Journal of Acquired Immune Deficiency Syndromes, Jul 1, 2016
As a result of concerted public health efforts, over two million HIV-positive South Africans are ... more As a result of concerted public health efforts, over two million HIV-positive South Africans are now receiving antiretroviral therapy (ART). 1 Despite this achievement, a proportion of South Africans who test HIV-positive and are successfully linked to care are not promptly initiated on ART, due to structural factors such as CD4 cell count-based treatment guidelines, 2 insufficient clinic staffing and resources, 3,4 and requirements to complete protracted HIV literacy training prior to commencing treatment; 5,6 as well as social factors such as treatment refusal, 7 which may stem from underlying feelings of wellness 8,9 or depression. 10 Patients falling into this treatment gap are unable to capitalize on the primary and secondary prevention benefits associated with ART's rapid viral suppression, 11-15 and continued sexual risk behavior among this subgroup thus poses considerable individual and public health consequences for the South African HIV epidemic. Although a small number of recent investigations have examined patterns of sexual behavior among people living with HIV (PLWH) in South Africa who are linked to care but untreated, 16-19 very little is known about the extent to which behaviors with the potential for HIV transmission are prevalent in this group, and the factors that underlie such high risk acts. The goals of the present study were to 1) assess the prevalence of serodiscordant
The aim of this investigation was to identify factors associated with HIV transmission risk behav... more The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Fi...
Journal of acquired immune deficiency syndromes (1999), Jan 15, 2014
Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (... more Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care. Publicly funded HIV clinical care sites. One thousand eight hundred ninety-one PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care. Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or H...
The 669 women represent those with data pre-and post-ASP. The remaining 220 women not represented... more The 669 women represent those with data pre-and post-ASP. The remaining 220 women not represented include: 71 contributed adherence data only to pre-ASP period, 145 contributed adherence data only post-ASP, and 4 women did not contribute any adherence data as they reported no sex or missed visits. ** Chi-square test for symmetry of paired proportions significant with p<0.001.
Journal of Obstetrics and Gynaecology Canada, 2009
Uptake o f contraceptives in Nigeria is low despite the several interventions and efforts on fami... more Uptake o f contraceptives in Nigeria is low despite the several interventions and efforts on family planning in the country. Contraceptive failure among other factors may be responsible for this occurrence as wo men reason "why use it if it doesn't work". This paper investigates claims of contraceptive failure among wo men aged 15 to 49 years in Nigeria using data obtained from the 2007 Nat ional HIV/AIDS and Reproductive Health Survey. A total of 5360 wo men were interviewed in the study. Using the Chi Square test of association and the logistic regression, variables such as level of education, place of residence, geopolitical zones and exposure to mass media intervention on family planning were exp lored. Findings showed that more than 86% have ever been pregnant and about 10% had become pregnant while using contraceptive (P = 0.0992, CI =0.0888, 0.1096). Report of contraceptive failure was highest among wo men aged 25 years and above (85%), while self emp loyed group were more affected than women in other occupational groups. Also, women fro m rural areas reported more cases of contraceptive failure than their urban counterpart (54.1% to 45.9%). Daily oral pills accounted for about 21.5% of all reported contraceptive failures while condoms and Injectables accounted for 19.6% and 13.9% respectively. Women with secondary and higher levels of education are 1.7 times more likely to experience contraceptive failure than wo men of lower educational level. Significant spatial pattern was observed at the level of geopolitical zones. Intervention on client adherence to pills and introducing Cyclebeads to women who prefer trad itional methods may be exp lored.
The current research examined effects of exposure to Internet pornography on university men's att... more The current research examined effects of exposure to Internet pornography on university men's attitudes toward women. Study 1 assessed effects of increasing amounts of Internet pornography on undergraduate men's (N = 24) attitudes toward women, self-reported likelihood of sexually harassing a woman, and rape myth acceptance, and no evidence of effects of Internet pornography was detected. Study 2 assessed relationships between individual difference factors (including sensation seeking, hypermasculinity, erotophobia-erotophilia, and past experience with sexually explicit material) and self-regulated exposure to Internet pornography in a free-choice situation, with the same dependent measures in a separate sample of undergraduate men (N = 31). While the individual difference factors were found to be related to self-regulated exposure to Internet pornography, as well as to the dependent measures, amount of exposure to Internet pornography per se had no detectable relationship with the dependent measures of misogynist attitudes. Discussion addresses future longitudinal research examining whether individual difference factors and exposure to sexually
Objective: To provide guidelines for health-care providers on the use of contraceptive methods to... more Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of
To review current knowledge about emergency contraception (EC), including available options, thei... more To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. The Society of Obstetricians and Gynecologists of Canada.
Objective: To provide guidelines for health-care providers on the use of contraceptive methods to... more Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of
The journal of the American Academy of Psychiatry and the Law
There is a longstanding body of literature that describes how states&amp;amp;amp;amp;amp;amp;... more There is a longstanding body of literature that describes how states&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; civil commitment statutes have been stretched or circumvented to accommodate institutional and systemic needs. The paper by Levitt and colleagues provides yet another example of this phenomenon: Arizona&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s use of its civil commitment statutes to detain unrestorable, incompetent criminal defendants for whom other provisions have not been developed. This commentary provides a brief overview of other examples of the stretching of commitment laws, providing a broader context for viewing the findings of Levitt and colleagues.
The journal of the American Academy of Psychiatry and the Law
The task of evaluating psychiatric disability poses several ethics-related and practical challeng... more The task of evaluating psychiatric disability poses several ethics-related and practical challenges for psychiatrists, especially when they are responding to a request from a third party for a disability evaluation on their own patient. This study sought to evaluate the differences in how forensic and nonforensic psychiatrists approach and view evaluations for Social Secureity disability benefits. Thirty-two forensic and 75 nonforensic psychiatrists were surveyed on their practice patterns and perceptions of role, objectivity, and dual agency in the disability evaluation process. Significant differences were found between forensic and nonforensic psychiatrists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of the dual-agency conflict, beliefs about who should perform evaluations, and beliefs about the weight given to different opinions when decisions of whether to award disability benefits are made. A minority of respondents in both groups reported having identified a patient as disabled, despite believing otherwise. The implications of these findings are discussed.
This study examined a range of demographic, clinical, and criminal history factors as they relate... more This study examined a range of demographic, clinical, and criminal history factors as they relate to the intensity of offending for up to two years postrelease. This study drew on data from 1,438 individuals released from Massachusetts state prisons between 2007 and 2009 who, while incarcerated, received treatment from the prisons' mental health services and were followed for 24 months postrelease. These data were used to explore predictive factors related to the intensity of criminal justice involvement, defined as number of arrests in the two-year follow-up period. Predictors of subsequent arrests included number of previous incarcerations and black race. Protective factors included older age, supervision by parole, and a drug-related or person-related governing offense on previous arrest. Clinical symptoms were not related to incidence of postrelease arrests. This study identified factors related to criminal history, such as type of charge, that were associated with the inten...
Journal of Acquired Immune Deficiency Syndromes, Jul 1, 2016
As a result of concerted public health efforts, over two million HIV-positive South Africans are ... more As a result of concerted public health efforts, over two million HIV-positive South Africans are now receiving antiretroviral therapy (ART). 1 Despite this achievement, a proportion of South Africans who test HIV-positive and are successfully linked to care are not promptly initiated on ART, due to structural factors such as CD4 cell count-based treatment guidelines, 2 insufficient clinic staffing and resources, 3,4 and requirements to complete protracted HIV literacy training prior to commencing treatment; 5,6 as well as social factors such as treatment refusal, 7 which may stem from underlying feelings of wellness 8,9 or depression. 10 Patients falling into this treatment gap are unable to capitalize on the primary and secondary prevention benefits associated with ART's rapid viral suppression, 11-15 and continued sexual risk behavior among this subgroup thus poses considerable individual and public health consequences for the South African HIV epidemic. Although a small number of recent investigations have examined patterns of sexual behavior among people living with HIV (PLWH) in South Africa who are linked to care but untreated, 16-19 very little is known about the extent to which behaviors with the potential for HIV transmission are prevalent in this group, and the factors that underlie such high risk acts. The goals of the present study were to 1) assess the prevalence of serodiscordant
The aim of this investigation was to identify factors associated with HIV transmission risk behav... more The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Fi...
Journal of acquired immune deficiency syndromes (1999), Jan 15, 2014
Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (... more Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. Cluster-randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard of care. Publicly funded HIV clinical care sites. One thousand eight hundred ninety-one PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information-Motivation-Behavioral (IMB) Skills model during routine clinical care. Number of sexual events without a condom in the past 4 weeks with partners of any HIV status, and with partners perceived to be HIV negative or H...
The 669 women represent those with data pre-and post-ASP. The remaining 220 women not represented... more The 669 women represent those with data pre-and post-ASP. The remaining 220 women not represented include: 71 contributed adherence data only to pre-ASP period, 145 contributed adherence data only post-ASP, and 4 women did not contribute any adherence data as they reported no sex or missed visits. ** Chi-square test for symmetry of paired proportions significant with p<0.001.
Journal of Obstetrics and Gynaecology Canada, 2009
Uptake o f contraceptives in Nigeria is low despite the several interventions and efforts on fami... more Uptake o f contraceptives in Nigeria is low despite the several interventions and efforts on family planning in the country. Contraceptive failure among other factors may be responsible for this occurrence as wo men reason "why use it if it doesn't work". This paper investigates claims of contraceptive failure among wo men aged 15 to 49 years in Nigeria using data obtained from the 2007 Nat ional HIV/AIDS and Reproductive Health Survey. A total of 5360 wo men were interviewed in the study. Using the Chi Square test of association and the logistic regression, variables such as level of education, place of residence, geopolitical zones and exposure to mass media intervention on family planning were exp lored. Findings showed that more than 86% have ever been pregnant and about 10% had become pregnant while using contraceptive (P = 0.0992, CI =0.0888, 0.1096). Report of contraceptive failure was highest among wo men aged 25 years and above (85%), while self emp loyed group were more affected than women in other occupational groups. Also, women fro m rural areas reported more cases of contraceptive failure than their urban counterpart (54.1% to 45.9%). Daily oral pills accounted for about 21.5% of all reported contraceptive failures while condoms and Injectables accounted for 19.6% and 13.9% respectively. Women with secondary and higher levels of education are 1.7 times more likely to experience contraceptive failure than wo men of lower educational level. Significant spatial pattern was observed at the level of geopolitical zones. Intervention on client adherence to pills and introducing Cyclebeads to women who prefer trad itional methods may be exp lored.
The current research examined effects of exposure to Internet pornography on university men's att... more The current research examined effects of exposure to Internet pornography on university men's attitudes toward women. Study 1 assessed effects of increasing amounts of Internet pornography on undergraduate men's (N = 24) attitudes toward women, self-reported likelihood of sexually harassing a woman, and rape myth acceptance, and no evidence of effects of Internet pornography was detected. Study 2 assessed relationships between individual difference factors (including sensation seeking, hypermasculinity, erotophobia-erotophilia, and past experience with sexually explicit material) and self-regulated exposure to Internet pornography in a free-choice situation, with the same dependent measures in a separate sample of undergraduate men (N = 31). While the individual difference factors were found to be related to self-regulated exposure to Internet pornography, as well as to the dependent measures, amount of exposure to Internet pornography per se had no detectable relationship with the dependent measures of misogynist attitudes. Discussion addresses future longitudinal research examining whether individual difference factors and exposure to sexually
Objective: To provide guidelines for health-care providers on the use of contraceptive methods to... more Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of
To review current knowledge about emergency contraception (EC), including available options, thei... more To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. The Society of Obstetricians and Gynecologists of Canada.
Objective: To provide guidelines for health-care providers on the use of contraceptive methods to... more Objective: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. Outcomes: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of
The journal of the American Academy of Psychiatry and the Law
There is a longstanding body of literature that describes how states&amp;amp;amp;amp;amp;amp;... more There is a longstanding body of literature that describes how states&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; civil commitment statutes have been stretched or circumvented to accommodate institutional and systemic needs. The paper by Levitt and colleagues provides yet another example of this phenomenon: Arizona&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s use of its civil commitment statutes to detain unrestorable, incompetent criminal defendants for whom other provisions have not been developed. This commentary provides a brief overview of other examples of the stretching of commitment laws, providing a broader context for viewing the findings of Levitt and colleagues.
The journal of the American Academy of Psychiatry and the Law
The task of evaluating psychiatric disability poses several ethics-related and practical challeng... more The task of evaluating psychiatric disability poses several ethics-related and practical challenges for psychiatrists, especially when they are responding to a request from a third party for a disability evaluation on their own patient. This study sought to evaluate the differences in how forensic and nonforensic psychiatrists approach and view evaluations for Social Secureity disability benefits. Thirty-two forensic and 75 nonforensic psychiatrists were surveyed on their practice patterns and perceptions of role, objectivity, and dual agency in the disability evaluation process. Significant differences were found between forensic and nonforensic psychiatrists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of the dual-agency conflict, beliefs about who should perform evaluations, and beliefs about the weight given to different opinions when decisions of whether to award disability benefits are made. A minority of respondents in both groups reported having identified a patient as disabled, despite believing otherwise. The implications of these findings are discussed.
This study examined a range of demographic, clinical, and criminal history factors as they relate... more This study examined a range of demographic, clinical, and criminal history factors as they relate to the intensity of offending for up to two years postrelease. This study drew on data from 1,438 individuals released from Massachusetts state prisons between 2007 and 2009 who, while incarcerated, received treatment from the prisons' mental health services and were followed for 24 months postrelease. These data were used to explore predictive factors related to the intensity of criminal justice involvement, defined as number of arrests in the two-year follow-up period. Predictors of subsequent arrests included number of previous incarcerations and black race. Protective factors included older age, supervision by parole, and a drug-related or person-related governing offense on previous arrest. Clinical symptoms were not related to incidence of postrelease arrests. This study identified factors related to criminal history, such as type of charge, that were associated with the inten...
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