Michelle R Kaufman

• PhD
• Professor (Associate) at Johns Hopkins Bloomberg School of Public Health

: Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social-structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behav...

We examine peer violence trajectories among a purposive sample of urban poor adolescents over 3 years in Kinshasa, Democratic Republic of Congo (DRC); Shanghai, China, and Bandar Lampung, Denpasar, and Semarang, Indonesia. We examine peer violence experiences over time and seek to understand the relationship between gender norm perceptions and pers...

In today’s world, the internet is seamlessly woven into every facet of our existence. This constant engagement with digital media has generated concerns about the negative effects of digital media use, especially among adolescents. These concerns have led to the development and testing of numerous digital wellbeing interventions that focus on adole...

Background Research that investigates the negative health effects of stigma beyond the individual and interpersonal levels is increasingly using the concept of “structural stigma.” This scoping review investigates how the concept of “structural stigma” has been used and operationalized in health-related literature to date in order to characterize i...

India has consistently had one of the highest birth sex ratios (i.e., most males per female) globally. This analysis seeks to describe the sex composition of live births over the past decades among subgroups of the Indian population considering ongoing efforts to mitigate sex selection practices. Distribution of sex from the birth history data from...

Large language models (LLMs) acquire beliefs about gender from training data and can therefore generate text with stereotypical gender attitudes. Prior studies have demonstrated model generations favor one gender or exhibit stereotypes about gender, but have not investigated the complex dynamics that can influence model reasoning and decision-makin...

Socio-demographic inequities in health treatment and outcomes are not new. However, the COVID-19 pandemic presented new opportunities to examine and address biases. This article describes a scoping review of 170 papers published prior to the onset of global vaccinations and treatment (December 2021). We report differentiated COVID-19-related patien...

Background: People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been establis...

BACKGROUND In Saudi Arabia, the use of digital media and technology, such as the Internet and smartphones, has experienced significant growth. This has contributed to concerns about problematic digital media use and its negative impacts on wellbeing, especially among young people. However, there is a paucity of research on stakeholder perspectives...

The COVID-19 pandemic and associated need for social isolation left in-person youth mentoring programs scrambling to keep mentees and mentors connected, and many programs turned to e-mentoring. To better understand the transition period and to inform e-mentoring practice in a post-COVID world, this study explored the experience of mentoring program...

While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevent...

We investigated the feasibility of an interactive voice response (IVR) survey in Tanzania and compared its prevalence estimates for tobacco use to the estimates of the 'Global Adult Tobacco Survey (GATS) 2018′. IVR participants were enrolled by random digit dialing. Quota sampling was employed to achieve the required sample sizes of age-sex strata:...

Background Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in...

Background Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental h...

Effectively tracking progress on initiatives focused on gender equity requires clear differentiation between the terms sex and gender. Sex usually refers to a person’s biological characteristics, whereas gender refers to socially constructed roles and norms. Although both terms are often treated as binaries, gender is a spectrum and sex may include...

Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are inadequate, mostly due to the cost and burden of collecting in-person population-level estimates. High-income countries regularly use phone-based surveys, and with increasing mobile phone subscription in developing countries, mobile phone surveys (MPS)...

Introduction Although interactive voice response (IVR) is a promising mobile phone survey (MPS) method for public health data collection in low- and middle-income countries (LMICs), participation rates for this method remain lower than traditional methods. This study tested whether using different introductory messages increases the participation r...

BACKGROUND Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in...

Objective: The association between explicit and implicit psychological measures might be affected by the similarity of the assessment method and by the overlap of the components of the constructs being assessed. This study examined the association between condom use barriers and explicit and implicit measurements of condom use and the moderating r...

Background Lesbian, gay, and bisexual (LGB) young adults are at increased risk of mental distress in China. To better carry out psychological intervention, it is essential to understand unique patterns of mental distress and their association with childhood abuse/neglect, including experiencing being left behind by migrating parents. Objective In...

Female sex workers (FSW) experience many structural vulnerabilities (SV; e.g., violence, economic insecurity) which contribute to increased risk of HIV and mental distress. However, little research has examined how SV co-occur to shape HIV risk, and none have studied mental distress. Among FSW (n = 385) in Baltimore, Maryland, latent class analysis...

Prevention of vertical transmission of HIV has evolved over the past two decades. Although public health agencies advocate for male involvement in such interventions, their role in the prevention of vertical transmission of HIV remains limited. This study aims to explore the role of men in antenatal care and prevention of vertical transmission of H...

Background Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to...

In traditional Confucianist culture in China, marriage and offspring are highly valued, placing sexual minority adults under tremendous pressure to marry an opposite sex partner. This study explored how Confucianism and stigma were associated with the intention to pursue a heterosexual marriage among Chinese sexual minority individuals as well as t...

Purpose Suffering during events such as the COVID-19 pandemic threatens university students’ physical and psychological health. Given the literature indicating the protective role of resilience and social support, the current study explored the mediating and moderating roles of social support in the association between resilience and prosocial beha...

Plain Language summary A reproductive health study involving mixed quantitative and qualitative methods was conducted in Ethiopia in 2016–2017. The overall objectives of the study are (1) to use mixed methods research to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms,...

This study used a mixed methods approach to explore the experience of mentors involved in the Mentor-UP program during the COVID-19 pandemic in Padova, Italy. In Study 1, a total of 53 mentors completed an online questionnaire at the end of the program. Results of the path analysis showed that mentors’ perceived support from the program staff was a...

This study explored how mentoring begins and the benefits provided for African American sexual and/or gender minority (SGM) youth. Participants were mentors and mentees living in three Mid-Atlantic cities. Mentees (ages 15–21, n = 14) identified as African American; cisgender male, transgender female, or non-binary assigned male; and had sexual int...

Electronic mentoring (e-mentoring), the integration of digital technology in mentoring relationships, has recently grown in popularity; however, the effectiveness of e-mentoring in addressing youth health has not been synthesized to date. The current study synthesizes the literature on e-mentoring to affect the health and well-being of youth (10–24...

This study explored the experiences of mentors to youth during the early months of the COVID-19 pandemic. The study aims were to examine (1) the role of the pandemic on mentor-mentee interactions and relationships and (2) the ways in which mentors could be supported during the health crisis to better meet youth needs. Six online focus groups were c...

People transitioning from incarceration to community-based HIV care experience HIV stigma, incarceration stigma, and the convergence of these stigmas with social inequities. The objective of this study is to understand intersectional stigma among people returning from incarceration with HIV in Gauteng Province, South Africa. Qualitative interviews...

Background African American men who have sex with men (MSM) and transgender women bear a disproportionate burden of HIV. Young MSM account for 75% of this burden for youth. When youths lack socially protective resources such as strong networks of adults, including parents, teachers, or community members, mentors may play a critical role in promotin...

Background Public health has begun using social media forums such as Reddit to enhance surveillance and modernize interventions for young people. The current study’s objective was to examine Reddit posts about the HBO series Euphoria to identify show themes that resonate with adolescent and young adult viewers in order to inform future social media...

Conditions prevailing in humanitarian crises often create a coercive environment for women. Material and security needs and pre-exisiting inequalities render women particularly vulnerable to social and contextual coercion in such situations, which can often result in unwanted pregnancies. Some women may resort to unsafe abortions, sometimes resulti...

Background: Sexual relationships among adolescent girls and young women (AGYW) are influenced by social, economic, and gender dynamics. Understanding AGYW's different relationship types and their implications for HIV risk is important for development of tailored interventions. We sought to identify relationship typologies among AGYW and their impa...

Introduction Adolescent girls and young women (AGYW) in sub‐Saharan Africa have emerged as a priority population in need of HIV prevention interventions. Secondary distribution of home‐based HIV self‐test kits by AGYW to male partners (MP) is a novel prevention strategy that complements pre‐exposure prophylaxis (PrEP), a female‐controlled preventio...

Objective: Condom use prevents the contraction of the HIV. Research shows limited effects of education on increasing condom use. Psychological inoculation (PI) has been found to be more effective in this domain, however, its mechanism is unknown. This study examined effects of PI versus education on condom use barriers and tendencies, and its relat...

China has the largest population of male smokers globally. Men who have sex with men (MSM) are at greater risk of cigarette smoking compared to the general population. Limited data are available regarding cigarette smoking and its associations with other health issues among Chinese MSM. Eligible MSM (n = 1100) were recruited from mainland China usi...

This review examines research on youth mentoring as a strategy for preventing and reducing adolescent substance use, including opioids. The review is organized around four questions: 1. What are the effects of mentoring on substance use and associated risks to personal health and well-being among youth? 2. What factors condition or shape the effect...

BACKGROUND African American men who have sex with men (MSM) and transgender women bear a disproportionate burden of HIV. Young MSM account for 75% of this burden for youth. When youths lack socially protective resources such as strong networks of adults, including parents, teachers, or community members, mentors may play a critical role in promotin...

Background: There is a high prevalence of gender-based violence (GBV) victimization among young Ethiopian women, including in universities, where female enrollment is low but growing. Understanding factors contributing to GBV in this context and students' perspectives on gender, relationships, and interpersonal violence is essential to creating ef...

We examined whether the interplay between community disadvantage and a conduct disorder polygenic risk score (CD PRS) was associated with sexual health outcomes among urban women. Participants (N = 511; 75.5% African American) were originally recruited to participate in a school-based intervention and were followed into adulthood. Community disadva...

Women who experience gender-based violence (GBV) are at risk for adverse sexual health outcomes, as they may be unable to fully negotiate sexual encounters. This may be especially true for females at universities in Ethiopia, where women are the minority and patriarchal norms prevail. This study explored students’ experiences and faculty’s percepti...

The #MeToo Movement has brought new attention to sexual harassment and assault. While the movement originates with activist Tarana Burke, actor Alyssa Milano used the phrase on Twitter in October 2017 in response to multiple sexual harassment allegations against Hollywood producer Harvey Weinstein. Within 24 hours, 53,000 people tweeted comments an...

Female sex workers (FSWs) in Nepal are vulnerable to an array of occupational risks, which may compromise their psychosocial health and ability to engage in protective behaviors. A peer education (PE) intervention designed to empower and promote the psychosocial health of FSWs was pilot tested in Kathmandu, Nepal. FSWs who were exposed to the PE in...

Background: Both alcohol use/misuse and HIV incidence are increasing among men who have sex with men (MSM) in China. Little is known about predictors of alcohol use/misuse. Methods: An online nationwide sample (n = 1100) of MSM from mainland China was recruited between 2014 and 2015. The study objective was to examine the prevalence of a history...

Power in Close Relationships - edited by Christopher R. Agnew February 2019

Background Health education alone has a limited impact on HIV prevention programs, possibly because it does not systematically target social and cognitive factors that affect condom use. Objectives To systematically evaluate the effectiveness and methodological quality of HIV prevention interventions, which targeted factors related to social cogni...

The current study examines the association between multiple interpersonal violence victimization types experienced in a university setting and the consequences for each type. Students at a mid-Atlantic university (n = 3977) completed a survey in 2015 assessing attitudes, experiences, consequences of (physical, behavioural, academic, mental), and un...

In China, men who have sex with men (MSM) account for an increasing proportion of new HIV infections. We aim to assess recent HIV testing (in the past 6 months) among Chinese MSM and to identify barriers to testing. A nationwide sample of MSM (n = 1100) from mainland China was recruited. Data on sociodemographics, HIV-related risks, perceived barri...

Unwanted sexual incidents on university campuses pose significant public health and safety risks for students. This study explored survivors’ perspectives on secondary prevention of campus sexual assault and effective strategies for intervention programs for unwanted sexual incidents in university settings. Twenty-seven student survivors of unwante...

Background: Adolescent boys (aged 10-19 years) constitute the majority of voluntary medical male circumcision (VMMC) clients in sub-Saharan Africa. They are at higher risk of postoperative infections compared to adults. We explored adolescents' wound-care knowledge, self-efficacy, and practices after VMMC to inform strategies for reducing the risk...

Background: Experience with providers shapes the quality of adolescent health services, including voluntary medical male circumcision (VMMC). This study examined the perceived quality of in-service communication and counseling during adolescent VMMC services. Methods: A postprocedure quantitative survey measuring overall satisfaction, comfort, p...

Background: The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whe...

Background: The majority of individuals who seek voluntary medical male circumcision (VMMC) services in sub-Saharan Africa are adolescents (ages 10-19 years). However, adolescents who obtain VMMC services report receiving little information on human immunodeficiency virus (HIV) prevention and care. In this study, we assessed the perceptions of VMM...

Background: Little is known regarding the impact of counseling delivered during voluntary medical male circumcision (VMMC) services on adolescents' human immunodeficiency virus (HIV) knowledge, VMMC knowledge, or post-VMMC preventive sexual intentions. This study assessed the effect of counseling on knowledge and intentions. Methods: Surveys wer...

Background: The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among boys and men aged 10-29 years in priority settings by 2021. We aimed to identify age-specific facilitators of VMMC uptake among adolescent...

Background: While female involvement in voluntary medical male circumcision (VMMC) has been studied among adults, little is known about the influence of adolescent females on their male counterparts. This study explored adolescent females' involvement in VMMC decision making and the postoperative wound healing process in South Africa, Tanzania, an...

Background: Voluntary medical male circumcision (VMMC) is one of few opportunities in sub-Saharan Africa to engage male adolescents in the healthcare system. Limited data are available on the level of parental communication, engagement, and support adolescents receive during the VMMC experience. Methods: We conducted 24 focus group discussions w...

Malawi is one of 14 priority countries for voluntary medical male circumcision (VMMC) initiatives with the lowest VMMC uptake. Using data from a study of 269 men accessing VMMC in southern Malawi and latent class analysis, men were classified based on four risk factors: ever tested for HIV, condom use at last sex, having casual/concurrent sexual pa...

Unwanted sexual experiences are common among university students in the United States and pose a substantial public health concern. Campus policies and programs to prevent unwanted sexual incidents in university settings require research on prevalence and risk correlates of both victimization and perpetration. This study determined the prevalence o...

Background Despite marked improvements over the last few decades, maternal mortality in Tanzania remains among the world’s highest at 454 maternal deaths per 100,000 live births. Many factors contribute to this disparity, such as a lack of attendance at antenatal care (ANC) services and low rates of delivery at a health facility with a skilled prov...

Objective Voluntary medical male circumcision (VMMC) is one of the first opportunities for adolescent males in African countries to interact with the healthcare system. This study explored the approaches used during adolescent VMMC counseling and whether these strategies maximize broader HIV prevention opportunities. Methods Qualitative interviews...

Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during...

PurposeThis study examined correlates of condom use (CU) and voluntary medical male circumcision (VMMC) knowledge among men accessing VMMC services in Malawi. Methods Two hundred sixty-nine men ages 16 or older accessing VMMC were recruited at service sites. Bivariate and multivariate logistic regressions were used to determine associations, and th...

This study draws on a social norms framework to examine the influence of interview context—specifically the presence of other women and men—on women’s reported attitudes toward intimate partner violence (IPV) in Ethiopia, where IPV rates are among the highest in the world. The sample (16,515 women, ages 15-49) was taken from Ethiopia’s 2011 Demogra...

The Fataki campaign aired in Tanzania via radio from 2008 to 2011 to address cross-generational sex, a major driver of HIV in the region. The campaign sought to incite social disapproval of men who engage in such relationships, generate dialogue around the issue, and encourage community interventions in these relationships through social learning....

Background Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how...

PRISMA flow Diagram. (PDF)

PRISMA 2009 Checklist. (DOC)

Sub-Saharan Africa bears 69 % of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and...

Through this exploratory study, we sought to better understand Nepali female commercial sex workers' (FCSWs) experiences in order to inform HIV prevention and health promotion interventions for this vulnerable and hard-to-reach population. Data were collected through phenomenological interviews with eight FCSWs. Through analysis we reveal promising...

This study provides a glimpse into the daily life of women living in the brothels of Delhi, India, highlighting the process of acculturation and habituation of females trafficked into sex work. Participants were 30 female sex trafficking survivors, rescued from red-light establishments, and recruited from a government shelter home using purposive s...

Introduction/Purpose: Wazazi Nipendeni (Love me, parents), is a national, integrated safe motherhood campaign in Tanzania encouraging pregnant women and their partners to take steps for a healthy pregnancy and safe delivery. Communication channels included radio and TV spots, billboards, posters, brochures, promotional materials and SMS. An evalua...

This study identified characteristics of Tanzanians who have never tested for HIV in order to inform localized interventions to increase HIV testing coverage and uptake. A total of 3257 randomly selected participants aged 18-49 years were surveyed in 16 Mainland regions. Those surveyed were asked about demographics, HIV risk perception, HIV testing...

Objective: District policies were recently put into place in Indonesia prohibiting smoking in public spaces. This study sought to (1) assess participants' general knowledge of secondhand smoke (SHS) dangers; (2) assess participants' awareness of and specific knowledge of smoke-free (SF) policies; and (3) assess the extent to which such policies ar...

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and...

Rising rates of HIV in Nepal signal an impending epidemic. In order to develop culturally appropriate and effective actions and programmes to reduce HIV transmission, it is necessary to understand attitudes, behaviours and norms surrounding sexual networking and safer-sex practices in Nepal. Nepali women are thought to be at increased risk of sexua...

This study's objective was to describe awareness of, access to, belief in, and utilization of the healing tea Kikombe cha babu and other alternative treatments for HIV in Tanzania. Associations with HIV testing, treatment, and prevention behaviors are also explored. A survey with questions about alternative medicine was administered to a sample in...

This qualitative, thematic analysis explores how patriarchal power is reflected in labels used to describe women and men who engage (or not) in multiple and concurrent sexual partnerships. Label research and muted group theory provide theoretical frames to assess how sexual network-related labels are used by women and men. The use of power-embedded...