Amy Knowlton

Publications (15)49.4 Total impact

• Article: Are smokers with HIV using information and communication technology? Implications for behavioral interventions.

  Geetanjali Chander, Cassandra Stanton, Heidi E Hutton, David B Abrams, Jennifer Pearson, Amy Knowlton, Carl Latkin, David Holtgrave, Richard D Moore, Raymond Niaura
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  ABSTRACT: Smoking is highly prevalent among persons living with HIV/AIDS (PLWHA) and associated with adverse outcomes including malignancy and cardiovascular disease. Information and communication technology (ICT) may be effective in disseminating cessation interventions among PLWHA. This study examines the prevalence of ICT use among 492 PLWHA attending an urban clinic and characteristics associated with ICT use. Participants completed a survey of demographics, smoking status, and ICT use. Factors associated with ICT use were examined with logistic regression. Overall, 63% of participants smoked with 73% of smokers owning their own cell phone. Use of other modalities was lower, with 48% of smokers reporting any internet use, 39% text messaging, and 31% using email. Higher education was associated with the use of all modalities. Cell phone interventions may have the broadest reach among PLWHA, though with almost half using the internet, this may also be a low-cost means of delivering cessation interventions.
  AIDS and Behavior 03/2011; 16(2):383-8. · 3.49 Impact Factor
• Article: The relationship between social network factors, HIV, and Hepatitis C among injection drug users in Chennai, India.

  Carl Latkin, Cui Yang, Aylur K Srikrishnan, Suniti Solomon, Shruti H Mehta, David D Celentano, Muniratnam Suresh Kumar, Amy Knowlton, Sunil Suhas Solomon
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  ABSTRACT: The purpose of this study was to examine whether social network factors predict HIV and Hepatitis C (HCV) serostatus after controlling for individual-level factors at baseline among a cohort of male injection drug users in Chennai, India. The sample, which was recruited through street outreach, consists of 1078 males who reported having injected drugs in the last 6 months. The participants reported 3936 social support and risk network members. HIV and HCV positive serostatus were negatively associated with network member providing emotional support, and positively associated with network member providing material support. In addition, HCV positivity was associated with network member being an active drug user known for more than 10 years and network member being male kin networks, even after adjusting for individual demographic factors and risk behaviors. These findings suggest that social network factors are significantly linked to HIV and HCV status among IDUs in Southern India and highlight the mixed effects of social capital on health. Future HIV/HCV prevention efforts should incorporate IDU peers to alter drug network injection risk norms. For drug users who have minimal network support, support groups and other informal and formal support mechanisms may be need to help them with health care and psychological support needs for dealing with HIV/HCV.
  Drug and alcohol dependence 02/2011; 117(1):50-4. · 3.60 Impact Factor
• Article: Caregiver role overload and network support in a sample of predominantly low-income, African-American caregivers of persons living with HIV/AIDS: a structural equation modeling analysis.

  Mary M Mitchell, Amy Knowlton
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  ABSTRACT: While informal caregivers play an important role in improving the health of disadvantaged persons living with HIV/AIDS (PLHAs) in the United States, caregiver role overload has the potential for distress. We used latent profile analysis (LPA) to classify caregivers based on their perceived level of support and structural equation modeling (SEM) to examine the relationships among role overload, perceived support, caregiver demographic characteristics, and social network members' characteristics in a sample of 215 predominantly low-income, African-American informal caregivers. The LPA resulted in two classes of caregivers with higher and lower perceived support. The SEM results indicated that caregiver role overload was associated with being in the less supported class, younger age, and limited physical functioning, while social support class was associated with being female and being HIV seropositive in addition to support network characteristics. Interventions should address the support needs of HIV caregivers to reduce their potential for distress.
  AIDS and Behavior 01/2011; 16(2):278-87. · 3.49 Impact Factor
• Article: Stigma, disclosure, and depressive symptoms among informal caregivers of people living with HIV/AIDS.

  Mary M Mitchell, Amy Knowlton
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  ABSTRACT: Informal care receipt is associated with better HIV treatment outcomes among patients vulnerable to treatment failure. Yet, informal caregiving can be highly stressful, leading to distress and cessation of caregiving. Research on factors contributing to informal caregivers' psychological distress may advance our understanding of how to improve caregivers' well-being and sustained HIV caregiving for a vulnerable population. We examined relationships among caregiver stigma, disclosure, and depressive symptoms in a cross-sectional sample of 207 informal caregivers of people living with HIV/AIDS (PLWHAs) in Baltimore, Maryland. Caregivers were primarily African American, low-income, urban adults participating in the Action, Resources, and Knowledge (ARK) study (2003-2005), which recruited urban PLWHAs and their main supporters. Results indicated that among caregivers, HIV caregiving-related stigma was associated with more depressive symptoms, while disclosure of caregiving status was associated with fewer symptoms. We also explored the buffering effect of disclosure in the relationship between stigma and depressive symptoms. Results indicated that among those who reported greater stigma, there was a significant decrease in depressive symptoms as the number of disclosures increased. In contrast, participants who indicated lower stigma had consistently fewer depressive symptoms regardless of number of disclosures. These results suggest the need for interventions to address high levels of depressive symptoms among informal HIV caregivers, particularly those who report greater caregiving stigma and less disclosure of their caregiver status. In addition, future research should examine these relationships further using longitudinal data from informal caregivers and their care recipients.
  AIDS patient care and STDs 08/2009; 23(8):611-7. · 2.68 Impact Factor
• Article: Is sexual serosorting occurring among HIV-positive injection drug users? Comparison between those with HIV-positive partners only, HIV-negative partners only, and those with any partners of unknown status.

  Yuko Mizuno, David W Purcell, Mary H Latka, Lisa R Metsch, Helen Ding, Cynthia A Gomez, Amy R Knowlton
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  ABSTRACT: Using baseline data from a multi-site, randomized controlled study (INSPIRE), we categorized 999 HIV-positive IDUs into three groups based on serostatus of their sex partners. Our data provide some evidence for serosorting occurring in our sample; about 40% of the sample had sex exclusively with HIV-positive partners, and about half of them reported having unprotected sex with these partners. Twenty per cent had sex exclusively with HIV-negative partners; their sexual behaviors tended to be least risky with about two-thirds reporting their sex was protected. However, we also found that another 40% had at least one partner of unknown HIV status and sexual and drug risk was the highest among them. They were also least empowered, showing attributes that may undermine HIV prevention. Some of these findings are consistent with findings from MSM studies, suggesting that partner selection practices are similar between primarily heterosexual IDUs and MSM.
  AIDS and Behavior 04/2009; 14(1):92-102. · 3.49 Impact Factor
• Article: Predictors of Sharing Injection Equipment by HIV-Seropositive Injection Drug Users.

  Carl Latkin, Amy Buchanan, Lisa Metsch, Kelly Knight, Mary Latka, Yuko Mizuno, Amy Knowlton
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  ABSTRACT: Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in Intervention for Seropositive Injectors-Research and Evaluation, a secondary prevention intervention for sexually active HIV-positive IDUs in 4 US cities during 2001-2005. The analyses involved 357 participants who reported injecting drugs in the prior 6 months at either the 6- or 12-month follow-up visit. About half (49%) reported at least 1 sharing episode. In adjusted analyses, peer norms supporting safer injection practices and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress were associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs' transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services.
  JAIDS Journal of Acquired Immune Deficiency Syndromes 11/2008; · 4.43 Impact Factor
• Article: Predictors of current housing status among HIV-seropositive injection drug users (IDUs): results from a 1-year study.

  Yuko Mizuno, David W Purcell, Jun Zhang, Amy R Knowlton, Martina De Varona, Julia H Arnsten, Kelly R Knight
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  ABSTRACT: Using longitudinal data collected from 821 HIV-seropositive injection drug users (IDUs) who participated in a multi-site behavioral intervention study, we identified predictors of current housing status at baseline and 12-month follow-up time points. The study was conducted in Baltimore, Miami, New York, and San Francisco from 2001 to 2005. Logistic regression, incorporating the general estimating equations (GEE) method was performed. Multivariate analysis found that Miami participants (OR = 0.56) were less likely to report having current housing (P < 0.05). Among the potential barriers to housing, lower income (OR = 0.68), injection cocaine/crack use (OR = 0.66) and recent incarceration (OR = 0.10) were statistically significant (P < 0.05). Among the potential facilitators of housing, case management (OR = 1.38), outpatient drug treatment attendance (OR = 1.74), and social support (OR = 1.39) were significant. The association between social support and housing was stronger among those who had been recently incarcerated. Additional research is needed to identify types of support and resources beyond what is currently provided in order to better serve housing needs of HIV-seropositive IDUs.
  AIDS and Behavior 02/2008; 13(1):165-72. · 3.49 Impact Factor
• Article: Externalizing behaviors among children of HIV seropositive former and current drug users: parent support network factors as social ecological risks.

  Amy Knowlton, Amy Buchanan, Lawrence Wissow, Daniel J Pilowsky, Carl Latkin
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  ABSTRACT: Children affected by their parents' dual drug use and HIV/AIDS face considerable challenges to their psychosocial development, including parent dysfunction and foster care placement. While HIV/AIDS may increase parents' mobilization of social support, their drug use may restrict who is available to help them, with potential implications to the adjustment of their children with whom they remain in contact. This study sought to identify dually affected children's living situations, and parent and parent's support network factors as correlates of children's externalizing problem behaviors. An urban community sample of 462 HIV seropositive, current or former drug-using parents were queried about their children aged 5-15 years old. One hundred ninety-four children were reported by 119 parents. The outcome was children's externalizing behaviors of ever having been suspended or expelled from school, criminal-justice system involvement, or illicit drug or heavy alcohol use. Independent variables included kin and drug users in parent's support network. Generalized estimating equations were used to adjust for the potential correlation of children of the same parent. Among parents, 63% were mothers, 57% current opioid or cocaine users, 85% were African American, 35% had AIDS or CD<200, and 53% had high depressive symptoms (CES-D>or=16); median age was 38. Among children, median age was 12; 23% lived with the nominating parent, 65% with other family, and 11% in non-kin foster care. While only 34% of parents reported child custody, 43% reported daily contact with their child, and 90% reported high emotional closeness. Parents reported externalizing behaviors among 32% of the children. Logistic regression indicated that externalizing behavior was positively associated with parent's physical limitations and proportion of illicit drug users in parent's support network. A significant interaction was found indicating that the effect of parent's support network-level drug use was greater for children living with versus not living with the parent. The model adjusted for parent's current drug use and depressive symptoms, which were not significant. Results indicate that while only a minority of these dually affected children lived with the parent, the parents' physical limitations and embeddedness in drug using support networks, particularly if living with their children, was associated with the children's maladjustment. It is plausible that these factors interfere with parenting, expose the children to conflict or adverse social influences, or obligate children to assume caregiving for their parent. While dually affected children's contact with their parents may have important benefits, results suggest it presents ongoing needs for intervention with the children, their parents, and caregivers.
  Journal of Urban Health 01/2008; 85(1):62-76. · 2.13 Impact Factor
• Source

  Available from: Wei Zhao

  Article: Providers' HIV prevention discussions with HIV-seropositive injection drug users.

  James D Wilkinson, Wei Zhao, Scott Santibanez, Julia Arnsten, Amy Knowlton, Cynthia A Gómez, Lisa R Metsch
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  ABSTRACT: Public health agencies have recommended incorporating HIV prevention counseling into the medical care of persons living with HIV/AIDS. Injection drug users (IDUs) especially need HIV risk-reduction counseling because of their high risk for HIV transmission through both sexual and injection behaviors. The objective of this study was to assess the prevalence of, and patient factors associated with, the delivery of HIV prevention messages to HIV-seropositive IDUs in primary care settings. A majority of participants reported having an HIV prevention discussion with their provider during their most recent primary care visit. Factors significantly associated with report of such discussion were being Hispanic or non-Hispanic Black; high school education or less; and better perception of engagement with provider. Medical providers should provide prevention messages to all HIV-seropositive IDUs, regardless of demographic factors. Effective HIV prevention interventions in primary care settings, including interventions to improve patient-provider communication, are needed for HIV-seropositive IDUs.
  AIDS and Behavior 12/2006; 10(6):699-705. · 3.49 Impact Factor
• Article: Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users.

  Amy Knowlton, Julia Arnsten, Lois Eldred, James Wilkinson, Marc Gourevitch, Starley Shade, Krista Dowling, David Purcell
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  ABSTRACT: Among individuals receiving highly active antiretroviral therapy (HAART), injection drug users (IDUs) are less likely to achieve HIV suppression. The present study examined individual-level, interpersonal, and structural factors associated with achieving undetectable plasma viral load (UVL) among US IDUs receiving recommended HAART. Data were from baseline assessments of the INSPIRE (Interventions for Seropositive Injectors-Research and Evaluation) study, a 4-site, secondary HIV prevention intervention for heterosexually active IDUs. Of 1113 study participants at baseline, 42% (n = 466) were currently taking recommended HAART (34% were female, 69% non-Hispanic black, 26% recently homeless; median age was 43 years), of whom 132 (28%) had a UVL. Logistic regression revealed that among those on recommended HAART, adjusted odds of UVL were at least 3 times higher among those with high social support, stable housing, and CD4 > 200; UVL was approximately 60% higher among those reporting better patient-provider communication. Outpatient drug treatment and non-Hispanic black race and an interaction between current drug use and social support were marginally negatively significant. Among those with high perceived support, noncurrent drug users compared with current drug users had a greater likelihood of UVL; current drug use was not associated with UVL among those with low support. Depressive symptoms (Brief Symptom Inventory) were not significant. Results suggest the major role of social support in facilitating effective HAART use in this population and suggest that active drug use may interfere with HAART use by adversely affecting social support. Interventions promoting social support functioning, patient-provider communication, stable housing, and drug abuse treatment may facilitate effective HAART use in this vulnerable population.
  JAIDS Journal of Acquired Immune Deficiency Syndromes 05/2006; 41(4):486-92. · 4.43 Impact Factor
• Article: Social support among HIV positive injection drug users: implications to integrated intervention for HIV positives.

  Amy Knowlton, Wei Hua, Carl Latkin
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  ABSTRACT: The study compared social support networks of HIV seropositive versus seronegative injection drug users (IDUs). Participants were 635 low income African Americans; 47% were HIV seropositive (of whom 17% had AIDS), 45% female, and 45% current drug users. A social network methodology elicited structural, functional, and relational network components. After controlling for confounders, HIV seropositive compared with HIV seronegative IDUs had larger support networks, including more females, kin and sources of instrumental assistance, and marginally more sources of emotional support, though they were less likely to have a sex partner. There was no difference between HIV status and number of active drug users in support networks. Results suggest that HIV seropositive IDUs had mobilized a range of network support but that they also relied on drug using social influences. Findings may have implications to the development of integrated HIV prevention and care intervention that builds on HIV seropositives' natural support structures.
  AIDS and Behavior 01/2005; 8(4):357-63. · 3.49 Impact Factor
• Article: Values and identity: the meaning of work for injection drug users involved in volunteer HIV prevention outreach.

  Julia B Dickson-Gómez, Amy Knowlton, Carl Latkin
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  ABSTRACT: Most HIV behavioral interventions provide participants with preventive information emphasizing how not to behave, and have neglected to provide attractive and feasible alternatives to risky behavior. Interventions that emphasize cultural strengths may have more powerful effects and may help remove the stigma of HIV, which has hampered prevention efforts among African American communities. Starting in 1997, the SHIELD (Self-Help in Eliminating Life-Threatening Diseases) intervention trained injection drug users (N=250) to conduct risk reduction outreach education among their peers. Many participants saw their outreach as "work," which gave them a sense of meaning and purpose and motivated them to make other positive changes in their lives.
  Substance Use &amp Misuse 07/2004; 39(8):1259-86. · 1.10 Impact Factor
• Article: Hoppers and oldheads: qualitative evaluation of a volunteer AIDS outreach intervention.

  Julia Dickson-Gómez, Amy Knowlton, Carl Latkin
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  ABSTRACT: Qualitative research can play an important role in explaining outcomes of behavioral interventions and constitutes a largely unrealized potential of ethnographic methods in AIDS research. The Self Help in Eliminating Life Threatening Diseases (SHIELD) intervention trained African American injection drug users to conduct outreach among their drug-using peers and sexual partners. Though the intervention was not targeting adolescents, some participants chose to conduct outreach with youth fortuitously found on the street. Still others spoke to groups of youth in their homes. This paper seeks to understand the dynamics of outreach encounters between older, drug-using outreach workers and adolescents. Contextual features that were important in determining the quality of outreach encounters with youth included the setting (on the street or in the home), characteristics of the outreach worker such as gender, content of the outreach message, and style of interpersonal communication.
  AIDS and Behavior 10/2003; 7(3):303-15. · 3.49 Impact Factor
• Article: HIV prevention among drug users: outcome of a network-oriented peer outreach intervention.

  Carl A Latkin, Susan Sherman, Amy Knowlton
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  ABSTRACT: A network-oriented HIV prevention intervention based on social identity theory and peer outreach was implemented for HIV positive and negative drug users. A community sample of 250 were randomly assigned to an equal-attention control condition or a multisession, small-group experimental condition, which encouraged peer outreach; 94% of participants were African American, and 66% used cocaine or opiates. At follow-up, 92% of participants returned, and experimental compared with control group participants were 3 times more likely to report reduction of injection risk behaviors and 4 times more likely to report increased condom use with casual sex partners. Results suggest that psychosocial intervention emphasizing prosocial roles and social identity, and incorporating peer outreach strategies, can reduce HIV risk in low-income, drug-using communities.
  Health Psychology 08/2003; 22(4):332-9. · 3.87 Impact Factor
• Article: Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users.

  Carl A Latkin, Valerie Forman, Amy Knowlton, Susan Sherman
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  ABSTRACT: Altering norms may be an important approach to introducing and sustaining health protective behavior change. This study sought to examine the relationship between condom use, condom norms, and social network characteristics among a sample of economically impoverished individuals at risk for acquiring and transmitting HIV. Participants were 1051 individuals from a drug-using community in the USA. Eighty percent were current drug users; 17% were HIV seropositive. Reported condom use was strongly associated with peer norms about condom use (friends talking about condoms, encouraging condom use, and using condoms). Women were less likely than men to report that their friends used condoms. Injection drug use was negatively associated with peer norms about condom use, while church attendance and network characteristics were positively associated with condom-promoting norms. The size of the health advice and the financial support networks was most positively related to condom norms. Network methodology may aid in the identification of specific ties that promote condom use norms in a population. The findings of this study may have implications for norm change interventions among disadvantaged communities at high risk for HIV/AIDS.
  Social Science [?] Medicine 03/2003; 56(3):465-76. · 2.70 Impact Factor