Knowledge and perceptions about HIV/AIDS and safer sex practices among Korean-Americans in Dade County, Florida

This study was conducted to identify Korean-Americans' knowledge, perceptions, and efficacy (both self and response) relating to HIV/AIDS, as well as safer sex practices. Age, gender, education, Confucianism, religion, and acculturation were also examined for potential relationships with the main variables. A total of 200 Korean-Americans in Dade County, Florida, participated in the study. The mean age of the participants was 32.6 years (range 19-55). The AIDS Risk Assessment Questionnaire (ARA-Q) derived from the AIDS Risk Measurement Study Questionnaire (ARMS-Q) and the Risk Behavior Assessment (RBA) were used for data collection. The overall mean score of HIV/AIDS knowledge was 12.3 (77%) out of a possible 16. Knowledge, and perceptions about HIV/AIDS were not related to safer sex practices. Significant correlations between attitudes toward condoms and the frequency of condom use during oral intercourse were evident. Male subjects reported more sexual partners in their lifetime and more frequent condom use during vaginal intercourse during the last year than female subjects. The number of sexual partners in the last year was not related to perceived HIV/AIDS susceptibility and response-efficacy among men or women, but response-efficacy positively correlated to frequency of condom use among both genders. Acculturation scores were positively correlated with the number of sexual partners and the frequency of condom use during vaginal intercourse for men and women. Further research is needed to determine factors that may increase the cultural relevance of AIDS prevention strategies to the Korean-American community. The findings of this study may be used as a basis for designing culturally-sensitive HIV/AIDS education programs to reach various segments of this ethnic community. ^

Substance use and sexual risk behaviors among adolescent detainees

There is a commonly presumed link among sexual risk behavior, substance use, and other psychosocial factors among adolescents. However, these relationships have been relatively understudied in detained, low-income, minority, substance abusing adolescents. This study addresses this gap in the literature with a secondary data analysis based on a sample of adolescent offenders in two detention and treatment centers in Miami-Dade County. Univariate, bivariate statistical analysis and multivariate logistic regressions were conducted on baseline data from structured interviews with 455 adolescents participating in an NIH funded prevention intervention. Data were analyzed to assess relationships among self-reported substance use, STD history, HIV/AIDS knowledge, condom use, condom use attitudes, and skills, peer and parental approval to use condoms, and race/ethnicity. The adolescent sample was 74.1% male, and 25.9% female and 35.4% African American, 25.1% non-African American Latino, 11.2% White, and 28.4% of other race/ethnicity categories. The mean age was 15.6 years. Results suggested that alcohol use (p < 0.001) and use of marijuana, cocaine and other drugs (p < 0.001) are significant variables when explaining the variability in sexual risk behaviors. Results also suggested that unprotected vaginal, anal, and oral sex increased with higher alcohol and drug use (p < 0.001) and that positive attitudes about personally using condoms (p < 0.001) were also significantly related to condom use. Logistic regressions showed that race/ethnicity was a significant control variable when explaining the variability of condom use. Being White and Latino were significantly associated with less condom use during oral and anal sex when compared to other racial/ethnic groups. These results indicated that risky sexual behavior and HIV infection risk are significantly associated with substance use, particularly alcohol use. Therefore, proper screening and identification of alcohol use, and condom use attitudes could maximize the efficacy of referrals to programs targeting both issues and increase the potential for appropriate primary and secondary prevention and treatment among adolescent detainees.

The effectiveness of an enhanced cognitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The E-CB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk-taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. ^ The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. ^ This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population. ^

Stress Urinary Incontinence in Female Athletes

Objective: The purpose of this study is to educate allied health professionals and female athletes of the anatomy of the pelvic floor, and the pathology, etiology, and prevalence of stress urinary incontinence in female athletes. Background: Urinary incontinence is not a life-threatening or dangerous condition, but it is socially embarrassing, may cause the individual to remove herself from social situations, and decrease quality of life. While typically associated with parous women who had vaginal delivery, research has shown prevalence of the condition in physically active women of all ages. Stress urinary incontinence has shown to lead to withdrawal from participation in high-impact activities such as gymnastics, aerobics, and running. It may be considered a barrier for life-long athletics participation in women. Description: An in-depth introduction to the cause and origin of stress urinary incontinence including review of the female pelvic floor anatomy and prevalence of stress urinary incontinence in the female athletic population. Clinical Advantages: Athletic trainers and other allied health professionals will develop an understanding of the multiple mechanisms that cause stress urinary incontinence. Clinician competency of the dynamics and mechanism of urinary incontinence prepares the individual to learn diagnostics, prevention, pharmacological intervention, and treatment of this pathology.

Epidemiologic Features of Vulvovaginal Candidiasis among Reproductive-Age Women in India

Background. Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs. Materials and Methods. We examined the incidence, prevalence, and risk factors for vulvovaginal candidiasis among a cohort of 898 women in south India. Participants completed three study visits over six months, comprised of a structured interview and a pelvic examination. Results. The positive predictive values for diagnosis of vulvovaginal candidiasis using individual signs or symptoms were low (<19%). We did not find strong evidence for associations between sociodemographic characteristics and the prevalence of vulvovaginal candidiasis. Women clinically diagnosed with bacterial vaginosis had a higher prevalence of vulvovaginal candidiasis (Prevalence 12%, 95% CI 8.2, 15.8) compared to women assessed to be negative for bacterial vaginosis (Prevalence 6.5%, 95% 5.3, 7.6); however, differences in the prevalence of vulvovaginal candidiasis were not observed by the presence or absence of laboratory-confirmed bacterial vaginosis. Conclusions. For correct diagnosis of vulvovaginal candidiasis, laboratory confirmation of infection with Candida is necessary as well as assessment of whether the discharge has been caused by bacterial vaginosis. Studies are needed of women infected with Candida yeast species to determine the risk factors for yeast’s overgrowth.

Social capital, HIV risk behavior and substance use among recent Latino immigrants in South Florida

Social capital, or social cohesion or group connectedness, can influence both HIV risk behavior and substance use. Because recent immigrants undergo a change in environment, one of the consequences can be a change in social capital. There may be an association among changes in social capital, and HIV risk behavior and substance use post immigration. The dissertation focused on the interface of these three variables among recent Latino immigrants (RLIs) in South Florida. The first manuscript is a systematic review of social capital and HIV risk behavior, and served as a partial background for the second and third manuscripts. Twelve papers with a measure of social capital as an independent variable and HIV risk as the dependent variable were included in the analysis. Eleven studies measured social capital at the individual level, and one study measured social capital at the group level. HIV risk was influenced by social capital, but the type of influence was dependent on the type of social capital and on the study population. Cognitive social capital, or levels of collective action, was protective against HIV in both men and women. The role of structural social capital, or levels of civic engagement/group participation, on HIV risk was dependent on the type of structural social capital and varied by gender. Microfinance programs and functional group participation were protective for women, while dysfunctional group participation and peer-level support may have increased HIV risk among men. The second manuscript was an original study assessing changes in social capital and HIV risk behavior pre to post immigration among RLIs in South Florida (n=527). HIV risk behavior was assessed through the frequency of vaginal-penile condom use, and the number of sexual partners. It was a longitudinal study using secondary data analysis to assess changes in social capital and HIV risk behavior pre immigration to two years post immigration, and to determine if there was a relationship between the two variables. There was an 8% decrease in total social capital (p < .05). Reporting of 'Never use' of condoms in the past 90 days increased in all subcategories (p < .05). Single men had a decrease in number of sexual partners (p < .05). Lower social capital measured on the dimension of 'friend and other' was marginally associated with fewer sexual partners. The third manuscript was another original study looking at the association between social capital and substance use among RLIs in South Florida (n=527). Substance use with measured by frequency of hazardous alcoholic drinking, and illicit drug use. It was a longitudinal study of social capital and substance-use from pre to two years post immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased (p<.001). After adjusting for time, compared to males, females were less likely to engage in hazardous drinking (OR=.31, p<.001), and less likely to engage in illicit drug use (OR=.67, p=.01). Documentation status was a moderator between social capital and illicit drug use. 'Business' and 'Agency' social capital were associated with changes in illicit drug use for documented immigrants. After adjusting for gender and marital status, on average, documented immigrants with a one-unit increase in 'business' social capital were 1.2 times more likely to engage in illicit drug use (p<.01), and documented immigrants with one-unit increase in 'agency' social capital were 38% less likely to engage in illicit drug use (p<.01). 'Friend and other' social capital was associated with a decrease in illicit drug use among undocumented immigrants. After adjusting for gender and marital status, on average, undocumented immigrants with a one-unit increase in 'friend and other' social capital were 45% less likely to engage in hazardous drinking and 44% less likely to use illicit drugs (p<.01, p<.05). Studying these three domains is relevant because HIV continues to be a public health issue, particularly in Miami-Dade County, which is ranked among other U.S. regions with high rates of HIV/AIDS prevalence. Substance use is associated with HIV risk behavior; in most studies, increased substance use is associated with increased chances of HIV risk behavior. Immigration, which is the hypothesized catalyst for the change in social capital, has an impact on the dynamic of a society. Greater immigration can be burdensome on the host country's societal resources; however immigrants are also potentially a source of additional skilled labor for the workforce. Therefore, successful adaption of immigrants can have a positive influence on receiving communities. With Florida being a major receiver of immigrants to the U.S, this dissertation attempts to address an important public health issue for South Florida and the U.S. at large.

The effectiveness of an enhanced congnitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The ECB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk- taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population.

The influence of gene environment interaction on the risk of cognitive impairment: Reducing sexual risk behaviors and alcohol use in HIV-infected adults

Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life, antiretroviral adherence, and HIV risk behaviors. Several factors have been suggested including the role of genetics in relation to HIV disease progression. This dissertation aimed to determine whether genetic differences in HIV-infected individuals were correlated with impaired memory, cognitive flexibility and executive function and whether cognitive decline moderated alcohol use and sexual transmission risk behaviors among HIV-infected alcohol abusers participating in an NIH-funded clinical trial comparing the efficacy of the adapted Holistic Health Recovery Program (HHRP-A) intervention to a Health Promotion Control (HPC) condition in reducing risk behaviors. ^ A total of 267 individuals were genotyped for polymorphisms in the dopamine and serotonin gene systems. Results yielded significant associations for TPH2, GALM, DRD2 and DRD4 genetic variants with impaired executive function, cognitive flexibility and memory. SNPs TPH2 rs4570625 and DRD2 rs6277 showed a risk association with executive function (odds ratio = 2.5, p = .02; 3.6, p = .001). GALM rs6741892 was associated with impaired memory (odds ratio = 1.9, p = .006). At the six-month follow-up, HHRP-A participants were less likely to report trading sex for food, drugs and money (20.0%) and unprotected insertive or receptive oral (11.6%) or vaginal and/or anal sex (3.2%) than HPC participants (49.4%, p^

The Influence of Gene Environment Interaction on the Risk of Cognitive Impairment: Reducing Sexual Risk Behaviors and Alcohol Use in HIV-infected Adults

Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life, antiretroviral adherence, and HIV risk behaviors. Several factors have been suggested including the role of genetics in relation to HIV disease progression. This dissertation aimed to determine whether genetic differences in HIV-infected individuals were correlated with impaired memory, cognitive flexibility and executive function and whether cognitive decline moderated alcohol use and sexual transmission risk behaviors among HIV-infected alcohol abusers participating in an NIH-funded clinical trial comparing the efficacy of the adapted Holistic Health Recovery Program (HHRP-A) intervention to a Health Promotion Control (HPC) condition in reducing risk behaviors. A total of 267 individuals were genotyped for polymorphisms in the dopamine and serotonin gene systems. Results yielded significant associations for TPH2, GALM, DRD2 and DRD4 genetic variants with impaired executive function, cognitive flexibility and memory. SNPs TPH2 rs4570625 and DRD2 rs6277 showed a risk association with executive function (odds ratio = 2.5, p = .02; 3.6, p = .001). GALM rs6741892 was associated with impaired memory (odds ratio = 1.9, p = .006). At the six-month follow-up, HHRP-A participants were less likely to report trading sex for food, drugs and money (20.0%) and unprotected insertive or receptive oral (11.6%) or vaginal and/or anal sex (3.2%) than HPC participants (49.4%, p