HIV/AIDS and Older Women: Understanding HIV Testing Behaviors in a High-Risk Community

Americans 50 years of age and older have consistently represented 10% of all HIV/AIDS cases since early in the epidemic. However, in recent years, the proportion of cases among older persons has begun to rise 3 with people over the age of 50 represented 14% of all HIV/AIDS cases in 2003. As with younger adults, HIV/AIDS cases among older adults are not equally distributed between different socio-demographic groups. Males are primarily affected but rates among older women are rising faster than rates among older men. There are also marked racial/ethnic disparities with African Americans and Hispanics disproportionately affected. Despite these facts, HIV testing rates among older persons are low compared to younger adults, particularly among older women. Although 44% of young adults have been tested in their lifetime, only 10-15% of those aged 45-64 have undergone testing. Older adults who are tested frequently do so late in their disease course. As a consequence, they are more likely to present with opportunistic infections, progress to AIDS, or die within a year of HIV diagnosis leaving little opportunity for treatment or secondary prevention. For my Master's paper, I performed a secondary data analysis examining the sociodemographic factors associated with past HIV testing, current interest in HIV testing, and the reasons for interest in HIV testing in an older, female population.Master of Public Healt

“When you got nothing to do, you do somebody”: A community’s perceptions of neighborhood effects on adolescent sexual behaviors

This study explores community members’ perspectives regarding the relationship between neighborhood characteristics and adolescent sexual behaviors in two rural, African American communities. The data were collected as part of a community needs assessment to inform the development of HIV prevention interventions in two contiguous counties in northeastern North Carolina, USA. We conducted eleven focus groups with three population groups: adolescents and young adults aged 16–24 (N=38), adults over age 25 (N=42), and formerly incarcerated individuals (N=13). All focus groups were audio-recorded, transcribed and analyzed using a grounded theory approach to content analysis and a constant comparison method. Six major themes emerged from the discussions linking neighborhood context and adolescents sexual behavior: the overwhelming absence of recreational options for community members; lack of diverse leisure-time activities for adolescents; lack of recreational options for adolescents who are dating; adolescent access to inappropriate leisure time activities that promote multiple risk behaviors; limited safe environments for socializing; and cost-barriers to recreational activities for adolescents. In addition, lack of adequate parental supervision of adolescents’ time alone and with friends of the opposite sex, as well as ineffective community monitoring of adolescent social activities, were thought to create situations that promoted sexual and other risk behaviors. These findings allowed us to develop a conceptual model linking neighborhood structural and social organization factors to adolescent sexual behaviors and provided insights for developed interventions tailored to the local socioeconomic realities

Family Discussions About Contraception And Family Planning: A Qualitative Exploration Of Black Parent and Adolescent Perspectives

Parent-adolescent communication is associated with increased adolescent contraceptive use. However, studies of this association are limited by their lack of examination of the communication process, reliance on cross-sectional designs and infrequent comparison of parent and adolescent perspectives. Examining communication in black families is particularly important, given the high pregnancy rate among black adolescents

Satisfaction with Intrauterine Device Insertion Procedure Among Adolescent and Young Adult Women in a Clinical Trial

OBJECTIVE: To evaluate satisfaction with intrauterine device (IUD) insertion procedures among adolescent and young adult women. METHODS: This secondary analysis of data from a multisite, single-blind, sham-controlled randomized trial of women having a levonorgestrel 13.5-mg IUD inserted enrolled participants from March 2015 through July 2016 at three family planning clinics in Philadelphia, Pennsylvania. Eligible participants were 14-22 years of age, nulliparous, not pregnant, and English-speaking. Randomization was computer-generated allocation in block sizes of four to a 1% lidocaine paracervical or sham block. Only patients were blinded. Satisfaction was measured with three items that assessed overall satisfaction with the procedure, whether participants would recommend the IUD to a friend, and the perception that the IUD was worth the discomfort. Predictors included demographics, sexual and reproductive history, pain after IUD insertion, and treatment group. RESULTS: Ninety-five women enrolled; 93 (97.9%) were included in the analysis. Forty-five (47.4%) were white, 34 (36.0%) were black, 62 (66.0%) were privately insured, and 75 (79.0%) had used contraception previously. Most (n=73 [76.8%]) reported high overall satisfaction with the procedure, 64 (67.4%) would recommend an IUD to a friend, and 79 (83.2%) perceived the IUD was worth the discomfort. The odds of reporting high overall satisfaction were lower among adolescents compared with young adults (odds ratio [OR] 0.07, 95% CI 0.008-0.68); those who never had a gynecologic examination compared with those who had (OR 0.26, 95% CI 0.07-0.99); and decreased as pain score increased (OR 0.96, 95% CI 0.94-0.99). Higher pain scores were negatively correlated with the odds of recommending an IUD to a friend and perceiving the IUD was worth the discomfort. CONCLUSION: Adolescent and young adult women report high levels of satisfaction after the IUD insertion procedure. Young age, lack of experience with gynecologic examinations, and high pain were inversely related to satisfaction

A Qualitative Study of Rural Black Adolescents’ Perspectives on Primary STD Prevention Strategies

Primary STD prevention relies on five key strategies: practicing abstinence, choosing low-risk partners, discussing partners’ sexual history, using condoms consistently and not having multiple partners. Few studies have examined all of these strategies simultaneously, and few have focused on rural black adolescents, whose rates of early sexual initiation and STDs are among the highest in the nation

Intervention Mapping as a Participatory Approach to Developing an HIV Prevention Intervention in Rural African American Communities

Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated Intervention Mapping (IM) methodology with community based participatory research (CBPR) principles to develop a multi-level, multi-generational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR

Respecting Tribal Voices in the Development of a Gestational Diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study

Background American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented. Methods We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews. Results Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals. Conclusion Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies

The Effect of Teach One Reach One (TORO) on Youth Acceptance of Couple Violence

This study evaluated the impact of the Teach One Reach One intervention, a community-based participatory research project designed to address the co-occurrence of adolescent risk behaviors on acceptance of teen dating violence. Data were derived from 331 rural African American youth between 10–14 years of age who participated in caregiver-youth dyads as either: 1) peer lay health advisor dyads, or Ambassadors, 2) caregiver-youth dyads recruited by Ambassadors, or Allies, or 3) comparison dyads. The following study focuses on participating youth only and our results indicated that: 1) Ambassadors and Allies reported less acceptance of couple violence than youth within the comparison group, and 2) less family cohesion, greater family conflict, and greater knowledge of healthy dating behaviors predicted greater acceptance of couple violence. Our findings highlight the efficaciousness of the TORO intervention, which directly engaged participants in prevention efforts through community-based participatory research methods and the use of lay heath advisors

Variation in Sexual Behaviors in a Cohort of Adolescent Females: The Role of Personal, Perceived Peer, and Perceived Family Attitudes

Little is known about how adolescent sexual behaviors develop and the influence of personal or perceived social attitudes. We sought to describe how personal, perceived peer and perceived family attitudes towards adolescent sexual activity influences adolescent females’ sexual behaviors over time

A Process Evaluation of an HIV/STI Intervention for Rural African American Youth

We evaluated the fidelity and implementation of an HIV/AIDS and sexually transmitted infections intervention for rural African American youth. Using a community-based evaluation approach, community partners and researchers monitored four core process-evaluation components: reach, fidelity, dose delivered, and dose received. Researchers collected evaluation data through session observations, facilitator debriefing interviews, a youth focus group, and a satisfaction survey. For reach, more than half of the participants attended the 13 sessions. Participation varied between 62% and 100%. For fidelity, not all sessions were implemented as intended; multiple modifications occurred across sessions. For dose delivered, some lessons were missing materials and content was omitted; facilitators omitted content when there was insufficient time to complete a lesson. For dose received, engagement varied across lessons but youth reported high levels of satisfaction with the intervention. This formative process evaluation enabled us to identify and address multiple challenges to implementation