John A. Sauceda

The role of prospective memory in medication adherence: a review of an emerging literature

Although neurocognitive impairment is an established risk factor for medication nonadherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one’s ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence.

Childhood sexual abuse and depression in Latino men who have sex with men: Does resilience protect against nonadherence to antiretroviral therapy?

This study tested depression as a mediator between childhood sexual abuse and adherence to antiretroviral therapy, an effect moderated by resilience. In total, 149 HIV+ Latino men who have sex with men were recruited for this study. Using a regression-based bootstrap approach, depression mediated the relationship between childhood sexual abuse and antiretroviral therapy adherence, with worse adherence for participants at lowest percentiles of the resilience index. The prevalence of childhood sexual abuse and depression in HIV+ men who have sex with men is high and must be addressed to better prevent disease progression and reduce transmission, especially in expanding Latino populations.

Partner reports of HIV viral suppression predict sexual behavior in serodiscordant male couples.

To the Editors: Biomedical prevention strategies, specifically the achievement of an undetectable viral load, can prevent transmission of HIV among men who have sex with men (MSM). Moreover, among MSM, viral load information is used in the negotiation of condomless anal intercourse (CAI), and studies find that MSM are more likely to engage in CAI if they believe their partners are virally suppressed. To date, research on the association between viral load and CAI has focused exclusively on a single partner (ie, the HIV-negative or HIV-positive partner) without attending to the dyadic nature of sexual relationships and potentially contributing to pseudounilaterality—a bias that results from continually studying only 1 side of a 2-way interaction. The probability of HIV transmission is low when a partner is virally suppressed and clear of genital tract inflammation. Yet viral-sorting practices (ie, considering a partner’s viral load when making decisions about sexual behaviors) rely on subjective beliefs about viral suppression, and recent data show that MSM are likely to overestimate that their primary partner is virally suppressed. Thus, a better understanding of partner perceptions of viral suppression and sexual risk behavior has important implications for HIV prevention and clinical practice. In this study, we fill a key gap in the literature by examining the relative importance of both partners’ self-reports of viral suppression—and confirmatory viral load blood test results—on intradyadic (ie, within-couple) sexual risk behavior.

Factors Associated with Sexual Risk of HIV Transmission Among HIV-Positive Latino Men Who have Sex with Men on the U.S.-México Border

We present results from a cross-sectional, clinic-based survey of border-region Latino men who have sex with men (MSM) and who also are living with HIV in the El Paso-Ciudad Juárez area. Among the 66 participants who reported serodiscordant anal or vaginal intercourse, we examined levels of psychological distress and substance use and the association of these variables with condomless sex. Bivariate analyses indicated that MSM who reported condomless sex with a serodiscordant partner were more likely to report higher scores on measures of anxiety, depression, and trauma. These men were also more likely to report more days of alcohol use to the point of intoxication. In multivariate logistic regression, no variables were independently associated with sexual risk behavior, but symptoms of anxiety trended toward statistical significance. Our study is one of few reports aimed at understanding the HIV epidemic among Latino MSM living with HIV in the El Paso-Ciudad Juárez border region. Although we found no evidence of a relation between our measures of psychological distress and substance use and sexual risk behavior in multivariate analyses, psychological distress and problematic alcohol use were common in the sample and are important targets for intervention in their own right.ResumenNosotros presentamos los resultados de un estudio transversal, encuesta basada en la clínica de la región fronteriza de El Paso Ciudad Juárez con hombres latinos que tienen sexo con hombres (HSH) y que viven con VIH. Entre los 66 participantes que reportaron sexo anal o vaginal serodiscordante, examinamos los niveles de estrés psicológico y el uso de sustancias y la asociación de estos variables con el variable de sexo sin condón. Los análisis bivariantes indicaron que los HSH que reportaron tener sexo sin condón con una pareja serodiscordante eran más propensos a reportar puntuaciones más altas en las medidas de la ansiedad, la depresión y el trauma. Estos hombres también eran más propensos a reportar más días de consumo de alcohol hasta el punto de intoxicación. En la regresión logística multivariante, los variables no se asociaron de forma independiente con comportamientos sexuales de riesgo, pero los síntomas de ansiedad mostraron una tendencia hacia la significación estadística. Nuestro estudio es uno de los pocos reportes dirigido a la comprensión de la epidemia del VIH entre HSH latinos que viven con el VIH en la región fronteriza de El PasoCiudad Juárez. Aunque nosotros no encontramos ron pruebas de un relación entre nuestras medidas de los trastornos psicológicos, consumo de sustancias, y el comportamiento sexual de riesgo en los análisis multivariantes, angustia psicológica y problemático uso de alcohol eran comunes en la muestra, y son objetivos importantes para la intervención en su propio derecho.

HIV-Related Stigma and HIV Disclosure Among Latinos on the US-Mexico Border

Latinos in the USA have lower levels of disclosure and higher levels of HIV-related stigma when compared to non-Hispanic whites. However, the nature of the stigma-disclosure relation has not been fully explored. We hypothesize that the path between HIV-related stigma and disclosure may be through a mediating attitude toward disclosure. As a secondary hypothesis, we predicted differences in the strength of association that cognitive attitudes and affective attitudes share with disclosure. We interviewed 241 HIV-positive individuals on HAART at an outpatient clinic in El Paso, Texas, a large city that borders Mexico. The significant association between HIV-related stigma and HIV disclosure was fully mediated by attitudes toward disclosure. In addition, the differences between correlations (i.e., both affective and cognitive attitudes with disclosure behaviors) were statistically significant for family members and casual sex partners (Steiger’s Z-test, Z = 5.15 and 2.54, ps < .01). Our model of disclosure-related attitudes suggests that as stigma becomes more salient, negative evaluations about disclosing may become more important during the disclosure decision-making process. Also, despite evidence from the literature that disclosure to certain targets (e.g., intimate partners) may occur for emotional reasons related to catharsis or emotional relief, our data suggest that cognitive appraisals (e.g., responsibility to educate) are more strongly related to disclosure rates to family members and casual sex partners.

Assessing Mood Disorders and Suicidality in Hispanics

Although epidemiological studies do not consistently show differential rates of depression and bipolar disorders between US Hispanics and non-Hispanic Whites, these results mask important differences among Hispanic subgroups primarily in depression, with Puerto Rican samples exhibiting greater symptomatology than Cuban Americans and Mexican Americans. Evidence is equivocal regarding the role of somatization of depression in explaining the lower rates of diagnosed depression in some ethnic subgroups. There has been substantial empirical work done in Spanish and/or with US Hispanic samples with common depression measures, including the Beck Depression Inventory, the Patient Health Questionnaire-9, the Center for Epidemiological Studies Depression Scale, and the Hospital Anxiety and Depression Scales. Much less work has been done with Hispanics or Spanish-language measures in the assessment of bipolar disorder and suicidality. In general, Hispanic culture appears to be a protective factor against suicide, although there are substantial differences among US Hispanics in suicide attempts as a function of ethnic subgroup, family dynamics, and substance use patterns.

If someone cares about you, you are more apt to come around: improving HIV care engagement by strengthening the patient–provider relationship

Purpose The patient–provider relationship is a central factor that can promote or hinder long-term engagement in care among people living with chronic illnesses. In this paper, we explore characteristics of the patient–provider relationship that facilitated or hindered engagement in care among patients receiving care at HIV specialty clinics. Patients and methods We conducted 6 focus group discussions with a total of 43 well-retained and less well-retained HIV+ patients in San Francisco, Seattle, and Birmingham, to elicit a wide range of perspectives on engagement in HIV care. Borrowing from the field of psychotherapy, we examined patient–provider relationship characteristics through the lens of the therapeutic alliance, and with regard to their therapeutic efficacy and impact on patient engagement. Results The majority of participants emphasized how a strong patient–provider relationship defined by trust, intimacy, and collaboration promoted engagement, while a weak patient–provider relationship impeded engagement. Conclusion We discuss practical strategies and therapeutic techniques that may be helpful to providers in building strong patient–provider relationship and contend that a strong patient–provider relationship is crucial for patients to feel cared for during clinical encounters, which can promote long-term and sustained engagement in HIV care.

From Theory to Application: A Description of Transnationalism in Culturally-Appropriate HIV Interventions of Outreach, Access, and Retention Among Latino/a Populations

Interventions aiming to improve access to and retention in HIV care are optimized when they are tailored to clients’ needs. This paper describes an initiative of interventions implemented by ten demonstration sites using a transnational framework to tailor services for Mexicans and Puerto Ricans living with HIV. Transnationalism describes how immigrants (and their children) exist in their “receiving” place (e.g., continental U.S.) while simultaneously maintaining connections to their country or place of origin (e.g., Mexico). We describe interventions in terms of the strategies used, the theory informing design and the tailoring, and the integration of transnationalism. We argue how applying the transnational framework may improve the quality and effectiveness of services in response to the initiative’s overall goal, which is to produce innovative, robust, evidence-informed strategies that go beyond traditional tailoring approaches for HIV interventions with Latino/as populations.

Acculturation, Family Cohesion, and Mental Health Among Latinos Living With HIV on the U.S.-Mexico Border.

Objective: The objective of the study was to investigate whether acculturation to U.S. culture is associated with greater posttraumatic stress disorder (PTSD) symptomatology through diminished family cohesion among Latinos living with HIV on the U.S.-Mexico border. Method: Baseline survey data were analyzed from a sample of Latinos seeking HIV care from a publicly funded HIV clinic in El Paso, Texas. We used a regression-based bootstrapping approach to test our mediation hypothesis. Results: A total of 248 Latinos living with HIV completed the survey, with 96.4% being of Mexican descent, 19.4% female (gender self-identification), and 63.7% nonheterosexual (sexual orientation self-identification). Family cohesion mediated the relationship between U.S. acculturation and PTSD symptom scores (a1 b1 = .03, 95% confidence interval [.01–.06]), an effect independent of acculturation to Latino culture. Conclusions: Acculturation to U.S. culture may negatively impact mental health through weakening family bonds in this vulnerable population.

ASSESSING COLLECTIVISM IN LATINO, ASIAN/PACIFIC ISLANDER, AND AFRICAN AMERICAN MEN WHO HAVE SEX WITH MEN: A PSYCHOMETRIC EVALUATION

The study of collectivism has implications for HIV prevention research, especially in studies that use a social networking or community mobilization approach. However, research on collectivism in race/ethnicity and sexual minority groups is limited. We psychometrically evaluated a brief version of the Individualism-Collectivism Interpersonal Assessment Inventory (ICIAI) in a chain-referral sample of 400 Latino, 393 Asian/Pacific Islander, and 403 African American men who have sex with men (MSM). Data were collected via a one-time survey on demographics, the ICIAI, acculturation, and ethnicity identity. We conducted a multiple groups confirmatory factor analysis to assess for measurement invariance across the three groups of MSM, as well as tested its reliability and validity. The ICIAI evidenced good psychometric properties and was invariant across all groups. We highlight implications for how this measure of collectivism can be applied toward the study of HIV prevention and in lesbian, gay, bisexual and transgender communities.