Kimberly A. Parker

Delivering a "dose of hope": a faith-based program to increase older african americans' participation in clinical trials.

Background Underrepresentation of older-age racial and ethnic minorities in clinical research is a significant barrier to health in the United States, as it impedes medical research advancement of effective preventive and therapeutic strategies. Objective The objective of the study was to develop and test the feasibility of a community-developed faith-based intervention and evaluate its potential to increase the number of older African Americans in clinical research. Methods Using a cluster-randomized design, we worked with six matched churches to enroll at least 210 persons. We provided those in the intervention group churches with three educational sessions on the role of clinical trials in addressing health disparity topics, and those in the comparison group completed surveys at the same timepoints. All persons enrolled in the study received ongoing information via newsletters and direct outreach on an array of clinical studies seeking participants. We evaluated the short-, mid-, and longer-term effects of the interventional program on clinical trial-related outcomes (ie, screening and enrollment). Results From 2012 to 2013, we enrolled a balanced cohort of 221 persons in the program. At a 3-month follow-up, mean intention to seek information about clinical trials was higher than baseline in both treatment (mu=7.5/10; sigma=3.1) and control arms (mu=6.6/10; sigma=3.3), with the difference more pronounced in the treatment arm. The program demonstrated strong retention at 3-month (95.4%, 211/221) and 6-month timepoints (94.1%, 208/221). Conclusions The “Dose of Hope” program addressed an unmet need to reach an often overlooked audience of older African Americans who are members of churches and stimulate their interest in clinical trial participation. The program demonstrated its appeal in the delivery of effective messages and information about health disparities, and the role of clinical research in addressing these challenges.

Assessment of a microbicide candidate among a diverse cohort of urban southern US women and their male sexual partners.

Background: This mixed methods study reports on product acceptance from a Phase I clinical trial of a candidate non-nucleoside reverse transcriptase inhibitor (NNRTI) vaginal microbicide product (UC781). The product was evaluated in the context of a Phase I clinical trial in an area characterized by high HIV prevalence among minority women. The findings will inform the development of an acceptable microbicide that will address the needs of diverse women and their partners. Methods: This is a mixed methods study of 34 racially and ethnically diverse female participants and 10 male partners in Atlanta, Georgia. Chi-square tests for marginal homogeneity and kappa statistics were calculated to analyze differences between groups on product attributes and use intention. ANOVA was used to examine difference between the treatment groups. Qualitative data were analyzed via constant comparative methodology. Results: Thirty-four out of the original female cohort of 36 completed the questionnaire. Approval of future microbicide development was high at 91.2% (n=31) despite a lack of enthusiasm for the placebo and UC781 formulations. Overall female acceptability was correlated with personal protection motivation (r=1.00, p<0.001). African American women indicated greater likelihood of post-licensure microbicide use (χ2 (3)=7.9, p=0.048) and ascribed greater importance to its potential protection against HIV (χ2 (4)=18.7, p=0.001) and its potential for dual protection (protective against STIs and/or pregnancy) compared to white women (χ2 (4)=11.3, p=0.024). Men and women supported development in the form of an intravaginal ring or suppository. Men were more likely to encourage female adoption of the method if it afforded HIV protection (r=0.935, p=0.001). Conclusions: Although most women agreed that the development of a microbicide was an important endeavor, quantitative and qualitative data indicated they would not use placebo or UC781 due to the objectionable viscosity, odor, and color. Male partners felt the potential protective benefit of a future microbicide product was its most important feature.

Identifying spiritual markers in African American HIV positive women

ABSTRACT This article contributes new information to the literature on the role of spirituality in the lives of HIV positive African American women. Spirituality has been found to have a direct relationship with cognitive and social functioning and inversely related to HIV symptoms among African American women. This study uses secondary data analysis on interview data previously collected to assess the lived experiences of HIV positive African American women to identify, define, and describe the role of spirituality in coping among this population. Transcripts were coded by reading the transcripts and highlighting all text that on first impression appear to represent an expression or experience of spiritual or social support. Core elements of the interviews revealed God as an attachment figure, faith in God as a coping resource, and family as a support network, above church attendance for many of the participants.

The Intersection of Women’s Health and Poverty

We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the USA. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. We analyzed data from four diverse locations: Atlanta, New York City (the Bronx), Raleigh/Durham, and Washington, D.C. The following themes were identified at four levels including (1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; (2) mesosystem (network): organizational social support and sexual concurrency; (3) microsystem (dyadic): sex exchange, interpersonal social support, and intimate partner violence; and (4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. Multilevel syndemic factors contribute to women’s vulnerability to HIV in the USA. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk.

Chapter 2 Qualitative Methodological Approach

This chapter discusses the methods used to collect and analyze data for the HIV Prevention Trials Network (HPTN) 064 Study. Four study sites (the Bronx, NY; Washington, D.C.; Raleigh/Durham, NC; and Atlanta/Decatur, GA) conducted semi-structured interviews (SSIs) and focus groups (FGs) between June 2009 and August 2010 designed to explore social, structural, and contextual factors related to HIV risk among participants. We conducted 120 SSIs (30 per site) and 32 FGs (6–12 per site). SSI participants were selected using sequential sampling and quota sampling was used to identify FG participants. All transcripts were structurally coded, a method that identified text associated with each question in the SSI/FG guide. A random sample of transcripts (36 [30 %] of SSIs, 16 [51 %] of FGs) was selected for advanced systematic coding and analysis. Saturation (i.e., no new codes emerged) was achieved once 90 % of the sample was coded. Twenty percent of the transcripts were double-coded and intercoder reliability (ICR) was assessed throughout coding. The final ICR was a combined average Kappa score of 0.92. Data were analyzed using NVivo (QSR International Zty Ltd. Version 9.0).

The role of functional, social, and mobility dynamics in facilitating older African Americans participation in clinical research

Purpose Older African Americans experience disproportionately higher incidence of morbidity and mortality related to chronic and infectious diseases, yet are significantly underrepresented in clinical research compared to other racial and ethnic groups. This study aimed to understand the extent to which social support, transportation access, and physical impediments function as barriers or facilitators to clinical trial recruitment of older African Americans. Methods Participants (N=221) were recruited from six African American churches in Atlanta and surveyed on various influences on clinical trial participation. Results Logistic regression models demonstrated that greater transportation mobility (odds ratio [OR]=2.10; p=0.007) and social ability (OR=1.77; p=0.02) were associated with increased intentions of joining a clinical trial, as was greater basic daily living ability (OR=3.25; p=0.03), though only among single participants. Among adults age ≥65 years, those with lower levels of support during personal crises were more likely to join clinical trials (OR=0.57; p=0.04). Conclusion To facilitate clinical trial entry, recruitment efforts need to consider the physical limitations of their potential participants, particularly basic physical abilities and disabilities. Crisis support measures may be acting as a proxy for personal health issues among those aged >65 years, who would then be more likely to seek clinical trials for the personal health benefits. Outreach to assisted living homes, hospitals, and other communities is a promising avenue for improved clinical trial recruitment of older African Americans.

Chapter 10 Physical Safety and Neighborhood Issues

Residents of disadvantaged neighborhoods, or communities that are burdened by the lack of financial resources and economic stability, are exposed to higher levels of crime and violence. These residents also lack the economic mobility needed to increase earning potential as a way of climbing up the proverbial socioeconomic ladder. Since disadvantaged neighborhoods tend to be racially homogenous, historical and systematic discrimination has led to a creation of poverty that negatively impacts minorities, especially African Americans who reside in these areas. Social disorder and diminishing resources to deter crime serve as two primary characteristics seen in disadvantaged neighborhoods. Over time, the intersection of poverty, race, and economic disadvantage has led to a decrease in the quality of life and higher rates of health disparities among residents of impoverished communities, especially among African-American women. This chapter discusses how historical aspects of racism and the creation of power systematically led to the racial divide that plagues most disadvantaged neighborhoods. We use results from the HPTN 064 study to illustrate how social disorder and lack of economic mobility lead to negative health outcomes for women of color.

Chapter 11 Housing and Health: Exploring the Complex Intersections Between Housing Environments and Health Behaviors Among Women Living in Poverty

Location, quality, and reliability of housing are associated with physical and mental health. Financial resources (or lack thereof) and availability of affordable housing may restrict housing choice and mobility. Women, and unmarried women with children in particular, experience greater poverty rates than other groups, and, as a result, are particularly vulnerable to the ill effects of precarious housing conditions. This chapter explores interview and focus group themes as they relate to women’s experiences of their housing environment. The aims of this chapter are to (1) describe the physical attributes of housing where women reside, and the social and built characteristics of the neighborhoods where this housing is situated, and (2) explore how poverty affects housing choice and mobility. Participants felt trapped by marginal living situations resulting from limited housing choice, financial constraints, and transportation needs. Participants believed that their environments affected their physical and emotional well-being and described trade-offs that had immediate and long-term health implications (e.g., exchanging sex for housing, staying in dilapidated housing to keep benefits), and perceived low control over these situations. Women living in poverty require assistance identifying and relocating to safe, affordable housing with adequate transportation access. Programming should be coupled with interventions to increase women’s financial assets and mental health and with reevaluations of policies contributing to poverty and unstable housing.

Chapter 9 The Logic of Exchange Sex Among Women Living in Poverty

Exchange sex, defined as having sex in exchange for money or for commodities such as food, shelter or drugs, is linked to poverty and HIV risk. Drawing on data from HPTN 064, this chapter outlines participants’ perspectives on exchange sex and the economic and practical logic behind decisions regarding exchange sex. Women who engage in exchange sex often do so out of a need for money, food, and shelter for themselves and their children, and some engage in exchange sex for drugs and personal gain. Despite the many potential adverse outcomes, for those who live in poverty, lack alternatives for income generation, or are involved in drugs, exchange sex is a logical way to meet immediate needs or obtain basic life necessities.

Chapter 8 Partner Concurrency and Relationship Dynamics

Although marriage rates have declined slightly over the past decade, the desire to be married among men and women still remains. Subsequently, desire for marriage is higher among women compared to men, and the likelihood of both genders being married by the age of 30 had decreased. The benefits of marriage or coupling include access to higher levels of wealth and more resources, financial stability, and an elevated standard of living. These benefits are far greater for women; subsequently, gender norms and the dynamics of power yield decision-making control within heterosexual relationships to men. Sexual concurrency is defined as the overlapping of sexual partners and can occur within the dynamics of all relationships, regardless of race. This chapter explores the variables used to define sexual concurrency, the manifestation of sexual concurrency in African-American relationships, and a subsequent relationship between sexual concurrency and HIV transmission among African-American women. The chapter also provides examples of these interconnecting variables among women living in poverty among the participants of the HPTN 064 study.