Search

HIV disproportionately impacts young African American men who have sex with men (MSM). In this study, we sought to understand how previous relationship experiences and expectations for romantic relationships influence condom use among young African American MSM. Twenty African American MSM aged 16 to 24 years completed a semi-structured interview and questionnaire on sexual experiences, romantic relationships, and sexual behavior. We identified three major themes characterizing romantic male-male relationships: (1) partner selection, (2) relationship ideals and expectations, and (3) relationship rules for condom use. Our findings indicate that young African American MSM rely on previous relationship experiences and desires for romantic relationships to determine condom use in subsequent relationships. Participants revealed that their previous relationship experiences and desires are often in conflict with their descriptions of their ideal romantic relationships and subsequently influence their condom use. Our findings fill a gap in the literature describing male-male romantic relationships and condom use among young African American MSM.

Generalized perceived powerlessness is an important psychosocial construct that determines a wide range of health behaviors and outcomes. This study has two aims: (1) examine the structure of the newly developed perceived powerlessness scale using exploratory and confirmatory factor analyses and (2) assess the scale's invariance across key demographic variables using multi-group confirmatory factor analysis among a random household sample of African American and White youth (aged 15–24 years) residing in Baltimore, MD. Our study results demonstrated that the powerlessness scale is valid among a demographically diverse sample of urban youth, showing promise for use in future health behavior and outcome studies. [ABSTRACT FROM AUTHOR]

Youth living with HIV have sub-optimal rates of adherence to antiretroviral therapy (ART). Mindfulness instruction interventions have shown promise for improving medication adherence, but the effects and mechanisms of these interventions are still being explored among people living with HIV, including youth. In the context of a randomized controlled trial of the efficacy of a Mindfulness-Based Stress Reduction (MBSR) program on ART adherence and viral suppression among youth living with HIV, we conducted 44 iterative, semi-structured, in-depth interviews with 20 study participants (13-24 years) recruited from clinics at two academic centers in Baltimore, Maryland. Interviews explored the social context and psychosocial dynamics of ART adherence in the context of the MBSR intervention, compared with those in a control arm. We employed thematic content analysis to systematically code and synthesize textual interview data. Participants’ challenges with ART adherence were often situated within an ongoing process of working to manage HIV as a stigmatized, chronic condition in addition to other intersecting social stigmas, inequalities, and stressors. Participation in the MBSR program and related group support allowed participants to non-judgmentally observe and accept difficult thoughts, feelings, and experiences associated with living with HIV and taking ART, which facilitated greater reported adherence. Mindfulness training may stimulate new perspectives and understanding, including greater self- and illness-acceptance among youth living with HIV, leading to improved HIV outcomes. [ABSTRACT FROM AUTHOR]

Adolescents and young adults living with HIV (YLHIV) face numerous stresses that affect their care and medication adherence. The clinic social environment may play an important supportive role for YLHIV, influencing health outcomes. The aim of this article is to explore how YLHIV in Baltimore, Maryland understand the various forms of social support provided within the social environment of their HIV clinic. We used qualitative research methods including iterative, semi-structured in-depth interviews with 20 YLHIV interviewed up to three times each to explore HIV stressors, support systems, and medication adherence. We employed thematic content analysis to systematically code and synthesize textual interview data. We found that YLHIV experienced social embeddedness with their healthcare teams and through clinic activities. Participants largely perceived these social connections as support, acknowledging that these supports are available to them when needed. Support was enacted through the provision of instrumental support for issues outside of the young person's medical care (i.e., finding a crib for a participant's baby), appraisal (i.e., through respect of the young person's agency and decision making), and information about their HIV care and medication. Support was not always well received, however, as some young people found the support from clinicians demeaning. Limitations of the clinic social support environment included concerns about trust and privacy, and perceiving support as inappropriate or unwanted. Participants identified a number of ways in which the clinic provided meaningful social support. Future research should explore how these supports may improve care and medication adherence of YLHIV. [ABSTRACT FROM AUTHOR]

Sexual concurrency may increase risk for HIV/STIs among youth. Attitudes about gender roles, including power balances within sexual partnerships, could be a driver. We examined this association among Baltimore youth (N = 352), aged 15-24. Data were collected from February, 2011 to May, 2013. We examined whether index concurrency in male-reported partnerships (N = 221) and sex partner's concurrency in female-reported partnerships (N = 241) were associated with youth's attitudes towards relationship power. Males with more equitable beliefs about power were less likely to report index concurrency. Females with more equitable beliefs were more likely to report sex partner's concurrency. The relationship was significant in main and casual partnerships among females and main partnerships among males. The strongest associations were detected among middle-socioeconomic status (SES) males and low-SES and African American females. Implementing interventions that recognize the complex relationship between socioeconomic context, partner dynamics, gender, and sexual behavior is an important step towards reducing HIV/STI risk among youth. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. The social determinants of health (SDH) include factors apart from genes and biology that affect population health. Zoning is an urban planning tool that influences neighborhood built environments. We describe the methods and results of a health impact assessment (HIA) of a rezoning effort in Baltimore, Maryland, called TransForm Baltimore. We highlight findings specific to physical activity, violent crime, and obesity. Methods. We conducted a multistage HIA of TransForm Baltimore using HIA practice guidelines. Key informant interviews identified focus areas for the quantitative assessment. A literature review and a zoning code analysis evaluated potential impacts on neighborhood factors including physical activity, violent crime, and obesity. We estimated potential impacts in high- and low-poverty neighborhoods. The findings resulted in recommendations to improve the health-promoting potential of TransForm Baltimore. Results. Mixed-use and transit-oriented development were key goals of TransForm Baltimore. Health impacts identified by stakeholders included walkability and healthy communities. For Baltimore residents, we estimated that (1) the percentage of people living in districts allowing mixed-use and off-premise alcohol outlets would nearly triple, (2) 18% would live in transit-oriented development zones, and (3) all residents would live in districts with new lighting and landscaping guidelines. Limiting the concentration of off-premise alcohol outlets represented an opportunity to address health promotion. Conclusions. Changes to Baltimore's zoning code could improve population health including decreasing violent crime. HIAs are an important platform for applying SDH to public health practice. This HIA specifically linked municipal zoning policy with promoting healthier neighborhoods. [ABSTRACT FROM AUTHOR]

This paper examines the activities of churches in Baltimore, Maryland, concerning the issues of sexuality, whether they potentially stigmatize persons with or at risk for HIV/AIDS, and to what extent individual agency versus institutional forces influence churches in this regard. In-depth interviews were conducted with 20 leaders from 16 churches and analyzed using a grounded theory methodology. Although many churches were involved in HIV/AIDS-related activities, the content of such initiatives was sometimes limited due to organizational constraints. Church leaders varied, however, in the extent to which they responded in accordance with or resisted these constraints, highlighting the importance of individual agency influencing churches' responses to HIV/AIDS. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)-infected and at-risk urban youth. Methods: Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data-attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile-Adolescent Edition)-and qualitative data-in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre- and postintervention surveys and content analysis of interviews. Results: Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered 'program completers.' Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility ( p = 0.02), general discomfort ( p = 0.01), and emotional discomfort ( p = 0.02). Qualitative data ( n = 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress. Conclusions: The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains. [ABSTRACT FROM AUTHOR]

Objectives: Qualitative research suggests that young women's relationships with the biological fathers of their children (BFRs), known colloquially as 'baby daddy' relationships, enable risk for pregnancy and STI/HIV. Our study compared partner characteristics and sexual risk within dyads based on BFR, among a sample of young women in Baltimore, Maryland, USA.Methods: We conducted secondary analysis of survey data collected in 2011-2013 from heterosexually experienced youth ages 15-24 in Baltimore, Maryland, USA. Analyses are limited to women with at least one recent (past 6 months) sex partner (n=171 participants, reporting on 271 relationships). Using generalised estimating equations with logit function for correlated binary responses, we evaluate associations of BFR with partner characteristics, sexual risk behaviour and contraceptive non-use.Results: At least one BFR partner was reported by 25.2%. Male partners in BFRs were more likely to have been incarcerated or arrested. BFRs were more often characterised by women as 'main' versus 'casual' partners (adjusted OR (AOR) 3.92, 95% CI 1.19 to 12.9). In adjusted analyses, BFR was associated with condom non-use for vaginal (AOR 12.3, 95% CI 3.92 to 38.7) and anal (AOR 3.32, 95% CI 1.34 to 8.22) intercourse. While BFR was associated with contraceptive non-use (AOR 2.21, 95% CI 1.01 to 4.84), this association attenuated to non-significance after adjusting for partnership type (AOR 2.06, 95% CI 0.91 to 4.67).Conclusions: While few differences in BFR partner characteristics emerged, significantly greater risk for unprotected intercourse was identified within BFR relationships. Findings suggest that the relationship context of a shared child heightens sexual risk for the young women most affected by STI. [ABSTRACT FROM AUTHOR]

The article attempts to determine whether shifts in syphilis epidemic phases are associated with changes between or within high-risk populations, using the data from Baltimore, Maryland. The authors retrospectively define epidemic phases and compare epidemiologic profiles of syphilis cases infected during epidemic phase. Results show that the shift from a decline to growth phase in Baltimore was mostly because of increases in morbidity among non-African American men who have sex with men (MSM) and young, noninjecting drug-using women. They underscore the need for real-time investigation of potential tipping points to ensure interventions are properly focused at the beginning of any potential growth phase.

This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with 50 African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention. [ABSTRACT FROM AUTHOR]

The relationship between neighborhood social dynamics and adolescent sexual behavior has not been well explored. We conducted a cross-sectional survey with 343 adolescents recruited from two health clinics in Baltimore. Multivariate logistic regression was utilized to assess the influence of perceived neighborhood social cohesion and collective monitoring of youth on condom use at last sex, controlling for family and individual factors. Condom use was significantly higher among participants who perceived their neighborhoods as high, 54.7%, versus low, 40.4%, in social cohesion. Neighborhood cohesion was significantly associated with condom use in multivariate analyses, as was parental communication, family structure, and gender. No association between perceived neighborhood collective monitoring of youth and condom use was found. We conclude that perceived neighborhood social cohesion is positively associated with condom use among adolescents vulnerable to HIV/STI and should be encouraged in the context of community-based prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Traditional syphilis control tools could be limited in high-risk groups in which the disease is concentrated. Novel programmatic methods such as tracking and targeting sex partner meeting venues could be valuable.Goal: The goals of this study were to determine if syphilis cases' sex partner meeting venues are geographically different than their residences and to determine the characteristics of identified meeting places.Results: For cases diagnosed from September 2001 to December 2002 with geocodable data, only 9% of meetings took place in the same census block group as residence, and mean and median distance from residence to meeting place was 1.73 and 1.03 miles. The most common meeting location type overall was a street or corner, but differed by risk behaviors.Conclusion: Baltimore syphilis cases in general met sex partners outside their immediate neighborhoods. Meeting locations could provide new targets for syphilis control interventions. [ABSTRACT FROM AUTHOR]

Baltimore, Maryland ranks among U.S. cities with the highest incidence of HIV infection among men who have sex with men (MSM). HIV screening at sex partner meeting places or venues frequented by MSM with new diagnoses and/or high HIV viral load may reduce transmission by identifying and linking infected individuals to care. We investigated venue-based clustering of newly diagnosed MSM to identify high HIV transmission venues. HIV surveillance data from MSM diagnosed between October 2012–June 2014 and reporting ≥1 sex partner meeting place were examined. Venue viral load was defined according to the geometric mean viral load of the cluster of cases that reported the venue and classified as high (>50,000 copies/mL), moderate (1500–50,000 copies/mL), and low (<1500 copies/mL). 143 MSM provided information on ≥1 sex partner meeting place, accounting for 132 unique venues. Twenty-six venues were reported by > 1 MSM; of these, a tightly connected cluster of six moderate viral load sex partner meeting places emerged, representing 66% of reports. Small, dense networks of moderate to high viral load venues may be important for targeted HIV control among MSM. [ABSTRACT FROM AUTHOR]

Purpose: Places are an important determinant of risk for sexually transmitted infection (STI) acquisition and transmission. We sought to identify social places that are critical for targeted STI control activities. The objective of this study was to determine whether sex partner meeting places characterized by drug markets, sex markets, and separately, drug and/or sex markets were more likely to have potential core transmitters as compared with other sex partner meeting places in one urban setting.Methods: In 2008-2009, heterosexual sex partner places or venues were identified in Baltimore, MD using a venue-based study approach.Results: A total of 1334 participants aged 18 to 35 years were enrolled at 85 venues. In those participants, 39 potential core transmitters were identified and 31% of venues had at least one potential core transmitter. In final age-adjusted and gender-adjusted models, core transmitters were significantly more likely to be identified at drug markets (OR = 1.37; 95% CI = 1.23-1.53), sex markets (OR = 1.27; 95% CI = 1.14-1.41), and drug and/or sex markets (OR = 1.49; 95% CI = 1.32-1.68).Conclusions: This study identified key characteristics of venues, such as drug and sex market activity, that may be important in identifying places for the targeted control of STI transmission. [ABSTRACT FROM AUTHOR]

This study explored the relationship between the social organization of neighborhoods including informal social control and social cohesion and a current bacterial sexually transmitted infection (STI) among adolescents and young adults in one U.S. urban setting. Data for the current study were collected from April 2004 to April 2007 in a cross-sectional household study. The target population included English-speaking, sexually-active persons between the ages of 15 and 24 years who resided in 486 neighborhoods. The study sample included 599 participants from 63 neighborhoods. A current bacterial STI was defined as diagnosis of a chlamydia and/or gonorrhea infection at the time of study participation. Participants reported on informal social control (i.e. scale comprised of 9 items) and social cohesion (i.e. scale comprised of 5 items) in their neighborhood. In a series of weighted multilevel logistic regression models stratified by gender, greater informal social control was significantly associated with a decreased odds of a current bacterial STI among females (AOR 0.53, 95% CI 0.34, 0.84) after controlling for individual social support and other factors. The association, while in a similar direction, was not significant for males (AOR 0.73, 95% CI 0.48, 1.12). Social cohesion was not significantly associated with a current bacterial STI among females (OR 0.85, 95% CI 0.61, 1.19) and separately, males (OR 0.98, 95% CI 0.67, 1.44). Greater individual social support was associated with an almost seven-fold increase in the odds of a bacterial STI among males (AOR 6.85, 95% CI 1.99, 23.53), a finding which is in contrast to our hypotheses. The findings suggest that neighborhood social organizational factors such as informal social control have an independent relationship with sexual health among U.S. urban youth. The causality of the relationship remains to be determined. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to determine whether the syphilis epidemic in Baltimore City during the mid-1990s was associated with changes in sexual networks. Methods: Data on index cases of syphilis and their partners were collected from 1996 to 2000 and entered into CDC STD*MIS software. Unique pairs of dyads were used to create networks using SAS Inter- active Matrix Language. PAJEK and UCINET were used to analyze the largest component from all years (1996-2000), during the epidemic (1997-1998), and after the epidemic (1999-2000). Results: Between 1996 and 2000, there were 3343 components containing 18,709 nodes. The 2 largest components were comprised of 1103 nodes and 125 nodes, respectively. From the period during the epidemic to after the epidemic, the average distance among reachable pairs, network centralization, number of n-cliques (n = 2, size = 3), and number of k-plexes (k = 2, n = 3) declined, whereas the block densities increased. Conclusions: Important differences exist between the sexual net- works during and after the syphilis epidemic. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Many urban youth experience significant and unremitting negative stressors, including those associated with community violence, multigenerational poverty, failing educational systems, substance use, limited avenues for success, health risks, and trauma. Mindfulness instruction improves psychological functioning in a variety of adult populations; research on mindfulness for youth is promising, but has been conducted in limited populations. Informed by implementation science, we evaluated an adapted mindfulness-based stress reduction (MBSR) program to ameliorate the negative effects of stress and trauma among low-income, minority, middle school public school students. METHODS; Participants were students at two Baltimore City Public Schools who were randomly assigned by grade to receive adapted MBSR or health education (Healthy Topics [HT]) programs. Self-report survey data were collected at baseline and postprogram. Deidentified data were analyzed in the aggregate, comparing MBSR and HT classes, by using regression modeling. RESULTS: Three hundred fifth- to eighth-grade students (mean 12.0 years) were in MBSR and HT classes and provided survey data. Participants were 50.7% female, 99.7% African American, and 99% eligible for free lunch. The groups were comparable at baseline. Postprogram, MBSR students had significantly lower levels of somatization, depression, negative affect, negative coping, rumination, self-hostility, and posttraumatic symptom severity (all Ps < .05) than HT. CONCLUSIONS: These findings support the hypothesis that mindfulness instruction improves psychological functioning and may ameliorate the negative effects of stress and reduce trauma-associated symptoms among vulnerable urban middle school students. Additional research is needed to explore psychological, social, and behavioral outcomes, and mechanisms of mindfulness instruction. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate care delivery patterns in patients treated for pelvic inflammatory disease in pediatric outpatient settings and to determine the effect of practice type on care delivery., Design/setting: Retrospective review of medical records for patients treated as outpatients in an urban academic pediatric facility. Care patterns were evaluated according to the Centers for Disease Control sexually transmitted disease guidelines., Participants: Fifty-six adolescent patients who were diagnosed with pelvic inflammatory disease in pediatric ambulatory settings between January 1, 2002, and December 31, 2002., Main Outcome Measures: Demographic information, documented patient history and examination, laboratory data, and discharge instructions., Results: Forty percent of patients were prescribed inadequate courses of medications. Patients who were seen in the pediatric emergency department were less likely to receive a standard medication regimen than those seen in the ambulatory setting. Most patients did not receive adequate instruction for self-care on review of written discharge instructions, and there were no differences based on location of care., Conclusions: Many adolescents treated as outpatients for pelvic inflammatory disease may not receive adequate medications and instructions for self-care at discharge in pediatric ambulatory settings. This study suggests a need for aggressive quality improvement measures to enhance the care of adolescents with pelvic inflammatory disease in pediatric outpatient settings.

Background: Effective syphilis control and elimination require community effort and innovative case-finding techniques, especially to identify infected persons from core transmission groups., Goal: To summarize the implementation and outcomes of a community-oriented response to a localized outbreak of syphilis directed at sex partner meeting places., Study Design: Syphilis surveillance and rapid response data from a 7-month period were analyzed for risk behaviors, sex partner meeting locations, field investigation outcomes, and social and sexual network connections., Results: Four (6%) of the sixty-nine persons tested were confirmed syphilis reactors, of whom three were new cases. A sexual and needle-sharing network of 15 persons was identified that included two of the new syphilis cases. These two had not been found through standard field investigation., Conclusions: Targeting interventions to sex partner meeting places may effectively complement traditional syphilis control tools and find previously unidentified syphilis cases in high-morbidity areas.