risk after adjustment for potentially confounding sociodemographic variables, substance use, childhood sexual abuse, and intimate partner violence.
A large majority of the sample self-identified as Latina (49%) or African American (44%). Almost one third (29%) of the participants met PTSD criteria. Women who exhibited symptoms in 1 or more PTSD symptom clusters were more likely than women who did not to report having had sex with multiple sexual partners, having had sex with a risky partner, and having experienced partner violence related to condom use in the preceding 6 months.
The high rate of PTSD found in this sample and the significant associations between PTSD symptom clusters and partner-related risk behaviors highlight the need to take PTSD into account when designing HIV prevention interventions for low-income, urban women.
American Journal of Public Health 11/2010; 101(1):120-7. · 3.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Health and psychosocial service needs that may be co-morbid with opioid addiction may impede the success of drug treatment among patients attending methadone maintenance treatment programs (MMTPs). This longitudinal panel study investigates whether receipt of services from one or more helping professionals outside of the MMTP confers a benefit for drug treatment outcomes among a random sample of male MMTP patients (N=356). Each participant was interviewed 3 times, with 6 months between each interview. Since this observational study did not employ random assignment, propensity score matching was employed to strengthen causal validity of effect estimates. Results support hypotheses that receiving additional off-site services has significant beneficial effects in increasing the likelihood of abstaining from cocaine, heroin, and any illicit drug use over both the ensuing 6- and 12-month time periods. These findings indicate that receipt of additional medical and/or psychosocial services enhances the efficacy of methadone treatment in increasing abstinence from illicit drug use.
Evaluation and program planning 11/2010; 33(4):403-9. · 0.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Perpetrators of male-to-female intimate partner violence (IPV) may be likely to have multiple service needs, the extent of which may vary with respect to criminal justice involvement. The salience of the criminal justice system and the potential impact on service needs due to arrest and incarceration is underscored given the association between substance use and IPV. This study utilized a sample of men in methadone treatment who perpetrated male-to-female IPV in order to examine associations between criminal justice involvement and perceived additional service need(s). Results indicate that the likelihood of having a service need(s) significantly increased as time since most recent arrest or incarceration decreased. These findings highlight the need and potential benefit that can be derived from greater coordination amongst the criminal justice, IPV prevention, and drug treatment systems and service providers.
Journal of Criminal Justice 07/2010; 38(4):835-840. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This pilot randomized controlled trial in Kazakhstan aimed to adapt and test the feasibility of a couple-based HIV/STI risk-reduction intervention (CHSR) for couples who are injecting drug users (IDUs). The study examined the preliminary effects of the intervention versus an attentional control wellness promotion (WP) condition on HIV risk behavioral outcomes among 40 couples who are IDUs (n = 80 participants). Compared with WP participants, CHSR participants were significantly more likely to increase condom use and decrease unsafe injection acts at the 3-month follow-up. This pilot trial demonstrates the feasibility and preliminary effects of the CHSR in reducing drug-related and sexual HIV risks.
Journal of Prevention & Intervention Community 04/2010; 38(2):162-76.
-
[show abstract]
[hide abstract]
ABSTRACT: This study examines the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. Logistic regression models were used to estimate the associations between recent criminal justice involvement (arrest or incarceration in the past 6 months) and recent high-risk partnerships (multiple sex partners, sex trading, or sex with a risky partner in the past 6 months) when adjusting for sociodemographic factors and recent regular drug use. Women with recent criminal justice involvement demonstrated higher odds of engaging in high-risk sex partnerships. Although regular drug use was a significant confounder of several of these relationships, recent arrest or incarceration remained significantly associated with multiple sex partnerships, sex with a risky partner, and engaging in unprotected sex and a high-risk partnership even after controlling for regular drug use and other social stressors. This study highlights the vulnerability of drug-involved women offenders to human immunodeficiency virus (HIV) risk and points to the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection.
Journal of substance abuse treatment 03/2010; 38(4):375-83. · 2.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Individuals' accurate assessment of their exposure to the risk of HIV and other STDs requires awareness of their sexual partners' risk behaviors and disease status.
In a sample of 217 couples enrolled in a risk intervention trial in 1997-2002, both partners reported on their own risk behaviors and their perceptions of their partner's behavior; concordance of partners' reports was examined using kappa statistics. Individual and relationship characteristics predicting lack of awareness of a partner's risk behavior were explored using multivariate logistic regression.
Three percent of women and 14% of men were unaware that their partner had recently had a concurrent partner. Eleven percent and 12%, respectively, were unaware that their partner had ever injected drugs; 10% and 12% were unaware that their partner had recently received an STD diagnosis; and 2% and 4% were unaware that their partner was HIV-positive. Women's lack of awareness of partner risk was associated with increasing age (odds ratio, 1.1), being of a race or ethnicity other than black or Latina (15.8) and having a Latino partner (3.7); it was positively associated with a man's report that he was married (4.4) and with relationship satisfaction as reported by both the woman and her partner (1.2 for each). Among men, lack of awareness was positively associated with partner's age (1.1) and with having a partner who was formerly married (8.2).
Couple-based interventions that assess each partner's awareness of the other's risk behavior may help programs better target couples' STD prevention needs.
Perspectives on Sexual and Reproductive Health 03/2010; 42(1):49-55. · 1.41 Impact Factor
