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Biomedical subjects

Lance S Weinhardt

Publications and source records attributed to Lance S Weinhardt.

15 recordsLinked to original sources
PubMed2006

Development of a computer-based risk-reduction counseling intervention: acceptability and preferences among low-income patients at an urban sexually transmitted infection clinic.

In preparation for the development of an individually tailored, multimedia, computerized sexually transmitted infection (STI)/HIV-risk reduction intervention software application for use in publicly funded STI clinics, we conducted a waiting-room survey among 583 inner-city patients (67% male; 79% African American; mean age = 30.3) at an STI clinic in Milwaukee, Wisconsin regarding their computer experience and opinions related to a computerized approach to HIV/STI-risk reduction counseling. A substantial minority of respondents indicated they would prefer having either a combined computerized and human counseling intervention (30%) or preferred a computerized intervention alone (13%). Perceived benefits of computerized counseling included impartiality of the response, privacy, accuracy of the information, convenience, and being able to control the dissemination of information. Perceived disadvantages included lack of human contact, inability to obtain necessary information, technical problems, threats to privacy, and failure to take information from a computer seriously. Despite their limited economic resources, participants reported relatively high levels of computer experience overall and a willingness to use an individually tailored computerized risk-reduction counseling approach. We discuss how participants' responses were used to inform the development of such an intervention.

Adolescent↗
PubMed2006

Depressive symptomatology among HIV-positive women in the era of HAART: a stress and coping model.

OBJECTIVE: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace. METHOD: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors. RESULTS: Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. CONCLUSIONS: Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood.

Adaptation, Psychological↗
PubMed2006

Health information on the Internet and people living with HIV/AIDS: information evaluation and coping styles.

Individuals who seek information on the Internet to cope with chronic illness may be vulnerable to misinformation and unfounded claims. This study examined the association between health-related coping and the evaluation of health information. Men (n = 347) and women (n = 72) who were living with HIV/AIDS and reported currently using the Internet completed measures assessing their Internet use. Health Web sites downloaded from the Internet were also rated for quality of information. HIV-positive adults commonly used the Internet to find health information (66%) and to learn about clinical trials (25%); they also talked to their physicians about information found online (24%). In a multivariate analysis, assigning higher credibility to unfounded Internet information was predicted by lower incomes, less education, and avoidant coping styles. People who cope by avoiding health information may be vulnerable to misinformation and unfounded claims that are commonly encountered on the Internet.

Adaptation, Psychological↗
PubMed2005

Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus.

BACKGROUND AND OBJECTIVES: Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort. METHODS: Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization. RESULTS: Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis. CONCLUSIONS: A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.

AIDS-Related Opportunistic Infections↗
PubMed2005

The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons.

The NIMH Healthy Living Project (HLP), a randomized behavioral intervention trial for people living with HIV, enrolled 943 individuals, including women, heterosexual men, injection drug users, and men who have sex with men from Los Angeles, Milwaukee, New York, and San Francisco. The intervention, which is based on qualitative formative research and Ewart's Social Action Theory, addresses three interrelated aspects of living with HIV: stress and coping, transmission risk behavior, and medication adherence. Fifteen 90-minute structured sessions, divided into 3 modules of five sessions each, are delivered to individuals. Sessions are tailored to individuals within a structure that uses role-plays, problem solving, and goal setting techniques. A 'Life Project'--or overarching goal related to personal striving-provides continuity throughout sessions. Because this is an ongoing project with efficacy yet to be established, we do not report intervention outcomes. However, the intervention was designed to be useful for prevention case management, settings where repeated one-on-one contact is possible, and where a structured but highly individualized intervention approach is desired.

Adaptation, Psychological↗
PubMed2004

Distance communication transfer of HIV prevention interventions to service providers.

Most acquired immunodeficiency syndrome (AIDS) service providers are in countries with little access to scientific developments relevant to their programs. It is critical to transfer advances from the scientific arena to service providers on a global scale. Human immunodeficiency virus (HIV) prevention organizations in 78 countries were randomized to receive either a control condition or a technology transfer condition with an interactive distance learning computer training curriculum and individualized distance consultation. Of 42 nongovernmental organizations in the technology transfer condition, 29 adopted the science-based program in their communities or trained other agencies to also use it. Advanced communication technologies can create a cost-effective infrastructure to disseminate new intervention models to service providers worldwide.

Communication↗
PubMed2004

HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States.

Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.

Adult↗
PubMed2004

HIV-AIDS patients' evaluation of health information on the internet: the digital divide and vulnerability to fraudulent claims.

Access to health information on the Internet has revolutionized how medical patients learn about their illnesses. Valuable information can be found online; however, many health Web sites contain inaccurate or misleading information. The authors surveyed 324 adults with HIV concerning their Internet use for obtaining health information. Health information found online was then rated for quality by participants and by medical professionals. Participants were less critical of health information found online than medical professionals and made smaller distinctions between high-quality and low-quality information. Assigning credibility to low-quality information was predicted by lower incomes and educational attainment, poorer reading comprehension, lower literacy levels, and irrational health beliefs. Results suggest that patients do not always evaluate online information critically and may be vulnerable to misinformation.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities.

Most studies examining HIV antiretroviral medication treatment adherence involve quantitative surveys. Although these studies have identified factors associated with medical adherence, no single variable or combination of variables is sufficiently consistent to apply to any individual or group of people. Using qualitative methods, an ethnically diverse sample (N=110) of HIV+ women, men who have sex with men, and male injecting drug users in four U.S. cities were interviewed in depth to elicit their experiences, perspectives, and life contexts regarding knowledge, attitudes, beliefs, and experiences with HIV medication adherence. Most described multiple influences on medication-taking behavior, describing adherence as a dynamic phenomenon that changes over time with their changing beliefs, attitudes, emotions, and daily and larger life events. Prevalent themes include ambivalence toward HIV medication and intentional nonadherence, usually to address physical side effects. Factors from different domains (e.g., cognitive, emotional, interpersonal) can have compensatory influences on behavioral outcomes. Findings are discussed in terms of social action theory, contributing to our theoretical understanding of the phenomenon of adherence.

Adaptation, Psychological↗
PubMed2003

Efficacy and cost-effectiveness of the first generation of HIV prevention interventions for people with severe and persistent mental illness.

BACKGROUND: People with serious mental illness are at elevated risk for human immunodeficiency virus (HIV) infection. A small body of published research has evaluated the efficacy of HIV prevention interventions that aim to help persons with mental illness modify sexual behaviors that place them at risk for HIV infection. Additional research has evaluated the economic efficiency ('cost-effectiveness') of these interventions. AIMS OF THE STUDY: We provide a detailed and critical review of the efficacy and cost-effectiveness of randomized, controlled trials of HIV prevention interventions for this population. We present a brief overview of the epidemiology of HIV among men and women with serious mental illness and describe HIV risk factors for members of this population. The efficacy literature is critically reviewed, and the results of the available studies are compared using a common effect size metric. The cost-effectiveness of HIV prevention interventions for mentally ill adults is then reviewed. METHODS: The efficacy of interventions at reducing risk behaviors and increasing preventive behaviors was summarized using effect size estimation techniques. First, we reviewed interventions that have been evaluated in randomized clinical trials and published in the peer-reviewed scientific literature so as to summarize the interventions that have been subjected to the most rigorous evaluation. For each of the five studies that met the inclusion criteria, we briefly described the methodology and intervention content, summarized the evidence for intervention efficacy, and calculated appropriate effect size estimates. A narrative review of two cost-effectiveness studies published to date was included. RESULTS: The review of intervention efficacy indicated that the risk reduction interventions evaluated to date have had only limited success at helping people with severe mental illness reduce their HIV risk behavior. Most effect sizes indicating successful condom use increases were in the small or small to moderate range. Overall, studies with the largest sample sizes, and presumably the most generalizable results, produced smaller intervention effect sizes than studies with smaller samples. The cost-effectiveness literature revealed similarly mixed results: economic efficiency varied from not cost-effective to highly cost-effective. DISCUSSION: Limited information is presently available regarding the efficacy and cost-effectiveness of HIV prevention interventions for people with severe and persistent mental illness. Encouraging results were obtained in some, but not all studies. Methodological limitations will need to be addressed in the next generation of HIV risk reduction intervention studies for this population. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Persons with severe mental illness warrant attention from health care providers due to elevated risk for HIV infection. Interventions discussed herein, focusing on information and behavioral skills training, can be employed until strategies with stronger results are developed. IMPLICATIONS FOR HEALTH POLICIES: Effective and cost-effective HIV risk reduction interventions are available for adults with mental illness and should be more widely implemented. The cost-effectiveness of these interventions could be further enhanced by screening potential participants for high-risk sexual behaviors. IMPLICATIONS FOR FURTHER RESEARCH: To advance the field, the next generation of intervention research for people with severe mental illness will need to improve upon the designs and intervention strategies of the first generation, include larger samples, and devote increased attention to the life circumstances and particular mental health issues of intervention participants.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Effects of a detailed sexual behavior interview on perceived risk of HIV infection: preliminary experimental analysis in a high risk sample.

Effects of the HIV-Risk Timeline Followback Interview (TLFB), which uses detailed memory cues to assess retrospectively sexual behavior and substance use on a day-by-day basis, on HIV risk-reduction motivation were tested. Thirty-four adults (76% male, 100% African American) were randomly assigned to three interview conditions: (a) HIV-Risk TLFB Interview, (b) 27 sexual behavior frequency questions, and (c) diet and nutrition using the TLFB format. Participants completed measures of HIV risk-reduction motivation immediately before and after the experimental assessment component. The a priori hypotheses that the HIV-Risk TLFB group would exhibit greater increases on indices of HIV risk reduction motivation than participants in either of the other two groups and that participants in the nutrition interview condition would exhibit greater increases in motivation for dietary improvement were supported, indicating that participating in detailed health behavior interviews, but not cursory assessments, may lead to increased motivation for behavior change.

Adult↗
PubMed2002

Internet use among people living with HIV/AIDS: association of health information, health behaviors, and health status.

The telecommunications revolution provides open access to health information that can inform and empower people living with chronic illnesses. However, many people living with HIV may not access the Internet and are not benefiting from available health information. This study investigated Internet access among people living with HIV/AIDS and its relation to health. Results of a survey of men (n = 175) and women (n = 84) living with HIV/AIDS recruited from infectious disease clinics and community-based AIDS services showed that 51% (n = 116) of participants reported ever using the Internet, of which 59% (n = 68) had used the Internet to access health-related information. As expected, Internet users were significantly more likely to be better educated and of higher incomes. Internet users, including those who used the Internet for general purposes and those who reported health-related use, also demonstrated significantly greater knowledge of HIV disease and greater confidence in their ability to adhere to medications. Persons who used the Internet for general purposes were more likely to have an undetectable viral load compared to persons who had not used the Internet. The disparities in Internet use identified in this study suggest that individuals who access the Internet, particularly for health information, are among the better resourced and healthier persons living with HIV/AIDS.

Adult↗
PubMed2002

Sex-related alcohol expectancies predict sexual risk behavior among severely and persistently mentally ill adults.

Three hundred three adults (57% male, average age 42 years) with severe and persistent mental illness receiving treatment at community mental health clinics completed a survey, which included B. C. Leigh's (1990) sex-related alcohol expectancy scale and measures of alcohol use and sexual risk behavior. Hierarchical logistic regression analyses, controlling for drinking behavior, revealed that participants with stronger expectancies that drinking would lead to enhanced sexual experience were more likely to have drank prior to intercourse and that, among participants who drank prior to intercourse, those with stronger expectancies that alcohol would lead to riskier sexual behavior were more likely to have engaged in sexual risk behavior. Implications for preventing HIV infection among people with severe mental illness are discussed.

Adult↗
PubMedDate not supplied

Psychological distress, substance use, and adjustment among parents living with HIV.

BACKGROUND: Being a parent, especially a custodial parent, living with HIV was anticipated to increase psychological distress and challenges to self-care. METHODS: Mental health symptoms, substance use, and health care utilization were assessed among 3818 HIV-infected adults, including custodial parents, noncustodial parents, and nonparents, in 4 AIDS epicenters. RESULTS: Custodial parents demonstrated significantly poorer medication adherence and attendance at medical appointments but were similar to nonparents and noncustodial parents in mental health symptoms and treatment utilization for mental health and substance use problems. Noncustodial parents demonstrated the highest levels of recent substance use and substance abuse treatment. Other markers of risk, such as African American ethnicity, lack of current employment income, and injection drug use moderated many of the apparent psychosocial disadvantages exhibited by parents. CONCLUSIONS: Interventions specific to the psychosocial stressors facing families living with HIV are needed.

Adaptation, Psychological↗