Resource allocation theory, Polich (2007) suggests cortical measures may attenuate when processing demands increase. Thirteen HIV-negative women (M = 36.5) and 15 HIV-positive women (M = 36.1) infected were instructed to view neutral and negative IAPS images and then to detect rare tones in a subsequent auditory oddball task. A 2 x 2 ANOVA for the auditory P3 did not indicate a main effect for picture valence however an interaction was found between picture valence and serostatus at location Fz, F(1,24) = 18.99, p<.001. During the visual ERP sequence an interaction between valence and serostatus was found at the Pz location, F(1,24) = 18.99, p<.001, meaning the late positive potential (LPP) was not modulated between viewing neutral and negative images in HIV-positive women. These findings suggest that the manifestation of HIV in women may alter the neural processing of emotions, though not to the detriment of a subsequent cognitive task. / by Roger C. McIntosh. / Thesis (M.A.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Thesis advisor: Kevin J. Mahoney / Recent empirical epidemiological and behavioral research has indicated that some secondary intervention preventions (e.g., condom use, HIV-disclosure, serosorting, etc.) might not be suitable for all HIV-infected gay and bisexual men, particularly for those who engage in multiple episodes of unprotected anal intercourse (UAI). The purpose of this dissertation was to answer the primary research question: What are the psychological, behavioral and contextual factors associated with HIV-infected men who have sex with men (MSM) who engage in risky sexual behavior? A qualitative descriptive approach was used to conduct a content analysis of 14 in-depth, semi-structured interviews and to provide a description of the lives of MSM who do not consistently use traditional secondary risk behavior strategies (e.g., safer-sex negotiation, condom use, etc.) to reduce HIV transmission among sexual partners, particularly those partners who are HIV-uninfected or whose HIV status is unknown. Risky sexual behavior was defined by HIV-infected MSM who had engaged in multiple episodes of UAI in the past three months. These interviews gathered preliminary data on the feasibility and acceptability of secondary HIV behavioral prevention strategies for MSM who engage in very risky sexual behavior. In addition, these data have identified descriptive themes that could be used to augment traditional secondary HIV invention preventions, creating new and specific risk-reduction strategies for this very high-risk group. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Health information exchange (HIE) has the potential to improve care quality through improved information sharing and coordination of care. In Phase 1, a sociotechnical analysis was conducted at one HIV clinic to explore the interrelated factors that affect the consent of persons living with HIV (PLWH) to electronically share their protected health information (PHI) through a HIE. The findings of the sociotechnical analysis revealed that there is not a single solution that can adequately address the complex, interrelated issues that affect PLWH decision to electronically share PHI. Improvement in the consent process was selected as the target of intervention for Phase 2, which focused on designing and pilot testing a prototype HIE eConsent iPad app at the HIV clinic. A one-group post-test design examined if HIV clinic patients preferred the eConsent or the paper consent. Semi-structured interviews were used to assess overall comprehension of HIE after reading both consents. Over half of the participants favored eConsent as compared to paper consent. The proportion of participants who were able to verbalize essential components of HIE were as follows: more than one component – 35%, one component - 20%, and no component – 45%. While racially and ethnically diverse, the sample was well-educated (50% with a college degree); however, the low comprehension levels suggested that educational attainment was insufficient for HIE comprehension. A hybrid approach that integrates discussion with knowledgeable personnel and multimedia usage may be useful to convey complex information and facilitate HIE comprehension.

Introduction: In the US, Black/African Americans comprise the largest proportion of People Living with HIV (PLWH). Depressive symptoms and fatigue are highly prevalent among PLWH. Depressive symptoms are linked to progression of HIV disease, and fatigue is linked to severity of depressive symptoms. Resistance exercise is known to have psychological benefits in non-HIV depressed populations, and these benefits are hypothesized to be intensity-dependent. That is, moderate intensity exercise seems to stimulate better psychological outcomes compared to other exercise intensities. To date, no study has examined the acute psychological effects of resistance exercise intensity with depressed PLWH. Purpose: To test the acute effects of resistance exercise intensity on affect, perceived activation, and perceived distress among sedentary Black/African American PLWH who experience depressive symptoms. Methods: Twenty-five men and 17 women ages 24-66 (47.5±11.2) with a Center for Epidemiologic Studies Depression Scale score of ≥10 completed a battery of questionnaires and 10-repetition maximum (10-RM) muscular strength tests. Participants were randomized into a moderate intensity resistance exercise group (i.e., 70% of 10-RM), n=21, or vigorous intensity resistance exercise group (i.e., 100% of 10-RM), n=21. Both groups completed 3 sets of 10 repetitions for 5 exercises at the assigned intensity. Exercises include squat, chest press, lat pull-down, dumbbell shoulder press, and dumbbell biceps curl. Affect, perceived activation, and perceived distress were measured with the Feeling Scale, Felt Arousal Scale, and Subjective Units of Distress Scale, respectively. Measures were administered at PRE, MID, POST, at 15-minute DELAY, and at 30-minute DELAY. Changes were analyzed using repeated measures ANOVA, with Bonferroni adjustments for post-hoc analyses. Results: There were significant Time x Group interactions for affect (F=2.6, p=0.03, η2=0.1), and perceived distress (F=5.5, p<0.01, η2=0.1), and a main effect of Time for perceived activation (F=16.2, p<0.001, η2=0.3). In the moderate intensity group, affect improved PRE to POST (t=3.2, p<0.01, d=0.7), PRE to DELAY 15 (t=4.1, p<0.01, d=0.9), and PRE to DELAY 30 (t=4.1, p<0.001, d=0.7). In addition, perceived distress was reduced from PRE to MID (t=4.2, p<0.001, d=0.9), PRE to POST (t=5.5, p<0.001, d=1.2), PRE to DELAY 15 (t=5.6, p<0.001, d=1.2), and PRE to DELAY 30 (t=6.7, p<0.001, d=1.5). In the vigorous intensity group, affect declined PRE to MID (t=2.9, p<0.01, d=-0.6), while perceived distress improved PRE to DELAY 15 (t=4.8, p<0.001, d=1.0) and PRE to DELAY 30 (t=3.5, p<0.01, d=0.7). Perceived activation increased in both groups similarly PRE to MID (t=5.1, p<0.01, d=1.5), and PRE to POST (t=6.1, p<0.001, d=1.8). Conclusions: Results suggest that an acute bout of moderate intensity resistance exercise is more effective than vigorous intensity resistance exercise in improving affect, increasing energy, and reducing distress in depressed Black/African American PLWH. However, vigorous intensity resistance exercise also appears to have distress-reducing benefits, but this appears to only occur after exercise. These findings should be considered when prescribing exercise for depressive symptom management in this population.

Aside from sub-Saharan Africa, the Caribbean is the only region where the number of women and girls living with human immunodeficiency virus (HIV) is greater than that of men and boys. In the Dominican Republic (DR), the number of all diagnosed HIV cases that were women increased from 27% in 2003 to 51% in 2013, which indicates a shift in the burden of HIV from men to women. Women in stable relationships in the DR have risk for HIV and other sexually transmitted infections (STIs) related to high rates of multiple concurrent partners and low condom use among stable partners. Past HIV prevention efforts in the DR have largely focused on encouraging consistent condom use. However, this may not be a feasible solution for women in relationships. In this dissertation, I sought to examine safe sex communication (SSC) as a possible alternative to consistent condom use for HIV/STI prevention among women in stable heterosexual relationships in DR. I began by conducting an integrative literature review and identified multiple relationship, individual, and partner factors related to SSC among Latina women in stable relationships. Then I conducted a mixed methods study guided by the Theory of Gender and Power with women in stable heterosexual relationships who seek care at Clínica de Familia La Romana in the DR. First, I conducted a qualitative descriptive study to describe SSC. Emergent content analysis of eleven interview transcripts following Colaizzi’s method revealed two main themes: (1) Context of sexual risk (i.e., the meaning of safe sex for stable partners, behaviours related to sexual risk, beliefs and attitudes related to sexual risk, confianza (trust) between stable partners, economic power within relationships, and learning to manage safe sex within a stable relationship) and (2) SSC (i.e., reasons to talk about safe sex, methods, content, and outcomes, influential factors, and ideas for improvement). Second, I conducted a cross sectional survey with 100 women to identify psychosocial correlates of SSC. The mean age of women was 35.72 years, average relationship length was 8.5 years, and 46.91% were living with HIV. Logistic regression analysis revealed that lower SSC self-efficacy (OR = 0.20, 95% confidence interval = 0.08 – 0.50) and greater difference in age between partners (OR = 0.91, 95% confidence interval = 0.85 – 0.98) were both significantly related to less SSC. Information from this dissertation can be used to help identify women in the DR who are at risk for poor SSC with their stable partners and guide researchers, health care providers, and other individuals involved in efforts to reduce HIV/STI risk among this population to develop more effective interventions for this population. Future research should determine which safe sex behaviors SSC is related to among Latina women with stable partners, as well as which aspects of SSC can be generalized to women of all Latino subcultures and nationalities. Additionally, more information is needed about the male partner’s role in SSC within their stable relationship and what factors influence partner SSC among Latino men in stable relationships.

Effective symptom management is essential to decrease symptom severity and improve health-related quality of life for persons living with HIV (PLWH). A mobile health (mHealth) application (app) has the potential to be an effective delivery mode of an existing paper-based symptom management manual with self-management strategies for underserved PLWH. The quality of the mHealth app requires a thorough understanding of the needs of the intended end-users and ensuring the app’s usability. The purpose of this study was to translate paper-based health information into an mHealth app for symptom self-management in underserved PLWH, entitled mVIP (mobile Video Information Provider), and assess its usability. To achieve this goal, usability was evaluated rigorously throughout the development process of mVIP. Based on a stratified view of health information technology (IT) usability evaluation framework, usability evaluation was sequentially conducted with the following three levels: 1) user-task, 2) user-task-system, and 3) user-task-system-environment. At level 1 (user-task), we applied a user-centered design method to guide the information architecture of mVIP. Using a reverse in-person card sorting technique, symptoms and self-management strategies from a paper-based HIV/AIDS symptom management manual were ranked. The rank order of the 13 symptoms and 151 self-management strategies determined the order of appearance to end-users of the mVIP app, with higher-ranked symptoms and strategies appearing first. Based on the findings, we developed a prototype of mVIP as following: 1) once users log in, they are guided by an avatar through a series of 13 symptom questions ascertaining the nature and severity of their symptoms, and 2) the avatar recommends three self-management strategies for each symptom reported. At level 2 (user-task-system), we conducted a usability evaluation of the mVIP prototype in a laboratory setting through end-user usability testing and heuristic evaluation. In end-user usability testing, we used an eye-tracking and retrospective think-aloud method to examine task performance by 20 PLWH. For the heuristic evaluation, five usability experts in informatics assessed the user interface. In the two usability evaluations conducted in a laboratory setting, we found strong user acceptance of the mVIP prototype while identifying a number of usability issues with this prototype. Based on the recommendations from the end-users and heuristic evaluators, we iteratively refined the app’s content, functionality, and interface. We then inserted videos of the finalized symptom self-management strategies into the refined mVIP prototype. At level 3 (user-task-system-environment), the usability of the refined mVIP prototype was evaluated in a real-world setting. Through 10 in-depth interviews and four focus groups conducted at the conclusion of a three-month randomized controlled trial, we explored in-depth understandings of users’ experiences, perceptions, and satisfaction of mVIP use. Findings from the study showed that first, mVIP is useful for HIV-related symptom self-management and has the potential for being used as a communication tool with healthcare providers; and second, mVIP is easy to use to monitor symptom experience over time. At the same time, participants suggested mVIP be more sensitively tailored based on years from initial diagnosis of HIV, an individuals’ age, and conditions. The overall user satisfaction with the mVIP prototype was high, which reflects strong user acceptance of mVIP. Integral to the findings from the three-level usability evaluation, we assessed the quality of the mVIP prototype in use and found the prototype was highly accepted by PLWH with high user satisfaction. This study will add to the body of literature on translation of evidence-based health information into an mHealth app and its usability assessment, which highlights the importance of the use of mobile technology for PLWH, specifically racial and ethnic minorities and those from low-socioeconomic groups who have limited health literacy and low level of education.

In 2007 it was reported that an estimated 33 million people worldwide were living with the Human Immunodeficiency Virus (HIV). Of this, 35% (approximately 11.5 million) live in South Africa, most of whom were infected with HIV by mother to child transmission. Due to government legislation, until 2004, South Africans had limited access to Antiretroviral (ARV) treatment at and after birth. As a consequence, treatment of HIV was, at this time, only in government facilities, initiated after the clinical presentation of immune deficiency. This study compared the memory functioning of low socio-economic seropositive adolescents that were on a managed anti-retroviral programme to that of a contrast group that were HIV negative. The groups were matched for age, gender, demographics and educational level. The relative impact of variables such as duration of ARV treatment, drug regimen, WHO stage at diagnosis and CD4+ count were all considered. Performance on a comprehensive neuropsychological battery was compared between the HIV positive group and their typically developing counterparts both in terms of memory functions as well as other cognitive processes that may have an effect on memory. The HIV positive group performed significantly below their HIV negative peers in processing speed, holistic processing, and spatial processing as well as specific visual functions such as visual constructional skills, visual recall ability, disruptions in both storage and retrieval of visuospatial information, and visual spatial working memory. No significant differences were found between the groups on tasks measuring verbal memory and verbal learning ability indicating that the neurocognitive profile of clade C HIV has a different presentation from the other clades. The findings suggest that the preferential effect HIV has on the frontostriatal circuits in the brain impacts memory processes due to the destructive impact of the virus on the myelination of these circuits. As a result of the higher degree of white matter tracts in the right hemisphere, holistic and integrative processing is impaired and visuospatial functions are affected whereas verbal processes are largely spared. The resulting neurocognitive profile is similar to that of nonverbal learning disorders and may benefit from similarly constructed interventions such as placing more emphasis on verbal learning strategies and limiting dependence on visual information for HIV positive pupils.

Thesis (Ph. D. (Social Work)) --University of Limpopo, 2018 / Despite the laudable progress on HIV and AIDS interventions encountered in South Africa, new HIV infection remains a challenge. Limpopo Department of Agriculture is not an exception as far as new HIV infections are concerned, regardless of the intervention efforts made. This study aimed at exploring on perceptions of LDA employees on social-behavioural and structural core drivers of HIV infection. Qualitative research methodologies were applied. A purposive sample of twenty participants (10 men and 10 women) was selected from Department of Agriculture, Mopani District, Limpopo Province. Constructivism and structuralism theoretical framework were used to navigate the study. Semi-structured, face-to-face interviews were designed. Data was collected through interviews, audio-recorded and transcribed. Eight steps of data analysis were followed as proposed by Creswell. Guidelines for the prevention of new HIV infection were developed. Some of the major findings are that: the socio-behavioural core drivers that place all partners at risk of contracting new HIV infections is the Multiple Sexual Partnerships (MSPs). Age-disparate relationships in a workplace were also socio-behavioural drivers of new HIV infection. Young women and men who enter into age-disparate relationships have intention of obtaining permanent employment. Patriarchy was found to be amongst the structural core drivers of new HIV infections. The fact that men are not tested involuntarily is viewed as a structural barrier towards eliminating the spread of new HIV infections. Stigma has been also found to be a core driver of new HIV infections. Some conclusions made are: MSPs is a closed sexual network system, characterised by “secrecy” and “trust”. Despite some reforms purporting to improve women’s status, patriarchal domination is still at its toll. Unsymbolised stigma remains a threat towards elimination of the spread of HIV infections. The major recommendations are that working women still require empowerment in number of areas of their social functioning, and the leadership involvement in the fight against the spread of new HIV infections.

Highly active antiretroviral therapy (HAART) contributes to metabolic disorders and the growing prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV)-infected patients. Hypertension, obesity, and hyperglycemia (components of MetS) are risk factors for cardiovascular disease. Studies have shown that HIV patients on HAART have a 2-fold risk of dying from MetS. There are no such studies in Umuahia; hence the need for this study to fill this gap. Using a sample size of 192 medical records of HIV-infected patients in Federal Medical Centre, Umuahia, and applying metabolic syndrome theory, this study examined the relationships among types of HAART regimen, duration of HAART and hypertension, obesity, and hyperglycemia among HIV-infected adult patients. The records were stratified into 4 by duration of HAART. Chi-square test was used to determine associations between the nonparametric variables, whereas multiple logistic regressions were used to estimate the odds ratios. Odds of hypertension were more than 18-fold (OR = 18.52, 95% confidence interval [CI] = 5.464, 42.50) at >12 months on HAART, whereas odds of obesity was more than 5-fold (OR = 5.43, 95% CI = 2.227, 13.158) at >12 months. Odds of hyperglycemia were more than 14-fold at >12 months compared with <12 months on HAART. Statistical significance was achieved with duration of HAART for hypertension and hyperglycemia (p < .05) but none with types of HAART (p < .05). Being male, older age, and duration of HAART were associated with odds of metabolic syndrome components. This knowledge provides a base for population-based intervention programs for the HIV-positive population undergoing antiretroviral therapy in the Umuahia metropolis.

Thesis (M.Dev.) --University of Limpopo, 2011 / Refer to document.