Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti's resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.
Brief Strategic/Structural Family Therapy was implemented as an indicated prevention intervention to reduce the likelihood that African American and Hispanic youth initiated drug use. The intervention was designed to impact two important risk factors for initiation, namely behavior problems and poor family functioning. One hundred twenty‐two youth, 12–14 years of age and exhibiting behavior problems, were assigned within a basic one‐group pretest/posttest/follow‐up design. The first important finding was that the prevention intervention was effective in significantly modifying both high‐risk factors, reducing behavior problems [F(2, 120) × 32.92; p < .000] and improving family functioning [F(1, 121) × 41.8; p < .000]. A second important finding was that both high‐risk variables targeted were statistically significant predictors of initiation nine months later. A third important finding was that for a small subset of youth who entered the program already using, overall use was significantly decreased [t(22) × 2.11, p < .05]. © 1997 John Wiley & Sons, Inc.
Guided by the Information Motivation Behavioral Skills (IMB) model, we examine the alcohol severity/sexual risk relationship for juvenile offenders who are at extreme risk for HIV/AIDS due to situational vulnerabilities, substance abuse,1 and personality factors. Sexual risk behavior was analyzed by levels of alcohol use among 634 ethnically diverse adolescents in Miami between 1998 and 2002. Adolescents with the highest levels of alcohol use reported significantly higher levels of total and unprotected sexual activity and sex acts proximate to drinking. Alcohol use related problems require more attention by HIV interventionists. Alcohol severity may reduce the effectiveness of HIV interventions that do not address concurrent substance use.
The increase in the incidence of HIV/AIDS among minorities in the United States and in certain developing nations has prompted new intervention priorities, stressing the adaptation of efficacious interventions for diverse and marginalized groups. The experiences of Florida International University's AIDS Prevention Program in translating HIV primary and secondary prevention interventions among these multicultural populations provide insight into the process of cultural adaptations and address the new scientific emphasis on ecological validity. An iterative process involving forward and backward translation, a cultural linguistic committee, focus group discussions, documentation of project procedures, and consultations with other researchers in the field was used to modify interventions. This article presents strategies used to ensure fidelity in implementing the efficacious core components of evidence-based interventions for reducing HIV transmission and drug use behaviors and the challenges posed by making cultural adaptation for participants with low literacy. This experience demonstrates the importance of integrating culturally relevant material in the translation process with intense focus on language and nuance. The process must ensure that the level of intervention is appropriate for the educational level of participants. Furthermore, the rights of participants must be protected during consenting procedures by instituting policies that recognize the socioeconomic, educational, and systemic pressures to participate in research.
This study assessed the impact of an 8-week community-based translation of Becoming a Responsible Teen (BART), an HIV intervention that has been shown to be effective in other at-risk adolescent populations. A sample of Haitian adolescents living in the Miami area was randomized to a general health education control group (N = 101) or the BART intervention (N = 145), which is based on the information-motivation-behavior (IMB) model. Improvement in various IMB components (i.e., attitudinal, knowledge, and behavioral skills variables) related to condom use was assessed 1 month after the intervention. Longitudinal structural equation models using a mixture of latent and measured multi-item variables indicated that the intervention significantly and positively impacted all IMB variables tested in the model. These BART intervention-linked changes reflected greater knowledge, greater intentions to use condoms in the future, higher safer sex self-efficacy, an improved attitude about condom use and an enhanced ability to use condoms after the 8-week intervention.Correspondence concerning this article should be addressed to Dr. Robert Malow, Florida International University Biscayne Bay Campus, AC1-260, 3000 N.E. 151 st Street, North Miami, Florida 33181-3600. E-mail: E-mail: RMalow@bellsouth.net, Phone: 305.919.4200. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. et al., 1993). In addition, a larger proportion of minority youth begin engaging in sexual activity earlier than the majority of adolescents, again placing them at heightened risk for contracting the disease. Recent statistics reveal that 32% of African American and 13% of Hispanic males engage in sexual activity before the age of 13, compared to only 7% among Caucasian males (CDC, 2005). This early initiation of sexual activity occurs at a developmental stage when adolescents may not yet have acquired the necessary skills or knowledge to apply safe sex practices (DiClemente, 1991). In fact, one of the most basic neuroanatomic realities is that the human brain does not reach levels of adult complexity, as measured by the Gyrification Index (method for measuring the degree of gyri or convolutions of the brain's surface, the prevalence of which distinguishes Homo sapiens), until an individual's early twenties (Andreasen, 2001). Consequently, adolescent HIV prevention interventions must strive to include developmentally appropriate components in addition to, or in place of, frameworks shown to be successful with adult populations (Pedlow & Carey, 2003). The intervention trial with this special population was appro...
Psychological trauma resulting from natural disasters can negatively affect the health of persons living with HIV/AIDS (PLWH). This study examined relationships of alcohol use and exposure to the 2010 Haiti earthquake on symptoms of post-traumatic stress disorder (PTSD) among HIV-positive adults enrolled in an intervention study. Baseline data was collected from male and female PLWH, 19–56 years old on: alcohol consumption and related harms; anxiety; and coping strategies used to deal with HIV. Two to three months post-earthquake, data was collected from 104 of the study participants on PTSD and earthquake-related impacts. Most participants had less than secondary education (66%) and very low income (92% ≤ H$10,000 or ≤ US$1,250/year). Over two-thirds of participants felt at some point that they should cut down on drinking. Fifty two (50.5 %) met criteria for PTSD. More than 83% lost their belongings and 64% had someone close to them hurt or killed during the earthquake. Bivariate analysis showed that women, younger participants, those who lost all belongings, and those with greater overall alcohol impact were more likely to report PTSD symptoms. In the multivariate model, participants more likely to meet PTSD criteria (p<0.05) were those who reported feeling a need to cut down on drinking (OR=3.14, [CI=1.16, 8.49]) and participants who used behavioral disengagement as a coping mechanism (OR=1.49, [CI=1.15, 1.92]). Following a natural disaster, it is important to address trauma-related mental health needs of PLWH—particularly women and individuals who abuse alcohol.
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