Behavioral Mechanisms in HIV Epidemiology and Prevention: Past, Present, and Future Roles

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72261/1/j.1728-4465.2009.00202.x.pd

Natural Mentors and Adolescent Resiliency: A Study with Urban Youth

Natural mentors may play an important role in the lives of adolescents. We interviewed 770 adolescents from a large Midwestern city. Fifty-two percent reported having a natural mentor. Those with natural mentors were less likely to smoke marijuana or be involved in nonviolent delinquency, and had more positive attitudes toward school. Natural mentors had no apparent effect on anxiety or depression. Using the resiliency theory framework, natural mentors were found to have compensatory but not protective effects on problem behaviors, and both compensatory and protective effects on school attitudes. Direct and indirect (mediated) effects of natural mentors are explored for problem behaviors and school attitudes. The potential importance of natural mentors is supported, and implications for future research are considered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44059/1/10464_2004_Article_368417.pd

They Destroy the Reproductive System : Exploring the Belief that Modern Contraceptive Use Causes Infertility

© 2018 The Authors. Studies in Family Planning published by John Wiley & Sons Ltd. on behalf of The Population Council, Inc. A common reason for nonuse of modern contraceptives is concern about side effects and health complications. This article provides a detailed characterization of the belief that modern contraceptives cause infertility, and an examination of how this belief arises and spreads, and why it is so salient. We conducted focus group discussions and key informant interviews in three rural communities along Kenya\u27s eastern coast, and identified the following themes: (1) the belief that using modern contraception at a young age or before childbirth can make women infertile is widespread; (2) according to this belief, the most commonly used methods in the community were linked to infertility; (3) when women observe other women who cannot get pregnant after using modern contraceptives, they attribute the infertility to the use of contraception; (4) within the communities, the primary goal of marriage is childbirth and thus community approval is rigidly tied to childbearing; and, therefore (5) the social consequences of infertility are devastating. These findings may help inform the design of programs to address this belief and reduce unmet need

Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda.

PURPOSE: Transactional sex or informal sexual exchange relationships increase adolescent girls' and young women's (AGYW) HIV and pregnancy risk in sub-Saharan Africa. These relationships are grounded in the shared expectation that men should provide financial support to their partners. We built a vignette experiment to assess whether gender norms influenced by expectations of provision help to explain how transactional sex increases AGYW's sexual and reproductive health risks. METHODS: We used mixed methods to develop a vignette experiment in Central Uganda with AGYW including 10 focus group discussions, 32 cognitive interviews, and a pilot survey experiment with 108 sexually active unmarried AGYW. Respondents were randomly assigned to one of the two manipulations for three vignettes. The vignettes examined whether the amount a man provided changed perceived social approval of men's authority in relationships, sexual decision-making power, or women having multiple partners. RESULTS: We find that a higher level of male provision is associated with higher levels of perceived community approval for his sexual decision-making power (p < .001) and lower levels of perceived peer approval for AGYW's to seek a second partner (p < .05). We also find that higher levels of male provision are associated with respondent's own approval of male authority and sexual decision-making. CONCLUSION: Our findings suggest that approval of men's sexual decision-making power increases when they provide more and that girls who seek a second partner find higher levels of social approval for this behavior when their primary partner provides less. Vignette experiments may be valuable for identifying social norms that put AGYW's sexual and reproductive health at risk

Gender-transformative Bandebereho couples\u27 intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial.

BACKGROUND: Rigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women\u27s decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples\u27 intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations. METHODS: We conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples). Primary outcomes include women\u27s experience of physical and sexual IPV, women\u27s attendance and men\u27s accompaniment at ANC, modern contraceptive use, and partner support during pregnancy. At 21-months post-baseline, 1123 men and 1162 partners were included in intention to treat analysis. Generalized estimating equations with robust standard errors were used to fit the models. FINDINGS: The Bandebereho intervention led to substantial improvements in multiple reported outcomes. Compared to the control group, women in the intervention group reported: less past-year physical (OR 0.37, p CONCLUSIONS: Our study strengthens the existing evidence on male engagement approaches; together with earlier studies our findings suggest that culturally adapted gender-transformative interventions with men and couples can be effective at changing deeply entrenched gender inequalities and a range of health-related behavioral outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02694627

Mortality from competing risks and the spread of HIV-1 in human populations.

In this dissertation I explore the contribution of behavioral variations between populations to heterogeneity in the spread of HIV-1, as well as the sources of those behavioral variations, particularly rates of mortality from competing risks. Chapter 2 provides a critical review of epidemiological explanations for heterogeneity in the spread of HIV-1. These explanations proceed from the proximate determinants of HIV-1 transmission, primarily the practices by which HIV-1 is transmitted and the factors that influence host susceptibility and infectiousness. I argue that a key assumption of the proximate determinants framework---that the rate of partner change is exogenously fixed---is unrealistic and produces misleading conclusions in empirical and simulation studies. It obscures interrelationships between the proximate determinants that may result from behavior change, and also limits the ways in which distal factors may operate to influence the spread of HIV-1. I conclude by introducing the concept of the risk-response function as a tool for organizing thinking and research on the dynamic and socially situated interrelationships between susceptibility, infectiousness, behavior, and prevalence. In Chapter 3 I present a modeling study focused on the relationship between mortality from competing risks and the equilibrium prevalence of HIV-1. The standard formulation of the proximate determinants framework predicts that the prevalence of HIV-1 at equilibrium is a decreasing function of competing-cause mortality, yet the most severe HIV-1 epidemics have occurred among populations with high mortality. I explore the potential for mortality-dependent behavior change to resolve this apparent contradiction. By incorporating a mortality-dependent behavior change function into standard compartmental models of HIV-1 transmission dynamics, I show that such a function can generate a positive association between background mortality and the equilibrium prevalence of HIV-1, but that this positive association occurs only over a restricted range of mortality. In Chapter 4 I explore the relationships between mortality from competing risks, the severity of the local heterosexual HIV-1 epidemic, and the timing of first sexual intercourse among adolescents in the neighborhoods of Chicago, Illinois. At the neighborhood level, male and female mortality from competing risks are strongly and positively correlated with a measure of the severity of the heterosexual HIV-1 epidemic. Local mortality rates also accelerate the initiation of sexual intercourse among adolescents, but do not condition the relationship between the severity of the local HIV-1 epidemic and the timing of first intercourse in the expected direction.Ph.D.Ethnic studiesHealth and Environmental SciencesPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/125298/2/3192579.pd