Nikia D. Braxton

Comparative Effectiveness of a Faith-Based HIV Intervention for African American Women: Importance of Enhancing Religious Social Capital

OBJECTIVES We assessed the effectiveness of P4 for Women, a faith-based HIV intervention. METHODS We used a 2-arm comparative effectiveness trial involving 134 African American women aged 18 to 34 years to compare the effectiveness of the Centers for Disease Control and Prevention-defined evidence-based Sisters Informing Sisters about Topics on AIDS (SISTA) HIV intervention with P4 for Women, an adapted faith-based version of SISTA. Participants were recruited from a large black church in Atlanta, Georgia, and completed assessments at baseline and follow-up. RESULTS Both SISTA and P4 for Women had statistically significant effects on this studys primary outcome-consistent condom use in the past 90 days-as well as other sexual behaviors. However, P4 for Women also had statistically significant effects on the number of weeks women were abstinent, on all psychosocial mediators, and most noteworthy, on all measures of religious social capital. Results were achieved by enhancing structural social capital through ministry participation, religious values and norms, linking trust and by reducing negative religious coping. High intervention attendance may indicate the feasibility of conducting faith-based HIV prevention research for African American women. CONCLUSIONS P4 for Women enhanced abstinence and safer sex practices as well as religious social capital, and was more acceptable than SISTA. Such efforts may assist faith leaders in responding to the HIV epidemic in African American women.

Design of a Faith-Based HIV Intervention Successful Collaboration Between a University and a Church

This article describes the development of a gender-specific and culturally tailored, theoretically derived, faith-based HIV intervention created to reduce HIV vulnerability among African American women. This innovative culturally congruent approach to HIV prevention involves one of the most influential social structures in the African American community—the African American church. Using the ADAPT-ITT model, and principles of community-based participatory research, this faith-based HIV intervention was adapted from a CDC-defined evidence-based HIV prevention intervention for young African American women. Results of data assessing the feasibility of implementing this faith-based HIV intervention suggests that young African American women are receptive and willing to participate in a faith-based HIV intervention. Results show that fidelity to intervention implementation (97%) and participant attendance to both sessions (92%) was high, and the HIV risk behaviors targeted in the faith-based intervention matched the participants’ HIV behavioral risk profile. Given the vulnerability of young African American women to HIV sustainable efforts, in particular, the institutionalization of this intervention within the church structure could halt the persistent increase in HIV infections within this community.

Preliminary efficacy of a computer-based HIV intervention for African-American women.

This study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21–29 years of age, seeking services at Planned Parenthood in Atlanta, GA. Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR = 5.9; p < 0.039) and were more likely to use condoms consistently for oral sex (OR = 13.83; p < 0.037). This relatively brief intervention provides preliminary support that an evidence-based group-based HIV prevention intervention for young African-American women can be adapted to a computer-based HIV intervention.

Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: results of a randomized-controlled trial

Background:The HIV epidemic has a devastating impact among South African women. The current study evaluated the efficacy of SISTA South Africa, a culturally congruent HIV intervention for isiXhosa women in South Africa, which was adapted from SISTA, an HIV intervention for African American women. Methods:A randomized-controlled trial recruited 342 isiXhosa women aged 18–35 years. Participants were randomized to the general health comparison or the SISTA South Africa intervention. Xhosa-speaking peer health educators tailored the SISTA South Africa curriculum, while maintaining the core elements of the original SISTA intervention. Participants completed assessments at baseline and 6 months follow-up. Results:Relative to participants in the comparison, participants in the HIV intervention reduced the frequency of unprotected vaginal intercourse acts (adjusted mean difference = 1.06; P = 0.02), were more likely to report not desiring dry sex (adjusted odds ratio = 0.229; 95% confidence interval = 0.10 to 0.47; P = 0.0001), and were more likely to perceive that their main sexual partner did not desire dry sex (adjusted odds ratio = 0.24; 95% confidence interval = 0.11 to 0.52; P = 0.0001). In addition, women randomized to the intervention also reported an increase in HIV knowledge, greater relationship control, and had more opposing attitudes toward HIV stigma. The HIV intervention did not reduce sexually transmitted infection incidence. Conclusions:This trial demonstrates that an HIV intervention, which is adapted to enhance its gender and cultural relevance for rural isiXhosa women, can reduce self-reported sexual risk behaviors and enhance mediators of HIV among this vulnerable population.

Racial Identity and Risky Sexual Behaviors Among Black Heterosexual Men

The purpose of this study was to examine the relationship between racial identity and risky sexual behaviors among young Black heterosexual men to better inform future HIV prevention interventions. A community sample of 80 self-identified African American heterosexual men aged 18 to 29 years completed an audio computer-assisted self-interview survey. Bivariate analyses were performed to assess the associations among variables related to demographics, racial identity, and sexual behaviors. Multivariate linear and logistic regression analyses were employed to determine the relationship between racial identity and risky sexual behaviors. Results indicate that more positive feelings toward African Americans and positive attitudes toward being Black predicted fewer sexual partners. The centrality of race was associated with a decrease in the odds of having concurrent sexual partners and marginally predicted increased condom use with a main female partner. Findings suggest that future HIV prevention interventions designed for African American heterosexual men should seek to strengthen their sense of racial identity.

Erratum to: interpersonal- and community-level predictors of intimate partner violence perpetration among African American men

This research was supported, in part, through the Emory Center for AIDS Research, the Atlanta Clinical & Translational Sciences Institute, and the Center for Contextual Genetics & Prevention. The authors would like to acknowledge the contribution of the research team who helped make this study possible: Phillip D. Williams, MPH, Nikia D. Braxton, MPH, Adannaa Oparanozie, MPH, Deja Er, MPH, Tamu M. Daniel, MPH, Anita C. Conner, MPH, Puja Seth, PhD, Jerris L. Raiford, PhD, Rachel Nash, MPH, Tiffany A. Pennick, MPH, Ralph J. DiClemente, PhD, Gina M. Wingood, ScD, Michelle Mott, MSN, Tiffaney Renfro, MSW, Mary Ukuku, MPH, and Jamilia LaFleur, MPH. The authors would also like to acknowledge Angela M. Caliendo, MD, PhD, professor of pathology and laboratory medicine at Emory University and her molecular diagnostics and microbiology laboratory staff for conducting biological assays of the three sexually transmitted infections collected in this study. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.

Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment

BACKGROUND Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. METHODS Three hundred and seventy nine sexually active adolescents, aged 13-18 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. RESULTS After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)=3.2, P=0.0001), obtain their HIV test results (AOR=2.9, P=0.03), refuse sex out of fear for STI acquisition (AOR=1.7, P=0.04), or avoid a situation that might lead to sex (AOR=2.4, P=0.001), and were less likely to have a casual sex partner (AOR=0.40, P=0.002). Additionally, females were more likely to report inconsistent condom use (AOR=2.60, P=0.001) and have a STI (AOR=9.1, P=0.0001) than their male counterparts. CONCLUSIONS Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.

African-American men’s exposure to music videos and their sexual attitudes and risk behaviour

BACKGROUND Media is a social determinant of HIV and sexually transmissible infection (STI) risk. However, limited empirical data have examined mens media exposure and their sexual attitudes and behaviour towards women. METHODS Eighty heterosexual African-American men were assessed on their exposure to music videos, sexual attitudes and behaviour. They also were tested for STIs. RESULTS Findings indicated that men influenced by music videos reported more sexual adventurism, more condom barriers, more lifetime sexual partners, more condom request refusals, substance abuse and a history of incarceration. CONCLUSIONS Further longitudinal research is needed to better understand this relationship and to address the role of media in HIV and STI prevention interventions.