Biomedical subjects
Publications and source records attributed to J A Kelly.
The specificity constant, kcat/Km, for the hydrolysis of hippuryl-mercaptoacetate by crystals of the Streptomyces R61 D-D peptidase was measured by reaction of the thiol produced with 4,4'-dithiodipyridine. The values of kcat/Km for the crystal and in solution were the same (within experimental error). A novel method for treating the lag in the progress curves was developed.
In the decade since acquired immune deficiency syndrome (AIDS) was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with human immunodeficiency virus (HIV) conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and injection drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "second wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection.
Two hundred seventy-two women sampled from mass transit waiting areas in an urban center completed anonymous surveys of AIDS-related risk behavior, perceptions of susceptibility, and knowledge. Variable patterns of human immunodeficiency virus (HIV) risk behaviors were identified, with 22% of women reporting high-risk behavior. Perceptions of susceptibility were associated with an interaction between ethnicity and level of risk; nonminority women at high risk reported greater concern about AIDS than did minority women at high risk, who did not differ from women at low risk. With an array of life problems and inaccurate information about HIV transmission, minority women were found to be at continued risk for AIDS-related behavior. Implications for culturally sensitive and relevant AIDS prevention efforts are discussed.
OBJECTIVE: There is growing concern that chronic mentally ill adults living in the community have a high risk for HIV infection. The purpose of this study was to identify risk knowledge, high-risk behaviors, and risk-related encounters of chronic psychiatric outpatients. METHOD: Detailed information on high-risk behaviors and risk-related situations during the past 12 months was collected from 60 outpatients appearing for regular visits at inner-city community mental health clinics. RESULTS: Of the 60 outpatients, 37 (62%) had been sexually active during the past year, and 42% of the men and 19% of the women reported multiple sexual contacts and infrequent use of condoms during intercourse. Assessments of the patients' knowledge of AIDS risks revealed substantial deficits in their practical understanding of AIDS and risk reduction measures. Although use of intravenous drugs was uncommon in this group, many subjects reported histories of 1) trading sex for money, drugs, or a place to stay, 2) coercion to engage in unwanted sex, 3) causal sexual encounters, and 4) sexual activity after use of drugs or intoxicants. Twenty percent of the subjects had met their sexual partners on the streets, in parks, or in other public places. One-third had been treated for sexually transmitted diseases other than AIDS. CONCLUSIONS: These findings underscore the need for AIDS risk assessment, counseling, and prevention programs for the chronic mentally ill.
OBJECTIVES: It is critical to extend community-level acquired immunodeficiency syndrome (AIDS) prevention efforts beyond education alone and to develop models that better encourage behavioral changes. Gay men in small cities are vulnerable to human immunodeficiency virus (HIV) infection due to continued high rates of risk behavior. This research introduced an intervention that trained popular people to serve as behavioral change endorsers to peers sequentially across three different cities. METHODS: Populationwide surveys were conducted of all men patronizing gay clubs in each city to establish risk behavior base rates. After a small cadre of popular "trendsetters" were identified, they received training in approaches for peer education and then contracted to communicate risk reduction recommendations and endorsements to friends. Surveys were repeated at regular intervals in all cities, with the same intervention introduced in lagged fashion across each community. RESULTS: Intervention consistently produced systematic reductions in the population's high-risk behavior (unprotected anal intercourse) of 15% to 29% from baseline levels, with the same pattern of effects sequentially replicated in all three cities. CONCLUSIONS: This constitutes the first controlled, multiple-city test of an HIV prevention model targeting communities. The results support the utility of norm-changing approaches to reduce HIV risk behavior.
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BACKGROUND: Most research on acquired immunodeficiency syndrome has been conducted in several of the country's largest cities, and little is known about the current level of human immunodeficiency virus risk taking among gay men in other geographical areas. The purpose of this study was to determine the frequency of risk behavior practices among gay men in smaller communities. METHOD: A large sample of men who patronized gay bars in 16 small and moderate-size cities drawn from six states in four different regions of the country was surveyed to determine the frequency of high-risk behavior and factors influencing risk taking. Eighty-five percent of men in all cities' bars completed all survey measures. The community samples were 1991 men; mean age, 31.3 years; mean education, 10.6 years; 90% were white and 10% were of other ethnicities. All participants provided detailed information on their sexual behavior practices over the preceding 2 months and completed measures assessing their perceived peer norms concerning safer sex practices and risk avoidance, intentions to avoid risk, personal risk estimation, acquired immunodeficiency syndrome risk knowledge, perceived threat of acquired immunodeficiency syndrome/human immunodeficiency virus, and serostatus testing history. RESULTS: High-risk patterns were still common among gay men in these smaller cities; nearly one third of all men had engaged in unprotected anal intercourse an average of eight times in the past 2 months, usually outside monogamous relationships. High-risk behavior was most strongly associated with beliefs that safer sex practices would not be well accepted by peers, weak intentions to use condoms, underestimation of personal vulnerability to the acquired immunodeficiency syndrome, younger age, and higher levels of overall sexual activity. Nine percent of men tested said they were seropositive. CONCLUSIONS: Growing human immunodeficiency virus prevalence and continued high rates of risk behavior indicate that a new "front line" for human immunodeficiency virus prevention among homosexually active men has shifted to the country's smaller cities. Community prevention efforts in these areas are urgently needed to avert sharp increases in future human immunodeficiency virus infections in this population.
Few studies have surveyed HIV-infected patients to determine how adequately medical, legal, psychological, social service, and financial needs are being met through current treatment services. Fifty HIV-infected men seen at a county medical facility were surveyed to determine which of 17 needs were being met and the importance rating attributed to those needs. Five needs were reported by more than 30% of the sample as not being met: 1) being able to talk about fears of the future, illness, or death; 2) being occupied and having things to do; 3) having up-to-date information about HIV; 4) having someone to help them with their feelings of depression, helplessness, anxiety, or anger; and 5) help for the patient's family. Three of these five needs involve better access to psychological services. Although patients felt they had knowledgeable medical staff and good health care, they wanted more up-to-date information on HIV treatment.
Sixty-eight gay men who earlier attended AIDS prevention sessions were longitudinally followed for 16 months and categorized as successful or unsuccessful in change maintenance. Psychological and behavioral data obtained prior to entry in the prevention program were used as variables to predict long-term change. Resumption of high-risk sexual practices was associated with younger age, earlier history of frequent unprotected receptive anal intercourse with multiple partners, greater number of past sex partners, reinforcement value levels of high-risk practices and condom use, intoxication preceding sex, lower scores on a depression measure, greater belief that HIV infection is largely determined by external factors such as chance or luck, and homosexuality "outness." Discriminant analysis revealed that 86% of Ss could be classified as relapsers or change-maintainers on the basis of these variables. Prevention implications are discussed.
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The sequences of class A beta-lactamases were compared. Four main groups of enzymes were distinguished: those from the gram-negative organisms and bacilli and two distinct groups of Streptomyces spp. The Staphylococcus aureus PC1 enzyme, although somewhat closer to the enzyme from the Bacillus group, did not belong to any of the groups of beta-lactamases. The similarities between the secondary structure elements of these enzymes and those of the class C beta-lactamases and of the Streptomyces sp. strain R61 DD-peptidase were also analyzed and tentatively extended to the class D beta-lactamases. A unified nomenclature of secondary structure elements is proposed for all the penicillin-recognizing enzymes.
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While most gay men have reduced behavior practices at high risk for HIV infection, there is growing evidence that many also lapse to unsafe sex. This study examined situational factors related to risk behavior lapses as well as coping strategies used by men who successfully resist lapse urges. A convenience sample of 470 men patronizing gay bars or attending social organization meetings in four cities was surveyed. Forty-five percent of men were classified as "lapsers" (those who had had unprotected anal intercourse in the previous 6 months) and 24% were classified as "resisters" (those who successfully resisted urges to engage in this behavior). All provided information concerning the importance of factors related to the most recent occurrence of either unsafe sex or resisting unsafe urges. Most episodes of unsafe sex occurred outside monogamous relationships and with partners of unknown HIV serostatus, although simply inquiring about partner serostatus was relatively common. Lapsers rated affectionate feelings and wishing to please a partner as well as spontaneity of unsafe sex as the most important situational factors surrounding high-risk behavior. Resisters of unsafe sex urges reported active cognitive self-guidance, experience in safe sex, and recall of both AIDS fears and safety benefits as their most important coping strategies. Gay men who continue high-risk behavior may be overrelying on partner reports of negative serostatus. Lapse prevention approaches tailored to situations that create increased risk vulnerability must be developed. Teaching skills already used by men who successfully resist unsafe sex urges might be one approach.
BACKGROUND AND PURPOSE: Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population. METHODS: We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities. RESULTS: In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time. CONCLUSIONS: Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection.
A review of 30 AIDS behavioral research studies revealed that almost half employed retrospective sexual activity assessment periods of 12 months or longer. The present study examined the correspondence between retrospective reports of sexual activity for 3 overlapping time-frames (past 2 weeks, past 3 months, and past 12 months) for 61 gay men. Adjusted for equivalent 12-month intervals, the reported mean frequencies of sexual practices were considerably higher for shorter recall periods than for longer recall periods, a discrepancy greater than would be expected by normal activity fluctuation. The study also found that behavior reported across shorter retrospective time-frames was more consistent, while reliability for frequently occurring and unsafe sexual activities decreased as the recall period lengthened. Studies utilizing recall periods of 12 months or more may produce data of questionable reliability.
This article presents the results of a survey of 70 master of social work (MSW) programs to determine the extent and manner in which educational curricula include instruction on acquired immune deficiency syndrome (AIDS). Most programs offer students training in foundation areas pertinent to AIDS, including health and mental health systems, practice with racial and ethnic minorities, and substance abuse prevention and treatment. However, over 40 percent of programs provide no training in such key areas as human sexuality and primary prevention. Less than 15 percent of programs offer courses specific to AIDS, although a third of programs have incorporated AIDS content into other courses. Between 20 percent and 30 percent of MSW programs offer little or no attention to AIDS in their curricula. Implications of these findings are discussed.
Men (N = 526) who patronized gay bars in three cities completed measures of sexual behavior covering the previous 3 months and psychological measures theoretically pertinent to AIDS risk. Thirty-seven percent of the sample reported engaging in unprotected anal intercourse, the behavior most strongly associated with transmission of human immunodeficiency virus (HIV) infection. Perceived peer norms concerning the acceptability of safer sex practices, AIDS health locus of control scores, risk behavior knowledge, age, and accuracy of personal risk estimation, but not personal HIV serostatus knowledge, were associated with high-risk and precaution-taking behavior.
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