Jessy G. Dévieux

HIV risk reduction for substance using seriously mentally ill adults: test of the information-motivation-behavior skills (IMB) model.

The information-motivation-behavioral skills (IMB) model (Fisher & Fisher, 1992) was used as the theoretical framework for predicting unprotected sexual behavior among substance abusing men and women diagnosed with serious mental illnesses (n = 320; 150 men and 170 women, primarily of minority ethnicity). In a structural equation model, gender, HIV transmission knowledge, and motivational variables of pro-condom norms and attitudes, and perceived susceptibility predicted behavioral skills markers: condom use skills and condom use self-efficacy. Along with the other variables in the model, condom skills and condom self-efficacy were hypothesized to predict condom use over a six-month period. Results showed that greater condom skills were predicted by female gender, positive condom attitudes, and transmission knowledge. Engaging in lower rates of unprotected sex was predicted by pro-condom norms, less perceived susceptibility, and greater condom self-efficacy. Positive attitudes toward condoms had a significant indirect effect on rates of unprotected sex, exerting its influence through condom use self-efficacy. Results suggest that changing personal attitudes about condoms and reinforcing pro-condom attitudes among significant others will encourage condom use among seriously mentally ill (SMI) adults who are at high risk for HIV and other sexually transmitted diseases (STDs).

Depression, Substance Abuse and Other Contextual Predictors of Adherence to Antiretroviral Therapy (ART) Among Haitians

Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti’s resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.ResumenHaití tiene el número más alto de personas que viven con el VIH en el Caribe. Debido a la escases de recursos y servicios de salud mental y tratamiento del abuso de sustancias psicoactivas en el entorno Haitiano, la adherencia a la terapia antirretroviral (TARV) se puede volver especialmente difícil. Este estudio examinó asociaciones entre características demográficas, métodos inadaptados de lidiar, conflicto con la pareja, problemas relacionados al consumo del alcohol, la depresión, y las actitudes negativas sobre los medicamentos, y el impacto de dichas variables en la adherencia en 194 haitianos VIH-positivos. En un modelo de ecuación estructural, la depresión y las actitudes negativas sobre la TARV directamente predecían una adherencia inferior. Niveles más altos de conflicto con la pareja, métodos inadaptados de lidiar y problemas relacionados al consumo del alcohol predecían más depresión. Los métodos inadaptados de lidiar predecían una actitud negativa frente a la TARV. Problemas con el consumo del alcohol predecían conflicto con la pareja y métodos inadaptados de lidiar. Efectos indirectos significativos que afectan la adherencia mediados por ambas la depresión y las actitudes negativas sobre la TARV incluyen los efectos negativos del sexo femenino, problemas relacionados al consumo del alcohol y los métodos inadaptados de lidiar. Estos hallazgos recalcan la necesidad de una atención integral para la depresión, el consumo de alcohol y los problemas psicosociales para aumentar la adherencia a la TARV.

Triple jeopardy for HIV: substance using Severely Mentally Ill Adults.

SUMMARY Severely Mentally Ill (SMI) adults have disproportionately high HIV seroprevalence rates. Abuse of alcohol and other substances (AOD) and lifetime exposure to trauma by others are particularly potent risk factors, which, in combination with psychiatric disabilities, create triple jeopardy for HIV infection. This study examined the predictive utility of demographic characteristics; history of physical, emotional, or sexual abuse; extent of drug and alcohol abuse; knowledge about HIV/AIDS; sexual self-efficacy; and condom attitudes toward explaining the variance in a composite of HIV high-risk behavior among 188 SMI women and 158 SMI men. History of sexual abuse, engaging in sexual activities while high on substances, and lower cannabis use were the most significant predictors of HIV sexual risk behaviors. Given the triple jeopardy for HIV risk in this population, a triple barreled approach that simultaneously addresses multiple health risks within an integrated treatment setting is warranted.

Alcohol use severity and HIV sexual risk among juvenile offenders.

Guided by the Information Motivation Behavioral Skills (IMB) model, we examine the alcohol severity/sexual risk relationship for juvenile offenders who are at extreme risk for HIV/AIDS due to situational vulnerabilities, substance abuse, and personality factors. Sexual risk behavior was analyzed by levels of alcohol use among 634 ethnically diverse adolescents in Miami between 1998 and 2002. Adolescents with the highest levels of alcohol use reported significantly higher levels of total and unprotected sexual activity and sex acts proximate to drinking. Alcohol use related problems require more attention by HIV interventionists. Alcohol severity may reduce the effectiveness of HIV interventions that do not address concurrent substance use.

History of Childhood Sexual Abuse as a Risk Factor for HIV Risk Behavior

Abstract This article presents a review of literature and concepts linking child sexual abuse history and HIV risk behavior. Correlates of both CSA and HIV risk are reviewed and a proposed model of association is presented. Much of the research on this topic to date is theoretical or correlational in design. Complex and rigorous research designs allowing for further exploration of mediating and moderating variables are warranted to establish the nature of these relationships. Clinical implications include the need to assess: (1) abuse history among high-risk populations and (2) HIV risk behavior among CSA and other trauma survivors.

Negative Affect and HIV Risk in Alcohol and Other Drug (AOD) Abusing Adolescent Offenders

ABSTRACT Various depressive symptoms have been linked to elevated levels of HIV risk across diverse adult populations in multiple studies. However, this link has been examined in a much more limited manner among adolescents, despite an exceedingly heightened risk of both HIV and negative affect in this age group. To address the current lack of clinically pertinent knowledge in this area, we analyzed baseline data from 256 male and 107 female inner city, culturally diverse adolescent offenders. Relatively “high” and “low” negative affect subgroups were formed by conducting a median split on scores from the well-validated depressive affect scale of the Millon Adolescent Clinical Inventory (MACI). Compared to the low negative affect subgroup, the high negative affect participants reported significantly more sexual partners, unprotected sex, and increased susceptibility to HIV, as well as more marijuana, cocaine, and alcohol use (all ps <.05). Although demonstrating better condom skills, negative affect participants reported less favorable attitudes towards using condoms, less knowledge about HIV transmission, and lower sexual self-efficacy than non-depressive participants. Symptoms of negative affect are therefore of particular concern for adolescents, who are at risk not only for generally acknowledged difficulties such as suicide, but also for multiple HIV risk factors. The theoretical and applied implications of these findings will be discussed.

Cultural adaptation in translational research: field experiences.

The incrasse in the incidence of HIV/AIDS among minorities in the United States and in certain developing nations has prompted new intervention priorities, stressing the adaptation of efficacious interventions for diverse and marginalized groups. The experiences of Florida International University’s AIDS Prevention Program in translating HIV primary and secondary prevention interventions among these multicultural populations provide insight into the process of cultural adaptations and address the new scientific emphasis on ecological validity. An iterative process involvcing forward and backward translation, a cultural linguistic committee, focus group discussions, documentation of project procedures, and consultations with other researchers in the field was used to modify interventions. This article presents strategies used to ensure fidelity in implementing the efficacious core components of evidencebased interventions for reducing HIV transmission and drug use behaviors and the challenges posed by making cultural adaptation for participants with low literacy. This experience demonstrates the importance of integrating culturally relevant material in the translation process with intense focus on language and nuance. The process must ensure that the level of intervention is appropriate for the educational level of participants. Furthermore, the rights of participants must be protected during consenting procedures by instituting policies that recognize the socioeconomic, educational, and systemic pressures to participate in research.

Prevention of mother-to-child transmission of HIV in Haiti

OBJECTIVES To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT) of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3% received zidovudine (AZT), 2.9% received nevirapine (NVP), and 10.1% received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8% received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2% (95% CI: 6.14-12.24), in contrast to the historical mother-to-child transmission rate of 27% in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (chi(2) = 19.06, P < .001, log rank test). Infant survival improved with early pediatric diagnosis and antiretroviral treatment. CONCLUSIONS The MTCT prevention program described proved to be feasible and effective in reducing vertical HIV transmission in Haiti. The authors emphasize the need to expand testing, extend services to rural areas, and implement early HIV diagnosis to reduce infant mortality.

The Impact of Disaster on HIV in Haiti and Priority Areas Related to the Haitian Crisis

In recognition of the public health crisis in Haiti, the Journal of the Association of Nurses in AIDS Care (JANAC) plans to publish a themed issue on natural disaster, trauma, and HIV in Haiti. The issue will be published in early 2011. Haiti’s current crisis is exacerbated by a history of poverty and political instability and some effort is warranted to contextualize the crisis and to focus on priorities for HIV prevention and care. This commentary provides background information and a discussion of areas that affect HIV-infected Haitians in the present environment. ment of Health Promotion & Disease Prevention and AIDS Prevention Program, Robert Stempel College of Public Health & Social Work, Florida International University, Background Biscayne Bay Campus, North Miami. Bronwen Lichtenstein, PhD, is an associate professor, Department of Criminal Justice, The University of Alabama, Tuscaloosa, research fellow, Rural Center of AIDS/STD Prevention, Indiana University, Bloomington. Jessy G. D evieux, PhD, is an associate professor, Department of Health Promotion & Disease Prevention, and a co-director of the AIDS Prevention Program, Robert Stempel College of Public Health & Social Work, Florida International University, Biscayne Bay Campus, North Miami. The authors report no real or perceived vested interests that relate to this article (including relationships with pharmaceutical companies, biomedical device manufacturers, grantors, or other entities whose products or services are related to topics covered in this manuscript) that could be construed as a conflict of interest. This study was funded in part by Grant R01AA018084 from the National Institute on Alcohol Abuse and Alcoholism to Dr. Malow. The HIV prevention community is largely familiar with Haiti’s history of high prevalence of HIV. However, health workers and others might not be aware of Haiti’s robust scientific and clinical response to the epidemic or the particular character of the Haitian epidemic, which is complicated by high rates of co-infection with malaria, tuberculosis (TB), and several neglected tropical diseases (NTDs; Beau de Rochars et al. 2004; Hotez, Bottazzi, Franco-Paredes, Ault, & Periago, 2008; Pape, 2004; Streit & Lafontant, 2008). These infections compound the challenge of HIV prevention and treatment in ways rarely seen by researchers and practitioners in developed countries.

Effects of a Culturally Adapted HIV Prevention Intervention in Haitian Youth

&NA; This study assessed the impact of an 8‐week community‐based translation of Becoming a Responsible Teen (BART), an HIV intervention that has been shown to be effective in other at‐risk adolescent populations. A sample of Haitian adolescents living in the Miami area was randomized to a general health education control group (n = 101) or the BART intervention (n = 145), which was based on the information‐motivation‐behavior (IMB) model. Improvement in various IMB components (i.e., attitudinal, knowledge, and behavioral skills variables) related to condom use was assessed 1 month after the intervention. Longitudinal structural equation models using a mixture of latent and measured multi‐item variables indicated that the intervention significantly and positively impacted all IMB variables tested in the model. These BART intervention‐linked changes reflected greater knowledge, greater intentions to use condoms in the future, higher safer sex self‐efficacy, an improved attitude about condom use, and an enhanced ability to use condoms after the 8‐week intervention.