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Dudley, Dawn M.HIV-1 ENV: IMPACTING HIV-1 FITNESS, ENTRY INHIBITOR DRUG SENSITIVITY, AND IN VIVO SELECTION OF A RESISTANT VIRUS TO THE MICROBICIDE PSC-RANTES
Doctor of Philosophy, Case Western Reserve University, 2008, Molecular Biology and Microbiology

In the advent of the promise for HIV-1 entry inhibitors to treat patients with drug resistance to available antiretroviral therapy, there has been a surge in studies related to HIV-1 entry. It is clear that the intrinsic susceptibility of primary virus isolates to entry inhibitors varies, which indicates a greater probability for intrinsic resistance to this class of drugs. The studies presented here provide tools and insights into the impact of the envelope (env) gene on HIV-1 replicative capacity, how that capacity influences the emergence of drug resistance, and how easily drug resistance is selected in vivo to a microbicide entry inhibitor.

The fitness of a virus is a marker of its replication capability in a given environment. The specific impact of HIV-1 entry on the overall fitness of a virus was tested by cloning a region of the env gene into a common backbone and comparing the resultant recombinant fitness to that of the wildtype virus. The env gene was sufficient to determine the overall fitness of these viruses, which also correlated with sensitivity to entry inhibitors. Specifically, the binding avidity of a virus to the host cell coreceptor contributed the most to fitness.

PSC-RANTES is an entry inhibitor that acts on the coreceptor CCR5 to block HIV-1 binding and down-regulate coreceptor expression. When used as a microbicide in a rhesus macaque model, PSC-RANTES failed to block transmission of SHIV¬¬¬SF162 at high doses in some animals. Two mutations were identified in isolates from one of these animals and were cloned into a common HIV-1 backbone to create a chimeric virus. The chimeric virus exhibited resistance to PSC-RANTES and an increase in fitness over that of the wildtype virus used to infect the rhesus macaques. This study showed for the first time the selection of drug resistant viruses to a microbicide in an HIV-1 animal model system.

Lastly, a cloning strategy was developed to quickly create replication-competent, fully infectious HIV-1 chimeric viruses. This system eliminates the need for common endonuclease sites among diverse primary isolates of HIV-1 and can be used to clone any gene region from any HIV-1 isolate.

Committee:

Eric Arts (Advisor)

Keywords:

HIV-1; SHIV; microbicide; chimeric virus; HIV-1 fitness; HIV-1 entry; HIV-1 drug resistance; Rhesus macaque; PSC-RANTES; HIV-1 cloning

Perazzo, Joseph DTranslating the News: A Grounded Theory of Care Initiation by Individuals Living with HIV
PhD, University of Cincinnati, 2015, Nursing: Nursing - Doctoral Program
Background: Despite tremendous advances in HIV treatment, less than 30% of the more than 1 million people living with HIV in the US are achieving optimal treatment outcomes. Researchers have recognized that there is an urgent need to understand factors and processes that influence individuals with HIV to initiate HIV care. Purpose: The specific aims of the study were to develop a theoretical framework to explain the psychosocial process of care initiation in individuals living with HIV to identify the critical junctures, defined as pivotal events reported by study participants, that influence individuals living with HIV in their decision to initiate HIV care Methods: Grounded theory was the method used to analyze in-depth interviews with individuals living with HIV. A team of IRB-approved researchers analyzed the data using three levels of coding: Open coding, selective coding, and theoretical coding. Analysis was conducted with an aim of identifying the psychosocial process of care initiation by individuals living with HIV. Results: 30 individuals living with HIV (28 men, 2 women) participated in the study. Participants shared their stories about how they went from learning that they had HIV to the point of HIV care initiation. The core category discovered in the data was concept of HIV as news. News, by definition, is impactful information that was not previously known that is delivered by one party and received by another. Participants described a process in which they progressed through five distinct stages: a) receiving the news, b) interpreting the news, c) incorporating the news, d) acting on the news, and e) moving beyond the news. Each stage was moderated by influential factors including perceived susceptibility to HIV infection, symptoms, HIV information, and feedback from others. The initial receipt of the news was typically interpreted as `bad news’. However, through reflection, interaction with others, and information seeking, participants learned that HIV was not a death sentence and that there are treatment options available to them. In effect, the participants were able to translate the news, often beginning as something bad, but changing into something good. The constructed framework is known as “Translating the News: A Grounded Theory of HIV Care Initiation” Conclusion: Individuals who are diagnosed with HIV often encounter a myriad of challenges at the point of diagnosis. Individuals are able to move through the care initiation process with fewer complications when they are provided with encouragement and information, particularly about their treatment options. The key to successful care initiation is helping individuals with HIV to realize that while the diagnosis may seem like bad news, there is also good news: HIV is not a death sentence.

Committee:

Donna Martsolf, Ph.D. R.N. (Committee Chair); Judith Feinberg, M.D. Ph.D. (Committee Member); Donna Shambley-Ebron, Ph.D. (Committee Member)

Subjects:

Nursing

Keywords:

HIV;Care Initiation;Grounded Theory;HIV Care Factors;HIV Care;HIV Care Theory

Wandera, BonnieSexual Behavior of HIV-infected Patients Receiving Antiretroviral therapy in Kampala, Uganda: A Prospective Cohort Study
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

Keywords:

HIV; AIDS; Sexual Behavior; Antiretroviral Therapy; Positive prevention; Secondary HIV prevention; Prevention for positives;Africa; Sub-Saharan Africa;Heterosexual HIV Transmission; HAART; Sexual Transmission of Drug resistant HIV

Collins, Linetta D.Educational Professionals and HIV: An Investigation of the Attitudes of School Administrators and Teachers
EdD, University of Cincinnati, 2005, Education : Urban Educational Leadership
Historically, the issue of HIV and adolescence has not generally been considered a priority for most school educators and administrators. As treatments for HIV have advanced over the years, more students infected by the disease have been able to participate in learning environments in the public schools. With the No Child Left Behind Act permeating schools, urban administrators, and educators are forced to focus primarily on academically based achievement standards; negating the social, medical, legal, and moral complexities of students who are infected with HIV. The purpose of this research was to explore the attitudes of administrators and teachers in urban schools. This study found that their attitudes about HIV and HIV positive adolescents centered on 3 main themes:(1) the (non)compassion on the part of the administrator or teacher depending on the mode of HIV transmission, (2) their beliefs about factors that impede student learning, and whether a medical condition can be considered an impediment, and (3) the professional experience of the administrator and teacher that impacts school change.

Committee:

Dr. James Koschoreck (Advisor)

Keywords:

educational administation; social justice; HIV/AIDS; Secondary students and HIV; academic achievement and HIV

Heaphy, Emily Lenore GoldmanEvaluation of HIV-risk behaviors of Puerto Rican women with severe mental illness in Cuyahoga County, Ohio
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 need of targeted interventions that simultaneously address substance, childhood, and partner abuse, specific symptomatology, and the indirect effects associated with SMI such as living in poverty. A comparison of qualitative and quantitative methods revealed that inconsistent and contradictory responses are not uncommon and that a mixed-method design may provide a more complete way of obtaining HIV-risk behavior data of a sensitive nature.

Committee:

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

Subjects:

Epidemiology

Keywords:

HIV-RISK; HIV; SMI; HIV-RISK BEHAVIORS; sexual; abuse; CSA

Schreibman, Jeffrey P.Food Security and Physical Activity in Individuals Living With HIV/AIDS in Rural Appalachia
Master of Science (MS), Ohio University, 2013, Food and Nutrition Sciences (Health Sciences and Professions)
This study examined household food security (HFS) and physical activity (PA among individuals living with HIV/AIDS living in rural Appalachia (West Virginia, Appalachian Ohio, Kentucky, and Pennsylvania). Participants (n = 82) completed an online or paper survey that included validated measures of HFS (USDA short form) and physical activity. Data were analyzed using PASW statistical software (version 18.0,) to determine the relationship between the variables (Mann-Whitney U). The majority of participants (n = 82) were: male (n = 63) and Caucasian (n = 59). For all patients, 28 (34.1%), 10 (12.2%), 12 (14.56%), and 32 (39.0%) were living in households characterized as being high, marginal, low, and very low HFS, respectively. There was no significant difference in distribution of IPAQ scores (Mann-Whitney U, p = .161), and total MET-min per week of physical activity between the HIV and AIDS groups (t-test, p = 0.200). There was no significant difference between distribution of IPAQ scores (Mann-Whitney U, p = 0.929), and total MET-min per week (t-test, p = 0.944) between food security groups. Further exploration is warranted in other rural regions.

Committee:

David Holben, PhD, RD, LD (Advisor); Tania Basta, Ph.D., MPH, CHES (Committee Member); Deborah Murray, MS, RD, LD (Committee Member)

Subjects:

Health; Health Education; Nutrition

Keywords:

Food Security; Physical Activity; HIV; AIDS; Physical activity and HIV/AIDS; Physical activity and food security

St. Pierre, ValessaQuality of Life in Older African American Men Living with HIV/AIDS: A Structural Equation Analysis
Master of Science (MS), Ohio University, 2011, Psychology (Arts and Sciences)
Older HIV-positive African American men have unique needs stemming from added risk factors for diabetes mellitus, hypertension, stigma, and limitations imposed by psychosocial disparities. These complex experiences may adversely affect the quality of life of older HIV-positive African American men. Yet, it is unclear whether an existing quality of life model (CIQOL; Heckman, 2003) will generalize to older HIV-positive African American men. Structural equation modeling analyses assessed the generalizability of two models to 167 HIV-positive older African American and Caucasian men between the ages of 48 and 73 years. The first model (Adapted CIQOL Model) was adapted from the Chronic Illness Quality of Life Model (CIQOL; Heckman, 2003). The second model is a revised version of the Adapted CIQOL Model in that the causal relationships were modified based on the empirical literature on African Americans (The Revised CIQOL). The Adapted CIQOL Model and Revised CIQOL Model demonstrated goodness of fit for both samples. The findings' implications are discussed.

Committee:

John Garske, PhD (Committee Chair); Christine Gidycz, PhD (Committee Member); Francis Bellezza, PhD (Committee Member)

Subjects:

African American Studies; African Americans; Aging; Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Black Studies; Clinical Psychology; Counseling Education; Counseling Psychology; Cultural Anthropology; Ethnic Studies; Health; Health Care; Health Sci

Keywords:

Quality of life; General Well-Being; Satisfaction with Life; Structural equation modeling; African American men; Caucasian men; HIV/AIDS; HIV-positive; Older; Aging

Mugambi, Melissa LatigoCOST-EFFECTIVENESS OF POINT-OF-CARE DEVICE ALLOCATION STRATEGIES: THE CASE OF EARLY INFANT DIAGNOSIS OF HIV
Doctor of Philosophy, Case Western Reserve University, 2013, Epidemiology and Biostatistics
Point-of-care (POC) devices for HIV Early Infant Diagnosis (EID) will soon become available in resource-limited settings. During the scaling-up process, it will be important to determine the types of facilities in which implementation of the device is likely to be more cost-effective. The main objective of this dissertation was to develop a model to determine the cost-effectiveness of POC device allocation strategies in Uganda's HIV EID network. We accounted for turnaround time changes that may occur with progressive POC scale-up among facilities that perform centralized testing. In Aim 1, we evaluated the association between turnaround time and result receipt under centralized testing. Data were obtained from 703 infant HIV test records for tests performed between January 2008 and February 2009 in two health facilities in Uganda. We performed multivariable modified Poisson regression with robust standard errors and included other population and health system factors. We accounted for within-clinic correlation using generalized estimating equations. We found that caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days in a pooled sample from both facilities (RR = 0.83; p = 0.006). In Aim 2, we developed an illustrative model comprising four health facilities that conducted centralized testing among HIV-exposed infants. We used discrete-event simulation to model centralized testing, the allocation of POC devices among the facilities, and to generate turnaround time distributions for each allocation scenario. We used individual level Markov modeling to simulate caregiver return for test results and infant HIV disease progression based on findings from Aim 1 and the turnaround time distributions. We demonstrated that our model can be used at the small-scale level to select the most cost-effective allocation strategy and scale-up approach. Our model can be extended to include a larger number of health facilities and provide evidence on the cost-effectiveness of allocation strategies at the country-level. Model projections will be important in enabling decision-makers to quantify the public health and economic impact of allocation strategies.

Committee:

Mendel Singer, PhD, MPH (Committee Chair); Sarang Deo, PhD (Committee Member); Roger Bielefeld, PhD (Committee Member); Kathleen Smyth, PhD (Committee Member)

Subjects:

Biostatistics; Economics; Health Care; Public Health

Keywords:

HIV; Early Infant Diagnosis; HIV-exposed infants; Point-of-care testing; Resource allocation; Cost-effectiveness; Uganda; sub-Saharan Africa;

Kessler, Laura E.Examing Links of Racial and Sexual Identity Development, Psychological Well-being, and Sexual Risks Among HIV-Positive, Same Sex Attracted African American Men
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, and same sex attracted identity of Need for Acceptance, to predict circumstances predicting unsafe sex; higher endorsements of the African American identities of Anti-White and Afrocentric to predict interpersonal barriers to unsafe sex; and higher endorsements of the Anti-White identity to predict sexual risk practices outside of a committed relationship. Descriptive data suggested that participants endorsed African American and same sex attracted identities differently than scale development samples. An exploratory factor analysis showed that the six-factor structure of the CRIS generally replicated within the current sample. However, there was an insufficient sample size to investigate the LGIS factor structure within the current sample. Qualitative data also suggested that participants are experiencing racial and sexual identity challenges, but also engaging in effective ways of coping with and resolving these challenges. Qualitative data also highlighted the importance of social support that is accepting of African American and same sex attracted male identities. Results imply that interventions highlighting issues around effectively managing racial and sexual identity challenges, and psychological distress, while providing social support, could help promote sexual health among HIV-positive African American MSMs.

Committee:

Charles Waehler, Ph.D. (Advisor)

Subjects:

African Americans; Behaviorial Sciences; Demographics; Developmental Psychology; Gender; Health; Multicultural Education; Psychology; Psychotherapy; Public Health; Social Psychology

Keywords:

African American identity development; same sex attracted; gay identity development; sexual risk behaviors; HIV-positive; HIV prevention; men who have sex with men; MSM

Marathe, Jai GovindSusceptibility of Primary Eosinophils to Infection with HIV-1 Strain HTLV-IIIB
Master of Science (MS), Wright State University, 2006, Microbiology and Immunology
Over the past two decades, much research has been done in the field of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). However, many of the aspects of pathogenesis of HIV infection and its persistence in the body, despite treatment, remain a mystery. Recent evidence suggests that HIV positive patients develop eosinophilia, especially in the later stages of infection and AIDS. Eosinophils are CD4 positive cells that have the potential to be infected by HIV. Studies have shown that an eosinophilic cell line, AML14.3D10, can be productively infected with a T-cell tropic, CXCR4-using (X4) strain of HIV-1. In this study, primary human eosinophils from four healthy volunteers were shown to be susceptible to infection with a T-cell tropic, CXCR4-using (X4) strain of HIV-1, HTLV-IIIB. This data was supported by results from quantitative polymerase chain reaction (Q-PCR), which detected high HIV copy numbers in infected eosinophil samples. In two out of four donors, these copy numbers were comparable to those obtained from infected AML14.3D10, used as a positive control. In all four donors, the number of viral copies detected in infected eosinophils were significantly (p<0.05) higher than those detected in infected peripheral blood mononuclear cells (PBMCs). Donor variability was observed in viral loads detected. No correlation was observed between the viral load and the production of p24. However, infected eosinophils showed higher amounts of p24 production, as compared to infected PBMCs with or without IL-2, in three out of four donors suggesting productive infection. Therefore, it is concluded that primary human eosinophils are susceptible to productive infection by X4 HIV-1.

Committee:

Dawn Wooley (Advisor)

Subjects:

Biology, Microbiology

Keywords:

Hiv-1; Eosinophils; HIV-1 infection of eosinophils

Atem, Jude N.Human Immunodeficiency Virus-1 Productively Infects Mature Terminally Differentiated Eosinophils in HIV/AIDS Patients
Master of Science (MS), Wright State University, 2008, Microbiology and Immunology
Eosinophils express membrane CD4 protein and can bind HIV-1 glycoprotein (gp) 120. Therefore, eosinophils could serve as host cells for HIV-1 infection in vivo, especially in the late phase of the infection. In culture, HIV-1 infects eosinophil precursors and primary eosinophils. Additionally HIV-1 proviral DNA sequences have been detected in the eosinophils of some HIV-1 positive patients. Since elevated levels of eosinophils occur during HIV-1 infection and parasitic infections, it implies that co-infection of parasites and HIV-1 could cause a much greater increase in the level of potential HIV-1 susceptible eosinophils. Therefore HIV-1 infection of eosinophils could partly explain the rapid spread of HIV-1 and the exacerbation of the disease especially in developing countries where HIV-1 and parasitic infections run concurrently. This study is a critical analysis of the current knowledge on HIV-1 infection of eosinophils focused on highlighting evidence that HIV-1 can productively infect mature human eosinophils in HIV/AIDS patients.

Committee:

Dawn Wooley, Ph.D (Advisor); Barbara Hull, Ph.D (Committee Member); Nancy Bigley, Ph.D (Committee Member)

Subjects:

Biology; Microbiology

Keywords:

HIV-1; Eosinophils; HIV-1 infection of eosinophils

Baliga, Reshma SRoles and mechanisms of oxidant stress in cardiovascular disease
Doctor of Philosophy, The Ohio State University, 2004, Pharmacy
My primary dissertation focus is understanding the pathology behind cardiovascular disease across disease states, in an attempt to provide novel mechanistic insight so that specialized therapy can be developed. Section I: HIV related cardiovascular disease: The first four chapters: HIV-related cardiovascular complications represent increasingly important contributors to the overall morbidity and mortality of HIV/AIDS patients. Chapter 2 reviews the emergent field of HIV related vascular abnormalities primarily related to alterations in the vascular endothelium. In Chapter 3, we employed a well-established murine model of retroviral infection (LPBM5 virus) and defined the time-dependencies of retroviral progression and cardiac dysfunction corroborated our findings in human tissues. In chapter 4 we tested the hypothesis that HIV-PI’s impose direct detrimental effects on vascular endothelium. Chapter 5 details a role for direct endothelial toxicity induced by Saquinavir (SAQ). Section II deals with cardiovascular complications of diabetes in a mouse model of streptozotocin induced hyperglycemia, a type I diabetes model, studied longitudinally at 0, 1week and 5 weeks post-STZ, for assessment of diastolic and systolic performance by non-invasive echocardiography, and electrocardiographically for conduction abnormalities. We found the STZ mouse model to be appropriate for mechanistic study of Type I diabetic cardiomyopathy, providing time-dependent, clinically relevant assessments of cardiac performance (systolic, diastolic and electrocardiographic) as a foundation for further mechanistic studies, which are shown in chapter 7. Section 3, Chapter 8, appendix A and B: we looked at mechanisms of cardiac dysregulation and development of arrhythmias in canine models. In Appendix A we tested the hypothesis that two models had differing underlying mechanisms of structural remodeling, resulting in development of substrate for AF. Chapter 8, looks in more detail at the MR Dog model, studying development of AF susceptibility over time, to isolate the mechanisms of dysfunction. Finally in Appendix B we tested a novel therapeutic agent, ALT-711 that specifically targets fibrosis stability for its therapeutic value in chronic atrial dilatation (MR) induced AF. Taken together, these studies show that increased oxidative stress is a common factor in cardiovascular dysfunction across disease states, and therapeutic agents targeting oxidative damage might have unique importance to cardiovascular health.

Committee:

John Bauer (Advisor)

Keywords:

HIV/AIDS; atrial; endothelial; diabetic; HIV-PI; cardiac; Fibrosis

Mweemba, PrudenciaQuality of Life among Rural and Urban Zambian Men and Women with HIV/AIDS
PHD, Kent State University, 2008, College of Nursing

Once considered a terminal illness, HIVAIDS has become a chronic illness as those infected are living longer. Given the longevity achievable with the current prophylactic and therapeutic strategies for people living with HIV/AIDS (PLWHA), quality of life has emerged as a significant measure of health outcome, and quality of life enhancement is an important goal. However, little is known about quality of life in impoverished developing countries such as Zambia. Furthermore, in Zambia, there is significant variation in the impact of the HIV pandemic, with much higher HIV prevalence rates occurring in women than men and in urban versus rural areas.

The purpose of the study was threefold. First, the study was to test the quality of life factor structure of the Zambian sample using the World Health Organization Quality of Life HIV (WHOQOL-HIV) instrument. Second, the study was to determine quality of life of the Zambian sample using the resultant factor structure of quality of life. Last, the study was to examine the effect of gender and residence on the quality of life of the Zambian sample using resultant factor structure of quality of life.

A cross-sectional descriptive, correlational, four-group 2x2 factorial design on a convenience sample of 160 PLWHA was conducted using both the WHOQOL-HIV Model and instrument. Factor analysis yielded three new scales: “Zambian WHOQOL-HIV, Zambian WHOHIV Medication Dependence, and Zambian WHOHIV Spirituality Religion Personal Beliefs (SRPB)” and validated the “Overall Quality of Life and General Health Perceptions” scale. The quality of life of the Zambian sample was found to be above average on all the four scales. There were no gender effects on any of the four scales. There was a significant medication dependence residence effect showing that urban participants were more dependent on medication than their rural counterparts. However, this effect disappeared when controlling for individual and clinical characteristics. There was a significant gender by residence interaction effect on spirituality/religion/personal beliefs (SRPB) showing that urban females and rural men had better SRPB than rural women and urban men. This effect was stronger when controlling for individual characteristics were controlled for, but disappeared when clinical characteristics were controlled for. The study also showed that symptomatic patients had lower quality of life and SRPB.

The study is important to nursing because it tested the WHOQOL-HIV instrument among a Zambian sample which has not been done before. This study validated one scale that can be used regularly to assess “overall quality of life and general health perceptions” and provided three scales that can be used for comprehensive assessment of quality of life in order to monitor disease progression and response to care. These assessments of quality of life will lead to development of holistic nursing interventions based on an individual’s perception of their quality of life.

Committee:

Ruth Ludwick (Advisor); Davina Gosnell (Other); Rose Beeson (Other); Ratchneewan Ross (Other); Kenneth Cushner (Other); Richard Zeller (Other)

Subjects:

African Literature; Gender; Health; Nursing; Social Research

Keywords:

HIV/AIDS; Quality of Life; WHOQOL-HIV; Zambia; Factor analysis

Vithayachockitikhun, NiranartThe Experiences of Thai Caregivers of Persons Living with HIV/AIDS
Doctor of Philosophy, Case Western Reserve University, 2009, Nursing

The purpose of this phenomenological study was to explore the lived experiences of Thai caregivers of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) (PLWAs) who were residing at Phra Baat Nam Phu Temple, Lopburi Province, Thailand at the time of the interviews. A semi-structured, face-to-face interview was conducted with 10 Thai caregivers of PLWAs. There were seven female and three male caregivers (ages ranged from 29-62 years). All study participants were family members of PLWAs who required care in home settings. Caregivers were spouses, parents, sisters, a brother, and an aunt. The interviews occurred in the caregivers' homes (n = 8) and at the temple (n = 2). Six themes and 15 categories under these themes emerged from the interviews: 1) caregiving is embedded in the Buddhist philosophy, 2) caregiving is suffering, 3) caregiving is supporting, 4) the caregiving role, 5) the impact of caregiving on the caregivers, and 6) the need to support the caregiving role.

Caregiving is embedded in the Buddhist philosophy, which suggests that suffering and loving one's family and friends is one of its basic guiding principles. Caregivers identified both negative and positive consequences of taking care of their loved ones with HIV/AIDS. The negative impacts included physical, emotional, and financial stress. Moreover, caregiving affected the caregivers' health and demanded changes in their life-styles. This research also demonstrated that HIV/AIDS related stigma is a barrier to caregivers' efforts to seek support. However, caregivers utilized various coping strategies such as accepting the situation, thinking positively, minimizing stress, and managing the financial to cope with caregiving. The positive consequences of caregiving suggest that caring for PLWAs can result in a deeper meaning of life for the caregivers. They reported an abiding sense of fulfillment that was associated with loving humankind, self-value, and knowledge gained through their experiences.

Finally, caregivers need support and understanding from their families, the health care providers, and the Thai government. The results of this study have substantive implications for the understanding of the impact of caregiving upon family members providing assistance to PLWAs.

Committee:

Faye A. Gary, EdD, RN, FAAN (Committee Chair); May L. Wykle, PhD, RN, FAAN, FGSA (Committee Member); Noreen Brady, PhD, RN, APN, LPCC (Committee Member); Sharon E. Milligan, PhD, MSW, MPH (Committee Member)

Subjects:

Nursing

Keywords:

Caregivers of persons living with HIV/AIDS; The experiences of caregiving; The impact of caregiving; Caregivers' health status; HIV/AIDS related stigma

Herr, Scott WilliamHigh School Health Education Teachers' Attitudes and Perceptions Related to Teaching HIV Prevention
Doctor of Philosophy, University of Toledo, 2011, Health Education

The purpose of this study was to identify the factors that significantly influence the attitudes and perceptions of high school health education teachers relative to HIV prevention instruction. Despite a steady decrease in the number of diagnosed cases each year, HIV/AIDS continues to rank as one of the leading causes of illness and death in the United States. Individuals between the ages of 13 and 19 years are particularly vulnerable for HIV transmission, as evidenced by the steady increase in the number of reported infections in this age group over the past decade. Underlying this trend is a growing lack of awareness, a decreasing perception of vulnerability and a general lack of accurate knowledge regarding HIV/AIDS among adolescents and young adults in the United States. The CDC, along with a number of researchers in sexuality education, recommends that education about HIV prevention is most appropriate and effective when executed within the context of a comprehensive school health education program that establishes a foundation for understanding the relationships between personal behavior and health. While the CDC’s 2006 School Health Policies and Practices study indicates that 31 states require instruction in HIV prevention, research indicates that there is great variability between states and individual districts in the provision of the requirements for the certification, licensure, and training in sexuality education of the teachers providing that instruction.

The population of interest in this study was high school health education teachers in public school systems in the United States. A systematic random sample of 800 high school health education teachers representing states with mandates requiring instruction in HIV prevention and states with no such requirements was selected from a list of public high schools derived from the Common Core of Data (CCD) of the United States Department of Education’s National Center for Educational Statistics database. An a priori power analysis, for external validity of the results, suggested a sample size of 374 completed surveys based on a 5% sampling error and 50/50 split in responses for a population of 11,250 schools. Sample size was determined based on alpha at .05, the effect size at .20 and 90% power. Based on response rates of studies with similar populations, a total of 800 surveys were sent to lead health education teachers in the selected high schools. Seventy-nine surveys were undeliverable, leaving a potential sample size of 721. A total of 362 high school health education teachers (50%) responded. While there is almost complete agreement (99%) among respondents in this study that HIV prevention instruction is needed, the results of this study indicate that there is significant variance in outcome expectations, efficacy expectations, perceived barriers and benefits, and attitudes of high school health education teachers about teaching HIV prevention. The factors in this study that emerged as most significantly influencing the attitudes and perceptions of high school health education teachers about teaching HIV prevention were related primarily to teacher preparation and training and the number of years of experience teachers had teaching health education. The presence of a state mandate requiring HIV prevention instruction was significantly associated with higher efficacy expectations and more perceived benefits by high school health education teachers, but did not appear to have significant influence in relation to practices in the classroom. Characteristics of high school health education teachers that were significantly related to attitudes, perceptions and instructional practices included the age, gender and race/ethnicity of the instructor. The findings of this study are consistent with and affirm findings from previous studies that have emphasized the significance of teacher preparation and training relative to teachers’ perceptions, attitudes, perceived benefits and barriers, and efficacy and outcome expectations, which ultimately influence student outcomes. Findings from this study also indicate the need to further investigate certain teacher characteristics, such as race/ethnicity, age, experience level, and gender to determine the extent that those variables may influence curricular content and instruction.

Committee:

Susan Telljohann, HSD (Advisor); Joseph Dake, PhD (Committee Member); James Price, PhD (Committee Member); Gregory Stone, PhD (Committee Member)

Subjects:

Education; Health Education; Public Health; Public Health Education; Teaching

Keywords:

HIV; AIDS; school health; high school; teacher training; self-efficacy; outcome expectations; health belief model; health education; HIV instruction

Vira, RohiniCross-cultural study on hiv-positive Indian and American men on disclosure, perceived social support and psychological well-being: implications for marriage and family therapists
Doctor of Philosophy, The Ohio State University, 2004, Human Development and Family Science
The estimated number of people living with HIV/AIDS in India was at 3.86 million (UNAIDS, 2001) and in the United States were over 793,000 (CDC, 2001). Given these high numbers, it is clear that millions of Indians and Americans are facing issues around HIV infection. Although past research has validated the influence of cultural on the individual and families’ psychological well-being (Triandis, 1995), literature on psychosocial variables has mostly been conducted in the United States (e.g., Mason, et al., 1995). Research utilizing samples living in other countries warrants attention because the HIV research in the United States is disproportionately represented and is growing at a much faster pace than in other countries such as South Africa, and India. Further, due to cultural differences, it is inappropriate to apply research generated from American samples and impose them on men living in other nations. The purpose of this research is to investigate the relationship between disclosure of HIV-status to partners, parents and siblings, perceived support from family and friends, depression and loneliness. Analysis of the disclosure rates, and reasons for disclosure and non-disclosure of their HIV-status to others was also conducted. Existing datasets on HIV positive Indian (n = 100) and American men (n = 139) were used. Hierarchical regression was the main mode of analysis. Results clearly showed that partners were disclosed to at a greater rate than parents and siblings for both Indian and American men, and disclosure rates to all family members was higher for American in comparison with Indian men. The HIV-positive men’s age, employment status, and length of HIV diagnosis together were also found to be significantly associated with disclosure to parents, partners, and siblings. Further, it seemed that the American men’s reasons for disclosure were more relation-focused, whereas for Indians men it was more obligatory/required. Perceived support from family and friends was found to significantly vary by the participant’s county-of-origin, and disclosure to family. Interestingly, no significant relationship was found between the Indian and American men’s age, time since diagnosis, perceived support, and disclosure to family. Clinical and research implications, and limitations of this study were also discussed.

Committee:

Julianne Serovich (Advisor)

Keywords:

DISCLOSURE; HIV/AIDS; HIV positive; Indian men; AMERICAN MEN; Disclosure to Partner

Nankya, Immaculate LillianHIV-1 EVOLUTION: ROLE OF DIVERSITY AND FITNESS—IMPLICATIONS FOR THE EPIDEMIC
Doctor of Philosophy, Case Western Reserve University, 2010, Molecular Biology and Microbiology
Human Immunodeficiency virus is a rapidly evolving virus, constantly mutating to escape host immune recognition. A stronger diversifying pressure by the immune system on the env gene is thought to be responsible for this high mutation rate, while other genes like the gag and pol that are under less diversifying pressure and more purifying selection pressure show lower rates. Not only is there an increase in viral quasispecies as the disease progresses but there is also coreceptor evolution from the CCR5- (R5) using viral variants that predominate in the early and asymptomatic phase of infection to the CXCR4 (X4) (and the dual-tropic R5X4) variants that are normally found in the late stage of the disease. Furthermore, as the disease progresses, HIV evolves from the less fit to the more fit variants such that in end-stage disease, there is a diverse viral population that is predominantly CXCR4-using and exhibiting increased fitness. Using selective inhibition of each phenotype by either drugs or U87.CD4 cells that express either of the receptors, we found that in dual-tropic isolates, the CXCR4 phenotype is the major determinant of viral fitness. HIV-1 subtype C is dominating the global epidemic and is rapidly spreading both as a pure subtype and as a recombinant. The reasons for this rapid spread are not yet well delineated. Using two well characterized cohorts; a subtype A and D cohort and a subtype C cohort, we found that the rates of CD4 cell declines were much slower in the subtype C. The slower CD4 cells declines coupled with the reduced fitness of this subtype plus efficient transmission as well as the fact that subtype C rarely switches from CCR5 to CXCR4, may be part of the reason this subtype is dominating in the epidemic.

Committee:

Catherine Patterson, PhD (Committee Chair); Eric Arts, PhD (Advisor); Henry Boom, MD (Committee Member); Amiya Banerjee, PhD (Committee Member)

Subjects:

Microbiology; Virology

Keywords:

HIV-1; env gene; diversity; fitness; disease progression; HIV-1 subtypes

Atzberger, Craig PhilipA Complex Systems Approach to Sustainability: Can Peak Oil Fuel the Sub-Saharan AIDS Epidemic?
Doctor of Philosophy, Case Western Reserve University, 2007, Systems and Control Engineering
The focus of this dissertation is development of a systems methodology to examine large scale interrelated complex global systems governing natural resource use, population, economy and global health. The study investigates questions regarding the individual disciplines and their integration as a system. Integrated assessment (IA) examines if the looming peak in world oil production, and the post-peak oil era, can intensify the HIV/AIDS epidemic. Other questions include: - When could the world reach peak oil production? - What are the economic implications for HIV/AIDS funding in the post-peak oil era? - What is the potential humanitarian cost in lives lost per barrel of oil deficit? A range of models have been developed and integrated in a decision support future assessment system as a reasoning support guide. An interactive cybernetic approach incorporating the global earth/human dimensions is applied to manage the many aspects of complexity and uncertainty. IA is enhanced by a decision-making paradigm that utilizes real data, a family of multi-level hierarchical models, and a human-in-the-loop approach. “Corner scenarios” envelope the scope of future development and hypothetical scenarios demonstrate possible futures within the envelope. Results show oil production may peak by 2015. Without an alternative to fill the gap left by declining oil supplies, economic growth, closely correlated with oil consumption, will slow or decline. Affluent countries of the Organization for Economic Cooperation and Development may become unable to provide Official Development Assistance (ODA) funding for needy countries. Without ODA, HIV/AIDS preventive/treatment programs in sub-Saharan Africa will likely disappear causing a spike in prevalence, higher mortality and a reduction in economy. Conversely, if the impending oil crisis is averted via strategic planning and alternative energy development, then ODA adequate to achieve the United Nations Millennium Development Goals (MDGs) could save millions of lives by preventing initial infection and providing antiretroviral therapy. IA through 2050 demonstrates that reductions in ODA lead to an increase from 6.1 to 15 percent HIV/AIDS prevalence in sub-Saharan Africa, as opposed to 1 percent prevalence if the MDGs are achieved; total population falls by over 450 million and Gross National Income growth drops by 30 percent.

Committee:

Sree Sreenath (Advisor)

Keywords:

HIV/AIDS Epidemic; Peak Oil; Mathematical Modeling of Global Systems; Millennium Development Goal on HIV/AIDS; Sustainability and Sub-Saharan Africa; Oil Deficit Crisis

Hokello, Joseph FrancisThe Individual Contribution of Transcription Factors Mobilized Following T-cell Receptor (TCR) or Mitogenic Activation in the Reactivation of HIV from Latency
Doctor of Philosophy, Case Western Reserve University, 2010, Molecular Virology
Human Immunodeficiency Virus latency remains the single greatest obstacle to successful HIV eradication. The precise molecular mechanisms utilized by HIV to emerge from latency are poorly understood although it is believed that NF-kappaB is the major transcription factor utilized. While NF-kappaB may be the major factor involved in HIV transcription, additional transcription factors including NF-AT and AP-1 have also been implicated in various studies to regulate HIV transcription albeit the individual contribution of each of these factors in HIV LTR-mediated transcription are unknown. In this dissertation, we determined the individual contribution NF-kappaB, NF-AT and AP-1 transcription factors in the reactivation of HIV from latency following TCR or mitogenic activation using Jurkat T-cell clones harboring single latent HIV proviruses. In order to tease out the contribution of each factor in HIV transcription, we utilized MAPK inhibitor PD98059 and Cyclosporin A to block AP-1 and NF-AT, respectively. Following TCR co-activation, NF-kappaB, NF-AT and AP-1 exhibit unique nuclear induction levels and kinetics. Each factor becomes available in the nucleus when it is required to modulate transcription. For instance, NF-kappaB exhibits two distinct nuclear entry cycles during which latent HIV proviruses are transcribed while AP-1 becomes available during latter time points where AP-1 c-Fos synergizes with NF-kappaB to modulate HIV transcription elongation which is inhibited by PD98059. Certain control cellular genes are transcribed during the first or second NF-kappaB induction cycles. Following TCR co-activation, NF-AT inhibits LTR activation through competitive binding with NF-kappaB. However, AP-1 c-Fos synergizes with NF-AT to activate HIV transcription in the absence of NF-kappaB following selective TCR activation. Mitogenic PHA activation of Jurkat T-cell clones induces NF-kappaB p65 and AP-1 as the major transcription factors during which AP-1 c-Fos synergizes with p65 homodimers in the absence of p50 to activate HIV transcription. Induction of NF-kappaB, NF-AT and AP-1 through co-stimulation of Jurkat T-cell clones using anti-CD3 antibody and TNF-alpha (replaces anti-CD28 antibody) combination to mimic classic TCR activation using anti-CD3 and anti-CD28 antibodies does not permit AP-1 c-Fos to synergize with NF-kappaB or NF-AT to modulate HIV transcription. We are utilizing these approaches to study HIV latency in primary CD4+ T-lymphocytes.

Committee:

Jonathan Karn, Ph.D. (Advisor); David McDonald, Ph.D. (Committee Chair); Carlos Subauste, M.D. (Committee Member); Eric Arts, Ph.D. (Committee Member); Koh Fujinaga, Ph.D. (Committee Member)

Subjects:

Biomedical Research; Molecular Biology; Virology

Keywords:

T-cell Receptor Signaling; Reactivation of HIV Latency; HIV transcription regulation

Opio, Alex AcholHIV-1 and coinfection with hepatitis B and delta viruses: What is the impact of HIV-1 infection on hepatitis B chronic carriage and the sero-prevalence of delta virus in Uganda?
Doctor of Philosophy, Case Western Reserve University, 1994, Epidemiology and Biostatistics
Since clearance of HBV infection is dependent on normally functioning cell-mediated immunity, it is possible that immunological dysfunction induced by HIV-1 infection leads to poor clearance of HBV. Consequently, HIV infection is expected to promote the spread of HBV infection. To determine whether HIV infection has the potential to promote the spread of HBV infection, a hospital-based cross-sectional study was conducted in Uganda. Information was collected on respondent's demographic characteristics, risk factors for, and clinical features of HBV infection. In addition, blood was obtained for HIV-1 and hepatitis tests. The overall prevalence of HBsAg, anti-HBs, anti-HBc and total HBV infection was 15.7%, 54.0%, 42.9% and 66.9% respectively. 64.4% of subjects with detectable levels of anti-HBs had "protective levels" of the antibody. Of 1392 subjects tested for all the three key markers of HBV infection (HBsAg, anti-HBs and anti-HBc), 463 (33.2%) had no evidence of infection, 51 (3.7%) were in a serologic window period, 210 (15.1%) had evidence of infection that occurred in the distant past, 450 (32.3%) were i n convalescence, and 218 (15.5%) had active infection. Of 218 subjects with active infection, 111 (50.9%) were in the early phases of infection, 96 (44.1%) had either acute or chronic hepatitis, and 11 (5.0%) had reinfections. 43 subjects had concurrent circulation of HBsAg and anti-HBs. The overall prevalence of HBV chronic carriage was 4.9%. HIV positive individuals were more likely than those negative to have chronic carriage (P = 0.0007). After controlling for other variables, being HIV positive was associated with a 3.66 fold increase in the likelihood of chronic carriage. Being a male or having both fever and fatigue were independently predictive of HBV chronic carriage. Of 172 HBsAg positive subjects tested for anti-HD, 4 (2.3%) had the antibody. Of 152 HBsAg positive subjects tested for HBeAg, 23 (15.1%) had the antigen. There was no difference in HBeAg seropositivity by HIV status (P > 0.05). In conclusion, the study shows that HBV infection is highly endemic in Uganda, HDV infection is not a problem in southern Uganda, HIV infection has the potential to promote HBV chronic carriage, and, presence of anti-HBs may not always represent immunity. Ensuing from above, recommendations are made: (a) Institution of HB vaccination programme, (b) Prevention of HBV infection through blood screening and sterilization of injection/surgical equipments, (c) Continued prevention of HIV infection through counselling, (d) Further research to find out how maternal transmission of HBV is impacted by HIV infection, and to elucidate the subject of co-occurrence of HBsAg and anti-HBs.

Committee:

Edward Mortimer, Jr. (Advisor)

Keywords:

HIV-1 coinfection hepatitis B delta viruses impact HIV-1 infection hepatitis B chronic carriage sero-prevalence delta virus Uganda?

Mullins, Tanya Lilliane KowalczykHIV Testing Attitudes and Preferences Among Urban Adolescents
MS, University of Cincinnati, 2008, Medicine : Epidemiology (Environmental Health)

Objective: To determine factors associated with adolescent HIV testing and preferences for different testing methods.

Methods: Sexually active 13-22 year-olds (N=200) completed a theory-based survey and were offered HIV testing. Those who agreed chose one of three HIV tests. Chi-square and logistic regression were performed to determine factors associated with testing.

Results: Half of participants (49.5%) agreed to HIV testing: 51% chose rapid oral, 30% venipuncture, and 19% rapid fingerstick. Male gender (OR 3.52; 95% CI 1.35-9.21), parental completion of high school (OR 2.69; 95% CI 1.15-6.31), intention to test for HIV if offered by clinician (OR 6.78; 95% CI 2.01-22.92), and higher perceived likelihood of current HIV infection (OR 10.0; 95% CI 2.9-33.3) were independently associated with testing.

Conclusions: Intention to test if offered by a clinician and perceived likelihood of current HIV infection appear to be important factors in decision to test.

Committee:

Paul Succop, PhD (Committee Chair); Lorah Dorn, PhD (Committee Member); Jessica Kahn, MD, MPH (Committee Member)

Subjects:

Biomedical Research; Epidemiology; Health Care; Public Health

Keywords:

HIV Testing; HIV Serodiagnosis; Adolescents; Point-of-Care testing; Health attitudes; Questionnaire

Lofquist, Daphne AmberHIV Testing Behaviors of At-Risk Populations in Kenya
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 been tested for HIV) and cues-to-action (having participated in HIV education programs is positively associated with having been tested for HIV). For men in worksites, two components of the Health Belief Model are significantly associated with having been tested for HIV: perceived barriers (believing that confidential testing is not available is negatively associated with having been tested for HIV) and cues-to-action (having participated in HIV education programs is positively associated with having been tested for HIV). None of the components of Health Belief Model is significantly associated with having been bested for HIV for policemen. For all four populations, none of the gendered culture variables is significantly related to having been tested for HIV. Results point to the importance of barriers and cues-to-action for having been tested for HIV. This underscores the need for accurate education on the transmission of HIV.

For the second research question – predicting having acquired HIV test results, conditional on having been previously tested – five components of the Health Belief Model and several gendered culture variables are used. Only one component of the Health Belief Model is significantly associated with having acquired the HIV test results for female sex workers: perceived barriers (believing that no confidential testing is available and having been required to be tested for HIV are negatively related to having acquired HIV test results). For men in worksites, only one component of the Health Belief Model is significantly associated with having acquired the HIV test results: perceived barriers (having been required to be tested for HIV are negatively related to having acquired HIV test results). None of the gendered culture variables are significantly associated with having acquired HIV test results for female sex workers and men in worksites. Results point to the importance of decreasing barriers to confidential testing facilities, which in turn could increase voluntary testing.

Committee:

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

Subjects:

Sociology

Keywords:

HIV; HIV testing; Kenya; High risk populations; Africa

Natanzon, YaninaMETABOLIC SYNDROME IN AN IMMUNOSUPPRESSED POPULATION: GENETIC CONTRIBUTION TO METABOLIC SYNDROME TRAITS IN THE WOMEN'S INTERAGENCY HIV STUDY
Doctor of Philosophy, Case Western Reserve University, 2016, Epidemiology and Biostatistics
This is a study to evaluate cross-sectional and longitudinal genetic associations among Metabolic Syndrome (MetS) risk factors and a select set of candidate genes involved in inflammatory, vasoconstrictive, and coagulation processes at the vascular epithelium in the Women's Interagency HIV Study (WIHS) Cohort. We conducted a candidate gene association analysis of multiple clinical measures for each component trait of MetS in a group of HIV-positive and -negative women of the WIHS. Thirty-two candidate genes were selected based on their pro-inflammatory, pro-vasoconstrictive, and pro-coagulative functions and expression in the vascular endothelium. The association was modeled with mixed effects model with both random slope and random intercepts. We have identified genetic variants in CKD14 and NFKB1 with longitudinal effects on MetS risk factors in African Americans and Hispanics. We provide evidence that the genetic architecture of MetS includes genes previously implicated in inflammation (NFKB1) and vessel repair (CDK14) and that HIV may mediate the magnitude of the some genetic associations.

Committee:

Xiaofeng Zhu, Ph.D. (Committee Chair); Robert Elston, Ph.D. (Committee Member); Nathan Morris, Ph.D. (Committee Member); Nora Nock, Ph.D. (Committee Member); Barbara Gripshover, M.D. (Committee Member); Bradely Aoiuzerat, Ph.D. (Committee Member)

Subjects:

Epidemiology; Genetics

Keywords:

Metabolic Syndrome; HIV; Womens Interagency HIV Study; WIHS; Inflammation; Longitudinal genetic analysis; Pulse pressure; NFKB1; CDK14; Cardiovascular Disease; Repeated measures analysis; Genetics; Genetic Epidemiology; Hispanics; African Americans;

Karim-Sesay, Waithera KimaniUkimwi Ni Kamaliza, the wasting disease: socio-cultural factors related to HIV/AIDS vulnerability among women in Kenya
Doctor of Philosophy, The Ohio State University, 2006, Agricultural Education

HIV/AIDS has affected women from sub-Saharan Africa in disproportionate numbers more than anywhere else in the world. Women are vulnerable to HIV/AIDS infection in Kenya as a result of powerful patriarchal influences that permeate women’s lives leading to marginalization and disempowerment in social, cultural, and economic avenues.

To address the research questions, secondary analysis of data from the 2003 Kenya Demographic and Health Survey was utilized. In this study, it was expected that the demographic variables of age, education, religion, ethnicity, region of residence, marital status, and employment were the independent variables that would influence HIV vulnerability among women. A dependent variable, HIV vulnerability was conceived of a larger concept comprised of powerlessness, AIDS-related knowledge, cultural practices, sexual behavior, and perception of HIV risk.

A one-way analysis of variance, ANOVA was performed to test if significant relations existed between the independent variables and dependent variable. Between-subject effects were identified and multiple comparison tests (Bonferroni) were conducted for these variables; plots were also used to visually present the mean scores. The tests of between-subject effects showed that age (F = 78.848, p = .000), region of residence (F = 21.452, p = .000), education (F = 130.088, p = .000), ethnicity (F = 13.276, p = .000), marital status (F = 39.002, p = .000), and employment (F = 216.592, p = .000) were all statistically significant. However, religion (F = .730, p = .572) was not statistically significant. It had been hypothesized that religion would play a significant role in HIV vulnerability. However this was not the case, and was in contrast with the hypothesis.

In this study, the data strongly suggest that women in Kenya are more vulnerable to HIV/AIDS when they are younger, have low levels of education, are from different ethnicities and from certain regions, are unmarried, and not employed. The findings supported the literature that women’s vulnerability is strongly influenced and tied by broader forces present in the society.

The results of this study provide a framework for further vulnerability studies based on a socio-cultural framework. Future studies should consider incorporating qualitative research methods in order to get a holistic picture of the concept of vulnerability.

Committee:

Theresa Ferrari (Advisor)

Keywords:

Ukimwi Ni Kamaliza; HIV/AIDS Vulnerability and women in Kenya; Women and AIDS in Kenya; Socio-cultural factors and HIV; Women and Kenya

Rose, Jared S.A Dissertation entitled Development and Validation of the Mental Health Professionals’ Attitude Towards People Living with HIV/AIDS Scale (MHP-PLHIV-AS)
Doctor of Philosophy, University of Toledo, 2016, Counselor Education and Supervision
Individuals infected and affected by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have distinctive mental and emotional health issues (Acuff et al., 1999; Badiee et al., 2012; Hult et al., 2007). This study sought to create an instrument that measures the attitude element of competency with the development of the Mental Health Professionals’ Attitude Towards People Living with HIV/AIDS (MHP-PLHIV-AS). After the MHP-PLHIV-AS’s creation by a Content Evaluation Panel of HIV/AIDS Experts, it was piloted for calibration with a sample of mental health professionals (n = 43), then administered to a larger sample for validation (n = 454). The newly designed MHP-PLHIV-AS was analyzed through a Rasch Measurement Model (RMM; Rasch, 1960, 1980). RMM diagnostics and analyses provides evidence to support a two-dimensional (societal and personal dimensions) measurement of the attitude towards PLHIV construct. The authors provide background, processes, and results of the study, and implications not only for the use of the MHP-PLHIV-AS, but also of attitude being a two-dimensional construct.

Committee:

John Laux (Committee Chair); Christine Fox (Committee Member); Christopher Roseman (Committee Member); Mojisola Tiamiyu (Committee Member); Caroline O'Hara (Committee Member)

Subjects:

Counseling Education; Counseling Psychology; Multicultural Education; Psychology; Public Health; Therapy

Keywords:

HIV; AIDS; people living with HIV-AIDS; PLHIV; attitude; competency; mental health; Rasch Measurement Model

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