PubMed Health⌕ Search

Biomedical subjects

S C Kalichman

Publications and source records attributed to S C Kalichman.

At least 19 recordsLinked to original sources
PubMed2007

Sexual assault, sexual risks and gender attitudes in a community sample of South African men.

Sexual assault against women and HIV infection are both prevalent and related social problems in South Africa. The current study examined hostile attitudes toward women, acceptance of violence against women and masculine ideological beliefs in relation to sexual assault history among men in a Cape Town township in South African. Men (n=435) completed anonymous surveys of sexual assault history, HIV risk history and gender-based attitudes. More than one in five men in this community sample reported that they had either threatened to use force or used force to gain sexual access to a woman in their lifetime. Men with a history of sexual assault were at significantly higher risk for HIV transmission than their non-sexually assaultive counterparts. Men with a history of sexual assault were also more likely to endorse hostile attitudes toward women and were more likely to accept violence against women, although these attitudes and beliefs were prevalent and pervasive across men with and without histories of sexual assault. These findings extend previous research to show that men who have a history of sexual assault also exhibit elevated risks for HIV infection and transmission. Interventions are needed to address hostile attitudes toward women, sexual assault and sexual risks for HIV among South African men.

Adolescent↗
PubMed2006

Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa.

BACKGROUND: The HIV epidemic continues to amplify in southern Africa and there is a growing need for HIV prevention interventions among people who have tested HIV positive. METHODS: Anonymous surveys were completed by 413 HIV-positive men and 641 HIV-positive women sampled from HIV/AIDS services; 73% were <35 years old, 70% Black African, 70% unemployed, 75% unmarried, and 50% taking antiretroviral treatment. RESULTS: Among the 903 (85%) participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV-negative partners, partners of unknown HIV status and unprotected intercourse with non-concordant sex partners. Not disclosing their HIV status to partners was also associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners. CONCLUSIONS: HIV-related stigma and discrimination are associated with not disclosing HIV status to sex partners, and non-disclosure is closely associated with HIV transmission risk behaviours. Interventions are needed in South Africa to reduce the AIDS stigma and discrimination and to assist people with HIV to make effective decisions on disclosure.

Adult↗
PubMed2004

Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States.

The current study delineated patterns and predictors of adherence to antiretroviral therapy in 329 persons living with HIV disease in rural areas of 12 US states. Participants provided self-report data on patterns of HIV medication adherence, reasons for missing medication doses, psychological symptomatology, life-stressor burden, social support, ways of coping, coping self-efficacy, the quality of their relationship with their main physician, and barriers to health care and social services. Based on adherence data collected via retrospective, self-report assessment instruments, only 50% of participants adhered consistently to antiretroviral therapy regimens in the past week. Consistent adherence was more common in White participants, persons who had progressed to AIDS, and 'native infections' (i.e. persons who were born, raised, and infected in their current place of residence). Logistic regression analyses indicated that consistent adherence was reported by persons who drank less alcohol, had a good relationship with their main physician, and engaged in more active coping in response to HIV-related life stressors. As the number of rural persons living with HIV disease continues to increase, research that identifies correlates of non-adherence and conceptualizes approaches to optimize adherence in this group is urgently needed.

Adolescent↗
PubMed2004

Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa.

AIDS-related stigmas are pervasive in some segments of South African society and stigmas can impede efforts to promote voluntary counselling and testing and other HIV-AIDS prevention efforts. The current study examined associations among the belief that AIDS is caused by spirits and supernatural forces, AIDS-related knowledge and AIDS-related stigmas. A street intercept survey with 487 men and women living in a Black township in Cape Town, South Africa showed that 11% (n=54) believed that AIDS is caused by spirits and supernatural forces, 21% (n=105) were unsure if AIDS is caused by spirits and the supernatural, and 68% (n=355) did not believe that AIDS is caused by spirits and supernatural forces. Multiple logistic regression analyses controlling for participant age, gender, years of education and survey venue showed that people who believed HIV-AIDS is caused by spirits and the supernatural demonstrated significantly more misinformation about AIDS and were significantly more likely to endorse repulsion and social sanction stigmatizing beliefs against people living with HIV-AIDS. However, nearly all associations between beliefs that AIDS is caused by spirits and AIDS stigmas were non-significant when logistic regressions were repeated with AIDS-related knowledge included as a control variable. This finding suggests that relationships between traditional beliefs about the cause of HIV-AIDS and AIDS stigmas are mediated by AIDS-related knowledge. AIDS education efforts are urgently needed to reach people who hold traditional beliefs about AIDS to remedy AIDS stigmas.

Adult↗
PubMed2004

Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa.

Sexual violence is associated with women's risks for HIV infection. The current study investigated factors related to risks for sexually transmitted infections (STIs), including HIV, among South African women with a history of sexual assault. An anonymous street intercept survey of women (N = 272) living in an African township in the Western Cape, South Africa assessed demographic characteristics, history of sexual assault, HIV risk behaviours, substance use and non-sexual relationship abuse. Surveys were completed by 90% of women approached. Forty-four per cent (N = 119) of women reported a history of sexual assault. Multiple logistic regressions, controlling for participant age, education, marital status and survey venue, showed that women who had been sexually assaulted were significantly more likely to have shared injection drug equipment, exchanged sex to meet survival needs, and used alcohol compared to women who had not been sexually assaulted. Women with a history of sexual assault were also significantly more likely to have multiple male sex partners, greater rates of unprotected vaginal intercourse, lower rates of condom protected anal intercourse, more sexual contacts involving blood, more STIs and genital ulcers. Finally, women who had been sexually assaulted were more likely to have been non-sexually abused by relationship partners and were more likely to fear asking partners to use condoms. There is a close connection between sexual assault and women's risks for STIs and HIV. Structural and behavioural interventions are needed to simultaneously reduce the prevalence of sexual assault against women and prevent the transmission of HIV.

Adult↗
PubMed2003

HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy.

BACKGROUND: Poor HIV treatment adherence can result in the development of drug resistant strains of HIV and HIV positive people may transmit drug resistant virus to their sex partners. OBJECTIVE: To examine the association between HIV treatment adherence and sexual risk behaviour practices in people living with HIV-AIDS. METHODS: Surveys and interviews with 255 men and women living with HIV and receiving antiretroviral therapy. RESULTS: People who were currently taking antiretroviral medications and missed at least one dose of their medications in the past week scored significantly higher on a hopelessness scale and reported more current use of marijuana. People who had been non-adherent also reported significantly more sex partners, greater rates of unprotected vaginal intercourse, and less protected sex behaviours including less protected sex with partners who were HIV negative or of unknown HIV status. CONCLUSIONS: Associations between HIV treatment adherence and sexual transmission risk behaviours indicate the need for comprehensive and integrated health behaviour interventions for people living with HIV-AIDS.

Adult↗
PubMed2003

HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa.

OBJECTIVES: A cornerstone of HIV prevention in South Africa is voluntary HIV antibody counselling and testing (VCT), but only one in five South Africans aware of VCT have been tested. This study examined the relation between HIV testing history, attitudes towards testing, and AIDS stigmas. METHODS: Men (n = 224) and women (n = 276) living in a black township in Cape Town completed venue intercept surveys; 98% were black, 74% age 35 or younger. RESULTS: 47% of participants had been tested for HIV. Risks for exposure to HIV were high and comparable among people tested and not tested. Comparisons on attitudes toward VCT, controlling for demographics and survey venue, showed that individuals who had not been tested for HIV and those tested but who did not know their results held significantly more negative testing attitudes than individuals who were tested, particularly people who knew their test results. Compared to people who had been tested, individuals who were not tested for HIV demonstrated significantly greater AIDS related stigmas; ascribing greater shame, guilt, and social disapproval to people living with HIV. Knowing test results among those tested was not related to stigmatising beliefs. CONCLUSIONS: Efforts to promote VCT in South Africa require education about the benefits of testing and, perhaps more important, reductions in stigmatising attitudes towards people living with AIDS. Structural and social marketing interventions that aim to reduce AIDS stigmas will probably decrease resistance to seeking VCT.

Adult↗
PubMed2002

Closing the digital divide in HIV/AIDS care: development of a theory-based intervention to increase Internet access.

Advances in information technology are revolutionizing medical patient education and the Internet is becoming a major source of information for people with chronic medical conditions, including HIV/AIDS. However, many AIDS patients do not have equal access to the Internet and are therefore at an information disadvantage, particularly minorities, persons of low-income levels and individuals with limited education. This paper describes the development and pilot testing of a workshop-style intervention designed to close the digital divide in AIDS care. Grounded in the Information-Motivation-Behavioral Skills (IMB) model of health behaviour change, we developed an intervention for persons with no prior history of using the Internet. The intervention included instruction in using hardware and search engines, motivational enhancement to increase interest and perceived relevance of the Internet, and skills for critically evaluating and using health information accessed via the Internet. Participants were also introduced to communication and support functions of the Internet including e-mail, newsgroups and chat groups. Pilot testing demonstrated feasibility, acceptability and promise for closing the digital divide in HIV/AIDS care using a relatively brief and intensive theory-based intervention that could be implemented in community settings.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Sexual transmission risk perceptions and behavioural correlates of HIV concentrations in semen.

HIV transmission risk behaviours are related to perceived infectiousness and HIV-positive men who have undetectable blood viral loads may practise less protective behaviours. The current study extends previous research by reporting the association between perceived HIV transmission risks, risk behaviours and viral load in semen. Results showed significant associations between perceived risks for transmitting HIV, unprotected intercourse and viral load in semen. Further analyses showed that men with greater concentrations of HIV in their semen were practising higher rates of transmission risk behaviours while perceiving less risk for potentially transmitting HIV. We conclude that behavioural interventions are needed for HIV-positive men to inform them that HIV infectiousness cannot be inferred from peripheral blood viral loads and to support maintenance of HIV risk reduction behaviours.

Attitude to Health↗
PubMed2001

Human immunodeficiency virus in semen and plasma: investigation of sexual transmission risk behavioral correlates.

Risks for sexually transmitted HIV may be related to concentrations of virus detected in semen and previous research shows a small to moderate association between viral load in blood and semen. This study examined the association between viral load in semen and plasma in a community sample of HIV-infected men and is the first study to examine semen viral load in relation to sexual transmission risk behaviors. A sample of 44 HIV-positive men recruited from community service agencies provided semen, blood, and urine samples and completed clinical interviews assessing health and behavior. We failed to find an association between viral load in semen and plasma, Spearman rho = 0.07, p > 0.1. When restricted to participants with detectable virus in semen and plasma, the correlation remained nonsignificant, rho = -0.16, p > 0.1. Men who had higher semen viral loads relative to their plasma viral load were distinguished by having engaged in significantly higher rates of unprotected intercourse as the insertive sex partner in the previous 3 months. Semen viral load was not, however, related to recent or current sexually transmitted infections (STIs). This study is among the first to examine sexual transmission risk behaviors as marker for HIV infectiousness. Results caution against inferring sexual transmission infectiousness based on plasma viral load and suggest that HIV-positive men who practice higher rates of insertive intercourse may be more infectious even in the absence of other STIs.

Adult↗
PubMed2001

Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people.

BACKGROUND: As many as one in three HIV-positive people continue unprotected sexual practices after learning that they are HIV infected. This article reports the outcomes of a theory-based intervention to reduce risk of HIV transmission for people living with HIV infection. METHODS: Men (n=233) and women (n=99) living with HIV-AIDS were randomly assigned to receive either (1) a five-session group intervention focused on strategies for practicing safer sexual behavior, or (2) a five-session, contact-matched, health-maintenance support group (standard-of-care comparison). Participants were followed for 6 months post-intervention. RESULTS: The intervention to reduce risk of HIV transmission resulted in significantly less unprotected intercourse and greater condom use at follow-up. Transmission-risk behaviors with non-HIV-positive sexual partners and estimated HIV transmission rates over a 1-year horizon were also significantly lower for the behavioral risk-reduction intervention group. CONCLUSIONS: This study is among the first to demonstrate successful HIV-transmission risk reduction resulting from a behavioral intervention tailored for HIV-positive men and women.

Adaptation, Psychological↗
PubMed2001

Substance-abusing adolescents at varying levels of HIV risk: psychosocial characteristics, drug use, and sexual behavior.

PURPOSE: To evaluate the relationship of various psychosocial factors on HIV sexual risk behavior in a sample of 169 "inner city" male and female adolescents mandated into in court-ordered substance abuse treatment. METHOD: The Millon Adolescent Clinical Inventory (MACI) and measures of sexual behavior, condom attitudes and skills, HIV knowledge, and substance abuse were administered. Data were evaluated according to five HIV risk groups: abstinent (n = 37); monogamous and practicing only protected sex (n = 19); monogamous and practicing unprotected sex (n = 45); multiple partners and practicing only protected sex (n = 11); and multiple partners and having only unprotected sex (n = 57). RESULTS: Significant main effects were found for impulsive propensity, submissiveness, marijuana and alcohol use, condom attitudes, and intentions to engage in safer sex. Protective behavior was directly associated with submissiveness and inversely associated with impulsive personality profiles, with increased marijuana use emerging as a significant predictive factor in the choice for sexual activity vs. abstinence. More alcohol use was predictive of choosing multiple partners vs. monogamy. IMPLICATIONS: Factoring risk variation into the design of HIV psychosocial research may enhance the tailoring of effective prevention strategies.

Adolescent↗
PubMed2001

Outcomes of a randomized small-group HIV prevention intervention trial for people with serious mental illness.

HIV prevalence is alarmingly high among persons with serious mental illness and severely mentally ill adults frequently engage in high-risk behavior practices. This study evaluated the effectiveness of a small-group HIV risk reduction intervention offered to 189 men and women in outpatient programs for severely mentally ill adults. Participants screened for HIV risk were randomly assigned to attend either a 7-session small-group cognitive-behavioral HIV risk reduction intervention or a time-matched comparison intervention and were followed at 3-month intervals for one year. Participants who attended the HIV risk reduction intervention increased their condom use, had a higher percentage of intercourse occasions protected by condoms, and held more positive attitudes toward condoms. Women showed greater response to the intervention than men. While many behavior change effects were present at 3-, 6- and 9-month followup assessments, most diminished by the 12-month followup. These results under-score the need for tailored but ongoing HIV prevention efforts integrated into community programs that serve people with serious mental illness.

Acquired Immunodeficiency Syndrome↗
PubMed2001

A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA.

As AIDS becomes more prevalent among late middle-aged and older adults, mental health support services that facilitate the coping and adjustment efforts of this group are increasingly needed. The current article: (1) outlines a coping improvement group intervention for HIV-infected older adults; and (2) examines the efficacy of the intervention utilizing a small sample (N = 16) of older adults living with HIV/AIDS in Milwaukee, Wisconsin and New York City. The intervention focused on enabling HIV-infected older adults to accurately appraise sources of stress, develop adaptive coping responses and access social support resources to facilitate coping efforts. An evaluation of this pilot intervention, conducted using a pretest-posttest, no control group design, revealed that the intervention increased participants' perceptions of social support, produced higher perceptions of social wellbeing and enabled participants to engage in more planful problem solving, confrontive coping and future optimism. Intervention participants also experienced less stressor burden associated with AIDS-related loss and health concerns. While the current intervention showed potential to facilitate the adjustment efforts of HIV-infected older adults, randomized clinical trials of this intervention with larger samples are needed before its appropriateness for this population can be determined.

Acquired Immunodeficiency Syndrome↗
PubMed2001

HIV risk behaviour among men who have sex with men in public sex environments: an ecological evaluation.

Men who have sex with men (MSM) in public sex environments (PSE) may be at high risk for HIV/AIDS. The majority of research on HIV risk behaviour among MSM has been conducted in open access venues more likely to be linked to networks that openly endorse preventive messages and safer sex norms. This study investigated risk practices among MSM in a PSE in order to develop effective prevention intervention strategies. Three outreach workers with previous MSM prevention experience trained in ethnographic and fieldwork observation techniques provided direct observation data. Seventy-seven observations, each lasting a minimum of two hours, were conducted over a five-month period at three city public parks. Of 614 men observed, over 250 exhibited activities and behaviours related to, or potentially related, to HIV-risk relevant sexual behaviour. Direct sexual contact between two or more men was observed 19 times, while men entering or leaving a sex area of the park was observed 66 times. Outreach workers were able to interact directly with 72 MSM, primarily discussing safer sex strategies. Sexual encounters occurred in more open areas of the PSE with partners migrating to secluded areas for intense and sexual interactions. Future prevention interventions will need to be tailored, and targeted, to specific sexual exchange access points in PSE.

Attitude↗
PubMed2001

Anticipated psychological impact of receiving medical feedback about HIV treatment outcomes.

Two hundred and seven persons taking antiretroviral HIV medications rated anticipated affective responses to two vignettes depicting different medical feedback situations. Participants were randomly assigned to a medical feedback vignette which varied between participants by (a) the direction of HIV viral load change (increase, decrease, no change) and (b) whether or not a medication change was recommended by the physician. The first experimental vignette was always followed by a second vignette depicting a viral load decrease (indicating treatment success in suppressing the virus). A mixed 3 (viral load change) x 2 (medication change) x 2 (within-subjects factor) factorial design was used. Significant differences in anticipated affective responses to treatment outcome situations were found, suggesting feedback about success or failure of treatment regimens impacts psychosocial adjustment of persons living with HIV.

Adaptation, Physiological↗