Torsten B Neilands

Centre for HIV/Aids Prevention Studies, Johannesburg, Gauteng, South Africa

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Publications (165)448.65 Total impact

  • Amanda Fallin · Torsten B Neilands · Jeffrey W Jordan · Pamela M Ling
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    ABSTRACT: Lesbian, gay, bisexual, and transgender (LGBT) individuals are more likely to smoke than the general population. This study evaluated a Social Branding intervention, CRUSH, which included an aspirational brand, social events, and targeted media to discourage smoking among LGBT young adults in Las Vegas, NV. Cross-sectional surveys (N = 2,395) were collected in Las Vegas LGBT bars at 2 time points 1 year apart. Multivariate logistic regressions examined associations between campaign exposure, message understanding, and current (past 30 days) smoking, controlling for demographics. LGBT individuals were significantly more likely to report current (past 30 day) smoking than heterosexual/straight, gender-conforming participants. Overall, 53% of respondents reported exposure to CRUSH; of those exposed, 60% liked the campaign, 60.3% reported they would attend a CRUSH event on a night when they usually went somewhere else, and 86.3% correctly identified that the campaign was about "partying fresh and smokefree." Current smoking was reported by 47% of respondents at Time 1 and 39.6% at Time 2. There were significant interactions between time and campaign exposure and campaign exposure and understanding the message. Among those who understood the CRUSH smokefree message, the highest level of campaign exposure was significantly associated with 37%-48% lower odds for current smoking. While longitudinal studies would better assess the impact of this intervention, CRUSH shows promise to reduce tobacco use among LGBT bar patrons. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    Nicotine & Tobacco Research 08/2015; 17(8):983-9. DOI:10.1093/ntr/ntu265 · 2.81 Impact Factor
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    ABSTRACT: Since the July 2012 approval by the FDA of emtricitabine/ tenofovir disoproxil fumarate (Truvada) for use as pre-exposure prophylaxis (PrEP) against HIV, its feasibility and acceptability has been under study. HIV-discordant couples are likely targets for PrEP but little is known about how this new prevention tool impacts relationships. We examined, among gay male couples, the acceptability of individual and partner use of PrEP and intentions to use condoms with primary and outside partners in the context of PrEP use. Data are from two independent samples of couples recruited in the San Francisco bay area and New York City-a qualitative one (N=48 couples) between March and November, 2011, and a quantitative one (N=171 couples) between June, 2012 and May, 2013. Data were categorized by couple HIV status and general linear models; chi-square tests of independence were used to examine condom-use intentions with primary and outside partners, by sexual risk profile, and race. Almost half of the HIV-negative couples felt PrEP was a good HIV prevention strategy for themselves and their partner. Over half reported that they would not change their current condom use if they or their partner were taking PrEP. However, approximately 30% of HIV-negative couples reported that they would stop using condoms or use them less with primary and outside partners if they were on PrEP or if their partner was on PrEP. A large percentage of couples view PrEP positively. However, to ensure safety for both partners, future programing must consider those who intend not to use condoms while on PrEP.
    AIDS patient care and STDs 06/2015; 29(7). DOI:10.1089/apc.2014.0315 · 3.58 Impact Factor
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    Leyla Karimli · Fred M Ssewamala · Torsten B Neilands · Mary McKernan McKay
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    ABSTRACT: This study examines variations in saving behavior among poor families enrolled in a Child Savings Account program for orphaned and vulnerable school-going children in Uganda. We employ multilevel analyses using longitudinal data from a cluster-randomized experimental design. Our analyses reveal the following significant results: (1) given the average number of months during which the account was open (18 months), families saved on average, USD 54.72, which, after being matched by the program (2:1 match rate) comes to USD 164.16—enough to cover approximately five academic terms of post-primary education; (2) children’s saving behavior was not associated with quality of family relations; it was, however, significantly associated with family financial socialization; (3) family demographics were significantly associated with children’s saving behavior in the matched Child Savings Account program; and (4) children enrolled in some schools saved better compared to children enrolled in other schools within the same treatment group.
    06/2015; 2(2):53-64. DOI:10.1007/s40609-015-0026-0
  • Sara Kalkhoran · Rachel A. Grana · Torsten B. Neilands · Pamela M. Ling
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    ABSTRACT: Objectives: To evaluate predictors of dual use of cigarettes with smokeless tobacco or e-cigarettes. Methods: Adult smokers (N = 1324) completed online cross-sectional surveys. Logistic regression evaluated predictors of dual use and cigarette quit attempts. Results: Smokeless tobacco dual use was associated with past attempts to quit smoking by switching to smokeless products. E-cigarette dual use was associated with using stop-smoking medication and strong anti-tobacco industry attitudes. Ever use of stop-smoking medication was associated with quit attempts among dual e-cigarette users and cigarette-only users. Conclusions: Dual users are more likely than cigarette-only users to endorse certain cessation-related attitudes and behaviors. This may provide an opportunity for clinicians or others to discuss evidence-based strategies for smoking cessation.
    American journal of health behavior 03/2015; 39(2). DOI:10.5993/AJHB.39.2.14 · 1.31 Impact Factor
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    ABSTRACT: Research suggests that optimal couple functioning depends on adopting a "we" orientation to health. Using qualitative data from 20 male couples in which at least one partner was HIV-positive, we examined how couples viewed their health involvement and its relation to social support. One group described their health as highly interconnected; in a second group, at least one partner viewed health as a personal responsibility. Results revealed that there was not a uniform "we" approach toward health; rather, sero-concordance, sero-discordance, and coping with other chronic illnesses strongly contributed to orientations toward health. Orientations toward health were not found to determine social support. © The Author(s) 2015.
    Journal of Health Psychology 02/2015; DOI:10.1177/1359105315571975 · 1.22 Impact Factor
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    ABSTRACT: Substance use is strongly linked to HIV risk, and members of couples can have a powerful influence on each other's health behaviors. We examined whether couple-level patterns of stimulant use were differentially associated with engaging in condomless anal intercourse with primary partners and outside partners. Members of HIV serodiscordant male couples (N = 117 couples, 232 men) completed surveys, and HIV-positive men had blood drawn for viral load. Results revealed that stimulant use by only one partner in the couple was associated with a decrease in the odds of engaging in condomless anal sex with one's primary partner (AOR = 0.09, 95% CI: 0.01, 0.89). When both partners reported stimulant use, the HIV-negative partner had an increase in the odds of condomless sex with outside partners (AOR = 6.68, 95% CI: 1.09, 8.01). Understanding the role of couples' stimulant use patterns in HIV transmission risk is an important area for future research and intervention.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2015; 68(2):147-51. DOI:10.1097/QAI.0000000000000418 · 4.39 Impact Factor
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    ABSTRACT: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa. CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.
    International Journal of Epidemiology 02/2015; 44(1):251-63. DOI:10.1093/ije/dyu271 · 9.20 Impact Factor
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    ABSTRACT: More than 25% of young adult Oklahomans smoked cigarettes in 2012. Tobacco marketing campaigns target young adults in social environments like bars/nightclubs. Social Branding interventions are designed to compete directly with this marketing. To evaluate an intervention to reduce smoking among young adult "Partiers" in Oklahoma. The Partier peer crowd was described as follows: attendance at large nightclubs, fashion consciousness, valuing physical attractiveness, and achieving social status by exuding an image of confidence and financial success. Repeated cross-sectional study with three time points. Randomized time location survey samples of young adult Partier bar and club patrons in Oklahoma City (Time 1 [2010], n=1,383; Time 2 [2011], n=1,292; and Time 3 [2012], n=1,198). Data were analyzed in 2013. The "HAVOC" Social Branding intervention was designed to associate a smoke-free lifestyle with Partiers' values, and included events at popular clubs, brand ambassador peer leaders who transmit the anti-tobacco message, social media, and tailored anti-tobacco messaging. Daily and nondaily smoking rates, and binge drinking rates (secondary). Overall, smoking rates did not change (44.1% at Time 1, 45.0% at Time 2, and 47.4% at Time 3; p=0.17), but there was a significant interaction between intervention duration and brand recall. Partiers reporting intervention recall had lower odds of daily smoking (OR=0.30 [0.10, 0.95]) and no difference in nondaily smoking, whereas Partiers who did not recall the intervention had increased odds of smoking (daily AOR=1.74 [1.04, 2.89]; nondaily AOR=1.97 [1.35, 2.87]). Among non-Partiers, those who recalled HAVOC reported no difference in smoking, and those who did not recall HAVOC reported significantly increased odds of smoking (daily AOR=1.53 [1.02, 2.31]; nondaily AOR=1.72 [1.26, 2.36]). Binge drinking rates were significantly lower (AOR=0.73 [0.59, 0.89]) overall. HAVOC has the potential to affect smoking behavior among Oklahoma Partiers without increasing binge drinking. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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    ABSTRACT: We conducted a secondary data analysis of 11 AIDS Clinical Trials Group (ACTG) studies to examine longitudinal associations between 14 self-reported antiretroviral therapy (ART) adherence barriers (at 12 weeks) and plasma HIV RNA (at 24 weeks) and to discern the relative importance of these barriers in explaining virologic detectability. Studies enrolled from 1997 to 2003 and concluded between 2002 and 2012. We included 1496 (54.2% of the original sample) with complete data. The most commonly selected barriers were "away from home" (21.9%), "simply forgot" (19.6%), "change in daily routine" (19.5%), and "fell asleep/slept through dosing time" (18.9%). In bivariate analyses, "too many pills to take" (OR=0.43, p<0.001), "wanted to avoid side effects" (OR=0.54, p=0.001), "felt drug was toxic/harmful" (OR=0.44, p<0.001), "felt sick or ill" (OR=0.49, p<0.001), "felt depressed/overwhelmed" (OR=0.58, p=0.004), and "problem taking pills at specified time" (OR=0.71, p=0.04) were associated with a lower odds of an undetectable HIV RNA. "Too many pills to take," "wanted to avoid side effects," "felt drug was toxic/harmful," "felt sick/ill,", and "felt depressed/overwhelmed" had the highest relative importance in explaining virologic detectability. "Simply forgot" was not associated with HIV RNA (OR=0.99, p=0.95) and was ninth in its relative importance. Adherence interventions should prioritize barriers with highest importance in explaining virologic outcomes rather than focusing on more commonly reported barriers.
    AIDS PATIENT CARE and STDs 01/2015; 29(3). DOI:10.1089/apc.2014.0255 · 3.58 Impact Factor
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    ABSTRACT: Previous studies of HIV testing among gay men describe the motivations, facilitators and barriers, behaviors, and demographic characteristics of individuals who test. What little research focuses on HIV testing among gay men in relationships shows that they do not test regularly or, in some cases, at all-their motivations to test have not been investigated. With so little data on HIV testing for this population, and the continued privileging of individually focused approaches, gay men in relationships fall into a blind spot of research and prevention efforts. This study examined motivations to test for HIV using qualitative data from both partners in 20 gay male couples. Analysis revealed that the partners' motivations were either event-related (e.g., participants testing at the beginning of their relationship or HIV-negative participants in an HIV-discordant relationship testing after risky episode with their discordant primary partner) or partner-related (e.g., participants testing in response to a request or suggestion to test from their primary partner or participants testing out of concern for their primary partner's health and well-being). These data provide insight into relationship-oriented motivations to test for HIV for gay men in relationships and, in doing so, evidence their commitment to their primary partner and relationship. These motivations can be leveraged to increase HIV testing among gay men in relationships, a population that tests less often than single gay men, yet, until recently, has been underserved by prevention efforts.
    Archives of Sexual Behavior 12/2014; 44(2). DOI:10.1007/s10508-014-0403-2 · 3.53 Impact Factor
  • David M Huebner · Brian C Thoma · Torsten B Neilands
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    ABSTRACT: Lesbian, gay, bisexual, and transgender (LGBT) adolescents are at increased risk for substance use, relative to their heterosexual counterparts. Although previous research has demonstrated that experiences of anti-LGBT harassment, discrimination, and victimization may explain some of this disparity, little is known about the mechanisms whereby such mistreatment leads to substance abuse. This study aimed to examine whether mechanisms suggested by the Social Development Model might explain the links between school-based victimization and substance use in this population. Five hundred and four ethnically diverse LGBT adolescents ages 14-19 reported their experiences with school victimization, substance abuse, school bonding, and deviant peer group affiliation. Anti-LGBT victimization in school was associated with substance abuse, and although causality cannot be established, structural equation modeling confirmed that the data are consistent with a theoretical model in which this association was mediated by increased affiliation with deviant peers. Preventive interventions for LGBT adolescents must not only attempt to make schools safer for these youth, but also help keep them engaged in healthy peer groups when they are confronted with mistreatment in school.
    Prevention Science 12/2014; 16(5). DOI:10.1007/s11121-014-0507-x · 2.63 Impact Factor
  • K E Gamarel · T B Neilands · S E Dilworth · J M Taylor · M O Johnson
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    ABSTRACT: High rates of cigarette smoking have been observed among HIV-positive individuals. Smoking has been linked to HIV-related medical complications and non-AIDS defining cancers and negatively impacts on immune function and virologic control. Although internalized heterosexism has been related to smoking behaviors, little is known about associations between partners' reports of smoking, internalized heterosexism, and HIV medication management in male couples with HIV. A sample of 266 male couples completed baseline assessments for a cohort study examining relationship factors and HIV treatment. A computer-based survey assessed self-reported smoking behaviors, alcohol use, internalized heterosexism, and antiretroviral therapy (ART) adherence. HIV-positive men also provided blood samples to assess viral load. Approximately 30% of the sample reported that they are currently smoking cigarettes. After adjusting for demographic characteristics, men in a primary relationship with a partner who reported currently smoking had more than five-fold greater odds of reporting smoking. Higher levels of internalized heterosexism and financial hardship were each independently associated with greater odds of reporting smoking. Among HIV-positive men on ART (n = 371), having a partner who reported smoking was associated with almost three-fold greater odds of having a detectable viral load. Our findings add new support to the evidence of romantic partners influencing each other's health behaviors, and demonstrate an association between smoking and disease management within male couples. Future research should explore the interpersonal and social contexts of smoking in order to develop interventions that meet the unique needs of male couples.
    AIDS Care 12/2014; 27(5):1-6. DOI:10.1080/09540121.2014.991269 · 1.60 Impact Factor
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    Leyla Karimli · Fred M Ssewamala · Torsten B Neilands
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    ABSTRACT: This study examines participants' savings in children's savings accounts (CSAs) set up for AIDS-orphaned children ages 10-15 in Uganda. Using a cluster randomized experimental design, we examine the extent to which families participating in a CSA program report more savings than their counterparts not participating in the program, explore the extent to which families who participate in the CSA program report using formal financial institutions compared with families who do not have a CSA, and consider whether families participating in the CSA program bring new money into the CSA or whether they reshuffle existing household assets. We find that participating in a CSA increased families' likelihood to report having saved money. However, our results show no intervention effect either on the amount of self-reported savings or on the likelihood of using formal financial institutions. Further research is needed to understand whether use of a CSA helps families generate new wealth.
    Social Service Review 12/2014; 88(4):658-694. DOI:10.1086/679256 · 0.72 Impact Factor
  • Eric Vittinghoff · Torsten B Neilands
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    ABSTRACT: This paper presents methods to calculate sample size for evaluating mediation by joint testing of both links in an indirect pathway from exposure to mediator to outcome. Calculations rely on simulations of the underlying data structure, with testing of the two links performed under the simplifying assumption that the two test statistics are asymptotically independent. Simulations show that the proposed methods are accurate. Continuous and binary exposures and mediators, as well as continuous, binary, count, and survival outcomes are accommodated, along with over-dispersion of count outcomes, design effects, and confounding of the exposure-mediator and mediator-outcome relationships. An illustrative example is provided, and a documented R program implementing the calculations is available online.
    Prevention Science 11/2014; DOI:10.1007/s11121-014-0528-5 · 2.63 Impact Factor
  • Kristi Gamarel · Sarah Woolf-King · Torsten Neilands · Mallory Johnson
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    ABSTRACT: Background: Agreements about sex with outside partners are common and can be protective among male couples, and discrepancies in these agreements can be indicative of HIV risk. Substance use has been associated with sexual risk behavior. Also, differences in substance use between partners have been linked with poor health outcomes. This study examined how substance use patterns were associated with being in a monogamous, open, or discrepant sexual agreement among serodiscordant male couples. Methods: HIV-positive men and their HIV-negative partners (N= 117 couples, 234 men) were surveyed. A multinomial logistic regression model examined associations between each partner’s AUDIT alcohol screening, stimulant use, and couple's substance use difference scores with the couple's sexual agreement type, adjusting for depressive symptoms, communication, relationship duration, and time since HIV diagnosis. Results: Participants' mean age was 46.70; 38.4% were racial/ethnic minority; and 40% earned less than $20,000 annually. In total, 31.6% of couples reported a monogamous agreement, 26.5% open, and 41.0 % discrepant agreements. HIV-positive partners’ stimulant use and higher alcohol use scores were associated with reporting a discrepant, compared to an open agreement (p<0.05). Higher couple alcohol use difference scores were associated with being in a discrepant, compared to open agreement (p<0.05). Discussion: Substance use is associated with a discrepant sexual agreement for gay couples. Differences in alcohol use between partners are associated with a discrepant sexual agreement. Examining how alcohol and use of other substances impacts sexual communication and agreements represent an important area for future research and intervention with male couples.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Individuals, rather than social-structural factors, have been the primary focus of most HIV prevention research. Consequently, considerable gaps exist about how social-structural factors such as neighborhoods facilitate or hinder sexual HIV risk. This is particularly the case for Black heterosexual men who do not inject drugs or report heavy drug use. Evidence of a generalized HIV epidemic (>1%) among Black heterosexuals in impoverished urban U.S. communities, underscore the need for more research on neighborhood context and sexual HIV risk for Black heterosexual men. Method: We used structural equation modeling (Mplus 7.11) to test a model of the pathways between neighborhood context (neighborhood disorder, personal and neighborhood violence), depression, substance use, and Black sexual risk behavior. Participants were 526 self-identified Black heterosexual men, ages 18 to 45 recruited in Philadelphia, PA via randomized venue-based probability sampling (e.g., restaurants, corner stores). Results: With the exception of the hypothesized pathway between depression and substance use, all hypothesized direct pathways were significant. We observed significant positive direct effects from neighborhood context, depression, and substance use on sexual risk. Results suggest that variability in sexual risk is explained by direct influences of neighborhood context, depression, and substance use, with the latter also being a conduit through which additional neighborhood context effects exert influence. Conclusion: In the context of Black heterosexual men’s sexual HIV risk, healthography matters. Our study underscores the need for more research and interventions to address and reduce the effects of negative neighborhood context on Black heterosexual men’s sexual HIV risk behaviors.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Abstract A self-administered, street intercept survey was conducted in order to examine the relation of stigma and shame associated with sexually transmitted infections (STI) to STI testing practices, partner notification, and partner-delivered treatment among young African American men (n=108) in a low-income, urban community in San Francisco with high STI burden. Multivariate logistic regression revealed that increasing STI-related stigma was significantly associated with a decreased odds of STI testing, such that every standard deviation increase in stigma score was associated with 0.62 decreased odds of having been tested (aOR: 0.62, 95% CI: 0.38-1.00), controlling for age. STI stigma was also significantly associated with a decreased willingness to notify non-main partners of an STI (aOR: 0.64 95% CI: 0.41-0.99). Participants with higher levels of stigma and shame were also significantly less likely to be willing to deliver STI medication to a partner (stigma aOR: 0.57, 95% CI: 0.37-0.88; shame aOR 0.53 95% CI: 0.34-0.83). Findings suggest that STI-related stigma and shame, common in this population, could undermine STI testing, treatment, and partner notification programs. The medical establishment, one of the institutional factors to have reinforced this culture of stigma, must aid efforts to reduce its effects through providing integrated services, reframing sexual health in campaigns, educating clients, and providing wider options to aid disclosure and partner notification practices.
    AIDS PATIENT CARE and STDs 09/2014; 28(9):499-506. DOI:10.1089/apc.2013.0316 · 3.58 Impact Factor
  • Drug and Alcohol Dependence 07/2014; 140:e28. DOI:10.1016/j.drugalcdep.2014.02.098 · 3.28 Impact Factor
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    ABSTRACT: The effects of neighborhood context on sexual risk behavior are understudied, particularly for Black heterosexual men who do not inject drugs or report heavy drug use. Evidence of a generalized HIV epidemic (>1 %) among Black heterosexuals in low-income urban U.S. communities underscores the importance of examining the effects of neighborhood context on Black heterosexual men's sexual risk, however. We used structural equation modeling to test the pathways between neighborhood context (neighborhood disorder, personal violence, neighborhood threats), depression, substance use, and sexual risk behavior. Participants were 526 self-identified Black heterosexual men, ages 18-45, recruited via randomized venue-based probability sampling in Philadelphia, PA. Analyses of model fit statistics from Mplus indicated statistically significant direct pathways between neighborhood context, depression, substance use, and sexual risk behavior. The total indirect effect of neighborhood context on sexual risk behavior through substance use was also significant. The study's results highlight a need for more research on neighborhood context and sexual HIV risk, and for multilevel interventions to address the effects of negative neighborhood context on Black heterosexual men's sexual HIV risk.
    AIDS and Behavior 06/2014; 18(11). DOI:10.1007/s10461-014-0803-2 · 3.49 Impact Factor

Publication Stats

3k Citations
448.65 Total Impact Points

Institutions

  • 2005–2015
    • Centre for HIV/Aids Prevention Studies
      Johannesburg, Gauteng, South Africa
  • 2001–2015
    • University of California, San Francisco
      • • Center for AIDS Prevention Studies
      • • Division of Hospital Medicine
      • • Department of Medicine
      San Francisco, California, United States
    • University of Texas at Austin
      • Department of Psychology
      Austin, Texas, United States
  • 2013
    • University of San Francisco
      San Francisco, California, United States
  • 2010
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2008
    • Drexel University
      • Department of Community Health and Prevention
      Philadelphia, PA, United States
    • CSU Mentor
      Long Beach, California, United States
  • 2007–2008
    • University of South Florida
      • Department of Community and Family Health
      Tampa, FL, United States
  • 2006
    • San Francisco Department of Public Health
      San Francisco, California, United States
  • 2003
    • San Francisco VA Medical Center
      San Francisco, California, United States