Stephen L. Schensul's research while affiliated with University of Connecticut and other places
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Publications (75)
In this research, the efficiency of reverse osmosis (RO) and nanofiltration (NF) treatment methods installed in the dry zone (Sri Lanka) were examined as a function of operation parameters, feed and product water quality, membrane type, user maintenance, and wastes handling. The quality of the feedwater varies as electrical conductivity (265–1329 m...
Background: Young migrant workers working in the industrial zones (IZ) in low and middle-income countries are at risk for HIV and other sexually transmitted diseases. This study examines the sex-related risks of young women migrant workers in the IZ in Vietnam.
Materials and Methods: This cross-sectional survey was conducted among 1,061 young migra...
Alcohol use has a deleterious effect on the health status of persons living with HIV, negatively affecting antiretroviral adherence and increasing the risk of transmission. Alcohol use is not an isolated behavior but intimately linked to stigma and poor psychological status among other factors. This paper utilizes a crossover design to test the eff...
A chronic Kidney Disease of unknown etiology (CKDu) has emerged with disproportionately high prevalence across dry lowland agricultural communities globally. Here we present the results of a prospective cohort of 293 patients with CKDu in the endemic region of Wilgamuwa, Sri Lanka, in whom we measured baseline kidney function and undertook quarterl...
The survey dataset presented in this article examines COVID-19-related knowledge, attitudes, perceived risk and adoption of prevention behaviors. The survey was conducted anonymously among non-random sample of 464 Connecticut residents in the early stage of social distancing and shutdown from March 23 to March 29, 2020. The questionnaires included...
Objective:
To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India.
Design:
A crossover randomized controlled trial in four sites.
Setting:
Government ART centres (ARTCs) offering core services in the greater Mumbai area.
Participants:
Seven hundred and fifty two (18...
Background
The rollout of antiviral therapy in Low and Middle Income Countries (LMICs) has reduced HIV transmission rates at the potential risk of resistant HIV transmission. We sought to predict the risk of wild type and antiviral resistance transmissions in these settings.
Methods
A predictive model utilizing viral load, ART adherence, genital u...
We examined the association between alcohol consumption, adherence and viral load (VL) in a cohort of 940 alcohol-consuming, human immunodeficiency virus (HIV)-positive men receiving antiretroviral therapy in Mumbai. Some of the participants (16.7%) had missed >1 doses in the last four days and 17.6% reported >1 treatment interruptions in the last...
This paper examined the demographic, temporal and spatial distribution of the coronavirus (COVID-19) epidemic in Vietnam. COVID-19 data abstracted from the official website of Vietnam Ministry of Health, which provides details of each new, infected case, including age, sex, place of residence, and travel history. Vietnam has only had 268 confirmed...
Objectives. To assess knowledge, attitudes, anxiety and behavioral adaptations to COVID-19.
Methods. A cross-sectional study was conducted among non-healthcare-related participants after a stringent stay-at-home directive was implemented. Multivariate logistic regression analysis was conducted to identify factors associated with anxiety, perceived...
Depression, as well as other psychosocial factors, remains largely unaddressed among people living with HIV (PLHIV) in low and middle-income countries. Depression is a common occurrence among PLHIV and is elevated in those who consume alcohol. This paper will document the presence of depressive symptoms in alcohol-consuming male PLHIV receiving ant...
Background and objectives:
A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.
Design, setting, participants, & measurements:
We designed a prospective stu...
Data from a six-year study of married women’s sexual health in a low-income community in Mumbai indicated that almost half the sample of 1125 women reported that they had a negative view of sex with their husbands. Qualitative interviews and quantitative survey data identified several factors that contributed to this diminished interest including:...
This paper draws on ethnographic data collected from two low-income communities in Mumbai India to explore types of risk and intimacy associated with marital practices. A rapidly globalising India offers access to media, social networks and changing gender norms that create opportunities for young women. Concurrently, enduring patriarchal norms imp...
MDM_PP_Technical_Appendix_online_supp – Supplemental material for Evaluating Alternative Designs of a Multilevel HIV Intervention in Maharashtra, India: The Impact of Stakeholder Constraints
Over the last two decades, a global epidemic of chronic kidney disease of unknown etiology (CKDu) has emerged in rural, arid, agricultural, lowland areas. Endemic regions have reported 15 to 20% prevalence among residents aged 30-60 years. CKDu is a progressive and irreversible disease resulting in renal failure and death in the absence of dialysis...
Background. Multilevel interventions combine individual component interventions, and their design can be informed by decision analysis. Our objective was to identify the optimal combination of interventions for alcohol-using HIV+ individuals on antiretroviral drug therapy in Maharashtra, India, explicitly considering stakeholder constraints. Method...
Les imams pourraient-ils, sans compromettre leur islamité, se faire les complices-promoteurs de l’équité de genre dans leur communauté et, si oui, comment et à quelles conditions ? C’est ici la question de fond que les auteurs taquinent dans cet article. À l’aide d’une méthode mixte, qualitative et quantitative, nous explorons cette (im)possible «...
Millions of adolescent girls live in low- and middle-income countries where early marriage is common and young wives face a range of social and health problems including coercive sex, limited contraceptive access and use, unplanned pregnancies, and maternal morbidity and mortality. Consistent with this pattern, almost 50% of women in India, mostly...
People living with HIV (PLHIV) on anti-retroviral treatment (ART) who drink are less adherent and more likely to engage in unprotected sex but the connections among these events are correlational. Using an adapted Timeline Follow-Back (A-TLFB) procedure, this paper examines the day by day interface of alcohol, medication adherence and sex to provid...
HIV transmission model schematic.
(PDF)
Intervention cost and effectiveness probabilistic analysis.
a, Graphical representation of intervention bundles identified on the efficient frontier across 100 probabilistic runs of all combinations of 7 interventions. b, focused for lower end of discounted cost (0.888–0.893 Billion USD). c, intervention bundle details corresponding to a and b.
(PD...
Distribution of epidemic outcomes across 1000 probabilistic baseline runs after 20 year simulations.
a., Discounted cost of care and treatment (2014 USD), b., total discounted QALYs for all and c., HIV infected and HIV infected in treatment, d., the number of new infections and HIV infected deaths over 20 years and e., the mean number of new infect...
Technical Appendix.
(DOCX)
Compartment dynamics in probabilistic intervention simulations.
Mean % change in key model compartments at 20 years for top intervention bundles compared to baseline (no intervention) control across 1000 probabilistic runs. Color legends were split to allow for easier visualization. Color legend 1 corresponds to the first 3 variables and color lege...
Objective
To inform the design of a combination intervention strategy targeting HIV-infected unhealthy alcohol users in Maharashtra, India, that could be tested in future randomized control trials.
Methods
Using probabilistic compartmental simulation modeling we compared intervention strategies targeting HIV-infected unhealthy alcohol users on ant...
Calibration of India-specific HIV progression model.
a, Comparing model generated survival curve with administrative data from India. b, Comparing model generated time to treatment failure with reported data for India. c, Comparing model generated CD4 recovery after ART initiation to administrative data from India.
(PDF)
Validation of HIV epidemic model.
a, Comparing model prevalence results with reported data for India. b, Comparing model incidence results with reported data for India. c, comparing annual proportion of people dying of HIV in model with reported data for India. d, comparing proportion of people with HIV on treatment compared with reported data for...
Histograms of probabilistic analysis for key input variables.
(PDF)
Objective:
The purpose of this study was to estimate the prevalence of alcohol use among men living with HIV on antiretroviral therapy (ART) and examine the association of alcohol use and psychosocial variables on ART adherence. The study was a cross-sectional survey supplemented by medical records and qualitative narratives as a part of the initi...
This article describes the design and implementation of a group couples' intervention focused on improving women's sexual health as a component of a multilevel community, clinical, and counseling intervention project conducted in association with a gynecological service in a municipal urban health center in a low-income community in Mumbai, India....
Community-based Participatory Research (CBPR) provides a methodology that creates mutually beneficial and equitable partnerships between researchers and community people involved in positive change. Participatory Action Research (PAR) is rooted in trust, connectivity, and reciprocity to address issues and actions that remedy inequitable social, eco...
Women in low- and middle-income countries (LMICs) facing poverty, challenging living conditions, and gender inequality often express their emotional difficulties through physical health concerns. These women seek care at primary health facilities. However, primary care providers in LMICs only treat the physical health symptoms and lack appropriate...
Inequitable gender norms in societies and communities negatively contribute to women's sexual and reproductive health. While the need for change in gender norms is well recognized, the task is highly challenging in terms of intervention design, implementation and assessment of impact. This paper describes a methodology for identification of gender...
Surgical sterilization is the primary method of contraception among low-income women in India. This article, using qualitative analysis of key informant, in-depth interviews, and quantitative analyses, examines the antecedents, process, and outcomes of sterilization for women in a low-income area in Mumbai, India. Family planning policies, socioeco...
Objectives: The objectives of this study were to describe a scale that operationalizes the World Health Organization concept of sexual health and to assess factors associated with scale variation. Methods: Qualitative in-depth interviews (N = 39), sexual health interviews (N = 21), and survey data (N = 1,128) for this article are drawn from an Indo...
This article describes the development of a
dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and pu...
This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qual...
Background: The relationship of negative body image and eating disorders is well-established among Western women, promoted in part by media presenting an “ideal” body. Less well understood is the impact of the globalized media bringing a new ideal body type that emphasizes thinness, cosmetics, and the latest fashions to young women in low and middl...
Background:
The present study assessed the effectiveness of a brief narrative intervention implemented by trained biomedical and Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH) providers from three low-income communities in Mumbai, India.
Methods:
A quasi-experimental research design compared attitudinal and behavioural changes among a cohort...
The authors propose a participatory approach for conceptualizing and implementing research-based interventions that has as its primary aim the development of acceptable and sustainable change efforts. The Participatory Intervention Model (PIM), rooted in participatory action research, provides a mechanism for integrating theory, research, and pract...
The growing rate of sexual risk-taking among young people contributes significantly to the spread of the HIV/AIDS epidemic in Nigeria. This study, explores the influence of socio-demographic, HIV/AIDS awareness and female empowerment on the sexual risk behaviors of unmarried Nigerian women aged 15-24. The data presented in this paper was drawn from...
This paper responds to the call for culturally-relevant intervention research by introducing a methodology for identifying community norms and resources in order to more effectively implement sustainable interventions strategies. Results of an analysis of community norms, specifically attitudes toward gender equity, are presented from an HIV/STI re...
This paper describes the interrelationship among men's self-reports of symptoms, unsafe sexual behavior, and biologically tested sexually transmitted infections (STIs). Data are drawn from the baseline survey of six-year (2001-2007) research and intervention project on men's sexual health and HIV/STI risk reduction conducted in three urban poor com...
Communicating about sex is a vital component of human immunodeficiency virus (HIV) prevention and influences how HIV educators convey messages to communities and how couples negotiate safer sex practices. However, sexual communication inevitably confronts culturally based behavioral guidelines and linguistic taboos unique to diverse social contexts...
Vaginal discharge (safed pani in Hindi, meaning "white water") is one of the leading symptoms for which women in India seek care. Treatment-seeking for safed pani is disproportionately high among poor women, representing a physical, emotional and financial burden for low-income families. Safed pani is only rarely indicative of a reproductive tract...
This paper examines the relationship of frequency, type of alcohol use, sexual risk behaviors and sexually transmitted infections (STIs) among married men living in economically marginal communities in Mumbai, India. The findings indicate that men who consume alcohol daily were four times more likely to have had extramarital sex in the past 12 mont...
This paper describes an Indo-US, research and intervention project for HIV/STI prevention and sexual risk reduction in urban poor communities in Mumbai, India in which formative research established the importance of reduction in alcohol use as one of the central features of the intervention. As a part of formative research, in-depth interviews wit...
Marital sex has been an unaddressed component of sexual risk. This article explores marital sex and its link to men's extramarital sexual behavior in 3 economically marginal communities in Mumbai, India. Using in-depth interviews with women, men, and couples, qualitative results are presented on first night experiences, ability of women to refuse t...
This chapter describes research, intervention, and evaluation projects conducted over a decade by a collaborative Indo-US group that are focused on the prevention of HIV/STI among married women and men living in urban poor communities in Mumbai, India. Formative research on men's and women's sexual and reproductive health, using qualitative and qua...
This paper examines the relationship of migration and mobility of husband and wife to sexual risk behaviors among married men living in economically marginal communities in Mumbai, India. Non-migrant men reported significantly more often than the migrant men that they had one or more sex partners other than their wives in the last year. Further, me...
This paper explores the meaning and applicability of multilevel interventions and the role of ethnography in identifying intervention opportunities and accounting for research design limitations. It utilizes as a case example the data and experiences from a 6-year, NIMH-funded, intervention to prevent HIV/STI among married men in urban poor communi...
The objectives of this study were to identify sexually transmitted infection (STI) prevalence, assess behavioral and symptom correlates, and develop intervention strategies.
The goal of this study was to conduct one of the first community-based surveys of STI prevalence and risk behaviors among married men in India.
In 2003, 2,408 randomly selected...
While there has been a trend toward greater disciplinary collaboration over the last several decades, the emergence of the HIV pandemic has required that disciplines work more closely and creatively to generate the multiple and innovative approaches necessary to meet the demands for effective prevention and treatment. This paper describes the natur...
The objectives of this paper are to (1) understand the nature of men's extramarital sexuality in three low income communities in Mumbai, India; (2) explore the associations between marital relationships and extramarital sex; and (3) assess the implications of the research results for intervention. Results are based on survey data collected from 2,4...
Men's pre- and extra-marital sexual behavior has been identified as the primary factor in the growing HIV/STI epidemic among both males and females in India. One major barrier to reaching men has been their underutilization of public health services, which has severely limited programs geared to prevention and early case identification. A significa...
The Interdisciplinary Qualitative Research Subcommittee (IQRS) of the Task for on Evidence-based Interventions in School Psychology assumed the responsibility of developing criteria for reviewing qualitative methods used in intervention research. The IQRS, composed primarily of psychologists and anthropologists, was confronted with the long-standin...
Ethnographic methods complement standard treatment or control group studies by providing contextual and culturally sensitive information to administrators and service providers in AIDS prevention programs.
Much of the responsibility for the transmission of HIV/STD lies with men involved in sexually risky behavior. While there are many programs aimed at reducing men's risky behavior, insuffi- cient attention has been paid to men's perspectives on sexual health and the cultural context within which men engage in risky behavior. This paper reports on a...
Despite the overwhelming evidence of the marital unit as a significant locus for transmission of HIV/STD for women throughout the world, there has been little effort to explore the factors in marital relationships that are associated with transmission or prevention. Data for this paper was collected through a structured survey and STD testing of bo...
This paper describes findings from a study on spousal communication and sexual decision making among women and men from a low-income community in Mumbai. The study explored the link between contextual, individual and socio-economic factors, sexual behaviours and communication to highlight sexual health consequences for women and men. It utilized a...
This article describes the design, implementation, and evaluation of a sexual-risk prevention program focused on the development of individual competencies and cultural norms promoting healthy sexual decision making. The community-based peer-facilitated intervention targeted adolescents and young adult men and women in Sri Lanka, who participated i...
OBJECTIVES: To test the hypothesis that the type of sexual initiation in terms of behavior involved, contextual factors (e.g.
location, relationship, sex of partner) and post episode feelings and attitudes have implications for sexual behavior and sexual
risk in later adolescence and young adulthood. DESIGN: Descriptive study. METHODS: Data were co...
Este ensayo presenta un informe sobre un proyecto de investigación y acción realizado con trabajadoras jóvenes en dos grandes fábricas en el EPZ en las Islas Mauricio. Nos informa sobre los cambios en la estructura familiar ahora que las jóvenes están trabajando, sobre su trabajo y amistades, sus relaciones con los jóvenes, los cambios en las práct...
Over the past 20 yr, researchers have attributed the apparent underutilization of institutional health and mental health services by Hispanics to barriers to service and cultural factors preventing service utilization. Current research in the Puerto Rican community of Hartford, coupled with a review of national statistics during the 1970s and early...
During the decade of the 1970's anthropologists at the University of Connecticut, particularly those associated with the medical anthropology program, developed long term relationships with several organizations and facilities in the city of Hartford. These sites have become key locations for our training program in action anthropology. (Although p...
Citations
... However, with the improvement of research and development in the water sector in Sri Lanka, advanced treatment technologies such as ions exchange (softening), activated carbon filtration, and reverse osmosis (RO) membrane filtration were introduced to these rural areas with groundwater quality issues. 14,15 This huge step in the development of the Sri Lankan drinking water production sector could improve the drinking water in rural regions at a significant level. Now, this RO drinking water has been widely spread throughout the dry zone of Sri Lanka as the major groundwater purification technology. ...
... This is because, if different analytical approaches have been used such as geographical information systems based integrated approach, the potential risk factors for the disease would have been easily understood. Historically, disease mapping, as one of core Geographic Information System (GIS) analytics, has been recognized as essential in public health matters particularly in understanding CKDu epidemics (Vlahos et al., 2021). The relationship between CKDu causing factors and population characteristics could easily be investigated in ...
... In particular, these models highlight the relevance of self-efficacy, sexual assertiveness, knowledge, attitudes, and perception of risk and severity, among other variables [15], as associated factors with SRBs [16]. Evidence shows that different safe (e.g., increased condom use) or risky behaviors (e.g., multiple sexual partners; inappropriate condom use) are associated with different psychological factors, including behavioral dispositions or personality traits [17]; ability to identify risky and safe behaviors [18]; perceived vulnerability or risk [19]; sexual self-image [20]; and attitude toward condoms [21]. Specifically, for this study, the following psychological factors were selected. ...
... A focus on "whole" selves can be informed by intersectionality theory to take into account interlocking systems of oppressionincluding stigma and discrimination [7,8]. More could be learned from other sectors regarding how to understand and address HIV-related stigma, including social ecologies of resilience [9,10], activism [11] and civic engagement [12], community mobilization [13], collective impact [14], peer support and solidarity among persons living with HIV [15], and collective and self-efficacy [16]. ...
... Moreover, in our study, 82.5% of the participants avoided getting contact with people during greeting which was lesser as compared to a study conducted by Ha et al. that reported 99.1% of the 464 participants avoiding contact with people especially handshaking and hugging. 15 In the current study, 35.4% of the participants believed stress to be an impact of social distancing during the pandemic while in a study done by Singh et al., 28.8 % of participants felt falling in stress or boredom to be associated with COVID-19 pandemic. 16 This could be due to loss of a job or decreased social interaction. ...
... In terms of stressors associated with sexual health care access, we suggest integrating mental health services with sexual health interventions and care [41][42][43]. Sexual health services could integrate mental health components by directly providing counseling services, providing referrals to psychological services, and organizing community engagement activities for the transgender and gender diverse people [42,44,45]. ...
... [15] One of the studies among HIV patients has found that alcohol use is negatively impacts viral load outcomes as the alcoholics have poor adherence to treatment. [16] Tuberculosis patient who are using alcohol also found to have additional risk factors similar to our study, like lower caste. [17] One of the recent study from Bengaluru has found that "a behavioral economics and cognitive behavioural therapy" as an effective intervention in reducing hazardous alcohol use. ...
... In particular, literature reports studies examining why some people believe in conspiracy theories about COVID-19, and why they choose to not follow the rules/laws given by the government to prevent contagion. Uncertainty and ambiguity regarding the information about COVID-19 could lead to a lack of trust in governmental regulations, bringing people to respond with adaptive or non-adaptive coping strategies [16]. Some studies investigated how people were influenced by the media (both traditional and new media), and how disinformation may be enhanced by the possibility offered by the new media to share an opinion about medical topics without the proper knowledge, widely spreading conspiracy theories [17]. ...
... These very expensive data-intensive methods may be relevant to further studies on well-studied NCCDs like diabetes and obesity. At a simpler level, Anand et al (2019) have discussed molecular and genetic methodologies for the investigation of the CKDu epidemiology and conclude that "research has been challenging because of political circumstances, the marginalized nature of populations afflicted, and the scarcity of personnel and funding". Given these bottlenecks for CKDu research, even basic statistical data on disease prevalence are sadly lacking. ...
... 8 Later, more objective, less complicated diagnostic models based on serum creatinine, urine albumin, and serum albuminbased diagnostic models were proposed with a good performance in a biopsy-based prospective study. 9 A novel approach using a panel of urinary markers for screening and diagnosis of CKDu has been reported by Fernando et al. 10 Nevertheless, as in most other kidney diseases, despite its invasiveness, renal biopsy remains the gold standard of diagnosis. 10 The main histological features in Sri Lankan CKDu are tubular atrophy (TA), interstitial fibrosis (IF), and periglomerular fibrosis (PGF) in the absence of or with a mild degree of interstitial mononuclear inflammatory cell infiltration and tubulitis. ...