Beth E. Meyerson

Hiv-associated histories, perceptions, and practices among low-income African American women: Does rural residence matter?

OBJECTIVES This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women. METHODS A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted. RESULTS Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P =.001), that a sex partner had not been tested for HIV (P =.005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P =.02), not using condoms (P =.009), and a belief that their partner was HIV negative, despite lack of testing (P =.04). CONCLUSIONS This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs.

Who's In and Who's Out: Use of Primary Medical Care Among People Living With HIV

OBJECTIVES We sought to achieve a more comprehensive picture of access to medical care for the treatment of HIV (HIV primary care) by combining evidence of medical services used (health utilization) and epidemiological client-level data. METHODS This study integrated health information from several data sources to measure utilization of HIV primary care in the St Louis, Mo, area between 1998 and 2002. Data from disparate HIV health utilization databases were combined with data from the Missouri HIV and AIDS Reporting System database and then deidentified to measure client-level utilization of HIV primary care over time. RESULTS About half of those with HIV showed evidence of having utilized HIV primary care in a given year. Although most of this group utilized HIV primary care in the first year after they received their HIV diagnosis, evidence of subsequent utilization was inconsistent. Utilization of primary care was most strongly associated with an AIDS diagnosis. About one quarter of people diagnosed with HIV after 1997 had an AIDS diagnosis when they first tested positive for HIV. CONCLUSIONS This study was the first of its kind to integrate several databases to understand HIV primary health care utilization over a period of years. Our findings reinforce the importance of CD4 and viral load values as indicators of utilization of HIV primary health care, particularly in the absence of other health data sets. The lack of available data and the way in which source data were available limited the study.

Achieving Pharmacy-Based Public Health: A Call for Public Health Engagement

©2013 Association of Schools of Public Health The evolution of pharmacy practice in the last 15 years has created expanded public health access. Community pharmacies now provide a range of public health services with promising improvements in health access and outcomes. The observed practice changes call our attention to systemic issues that remain in need of collective attention. As we strengthen our intersectoral public health system, we must focus on the pharmacy-public health partnership and establish collaborative policy and research agendas to guide this system change for maximum public health impact. Our collective effort to assure the health of communities depends upon our seeing opportunities across systems and sectors, and upon our success in shifting the policy environment to allow health system flexibility.

We Can Do More Than Just Sell the Test: Pharmacist Perspectives About Over-the-Counter Rapid HIV Tests

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or information, and consultation about the test results in order to provide post diagnosis support and facilitate linkage to care.ResumenLas actitudes de los farmacéuticos sobre el over-the-counter (OTC) venta de las pruebas rápidas del VIH en farmacias se exploró a través de entrevistas entre los 17 farmacéuticos comunitarios con licencia en un estado del Midwestern en Estados Unidos, moderado incidencia del VIH entre Mayo y Septiembre de 2012. Los participantes reconocieron que OTC pruebas rápidas de VIH aumentaría el número de personas que conocen su estado serológico. Las preocupaciones incluyen la vinculación con cuidado y consulta los resultados para los que el resultado es VIH-positivo. Point of sale de venta fue identificado como una oportunidad de consulta sobre la prueba y establecer una relación para un discussion futuro sobre los resultados y la vinculación a la atención. Los farmacéuticos podría ofrecer consulta inicial de prueba o información y consulta sobre los resultados de la prueba con el fin de ofrecer apoyo después de diagnóstico y facilitar la vinculación a la atención.

Frequency and Predictors of Condom Use and Reasons for Not Using Condoms Among Low-Income Women

This investigation assessed the frequency and predictors of condom use for HIV prevention among low-income women, and also explored the reasons for not always using condoms for HIV prevention and predictors of these reasons. Data were collected at 27 Women, Infants, and Children (WIC) program clinics in 21 Missouri counties. To be included in the study, women had to indicate a primary relationship with a male partner. Data were subjected to univariate and multivariate analyses. The sample (N = 2,010) was predominately White and ural, with median age being 25 years. Findings revealed that women sumeyed in the study were unlikely to use condoms, particularly those who were living in rural communities, who were pregnant, and who were either married or cohabiting with a primary male partner. The major reason for not using condoms was a belief that their male partner was not HIV infected, either because she believed he had been tested or because she simply believed that he was HIV negative. Other reasons for n...

Do protective behaviors follow the experience of testing positive for herpes simplex type 2

Objective: To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). Methods: Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). Results: Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group × time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. Conclusions: Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.

Institutional and Structural Barriers to HIV Testing: Elements for a Theoretical Framework

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Against the Odds: Syringe Exchange Policy Implementation in Indiana

Indiana recently passed legislation allowing local governments to establish syringe exchanges. While the effectiveness of syringe exchange programming is established, there is a dearth of studies about associated policy adoption and implementation. This study documents the experiences of 24 Indiana counties engaged in the process of establishing syringe exchange programming under new state law. A mixed method, qualitative, exploratory case study was conducted from May 2015 to April 2016. We observed rapid and widespread policy adoption interest, and yet counties reported significant policy ambiguity, epidemiologic and resource capacity issues. The emergence of health commons involving information and tangible resource sharing networks allowed institutional rearrangement in the midst of resource scarcity; however, such rearrangement appeared to be a central threat to policy adoption and implementation given state structural barriers. The emerging commons could be a critical policy success factor, as it would achieve efficiencies not possible in the current resource environment, and can help achieve institutional rearrangement for the improvement of population health. Several recommendations for improvement are offered.

Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic.

Background Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. Methods Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. Results Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08–2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08–3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47–10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22–5.51). Conclusions There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.

Characterizing Sexual Orientation Disclosure to Health Care Providers: Lesbian, Gay, and Bisexual Perspectives

ABSTRACT This study examines lesbian, gay, and bisexual patients’ disclosure patterns of sexual orientation to health care providers. Using a semistructured interview format, researchers conducted interviews with 24 lesbian, gay, bisexual, and queer (LGBQ) adults about sexual orientation disclosure strategies. All interviews were transcribed and independently coded using thematic analysis. Results suggest that patient sexual orientation disclosure may be patient initiated and may occur to clarify or correct provider misinformation. Participants disclosed their orientation early in the medical visit during introductions, during small talk with the provider, and during the history-taking phase of the visit. Participants characterized sexual orientation disclosures as presented with minimal information, casually, and often indirectly. Practical and theoretical implications are discussed.