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Biomedical subjects

Milton L Wainberg

Publications and source records attributed to Milton L Wainberg.

6 recordsLinked to original sources
PubMed2007

A model for adapting evidence-based behavioral interventions to a new culture: HIV prevention for psychiatric patients in Rio de Janeiro, Brazil.

As in other countries worldwide, adults with severe mental illness in Brazil have elevated rates of HIV infection relative to the general population. However, no HIV prevention interventions have been tested for efficacy with psychiatric patients in Brazil. We conducted participatory research with local providers, community leaders, patient advocates, and patients using an intervention adaptation process designed to balance fidelity to efficacious interventions developed elsewhere with fit to a new context and culture. Our process for adapting these interventions comprised four steps: (1) optimizing fidelity; (2) optimizing fit; (3) balancing fidelity and fit; and (4) pilot testing and refining the intervention. This paper describes how these steps were carried out to produce a Brazilian HIV prevention intervention for people with severe mental illness. Our process may serve as a model for adapting existing efficacious interventions to new groups and cultures, whether at a local, national, or international level.

Brazil↗
PubMed2006

Training South African mental health care providers to talk about sex in the era of AIDS.

OBJECTIVE: Mental health care providers in South Africa often lack the skills to conduct effective prevention activities in psychiatric settings. This article describes the development and evaluation of an HIV education program for mental health care providers at three psychiatric institutions in South Africa. METHODS: The research team worked with a core group of 16 mental health care providers to assess HIV training needs and to develop a training intervention focused on identified issues. The training intervention was administered to three groups (42 total) during three 1.5-day workshops. Providers completed pre- and post-intervention assessments that measured knowledge and attitudes about HIV and AIDS. RESULTS: Data analysis revealed a significant increase in reported levels of comfort with HIV care (d=.54), perceived knowledge of HIV (d=1.17), and factual knowledge (d=.74). CONCLUSIONS: This contextually relevant HIV education curriculum changed providers' attitudes and knowledge, demonstrated the feasibility of administering the training program, and provided a foundation for further prevention activities.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Reframing HIV adherence as part of the experience of illness.

Understanding and enhancing adherence to HIV medications has been identified as a major challenge. The purpose of this study was to explore patterns and determinants of non-adherence among individuals receiving HIV care in a medical clinic. Seven focus groups were conducted with 42 HIV+ patients, and verbatim transcripts of focus group sessions were analyzed through a combination of ethnographic and content analysis. Of the participants currently on combination therapy, 68% reported at least one recent instance of non-adherence. The most commonly cited reasons for non-adherent behavior were grouped into four categories: (1) problems with side effects; (2) conflicts with daily life activities; (3) feelings of aversion toward the medications themselves; and (4) deliberate alterations to the prescribed regimen. Findings based on structured analysis of patient responses in each category differ from past research which defines adherence as a treatment problem and emphasizes logistical characteristics of the treatment regimen itself and patients' ability or willingness to follow specific instructions. In contrast, our focus group data suggest an alternative frame for understanding barriers to adherence which focuses on: (1) the meaning that adherence/pill-taking behavior has for individuals experiencing chronic illness; and (2) the impact that this behavior has on their identity. Because adherence behavior is integral to patients' experience of their disease, non-adherence is no longer a treatment problem, but is an illness problem. Framing adherence as an illness problem rather than a treatment problem is a critical shift that can be applied to the creation of assessments and interventions designed to support patient adherence; this article ends with a series of specific recommendations for programs, policy, and research.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Patient-provider relationships, HIV, and adherence: requisites for a partnership.

This paper analyzes data collected through focus groups of patients at an outpatient AIDS clinic at a New York medical center. Seven focus groups were conducted with 42 HIV+ patients, and verbatim transcripts of focus group sessions were analyzed through a combination of ethnographic and content analysis. We examined patients' reports of interactions with and attitudes toward their providers and attempted to define what elements in the provider-patient relationship are necessary to enable patients to become more integrally involved in the management of their illness. Participants' statements emerged as consistent with three themes: (a) dynamics of provider-to-patient communication; (b) dynamics of patient-to-provider communication; and (c) dynamics of collaboration. Each of these themes is discussed in terms of its implications for creating patient-provider relationships based on mutual-participation, and requisites for effecting meaningful patient-provider partnerships are outlined.

Acquired Immunodeficiency Syndrome↗
PubMed2006

A double-blind study of citalopram versus placebo in the treatment of compulsive sexual behaviors in gay and bisexual men.

OBJECTIVE: Compulsive sexual behavior (CSB) is a condition characterized by loss of control over sexual behavior and repeated negative consequences, including unsafe sex. Selective serotonin reuptake inhibitors have been found to reduce CSB symptomatology in open-label trials. The objective of this study was to conduct a preliminary double-blind, placebo-controlled evaluation of the efficacy, acceptability, and tolerability of citalopram in the treatment of CSB. METHOD: Twenty-eight men who have sex with men who met the threshold for CSB on the basis of existing validated measures participated in a 12-week, double-blind trial of citalopram 20 to 60 mg/day to evaluate its effects on CSB symptoms. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale-Compulsive Sexual Behavior. The study was conducted from June 2002 to April 2004. RESULTS: Significant treatment effects were obtained for sexual desire/drive (p < .05) and frequency of masturbation (p < .01) and pornography use (p < .05). Both groups reduced sexual risk, but did not differ significantly. CONCLUSIONS: This study provides partial support for the effectiveness of citalopram for reducing symptoms of CSB in this population. Larger-scale trials are recommended to determine the public health benefits of this treatment.

Adult↗