79 research outputs found
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A Test of Factors Mediating the Relationship Between Unwanted Sexual Activity During Childhood and Risky Sexual Practices Among Women Enrolled in the NIMH Multisite HIV Prevention Trial
This study examined both the direct and indirect associations between unwanted sexual activity during childhood and HIV-related sexual practices of adult women. The sample consisted of 3,346 women recruited from sexually transmitted disease (STD) clinics and health service organizations. The findings demonstrated that participants who reported unwanted sexual activity as a child (USC) were more likely than women who did not report such experience to indicate that they had problems with alcohol, used drugs, received money or drugs in exchange for sex, had unwanted sex, and used mental health services. The women reporting USC also noted a greater number of unprotected sex acts, a greater number of partners, and a greater proportion of sex acts accompanied by drugs or alcohol in the past 90 days. Mediated analyses showed that drug use, exchange of sex for money/drugs, unwanted sex, and to a lesser extent, problems with alcohol mediated the relationship between USC and unprotected sex acts, number of partners, and sex under the influence of drugs and alcohol. These findings suggest that participation in non-sexual risky behaviors among women who report USC may be a bridge to participation in sexual behaviors that increase their risk of HIV infection
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Social-Cognitive Theory Mediators of Behavior Change in the National Institute of Mental Health Multisite HIV Prevention Trial
The National Institute of Mental Health Multisite HTV Prevention Trial was a trial of an intervention to reduce sexual HTV risk behaviors among 3,706 low-income at-risk men and women at 7 U.S. research sites. The intervention, based on social-cognitive theory and designed to influence behavior change by improving expected outcomes of condom use and increasing knowledge, skills, and self-efficacy to execute safer sex behaviors, was effective relative to a control condition in reducing sexual risk behavior. At 3 months after completion of the intervention, measures of these potential mediators were higher in the intervention than in the control condition. Although the effect of the intervention on sexual risk behavior was significantly reduced when the variables were controlled statistically, supporting the hypothesis of their mediation of the intervention effect, most of the effect remained unexplained, indicating the influence of unmeasured factors on outcome
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The NIMH Multisite HIV Prevention Trial: Reducing HIV Sexual Risk Behavior
The efficacy of a behavioral intervention to reduce human immunodeficiency virus (HIV) risk behaviors was tested in a randomized, controlled trial with three high-risk populations at 37 clinics from seven sites across the United States. Compared with the 1855 individuals in the control condition, the 1851 participants assigned to a small-group, seven-session HIV risk reduction program reported fewer unprotected sexual acts, had higher levels of condom use, and were more likely to use condoms consistently over a 12-month follow-up period. On the basis of clinical record review, no difference in overall sexually transmitted disease (STD) reinfection rate was found between intervention and control condition participants. However, among men recruited from STD clinics, those assigned to the intervention condition had a gonorrhea incidence rate one-half that of those in the control condition. Intervention condition participants also reported fewer STD symptoms over the 12-month follow-up period. Study outcomes suggest that behavioral interventions can reduce HIV-related sexual risk behavior among low-income women and men served in public health settings. Studies that test strategies for reducing sexual risk behavior over longer periods of time are needed, especially with populations that remain most vulnerable to HIV infection
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Eban HIV/STD Risk Reduction Intervention: Conceptual Basis and Procedures
Objective: To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention, and how the content was shaped by culturally congruent concepts to address the needs of the study target population.
Design: The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual-, interpersonal-, and community-level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant.
Methods: The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couple-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afrocentric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from 4 urban sites (Atlanta, Los Angeles, New York, and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements, and content of each session are described and lessons learned from this intervention trial are discussed.
Results: An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV-serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the participants responded very well to both the couple and the group sessions. Participant feedback suggests that the cultural congruence of the intervention and use of African American cofacilitators made them feel comfortable disclosing risky behaviors. Participant feedback also suggests that the intervention’s couple-based focus on enhancing dyadic communication and decision-making skills was key to helping the couples work together to overcome barriers to using condoms.
Conclusions: Participant and facilitator evaluations of the Eban Risk Reduction Intervention suggest that couples responded well to the Afrocentric content and mixed modalities of the intervention sessions. Couple sessions were optimal for enhancing interpersonal and microlevel factors, including communication, problem solving, and decision making
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Risky Sexual Behavior and Correlates of STD Prevalence Among African American HIV Serodiscordant Couples
This paper reports baseline behavioral and biological data collected from a cohort of 535 African American HIV serodiscordant couples enrolled in the Eban study across four urban metro areas. Data were collected on (1) the prevalence of risky sexual behaviors that occur within a couple and with concurrent sexual partners, (2) the STD prevalence for each member of the couple and (3) the correlates of STDs in the male partner as well as in the female partner. Presentation of the sociodemographic characterization and HIV risk behavior profiles of African American HIV serodiscordant couples represents an important initial description of a hidden, vulnerable population. Future research should be conducted with diverse samples of African American couples (i.e., younger couples, non-stable couples) to explore other potential correlates of STD prevalence
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The Contribution of Male and Female Partners’ Substance Use to Sexual Risks and STDs Among African American HIV Serodiscordant Couples
Growing evidence suggests that drug and alcohol use are fueling the heterosexual transmission of HIV among African Americans. This study aims to examine the relative contribution of drug and alcohol use of male and female partners to risks of heterosexual transmission of HIV among 535 African American HIV serodiscordant couples (N = 1,070 participants) who participated in an HIV prevention trial. Associations found between use of drugs and alcohol by one or both partners and sexual risk indicators varied by type of substance and whether male or female partner or both partners reported use. The findings suggest multiple ways in which substance use of male and female partners may be contributing to the heterosexual transmission of HIV and other STDs among African Americans and underscore the need for HIV prevention strategies to address dyadic patterns of substance use that lead to sexual risks
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Childhood Sexual Abuse and Risk Behaviors Among Men at High Risk for HIV Infection
Objectives: This study examined the association between unwanted sexual activity during childhood and risky behaviors among a sample of predominantly African American and Hispanic men. Methods: Data were obtained from baseline interviews completed by 2676 men enrolled in a multisite HIV prevention trial. Results: Approximately 25% of the men reported unwanted or uninvited sexual activity before 13 years of age, with Hispanic men more likely than African American men to report unwanted sexual activity during childhood. Men with a history of unwanted sexual activity during childhood were more likely to report unwanted sexual activity since age 13, the buying and selling of sex, problems with alcohol, and drug use. Men who reported unwanted sexual activity during childhood also reported a significantly greater frequency of unprotected sexual acts and more partners. Conclusions: Among men at high risk for HIV infection, unwanted sexual activity during childhood is more widespread than previously described and can increase the risk of participating in harmful health practices during adulthood, including risky sexual behaviors
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Conceptualizing the Multidimensional Nature of Self-Efficacy: Assessment of Situational Context and Level of Behavioral Challenge to Maintain Safer Sex
A. Bandura (1991) argued that self-efficacy measurement should be specific both to the situation in which the behavior occurs and level of challenge in that situation. Measures consistent with the 2 dimensions were developed with graded challenge levels and differing gender-appropriate situations. Participants were 1,496 controls in the National Institute of Mental Health Multisite HIV Prevention Trial recruited from STD clinics and health service centers (925 women and 571 men). The authors tested 4 separate-sex confirmatory factor analysis models as follows: (a) Condom negotiation efficacy as a unitary construct across situations and gradation of difficulty; (b) situation as preeminent, which transfers across skills whatever the gradation of difficulty; (c) skill as predominant, irrespective of situation; and (d) a multidimensional design that simultaneously accounts for both situation and graded difficulty. Consistent with Bandura's theory, the multidimensional model provided the best fit for both samples
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Formative Study to Develop the Eban Treatment and Comparison Interventions for Couples
Objective: To describe formative and pilot-testing research that generated themes and procedures, curricula, and critical measures for a randomized clinical trial testing a Risk Reduction Intervention for HIV-serodiscordant African American couples (Project Eban). Design: This paper describes the themes that emerged from discussions with African American serodiscordant couples about HIV-related risks from focus groups with 11 couples and pilot study results with 32 couples across four sites. Methods: In Step 1, focus groups examined the need for a Risk Reduction Intervention for HIV-serodiscordant African American couples and confirmed four themes that formed the basis for the intervention curriculum and study format. In Step 2, a pilot study refined the clinical trial procedures for this population and tested critical measures and selected portions of the curriculum for both the treatment and comparison interventions. Results: Based on these findings, stigma and psychological distress, barriers to condom use, insufficient support from community and service organizations, and the lack of skills that emphasize individual and relationship protection were ultimately integrated into the Risk Reduction Intervention. Conclusion: Pilot study findings highlighted the importance of examining gender and ethnicity in HIV- impacted couples along with factors that heightened HIV-related risk behaviors that affect couples’ skills and psychological adjustment. The goal was to ensure that a skill-based, culturally congruent, relationship-centered intervention could be understood and of interest to couples. Future analyses in the main trial will be discussed
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Methodological Overview of an African American Couple-Based HIV/STD Prevention Trial
Objective: To provide an overview of the NIMH Multisite HIV/STD Prevention Trial for African American Couples conducted in four urban areas: Atlanta, Los Angeles, New York, and Philadelphia. The rationale, study design methods, proposed data analyses, and study management are described. Design: This is a two arm randomized Trial, implementing a modified randomized block design, to evaluate the efficacy of a couples based intervention designed for HIV serodiscordant African American couples. Methods: The study phases consisted of formative work, pilot studies, and a randomized clinical trial. The sample is 535 HIV serodiscordant heterosexual African American couples. There are two theoretically derived behavioral interventions with eight group and individual sessions: the Eban HIV/STD Risk Reduction Intervention (treatment) versus the Eban Health Promotion Intervention (control). The treatment intervention was couples based and focused on HIV/STD risk reduction while the control was individual based and focused on health promotion. The two study conditions were structurally similar in length and types of activities. At baseline, participants completed an Audio Computer-assisted Self Interview (ACASI) interview as well as interviewer-administered questionnaire, and provided biological specimens to assess for STDs. Similar follow-up assessments were conducted immediately after the intervention, at 6 months, and at 12 months. Results: The Trial results will be analyzed across the four sites by randomization assignment. Generalized estimating equations (GEE) and mixed effects modeling (MEM) are planned to test: (1) the effects of the intervention on STD incidence and condom use as well as on mediator variables of these outcomes, and (2) whether the effects of the intervention differ depending on key moderator variables (e.g., gender of the HIV-seropositive partners, length of relationship, psychological distress, sexual abuse history, and substance abuse history). Conclusions: The lessons learned from the design and conduct of this clinical trial provide guidelines for future couples based clinical trials in HIV/STD risk reduction and can be generalized to other couples based behavioral interventions
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