Shilpa N. Patel

Modeling the impact of Trichomonas vaginalis infection on HIV transmission in HIV-infected individuals in medical care

Background: To assess factors associated with having a Trichomonas vaginalis (TV) infection among persons receiving care for human immunodeficiency virus (HIV) and estimate the number of transmitted HIV infections attributable to TV. Methods: HIV clinic patients were recruited from 2 secondary prevention studies, screened by urine nucleic-acid amplification tests for sexually transmitted infections, and interviewed about risk factors (baseline, 6, and 12 months). We conducted mathematical modeling of the results to estimate the number of transmitted HIV infections attributable to TV among a cohort of HIV-infected patients receiving medical care in North Carolina. Results: TV was prevalent in 7.4%, and incident in 2% to 3% of subjects at follow-up. Individuals with HIV RNA <400 copies/mL (odds ratio, 0.32; 95% CI: 0.14–0.73) and at least 13 years of education (odds ratio, 0.24; 95% CI: 0.08–0.70) were less likely to have TV. Mathematical modeling predicted that 0.062 HIV transmission events occur per 100 HIV-infected women in the absence of TV infection and 0.076 HIV infections per 100 HIV- and TV-infected women (estimate range: 0.070–0.079), indicating that 23% of the HIV transmission events from HIV-infected women may be attributable to TV infection when 22% of women are coinfected with TV. Conclusions: The data suggest the need for improved diagnosis of TV infection and suggest that HIV-infected women in medical care may be appropriate targets for enhanced testing and treatment.

The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents

Adolescents, particularly African American adolescents, are at high risk for sexually transmitted infections (STIs). The association between psychosocial factors and risky sexual behavior has been well established. However, only a small number of studies have examined the relationship between depressive symptomatology among African American female adolescents, specifically over time. The present study examined depressive symptoms as a predictor of risky sexual behavior, sexual communication, and STIs longitudinally among African American female adolescents between the ages 15 and 21. Binary generalized estimating equation models were conducted assessing the impact of depressive symptoms at baseline on risky sexual behavior and STIs over six- and 12-months follow-up. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high levels of depressive symptoms predicted no condom use during last sexual encounter and multiple sexual partners over six-months follow-up. Depressive symptoms also predicted having a main partner with concurrent partners, high fear of communication about condoms, and sex while high on alcohol or drugs over six- and 12-months follow-up. These findings could be used to inform HIV/STI prevention intervention programs and clinicians providing regular health care maintenance to African American female adolescents engaging in risky sexual behavior.

Longitudinal Effects of SafeTalk, a Motivational Interviewing-Based Program to Improve Safer Sex Practices Among People Living with HIV/AIDS

Programs to help people living with HIV/AIDS practice safer sex are needed to prevent transmission of HIV and other sexually transmitted infections. We sought to assess the impact of SafeTalk, a multicomponent motivational interviewing-based safer sex program, on HIV-infected patients’ risky sexual behavior. We enrolled sexually active adult HIV-infected patients from one of three clinical sites in North Carolina and randomized them to receive the 4-session SafeTalk intervention versus a hearthealthy attention-control. There was no significant difference in the proportion of people having unprotected sex between the two arms at enrollment. SafeTalk significantly reduced the number of unprotected sex acts with at-risk partners from baseline, while in controls the number of unprotected sex acts increased. Motivational interviewing can provide an effective, flexible prevention intervention for a heterogeneous group of people living with HIV.ResumenProgramas para ayudar a las personas que viven con VIH/SIDA practicar el sexo seguro es necesario para prevenir la transmisión del VIH y otras infecciones de transmisión sexual. Hemos tratado de evaluar el impacto de SafeTalk, un multe-componente motivacional programa basado en el sexo más seguro, sobre el comportamiento de pacientes infectados por VIH-sexuales de riesgo. Se incluyó a adultos sexualmente activos pacientes infectados por VIH de uno de los tres centros clínicos en Carolina del Norte y al azar a recibir la intervención SafeTalk de 4 sesiones en comparación con un corazón sano control de atención. No hubo diferencias significativas en la proporción de personas que tienen relaciones sexuales sin protección entre los dos grupos en la inscripción. SafeTalk redujo significativamente el número de relaciones sexuales sin protección con parejas en situación de riesgo desde el inicio, mientras que en los controles del número de actos sexuales sin protección mayor. La entrevista motivacional puede proporcionar una intervención eficaz, flexible para la prevención de un grupo heterogéneo de personas que viven con el VIH.

Longitudinal examination of alcohol use: a predictor of risky sexual behavior and Trichomonas vaginalis among African-American female adolescents.

Background: Alcohol use has been linked to risky sexual practices among adolescents. However, limited research on alcohol use and risky sexual behavior has been conducted on African-American female adolescents. This study examined high quantity of alcohol as a longitudinal predictor of risky sexual behavior and sexually transmitted diseases (STDs) among African-American female adolescents, a high-risk population for STDs. Methods: Three hundred ninety-three adolescent females, 15 to 21 years, were assessed on sociodemographics, alcohol use, and risky sexual behaviors. Participants also provided 2 swab specimens that were assayed for STDs. High quantity of alcohol use was defined as ≥3 drinks in 1 sitting. Results: Binary generalized estimating equation models were conducted assessing the impact of alcohol use at baseline on risky sexual behavior and STDs over a 12-month period. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high quantity of alcohol use predicted positive TV test results, inconsistent condom use, high sexual sensation seeking, multiple sexual partners, sex while high on alcohol or drugs, and having anal sex over a 12-month follow-up period. Conclusions: These findings suggest that HIV/STD-related behavioral interventions for African-American adolescents should discuss the link between alcohol and HIV/STD-risk behavior. A deeper understanding is paramount to the development of efficacious prevention programs at individual and community levels.

Psychosocial Characteristics and Sexual Behaviors of People in Care for HIV Infection: An Examination of Men Who Have Sex with Men, Heterosexual Men and Women

Few studies have examined the psychosocial factors associated with sexual transmission behaviors among HIV-positive men who have sex with men (MSM), heterosexual men (MSW) and women. We enrolled 1,050 sexually active HIV-positive patients at seven HIV clinics in six US cities as part of a clinic-based behavioral intervention. We describe the sexual transmission behaviors and examine demographic, clinical, psychosocial, and clinic prevention variables associated with unprotected anal or vaginal intercourse (UAVI). Twenty-three percent of MSM, 12.3% of MSW and 27.8% of women engaged in UAVI with partners perceived to be HIV-negative or of unknown serostatus. Among MSM and MSW, having multiple partners and lower self-efficacy were associated with increased odds of UAVI. Self-rating one’s health status as excellent/very good was a risk factor for UAVI among MSM. Among women, binge drinking and stressful life events were associated with UAVI. These findings identify variables that warrant attention in targeted interventions.

Translating Concern into Action: HIV Care Providers’ Views on Counseling Patients about HIV Prevention in the Clinical Setting

Recent Centers for Disease Control (CDC) guidelines recommend that HIV care practitioners provide HIV prevention counseling to patients at routine medical visits. However, research shows that HIV care practitioners provide such counseling infrequently, presenting a challenge for clinics implementing these guidelines. Our qualitative study of 19 HIV care providers at an infectious diseases clinic in the southeastern US explored providers’ beliefs about their patients’ HIV transmission behaviors, expected outcomes of conducting HIV prevention counseling, and perceived barriers and facilitators to counseling. Providers’ concern about HIV transmission among their patients was high but did not “translate into action” in the form of counseling. They anticipated poor outcomes from counseling, including harm to patient–provider relationships, and failure of patients to change their behavior. They also listed barriers and facilitators to counseling, most importantly time, state reporting policies, and conversational triggers. Implications for implementation of CDC guidelines and clinic-based “Prevention with Positives” programs are discussed.

Start Talking About Risks: Development of a Motivational Interviewing-Based Safer Sex Program for People Living with HIV

The epidemiology of HIV infection in the US in general, and in the southeast, in particular, has shifted dramatically over the past two decades, increasingly affecting women and minorities. The site for our intervention was an infectious diseases clinic based at a university hospital serving over 1,300 HIV-infected patients in North Carolina. Our patient population is diverse and reflects the trends seen more broadly in the epidemic in the southeast and in North Carolina. Practicing safer sex is a complex behavior with multiple determinants that vary by individual and social context. A comprehensive intervention that is client-centered and can be tailored to each individual’s circumstances is more likely to be effective at reducing risky behaviors among clients such as ours than are more confrontational or standardized prevention messages. One potential approach to improving safer sex practices among people living with HIV/AIDS (PLWHA) is Motivational Interviewing (MI), a non-judgmental, client-centered but directive counseling style. Below, we describe: (1) the development of the Start Talking About Risks (STAR) MI-based safer sex counseling program for PLWHA at our clinic site; (2) the intervention itself; and (3) lessons learned from implementing the intervention.

Racial Differences and Correlates of Potential Adoption of Pre-exposure Prophylaxis (PrEP): Results of a National Survey

Objective:To examine the association between sociodemographic factors, sexual behaviors, and social factors on potential uptake of preexposure prophylaxis (PrEP) among African American and White adult women in the United States. Methods:Participants were recruited through a nationally representative, random-digit dial telephone household survey. Participants comprised a nationally representative, random sample of unmarried African American (N = 1042) and White women (N = 411) aged 20–44 years. Interviews were conducted using computer-assisted telephone interviewing technology. Bivariate and multivariate analyses examined the relationship between sociodemographics, sexual behaviors, and social influences on womens potential uptake of PrEP. Results:In multivariate analyses, women with lower educational status, greater lifetime sexual partners, provider recommendations supportive of PrEP, and peer norms supportive of PrEP use were more likely to report potential PrEP uptake. Racial analyses revealed that compared with White women, African American women were significantly more likely to report potential use of PrEP [adjusted odds ratio (aOR) = 1.76, P ⩽ 0.001], more likely to report use of PrEP if recommended by a health-care provider (aOR = 1.65, P ⩽ 0.001), less likely to report that they would be embarrassed to ask a health-care provider for PrEP (aOR = 0.59, P ⩽ 0.05), and more likely to report use of PrEP if their female friends also used PrEP (aOR = 2.2, P ⩽ 0.001). The potential cost for PrEP was identified as a barrier to adoption by both African American and White women. Conclusions:Findings suggest that women at increased risk for HIV, including those with less education and greater number of sexual partners, may be more likely to use PrEP, although cost may serve as a barrier.

HIV serostatus disclosure: Experiences and perceptions of people living with HIV/AIDS and their service providers in Gujarat, India

Background: Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure. Materials and Methods: To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively. Results: Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands’ HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing. Interpretation and Conclusion: The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.

Exploring gender norms, agency and intimate partner violence among displaced Colombian women: A qualitative assessment.

Women displaced by conflict are often exposed to many factors associated with a risk of intimate partner violence (IPV) such as high levels of community violence and the breakdown of social support systems. Previous research found that Colombian women perceived IPV to increase after displacement. This study explored how the experience of displacement altered gendered roles in ways that influenced the risk of IPV. Thirty-three qualitative interviews were conducted with displaced partnered Colombian women. Women disclosed that couples often held patriarchal gender norms; however, the roles of each partner necessitated by conditions of displacement were often in conflict with these norms. Mens underemployment and womens employment outside the home were viewed as gender transgressive within some partnerships and increased relationship conflict. Economic resources intended to empower displaced women, notably womens earnings and home ownership, had unintended negative consequences for womens agency. These consequences included a corresponding decrease in partner financial contributions and reduced mobility. Womens ability to obtain support or leave violent relationships was hindered by interpersonal, social and structural barriers. For women to have agency to leave violent relationships, power relationships at all levels from the interpersonal to societal must be recognised and addressed.