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1.  Chronologically sampled flight feathers permits recognition of individual molt-migrants due to varying protein sources 
PeerJ  2015;3:e743.
This is a proof of concept paper based on chronological samples of growing feathers from geese thought to be molt-migrants. When molt-migrant birds initiate molt shortly after migrating to a new isoscape, isotope values measured along the length of their feathers should change continuously. To assess long-term changes and daily cycling in δ15N and δ13C values, we serially sampled a growing primary from three presumed molt-migrant geese. Two showed changing δ15N signatures along the length of their growing primary, indicating they were molt-migrants, while the third, presumably a resident, showed no change. We then resampled these feathers at closer intervals for evidence of the predicted diel cycle in the use of exogenous and endogenous protein for feather growth, generated by the diel feeding cycle of these geese. As predicted, a periodicity of ca. 24 h in δ15N values was found along the primary of the two equilibrating geese, but not in the other goose that was probably a resident. Our results demonstrate that chronological sampling along the length of individual primaries holds great potential for identifying individuals that are molt-migrants.
PMCID: PMC4312066  PMID: 25649835
Molt-migration; Isotopes; Feather chronology; 15-nitrogen; Diel cycling
3.  Using social network methods to reach out-of-care or ART-nonadherent HIV+ injection drug users in Russia: addressing a gap in the treatment cascade 
Journal of the International AIDS Society  2014;17(4Suppl 3):19594.
HIV treatment to reduce downstream HIV incidence and to decrease disease mortality and morbidity at a population level both require that hidden, out-of-care people living with HIV (PLH) in the community be reached and engaged to enter care. This research evaluated the feasibility of reaching out-of-care or non-adherent PLH through members of their social networks in St Petersburg, Russia.
Materials and Methods
To recruit a social network sample of HIV-positive injection drug users, 16 HIV+ seeds were enrolled into the study through PLH-oriented websites and online forums using recruitment ads or approached in needle exchange sites. Interested persons called the study phone number and completed a brief eligibility interview. Seed inclusion criteria were HIV+ status, being 18 years or older, having ever injected drugs, and having not visited an HIV doctor in the past 6 months. Seeds provided blood specimens tested for HIV to confirm their self-reported status. Eligible seeds were enrolled, completed brief network elicitation interview, and were asked to invite their own HIV+ friends into the study. Incentives were provided as compensation for participants’ time and additional smaller incentives were provided for inviting each HIV+ network member to also participate. The seed's PLH friends established the first ring of participants who, in turn were asked to invite their own PLH friends (second ring). All study participants completed assessment of psychosocial wellbeing and sexual and injection-related HIV risk behaviour. Blood samples were collected from all participants to confirm their HIV+ status.
Through this chain referral process, the initial 16 seeds led to the enrolment of a total of 66 PLH from the community (mean=4 per initial seed), most of whom – like the seed – were not presently in HIV care or were ART non-adherent.
Implementation of treatment cascade goals requires complementing conventional paths of identifying PLH with feasible and effective community-based approaches such as described in this study. This research establishes that PLH are connected in their day-to-day social networks with other HIV+ persons and shows that social network methods can be employed to reach infected persons through their connections with other PLH. This method has the potential to expand the reach of medical care efforts and ART uptake.
PMCID: PMC4224854  PMID: 25394099
4.  Stigma reduces and social support increases engagement in medical care among persons with HIV infection in St. Petersburg, Russia 
Journal of the International AIDS Society  2014;17(4Suppl 3):19618.
The proportion of people living with HIV (PLH) in care and on antiretroviral therapy (ART) in Russia is lower than in Sub-Saharan Africa [1]. This is undoubtedly due to a variety of systems and structural issues related to poor treatment access, linkage and care delivery models. However, little research has explored the reasons that PLH are not in care from their own perspectives. This information can help to guide the development of approaches for improving HIV care engagement in the country.
Materials and Methods
In-depth interviews were undertaken with 80 PLH in St. Petersburg who had never been in HIV medical care, had previously been out of care, or had always been in care. Participants were recruited through online PLH forums and Websites, outreach needle exchange and non-government organisation (NGO) programs, and chain referral. The interviews elicited detailed information about participants’ experiences and circumstances responsible for being out of care, and factors contributing to nonretention in HIV treatment. Verbatim transcriptions of the interviews were coded and analyzed using MAXQDA software to identify emerging themes.
Two types of care engagement barriers most often emerged. Some related to medical services, and others to the family and social environment. The most frequent medical service barriers were poor treatment infrastructure conditions and access; dissatisfaction with quality of services and medical staff; and concerns over confidentiality and HIV status disclosure. Social barriers were fears of potential harm to family relationships, negative consequences if status became known at work, and public stigmatization and myths associated having an HIV+ status. Social support from the PLH community and from family and close friends facilitated care engagement, as did motivation to take care of oneself and one's family. Most participants also described circumstances in which engaging into HIV care was brought about by an urgent issue (opportunistic infections) or was enforced through hospitalization or imprisonment. Trust in one's doctor and simply not wanting to die were also common motives.
Stigma was a major barrier to care engagement, including fear that others would learn of one's HIV+ status, whether at work, in one's family, or in the general community. By contrast, support from family, friends and the PLH community contributed to care engagement.
PMCID: PMC4224855  PMID: 25394122
5.  Seriously Mentally Ill Women’s Safer Sex Behaviors and the Theory of Reasoned Action 
Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the Theory of Reasoned Action, condom use attitudes and perceived social norms about safer sex were associated with safer sex intentions. Supplementing TRA variables with safer sex self-efficacy explained additional variance in safer sex intentions. Greater safer sex intentions were related to both greater condom use and to less frequent unprotected intercourse. In addition, less frequent sex after drug use and a less fatalistic outlook were associated with less frequent unprotected intercourse. Life circumstances specific to this population are particularly important to examine to improve the effectiveness of risk reduction interventions for seriously mentally ill women.
PMCID: PMC4107413  PMID: 19458268
sexual risk behavior; HIV/AIDS; severe mental illness
6.  High-Risk Sexual Behavior, HIV/STD Prevalence, and Risk Predictors in the Social Networks of Young Roma (Gypsy) Men in Bulgaria 
Roma (Gypsies), the largest and most disadvantaged ethnic minority group in Europe, are believed to be vulnerable to HIV/AIDS. This study’s aim was to examine HIV risk in 6 Roma male sociocentric networks (n=405 men) in Bulgaria.
Participants were interviewed concerning their risk practices and tested for HIV/STDs.
High-risk sexual behaviors were common. Over 57% of men had multiple sexual partners in the past 3 months. Over one-third of men reported both male and female partners in the past year. Condom use was low. Greater levels of sexual risk were associated with lower intentions and self-efficacy for using condoms, drug use, having male partners, knowing HIV-positive persons, and having higher AIDS knowledge but no prior HIV testing. Two men had HIV infection, 3.7% gonorrhea, and 5.2% chlamydia.
HIV prevention interventions directed toward high-risk social networks of Roma are needed before HIV infection becomes more widely established.
PMCID: PMC4107306  PMID: 22370730
HIV Risk Behavior; Sociocentric Social Networks; Ethnic Minorities; Roma; HIV/STD Prevalence
7.  Levels and Predictors of Sexual HIV Risk in Social Networks of Men who Have Sex with Men in the Midwest 
Past studies have primarily focused on individual-level of factors influencing the HIV risk practices of gay or bisexual men. The role of one’s social network has been less explored. This study identified 75 indexes in venues frequented by men who have sex with men and then recruited all willing persons named as members of each index’s egocentric social network. 255 unique network members completed assessments of risk-related characteristics and also sociometric measures that were used to identify the influence leader of each network. White and African American networks were composed primarily of men of the same race. Over 70% of men reported recent casual sexual partners. About one-fourth of men engaged in unprotected anal intercourse (UAI) with a casual partner or with multiple partners in the past 3 months. The social network to which a man belonged, weaker risk reduction intentions, and greater substance use independently predicted a range of high-risk sexual behaviors. There were modest but significant correlations between the risk-related characteristics of network members and network leaders. Social network-level approaches are feasible for reaching hidden subgroups of MSM at high risk for contracting HIV.
PMCID: PMC4103004  PMID: 21204625
8.  People with HIV in HAART-era Russia: Transmission Risk Behavior Prevalence, Antiretroviral Medication-Taking, and Psychosocial Distress 
AIDS and behavior  2011;15(4):767-777.
Russia has seen one of the world’s fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 59% of participants had partners of HIV-negative or unknown serostatus (mean=5.9). 52% reported unprotected intercourse with such partners, with 29% of acts unprotected. Greater perceived discrimination predicted lower condom use. 23% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. 25% of PLH had been refused general health care, 11% refused employment, 6% fired, and 6% forced from family homes. 39% of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. 54% of PLH were on HAART, 16% of PLH refused HAART regimens, and 5% took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.
PMCID: PMC4083488  PMID: 20803063
Acquired Immunodeficiency Syndrome; Russia; Sexual Behavior; Needle Sharing; Mental Health; HAART Adherence
9.  Levels and Predictors of HIV Risk Behavior Among Black Men Who Have Sex with Men 
Black men who have sex with men (MSM) contract HIV at disproportionately high rates, and National HIV/AIDS Strategy goals to reduce HIV incidence cannot be successful without improved HIV prevention among racial minority MSM. 210 Black MSM from three cities (Cleveland, Miami, and Milwaukee) completed measures assessing their sexual behavior and demographic characteristics, as well as AIDS-specific psychosocial scales, broader contextual domains, and substance use. Nearly 50% of men reported recent unprotected anal intercourse (UAI), often with non-main partners, with partners not known to be HIV seroconcordant, or with multiple partners. 37% of men reported being HIV-positive. In multiple regression analyses, higher levels of unprotected behavior were predicted by weaker perceived peer norms for condom use, weaker risk reduction behavioral intentions, being HIV-negative, and recent use of marijuana, cocaine/crack, and poppers. Greater number of UAI partners was associated with weaker perceived peer condom use norms, lower risk reduction intentions, illicit use of prescribed opiates, and fewer AIDS conspiracy beliefs. These findings suggest important factors that should be targeted in HIV prevention programs for Black MSM.
PMCID: PMC4067001  PMID: 23387951
10.  Ecological Energetics of an Abundant Aerial Insectivore, the Purple Martin 
PLoS ONE  2013;8(9):e76616.
The atmospheric boundary layer and lower free atmosphere, or aerosphere, is increasingly important for human transportation, communication, environmental monitoring, and energy production. The impacts of anthropogenic encroachment into aerial habitats are not well understood. Insectivorous birds and bats are inherently valuable components of biodiversity and play an integral role in aerial trophic dynamics. Many of these insectivores are experiencing range-wide population declines. As a first step toward gaging the potential impacts of these declines on the aerosphere’s trophic system, estimates of the biomass and energy consumed by aerial insectivores are needed. We developed a suite of energetics models for one of the largest and most common avian aerial insectivores in North America, the Purple Martin (Prognesubis). The base model estimated that Purple Martins consumed 412 (± 104) billion insects*y-1 with a biomass of 115,860 (± 29,192) metric tonnes*y-1. During the breeding season Purple Martins consume 10.3 (+ 3.0) kg of prey biomass per km3 of aerial habitat, equal to about 36,000 individual insects*km-3. Based on these calculations, the cumulative seasonal consumption of insects*km-3 is greater in North America during the breeding season than during other phases of the annual cycle, however the maximum daily insect consumption*km-3 occurs during fall migration. This analysis provides the first range-wide quantitative estimate of the magnitude of the trophic impact of this large and common aerial insectivore. Future studies could use a similar modeling approach to estimate impacts of the entire guild of aerial insectivores at a variety of temporal and spatial scales. These analyses would inform our understanding of the impact of population declines among aerial insectivores on the aerosphere’s trophic dynamics.
PMCID: PMC3783489  PMID: 24086755
11.  Psychiatric Risk Factors for HIV Disease Progression: The Role of Inconsistent Patterns of Anti-Retroviral Therapy Utilization 
In the era of anti-retroviral therapy (ART), depression and substance use predict hastened HIV disease progression but the underlying biological or behavioral mechanisms that explain these effects are not fully understood.
Using outcome data from 603 participants enrolled in a randomized controlled trial of a behavioral intervention, binary logistic and linear regression were employed to examine whether inconsistent patterns of ART utilization partially mediated the effects of depression and substance use on higher HIV viral load over a 25-month follow-up.
Elevated affective symptoms of depression independently predicted ART discontinuation (Adjusted OR [AOR] = 1.39, 95% CI = 1.08 – 1.78), and use of stimulants at least weekly independently predicted intermittent ART utilization (AOR = 2.62, 95% CI = 1.45 – 4.73). After controlling for the average self-reported percentage of ART doses taken and baseline T-helper (CD4+) count, elevated depressive symptoms predicted a 50% higher mean viral load, and weekly stimulant use predicted a 137% higher mean viral load. These effects became non-significant after accounting for inconsistent patterns of ART utilization, providing evidence of partial mediation.
Inconsistent patterns of ART utilization may partially explain the effects of depression and stimulant use on hastened HIV disease progression.
PMCID: PMC3494991  PMID: 21116186
Access; Adherence; Antiretroviral; Cocaine; Depression; Disease Progression; Highly Active; HIV/AIDS; HIV Viral Load; Methamphetamine; Substance Use; Utilization
13.  Climate and Weather Impact Timing of Emergence of Bats 
PLoS ONE  2012;7(8):e42737.
Interest in forecasting impacts of climate change have heightened attention in recent decades to how animals respond to variation in climate and weather patterns. One difficulty in determining animal response to climate variation is lack of long-term datasets that record animal behaviors over decadal scales. We used radar observations from the national NEXRAD network of Doppler weather radars to measure how group behavior in a colonially-roosting bat species responded to annual variation in climate and daily variation in weather over the past 11 years. Brazilian free-tailed bats (Tadarida brasiliensis) form dense aggregations in cave roosts in Texas. These bats emerge from caves daily to forage at high altitudes, which makes them detectable with Doppler weather radars. Timing of emergence in bats is often viewed as an adaptive trade-off between emerging early and risking predation or increased competition and emerging late which restricts foraging opportunities. We used timing of emergence from five maternity colonies of Brazilian free-tailed bats in south-central Texas during the peak lactation period (15 June–15 July) to determine whether emergence behavior was associated with summer drought conditions and daily temperatures. Bats emerged significantly earlier during years with extreme drought conditions than during moist years. Bats emerged later on days with high surface temperatures in both dry and moist years, but there was no relationship between surface temperatures and timing of emergence in summers with normal moisture levels. We conclude that emergence behavior is a flexible animal response to climate and weather conditions and may be a useful indicator for monitoring animal response to long-term shifts in climate.
PMCID: PMC3411708  PMID: 22876331
15.  Radar aeroecology: exploring the movements of aerial fauna through radio-wave remote sensing 
Biology Letters  2012;8(5):698-701.
An international and interdisciplinary Radar Aeroecology Workshop was held at the National Weather Center on 5–6 March 2012 on the University of Oklahoma campus in Norman, OK, USA. The workshop brought together biologists, meteorologists, radar engineers and computer scientists from 22 institutions and four countries. A central motivation behind the Radar Aeroecology Workshop was to foster better communication and cross-disciplinary collaboration among a diverse spectrum of researchers, and promote a better understanding of the ecology of animals that move within and use the Earth's lower atmosphere (aerosphere).
PMCID: PMC3440989  PMID: 22628093
radar; aeroecology; phenology; migration
16.  Reactions of Heterosexual African-American Men to Women’s Condom Negotiation Strategies 
Journal of sex research  2010;47(6):539-551.
This study describes responses of 172 single heterosexual African American men, ages 18–35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven’s (1992) influence model. The purpose was: 1) to identify strategies influencing participant acquiescence to request, and 2) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a ‘steady partner’. After each segment, participants completed measures of: request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men’s ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that while the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, STD history, and experience with sexual coercion. Also, the “least-willing-to-use” subgroup was highest in anger/rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.
PMCID: PMC2888974  PMID: 19760529
17.  Cerebral Blood Flow Heterogeneity in Preterm Sheep: Lack of Physiological Support for Vascular Boundary Zones in Fetal Cerebral White Matter 
Periventricular white matter (PVWM) injury is the leading cause of chronic neurological disability in survivors of prematurity. To address the role of cerebral ischemia in the pathogenesis of this injury, we tested the hypothesis that immaturity of spatially distal vascular “end” or “border” zones predisposes the PVWM to be more susceptible to falls in cerebral blood flow (CBF) than more proximal regions, such as the cerebral cortex. We used fluorescently-labeled microspheres to quantify regional CBF in situ in the 0.65 gestation fetal sheep in histopathologically-defined 3-dimensional regions by means of post hoc digital dissection and co-registration algorithms.
Basal flow in PVWM was significantly lower than gyral white matter and cerebral cortex, but was equivalent in superficial, middle and deep PVWM. Absolute and relative CBF (expressed as percentage of basal) CBF did not differ during ischemia or reperfusion between the PVWM and more superficial gyral white matter or cortex. Moreover, CBF during ischemia and reperfusion was equivalent at three distinct levels of the PVWM. Absolute and relative CBF during ischemia and reperfusion was not predictive of the severity of PVWM injury, as defined by TUNEL staining. However, the magnitude of ischemia to the cerebral cortex directly correlated with lesion severity (r= −0.48, p<.05). Hence, the PVWM did not display unique CBF disturbances that accounted for the distribution of injury. These results suggest that previously-defined cellular-maturational factors have a greater influence on the vulnerability of PVWM to ischemic injury than the presence of immature vascular-boundary zones.
PMCID: PMC3139427  PMID: 18091757
18.  Lessons Learned about Behavioral Science and Acute/Early HIV Infection. The NIMH Multisite Acute HIV Infection Study: V 
AIDS and behavior  2009;13(6):1068-1074.
Acute/early HIV infection is a period of heightened HIV transmission and a window of opportunity for intervention to prevent onward disease transmission. The NIMH Multisite Acute HIV Infection (AHI) Study was an exploratory initiative aimed at determining the feasibility of recruiting persons with AHI into research, assessing their psychosocial and behavioral characteristics, and examining short-term changes in these characteristics. This paper reports on lessons learned in the study, including: (1) the need to establish the cost-effectiveness of AHI testing; (2) challenges to identifying persons with AHI; (3) the need to increase awareness of acute-phase HIV transmission risks; (4) determining the goals of behavioral interventions following AHI diagnosis; and (5) the need for “rapid response” public health systems that can move quickly enough to intervene while persons are still in the AHI stage. There are untapped opportunities for behavioral and medical science collaborations in these areas that could reduce the incidence of HIV infection.
PMCID: PMC2787956  PMID: 19504179
Acute HIV infection; HIV prevention; Public health
This study recruited four sociocentric networks (n = 156) of men who have sex with men in Budapest, Hungary, and St. Petersburg, Russia. The sampling approach was based on identifying an initial “seed” in the community for each network, and then recruiting three successive friendship group waves out from the seed. HIV prevalence in the networks was 9%, and the composite rate of other sexually transmitted diseases was 6%. 57% of participants reported both main and casual male partners, and two thirds reported unprotected anal intercourse in the past 3 months. Fifty-five percent of men’s most recent anal intercourse acts were with nonexclusive partners, and 56% of most recent anal intercourse acts were unprotected. Sexual risk predictors were generally consistent with behavioral science theory. In addition, risk was associated with more often talking with friends about AIDS, higher ecstasy use, and less often drinking. Sociocentric social network sampling approaches are feasible and constitute a modality for reaching hidden high-risk populations inaccessible through conventional methods.
PMCID: PMC2802572  PMID: 19519240
20.  HIV Testing Rates, Testing Locations, and Healthcare Utilization among Urban African-American Men 
African-American men bear a disproportionate burden of HIV infection in the United States. HIV testing is essential to ensure that HIV-infected persons are aware of their HIV-positive serostatus, can benefit from early initiation of antiretroviral therapy, and can reduce their risk of transmitting the virus to sex partners. This cross-sectional study assessed HIV testing history and healthcare utilization among 352 young African-American men recruited in urban neighborhoods in a Midwestern city. The self-administered survey measured sexual risk behaviors, factors associated with HIV testing, and barriers to testing. The acceptability of community venues for HIV testing was also assessed. Of the respondents, 76% had been tested for HIV at some time in their lives, 52% during the prior 12 months. Of the participants, 70% had unprotected intercourse during the prior 12 months, 26% with two or more partners. Nearly three-quarters (72%) of participants had seen a healthcare provider during the prior year. In univariate analyses, those who had at least one healthcare provider visit during the prior 12 months and those who had a primary doctor were more likely to have been tested in the prior 12 months. In multivariate analyses, having a regular doctor who recommended HIV testing was the strongest predictor of having been tested [OR = 7.38 (3.55, 15.34)]. Having been diagnosed or treated for a sexually transmitted disease also was associated with HIV testing [OR = 1.83 (1.04, 3.21)]. The most commonly preferred testing locations were medical settings. However, community venues were acceptable alternatives. Having a primary doctor recommend testing was strongly associated with HIV testing and most HIV testing occurred at doctors’ offices. But, a substantial proportion of persons were not tested for HIV, even if seen by a doctor. These results suggest that HIV testing could be increased within the healthcare system by increasing the number of recommendations made by physicians to patients. The use of community venues for HIV testing sites could further increase the number of persons tested for HIV.
PMCID: PMC2629519  PMID: 19067176
HIV; HIV testing; Healthcare utilization; Healthcare access; Community-based HIV testing; African American; Urban; Inner city
21.  Condom Use Negotiation in Heterosexual African-American Adults: Responses to Types of Social Power-Based Strategies 
Journal of sex research  2008;45(2):150-163.
Little research has been performed on how people respond to different strategies to negotiate condom use in sexual situations, and whether certain strategies tend to be perceived as more or less effective in condom use negotiation. This study examined gender differences and preferences in the use of and response to six different styles of condom use negotiation with a hypothetical sexual partner of the opposite gender. Participants were 51 heterosexually-active African-American men and women between the ages of 18 and 35, attending an inner-city community center. Study participants completed a semi-structured qualitative interview in which they were presented with six negotiation strategies —coercive, reward, legitimate, expert, referent, and informational--based on Raven’s 1992 Power/Interaction Model of Interpersonal Influence. Results showed that women participants responded best to referent, reward, and legitimate strategies, and worst to informational tactics. Men participants responded best to reward strategies, and worst to coercion to use condoms. Further, responses given by a subset of both women—and, to a greater extent, men--indicated that use of negotiation tactics involving coercion to use condoms may result in negative or angry reactions. Finally, response to strategies may vary with the value of the relationship as viewed by the target of negotiation. Implications for HIV prevention programs and media campaigns are discussed.
PMCID: PMC2753393  PMID: 18569536
22.  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.
PMCID: PMC2653049  PMID: 19064372
coping; depression; HIV; sexual identity; symptoms; social support
23.  A Behavioral Intervention Reduces HIV Transmission Risk by Promoting Sustained Serosorting Practices Among HIV-Infected Men Who Have Sex with Men 
To examine factors that explain the effect of a cognitive-behavioral intervention on reductions in HIV transmission risk among HIV-infected men who have sex with men (MSM).
Of the 1,910 HIV-infected MSM screened, 616 participants considered to be at risk of transmitting HIV were randomized to a 15-session, individually delivered cognitive-behavioral intervention (n = 301) or a wait-list control (n = 315).
Consistent with previous intent-to-treat findings, there was an overall reduction in transmission risk acts among MSM in both intervention and control arms, with significant intervention effects observed at the 5, 10, 15, and 20 month assessments (Risk Ratios = .78, .62, .48, and .38, respectively). These intervention-related decreases in HIV transmission risk acts appeared to be partially due to sustained serosorting practices. MSM in the intervention condition reported a significantly greater proportion of sexual partners who were HIV-infected at the 5 and 10 month assessments (Risk Ratio = 1.14 and 1.18).
The Healthy Living Project, a cognitive-behavioral intervention, is efficacious in reducing transmission risk acts among MSM. This appears to have been due in large part to the fact that MSM in the intervention condition reported sustained serosorting practices.
PMCID: PMC2659703  PMID: 18989221
Men Who Have Sex with Men; Prevention with Positives; Randomized Controlled Trial; Prevention Case Management
24.  Severely Mentally Ill Women’s HIV Risk: The Influence of Social Support, Substance Use, and Contextual Risk Factors 
In structured interviews with 96 women with severe mental illness, nearly two-thirds had not used condoms during sexual intercourse in the past 3 months, more than two-thirds had sex with multiple partners, and almost one-third had been treated for a sexually transmitted infection (STI) in the past year. Women who reported fewer sexual risk context factors, such as having sex with someone the participant did not know or transactional sex, had fewer sexual partners. Larger social support networks were associated with less frequent sex after drug use. In turn, women who less often had sex after using drugs had unprotected intercourse less frequently.
PMCID: PMC2410084  PMID: 17143730
sexual risk behavior; HIV/AIDS; serious mental illness; women’s health
25.  Defining, Designing, Implementing, and Evaluating Phase 4 HIV Prevention Effectiveness Trials for Vulnerable Populations 
The efficacy of behavioral HIV prevention interventions has been convincingly demonstrated in a large number of randomized controlled phase 3 research outcome trials. Little research attention has been directed toward studying the effectiveness of the same interventions when delivered by providers to their own clients or community members, however. This article argues for the need to conduct phase 4 effectiveness trials of HIV prevention interventions that have been found efficacious in the research arena. Such trials can provide important information concerning the impact of interventions when applied in heterogeneous “real-world” circumstances. This article raises design issues and methodologic questions that need to be addressed in the conduct of phase 4 trials of behavioral interventions. These issues include the selection and training of service providers engaged in such trials, maintenance of fidelity to intervention protocol in provider-delivered interventions, determination of intervention core elements versus aspects that require tailoring, selection of relevant phase 4 study outcomes, interpretation of findings indicative of field effectiveness, sustainability, and other aspects of phase 4 trial design.
PMCID: PMC2409151  PMID: 18301131
effectiveness trial; HIV prevention; phase 4 trial; methodology

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