Caroline Mallory

Awakening as a Change Process among Women at Risk for HIV Who Engage in Survival Sex

Women who exchange sex for survival requirements risk exposure to the human immunodeficiency virus (HIV). This grounded theory study was conducted to better understand these women’s concerns, attitudes, and behaviors related to HIV, with the goal of informing prevention research. Interviews with 11 women engaged in survival sex were analyzed. Women described sliding into survival sex as a result of economic crises. Survival sex exposed women to violence, drug use, sexually transmitted infections, and HIV. Mitigating these risks is a process of awakening in which women reconstruct risk and survival and make changes in their behavior. These findings highlight the complexity of the problem of survival sex and suggest interventions to help women protect themselves against HIV.

Women and the Prevention of HIV Infection: An Integrative Review of the Literature

In the United States, recent epidemiological evidence suggests that the epidemic of AIDS is growing rapidly among women. However, the theories used to guide research in the area of prevention of HIV infection often do not account for gender. As a result, research with women has been limited and the development of interventions to reduce risk behaviors impeded. This review examines research with women and HIV related to prevention and identifies the gaps and strengths in this body of work. Content analysis was used to evaluate 40 published papers meeting the following criteria: title or abstract indicating a report of research with women and HIV/AIDS, refereed journal as source, English language, and implications for prevention of HIV among women. Findings suggest a growing awareness of womens risk of HIV, but basic research pertaining to the behavior of women related to their vulnerability to HIV infection is scant. Prevention research and evaluation of interventions are also in their infancy. This review calls attention to the need for continued research that specifically addresses womens needs in the prevention of HIV.

A Systematic Review of Oral Health Behavior Research in American Adolescents.

Despite improvements in prevention, oral diseases are a problem among adolescents, linked to poor health outcomes and poor school performance. Little is known about adolescent oral health behavior. This systematic review describes factors that influence oral health behavior in adolescents. Inclusion criteria for the literature search were American children aged 12–19 and research on oral health behavior. Articles (n = 353) were retrieved, eight met the inclusion criteria, and of these, six were descriptive and two were experimental studies. The matrix method, critical appraisal, and content analysis produced themes across the studies. Participants were primarily African Americans and Hispanics of both genders, of lower socioeconomic status, aged 12–19. Findings suggest that ethnicity, race, and gender may influence oral health behavior in adolescents and that interventions have an effect. Research is needed to explore what other factors may influence oral health behavior in adolescents, long-term health outcomes, and school performance.

A qualitative study of man-sharing and the implications for midlife African American women's risk for HIV infection.

Midlife African American women are at risk for HIV related to higher prevalence of infection among African Americans and concurrent sexual partnerships. In this grounded theory study, we explored the context of decision making related to concurrent sexual partnerships among 36 African American women between the ages of 40 and 65 years. Qualitative data from semi-structured interview and focus group schedules collected between fall 2003 and summer 2006 are the basis for analysis. Transcripts were analyzed using constant comparison to develop concrete and abstract categories, and member checking used to verify findings. Women reported that partner concurrency and competition for acceptable men partners, “Man-Sharing,” among midlife African American women influenced sexual decision-making, potentially resulting in greater risk for HIV infection. Future research focusing on the power differential in heterosexual relationships, inter-racial dating, and limiting the risks associated with partner concurrency may be fruitful.

African American Women's Experience of Infection With HIV in the Rural Southeastern United States

The design of effective behavioral interventions to prevent HIV infection among African American women requires a more complete understanding of the context and circumstances that precipitate infection with the virus. A descriptive study was designed to explore African American womens experiences of infection with HIV in the rural southeastern United States. Ten women living with HIV participated in interviews. All were infected through sex with a man or men; three had engaged in high-risk activities associated with HIV infection including sex trading; seven described themselves as at low risk for infection related to serial monogamy, no injection drug use, and no history of addiction. Participants reported that desire for intimacy coupled with inaccurate risk appraisal of sex partners contributed to their infection. These results provide insight into the role of intimacy in sexual risk taking. Inquiry into how women can be assisted to protect themselves in the context of intimate relationships may improve interventions to prevent HIV.

What's on the internet? Services for women affected by HIV and AIDS

In this article I report findings from a survey of Internet sites related to HIV and AIDS with a special focus on women. HIV and AIDS are serious threats to the health of women, but little has been published about the cultural, economic, and social environments in which these women reside, and how these environments relate to HIV. The Internet has become a part of many peoples daily environment and has the potential to provide information and support for women affected by HIV. Findings from this study suggest that although a large number of Internet sites related to HIV exist, only a few are designed for women. Future research might investigate how Internet sites related to HIV are received by the women who use them, and how these sites might be improved to meet their needs.

Pilot Test Results of an HIV Prevention Intervention for High-Risk Women

Minority women, incarcerated women, and women using drugs or engaged in survival sex are most vulnerable to HIV. This pilot study was designed to estimate efficacy of an intervention, Women First!, to help these women correctly and consistently use male condoms. Women (N = 74) were recruited from jails, substance-abuse treatment centers, and public health clinics, and enrolled in a randomized controlled trial with an attention-only comparison group. The intervention, based on social cognitive theory and the theory of gender and power and awakening, was delivered over 6 weeks; unprotected vaginal intercourse and correct condom use were measured before and after the intervention. Changes on the dependent variables did not rise to statistical significance due to low power, but descriptive statistics and the multivariate partial η2 effect size estimate of 0.27 suggest that Women First! is a promising intervention. Future research will require improvements in recruitment, retention, and measurement.

Reliability and validity of the Treatment Satisfaction Questionnaire for Medication among Portuguese-speaking Brazilian patients with hypertension.

AIMS AND OBJECTIVES This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. BACKGROUND Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. DESIGN Cross-sectional descriptive exploratory study. METHODS A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. RESULTS Correlational analyses, internal consistency (Cronbachs alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). CONCLUSIONS This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. RELEVANCE TO CLINICAL PRACTICE Within known limitations, clinicians will find the Treatment Satisfaction Questionnaire for Medication (version 1.4) useful for identifying adult Portuguese-speaking Brazilian patients at risk of poor adherence and tailoring adherence interventions to promote hypertension control.