Attitudes Related to HIV Risk Behavior Among Black South African MSM. Limited information exists on HIV sexual risk-taking behavior among Black South African men who engage in sex with other men (MSM). This study explores attitudinal, cultural, and social factors potentially influencing HIV sexual risk behavior among Black South African men residing in the Eastern Cape. Data were collected from demographic questionnaires and six focus groups with 41 men residing in the cities of East London and Port Elizabeth, Eastern Cape Province, South Africa. Participants ranged in age from 18 to 35 years, with a mean age of 23.8. Twenty-two (53.4%) reported that they had had anal sex with a man in the past six months. Seven (17.1%) reported that they had had sexual intercourse with a woman in the past six months. Eight (19.5%) reported that they used condoms every time that they had sex with a woman in the past six months. Participants shared their views that they were treated as outcasts and were not treatd as men by their families, even thought they hadi been to the “bush” and received circumcision rites of passage. Participants also shared stories of male sexual partners cutting condoms prior to having sex, and emerging social norms on group sex.
PI: Larry Icard
HIV Positive Men and Women Qualitative Study.The objective of this pilot study is to learn about the service needs, HIV/STI risk behavior and attitudes, and health and mental health problems important to men and women who have HIV/AIDS. Thirty volunteers participated in one of three focus group, one men only, another for women only, and a third for men and women.During the focus group discussions participants were asked to respond to questions probing their views on attitude, knowledge, and behavior related to sexual transmitted disease, including HIV, environmental constraints and resources, explore experiences related to stigma and discrimination, and constructions of social networks for support. Focus group participants indicated difficulty in disclosing their HIV+ status in both intimate and non-intimate settings. Participants indicated that they were more likely to engage in risk taking sexual behaviors when they were feeling depressive symptoms. Additionally, focus group participants expressed feeling stigmatized as a result of their HIV+ status.
PI: Larry Icard
Positive Intervention with HIV Positive men and Women.The purpose of this pilot study is to test a secondary prevention risk reduction intervention for Africa American men and women who are HIV positive. The 158 pilot study participants ranged in age from 19 to 62, with a mean age of 45 years old. Approximately 68% of participants were male, with 31.2% being female. Over 53% (n = 84) identified as heterosexual or straight, 25% (n = 39) identified as homosexual or gay, and 13% (n = 20) identified as bisexual. Approximately 30% of participants indicated that they had never been married, followed by 23.4% who indicated that they were living with a significant other, and 10% indicating married, but not living with their spouse. The majority of participants (80%) were either unemployed or disabled. Approximately 39% (n = 61) indicated that a high school diploma or GED was the highest grade of school attained, with 23% (n = 36) indicating that they completed some high school, and 9% (n = 13) indicating a 8th grade education as their highest level of education completed. Participants had known their HIV+ status for a mean 13.8 years, with a range of 1 to 38 years known. Over 34% (n = 37) of men indicated that they had had anal intercourse with a main or steady partner within the past month, with over 40% (n = 45) not using a condom with their primary partners. When asked about the last time they had anal intercourse with their primary partner, over 42% (n = 45) of male participants indicated that they did not use a condom. Over 32% (n = 21) of the female participants indicated that they did not use a condom when they had anal intercourse with their primary partner during the past month. Of the males who indicated that they had vaginal intercourse with a primary partner during the past month, approximately 42% (n = 45) indicated that they did not use a condom. Of the females who had vaginal intercourse with a primary partner during the past month, over 36% (n = 18) indicated that they did not use a condom.
PI. Larry Icard
African-American Men on the “Down Low”.In this pilot study, Icard and colleagues conducted six focus groups with 60 African-American men on the “Down Low” (DL), or men who engage in sex with men and women, and do not identify themselves as gay.Participants’ ranged in age from 18 to 52. Participants shared how they resolved incongruence between their same-sex relations and their heterosexual identity. Participants shared how their same-sex behavior was influenced by the unwillingness of their female sexual partners to engage in certain sexual behaviors that they could engage in with other men. Others shared their views on how their sexual relationships with men were influenced by their economic needs, and how they engaged in sex with another man in exchange for money. The observations from this pilot study help to shed light on the social, cultural, and economic factors influencing HIV sexual risk-taking behavior among men who self-identity as heterosexuals.
PI: Larry Icard
HIV, STI Risk Behavior and Substance Use Among South African MSM.
Among the 125 respondents, 71% reported ever having anal sex. About 60% of the men reported binge drinking, i.e., consuming five or more drinks on one occasion, at least one time in the past 30 days. Approximately 40% did not know that a pregnant woman who has HIV/AIDS could give it to her baby. Slightly more than 50% did not know that having unprotected anal sex would increase their chance of getting an STI, HIV/AIDS. Thirty-five percent thought witchcraft can cause HIV/AIDS. Twenty-two percent thought that one way to get HIV/AIDS was if you did not do good by your ancestors. The HIV/STD prevention intervention will address the gaps in participants’ knowledge of HIV and STDs
When asked, ‘“What do you consider yourself?” 31% of the MSM considered themselves as ‘a woman in a man's body. In South Africa a substantial proportion of men who identify as gay are also gender-nonconforming. This gets expressed in feminine behavior and, for some, a preference to be treated as a lady. These men are likely to see themselves as having a feminine gender, thus the label "woman in a male body." Sexually, these men have a preference for receptive anal intercourse and masculine looking partners. These men do not consider themselves to be transgender and they do not show evidence of gender dysphoria. Perceived need to reduce drinking in the past 30 days was significantly correlated with feminine gender identity, r =0.49, p = .000. Controlling for baseline data, participants in the Alcohol Use-HIV Risk Reduction Intervention (M=52) scored significantly higher than did participants in the General Health Intervention (M=32) for level of AIDS Knowledge, p = .02. Post-test scores revealed participants in the Alcohol Use and HIV/STI Risk Reduction Intervention (M= 2.18) reported having more favorable attitudes about not drinking than participants in the General Health Intervention (M=3.11) p = .04, (low numbers indicate more favorable attitudes.
PI. Larry Icard
HIV Prevention with Incarcerated Men
HIV+ incarcerated men who are soon to be released constitute a significant population for spreading HIV upon re-entry to their communities and families.
This feasibility study focused on incarcerated men recruited directly from Community Correction Centers (CCC) under the jurisdiction of the Pennsylvania Department of Corrections (DoC). Subjects were assigned to an intervention or standard of care condition. Guided by Social Cognitive Theory and the Theory of Planned Behavior, the risk reduction intervention was designed to dissuade men from engaging in HIV sex risk behavior, increase their medical treatment adherence, increase utilization of services, and enhance efficacy to inform sexual partners of their serostatus and encourage their partners to utilize HIV counseling and referral services. The standard of care control condition comprised basic HIV risk reduction information and literature provided by the Pennsylvania Department of Corrections.
PI: Larry Icard Co-PI: Scott Rutledge
Teaming African American Parents with Survival Skills: A Randomized Controlled Trial of Reducing HIV Risks among Pre-Adolescents of Economically Disadvantaged Urban Families. The primary aim of Teaming African American Parents with Survival Skills (TAAPSS), a randomized clinical trial (N=625), was to test the efficacy of an invention to dissuade early adolescents from engaging in HIV/STI risk behaviors. Focusing on African American women with lower levels of education and low incomes and their pre-adolescent children (ages 11-13), as high risk families, a secondary aim of TAAPSS was to determine whether the intervention was more effective when groups were led by parents (i.e., peers) or professional facilitators. The study employed a randomized 2 X 2 factorial design with repeated measures. The factors include treatment type, (HIV/STI risk reduction skills strategies intervention vs. a comparison health promotion intervention),and group facilitator type (parent led vs. professional facilitator led). All four interventions (parent peer led HIV/STI risk reduction, professional led HIV/STI risk reduction, parent peer led health promotion, professional led health promotion) consisted of 12- 2 hour sessions delivered across three consecutive Saturdays. Assessments were scheduled to occur at pretest prior to intervention, 2 weeks post-intervention, and at 6- and 12-month follow-ups.The analyses indicated significant mean differences in attitude and behavior between the pre-test and the first six-month measurement, for both the Sex and Health interventions, with no differences between the two groups. The growth curve analyses showed no correlations in the mother and child trajectories for either the behavior or attitude measures. Significant difference in the growth trajectories between the two intervention groups was that the Sex intervention group showed a significant increase in the child’s attitude over time, whereas the Health group showed no change in the child’s attitude over time. Significant differences in the two interventions were found in the relationship of child age with the child attitude trajectory. In the Sex intervention, the child’s age was a significant positive predictor of the six-month attitude measure (the initial level of the trajectory) and a significant negative predictor of the change in the child’s attitude (the slope of the trajectory).
PI: Larry Icard
Nonresidential fathers, risk, and resilience. This project examined whether fathers’ individual and family risk and resilience factors predicted the degree to which nonresidential fathers are engaged with their preschool-age children. This longitudinal study also examined whether fathers with low levels of risk are likely to move from nonresidential to residential arrangements with the mother and child.
PI: Jay Fagan
Family structure effects on young children’s developmental outcomes. The present study examined mediators of the association between fathers’ nonresidence and children’s school readiness. The mediators included mothers’ supportiveness, father engagement, and maternal depression. This project also examined the effects of never married mothers getting married on preschoolers’ emerging literacy skills.
PI: Jay Fagan
Coparenting support and father engagement in fragile families. This project examined the effects of coparenting support on fathers’ engagement with children. Although studies have examined coparenting in different family structures,research has not compared the effects of coparenting across different structures. The present study addressedthis gap by examining the effects of coparenting among four groups of parents who consistently remained in the same family structure and relational status category over time: married, cohabiting, nonresidential but romantically involved, and nonresidential nonromantically involved.
PI: Jay Fagan
The influence of mother, father, and child risk on parenting and children’s cognitive and social behaviors. Although research shows that fathers’ and children’s risk contribute to children’s development, studies investigating the simultaneous influence of maternal, paternal and child risk on parenting and child’s functioning are rare. Including all family members in research is consistent with a family system perspective that parents influence their children’s development through their relationships with them. In this study, family system theory and a risk perspective were used to examine the influence of maternal, paternal, and child risk when children were 9 months old on 24 months outcomes.
PI: Jay Fagan
Effects of a coparenting intervention on adolescent fathers and couples. This experimental study tested the effects of two pre-birth interventions—MELD coparenting and childbirth curricula—and a no intervention control group on young African American and Hispanic fathers and their adolescent partners. The coparenting intervention was associated with changing fathers’ perceptions of their coparenting behavior rather than mothers’ perceptions of the fathers’ behavior compared with the childbirth program. Fathers and mothers consistently reported fathers’ improved coparenting behavior when the coparenting intervention was compared with the no intervention group. Fathers (regardless of residence) and mothers residing with the father reported higher levels of father engagement with the infant when the father participated in the coparenting intervention compared with fathers who participated in the childbirth intervention.
PI: Jay Fagan
Non-residential fathers with children in the foster care system
The purposes of the proposed pilot project are to: (1) obtain information from nonresidential fathers through focus group discussions about the challenges they face in being involved in their child’s life when the child is in foster care and in relating to the child welfare system and (2) pilot test a survey instrument with a sample of 50 nonresidential fathers.
PI: Jay Fagan.
Limitations of Randomized Control Trial Research Design with High-Risk Populations; A Case Study of Pregnant and Parenting Adolescents. Evidence for effective interventions is critical for planning and implementing programs intended to address social problems such as the negative consequences of adolescent pregnancy. The randomized control trial (RCT), or experimental design, has been considered the “gold standard” of evaluation methods and has guided much of the research funding and subsequent research designs for providing this evidence. However, some researchers have questioned whether an RCT is always the best choice of design. This case study of one program evaluation empirically examines a number of related concerns. In our experience, implementing a RCT in the five-year evaluation of the Alcanza Care Project, a program serving pregnant and parenting teens in Philadelphia, was not only challenging, but raised questions about the appropriateness of an RCT design for evaluating programs that serve vulnerable and high-risk populations. Although experimental designs are appropriate in some settings, other methodologies may make more sense in high-needs social service settings. Researchers, funders, and policy makers should expand what constitutes “evidence” in the social service arena.
PI: Bernie Newman