Jennifer J. Harman

An information-motivation-behavioral skills model of adherence to antiretroviral therapy

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.

The Impact of Incarceration On Intimate Relationships

Although incarceration has a substantial impact on intimate relationships, little is known about how individuals cope with their separation and reunification. Incarceration also poses serious health risks for HIV infection, as rates are up to 6 times higher in the prison than the general population. A series of focus groups were conducted with individuals affected by incarceration to examine specific relationship challenges and factors that may place them at increased risk for HIV infection during and after their incarceration. Results highlight how institutional barriers and dependency lead to emotional withdrawal and disengagement from relationships. In addition, power differentials, avoidant communication strategies, and relationship instability were found to place these relationships at increased risk for HIV infection. Intervention recommendations for working with this population are discussed.

The Relationship-Oriented Information-Motivation-Behavioral Skills Model: A Multilevel Structural Equation Model among Dyads

Transmission rates of HIV infection have increased steadily among heterosexual adults, however current theoretical models have not been tested statistically at the dyadic level in which risk behaviors occur. The purpose of the current study was to test an Information-Motivation-Behavioral skills (IMB) model of HIV risk behavior (IMB) specifically articulated for heterosexual couples in established relationships using data from both members of 75 dyads. The multilevel relationship-oriented information-motivation-behavioral skills (RELO-IMB) model was evaluated at the individual and dyadic level of analysis to examine partner differences on core variables. Results indicated that not only did the RELO-IMB model provide a good fit to the data when analyzed at the dyadic level, but that the structural relations among the core variables were quite different between the individual- and dyadic-level models. This is the first theoretical model of HIV risk behavior to be analyzed at the dyadic level, and the results suggest ways to effectively design intervention strategies for individuals in intimate relationships.

Standard of care: promoting antiretroviral adherence in clinical care

Although there has long been demand for programs and procedures that support or enhance adherence to antiretroviral therapy (ART) among HIV+ patients, there is scant evidence about the extent to which medical clinics have been able to incorporate adherence interventions into their standard care. A survey of clinical care settings in New York and Connecticut indicated that the current standard of care is to provide only minimal levels of adherence services, with ad hoc adherence support being offered on an as-needed basis, often by overburdened primary care staff. These results suggest a strong need for the development of ART adherence interventions that are not only easily translatable to real-life clinical settings, but also offer an organized compendium of resources for HIV+ patients, from initiation to maintenance.

What You Think You Know Can Hurt You: Perceptual Biases About HIV Risk in Intimate Relationships

The use of heuristic biases and the false consensus effect can lead individuals to misperceive risk of HIV infection. The current paper presents the results of two studies which sought to examine whether individuals, (a) weigh risk relevant information accurately in their assessments of HIV risk, and (b) are susceptible to the false consensus effect in their assessments of actual intimate partner risk behaviors. The results of the first study support the hypothesis that individuals do not use objective risk information based on probability statistics in their assessments of HIV risk. In addition, the results of the second study find that female partners exhibit the false consensus effect regarding sexual risk behaviors, whereas male partners did not. Discussion centers on the role of perceptual biases in HIV risk behaviors among individuals in intimate relationships.

Perceptions of Primary and Secondary Relationships in Polyamory

In consensually non-monogamous relationships there is an open agreement that one, both, or all individuals involved in a romantic relationship may also have other sexual and/or romantic partners. Research concerning consensual non-monogamy has grown recently but has just begun to determine how relationships amongst partners in consensually non-monogamous arrangements may vary. The current research examines this issue within one type of consensual non-monogamy, specifically polyamory, using a convenience sample of 1,308 self-identified polyamorous individuals who provided responses to various indices of relationship evaluation (e.g. acceptance, secrecy, investment size, satisfaction level, commitment level, relationship communication, and sexual frequency). Measures were compared between perceptions of two concurrent partners within each polyamorous relationship (i.e., primary and secondary partners). Participants reported less stigma as well as more investment, satisfaction, commitment and greater communication about the relationship with primary compared to secondary relationships, but a greater proportion of time on sexual activity with secondary compared to primary relationships. We discuss how these results inform our understanding of the unique costs and rewards of primary-secondary relationships in polyamory and suggest future directions based on these findings.

Unveiling the silence: women's sexual health and experiences in Nepal

Rising rates of HIV in Nepal signal an impending epidemic. In order to develop culturally appropriate and effective actions and programmes to reduce HIV transmission, it is necessary to understand attitudes, behaviours and norms surrounding sexual networking and safer-sex practices in Nepal. Nepali women are thought to be at increased risk of sexually transmitted infections (STIs) and HIV, sexual violence and exploitation and other sexual health disparities due to cultural scripts limiting access to education, ability to control sexual relationships and acceptability in discussing sex and sexual health. The present study comprises a series of interviews with 25 women living in Kathmandu (13 individual interviews and 2 focus-group discussions) about their knowledge and experiences related to sex and sexual health. Interviews were translated and transcribed and two independent coders conducted a thematic analysis. Overall, the women described sex as primarily a male domain. Sex and sexual health were viewed as taboo discussion topics and formal sex education was perceived as minimally available and far from comprehensive in its scope. This formative study can inform future interventions aimed at reducing the spread of STIs/HIV in Nepal and empowering women on issues of sexual health and well-being.

Let's Talk about Sex: Development of a Sexual Health Program for Nepali Women.

The purpose of this study was to develop and test the feasibility of conducting a sexual health intervention for women in Nepal, a country with high political and economic instability and strong patriarchal systems. Of the 88 women enrolled, 100% retention was obtained over three sessions, and 85% completed a 1-month follow-up. Recruitment was so effective that some women were placed on a waitlist. All participants embraced the content and actively engaged in the intervention. Baseline results indicate HIV knowledge of the sample of educated women was low, and they did not often speak to other women about sex. Low knowledge about HIV and being comfortable discussing sex were associated with less frequent communication with others about sex. This study identified a great need for sexual health programs for women in Nepal, and we were able to effectively develop and implement an intervention to target this need.

Relationship-Specific Hope and Constructive Conflict Management in Adult Romantic Relationships Testing an Accommodation Framework

Using sequenced conflict interaction scenarios, this study tested Rusbult and colleagues’ partner accommodation framework. In addition, we examined the unique effects of relationship-specific hope, a variable we argue contributes to constructive conflict communication in adult romantic relationships. Results generally, but not completely, supported the predictive power of the partner accommodation model. Consistent with predictions, relationship-specific hope positively predicted partner accommodation in multiple scenarios. Moreover, relationship-specific hope positively predicted postconflict relational evaluations through its effects on partner accommodation. Supporting the tenets of hope theory, relationship-specific hope was found to be a more robust predictor of accommodation in multiple scenarios when partner responses were nonconciliatory (compared with conciliatory). This suggests that hope is most consequential to relational communication in especially trying relational circumstances. We interpret our findings, and their implications, based on interdependence theory, hope theory, and existing conflict management research.

Managing an Attractive Impression by Using Alcohol: Evidence From Two Daily Diary Studies

Two studies investigate impression management processes and alcohol use. In both studies, participants completed the Fear of Negative Evaluation scale and then a 21-day survey. In Study 1, participants reported daily desired impression and drinking. Men drank more than women; however, this effect was stronger on days in which they wanted to appear attractive as compared to other desired impressions. In Study 2, participants reported desired attractiveness, sex-composition, and drinking during social interactions. Attractiveness desires during social interactions related positively to drinking for men when interacting with mixed-sex others, and for women when interacting with mixed- and single-sex others.