Compensatory and Risk Factors for Substance Use in African American Youth

Substance use among all youth is a substantial public health concern and must be understood from specific cultural and developmental perspectives for different populations. The current study examined this issue from an African American cultural and developmental lens. This study sought to investigate how developmental, social, and cultural factors influence attitudes about and the use of alcohol and other drugs among a high risk African American sample. The participants of this study were 100 African American adolescents, ages 8 -16. For the purposes of this study, participants were divided into 2 age groups: 8-11 and 12-16. Multiple regressions were conducted for each age group and indicated that while there were several factors that contributed to attitudes about and involvement with substances for youth 12 -16, there were no predictors that were salient for younger youth. Findings have implications for the epidemiology and prevention of substance use among African American adolescents

Condom Use Self-Efficacy Among Younger Rural Adolescents: The Influence of Parent-Teen Communication, and Knowledge of and Attitudes Toward Condoms

This study examines the role of condom use knowledge and attitudes, and parent-teen communication about sex and relationship quality on reports of condom use self-efficacy among rural, African American youth. Participants were 465 North Carolinian youth (10–14 years). Results indicated that greater condom use self-efficacy was predicted by greater knowledge of condom use (β = .206; p < .001), more favorable attitudes toward condom use (β = −.20; p < .0001) and parent-teen communication about sex (β = .13; p < .05), and actual parent-teen communication about sex and dating (β = .14; p < .05). There was low agreement between parents and youth on measures related to parent-teen communication about sex. Findings call for interventions targeting improvement of condom use knowledge among early adolescents, as well as parent-teen communication about sex. In addition, given the low parent-teen agreement regarding sexual communication, parent-teen sexual communication is an important point of intervention

An implementation science protocol of the Women’s Health CoOp in healthcare settings in Cape Town, South Africa: A stepped-wedge design

Abstract Background HIV persists as a public health emergency in South Africa, especially among women of childbearing age. In response to the HIV epidemic, the Joint United Nations Programme on HIV/AIDS has put forth the 90–90-90 global goals to achieve an AIDS-free generation by 2020. This goal aspires to have 90% of people living with HIV diagnosed; 90% of those who test positive on sustained antiretroviral therapy (ART); and 90% of those on ART be virally suppressed. Ensuring access to ART is an important first step in reducing HIV incidence, especially among vulnerable populations such as women who use substances and bear the burden of HIV in South Africa. Additionally, alcohol and other drug (AOD) use and exposure to gender-based violence are associated with increased risk of HIV infection and reduced adherence to ART. However, no research has estimated ART adherence rates for women who use substances in South Africa since the government approved the provision of ART to all people living with HIV. Methods The Women’s Health CoOp (WHC) is an evidence-based, woman-focused, behavioral intervention that addresses the intersecting risks of AODs, sex behaviors, and violence and victimization, with the primary goal of increasing skills and knowledge to reduce substance abuse and HIV risks and to improve ART adherence. The WHC has been packaged for further dissemination. This article describes the study protocol used to assess the feasibility and acceptability of implementing the WHC intervention into standard of care in Cape Town health clinics and substance abuse rehabilitation centers to reduce HIV risk behavior and increase ART adherence among women who use substances and are living with HIV. Discussion Because few of the interventions that demonstrate efficacy for HIV prevention and ART adherence in randomized trials are sustainable, studies to adapt and test intervention variations are needed to determine the best strategies for implementing them in real-world, high-risk settings. However, implementation in real-world settings presents challenges. Consequently, intervention developers should consider the strengths and limitations of their anticipated implementation setting by engaging with key stakeholders before, during, and after the adaptation and implementation process when developing and attempting to scale-up interventions. Trial registration NCT 02733003 and date approved 1/21/2016

The importance of the individual in PrEP uptake : multilevel correlates of PrEP uptake among adolescent girls and young women in Tshwane, South Africa

DATA AVAILABILITY : Data is available upon request from Dr. Wendee Wechsberg.Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts.The Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health.https://link.springer.com/journal/104612024-07-13hj2024Medical MicrobiologySDG-03:Good heatlh and well-bein

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa

Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa

Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women : conflicting perspectives in South Africa

DATA AVAILABILITY : Data and materials are available on request from Dr. Wendee Wechsberg at [email protected] : Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. METHODS : Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. RESULTS : Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers’ identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. CONCLUSION : Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.The Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health.http://www.biomedcentral.com/bmcpublichealtham2023Medical Microbiolog

Configurations of Sexual Risk: A Person-Centered Approach

Young people account for 50% of new cases of sexually transmitted infections, but they continue to use condoms inconsistently. Theoretically, intentions determine behavior. However, research suggests that there is an intentions-condom use gap. This study attempted to examine how interrelations among factors influence the intentions-condom use association. A diverse sample of young adults (N = 337, 74.70% female) completed online baseline and one-month follow-up surveys. Latent class mixture modeling revealed four classes of sexual risk with a casual partner: high-risk (29.60%), low-risk (40.19%), sexual assault (17.13%), and assertive (13.08%) classes. Analyses revealed six classes of sexual risk with a relationship partner: high-risk (43.54%), low-risk (16.52%), intimate partner violence (IPV; 9.31%), assertive (8.71%), low PTS (8.12%), and high substance use (13.81%) classes. Overall, there was a significant correlation between intentions and condom use with a causal partner (n = 57, r = .55, p \u3c .01) and relationship partner (n = 169, r = .86, p \u3c .001). The intentions-condom use association was stronger for relationship partners than for casual partners (z = 4.31, p \u3c .001). There was a significant association between class membership and condom use, such that those in both high-risk classes (ps \u3c .05) reported the lowest rate of condom use. Findings also revealed complex associations among substance use, IPV, sexual assault, and condom negotiation. These findings have implications for interventions that target young adults who are at risk for engaging in unprotected sex, especially those with a history of sexual assault and intimate partner violence

Avoidant Coping as a Moderator of the Association Between Childhood Abuse Types and HIV/Sexual Risk Behaviors

Women who experience intimate partner violence (IPV) report high rates of HIV/sexual risk behaviors. Childhood abuse has been linked to HIV/sexual risk behaviors among IPV-victimized women; however, limited research has examined factors that may influence this association. The current study tested the moderating role of avoidant coping in the relation between childhood abuse types (physical, emotional, and sexual) and HIV/sexual risk behaviors. Participants were 212 community women currently experiencing IPV (mean age = 36.63 years, 67.0% African American). Higher levels of avoidant coping were related to more severe childhood abuse types. Severity of childhood abuse types was associated with greater HIV/sexual risk behaviors. Avoidant coping moderated the relation between childhood sexual abuse severity and HIV/sexual risk behaviors, such that this association was significant for IPV-victimized women with high (but not low) levels of avoidant coping. Findings suggest the utility of targeting avoidant coping in interventions aimed at preventing or reducing HIV/sexual risk behaviors among IPV-victimized women with a history of childhood sexual abuse

Promoting Health and Wellness in African American Males through Rites of Passage Training

The current work presents exploratory research findings related to the effectiveness of Let the Circle Be Unbroken, an African-centered rites of passage training program, to promote health and well-being in a sample of high-risk, African American males. An abbreviated version of the ADPRC-TADPOLE questionnaire was administered to 39 African American boys, between the ages of 8 and 16 years, who were participating in a community-based rites of passage training program. Findings suggest that the Let the Circle Be Unbroken training program is a viable program for improving self-esteem among young African American males. The implications of this research are relevant to the reduction of some health disparities observed among underrepresented populations, especially African American males. © Taylor & Francis