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, 2020, Anthropology

This research investigates political and economic issues of inequality and unemployment in Uganda, as manifested in one informal settlement in Kabalagala, and the effect of these issues on HIV. Uganda is one important site to study the intersections of inequality, formal sector unemployment, urbanization, and HIV/AIDS. Contemporary inequality and formal sector unemployment are driven by colonial policies that shaped urban stratification, and postcolonial policies that privileged economic growth over job creation. A central goal was to understand men's risk of HIV in the context of these and other structural and social drivers of risk. This research used an explanatory sequential mixed methods study design, including a pilot study (2016), survey pre-test (2017), and 12 months of fieldwork that began with survey data collection (N = 292) and ended with in-depth interviews (n = 54, a subset of the survey sample). Survey data were analyzed using multiple linear regression, and interview data and field notes were analyzed through thematic analysis. Quantitative data described the patterning of risky sexual behavior (e.g. HIV risk), while qualitative data expanded on these relationships and helped to clarify areas of contention. Men in this study have lower rates of HIV testing, compared to national averages. Men also frequently report defaulting on ART, once they do receive a positive diagnosis and begin treatment. Inequality and unemployment impact their daily lives through experiences of uncertainty that must be managed. Economic instability is important, and when men cannot access resources, they are likely to engage in a variety of strategies to improve their economic status. Men also face myriad vulnerabilities driven by the political-economic context, from housing instability to incarceration. This work contributes to the anthropological literature on the political economy of health, HIV, vulnerability, and social resilience. Men's experiences of HIV and (open full item for complete abstract)

Committee: Janet McGrath Ph.D. (Committee Chair); Lee Hoffer Ph.D. (Committee Member); Jill Korbin Ph.D. (Committee Member); Aloen Townsend Ph.D. (Committee Member) Subjects: Cultural Anthropology; Public Health

Doctor of Philosophy, Case Western Reserve University, 2009, Epidemiology and Biostatistics

Background: Latinos in the United States are at high risk for depression, anxiety, and substance abuse and HIV/AIDS has excessively impacted this community. Individuals with severe mental illness (SMI) are more likely to engage in HIV high-risk behaviors. A range of psychiatric and social factors have been considered as correlates of sexual risk behavior with findings indicating a need for future studies to provide insight into the direction and nature of these associations. Objective: To describe the HIV-risk behaviors of Puerto Rican women with SMI in Cuyahoga County, Ohio using quantitative and qualitative techniques. Aim 1 investigated the association of childhood sexual abuse (CSA) and adult HIV-risk behaviors using a retrospective cohort design. The second aim examined psychiatric and social correlates of HIV sexual risk behavior and aim 3 compared data obtained qualitatively to data obtained quantitatively using criterion validity. Methods: The study sample consisted of 53 Puerto Rican women with SMI recruited between October 2002 and December 2005. Consenting participants participated in a baseline interview, two follow-up, semi-structured interviews, and up to 100 hours of non-continuous participant observation. Descriptive, bivariate, and multivariate analyses were conducted to describe HIV-risk behaviors and assess the efficacy of two data collection methods. Results: The relationship between CSA and HIV-risk may be mediated by partner abuse and mental illness diagnosis. Psychiatric and social factors were differentially associated with sexual risk behaviors and multivariate analysis showed that increased severity of psychiatric symptoms and factors and living below the poverty line are predictive of sexual risk behaviors. The correlations between quantitative and qualitative responses concerning sexual and drug use behaviors revealed agreement in some cases and inconsistencies and contradictions in others. Conclusions: Puerto Rican women with SMI are in (open full item for complete abstract)

Committee: Sana Loue (Committee Chair); Martha Sajatovic (Committee Member); Leslie Heinberg (Committee Member); Daniel Tisch (Committee Member) Subjects: Epidemiology

PHD, Kent State University, 2005, College of Arts and Sciences / Department of Psychological Sciences

The current study tested a mediational model of the relationships between childhood physical (CPA) and sexual abuse (CSA) and sexual risk in adulthood. Posttraumatic stress disorder and adult sexual assault were hypothesized to mediate the relationships between childhood abuse and behavioral and relational risk for HIV in adulthood. Participants were 202 young, inner-city women who participated in a large-scale HIV prevention project. Structural equation modeling and a series of regression analyses were used to test the proposed relationships. Results suggested that both CSA and CPA were significantly associated with PTSD and rape in adulthood. CPA was significantly related to an increased number of sexual partners and high-risk sexual relationships in adulthood. In contrast, CSA was not associated with high-risk sexual behaviors or relationships in adulthood. Support was not found for a mediational role of either PTSD or adult rape on behavioral or relational risk. Limitations of the current study and future directions for research are reviewed.

Committee: Stevan Hobfoll (Advisor) Subjects: Psychology, Clinical

Doctor of Philosophy, Case Western Reserve University, 2005, Epidemiology and Biostatistics

Background: Recent studies have found that as many as one in three HIV infected persons may continue to engage in unprotected sex, sexual contact often occurring with seronegative or unknown status partners. While the issue of prevention has received greater attention in developed countries, little is known about the extent to which persons living with HIV/AIDS (PLWHA) might continue to engage in high-risk sexual behaviors in sub-Saharan Africa. Objectives: Propose and test a conceptual model explaining sexual-risk behaviors among PLWHA in terms of cognitive and situational factors. Methods: Cross-sectional study conducted in Abidjan, Cote d'Ivoire (West Africa). The study sample consisted of HIV-positive men and women at various stages of their illness and currently attending one of the largest outpatient clinics for HIV patients. All the data were collected through face-to-face structured interviews. Results: Three hundred forty-nine (349) valid questionnaires were completed. Fifty percent (50%) of the study sample reported one regular partner; 10% reported casual partners and 7% reported multiple partners. Over one-third of the respondents had engaged in high-risk sexual behaviors during the previous 6 months. As posited, two cognitive factors (an internal and external) emerged from the factor analysis process. Although only a small to moderate variance was explained by the model, most of the hypothesized effects were statistically significant: the internal cognitive and the situational factors were inversely related to sexual risk behaviors; the internal cognitive factor also partially mediated the relationship between situational factor and sexual risk-taking. The external cognitive had no significant effect on the outcome. Different models were found for the men and women. Conclusions: The present study indicates that the behavior of a sizable number of HIV patients may continue to increase the burden of the disease at the population. Because access to care is (open full item for complete abstract)

Committee: Mendel Singer (Advisor) Subjects:

PHD, Kent State University, 2024, College of Public Health

The purpose of this sequential explanatory mixed methods study was to explore HIV risk perception, the meaning of HIV testing, and HIV risk behavior among college students following a negative HIV test. An extended version of the theoretical framework of the health belief model (HBM) aided in the exploration of college students' perceptions of HIV, rationales for HIV risk behavior, and the meaning they attached to HIV testing. Following the sequential explanatory mixed methods design, the initial phase involved collecting quantitative data to assess HIV risk perception among college students who received a negative HIV test in the last 12 months. In the second phase, interpretative phenomenological analysis (IPA) was applied to gather data through individual semi-structured interviews to help explain HIV risk behavior in the context of HIV testing. Findings indicated that college students' perception of their HIV risk is aligned with their risk behavior. Results showed a statistically significant difference in HIV risk perception based on sexual orientation. Before HIV testing, college students justified their HIV risk behavior based on partner trust, not wanting to feel restrained, and acting on the need to fulfill their desire, lust, or temptation. After receiving a negative HIV test result, college students still experienced fear of contracting HIV. However, some students became more cautious and adopted preventive measures, while others continued with previous behavior patterns. Implications of the research findings include examining risk perception across college students of different sexual orientations to understand the impact of risk perception in HIV testing and exploring the differing needs of college students to remain HIV-negative. Participants recommended that colleges address access to free HIV testing, increase information dissemination regarding HIV risk and HIV testing services, and continue research that explores college students' lived experiences (open full item for complete abstract)

Committee: Jeffrey Hallam (Committee Co-Chair); Jo Dowell (Committee Member); Deric Kenne (Committee Member); Eric Jefferis (Committee Co-Chair) Subjects: Behaviorial Sciences; Epidemiology; Higher Education; Public Health; Social Research

Doctor of Philosophy, The Ohio State University, 2019, French and Italian

At the crossroads of French Studies, Visual Studies, and Queer theory, my dissertation seeks to confront notions of risk and responsibility to argue that society's perceptions of risk have changed in relation to a pre-AIDS world and the onset of AIDS and that contemporary treatments such as PrEP (Pre-Exposure Prophylaxis) continue to refine our definition of risk. While much recent scholarship has been written about AIDS in the 1980s and 1990s, I would like to address contemporary AIDS narratives that respond to advances in medication and a shift in our understanding of AIDS from a death sentence, to a chronic disease, and now to a preventable illness. In order to explore how gay men's relationship with risk has been articulated in artistic production and has evolved with the availability of PrEP in France, my dissertation confronts cultural production throughout the epidemic. Film and literature analysis of Herve Guibert's work establishes a relationship between taking risks with one's health and the feelings of shame often felt in the early days of the epidemic, while a critical look at Cyril Collard's Les Nuits fauves in tandem with public health campaigns demonstrate how beauty is manipulated in times of epidemic. Engaging with Erik Remes's allows for further nuancing of the question of responsibility, and suggest that the epidemic resulted in a vilification of behavior that was not only deemed risky, but also irresponsible. Finally, I explore contemporary notions of risk through a study of prevention campaigns, film, newspaper articles, and interviews. The HIV/AIDS narrative in contemporary France is one that is marked by new modes of communication, the creation of a digital queer space, and a revisiting of the trauma of AIDS. The first three chapters are in the tradition of medical humanities and film studies approach, and the fourth chapter requires a shift methodology to one that emphasizes cultural studies and oral testimonies, necessitating onsite rese (open full item for complete abstract)

Committee: Lucille Toth (Advisor); Margaret Flinn (Advisor); Dana Renga (Committee Member) Subjects: Film Studies; Foreign Language; Gender; Gender Studies; Health; Modern Literature; Public Health

Doctor of Philosophy, The Ohio State University, 2018, Human Ecology: Human Development and Family Science

Homeless youth frequently engage in high risk sex behaviors putting them at risk for Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs), and unplanned pregnancy (Edidin et al., 2012; Halcon & Lifson, 2004). Previous attempts to intervene have had limited success (Naranbhai et al., 2011). While previous research has documented high prevalence rates and risk factors for engaging in sexual risk behaviors (Halcon & Lifson, 2004; Edidin et al., 2012), less is known about homeless youths' perceptions regarding potential benefits and consequences of their sexual risk behaviors. The current dissertation presents the results of three qualitative studies that explored homeless youths' motivation for engaging in sexual risk behaviors and their perception of the potential risks. The studies used qualitative interviews with 30 substance using homeless youth (ages 14-24). Interviews were coded by three coders using grounded theory methods (Strauss & Corbin, 1998) and NVivo 10 software. The first study explored homeless youths' motivation for engaging in sex and how the potential threat of HIV/STIs impacted their decisions. Youth reported similar emotional and physical benefits of having sex as housed youth. However, the stressful context of experiencing unmet needs appeared to influence youth to make impulsive decisions about sex that were often based on their immediate feelings/needs. Consequently, they rarely considered the threat of HIV/STIs when deciding to have sex. Further, youth were generally unconcerned about their risk of contracting HIV/STI because they either underestimated their level of risk or did not believe they would be significantly impacted by contracting HIV or an STI. The second study examined youths' perception of how substance use influences their decisions to have sex and engage in sex work. Youth differed in whether they believed substance use impacted their decisions. Some youth believed their decisions about sex were not i (open full item for complete abstract)

Committee: Natasha Slesnick (Advisor); Suzanne Bartle-Haring (Committee Member); Keeley Pratt (Committee Member); Irene Hatsu (Committee Member) Subjects: Social Research

MA, University of Cincinnati, 2014, Arts and Sciences: Psychology

This study assessed the associations between victimization (physical, adult sexual, and child sexual abuse), relationship power, and unprotected sex occasions in substance abusing African American women. The current study was a secondary analysis of baseline data collected from 124 African American women from the National Institute on Drug Abuse Center for Clinical Trials Network 0019 (CTN 0019) (Tross, Campbell, Cohen, Calsyn, Pavlicova, Miele, et al., 2008). The CTN 0019 protocol was a multi-site randomized clinical trial that assessed the intervention of Safer Sex Skills Building (SSSB) in women substance abusers to reduce HIV risk. In the current sample, 70.2% (N=87) endorsed lifetime physical abuse from a male sexual partner. There were no associations between victimization and unprotected sexual occasions in the current sample at baseline (p>.05). Moreover, there were no associations between negotiation skills and unprotected sexual occasions in the current sample. The moderation model of SRP decreasing the relationship between victimization and risky sexual behavior was nonsignificant (p>.05). The current study is among the first to examine moderating factors of SRP in substance-abusing African American women.

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

Doctor of Philosophy, Case Western Reserve University, 2014, Epidemiology and Biostatistics

Objectives: (i) To derive indices to predict the risk of HIV acquisition in Rakai, Uganda. (ii) To determine whether HIV risk profiles differed between acceptors of safe male circumcision (SMC) and non-acceptors before and after SMC. Methods Derivation of indices We used data on 7,497 women and 5,783 men from the Rakai community cohort study (RCCS). Multivariable Cox proportional hazards models were used to estimate time-to-HIV infection associated with candidate predictors. Model discrimination was determined using Harrell's concordance index (c-index). Model calibration was determined graphically. Comparison of SMC acceptors and non-acceptors We compared HIV risk scores and behaviors of 1192 SMC acceptors and 2384 non-acceptors prior to SMC and at two subsequent RCCS survey visits. Results Derivation of indices A total of 342 and 225 new infections occurred among females and males respectively. The final models' c-indices were 69.1 percent (95 % CI=0.66-0.73); and 0.67 (95 % CI=0.64- 0.70) for men and women respectively. Models were well calibrated. Comparison of SMC acceptors and non-acceptors Compared to non-acceptors, HIV-risk scores were 6.4 points higher (p<0.001) among SMC acceptors prior to SMC and acceptors were 33.5 percent more likely to report genital ulcers (GUD). Comparing acceptors to non-acceptors, risk scores declined by 12.4 points more per visit (p<0.001) and GUD prevalence declined by 29.4 percent more per visit (p=0.011) after SMC. After SMC, condom use at last sex did not change among acceptors but reduced by 13 percent (p=0.002) per visit among non-acceptors. After SMC, partnerships with women in high-risk occupations increased by 13 percent per visit among acceptors (p=0.046), but no change among non-acceptors and the rate sexual debut was 5 percent higher among SMC acceptors. Conclusion Indices were discriminative and well calibrated and using them to compare SMC acceptors and non-acceptors showed that sexually ac (open full item for complete abstract)

Committee: Mendel Singer Ph.D (Committee Chair); Janet McGrath Ph.D (Committee Member); Duncan Neuhauser Ph.D (Committee Member); Pingfu Fu Ph.D (Committee Member) Subjects: Biomedical Research; Biostatistics; Epidemiology; Health; Public Health

MS, University of Cincinnati, 2007, Education : Health Promotion and Education

The purpose of this study was to determine if there was a relationship between HIV knowledge, perception of HIV risk and severity, prior sexuality education, and HIV risk behaviors among college students. The participants of this study consisted of a convenience sample of students who attended a large Midwestern urban university during the fall quarter of the 2006-2007 academic year. Most students were female, white, and heterosexual. It was concluded that sexual risk behaviors were affected by both HIV knowledge levels and whether or not sexuality education was received. Furthermore, it was concluded that a relationship existed between several factors: condom use frequency, HIV knowledge, number of partners in the past year, personal beliefs regarding HIV transmission, sex while under the influence of drugs or alcohol, and the type of sexuality education received.

Committee: Dr. Liliana Rojas-Guyler (Advisor) Subjects:

Doctor of Philosophy (PhD), Ohio University, 2008, Psychology (Arts and Sciences)

While several studies have characterized patterns and predictors of continued risky sexual behavior in HIV-infected rural persons, far less research has conceptualized and evaluated interventions to reduce risky sexual behavior in this group. This pilot randomized clinical trial tested if two telephone-delivered, HIV risk-reduction interventions could reduce high HIV-transmission risk behavior in HIV-infected rural persons. Participants (N=79) were recruited through AIDS service organizations in rural areas of 27 states and assigned to either a two-session, motivational interviewing and skills-building intervention (N=48) or a two-session, skills-building-only intervention (N=31). Participants completed self-report measures at pre- and post-intervention. A 2 x 2 repeated measures multivariate analysis of variance (RM MANOVA) found no significant "Time x Condition" interaction but did find a main effect for "Time" which showed that participants'condom use, motivation to reduce risky sexual behavior, and risk reduction behavioral skills improved in both intervention conditions. Results from this pilot RCT suggest that telephone-based interventions may increase motivation, behavioral skills, and condom use in rural PLWH over time and that motivational interviewing need not be integrated into standard skills-building interventions.

Committee: Timothy G. Heckman PhD (Advisor); Bernadette Heckman PhD (Committee Member); John Garske PhD (Committee Member); Tim Anderson PhD (Committee Member); John McCarthy PhD (Committee Member) Subjects: Psychology

Doctor of Philosophy, Case Western Reserve University, 2011, English

Bringing together life writing and medical sociology, "Constructed Bodies, Edited Deaths: The Negotiation of Sociomedical Discourse in Autothanatographers' Writing of Terminal Illness" interrogates the relationships among autobiographical writing practices, identity, and the cultures of illness in the nineteenth through the twenty-first centuries. Using texts by Emily Shore, Eric Michaels, Harold Brodkey, David Wojnarowicz, and Eva Markvoort, I argue that autothanatographies, or authors' writings of their own terminal illness, explore issues of subjective loss that occurs through bodily deterioration and under external forces of concomitant social and medical stigmatization, often operating in the guise of risk management. Such stigmatization arises from medicine's attention to pathological physiology and categorization rather than to holistic treatment of the ill subject. This study remedies gaps in theories of the genre by going beyond assertions that autothanatographical texts engage with extratextual influences that propose a shared and thus mutually expansive narrative, as proposed by theorists such as Suzanna Egan and Nancy Miller. Rather, I assert the ways in which the multiple external discourses surrounding disease, or sociomedical discourses, alter the actual illness experience and recorded expressions of the author as demonstrated through editing practices and control, thereby illustrating the challenge of representing the self in autothanatographical writing.

Committee: Kimberly Emmons (Committee Chair); Kurt Koenigsberger (Committee Member); Thrity Umrigar (Committee Member); William Siebenschuh (Committee Member); Vanessa Hildebrand (Committee Member) Subjects: Biographies; Health; Individual and Family Studies; Minority and Ethnic Groups; Public Health; Social Structure; Sociology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2012, Sociology

In this study, I use data from the 2002 Kenya Behavioral Surveillance Surveys to examine the factors associated with having been tested for HIV and the acquisition of test results for female sex workers, low-income women, men in worksites, and policemen. With so many of the HIV/AIDS cases residing in sub-Saharan Africa, testing and counseling should be at the forefront of policies. But broad cultural norms surrounding gender and stigma affect the HIV testing and diagnosis-seeking behaviors of members of at-risk marginalized populations. Patriarchal ideologies support differential treatment and differential access to resources between women and men, and these differences are accentuated for men and women who are part of stigmatized, high risk populations. The current project contributes to scientific research on the demographic, cultural, and social-psychological factors that condition at-risk populations' receptivity toward and pursuit of HIV testing and serostatus (HIV status) diagnosis. In the present study, I address two related questions concerning the research gap on HIV testing among at-risk populations. First, what factors influence the decision to be tested for HIV? Second, conditional on HIV testing having occurred, which factors influence the acquisition of test results for female sex workers and men in worksites? I explore these processes with rich data on vulnerable populations with unusually high HIV infection and transmission rates, using the gendered power perspective (Connell 1987; Wingood & DiClemente 2000) and Health Belief Model (Becker 1979; Strecher & Rosenstock 1997). For the first research question – predicting having been tested for HIV – five components of the Health Belief Model and several gendered culture variables are used. Two components of the Health Belief Model are significantly associated with having been tested for female sex workers and low-income women: perceived barriers (holding a high level of myths negatively predicts having (open full item for complete abstract)

Committee: Susan Brown (Advisor); Alfred DeMaris (Committee Member); Kara Joyner (Committee Member); Gary Lee (Committee Member); Wendy Watson (Committee Member) Subjects: Sociology

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