Master of Sciences, Case Western Reserve University, 2009, Epidemiology and Biostatistics

Understanding sexual behaviors of persons on Antiretroviral therapy(ART) is critical designing and implementation of positive prevention programs. 559 HIV infected adults were enrolled in clinic based prospective observational study and sexual behaviors ascertained at ART initiation and semi-annually thereafter. Using Logistic regression with generalized estimating equations, factors associated with sexual activity and unprotected sex were examined. Over the first three years of ART, the proportion sexually active did not change at ~52% (χ2 Trend, p=0.94) while the proportion reporting unprotected sex decreased (χ2 Trend, p<0.0001). Men reported unprotected sex less often than women (p<0.0001). In all analyses, having no children and female gender (controlling for any other factors) was associated with the practice of unprotected sex. The interventional effect of comprehensive HIV care resulted in marked reductions in unprotected sex particularly among men. Strengthening of positive prevention interventions, especially among females are needed in ART programs in this setting.

Committee: Ajay Sethi Phd,MHS (Committee Chair); Christopher Whalen MD, MS (Committee Member); Jeffrey Albert Phd (Committee Member) Subjects: Biostatistics; Epidemiology; Health; Health Care; Virology

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2021, Health Programs

Routine HIV testing for adults 65 years and older is imperative for prevention and treatment efforts among the vulnerable population. To date, limited research exists that examines associations between sex in HIV testing, HIV risk perception, and HIV risk among adults who are 65 years and older. Certain risk behaviors can lead to missed testing opportunities for some Medicare beneficiaries aged 65 and older, increasing the likelihood of new HIV transmissions and late-stage diagnoses. A federal mandate requires that Medicare Part B (outpatient insurance) cover annual wellness visits, which allow providers and beneficiaries to develop personalized prevention plans of care. However, Medicare does not offer routine HIV testing to beneficiaries 65 years and older, unless they specifically ask for a test (risk perception) or considered at risk (actual risk). This quantitative, cross-sectional, causal-comparative research design was guided by the health belief model (HBM) and theory of gender and power (TGP). Chi-square tests analyzed secondary data from the 2018 National Health Interview Survey, Adult Sample file regarding HIV testing, HIV risk perception and HIV risk among non-institutionalized adults, 65 years and older. The significance of statistical tests was determined at the .05 alpha level. Study findings revealed a significant association between sex and HIV testing prevalence, with men (24.3%) testing more frequently than do women (20.1%). Findings also revealed a significant association between sex and HIV risk. Men (41%), when compared to women (22%), were almost twice as likely to have at least one factor increasing HIV risk. There was no significant association between sex and HIV risk perception. Findings revealed that both men (99.6%) and women (99.6%) equally lacked HIV risk perception.

Committee: Mary Bynum DHA (Committee Chair); Cynthia Smoak DHA (Committee Member); Chenelle Jones PhD (Committee Member) Subjects: Aging; Gender Studies; Gerontology; Health; Health Care; Health Care Management; Health Education; Public Administration; Public Health; Public Health Education

Doctor of Philosophy, Case Western Reserve University, 2021, Nursing

Pre-exposure prophylaxis (PrEP) effectively reduces the risk of Human Immunodeficiency Virus (HIV) infection. PrEP implementation in public health clinics is suggested for increasing PrEP access; However, it is unclear if these venues can reduce the disparities in PrEP use that are observed for Black and Latinx adults. We analyzed data from health departments completing their first PrEP program year between June 1, 2016 and June 30, 2019. We estimated PrEP coverage and adherence in Black and Latinx clients. Semi-structured interviews were conducted with multidisciplinary public health workers (n=6). The Consolidated Framework for Implementation guided a thematic analysis of interviews. Of the 433 PrEP clients, 52.0% were non-Hispanic Black and 8.9% were Hispanic/Latinx. PrEP to need ratios were greater for White clients than for Black or Latinx clients at five of the nine health departments. The average medication possession ratio for Black and Latinx PrEP clients (.79) approached effective daily adherence levels. However, a single prescription was filled for 25.0% of Black and Latinx clients. Qualitative data indicated compatibility issues between PrEP services delivery and community preferences and needs. Challenges integrating longitudinal follow-up practices, and complex PrEP re-enrollment procedures emerged as additional factors influencing PrEP outcomes. The results of this dissertation indicate that public health clinics vary in their ability to deliver all components of PrEP clinical monitoring and in their ability to increase PrEP coverage in Black and Latinx adults. Tailoring of PrEP services to Black and Latinx adults may be necessary to optimize PrEP coverage and adherence.

Committee: Allison Webel PhD, RN (Committee Chair); Mary Dolansky PhD, RN (Committee Member); Patricia Higgins PhD, RN (Committee Member); Darcy Freedman PhD, MPH (Committee Member) Subjects: Nursing; Public Health

PhD, University of Cincinnati, 2019, Arts and Sciences: Psychology

One in 23 substance using women are likely to become HIV-positive within their lifetime at the current transmission rates (CDC, 2017). Transactional sex is one behavior that could be attributed to the increased HIV rate among this population. Transactional sex is often associated with increased sexual risk behaviors and higher rates of HIV. Despite the HIV risk associated with transactional sex, few studies target transactional sex for HIV prevention. Utilizing a Community-Based Participatory Research (CBPR) approach, the current study aims to reduce this gap. The current study occurred in two phases. The first phase aimed to collaborate with the target population by forming a community/academic partnership to develop an intervention aimed at reducing HIV risk associated with transactional sex. The second phase of the study aimed to test the effectiveness of the intervention in comparison to a control. It was hypothesized that individuals receiving the intervention would report higher intention to engage in future behaviors associated with decreased HIV risk than controls. During Phase I, the community/academic partnership was comprised of five women with a history of substance use and transactional sex as well as three academic research members. Through a series of four meetings the group defined transactional sex, identified three areas associated with decreasing HIV risk (i.e., effective communication, self-esteem, and economic independence), and collaboratively developed the intervention. Participants in Phase II were a group of 65 women who were enrolled in substance use treatment and reported a history of transactional sex. All eligible participants provided informed consent and were assigned to either the control group (n = 26) or the intervention group (n = 39). Descriptive information was collected at baseline. Participants also completed a modified version of the Intent to Engage Safer Sex and the Expectation to Engage in Safer Sex subscales of t (open full item for complete abstract)

Committee: Bridgette Peteet Ph.D. (Committee Chair); Ann Kathleen Hoard Burlew Ph.D. (Committee Member); Farrah Jacquez Ph.D. (Committee Member); Carolette Norwood Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy, The Ohio State University, 2019, Public Health

Introduction: Lifelong treatment for HIV-infected women offers profound benefits in terms of the prevention of mother-to-child transmission of HIV (PMTCT) and disease management, though poor adherence to antiretroviral drugs (ARV) and disengagement from PMTCT care can jeopardize these benefits. Insights from the field of behavioral economics reveal that high temporal discounting can lead to risky health behaviors, and these findings have informed the development of interventions, such conditional cash transfers (CCT), to mitigate these effects. Few studies, however, have directly assessed the effects of temporal discounting on behaviors relating to HIV prevention and treatment, and none have evaluated these effects among pregnant and breastfeeding women. Further, few studies have assessed the role of temporal discounting on the effect CCT or other similar interventions providing conditional economic incentives to improve behaviors relating to HIV treatment and prevention. Methods: We conducted a secondary analysis of data from a randomized controlled trial (RCT) conducted in Kinshasa, the Democratic Republic of Congo, which assessed the effect of a CCT intervention on retention in PMTCT care, adherence to ARV and viral suppression among newly-diagnosed HIV-infected pregnant women. We identified correlates of temporal discounting from health and demographic information collected at baseline. We then assessed the association between temporal discounting and retention in care at 6 weeks postpartum, uptake of available PMTCT services, and viral suppression at 6 weeks postpartum using log-binomial models to calculate unadjusted and adjusted RRs for high vs. low discounting for each outcome. We also evaluated possible interaction between temporal discounting and CCT for each outcome (retention, uptake of available PMTCT services and viral suppression). Results: High temporal discounting was associated with incomplete uptake of PMTCT services, and this effect was mitiga (open full item for complete abstract)

Committee: Abigail Norris Turner PhD (Advisor); Maria Gallo PhD (Committee Member); Abigail Shoben PhD (Committee Member); Marcel Yotebieng PhD, MD (Committee Member) Subjects: Economics; Epidemiology; Psychology; Public Health

MA, University of Cincinnati, 2017, Arts and Sciences: Psychology

African American women are disproportionately affected by HIV/STI. Extant literature suggests that attachment style may be associated with risky sexual behavior. Working model-self (WMS) and working model-other (WMO) are attachment-related constructs that reflect beliefs about oneself in relationships, and beliefs about others with whom one relates to or interacts with. The present study examined the associations between WMS, WMO and sexual risk behaviors: (a) proportion of condom use for vaginal and anal sex during past 3 months, (b) number of sexual partners in lifetime and during the past 3 months, (c) having a casual sexual partner during the past 3 months, and (d) using alcohol before having sex during the past 3 months. Potential partial mediators of the relationship between WMS, WMO and sexual risk behaviors were also assessed, including: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust, and (e) sex-related alcohol expectancies. Structural equation modeling analyses assessed a model of the Theory of Gender and Power (TGP) with the added attachment construct to explain risky sexual behaviors among African American women. A total of 560 participants completed the baseline assessment for an HIV prevention intervention trial and were randomized to study conditions. The current study includes only the baseline data obtain from these 560 participants (M age= 20.58, SD = 1.89). Participants self-reported sociodemographics, sexual history, alcohol use, communication skills, and psychosocial constructs associated with STI/HIV-preventive behaviors via an audio computer-assisted self-interview (ACASI) survey. Results indicated that WMS (but not WMO) was associated with number of lifetime and recent (during the past 3 months) sexual partners; however, WMS was not associated with having a recent causal sexual partner, proportion condom use, or consuming alcohol prior to sexual encounters. (open full item for complete abstract)

Committee: Jennifer Brown Ph.D. (Committee Chair); Kristen Jastrowski Mano Ph.D. (Committee Member); Sarah Whitton Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy (PhD), Ohio University, 2015, Communication Studies (Communication)

This project studies the phenomena of PrEP, gay health, gay sexuality and HIV/AIDS within the context of the gay male body. To understand all of these phenomena, and how they are mapped on the gay male body, this project will take interviews from 20 Gay Men in addition to various resources to help gain an understanding of this new HIV prevention measure (i.e. PrEP). This dissertation will also discuss the various challenges and opportunities associated with PrEP as it is introduced to the gay community.

Committee: Raymie McKerrow (Advisor) Subjects: Communication; Health

Master of Arts, The Ohio State University, 2009, ED Policy and Leadership

Educational Psychology research has noted the similarities between conceptual change and persuasion. Though some researchers (e.g. Murphy & Alexander, 2004) have cut across literatures to make the case for serious scholarly dialogue on persuasion in classrooms, many facets of persuasion in the classroom remain to be explored. The present investigation (N = 633) explores the link between the persuasive characteristics of teachers (i.e. teacher affinity and teacher credibility) and student gains in knowledge and valuing of learning about HIV and pregnancy prevention across classrooms. Results marshaled evidence for the role of persuasive characteristics in producing conceptual change in students. Above and beyond individual background characteristics, teacher credibility was positively related to increases in knowledge across classrooms, whereas teacher affinity was positively related to increases valuing of learning across classrooms. Future directions and implications for practice are discussed.

Committee: Eric Anderman (Advisor); Ann O'Connell (Committee Member) Subjects: Education; Educational Psychology; Health Education; Psychology; Teaching

Master of Arts (MA), Ohio University, 2011, International Development Studies (International Studies)

HIV/AIDS knowledge is an important aspect of HIV/AIDS reduction. Although there has been research on the level of knowledge of HIV/AIDS among older youth in Uganda, there has been no study assessing HIV/AIDS related knowledge for adolescents aged 10-14. This study investigates HIV/AIDS prevention knowledge among a representative sample of forty pupils living in Mukono municipality, Uganda.Participants for this study come from two primary schools in Mukono Municipality, and include male and female participants aged 10-14. The study used a qualitative method to interview participants. Participants were asked questions focused on their HIV awareness,information seeking, attitude and knowledge and risk reduction. Results showed that a good number of participants (42.5%) were aware that AIDS is the most serious disease,but only 20% knew a lot about the disease. Nearly all participants (95%) had positive attitudes towards people living with AIDS. Schools/teachers (45%) were identified as the main source of information followed by parents (17.5), hospital (15%), radio (7.5), and books (5%). The results also show that a loss of weight, red lips, diarrhea, herpes zoster and body weakness were identified as the main symptoms of an HIV infected person.Most of the participants had a good knowledge on transmission modes and prevention.Sexual intercourse, sharing sharp objects, blood to blood contact and mother to child transmission were the transmission modes commonly identified. Abstinence, being faithful and condom usage were identified as preventative measures. Although most of the pupils were knowledgeable about transmission and prevention, study identified some misconceptions. Thirty two percent (32%) of the pupils believed that having sex while standing could prevent getting AIDS, while 25% believed that having sex once with a virgin cannot transmit the virus. Others (15%) believed that sexual activity allows men to grow muscles and heal back pain. The results from the stu (open full item for complete abstract)

Committee: Tania Basta PHD (Committee Chair); Tom Smucker PHD (Committee Member); Anthony Sallar PHD (Committee Member) Subjects: Health Sciences

Master of Arts (MA), Ohio University, 2010, Communication and Development Studies (International Studies)

This research explores the opinions of religious leaders in Rwanda projected in their interpretation of a salient narrative and HIV prevention methods. The study established that the intersection of faith and health is something that is still of a highly contested terrain. The study also reveals that ABC has been communicated using behavioral messaging at the detriment of the foremost experiential, stage-matched approach of communication. Yet, religious leaders' opinions reflect fluctuating feelings about their roles in health and faith. The plight of religious leaders finds expression in their vacillating stances that are constantly evaluated, constructed and reconstructed. In order to validate and illustrate these findings, I locate data analysis in the theory of narrative persuasion, Problematic Integration theory and some vital problematics of narrative theorizing. The study concludes and recommends that narrative mode is a viable alternative communication avenue for effectively reaching religious leaders in Rwanda and (perhaps) beyond.

Committee: Rafael Obregon PhD (Committee Chair); Stephen Howard PhD (Committee Member); Anthony Sallar PhD (Committee Member) Subjects: Communication; Health Education

Master of Sciences, Case Western Reserve University, 2009, Epidemiology and Biostatistics

Objective: We sought to understand knowledge and attitudes regarding male circumcision for HIV-1 prevention among HIV-1 serodiscordant couples. Methods: Between May and August 2008, members of heterosexual HIV-1 serodiscordant couples attending a research clinic in Kampala, Uganda were interviewed separately using a standard questionnaire. Results: 318 couples were enrolled, 51.3 % were couples in which the male partner was HIV-1 infected and 48.7 % in which the female partner was HIV-1 infected. Overall, 77.1% of men and 89.6% of women were aware that male circumcision reduces men's risk for HIV-1 acquisition. In couples with uncircumcised HIV-1 negative men, 48.9% of men and 88.1% of female HIV-1 seropositive partners expressed interest in male circumcision. Conclusions: Heterosexual serodiscordant couples in Kampala were highly knowledgeable about the benefits and limitations of male circumcision for HIV-1 prevention. Nearly 50% of HIV-1 seronegative men expressed interest in being circucmcised, a feeling echoed by a majority of their HIV-1 seropositive female partners.

Committee: Christopher Whalen MD, MS (Committee Chair); Daniel Tisch PhD, MPH (Committee Member); Shelley Francis DrPH, MPH (Committee Member) Subjects: Public Health

Doctor of Philosophy, University of Akron, 2008, Counseling Psychology

The present study investigated associations among African American and same sex attracted identity developmental components, psychological well-being, difficult sexual situations, and sexual risk practices among a sample (N = 73) of HIV-positive African American men who have sex with men (MSMs). The current study responds to Mays, Cochran, and Zamudio's (2004) call for empirical investigations of culturally specific determinants impacting psychological health and sexual risk behaviors among African American MSMs. The current study parallels the methodology of Diaz, Ayala, and Bein (2004) and Diaz, Bein, and Ayala (2006), linking experiences of homophobia, racism, and poverty to psychological health and sexual risk practices among gay identified Latino men. Using a similar framework, the current study investigated the impact of African American and same sex attracted identity development on psychological health and sexual risk practices within a sample of African American HIV-positive MSMs. The current study's sample reported a diverse range of sexual identities (e.g., gay, heterosexual, “on the down low;”), with all participants having engaged in consensual sex with other men. Results indicated that higher endorsement of the Anti-White African American identity (as measured by the Cross Racial Identity Scale [CRIS, Vandiver et al., 2000]), as well as lower levels of psychological well-being, and younger ages, predicted circumstances promoting unsafe sex. Higher endorsements of the African American identities of Multiculturalist Inclusive and Miseducation, as well as the same sex attracted identity of Superiority (as measured by the Lesbian and Gay Identity Scale [LGIS; Mohr & Fassinger, 2000]), predicted interpersonal barriers to unsafe sex. Additional exploratory analyses showed higher endorsements of the same sex identity of Homonegativity to predict lower levels of psychological well-being; higher endorsements of the African American identity of Assimilation, an (open full item for complete abstract)

Committee: Charles Waehler Ph.D. (Advisor) Subjects: African Americans; Behaviorial Sciences; Demographics; Developmental Psychology; Gender; Health; Multicultural Education; Psychology; Psychotherapy; Public Health; Social Psychology

MA, University of Cincinnati, 2012, Arts and Sciences: Psychology

Rates of new HIV infections remain high among Black male substance users. Effective HIV prevention interventions are warranted, but many ignore relevant social-contextual factors that could influence sexual behaviors. This study measured the extent to which dimensions of masculinity (instrumental and expressive) and perceived condom barriers moderate the relationship between HIV treatment type (i.e., Control group vs. an HIV risk-reduction intervention known as Real Men are Safe or REMAS) and unprotected sexual occasions (USO) for 128 Black male substance users at 90- and 180-days post-intervention. Multiple regression analyses revealed that both partner and access barriers significantly predicted condom use at 180-days post-intervention with casual partners. However, only partner barriers moderated the relationship between treatment group and USO. REMAS men entering treatment with high partner barriers to condom use reported fewer USO than the control group at 180-days post-intervention with casual partners. Neither masculinity nor condom barriers were related to treatment response with main or casual partners at 90-days post-intervention. Masculinity was unrelated to treatment response at 180-days post-intervention. Implications for the development of effective HIV prevention interventions are discussed.

Committee: Ann Kathleen Hoard Burlew Ph.D. (Committee Chair); Rachel Kallen Ph.D. (Committee Member); Bridgette Peteet Ph.D. (Committee Member) Subjects: Psychology