Browsing by Subject "AIDS (Disease)"
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Item Association Between Educational Attainment And Sexual Behaviors Related To Hiv/Aids In Two Sub-Saharan African Countries(2011) Azuine, Romuladus Emeka; Velasco, Eduardo H.; Public Health and Policy; Doctor of Public HealthHuman Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) is a public health problem. Worldwide, about 24 million people have died from AIDS and 33.3 million are infected with HIV. Africa accounts for 68% of new infections and 72% of global AIDS mortality. Epidemiological studies are needed to investigate the social determinants of HIV/AIDS-related sexual behaviors in Africa. This study investigated the association between educational attainment (EA) and condom use at high-risk sexual intercourse and multiple sexual partnerships in two African countries. It also determined whether HIV/AIDS knowledge mediated the association between EA and condom use and single sexual partnerships. Secondary but separate country analyses of nationally-representative cross-sectional Demographic and Health Surveys (DHS) in Swaziland (SDHS 2006-07) and Zimbabwe (ZDHS 2005-06) were conducted. The dichotomous dependent variables were condom use at last high-risk sexual intercourse and single sexual partnerships. The independent variable was EA categorized as no education, incomplete primary, complete primary, incomplete secondary, complete secondary, and higher. Multivariate logistic regression models were used to analyze the effects of EA and other determinants on condom use and single sexual partnerships. In Swaziland, 42% used condoms at last high-risk sexual intercourse while 68% had one sexual partnership. After adjusting for demographic characteristics and HIV/AIDS knowledge, attitudes and beliefs, condom use was positively associated with all EA levels beyond primary education: incomplete secondary education; complete secondary education, and higher education. Condom use was not associated with HIV/AIDS knowledge, but single sexual partnership was associated with four correct HIV/AIDS knowledge. In Zimbabwe, 16% used condom at last high-risk sexual intercourse, and 86% engaged in single sexual partnerships. Condom use was associated with EA but for only those who completed secondary education. Condom use was associated with one, three and four correct HIV/AIDS knowledge levels, and single sexual partnership was associated with all but one correct HIV/AIDS knowledge levels. In both countries, single sexual partnership was not associated with EA and HIV/AIDS knowledge had no multiplicative effect on the observed association between condom use and sexual monogamy. Findings from this study will be useful in the design and implementation of multi-sectoral HIV/AIDS interventions and policies.Item Barriers And Facilitators To Hiv Testing Among Residents Of A High Risk African American Community(2009) Beane, Lindsay Richards; Sydnor, Kim Dobson; Public Health and Policy; Doctor of Public HealthHIV/AIDS is a leading cause of death among African Americans living in the United States. HIV testing is both an essential mechanism to support the accurate epidemiological tracking of the disease, and a crucial entry point into treatment for individuals who are infected with HIV. This cross-sectional study involving a probability sampling of adult residents of an impoverished, African American, high HIV prevalence community in northwest Baltimore was conducted to determine barriers to HIV testing on individual and system levels. The study's door-to-door household survey approach supported the goal to identify lower risk residents. An 84-question survey instrument, based on a conceptual framework loosely modeled on the Health Belief Model but tailored to an urban minority population, was used to explore both subjects' internal decision-making around HIV testing and systemic barriers to HIV testing. The instrument was implemented via face-to-face interviews with 223 adults between 18 and 88 years which were conducted in each subject's home. Regression analysis revealed that knowledge about HIV/AIDS, high risk behaviors, and perceived susceptibility to infection are all significantly associated with HIV testing, and that testing is widespread among 25 to 44-year-olds. Subjects' main reasons for testing included concerns about exposure and doctors' recommendations to get tested; subjects' reasons for not testing included the conviction that committed relationships do not carry risk, and a general lack of concern. The study's important implications included 1) perceived risk may not correlate with actual risk, and 2) a majority of subjects reported behaviors that place them at medium or high risk for infection. The disconnect between perceived and actual risk was most evident among women whose perceived susceptibility was low even while they reported their male sexual partners' high risk behaviors. In summary, while the study found no major barriers to HIV testing among an impoverished, urban, minority population, findings related to risk hold implications for HIV prevention efforts designed to reduce heterosexual transmission of the virus. Further qualitative research is needed to explore the cognitive, emotional, and socio-cultural aspects of both perceived and actual risk in the African American population.Item Correlates Of Receipt Of Gynecologic Care In Hiv-Infected Women Receiving Care In The United States(2010) Odunze, Adaora Nwabundo; Wagner, Fernando A.; Public Health and Policy; Doctor of Public HealthItem The cultural proficiency capacity building model for organizational and systems accountability(2011-04) Eaton, Ivan P.; Henderson, Lenneal J.; University of Baltimore. Yale Gordon College of Public Affairs; University of Baltimore. Doctor of Public AdministrationOverview: Reportedly, the Black Community represents over 80% of all HIV/AIDS cases in the State of Maryland, now ranking first (1st) in the nation for Blacks/African Americans living with AIDS. This two-phased project presents a capacity building model to incite community and public administration practitioner involvement to collectively ensure the delivery of equitable, accountable, ethical, effective, efficient, high-quality, responsive, and sustainable HIV prevention and treatment programs while striving toward an idealistic, milestone target of cultural proficiency1 in order to achieve any resemblance of cultural competence. Method: Phase I, a participatory action research approach, describes preliminary issue formulation, formation of a community action movement to hold accountable stewards of public funds and development of a model to incite ethical and culturally proficient decision making in the public administration of HIV prevention and health services. Phase II, evolution of the model, provides scholarly inquiry through qualitative data analysis of archival documents to determine what the State did, is doing, or proposes to do, to remedy the spread of HIV/AIDS in Maryland and ensure for equitable and culturally proficient responses to HIV/AIDS in Maryland. Conclusion: Analysis of State archival documents on HIV prevention and health services does not evidence fulfillment of federally promulgated Culturally and Linguistically Appropriate Standards (CLAS). The researcher recommends adoption of a capacity building model to garner support and provide direction toward cultural proficiency in the delivery of HIV prevention and health services.Item Examining The Relationship Between Program Support And Adherence To Highly Active Anti-Retroviral Therapy (Haart) In Kenya And Zambia: The Role Of Art Knowledge On This Relationship(2013) Hughes, Lateefah; Hossain, Mian Bazle; Public Health and Policy; Doctor of Public HealthHighly Active Antiretroviral Therapy (HAART) adherence is critical to slowing down reproduction of the AIDS virus and ensuring viral load suppression in people living with the disease. Few studies have assessed how well comprehensive structured treatment programs eliminate disparities in treatment outcomes, and positively influence a person's ability to adhere to HAART. This cross-sectional study examined the effect of program support, patient knowledge about HIV and HAART, and patient physical and behavioral factors on adherence for patients in structured comprehensive AIDSRelief treatment programs in Kenya and Zambia. Complete adherence was measured as patient self-reporting of no missed doses in the last week and month, and no missed clinic appointments in the last three months for patients currently on treatment for at least nine months. Of the 1,418 adults (ages 15 years and older) 54.4% self-reported complete adherence to treatment. Unadjusted and adjusted models were developed to estimate adherence based on study indicators. After controlling for socio-demographic, risk behavior, clinical, and knowledge indicators, receiving high levels of program support (Adjusted Odds Ratio=1.58, Confidence Interval=1.17, 2.14; p=0.003), having high knowledge (Adjusted Odds Ratio=1.66, Confidence Interval=1.01, 2.73; p<0.05) were predictive of positive adherence. Disclosing HIV status to a spouse (Adjusted Odds Ratio=0.60, CI 0.43, 0.83; p=0.005) was predictive of low adherence. Gender, age, marital status, home ownership, months on therapy, CD4 level, sexual risk behaviors of disclosing to sex partners and condom usage were not predictive of adherence. To improve treatment adherence in developing countries, continuous emphasis on structured program support is an ideal model for strengthening the health safety net for individuals living with HIV/AIDS in these settings. Study findings indicate that the AIDSRelief program promotes adherence overall and eliminates age and gender disparities in treatment access in developing countries. Additionally, programs in resource limited settings should focus on issues that prevent spousal disclosure of HIV status by incorporating a married component into structured education and counseling sessions to educate couples about familial support during treatment. Such activities may sensitize married couples to the issue and promote familial support in these settings.Item Lift Every Voice: Informal And Formal Social Support Experiences Among African-American Gay Men 50 Years And Older Living With Hiv/Aids(2014) Jones, Rodrica Michael; Vakalahi, Halaevalu F. O.; Social Work; Doctor of PhilosophyThe purpose and goal of this qualitative hermeneutic phenomenology study was to explore and understand the informal and formal social support experiences among African-American gay men that are 50 and over living with HIV/AIDS. The data collection process included the in-depth interviews of 12 participants. The findings of this study included six themes: 1) HIV Diagnosis Challenges/Coping Abilities 2) Formal Support Resource Availability 3) Perceived Informal and Formal HIV-related stigma 5) Ageism Bias 6) HIV Medication Adherence Challenges. From a macro implications perspective, social workers, policy advocates/legislators, LGBT advocates, and medical service providers must consider ways to reduce HIV-related stigma and ageism for this vulnerable population through the facilitation of interdisciplinary teams. Interdisciplinary teams can help build an inclusive systematic environment for older African-American gay men and all LGBT populations living with HIV/AIDS.Item Socialization, Sexuality, Susceptibility, Separation: Older African American Women In The District Of Columbia's Hiv/Aids Epidemic: Is There An Imagined Exclusion?(2012) Saran, Ama Rashida; Chipungu, Sandra S.; Social Work; Doctor of PhilosophyAfrican American women represent the majority of new HIV infections and AIDS among women, making them an essential source of improved understanding for prevention more than simply another risk group. They now account for 65% of the AIDS diagnoses among women 13 years and older with a diagnosis rate of 35.1/100,000 (CDC, 2011). Three decades of the epidemic, significantly improved therapies producing greater longevity among the infected, medicalized sexuality and an increase in divorce and dating among Baby Boomers drive the CDC prediction that 50% of people with HIV/AIDS will be over 50 by 2015 (2010). Thus, this qualitative study's purpose was to better understand how older black women managed their sexual relationships and constructed sexual safety as residents of an urban disease epicenter. Social Phenomenology and Participatory Action Research (PAR) structured the overall design which used in-depth interviews of five HIV positive, five HIV negative black women, 51-69 years. The goal was to better understand the women's perceptions of separation from HIV/AIDS to prevent susceptibility translated through their lived experience as sexually active older women. The findings were analyzed through Critical Black Feminist Standpoint Theory and Social Gerontology Theory which illuminated common themes of safety nets for exemption from susceptibility among all the women whether held prior to diagnosis or currently by the HIV negative. Interpretive phenomenological analysis revealed how imagination mediates between potential and real, reflecting how what was present in each women's consciousness created the reality of separation, situating it as essential truth. Themes were: 1) religion/spirituality buffering HIV/AIDS threat and reality, 2) conscious/unconsciousness use of knowledge to negotiate relationships, 3) role of sex/sexuality for social exchange, and 4) use of proxy measures for HIV/AIDS detection/prevention in lieu of HIV testing. The implications are that there exists a critical need to significantly normalize prevention by restructuring screening/testing for older black women using the perspectives of their lived experience to improve public health, social work and behavioral research to augment the psychological literature and significantly refine practice.Item The Association Of Hiv Knowledge, Attitudes, And Beliefs With Sexual Behavior Among A Sample Of Adolescents And Young Adults In Nigeria(2012) Oguamanam, Alphonsus Chike; Wagner, Fernando A.; Public Health and Policy; Doctor of Public HealthIn 2005, more than 25 million adults and children worldwide were living with HIV/AIDS and more than 75% of these were in sub-Saharan Africa. Studies indicate that the incidence of HIV infection and the prevalence of high-risk behaviors among young populations continue to rise in developing countries. AIDS has severe economic impacts, especially in high-risk countries such as Nigeria. This dissertation project used secondary data from the 2003 Nigeria Demographic and Health Survey. The 2003 NDHS is a cross-sectional, multistage, stratified survey with systematic sampling that was designed to obtain information on key population and health indicators such as sexual activity, knowledge about AIDS and other STDs, and behavior associated with AIDS and other STDs for the entire Nigerian population, including people living in rural areas, urban areas, and six major geographic regions. Analyses were restricted to sexually active adolescents and young adults 15 to 24 years of age who are Nigerians living in Nigeria in 2003. The sample size was (n=2,418), of which 2,009 are females and 409 are males. Non-Nigerians and Nigerians in Diaspora were excluded in the original design of the survey. Also, those younger than 15 years or older than 24 years were excluded in this study. This research examined the association between independent variables and other covariates with risky sexual behaviors such as lack of condom use and multiple sex partners, as well as possible difference by gender. Odds ratios (ORs) were calculated using multivariate logistic regression models, adjusting for age, education and religion. All tests were done at 95% significant level. A descriptive analysis of variable number of sex partners showed that about 32% of participants had multiple sex partners. Among those who had access to condom 34% also reported having multiple sex partners. Results of multivariate analyses indicated that gender was significantly associated with multiple sex partners but females have lower odds of having multiple sex partners, compared to males (OR=0.48; CI=0.40, 0.56; p=<0.001). Adjusting for all covariates greatly increased the odds for multiple sex partners for females (aOR=1.09, CI=0.82, 1.46, p=0.538). Adjusted odds ratios demonstrated strong association between multiple sex partners and religion, marital status, region, place of residence, wealth index, lack of perceived threats, and lack of self-efficacy (aOR=1.22, CI=0.81, 1.84, for perceived threats & aOR=1.21, CI=0.69, 2.11, for self-efficacy). The summary odds ratios showed that unmarried youth had lower odds of multiple sex partners, compared to currently married youth (aOR=0.02, CI=0.01, 0.03, p=<001). Rural resident youth had two times higher odds of multiple sex partners, compared with urban residence youth (aOR=2.07, CI=1.25, 3.44, p=0.005). The summary odds ratios demonstrated all associations between the independent variables/or other covariates and lack of condom use were statistically significant except for age, behavior change, and attitudes towards people with. Results also showed that the odds for lack of condom use among females were 1.34 times higher, compared to their male counterparts, controlling for age, education, and religion (aOR=1.34, CI=1.10,1.64). This study concludes that HIV knowledge, attitudes, and beliefs are associated with risky sexual behavior among young people and that HIV/AIDS epidemic is also driven by young people. Therefore, interventions must respond to the low condom use among adolescents and young adult population. In addition, HIV/AIDS knowledge information must include awareness messages about the risks of multiple sex partnerships. Finally, this study concludes that, in Nigeria, high-risk behavior commences for most part during adolescence, and large proportions of these high-risk populations are younger than 25 years.Item The Association Of Locus Of Control, Social Support And Family Structure With Self-Disclosure Among Hiv Infected Adolescents Aged 13-21.(2012) Peele, Yolanda LaSalle; Hossain, Mian Bazle; Public Health and Policy; Doctor of Public HealthHuman Immunodeficiency Virus (HIV) continues to be a significant health issue in the United States. While there have been considerable advances in preventing vertical transmission of HIV (transmission from mother to child), there is still cause for concern regarding the HIV incidence rates of the youth and young adult population in the United States. Increasing rates of HIV/AIDS among this population is disturbing and with many perinatally infected youth living longer, the issue of disclosure of HIV status becomes important in preventing transmission of HIV/AIDS to uninfected individuals. Few studies have examined HIV-positive adolescents and the issue of self-disclosure. The present study seeks to explore the complexity of disclosure and the predictive effects, if any, of family structure, social support, and locus of control among a sample of adolescents infected with HIV/AIDS. A cross-sectional study of adolescents infected with HIV/AIDS (n=166) aged 13-21, receiving care in three urban areas in the United States, reported disclosure of HIV status, locus of control indicators, social support indicators, and demographic characteristics. HIV related data were abstracted from medical records. Prevalence and predictors of self-disclosure of HIV status to others were determined using bivariate and multivariate logistic regression analysis. Of 166 participants (99 perinatal, 67 behavioral), self-disclosure of serostatus was reported by 94 youth (57%): 69% to family, 32% to friends, and 43% of those sexually experienced to partners. Analyses showed that younger adolescents (13-17 years) were less likely to self-disclose than older (18-21 years) (p<0.001), as were gay, lesbian, bisexual, and questioning adolescents versus heterosexual adolescents (p<0.04), those taking antiretroviral medications (p<0.002) and those living away from their families (p<0.02). Adolescents who had acquired HIV infection behaviorally were more than twice as likely to have disclosed their status as those with perinatal acquisition (87% vs. 36%, p<0.001). Behavioral acquisition of HIV significantly predicted self-disclosure to others (Adjusted Odds Ratio = 1.03, 95% Confidence Interval = 0.01, 0.25, p<0.001). Self-disclosure of sensitive health information is difficult, particularly for adolescents with a stigmatized illness such as HIV/AIDS. While a number of possible factors were associated with self-disclosure of serostatus, only behavioral acquisition of HIV independently predicted willingness to self-disclose one's status. The comparative reticence of perinatally infected youth to self-disclose may be due to several factors, but since disclosure can be an important means of gaining support and preventing secondary transmission of HIV infection, interventions should focus on helping youth, including perinatally infected youth, share their status in a way that affords them the social support and clinical benefits they need. Disclosure can be an important means of preventing secondary transmission of HIV infection, interventions should focus on helping youth, including perinatally infected youth, share their status in a way that affords them the social support and clinical benefits they need.