Leigh A. Willis

Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998–2007

This systematic review examines the overall efficacy of U.S. and international-based structural-level condom distribution interventions (SLCDIs) on HIV risk behaviors and STIs and identifies factors associated with intervention efficacy. A comprehensive literature search of studies published from January 1988 through September 2007 yielded 21 relevant studies. Significant intervention effects were found for the following outcomes: condom use, condom acquisition/condom carrying, delayed sexual initiation among youth, and reduced incident STIs. The stratified analyses for condom use indicated that interventions were efficacious for various groups (e.g., youth, adults, males, commercial sex workers, clinic populations, and populations in areas with high STI incidence). Interventions increasing the availability of or accessibility to condoms or including additional individual, small-group or community-level components along with condom distribution were shown to be efficacious in increasing condom use behaviors. This review suggests that SLCDIs provide an efficacious means of HIV/STI prevention.

Efficacy of HIV/STI Behavioral Interventions for Heterosexual African American Men in the United States: A Meta-Analysis

This meta-analysis estimates the overall efficacy of HIV prevention interventions to reduce HIV sexual risk behaviors and sexually transmitted infections (STIs) among heterosexual African American men. A comprehensive search of the literature published during 1988–2008 yielded 44 relevant studies. Interventions significantly reduced HIV sexual risk behaviors and STIs. The stratified analysis for HIV sexual risk behaviors indicated that interventions were efficacious for studies specifically targeting African American men and men with incarceration history. In addition, interventions that had provision/referral of medical services, male facilitators, shorter follow-up periods, or emphasized the importance of protecting family and significant others were associated with reductions in HIV sexual risk behaviors. Meta-regression analyses indicated that the most robust intervention component is the provision/referral of medical services. Findings indicate that HIV interventions for heterosexual African American men might be more efficacious if they incorporated a range of health care services rather than HIV/STI-related services alone.

Strengthening the Network of Mentored, Underrepresented Minority Scientists and Leaders to Reduce HIV-Related Health Disparities

OBJECTIVES We reviewed data for the Minority HIV/AIDS Research Initiative (MARI), which was established in 2003 to support underrepresented minority scientists performing HIV prevention research in highly affected communities. METHODS MARI was established at the Centers for Disease Prevention and Control as a program of competitively awarded, mentored grants for early career researchers conducting HIV prevention research in highly affected racial/ethnic and sexual minority communities. We have described progress from 2003 to 2013. RESULTS To date, MARI has mentored 27 scientist leaders using low-cost strategies to enhance the development of effective HIV prevention interventions. These scientists have (1) developed research programs in disproportionately affected communities of color, (2) produced first-authored peer-reviewed scientific and programmatic products (including articles and community-level interventions), and (3) obtained larger, subsequent funding awards for research and programmatic work related to HIV prevention and health disparities work. CONCLUSIONS The MARI program demonstrates how to effectively engage minority scientists to conduct HIV prevention research and reduce racial/ethnic investigator disparities and serves as a model for programs to reduce disparities in other public health areas in which communities of color are disproportionately affected.

A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas

Background HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population. Methods Using data from the National HIV Surveillance System and the US Census Bureaus American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract–level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling. Results Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased. Conclusions This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income.

Recruitment strategies to engage African American men in HIV testing randomized controlled trials in the rural southern United States.

f the estimated 1.1 million Americans living withHIVinfection, about 18% are unaware of their infec-tion (Centers for Disease Control and Prevention[CDC], 2012). Routine HIV testing can facilitateearly diagnosis and linkage to care for persons whomaybeunawareoftheirinfection,therebydecreasingunintended ongoing HIV transmission (CDC, 2011;Hall, Holtgrave & Maulsby, 2012). AfricanAmericans, especially men, are disproportionatelyrepresented among both persons living with HIVand persons unaware of their infection (CDC,2013). Increased HIV testing efforts are vital, androutine HIV testing has been recommended by theCDC and the United States Preventive ServicesTask Force (CDC, 2006; Chou et al., 2012).For manyAfrican Americans inthe southern UnitedStates, the challenges of HIV-related stigma, racism,and distrust (both historical and institutional), poverty,and decreased health care access often make seekingand utilizing routine HIV testing and/or care attraditional health venues a challenge, especially inrural areas (Adimora, Ramirez, Schoenbach, C Prejean, Tang, & Hall, 2013). In ruralnorthern Florida, where African Americans aredisproportionately affected by high rates of HIV(Figure 1), conducting research to better understandhow to best develop and deliver HIV services is a vitalpart of reducing the burden of HIV. Community-basedtesting approaches that bring services to people wherethey live, work, and play could increase HIV testing ofat-risk populations in the rural south. Research isneeded to identify effective means of increasing HIVtesting among southern rural African American menas part of our national HIV prevention strategy(Office of National AIDS Policy, 2010).Historically, recruiting African Americans intoresearch studies, including randomized controlledtrials, has been a challenge for reasons includingdistrust of researchers and the research process,geographical distance from research sites, timeconstraints, and fear of being stigmatized (Corbie-Smith, Thomas, Williams, & Moody-Ayers, 1999;Polanco et al., 2011). Recruitment of certainsubpopulations, such as African American men andresidents of rural areas, into HIV prevention

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15–24, Part 1: Listening to Your Target Audience

ABSTRACT Young people (15–24 years) in the United States are disproportionately affected by infection with human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Shortfalls in HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI) likely contribute to this discrepancy. In this report we describe our experience developing a novel means of health communication combining entertainment-education theory and recent technological advances to create a HIV/STD-focused “motion comic.” We also report the audience satisfaction and acceptance of the intervention. We used the Health Belief Model (HBM), entertainment-education (EE) principles, and the Sabido Method (SM) and conducted three rounds of focus groups to develop a 38-minute HIV/STD focused motion comic for young people between the ages 15 and 24 years. Participants indicated that motion comics were an acceptable method of delivering HIV/STD prevention messages. They also expressed satisfaction with motion comics plot, story settings, the tone of humor, and drama. Our results suggest that motion comics are a viable new method of delivering health communication messages about HIV/STD and other public health issues, and warrant further development and broader evaluation.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15–24, Part 2: Evaluation of a Pilot Intervention

ABSTRACT In the United States, young people (ages 15–24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.

Differences between residential and non-residential fathers on sexual socialisation of African American youth

Abstract This study investigated differences between residential and non-residential fathers on topics discussed during father–child sex communication and factors associated with child sexual socialisation. Young people (N = 159, 53% female) provided self-reports using computer surveys on the role of their fathers on father–child sex communication, general communication, parental monitoring, father social support and topics discussed during father–child sex communication. The analysis revealed differences in topics discussed between young people with residential vs. non-residential fathers. Independent group t-tests revealed significant differences between young people with residential vs. non-residential fathers on social support and parental monitoring for sons and parental monitoring for daughters. Sons and daughters with residential fathers had higher scores on these variables. Discriminant function analyses, chi-square tests and hierarchical linear regression analyses were carried out to determine whether there were meaningful distinctions between young people with residential vs. non-residential fathers. The analysis revealed social support and parental monitoring provided the most meaningful distinction between young people with residential vs. non-residential fathers. These results highlight the importance of non-residential fathers in the sexual socialisation of their young people through parent–child sex communication. Discussion focuses on the need for development of interventions to promote the inclusion of non-residential fathers in the sexual socialisation of African American youth.

Sociostructural correlates of AIDS progression for African American women living with diagnoses of HIV infection in the District of Columbia.

Background: Among women living with HIV infection in the District of Columbia (DC), African American women are disproportionately affected, comprising > 90% of reported cases. Sociostructural exploration of local HIV epidemics among African American women has been understudied. We explored sociostructural correlates of health for HIVinfected African American women in DC to inform local HIV prevention and intervention efforts. Methods: HIV surveillance data from the District of Columbia Department of Health for African American women living with HIV were reviewed. We analyzed data for sociostructural correlates for progressing to acquired immune deficiency syndrome (AIDS) (CD4 counts < 200 cells/ml) among African American women. Data were analyzed using SAS 9.2 and mapped by census tracts using ArcGIS. Results: Of 4,619 women living with HIV, 4,204 (91%) were African American; 3,050 (72.5%) had census tract information available and were included. Median age at diagnosis was 36.6 years. Among these 3,050 African American women, 1,814 (59.4%) had ever progressed to AIDS, 1,109 (36.4%) had CD4 counts < 200 cells/μl (AIDS) at most recent clinical visit, and 208 of 1,109 (18.8%) had progressed to AIDS within 12 months of their HIV diagnosis (late testers). Women who progressed to AIDS had a higher probability of being diagnosed at private facilities compared with public facilities (PR=1.1, 95% CI=1.1-1.3) and of being exposed through injection drug use (IDU) compared to being exposed through heterosexual contact (PR=1.3, 95% CI=1.2-1.5). In multivariate and geomapping analyses, poverty, education levels and census tracts were not associated with an AIDS diagnosis. Conclusion: Progression to AIDS is prevalent among HIV-infected African American women in DC. Increased, early routine HIV screening and intensified treatment efforts with African American women living with HIV infection in DC, regardless of socioeconomic status, are warranted, to improve outcomes and decrease disparities.