Amy R Knowlton

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

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Publications (75)185.01 Total impact

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    ABSTRACT: Sexual/gender minority persons commonly face rejection from parents and other family members. To date, research on this topic has either measured family rejection as one binary or continuous variable, or characterized family rejection using several variables representing specific behaviors or dimensions of behaviors (a variable-oriented approach). No research has been done on family rejection/negative treatment of sexual/gender minority people from a person-oriented approach, looking at whether the treatment by the families of different individuals could be classified into a number of categories – i.e., whether there are different types of family treatment experience. This study used data from an anonymous internet sample of 2664 adult sexual minority women and transmen in Viet Nam, and conducted latent class analysis on 19 items representing negative actions by parents or other family members. Six distinct classes were extracted: peace (36.7% of the sample), pressure (34.0%), aggressive to respondent and girlfriend (10.3%), aggressive to respondent (8.1%), severe (6.0%), and extreme (4.7%). We regressed class membership on individual, family and contextual variables, using three-step latent class regression with Vermunt correction for class uncertainty. Overall, younger age, transman identity, religion affiliation, and higher parent awareness of non-heterosexuality predicted being in more negative classes. This study shows that latent class methods can be used to expand knowledge about negative family treatment of sexual/gender minority persons by identifying a naturally occurring typology of family treatment classes and assessing predictors of negative classes. Future research should examine the effects of these family treatment classes on health and well-being.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Due to advancements in antiretroviral therapies, persons living with HIV/AIDS (PLHAs) are living longer and with increased care needs. The objectives of this study were to assess: (1) whether vulnerable PLHAs preferred informal versus professional care; and (2) factors associated with their end of life preference. Methods: Data were from the Being Active and Connected study, which examined social factors related to health outcomes among PLHAs. Structural equation modeling was used to identify individual and network characteristics associated with PLHAs’ care preferences at end of life. Results: Nearly half of respondents (47%) indicated a preference for informal care (N=383). Predictors of family care preference included: female sex (standardized coefficient [Std. Coef.] = .12, p<.05); having a main partner as their caregiver (Std. Coef. = .14, p<.05); receiving health assistance from social network members (Std. Coef. = .22, p< .001); having more social network members who felt it was important to take HIV medications (Std. Coef. = .23, p<.001); and having more female kin in their support network (Std. Coef. = .23, p<.001). Not wanting to owe favors to anyone was negatively associated with family care preference (Std. Coef. = -.26, p<.001). Conclusions: Given PLHAs' substantial need for familial care, our results suggest that support is needed for end of life informal caregivers. Interventions should bolster caregivers' coping skills and connection to support programs. Inclusion of informal caregivers in collaborative treatment decision making can reduce early caregiving cessation and improve health outcomes in a vulnerable population with less preference and/or means for professional care.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Quantitative research on parental/family disapproval and rejection of sexual/gender minority persons has often measured family rejection as one binary/continuous variable, or using several variables representing specific behaviors or dimensions of behaviors. Absent from this literature is analysis using a person-oriented approach, examining heterogeneity across individuals in the types of family treatment experience. Using data from 2,664 adult sexual minority women and transmen in Vietnam, latent class analysis was conducted on 19 items representing negative family behaviors. The six-class solution best fit the data, including one non-negative class (peace, 36.7% of the sample) and five negative classes (pressure, 34.0%; aggressive to respondent and girlfriend, 10.3%; aggressive to respondent, 8.1%; severe, 6.0%; and extreme, 4.7%). Class membership was regressed on individual, family, and contextual variables. Overall, younger age, transman identity, religious affiliation, and parent awareness predicted being in worse family treatment classes. Further research is needed to separate cohort and age effects and to examine developmental trajectories of family behavior. Findings suggested that it may be general conservativeness rather than a specific religious doctrine that predicts negative family treatment and revealed that nonparent family members’ role in family response to sexual/gender nonconformity may be significant.
    Journal of GLBT Family Studies 10/2014;
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    ABSTRACT: Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.
    AIDS and Behavior 09/2014; · 3.49 Impact Factor
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    ABSTRACT: With the advent of antiretroviral therapies, persons living with HIV/AIDS (PLHIVs) are living longer but with increased impairment and care needs. The purpose of this study was to assess whether a vulnerable population of PLHIVs preferred informal versus professional care when unable to care for themselves, and individual and support network factors associated with preference for informal care. The findings have potential implications for facilitating the population's informal care at end of life. Data were from the BEACON study, which examined social factors associated with health outcomes among former or current drug-using PLHIVs in Baltimore, MD. Structural equation modeling was used to identify individual and support network characteristics associated with PLHIVs' preference for informal (family or friends) compared to professional care. The structural equation model indicated preference for informal care was associated with female sex, greater informal care receipt, reporting one's main partner (i.e., boy/girlfriend or spouse) as the primary source of informal care, and a support network comprised greater numbers of female kin and persons supportive of the participant's HIV treatment adherence. Not asking for needed help to avoid owing favors was associated with preferring professional care. Findings suggest that interventions to promote informal end of life care should bolster supportive others' resources and skills for care provision and treatment adherence support, and should address perceived norms of reciprocity. Such intervention will help ensure community caregiving in a population with high needs for long-term care.
    AIDS care. 09/2014;
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    ABSTRACT: Because caregivers' monitoring of care recipients' mental health status likely facilitates provision of needed forms of assistance, the current study examines relationship factors associated with agreement in caregiver- and recipient self-reports of recipients' mental health status. Participants were former or current injection drug using persons with HIV/AIDS and their main caregivers (N = 258 dyads). Care recipients completed the Center for Epidemiologic Studies Depression scale and caregivers responded to a single item rating their recipients' mental health. Nearly two-thirds (64.7 %) of dyads agreed on care recipients' mental health status (κ = .26, p < .001). More secondary stressors of care, less reciprocity, and care recipients' greater physical limitations, substance use, and younger age predicted greater agreement on recipients' having poorer mental health. Greater secondary stressors and lower income were associated with less agreement on care recipients' mental health. Findings, which suggest that promoting reciprocity and alleviating secondary stressors of caregiving may help facilitate these caregivers' improved assessment of their care recipients' mental health status, have implications to dyadic approaches to promote drug users' HIV health outcomes.
    AIDS and Behavior 01/2014; · 3.49 Impact Factor
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    ABSTRACT: Introduction Cigarette smoking is highly prevalent among people living with HIV, and is associated with many negative health outcomes, including death. There is little research on smoking behaviors such as interest in quitting and lifetime quit attempts among smokers living with HIV. Existing research has focused on individual-level characteristics, to the neglect of social environmental characteristics. We explored individual- and social-level characteristics associated with interest in quitting and lifetime nicotine replacement (NRT) or medication use for smoking cessation. Methods Data are from a study of participants recruited from clinic and community venues originally designed to examine social environmental influences on current/former drug users’ HIV medication adherence and health outcomes. This analysis comprised 267 current smokers living with HIV. Chi-square tests were used to describe the sample; logistic regression was used to explore associations between covariates and outcomes. Results In adjusted analyses, older age (age 54-65: aOR = 4.64, 95% CI = 1.59-13.47) and lifetime use of NRT/medications (aOR = 2.02, 95% CI = 1.08-3.80) were associated with an interest in quitting smoking. Additionally, older age (age 45-49: aOR = 3.38, 95% CI = 1.57-7.26; age 54-65: aOR = 2.70 95% CI = 1.20-6.11), White race (aOR = 3.56, 95% CI = 1.20-10.62), and having a Supporter who had used NRT/medications for cessation (aOR = 2.13, 95% CI = 1.05-4.29) were associated with lifetime NRT/medications use. Conclusions Findings corroborate prior research concerning individual-level characteristics, and indicate the importance of social-level characteristics in association with prior use of NRT/medications for cessation. Findings have implications for the implementation of cessation interventions for smokers living with HIV.
    Drug and alcohol dependence 01/2014; · 3.60 Impact Factor
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    ABSTRACT: Cigarette smoking is endemic among HIV-positive populations and is related to substantial morbidity and mortality. Research has largely focused on individual-level characteristics associated with smoking, with less attention to social factors. We aimed to explore individual- and social-level characteristics associated with current cigarette smoking among people living with HIV. Data came from 358 individuals on antiretroviral therapy interviewed in a study on informal HIV caregiving, conducted in Baltimore, MD, USA. Most participants (75 %) were current smokers and 45 % reported current illegal drug use. In adjusted logistic regression analyses, current drug use (aOR 2.90, 95 % CI 1.58-5.30), 12-step program participation (aOR 1.74, 95 % CI 1.02-2.97), and having a main Supporter who is a current smoker (aOR 1.93, 95 % CI 1.12-3.33) were associated with current smoking. Findings suggest the importance of social-level factors in cigarette smoking among HIV seropositive drug users and have implications for developing targeted smoking cessation interventions for smokers living with HIV.
    AIDS and Behavior 11/2013; · 3.49 Impact Factor
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    ABSTRACT: Objectives: Concern about mass violence has led to calls for increased mental health support for violence prevention. Health information systems may help identify persons at risk of violence who may benefit from mental support services. Emergency medical services (EMS) serve an increasingly vulnerable population that, compared to other ED users, has high mental health problems. We explored the potential utility of EMS data in identifying at-risk persons. Methods: We reviewed Baltimore's 9-1-1 dispatch data and fire department EMS records over 23 months (2008-10). Health data was categorized and violent trauma related incident data was analyzed. We examined associations of subtypes of violent incidents to patient demographics, repeat EMS use, and evidence of behavioral (mental or substance use) problems. Results: We identified 7,190 violent trauma incidents linked to patient records, comprising 57.7% assaults; 13.3% shootings; 11.8% stabbings; 2.5% abuse/sexual assaults; and 14.7% attempted or threatened self-harm including suicide. Young Black males were over-represented for all incident types except abuse/sexual assault and self-harm, for which there was a wider age range, and whites, and only moderately males, were over-represented. There was evidence of repeat EMS use and behavioral health problems for one-fifth of all persons; of persons involved in self-harm, 35.2% were repeat users and 82.3% had behavioral health problems. Conclusions: Our findings suggest EMS data may aid in identifying persons at risk of violence to themselves or others. High levels of behavioral health problems and emergency care recidivism make them important targets for enhanced assessment and preventive intervention.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Objective: Low-income African-American, inner-city residents provide disproportionately high levels of informal (unpaid) HIV care (instrumental and emotional support) to family and friends living with HIV/AIDS. We examined evidence of the role of caregivers in care recipients' mental health and associations with their perceived associative stigma related to HIV caregiving. Methods: This study used a structural equation model to examine main effects of caregiver reports of recipients' mental health status and caregivers' self-reported associative stigma on care recipients' self-reported psychological distress (CES-D). Results: Results indicated that recipients' self-reported psychological distress was positively associated with caregiver reports of recipients' poor mental health (Beta=.24, p<.001) and with caregivers' associative stigma (Beta=.18, p<.05). In addition, stigma moderated the relationship between caregiver reports of recipients' mental health and recipient reports of their mental health (Beta=.43, p<.05), such that caregivers with higher perceived stigma and worse reports of recipients' mental health predicted recipient self reported poorer mental health. Conclusions: High agreement between caregivers' reports of recipients' mental health status and recipients' self reports of psychological distress suggest that caregivers were overall perceptive in assessing the mental health of their care recipients, and that caregivers who perceived high levels of associative stigma appeared to be most accurate in rating recipient's mental health status. These results suggest that, overall, the caregivers were aware of the mental health status of their care recipients and may provide a target population on which to focus interventions to monitor the mental health of PLHAs.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Background: Gun violence is a major threat to US public health. Information systems are needed to improve population surveillance of violence and inform preventive intervention. Emergency medical services (EMS) system data is an understudied potential source for incident-based surveillance of shootings and examination of personal correlates of violent injury. Methods: We reviewed Baltimore City 9-1-1 call dispatch data and Baltimore City Fire Department EMS patient records in a 23 months period 2008-10. We coded health data based on a prior schema, and compared numbers of firearm related incidents to police report data in a similar period, and examined associations with patient demographics, repeat use of EMS, and behavioral (substance use and mental) health problems. Results: We identified 954 gunshot wound incidents linked to EMS patient data, representing 13.3% of violent trauma incidents in the study period. Compared to the city and to the EMS patient population, young Black males were over-represented among gunshot victims. Compared to police reports of shootings in a comparable period, EMS records contained 19.5% fewer shooting incidents. Patients with gunshot wounds had below average levels of EMS utilization and evidence of substance abuse or mental health problems in their EMS records. Conclusions: Our findings suggest that while EMS records undercounted gunshot wound incidents in the city, EMS data may be an important source of real time incident level data to complement current data sources for firearm related injury surveillance. Future research should assess and promote the validity of EMS records on violence-related injury.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: To optimize health care utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of health care and may be indicative of challenges accessing, or poor outcomes of, health care. Patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a midsized city were identified. Study findings will aid in the development of targeted interventions to improve population health. The authors reviewed 9-1-1 call dispatch data and Baltimore City Fire Department (BCFD) EMS records from 2008 through 2010. Frequent use was defined as six or more EMS incidents in the 23-month period. Analyses used census data to compare demographics of EMS users to their population distribution and examined differences in demographics and health problems of frequent EMS users compared to nonfrequent users. Frequent EMS users (n = 1,969) had a range of six to 199 EMS incidents (mean = 11.2) during the observation period, and although they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, compared to nonfrequent users and to the population, were more likely to be male, African American, and 45 years of age or older. Of frequent users, the modal age group was 45 to 54 years, accounting for 29.7% of frequent users, which represented twice this age group's population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users) and was the peak age group for incidents related to substance abuse (28.0% of frequent users' incidents in this age group). Frequent users, compared to nonfrequent users, had lower levels of incidents related to trauma (5.1% vs. 16.7%) and higher levels of medical incidents (94.8% vs. 82.9%). As proportions of EMS incidents among frequent versus nonfrequent users, respiratory, mental health, and seizure-related incidents were highest in the youngest age groups; substance abuse-related incidents were highest in those middle-aged (35 to 44 and 45 to 54 years). Of health problems, behavioral health (mental health or substance use) contributed most to frequent EMS use (23.4% of frequent users' incidents). Across all incidents, 65.8% of frequent users had indications of behavioral health problems, representing 6.6-fold higher odds than nonfrequent users (22.5%). Frequent compared to nonfrequent users also had higher levels of select chronic conditions (diabetes, 39.9% vs. 14.6%; asthma, 40.9% vs. 13.4%; and HIV, 9.1% vs. 2.4%), with unadjusted odds almost four to seven times higher. The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use and that rates of frequent use were highest among those middle-aged, African American, and male. These results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to improve access and use of preventive services, with implications for health outcomes and costs. This study demonstrates the value of EMS patient data in identifying at-risk populations and informing novel, targeted approaches to public health interventions.
    Academic Emergency Medicine 11/2013; 20(11):1101-1111. · 2.20 Impact Factor
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    ABSTRACT: Abstract Background. Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods. We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008-2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. Results. Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00-5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45-54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug- or alcohol-related overdoses in Baltimore in 2008-2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions. While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support for using these data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose.
    Prehospital Emergency Care 06/2013; 17(3):317-29. · 1.86 Impact Factor
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    ABSTRACT: : This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 06/2013; 63 Suppl 1:S54-8. · 4.65 Impact Factor
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    ABSTRACT: BACKGROUND: Selling of single cigarettes, also known as loosies, is a public health concern. Loosies allow for those with fewer resources to buy cigarettes without having to purchase a pack. Selling of loosies may cue smoking behaviors. In the US, socioeconomically disadvantaged populations have high rates of smoking and illicit drug use and the selling of loosies appears to be linked to the urban informal economy. We examined the proportion and frequency of cigarette selling and roles in the informal economy associated with selling loosies among a sample of urban drug users. METHODS: There were 801 participants, recruited by community outreach, assessed at baseline, who were enrolled in an HIV prevention intervention for drug users. RESULTS: Most (89%) smoked cigarettes in the prior 30 days, of whom 92% smoked daily. Self-reported selling of cigarettes was common with 58% reporting that they had sold cigarettes within the last six months; 20.4% reported selling cigarettes a few times a week and 7.4% reported daily selling of cigarettes. In a stepwise regression model, four sources of income were associated with frequent cigarette selling: providing street security (OR=2.214, 95% CI 1.177-4.164), selling food stamps (OR=1.461, 95% CI 1.003-2.126), pawning items (OR=2.15, 95% CI 1.475-3.135), and selling drugs (OR=1.634, 95% CI 1.008-2.648). CONCLUSION: There is a high rate of selling loosies among urban substance users. The wide availability of loosies may promote smoking. Smoking cessation programs with drug treatment and economic development programs may help to reduce economic pressures to sell loosies.
    Drug and alcohol dependence 04/2013; · 3.60 Impact Factor
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    ABSTRACT: Abstract This study aimed to characterize the experience of having a treatment supporter among HIV-infected South African patients enrolled in a randomized controlled trial that compared the efficacy of patient-nominated treatment supporters administering partial directly observed antiretroviral therapy (DOT-ART) versus self-administered ART (Self-ART). Results of the parent study showed no virologic or sustained immunologic differences between groups, but revealed a significant survival benefit among the DOT-ART group. One hypothesis is that this survival benefit may be explained by differences in the training and involvement of the treatment supporters between groups. In the current study, results from a semi-structured exit interview of 172 participants indicate that most participants in both arms maintained a positive, satisfying relationship with a single supporter, typically family member or friend. Most patients (82.6%) perceived supporters as helpful with medication adherence, with no significant difference between groups (p=0.752). Additionally, supporters provided emotional, instrumental, and material support. DOT-ART patients were more likely than Self-ART patients to report that their supporter helped to decrease drug or alcohol use (p=0.03). Patients identified supporter trustworthiness, availability, good communication and reciprocity of support as factors beneficial to a successful relationship. These results suggest: (1) Patient-nominated peers are feasible candidates for ART supporters in this resource-constrained setting; (2) In addition to assistance with medications, treatment supporters have the capacity to promote healthy behaviors and provide other types of support, which may contribute to improved outcomes, particularly with enhanced training; (3) Trustworthiness, availability, good communication, and reciprocity are key factors in a successful patient-supporter relationship.
    AIDS patient care and STDs 02/2013; 27(2):96-102. · 2.68 Impact Factor
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    ABSTRACT: This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed. This study was funded by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA).
    Substance Use &amp Misuse 04/2012; 47(5):522-34. · 1.11 Impact Factor
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    ABSTRACT: Research suggests gender differences in interpersonal relationship factors important to health. This study examined relationship factors associated with HAART adherence among men. The sample (n = 154) comprised 95% African Americans and 48% current illicit drug users; 83% reported HAART adherence. Results revealed adherence was associated with comfort level taking HAART in the presence of close friends, and the interaction between informal care (having someone to care for oneself when sick in bed) and reciprocity of support. Among those with informal care, higher reciprocity of support to caregivers was associated with greater adherence. Promoting men's reciprocity of support to their caregivers and enhancing peer norms of medication taking are important strategies for improving men's adherence. The findings complement previous findings on relationship factors adversely associated with women's adherence. Results suggest the merit of interventions targeting men and their informal caregivers, particularly main partners, and gender-specific, contextually tailored strategies to promote HAART adherence.
    AIDS and Behavior 10/2011; 15(7):1429-36. · 3.49 Impact Factor
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    ABSTRACT: Research needs to build evidence for the roles that HIV status of injection partners may or may not play in injection risk behaviors of injection drug users (IDUs). Using baseline data collected from a randomized controlled study (INSPIRE) conducted in four cities (Baltimore, Miami, New York, and San Francisco) from 2001 to 2005, we categorized 759 primarily heterosexual HIV-positive IDUs into four groups based on HIV serostatus of drug injection partners. Thirty-two percent of the sample injected exclusively with HIV-positive partners in the past 3 months and more than 60% had risky injection behavior with these partners. Eight percent injected exclusively with HIV-negative partners and 49% injected with any unknown status partners. The remaining 11% reported having both HIV-positive and -negative injection partners, but no partners of unknown HIV status. Riskier injection behavior was found among the group with mixed status partners. The risk among the group with any unknown status partners appeared to be driven by the greater number of injection partners. No major group differences were observed in socio-demographic and psychosocial factors. Our analysis suggests that serosorting appeared to be occurring among some, but not an overwhelming majority of HIV-positive IDUs, and knowledge of HIV status of all injection partners per se did not appear to be as important as knowledge of sexual partner's HIV status in its association with risk behavior.
    Journal of Urban Health 04/2011; 88(6):1031-43. · 1.89 Impact Factor
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    ABSTRACT: Compared to US men, US women have worse HAART and HIV health outcomes. The study examined main partner factors associated with women's HAART adherence. The community sample comprised 85% African-Americans; 63% had a main partner and 32% relied on their partner for emotional support. Adherence was highest (92%) among those without a main partner and lowest (57%) among those with an HIV seropositive main partner. In adjusted analysis, adherence was 75% less likely among women with an HIV seropositive main partner and 78% less likely among those relying on their partner for emotional support. Furthermore, HIV seropositive versus other serostatus main partners were most likely to provide medication taking assistance and to be preferred in helping participants deal with HIV, yet were no more likely to be nominated as the most helpful to them. Findings reveal women's perceived unmet support needs from HIV seropositive main partners in this population and the need for interventions to promote their HAART adherence. Seroconcordant couples-focused intervention that enhances mutual support of HAART adherence may be an effective approach to improving women's HAART adherence and reducing US gender disparities in HIV health outcomes.
    AIDS Care 04/2011; 23(9):1102-10. · 1.60 Impact Factor

Publication Stats

2k Citations
185.01 Total Impact Points

Institutions

  • 1998–2014
    • Johns Hopkins Bloomberg School of Public Health
      • • Department of Mental Health
      • • Department of Health, Behavior and Society
      • • Department of Health Policy and Management
      • • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2001–2013
    • Johns Hopkins Medicine
      • • Department of Psychiatry and Behavioral Sciences
      • • Department of Health Policy and Management
      Baltimore, Maryland, United States
    • Columbia University
      New York City, New York, United States
    • National Institute on Drug Abuse
      • Research Branch Clinical Pharmacology and Therapeutics
      Maryland, United States
  • 2012
    • San Francisco State University
      San Francisco, California, United States
  • 2008–2009
    • Centers for Disease Control and Prevention
      • Division of HIV/AIDS Prevention, Intervention and Support
      Druid Hills, GA, United States
  • 1998–2009
    • Johns Hopkins University
      • • Department of Mental Health
      • • Department of Health, Behavior and Society
      • • Department of Epidemiology
      Baltimore, MD, United States
  • 2007
    • Albert Einstein College of Medicine
      • General Internal Medicine
      New York City, New York, United States
  • 2006–2007
    • University of Miami
      • • Department of Pediatrics
      • • Department of Epidemiology and Public Health
      Coral Gables, FL, United States
  • 2003–2004
    • Institute for Community Research (ICR)
      Alabama, United States