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1.  Gender, Empowerment, and Health: What Is It? How Does It Work? 
As the HIV/AIDS epidemic has progressed, the role of gender inequality in its transmission has become increasingly apparent. Nearly half of those living with the virus worldwide are women, and women's subordination to men increases their risk of infection and makes it harder for them to access treatment once infected. Men, too, suffer from harmful gender norms-the expectation that they will behave in ways that heighten their risk of HIV infection and that they will be cavalier about seeking health care increases their vulnerability to the disease. In the Middle East and North Africa, HIV infection rates are low, but changing gender norms have the potential to accelerate the spread of the disease if gender inequality is not addressed. Improving women's education, workforce participation, and social and political opportunities is crucial to strengthening health in the region. Work with men to shift gender imbalances is a further important task for the region's policymakers and civil society groups.
doi:10.1097/QAI.0b013e3181aafd54
PMCID: PMC3296368  PMID: 19553784
Gender inequality; gender empowerment; HIV/AIDS; health; Middle East and North Africa
2.  Lack of Understanding of Acute HIV Infection among Newly-Infected Persons – Implications for Prevention and Public Health. The NIMH Multisite Acute HIV Infection Study: II 
AIDS and behavior  2009;13(6):1046-1053.
Acute/early HIV infection is a period of high HIV transmission. Consequently, early detection of HIV infection and targeted HIV prevention could prevent a significant proportion of new transmissions. As part of an NIMH-funded multisite study, we used in-depth interviews to explore understandings of acute HIV infection (AHI) among 34 individuals diagnosed with acute/early HIV infection in six U.S. cities. We found a marked lack of awareness of AHI-related acute retroviral symptoms and a lack of clarity about AHI testing methods. Most participants knew little about the meaning and/or consequences of AHI, particularly that it is a period of elevated infectiousness. Over time and after the acute stage of infection, many participants acquired understanding of AHI from varied sources, including the Internet, HIV-infected friends, and health clinic employees. There is a need to promote targeted education about AHI to reduce the rapid spread of HIV associated with acute/early infection within communities at risk for HIV.
doi:10.1007/s10461-009-9581-7
PMCID: PMC2787764  PMID: 19533323
HIV/AIDS; Awareness; Acute HIV; HIV prevention
3.  A review of HIV/AIDS system-level interventions 
AIDS and behavior  2008;13(3):430-448.
The escalating HIV/AIDS epidemic worldwide demands that on-going prevention efforts be strengthened, disseminated, and scaled-up. System-level interventions refer to programs aiming to improve the functioning of an agency as well as the delivery of its services to the community. System-level interventions are a promising approach to HIV/AIDS prevention because they focus on (a) improving the agency’s ability to adopt evidence-based HIV prevention and care programs; (b) develop and establish policies and procedures that maximize the sustainability of on-going prevention and care efforts; and (c) improve decision-making processes such as incorporating the needs of communities into their tailored services. We reviewed studies focusing on system-level interventions by searching multiple electronic abstracting indices, including PsycInfo, PubMed, and ProQuest. Twenty-three studies out of 624 peer-reviewed studies (published from January 1985 to February 2007) met study criteria. Most of the studies focused on strengthening agency infrastructure, while other studies included collaborative partnerships and technical assistance programs. Our findings suggest that system-level interventions are promising in strengthening HIV/AIDS prevention and treatment efforts. Based on our findings, we propose recommendations for future work in developing and evaluating system-level interventions.
doi:10.1007/s10461-008-9379-z
PMCID: PMC2966590  PMID: 18369722
Systems; Structural; Social Intervention; HIV/AIDS; Review
4.  Leadership development and HIV/AIDS 
AIDS (London, England)  2008;22(Suppl 2):S19-S26.
Leadership development among all sectors addressing HIV/AIDS has come to be recognized as a critically important endeavor as the HIV pandemic moves into its fourth decade. Globally, there is a tremendous need for well-trained leaders in healthcare, research, policy, programme management, activism and advocacy, especially in countries and settings with high HIV prevalence and limited human resource capacity. This article examines the growing need for HIV/AIDS leadership development, and describes and assesses a number of current initiatives that focus on leadership development in a variety of populations and settings. A series of recommendations are provided to expand the scope and impact of leadership development activities; recommendations are primarily targeted towards foundations and other funders and leadership development programme managers.
doi:10.1097/01.aids.0000327433.90419.61
PMCID: PMC2810248  PMID: 18641465
AIDS; HIV; internationality; leadership
5.  Influence of Coping, Social Support, and Depression on Subjective Health Status Among HIV-Positive Adults With Different Sexual Identities 
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
doi:10.3200/BMED.34.4.133-144
PMCID: PMC2653049  PMID: 19064372
coping; depression; HIV; sexual identity; symptoms; social support
6.  Predictors of Attrition among High Risk HIV-Infected Participants Enrolled in a Multi-Site Prevention Trial 
AIDS and behavior  2008;12(6):974-977.
Objective
Recruiting and retaining high-risk individuals is critical for HIV prevention trials.
Design
The current analyses addressed predictors of trial dropout among high-risk HIV-infected men and women.
Results
Trial dropouts (n=74) were more likely to be younger, depressed, and not taking antiretroviral therapy than those who continued (n=815). No other background, substance use, or transmission risk differences were found, suggesting no dropout bias on key risk outcomes.
Conclusions
Efforts are warranted for early detection and treatment of depression and for improving retention of younger participants.
doi:10.1007/s10461-007-9356-y
PMCID: PMC2574761  PMID: 18202908
Clinical Trials; Prevention; Retention; Depression

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