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T W Valente

Publications and source records attributed to T W Valente.

13 recordsLinked to original sources
PubMed2001

Needle-exchange participation, effectiveness, and policy: syringe relay, gender, and the paradox of public health.

Needle-exchange programs (NEPs) have been politically controversial, and most studies have focused on evaluating their effectiveness on human immunodeficiency virus (HIV) transmission rates with little emphasis on the process of how they are used. This article shows that the way intravenous drug users use NEPs may influence their effectiveness. Using data from Baltimore's NEP, participants (N = 2,574) were classified as low, medium, and high users based on the volume, frequency, and duration of contact with the NEP. Higher NEP use was associated with shorter syringe circulation times and less syringe relay, returning syringes to the NEP originally acquired by someone else. For a subsample that was HIV tested (N = 262), syringe relay among women was associated with HIV seroconversion (at a 95% confidence interval). We conclude that exclusive use of the NEP (no relay) provides greater HIV protection than NEP use involving syringe relay. The paradox is that public health goals will not be achieved by prohibiting syringe relay activities and promoting exclusive use. NEPs should broaden their education efforts to have participants understand the value of repeated visits to the NEP.

Adult↗
PubMed2001

Interorganizational relationships among HIV/AIDS service organizations in Baltimore: a network analysis.

A wide variety of organizations has become involved in providing medical and social services to people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Although there is much interest among policymakers, service providers, and clients in coordination among HIV/AIDS service organizations, few studies have used network analytic tools to examine existing systems of HIV-related care. In an effort to fill this gap, this study used network analysis methods to describe several aspects of the interorganizational relationships among 30 HIV/AIDS service agencies in Baltimore, Maryland. Client referrals to other organizations, client referrals from other organizations, exchange of information about shared clients, formal written linkage agreements for client referrals, and joint programs were each examined as a distinct type of network tie, with each the basis of a separate network among these 30 organizations. All of the networks except the one based on joint programs were relatively well connected, with most organizations either directly or indirectly linked. Most of the interorganizational collaboration occurred on a rather ad hoc basis for the purposes of meeting the more immediate needs presented by clients. Highly structured coordination involving substantial investment of resources and ongoing interagency activities appeared to be less common. The findings from this study also suggest that the providers in Baltimore tend to work directly with others as client needs arise rather than negotiating through "clearinghouse" types of organizations. Of the 30 HIV/AIDS service organizations, 5 were highly central in at least four of the five different types of networks. These five organizations--each having a critical role in the continuum of care--may be considered the most central core of the HIV/AIDS service delivery network in Baltimore. These organizations tend to be those that have been created specifically to provide HIV-related services or that specialize in HIV/AIDS care. This research can help policymakers understand how an HIV-related service delivery network may function and delineate key features of a network. In all communities, this type of assessment is critical to designing interventions to promote collaboration that are feasible within the context of existing interorganizational relationships. This type of data also has implications for informing activities to build the capacity of HIV/AIDS service organizations.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Selective risk taking among needle exchange participants: implications for supplemental interventions.

OBJECTIVES: This study characterized social network context of HIV risk behavior among injection drug users who participated in a needle exchange program. METHODS: Interviews were conducted with 1184 injection drug users at the Baltimore Needle Exchange Program enrolled in an evaluation cohort. Analysis consisted of multiple logistic regression with statistical adjustment for the interdependence of observations. RESULTS: Of the 203 (17.1%) injection drug users who reported using a syringe after someone else, 78.3% reported sharing with close friends, and the adjusted odds ratio of any sharing and sharing with close friends was 30.9. Injection drug users were more likely to report sharing with a strong-tie close friend (adjusted odds ratio = 1.52) and less likely to report sharing with other close friends if those friends were weak ties and new to their network. Friendship ties were not stable, with fewer than 30% of the friends being repeat nominations. CONCLUSIONS: These data show that many injection drug users engage in selective risk taking that may minimize their disease risk exposure in the short term. The turnover in networks, however, suggests that programs need to emphasize the importance of exclusive use.

Adult↗
PubMed1999

Social network influences on reproductive health behaviors in urban northern Thailand.

Prevention approaches for reproductive health have evolved from an emphasis on individually focused models of behavior change to a recognition that risk reduction occurs within a context of social norms. Prevention programs can be improved by understanding how social structure influences sexual behavior and using that understanding to develop strategies for positive change. In a dynamic, urban context, communities are better conceptualized as informal networks of ties. These network structures may help to protect, or conversely, expose members to reproductive risk behaviors. Using data from a study of social and sexual networks conducted in northern Thailand, this article describes partner relations and social structure in the modern, urban context, and illustrates the links between individual, relational and structural properties and reproductive risk behaviors. Triangulation of ethnographic, survey and social network data collection and analytic tools provide an opportunity to interpret individual behaviors, meanings of relationships and structural properties of networks. Intervention approaches should build on existing networks, and address the complex meanings of romantic and sexual partnerships.

Community Networks↗
PubMed1999

An evaluation of the use of drama to communicate HIV/AIDS information.

This study evaluated the effectiveness of three dramas created to disseminate HIV/AIDS information. Predrama and postdrama interviews were conducted with a cohort of randomly selected audience members from ten separate performances in Tamil Nadu state, India (N = 93); an interview was also conducted with a postdrama--only comparison group (N = 99). The results showed that a significant increase in HIV/AIDS-related knowledge occurred as a result of watching the drama. Before the drama, audiences had relatively high levels of accurate knowledge about HIV/AIDS but lower knowledge levels of common HIV/AIDS misconceptions. The drama reduced these misconceptions. The drama also increased the level of reported intentions to treat HIV positive individuals more kindly. This research demonstrates that drama can be an effective medium for communicating HIV/AIDS information and can reduce knowledge gaps associated with low levels of formal education. Drama can also be used to convey socioemotive and sensitive material and could find wide applicability in many settings.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Satellite exchange in the Baltimore Needle Exchange Program.

OBJECTIVE: Our first objective was to develop an index of satellite exchange and then determine whether satellite exchangers (SEs) differed demographically or behaviorally from other injecting drug users (IDUs). Our second objective was to determine the degree that SEs contributed to needle exchange program (NEP) effectiveness. METHODS: We collected data from approximately 5000 Baltimore Needle Exchange Program (BNEP) participants on the number of syringes acquired and returned over the two-year period February 1995 to February 1997. We then conducted one-way ANOVAs and logistic regressions to determine if SEs were different from other IDUs. RESULTS: We classified 9.35% of the IDUs and SEs and showed that SEs reported levels of drug use and risk behavior similar to other BNEP participants. Although SEs represented less than 10% of all BNEP clients, they accounted for more than 64% of all needles distributed by the BNEP. We showed that SEs accessed more wide-ranging drug use networks than non-SE IDUs and thus can act as potential bridges for human immunodeficiency virus (HIV) prevention materials and messages to larger numbers of drug injectors. CONCLUSIONS: SEs can be expressly targeted with specific prevention messages and encouraged to be "ambassadors" for HIV prevention messages. Efforts to curtail the activities of SEs may detract from the effectiveness of NEPs.

Adult↗
PubMed1997

Social network associations with contraceptive use among Cameroonian women in voluntary associations.

This paper examines the association between social networks and contraceptive use. Using data from a survey of women belonging to voluntary associations in Yaoundé, Cameroon, we find that the behavior and characteristics of the members of a respondent's personal networks are associated with her contraceptive use, over and above a set of her own individual characteristics that are usually found to be important. Respondents who report that their network partners approve of contraception, use it, and encourage the respondent to use are more likely to use contraception themselves; the association with encouragement is particularly strong. Moreover, there is a strong association between the specific methods of contraception used by a respondent and those used by her network partners, suggesting that members of personal networks exchange and evaluate specific methods. Because most of the respondent's network partners were interviewed, we are able to compare the respondent's perceptions of contraceptive use by her network partners with the network partner's actual use. We find that it is perceptions of use that matter, even if those perception are incorrect.

Cameroon↗
PubMedDate not supplied

Campaign exposure and interpersonal communication as factors in contraceptive use in Bolivia.

Two mass media campaigns concerning reproductive health were broadcast in Bolivia from March 1994 to June 1996. Data were collected at three time points from both cross-sectional and panel samples of randomly selected, married, urban women. Campaign exposure and interpersonal communication with spouse, friends, and others were associated with contraceptive knowledge and use, but not attitudes. Campaign exposure was associated with perceptions that members of one's personal network used contraception. This study provides a more contextual view of campaign effects by linking mass media and personal network communication.

Adolescent↗
PubMedDate not supplied

Mass-media-generated interpersonal communication as sources of information about family planning.

This study suggests that mass-media-generated interpersonal communication networks vary according to an individual's behavior-change stage. As people in Peru adopted modern family planning methods, they increasingly formed and perhaps relied on information from more technical interpersonal communication networks, which shifted from peers to doctors and other service providers. Moreover, information seeking and giving varied with adoption stages in unexpected ways. In collaboration with Apoyo a Programmas de Población (Advocacy for Population Programs) of Peru, we present a model of how interpersonal communication networks generated by mass media messages vary with stage of behavior change.

Adolescent↗