Eusebius Small

Serostatus disclosure among adults with HIV in the era of HIV therapy.

Serostatus disclosure is an important component of secondary HIV prevention with potential benefits for both the individual by experiencing increased social support and society by reducing HIV transmission risk behaviors. This cross-sectional study assessed disclosure patterns to sex partners, family members, and friends by sociodemographic and HIV-related factors among an urban, Midwestern U.S. HIV clinic population (n = 809); a majority of whom were African American and male with a mean age of 41 years. Almost three quarters (n = 596) of the sample was currently receiving HIV therapy, with 68% (n = 404) successfully suppressing their HIV viral loads. Among sexually activity individuals, 97% reported disclosing their serostatus to sex partners. This high rate of disclosure to sex partners suggests that social desirability may play a role in this self-reported measure. Approximately half of the sample (n = 359) disclosed to at least one family member and 60% (n = 474) disclosed to at least one friend. Disclosing to family members occurred more often among participants who were unemployed and endorsed depressive disorder symptoms (p < 0.05 for all). Disclosing to friends occurred more frequently among women, Caucasians and those who completed higher levels of education (p < 0.001 for all). HIV disclosure and disease severity were unassociated. Given the chronic nature of HIV care, additional research is needed to develop interventions to facilitate timely disclosure of HIV serostatus.

Synthesizing Gender Based HIV Interventions in Sub-Sahara Africa: A Systematic Review of the Evidence

Gender is a critical component of HIV and sexual risk interventions. Examining the range, effectiveness and methodological rigor of studies that include a gender based component can inform current interventions and future directions for intervention research. This review investigated gender informed intervention studies conducted in sub-Saharan Africa that measured an outcome related to HIV. We reviewed 311 articles, 41 of which met our inclusion criteria, resulting in 11 articles that described eight different studies used in the analyses. The findings demonstrated wide variations in the types of interventions from low intensity educational content to multi-component interventions. Study outcomes were categorized into biological outcomes, HIV risk, behavioral, violence and risk reduction. Most interventions showed positive effects, and although research methodologies varied considerably, longer interventions appeared to be more effective. More research, however, is needed to build the evidence base for effectiveness of gender-based programs in reducing HIV infections in sub-Saharan Africa.ResumenEl género es un componente crítico del VIH y las intervenciones de riesgo sexual. Examinando el rango, la eficacia y el rigor metodológico de los estudios que incluyen un componente basado de género puede informar a las intervenciones actuales y a las futuras direcciones para la intervención investigativa.Esta revisóin investigó los estudios de intervención fundamentadas en género llevadas a cabo en África subsahariana, que medía un resultado relacionado con el VIH. Se revisaron 311 artículos, 41 de los cuales cumplieron con los criterios de inclusión, lo que resulta en 11 artículos que describían 8 diferentes estudios utilizados en los análisis. Los resultados demostraron amplias variaciones en los tipos de intervenciones desde baja intensidad en el contenido educativo a intervenciones de múltiples componentes. Los resultados del estudio se clasificaron en los resultados biológicos, riesgos del VIH, del comportamiento, la violencia y la reducción de riesgos. La mayoría de las intervenciones mostraron efectos positivos, y a pesar de las metodologías de investigación varían considerablemente, las intervenciones más largas parecían para ser más eficaces. Sin embargo, más investigación es necesaria para construir la base de pruebas para eficacia de los programas relacionados con el género en la reducción de infecciones por VIH en África subsahariana.

The Role of Perceived Peer Prejudice and Teacher Discrimination on Adolescent Substance Use: A Social Determinants Approach

Although Black adolescents have reported a lower prevalence of substance use relative to non-Hispanic Whites, Black youth are disproportionately affected by adverse social outcomes. Social scientists have highlighted that using a framework that includes perceived peer prejudice and teacher discrimination as social determinants of adolescent risk behaviors is essential to fully understanding substance use behaviors in adolescents. However, this area of research remains underdeveloped. This study examined whether and to what extent perceived peer prejudice and teacher discrimination affect binge drinking and marijuana use by Black (n = 514) and non-Hispanic White (n = 2,818) adolescents using data from the National Longitudinal Study of Adolescent Health, Wave 2, Public Use dataset. Findings suggest that peer prejudice increased the risk of substance use in non-Hispanic White youth only, whereas experiences of teacher discrimination increased the risk of substance use in both Black and non-Hispanic White youth. The studys limitations are noted, and implications for future research are discussed.

Components of resilience in gender: a comparative analysis of HIV outcomes in Kenya.

Gender is a critical concept of human immunodeficiency virus (HIV) sexual risk; yet, few studies have examined the intersection between risk and protective factors associated with incidence of HIV among couples. The paper examines gender-specific constructs of resiliency among couples in Kenya. Using data from the Demographic and Health Surveys, Kenya (2008/2009), we apply logistic regression techniques to analyse three resilience-related outcomes (condom use, HIV test and knowing an HIV test place) in estimating the gender differences and barriers to HIV/AIDS sexual risk. Men’s outcomes were significantly associated with previous HIV testing, urban residence, being insured and higher levels of education. Predictors for women’s indicators included previous experience of sexual violence, previous HIV test, urban residence, number of children and willingness to care for a relative with AIDS. Practical implications are discussed to include providing protective factors to women and formulating policies that minimise the challenges faced by women.

African American Caregivers and Substance Abuse in Child Welfare: Identification of Multiple Risk Profiles

Despite the strong correlation between caregiver substance abuse and child maltreatment, little information exists to understand the typology of African American caregivers with substance abuse problems in the child welfare system. Research shows African American caregivers contend with multiple problems stemming from substance abuse. Unfortunately, we do not yet know how to best tailor resources to be responsive to varying groups of African American caregivers. Using data from the National Survey of Child and Adolescent Well-being (NSCAW), this investigation tested for distinct multivariate profiles among a subset of African American caregivers with substance abuse problems (n = 258). Latent Class Analysis (LCA) was used to classify caregivers, and five classes were identified among this high risk sample—each with distinct risk profiles. Based on these findings, we discuss implications for tailored practices to enhance the safety and stability of children involved with child welfare.

Listening to refugees: How traditional mental health interventions may miss the mark

Understanding the dynamics of mental health of recently resettled refugees is an essential component of any comprehensive resettlement program, yet establishing the components of a successful and acceptable mental health intervention is an elusive task. Semi-structured interviews were conducted with 30 resettled refugees from five countries who had received treatment for depression, post-traumatic stress symptoms, or anxiety. Themes generated from the interviews emphasized the need for strong group-based social support as well as a focus on practical needs such as acquiring and maintaining employment, language and literacy training, and access to care.

Multi-level Barriers to Obtaining Mammograms for Women with Mobility Limitations: Post Workshop Evaluation

OBJECTIVES To assess the barriers and facilitators to mammogram use in middle aged women with mobility limitations who had completed an educational workshop, Promoting Access to Health Service (PATHS), on clinical preventive services. METHODS Women aged 40 to 64 with mobility impairments who reported not receiving a mammogram in the last 2 years were randomly assigned to a PATHS workshop and received follow-up monthly phone call interviews over 6 months. RESULTS Individual (eg, comorbidities, family responsibilities), interpersonal (eg, unclear provider communication, negative history), and environmental (eg, healthcare availability, insurance coverage, finances) factors were identified as unsolved barriers and potential facilitators (eg, reminders, physical proximity), to obtaining a mammogram. CONCLUSIONS A multi-level intervention approach is required to promote mammogram use by women with disabilities.

Profiles of Malawian adolescents at risk for HIV infections: Implications for targeted prevention, policy, and practices

Abstract Young people are at the center of the HIV epidemic. In fact, HIV has been referred to as a “youth-driven disease” worldwide. This cross-sectional study identified a typology of risk for HIV among Malawian adolescents, examined the distribution of HIV status within each group in the typology, and tested the association between class membership and changes in sexual behaviors to avoid HIV. The sample was restricted to males and females between the ages of 15 and 18 from three regions in Malawi who reported never having been married. Latent Class Analysis was conducted to examine youth population clusters based on shared characteristics. A chi-squared test was used to test whether class membership was associated with changes in sexual behaviors to avoid HIV. The study results indicate that two classes of risk exist among Malawian youths in this sample: At High Risk class and At Risk class. Individuals in the At High Risk class were significantly more likely than the At Risk class to perceive themselves as currently infected with HIV. The At High Risk class was not significantly less likely than the At Risk class to report changes in their sexual behaviors to avoid HIV. Findings are discussed and recommendations are suggested for clinicians to consider the heterogeneity among Malawi adolescents and tailor services accordingly. We provide suggestions on potential interventions that target the specific needs for the two groups to mitigate the spread of HIV among adolescents in Malawi.

Mental health treatment for resettled refugees: A comparison of three approaches

ABSTRACT Mental health concerns are a major factor in the overall wellness and stability of resettled refugees. While the need for mental health treatment for this population has been well-documented, less is known about the effectiveness of various treatment modalities on mental health outcomes. The purpose of this quasi-experimental study was to assess the impact of three different mental health interventions among refugees from Burundi, Burma, The Democratic Republic of Congo, Rwanda, and Bhutan. The effects of eight weeks of randomly assigned office-based counseling (treatment as usual [TAU]), home-based counseling (HBC), and a community-based psycho-educational group (CPG) on posttraumatic stress symptoms, depression, anxiety, somatization, and social support were evaluated using a pre–post design. Results indicate merit in each of the treatment modalities, with varying efficacy across intervention according to mental health symptoms. In general, however, participants in HBC and CPG demonstrated greater overall improvement in mental health outcomes than participants receiving TAU.

A Pilot Study Evaluating Students' Interest in International Social Work Education

International social work (ISW) has gained traction across the USA with a number of schools taking the lead in promoting the values of social work through exchange programs, service learning, and volunteerism. The internalization of campus through the proactive action of institutions to incorporate global perspectives into teaching, learning, and research in order to build intercultural competence among students, faculty, and staff has received little attention. This paper assesses the level of interest of social work students at a large urban university in the southwestern USA in embracing ISW and how they conceptualized their learning needs. Using a self-administered web-based survey offered to a total of 1,500 social work students with 18% respondent rate, the research determined through a chi-square test that students in Bachelor of Social Work, Master of Social Work, and PhD programs had a significant difference in preferences in areas of interests (χ2 = 153, p ≤ 0.000). Overall, students demonstrated interest in direct practice (74.3%) and community and administrative practice (16.6%). Students also differed in their level of interest in participating in international exchange programs (χ2 = 9.6, p = 0.047). Discussions address specific and unique interests categorized broadly as ‘globalized social worker,’ ‘humanitarian social worker,’ and ‘policy social worker,’ each of which requires specific skillsets and advanced behavior skills.