Stephanie L. Marhefka

The State of the Union: Sexual Health Disparities in a National Sample of US College Students

Abstract Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18–24; M = 20.1) responding to the Spring 2007 American College Health Association–National College Health Assessment; 64% were female and 94.7% were white. Results: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender. Conclusions: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.

“I feel like I'm carrying a weapon.” Information and motivations related to sexual risk among girls with perinatally acquired HIV

Abstract Some adolescent girls perinatally infected with HIV (PIH) engage in sexual behavior that poses risks to their own well-being and that of sexual partners. Interventions to promote condom use among girls PIH may be most effective if provided prior to first sexual intercourse. With in-depth interviews, we explored gender- and HIV-specific informational and motivational factors that might be important for sexual risk reduction interventions designed to reach US girls PIH before they first engage in sexual intercourse. Open-ended interview questions and vignettes were employed. The information–motivation–behavioral skills (IMB) model guided descriptive qualitative analyses. Participants (20 girls PIH ages 12–16 years) had experienced kissing (n=12), genital touching (n=6), and oral (n=3), vaginal (n=2), and anal sex (n=1). Most knew sex poses transmission risks but not all knew anal sex is risky. Motivations for and against condom use included concerns about: sexual transmission, psychological barriers, and partners’ awareness of the girls HIV+ status. Girls were highly motivated to prevent transmission, but challenged by lack of condom negotiation skills as well as negative potential consequences of unsafe sex refusal and HIV status disclosure. Perhaps most critical for intervention development is the finding that some girls believe disclosing ones HIV status to a male partner shifts the responsibility of preventing transmission to that partner. These results suggest a modified IMB model that highlights the role of disclosure in affecting condom use among girls PIH and their partners. Implications for cognitive–behavioral interventions are discussed.

State-Mandated School-Based BMI Screening and Parent Notification A Descriptive Case Study

To address childhood obesity, several states and local school districts across the United States have adopted body mass index (BMI) measurement initiatives. This descriptive case study explored psychosocial, environmental, and behavioral factors among parents of sixth-grade students who received BMI Health Letters (BMIHLs) in one Florida County. A nonexperimental postintervention design was employed to gather quantitative data via self-report Likert-type questionnaire. Participants were parents/guardians of sixth-grade students attending one Hillsborough County public middle school (n = 76). Results indicate three main findings: (a) most parents in this study (67.4%) who discussed the BMIHL with their child reported their child as “very” or “somewhat” uncomfortable with the discussion; (b) some parents of normal weight (NW) children responded by taking their child to a medical professional to control their weight; and (c) more parents of at risk of overweight/overweight (AR/OW) children (vs. NW) reported greater concern about their child’s weight, using food restriction and physical activity to control their child’s weight, and giving negative weight-related comments/behaviors. This case study illustrates the importance of adapting and tailoring state mandated BMIHLs for parents based on child’s BMI status.

Ethnic and Racial Differences in HPV Knowledge and Vaccine Intentions among Men Receiving HPV Test Results

We examined factors associated with HPV vaccine intentions by racial/ethnic group among men participating in a HPV natural history study. HPV knowledge, vaccine intentions and perceived barriers were assessed among non-Hispanic White, non-Hispanic Black and Hispanic men. Men were tested for HPV every 6 months. After receiving test results from their previous visit, participants (N=477) reported their intentions for HPV vaccination in a computer-assisted survey instrument (CASI). Vaccine intentions were high among all respondents, although differences were found between racial and ethnic groups in awareness and knowledge of HPV and, vaccine intentions and perceived access and barriers to receiving the HPV vaccine. In order to effectively disseminate the vaccine among men, factors that may promote or inhibit vaccine acceptability need to be identified. Identifying these factors related to vaccine intentions among minority and majority men offers an opportunity for addressing barriers to health equity and, in turn, reductions in HPV-related disparities.

Emotional and behavioral problems and mental health service utilization of youth living with HIV acquired perinatally or later in life

Abstract This study sought to examine predictors of psychological symptoms and psychiatric service receipt among youth with HIV. Data were from the baseline assessment of Adolescent Impact, a study of 13–21-year-old youth with HIV in three US cities. Between August 2003 and February 2005, participants completed the age-appropriate youth or adult self-report symptom checklists (Achenbach system of empirically based assessment) and reported their psychiatric treatment history. Psychiatric diagnoses were abstracted from medical records. The 164 participating youth living with HIV were Black (81%), female (52%), Heterosexually identified (62%), and perinatally HIV-infected (60%). Thirty-one percentage reported levels of internalizing (i.e., self-focused/emotional), externalizing (i.e., outwardly focused/behavioral), or overall symptoms consistent with clinical psychopathology. In multivariate analyses, questioning ones sexual identity was associated with greater internalizing problems, whereas identifying as Bisexual was associated with greater externalizing problems (p<0.05). Symptoms were not associated with HIV transmission group. Participants with ≥1 composite score within the clinical range were more likely to have received ≥1 psychiatric service (Odds ratio (OR): 2.51; 95% confidence interval (CI): 1.22, 5.13) and a psychiatric diagnosis in the past year (OR: 2.16; 95% CI: 1.09, 4.27). However, 27% with clinically elevated scores had never received psychiatric care. Results suggest that among youth with HIV, those who identify as Bisexual or Questioning are at greatest risk for emotional and behavioral problems. Despite available mental health services, some youth with HIV are not receiving needed mental health care. Enhanced evaluation, referral and mental health service linkage is needed for these high-risk youth.

Internet-based video-group delivery of Healthy Relationships – A “prevention with positives” intervention: Report on a single group pilot test among women living with HIV

Women living with HIV (WLH) face challenges related to stigma, disclosure of HIV status, and negotiating safer sex. Several effective behavioral interventions, such as Healthy Relationships (HR), help WLH address these challenges and are disseminated by the USA Centers for Disease Control and Preventions (CDC) Diffusion of Effective Behavioral Interventions project. However, many WLH living in poor urban or rural locations cannot access interventions such as HR because implementation is not feasible. Video-conferencing technology holds promise for expanding access to effective behavioral interventions for WLH. Following a systematic adaptation to the video-conferencing format, this pilot study tested the delivery of HR via video-group (VG) among WLH. The video-conferencing-based intervention, HR-VG, consisted of six, two-hour sessions led by two facilitators, and used structured activities and video-clips to build disclosure and safer sex skills. Four minority WLH received HR-VG at four different community-based intervention sites in a private room equipped with a video-phone for participating in HR-VG and a desktop computer for completing assessments via Audio Computer-Assisted Self Interview. Participants completed a baseline assessment prior to HR-VG and post-session assessment after each HR-VG session. The post-intervention assessment and video-focus group were completed following the last HR-VG session. Facilitators completed an assessment after each HR-VG session and an open-ended questionnaire following HR-VG. HR-VG was implemented in its entirety with minimal challenges. Both participants and facilitators reported feeling either “very comfortable” or “completely comfortable” with the technology and the overall intervention. Participants also reported high levels of unity and togetherness among the group. These preliminary findings suggest VG delivery of HR for WLH is both feasible and highly valued by participants. A follow-up randomized controlled trial is under way to test the feasibility and efficacy of HR-VG with a larger sample of WLH.

Does the Internet represent a sexual health risk environment for young people

This study examined sexual risk behaviors/outcomes among college students with online partners only, offline partners only, and both online/offline partners. Students with both online/offline partners were more likely to report sexually transmitted diseases, unintended pregnancy, and more vaginal/oral sex partners. Sex with online partners was not riskier than sex with offline partners.

Interest in, Concerns About, and Preferences for Potential Video-Group Delivery of an Effective Behavioral Intervention Among Women Living With HIV

Novel strategies are needed to expand access to effective behavioral interventions for HIV prevention. Delivering effective group-based interventions to people living with HIV using video-conferencing technology is an innovative approach that may address this need, but has not been explored. Twenty-seven women living with HIV (WLH) who had just completed Healthy Relationships, a group-based behavioral program for WLH, participated in focus groups to share their thoughts about potentially participating in Healthy Relationships via a video-conferencing group. Overall, WLH supported the idea of video-group delivery of the program. They had numerous questions about logistics, expressed concerns about safety and confidentiality, and indicated a preference for accessing video-groups via special video-phones versus computers. Findings warrant further research into the feasibility, acceptability, and effectiveness of video-group delivery of HIV prevention interventions and suggest important considerations for researchers and practitioners who may employ video-conferencing for intervention delivery.ResumenNuevas estrategias son necesarias para ampliar el acceso a intervenciones conductistas efectivas para la prevención del VIH. Entregando intervenciónes basados en grupos a personas que viven con el VIH a través por tecnología de video-conferencia es un enfoque innovador que puede dirigir esta necesidad, pero no ha sido explorado. Veintisiete mujeres que viven con el VIH (WLH) que acaban de completar las “Relaciones Sanas”, un programa basado en grupos de conductista para WLH, tomaron parte en un grupo de foco para compartir sus pensamientos acerca de la posibilidad de tomar parte en “Relaciones Sanas” a través de un grupo de video-conferencia. En general, WLH apoyó la idea de la entrega del programa basado en grupos a través de video-conferencia. Tuvieron numerosas preguntas acerca de la logística, expresaron su preocupación por la seguridad y confidencialidad, y indicaron una preferencia para conseguir acceso al video-conferencia a través de teléfonos de video especiales en vez de computadoras. Las conclusiones justifican investigación adicional en la viabilidad, en la aceptabilidad y en la eficacia de la entrega de video-conferencia basado en grupos sobre las intervenciones de prevención del VIH y sugieren consideraciones importantes para los investigadores y facultativos que pueden emplear video-conferencia para la entrega de intervención.

Disclosure of HIV Status Among Female Youth With HIV

Minority female youth are significantly affected by the HIV epidemic. The purpose of this pilot study was to explore sexual behavior practices, disclosure of HIV status, attitudes about disclosure, and knowledge of HIV disclosure laws among female youth with HIV (YWH). Findings suggest that the majority of YWH studied have been sexually active since their HIV diagnosis, although the nature and extent of sexual activity varied. Rates of nondisclosure to sexual partners varied based on the type of question asked, but at least some of the YWH in this sample reported sexual activity with a partner who was unaware of the participant’s HIV status. YWH appear to be more likely to disclose before, as opposed to after, sexual activity. Although most YWH believe disclosure to sexual partners is important for a variety of reasons, many reasons exist for nondisclosure, including fear of rejection and limited communication skills. The majority of YWH in this sample were aware of the potential legal ramifications of nondisclosure although fear of legal repercussions was not the most important factor related to disclosure. These findings favor the implementation of HIV disclosure interventions over the enactment of HIV criminalization laws as a strategy for reducing HIV transmission.

Cognitive and emotional responses to human papillomavirus test results in men.

OBJECTIVE To report psychosocial differences between self-reported HPV-positive and HPV-negative Florida men. METHOD Men (n=536) in an HPV natural-history study completed a cross-sectional survey (2007-2010). RESULTS Most participants were white, non-Hispanic, and unmarried with some college education. HPV knowledge was high overall. HPV-positive men reported more negative emotions and perceived threat (P<0.05). HPV-negative men were more likely to disclose test results. Most men (91%) reported strong intentions for the HPV vaccine if it became available for men. CONCLUSIONS Men reported an array of responses to HPV tests with intentions to receive the HPV vaccine. Findings are important for HPV-related health messages for men.