Simone C. Gray

Efficacy of an HIV/STI Sexual Risk-Reduction Intervention for African American Adolescent Girls in Juvenile Detention Centers: A Randomized Controlled Trial

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13–17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

A county-level analysis of persons living with HIV in the southern United States

ABSTRACT This study uses county-level surveillance data to systematically analyze geographic variation and clustering of persons living with diagnosed HIV (PLWH) in the southern United States in 2011. Clusters corresponding to large metropolitan areas – including Miami, Atlanta, and Baltimore – had HIV prevalence rates higher (p < .001) than the regional rate. Regression analysis within the counties included in these clusters determined that race was a significant indicator for PLWH. These results provide a general picture of the distribution of PLWH in the southern United States at the county level and provide insights for identifying local geographic areas with a high number of PLWH, as well as subpopulations that may have an increased risk of infection.

Association of Hiv diagnosis rates and laws criminalizing Hiv exposure in the United States

Objective: To assess whether state criminal exposure laws are associated with HIV and stage 3 (AIDS) diagnosis rates in the United States. Design: We assessed the relationship between HIV and stage 3 (AIDS) diagnosis data from the National HIV Surveillance System and the presence of a state criminal exposure law as identified through WestlawNext by using generalized estimating equations. Methods: We limited analysis to persons aged at least 13 years with diagnosed HIV infection or AIDS reported to the National HIV Surveillance System of the Centers for Disease Control and Prevention. The primary outcome measures were rates of diagnosis of HIV (2001–2010 in 33 states) and AIDS (1994–2010 in 50 states) per 100 000 individuals per year. In addition to criminal exposure laws, state-level factors evaluated for inclusion in models included income, unemployment, poverty, education, urbanicity, and race/ethnicity. Results: At the end of the study period, 30 states had laws criminalizing HIV exposure. In bivariate models (P < 0.05), unemployment, poverty, education, urbanicity, and race/ethnicity were associated with HIV and AIDS diagnoses. In final models, proportion of adults with less than a high school education and percentage of the population living in urban areas were significantly associated with HIV and AIDS diagnoses over time; criminal exposure laws were not associated with diagnosis rates. Conclusion: We found no association between HIV or AIDS diagnosis rates and criminal exposure laws across states over time, suggesting that these laws have had no detectable HIV prevention effect.

Accuracy of HIV Risk Perceptions Among Episodic Substance-Using Men Who Have Sex with Men

Using the HIV Incident Risk Index for men who have sex with men—an objective and validated measure of risk for HIV acquisition, and self-perceptions of belief and worry about acquiring HIV, we identified individuals who underestimated substantial risk for HIV. Data from a racially/ethnically diverse cohort of 324 HIV-negative episodic substance-using men who have sex with men (SUMSM) enrolled in a behavioral risk reduction intervention (2010–2012) were analyzed. Two hundred and fourteen (66%) SUMSM at substantial risk for HIV were identified, of whom 147 (69%, or 45% of the total sample) underestimated their risk. In multivariable regression analyses, compared to others in the cohort, SUMSM who underestimated their substantial risk were more likely to report: a recent sexually transmitted infection diagnosis, experiencing greater social isolation, and exchanging sex for drugs, money, or other goods. An objective risk screener can be valuable to providers in identifying and discussing with SUMSM factors associated with substantial HIV risk, particularly those who may not recognize their risk.ResumenEste estudio utilizó el índice de riesgo de incidentes de VIH para hombres que tienen sexo con hombres (HIRI-HSH)—una medida objetiva y validada de riesgo para la adquisición del VIH–y autopercepción de creencia y preocupación de contraer el VIH para identificar individuos que subestimaron su riesgo substancial para el VIH. Se analizaron los datos de un cohorte de diversidad racial/étnica de 324 HSH, VIH-negativos usadores de sustancias de forma episódica (por sus siglas en inglés, SUMSM) inscritos en una intervención de reducción de riesgo del comportamiento (2010-2012). Dos ciento catorce (66%) se identificaron SUMSM con substancial riesgo de VIH, de los cuales 147 (69% o 45% de la muestra total) subestima el riesgo. En el análisis multivariado de regresión, en comparación con el resto del cohorte, los SUMSM más propensos fueron los que subestimaron su riesgo sustancial: una reciente transmisión diagnóstico de infección, experimentando mayor aislamiento social y el intercambio de sexo por drogas, dinero ni otros cosas. La medida objetiva de riesgo para la adquisición de VIH, puede ser una herramienta valiosa para ayudar a los proveedores identificar e iniciar conversaciones con SUMSM sobre los factores importantes asociados con riesgo de VIH, particularmente para aquellos que no pueden reconocer conductas de riesgo.

Social Determinants of HIV Disparities in the Southern United States and in Counties with Historically Black Colleges and Universities (HBCUs), 2013–2014

HIV infection disproportionately affects Blacks in the southern United States (U.S.), a region where legal policies that may unintentionally impede earlier HIV detection and treatment are prevalent. Historically Black Colleges and Universities (HBCUs) have historically facilitated social change in communities of color and have been underexplored as partners for HIV prevention. We describe geographic and social determinants of health (SDH) in the southern U.S. to inform potential HBCU-public health partnerships that might improve HIV health equity. We evaluated the relationship between county-level HIV prevalences (2013), HBCU geographic coordinates, and SDH variables in the southern counties with HBCUs. U.S. Census-derived SDH variables included race/ethnicity (i.e., Black, White, Hispanic), unemployment, female head of household, poverty, percent owner-occupied housing units, urbanicity, and primary care provider rates. Associations were assessed using bivariate and multivariable linear regression. Of 104 HBCUs in the contiguous U.S., 100 (96%) were located in 69 southern counties with average Black populations of 40% and an average HIV prevalence of 615. 5 per 100,000, over two times the national rate (295.1 per 100,000). In bivariable analyses, higher HIV rates in these counties were associated with higher percent Black population, unemployment, female head of household, poverty, fewer owner-occupied housing units, and greater urbanicity (p < 0.05). In multivariable analyses, counties with higher HIV rates had higher percentages of Blacks, greater urbanicity, fewer owner-occupied housing units, and more female heads of households (p < 0.05). The southern U.S. is disproportionately affected by HIV, and many HBCUs are located in affected southern counties. HBCUs may be important public health partners for helping to develop structural interventions that strengthen HIV policies in support of health equity in these southern, mostly urban counties.

Teen pregnancy in rural western Kenya: a public health issue

Abstract Rates of teenage pregnancy remain high in sub-Saharan Africa. The KEMRI Health and Demographic Surveillance System provided the sampling frame for a survey. Analysis focused on 1,952 girls aged 13–19 years. Over a third (37.2%; n = 727) were sexually active and 23.3% (n = 454) had ever been pregnant. Adjusted odds of reporting a history of pregnancy were greater for older compared to younger teens, teens who were ever married or cohabiting compared to those who were single, teens with a primary education or less compared to those with a higher level of education, and teens who experienced partner violence in the last 12 months. Three-quarters of teens pregnant in the last 12 months did not want to get pregnant (n = 190); only 64.2% (n = 122) answered yes to using any family planning method. Teen pregnancy and its consequences are serious public health issues. Higher education levels are a crucial component to address the problem.