DIFFERENCES IN PSYCHOPATHOLOGY AMONG SUBSTANCE USERS IN RESIDENTIAL TREATMENT RELATED TO HIV STATUS

HIV-positive individuals engage in substance use at higher rates than the general population and are more likely to also suffer from concurrent psychiatric disorders and substance use disorders. Despite this, little is known about the unique clinical concerns of HIV-positive individuals entering substance use treatment. This study examined the clinical characteristics of clients (N=1712) entering residential substance use treatment as a function of self-reported HIV status (8.65% HIV-positive). Results showed higher levels of concurrent substance use and psychiatric disorders for HIV-positive individuals, who were also significantly more likely to meet criteria for bipolar disorder and borderline personality disorder. Past diagnoses of depression, posttraumatic stress disorder, and social phobia were also significantly more common. Study findings indicate a need to provide more intensive care for HIV-positive individuals, including resources targeted at concurrent psychiatric problems, to ensure positive treatment outcomes following residential substance use treatment discharge.

Experimentally Testing the Effect of Parent-Adolescent Conflict on HIV Risk, and Investigation of a Neurobiological Moderator of This Effect

Human immunodeficiency virus (HIV) is a condition in which immune cells become destroyed such that the body may become unable to fight off infections. Engaging in risk-taking behaviors (e.g., substance use) puts people at heightened risk for HIV infection, with mid-to-late adolescents at increasing risk (Leigh & Stall, 1993). Environmental and neurological reasons have been suggested for increased risk-taking among adolescents. First, family-level precursors such as parent-adolescent conflict have been significantly associated with and may pose risk for engaging in substance use and risk-taking (Duncan, Duncan, Biglan, & Ary, 1998). Thus, parent-adolescent conflict may be an important proximal influence on HIV risk behaviors (Lester et al., 2010; Rowe, Wang, Greenbaum, & Liddle, 2008). Yet, the temporal relation between parent-adolescent conflict and adolescent HIV risk-taking behaviors is still unknown. Second, at-risk adolescents may carry a neurobiological predisposition for engaging in trait-like expressions of disinhibited behavior and other risk-taking behaviors (Iacono, Malone, & McGue, 2008). When exposed to interpersonally stressful situations, their likelihood of engagement in HIV risk behaviors may increase. To investigate the role of parent-adolescent conflict in adolescent HIV risk-taking behaviors, 49 adolescents ages 14-17 and their parent were randomly assigned to complete a standardized discussion task to discuss a control topic or a conflict topic. Immediately after the discussion, adolescents completed a laboratory risk-taking measure. In a follow-up visit, eligible adolescents underwent electrophysiological (EEG) recording while completing a task designed to assess the presence of a neurobiological marker for behavioral disinhibition which I hypothesized would moderate the links between conflict and risk-taking. First, findings indicated that during the discussion task, adolescents in the conflict condition evidenced a significantly greater psychophysiological stress response relative to adolescents in the control condition. Second, a neurobiological marker of behavioral disinhibition moderated the relation between discussion condition and adolescent risk-taking, such that adolescents evidencing relatively high levels of a neurobiological marker related to sensation-seeking evidenced greater levels of risk-taking following the conflict condition, relative to the control condition. Lastly, I observed no significant relation between parent-adolescent conflict, the neurobiological marker of behavioral disinhibition and adolescent engagement in real-world risk-taking behavior.

BLACK SURVIVAL POLITICS: ORGANIZED MOBILIZATION STRATEGIES IN AFRICAN AMERICAN COMMUNITIES TO END THE HIV/AIDS EPIDEMIC

The purpose of this study is to examine organizational patterns of African American activism in response the HIV/AIDS epidemic. Given their political, economic, and social disenfranchisement, African Americans have historically developed protest and survival strategies to respond to the devaluation of their lives, health, and well-being. While Black protest strategies are typically regarded as oppositional and transformative, Black survival strategies have generally been conceptualized as accepting inequality. In the case of HIV/AIDS, African American religious and non-religious organizations were less likely to deploy protest strategies to ensure the survival and well-being of groups most at risk for HIV/AIDS—such as African American gay men and substance abusers. This study employs a multiple qualitative case study analysis of four African American organizations that were among the early mobilizers to respond to HIV/AIDS in Washington D.C. These organizations include two secular or community-based organizations and two Black churches or faith-based organizations. Given the association of HIV/AIDS with sexual sin and social deviance, I postulated that Black community-based organizations would be more responsive to the HIV/AIDS-related needs and interests of African Americans than their religious counterparts. More specifically, I expected that Black churches would be more conservative (i.e. maintain paternalistic heteronormative sexual standards) than the community-based organizations. Yet findings indicate that the Black churches in this study were more similar than different than the community-based organizations in their strategic responses to HIV/AIDS. Both the community-based organizations and Black churches drew upon three main strategies in ways that politicalize the struggle for Black survival—or what I regard as Black survival politics. First, Black survival strategies for HIV/AIDS include coalition building at the intersection of multiple systems of inequality, as well as on the levels of identity and community. Second, Black survival politics include altering aspects of religious norms and practices related to sex and sexuality. Third, Black survival politics relies on the resources of the government to provide HIV/AIDS related programs and initiatives that are, in large part, based on the gains made from collective action.