Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
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Education
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BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
Do Jobs Work? Risk and Protective Behaviors Associated with Employment among Disadvantaged Female Teens in Urban Atlanta
AbstractRosenbaum, J., Zenilman, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).Publication year
2014Journal title
Journal of Women, Politics and PolicyVolume
35Issue
2Page(s)
155-173AbstractAdolescent employment research has focused on middle-class rather than disadvantaged adolescents. We identified risks and benefits of adolescent employment in a 12-month study of 715 low-socioeconomic-status female African American adolescents using nearest-neighbor Mahalanobis matching on baseline factors including substance use and socioeconomic status. Employed adolescents were more likely to graduate high school and less likely to depend on boyfriends for spending money, but they were more likely to use marijuana, alcohol, and have sex while high or drunk. Employment may help female adolescents avoid potentially coercive romantic relationships, but increase access to drugs or alcohol.Drug users' willingness to encourage social, sexual, and drug network members to receive an HIV vaccine: A social network analysis
AbstractYoung, A. M., Diclemente, R. J., Halgin, D. S., Sterk, C. E., & Havens, J. R. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
9Page(s)
1753-1763AbstractThis study examined feasibility of peer-based promotion of HIV vaccination and dyadic correlates to vaccine encouragement in risk- and non-risk networks of drug users (n = 433) in the US. Data were collected on HIV vaccine attitudes, risk compensation intentions, likelihood of encouraging vaccination, and recent (past 6 months) risk (i.e. involving sex and/or injecting drugs) and non-risk (i.e. involving co-usage of noninjected drugs and/or social support) relationships. Willingness to encourage HIV vaccination was reported in 521 and 555 risk- and non-risk relationships, respectively. However, 37 % expressed hesitancy, typically due to fear of side effects or social concerns. Encouragement was often motivated by perceived HIV risk, though 9 % were motivated by risk compensation intentions. In non-risk partnerships, encouragement was associated with drug co-usage, and in risk relationships, with perceived vaccine acceptability and encouragement by the partner. Network-based HIV vaccine promotion may be a successful strategy, but risk compensation intentions should be explored.Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents: A randomized clinical trial
AbstractDiClemente, R. J., Wingood, G. M., Sales, J. M., Brown, J. L., Rose, E. S., Davis, T. L., Lang, D. L., Caliendo, A., & Hardin, J. W. (n.d.).Publication year
2014Journal title
JAMA PediatricsVolume
168Issue
10Page(s)
938-946AbstractIMPORTANCE: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.OBJECTIVE: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.DESIGN, SETTING, AND PARTICIPANTS: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.INTERVENTIONS: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.CONCLUSIONS AND RELEVANCE: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.RESULTS: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95%CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95%CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95%CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95%CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95%CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95%CI, -0.98 to -0.24; P < .001).MAIN OUTCOMES AND MEASURES: The primary outcomeswere percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.Efficacy of an HIV/STI Sexual Risk-Reduction Intervention for African American Adolescent Girls in Juvenile Detention Centers: A Randomized Controlled Trial
AbstractDiClemente, R. J., Davis, T. L., Swartzendruber, A., Fasula, A. M., Boyce, L., Gelaude, D., Gray, S. C., Hardin, J., Rose, E., Carry, M., Sales, J. M., Brown, J. L., & Staples-Horne, M. (n.d.).Publication year
2014Journal title
Women and HealthVolume
54Issue
8Page(s)
726-749AbstractFew HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13–17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.HIV vaccine acceptability among high-risk drug users in Appalachia: A cross-sectional study
AbstractYoung, A. M., Diclemente, R. J., Halgin, D. S., Sterk, C. E., & Havens, J. R. (n.d.).Publication year
2014Journal title
BMC public healthVolume
14Issue
1AbstractBackground: A vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern. Unfortunately, people who use drugs, particularly those residing in rural communities, have been underrepresented in previous research on HIV vaccine acceptability. This study examined HIV vaccine acceptability among high-risk drug users in a rural community in the United States. Methods. Interviewer-administered questionnaires included questions about risk behavior and attitudes toward HIV vaccination from 433 HIV-negative drug users (76% with history of injection) enrolled in a cohort study in Central Appalachia. HIV vaccine acceptability was measured on a 4-point Likert scale. Generalized linear mixed models were used to determine correlates to self-report of being "very likely" to receive a 90% effective HIV vaccine (i.e. "maximum vaccine acceptability", or MVA). Adjusted odds ratios (AORs) and corresponding 95% confidence intervals (CIs) are reported. Results: Most (91%) reported that they would accept a preventive HIV vaccine, but concerns about cost, dosing, transportation constraints, vaccine-induced seropositivity, and confidentiality were expressed. Cash incentives, oral-administration, and peer/partner encouragement were anticipated facilitators of uptake. In multivariate analysis, men were significantly less likely to report MVA (AOR: 0.33, CI: 0.21 - 0.52). MVA was more common among participants who believed that they were susceptible to HIV (AOR: 2.31, CI: 1.28 - 4.07), that an HIV vaccine would benefit them (AOR: 2.80, CI: 1.70 - 4.64), and who had positive experiential attitudes toward HIV vaccination (AOR: 1.85, CI: 1.08 - 3.17). MVA was also more common among participants who believed that others would encourage them to get vaccinated and anticipated that their behavior would be influenced by others' encouragement (AOR: 1.81, 95% 1.09 - 3.01). Conclusions: To our knowledge, this study was among the first to explore and provide evidence for feasibility of HIV vaccination in a rural, high-risk population in the United States. This study provides preliminary evidence that gender-specific targeting in vaccine promotion may be necessary to promoting vaccine uptake in this setting, particularly among men. The data also underscore the importance of addressing perceived risks and benefits, social norms, and logistical constraints in efforts to achieve widespread vaccine coverage in this high-risk population.HIV-related sexual risk behavior among African American adolescent girls
AbstractDanielson, C. K., Walsh, K., McCauley, J., Ruggiero, K. J., Brown, J. L., Sales, J. M., Rose, E., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
2014Journal title
Journal of Women's HealthVolume
23Issue
5Page(s)
413-419AbstractBackground: Latent class analysis (LCA) is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls. Methods: Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Participants were African American girls (n=701) aged 14-20 years presenting to sexual health clinics. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. Results: Two latent classes were identified with the probability statistics for the two groups in this model being 0.89 and 0.88, respectively. In the final multivariate model, class 1 (the "higher risk" group; n=331) was distinguished by a higher likelihood of >5 lifetime sexual partners, having sex while high on alcohol/drugs, less frequent condom use, and history of sexually transmitted diseases (STDs), when compared with class 2 (the "lower risk" group; n=370). The derived model correctly classified 85.3% of participants into the two groups and accounted for 71% of the variance in the latent HIV-related sexual behavior risk variable. The higher risk class also had worse scores on all hypothesized correlates (e.g., self-esteem, history of sexual assault or physical abuse) relative to the lower risk class. Conclusions: Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services.HIV-related stigma among african-american youth in the northeast and southeast US
AbstractKerr, J. C., Valois, R. F., Diclemente, R. J., Fletcher, F., Carey, M. P., Romer, D., Vanable, P. A., & Farber, N. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
6Page(s)
1063-1067AbstractHIV-related stigma inhibits optimal HIV prevention and treatment among African-Americans. Regional differences in HIV/AIDS prevalence may be related to stigma among young African-Americans. Baseline data (N = 1,606) from an HIV prevention intervention were used to investigate regional differences in HIV-related stigma and knowledge among African-American adolescents in four midsized cities in the Northeastern and Southeastern US. Analyses indicated greater HIV-related stigma among adolescents from the Southeast relative to adolescents from the Northeast (F = 22.23; p>0.0001). Linear regression indicated a negative relationship between HIV stigma and HIV knowledge (b = -0.65; p>0.0001). Addressing HIV/AIDS in high prevalence locales should include efforts to reduce HIV-related stigma.Impact of abuse history on adolescent African American women's current HIV/STD-associated behaviors and psychosocial mediators of HIV/STD risk
AbstractBrown, J. L., Young, A. M., Sales, J. M., Diclemente, R. J., Rose, E. S., & Wingood, G. M. (n.d.).Publication year
2014Journal title
Journal of Aggression, Maltreatment and TraumaVolume
23Issue
2Page(s)
151-167AbstractThis study examined if relationship power, sex refusal self-efficacy, or fear of condom negotiation mediated the relationship between abuse history and consistent condom use (CCU) among African American female adolescents (N = 593). Participants with an abuse history (58%) were less likely to report CCU. Women with an abuse history reported less relationship power and self-efficacy for refusing sex and more fear of condom negotiation, none of which independently or jointly mediated the association between abuse and CCU. Notably, history of abuse was associated with CCU across mediator models despite inclusion of psychosocial mediators. This study demonstrates the importance of understanding adolescents'condom use behaviors within the context of their life experiences, especially past abuse history.Influence of sexual sensation-seeking on factors associated with risky sexual behaviour among African-American female adolescents
AbstractRitchwood, T. D., Penn, D. C., Diclemente, R. J., Rose, E. S., & Sales, J. M. (n.d.).Publication year
2014Journal title
Sexual HealthVolume
11Issue
6Page(s)
540-546AbstractBackground The identification of antecedents to sexual risk among youth is critical to the development and dissemination of multilevel interventions. Therefore, the aim of the present study was to examine the effect of sexual sensation-seeking on partner age, partner communication, and the sexual attitudes and behaviours of African-American female youth. Methods: This study examined survey data collected by audio computer-assisted self-interviews from 701 young African-American females between 14 and 20 years of age. The survey consisted of items designed to measure adolescents' sexual risk and preventive behaviours. Results: The results of this study suggest that sexual sensation-seeking is associated with condom use among adolescent African-American females. For adolescents who reported greater sexual sensation-seeking, lower levels of sexual happiness were associated with a decreased likelihood of condom use at last intercourse (β≤1.01, P≤0.05). For those reporting lower levels of sexual sensation-seeking, greater sexual enjoyment was associated with a greater likelihood of condom use at last intercourse (β≤0.93, P≤0.01). Adolescents with younger sexual partners and lower levels of sexual sensation-seeking reported a higher proportion of condom use in the past 6 months (β≤0.70, P≤0.01). Higher partner communication self-efficacy and decreasing levels of sexual sensation-seeking were associated with fewer lifetime sexual partners (β≤-0.54, P≤0.05). Conclusions: Future research should address the impact of these variables on adolescent relationship dynamics and sexual decision-making.Interaction Between 5-HTTLPR Polymorphism and Abuse History on Adolescent African-American Females' Condom Use Behavior Following Participation in an HIV Prevention Intervention
AbstractSales, J. M., DiClemente, R. J., Brody, G. H., Philibert, R. A., & Rose, E. (n.d.).Publication year
2014Journal title
Prevention ScienceVolume
15Issue
3Page(s)
257-267AbstractNot everyone exposed to an efficacious human immunodeficiency virus (HIV) intervention will reduce sexual risk behaviors, yet little is known about factors associated with "failure to change" high-risk sexual behaviors post-intervention. History of abuse and polymorphisms in the serotonin transporter gene (5-HTT) may be associated with non-change. The current study sought to identify genetic, life history, and psychosocial factors associated with adolescents' failure to change condom use behaviors post-participation in an HIV prevention intervention. A sub-set of participants from a clinic-based sample of adolescent African-American females (N = 254) enrolled in a randomized trial of an HIV-prevention was utilized for the current study. Forty-four percent did not increase their condom use from baseline levels 6 months after participating in the sexually transmitted infection (STI)/HIV prevention intervention. In multivariable logistic regression analysis, an interaction between abuse and 5-HTTLPR group was significantly associated with non-change status, along with partner communication frequency scores at follow-up. Follow-up tests found that having a history of abuse was significantly associated with greater odds of non-change in condom use post-intervention for only those with the s allele. For those with ll allele, participants with higher partner communication frequency scores were at decreased odds of non-change in condom use post-intervention. Thus, STI/HIV interventions for adolescent females may consider providing a more in-depth discussion and instruction on how to manage and overcome fear or anxiety related to being assertive in sexual decisions or sexual situations. Doing so may improve the efficacy of STI/HIV prevention programs for adolescent women who have experienced abuse in their lifetime.Internalizing symptoms and safe sex intentions among adolescents in mental health treatment: Personal factors as mediators
Failed generating bibliography.AbstractPublication year
2014Journal title
Children and Youth Services ReviewVolume
46Page(s)
177-185AbstractLittle is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N. =. 893, M age. =. 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females
AbstractSteiner, R. J., Swartzendruber, A. L., Rose, E., & DiClemente, R. J. (n.d.).Publication year
2014Journal title
Sexually Transmitted DiseasesVolume
41Issue
10Page(s)
601-604AbstractAmong 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.Overcoming the triad of rural health disparities: How local culture, lack of economic opportunity, and geographic location instigate health disparities
AbstractThomas, T. L., Diclemente, R., & Snell, S. (n.d.).Publication year
2014Journal title
Health Education JournalVolume
73Issue
3Page(s)
285-294AbstractObjective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. Methods: We critically profile each component of the deterministic triad in shaping current healthrelated disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice. Results: The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. Conclusion: The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.Project STYLE: A multisite RCT for HIV prevention among youths in mental health treatment
AbstractBrown, L. K., Hadley, W., Donenberg, G. R., DiClemente, R. J., Lescano, C., Lang, D. M., Crosby, R., Barker, D., & Oster, D. (n.d.).Publication year
2014Journal title
Psychiatric ServicesVolume
65Issue
3Page(s)
338-344AbstractObjective: The study examined the efficacy of family-based and adolescentonly HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. Methods: A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. Results: Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p<.01) and self-efficacy (p<.05). The family-based intervention, compared with the other interventions, produced significant improvements in parent-teen sexual communication (p<.01), parental monitoring (p<.01), and parental permissiveness (p=.05). Conclusions: This RCT found that the HIV prevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.Safety and acceptability of couples HIV testing and counseling for us men who have sex with men: A randomized prevention study
AbstractSullivan, P. S., White, D., Rosenberg, E. S., Barnes, J., Jones, J., Dasgupta, S., O’Hara, B., Scales, L., Salazar, L. F., Wingood, G., Diclemente, R., Wall, K. M., Hoff, C., Gratzer, B., Allen, S., & Stephenson, R. (n.d.).Publication year
2014Journal title
Journal of the International Association of Providers of AIDS CareVolume
13Issue
2Page(s)
135-144AbstractWe tested a couples HIV testing and counseling (CHTC) intervention with male couples in Atlanta by randomizing eligible couples to receive either CHTC or separate individual voluntary HIV counseling and testing (iVCT). To evaluate the acceptability and safety of CHTC, main outcomes were satisfaction with the intervention and the proportions of couples reporting intimate partner violence (IPV) and relationship dissolution after the service. The results indicated that the service was very acceptable to men (median 7-item index of satisfaction was 34 for CHTC and 35 for iVCT, P =.4). There was no difference in either incident IPV (22% versus 17% for CHTC and iVCT, respectively, P =.6) or relationship dissolution (42% versus 51% for CHTC and iVCT, respectively, P =.5). Based on the preliminary data, CHTC is safe for male couples, and it is equally acceptable to iVCT for men who have main partners.Social discrimination and resiliency are not associated with differences in prevalent HIV infection in black and white men who have sex with men
AbstractPeterson, J. L., Bakeman, R., Sullivan, P., Millett, G. A., Rosenberg, E., Salazar, L., Diclemente, R. J., Cooper, H., Kelley, C. F., Mulligan, M. J., Frew, P., & Del Rio, C. (n.d.).Publication year
2014Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
66Issue
5Page(s)
538-543AbstractOBJECTIVES: To examine the associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white men who have sex with men (MSM). METHODS: The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA, designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Participants were recruited irrespective of HIV serostatus from community-based venues and from Internet advertisements and were tested for HIV. We assessed respondents' demographics, whether they had engaged in unprotected anal intercourse (UAI) within the past 6 months, and attitudes about perceived homophobia, perceived racism, and personal resiliency. RESULTS: Compared with white MSM, black MSM were less likely to report UAI in the past 6 months [odds ratio (OR): 0.59, confidence interval (CI): 0.44 to 0.80], more likely to be HIV positive (OR: 5.05, CI: 3.52 to 7.25), and - among those HIV positive - more likely to report not being aware of their HIV infection (OR: 2.58, CI: 1.18 to 5.65). Greater perceived racism was associated with UAI in the black sample (partial odds ratio: 1.48, CI: 1.10 to 1.99). Overall, perceived homophobia, perceived racism, and resilience were not associated with prevalent HIV infection in our samples. Greater resilience was associated with less perceived homophobia in both black and white samples (Spearman r = -0.27, P < 0.001, for both). CONCLUSION: Future studies of social discrimination at the institutional and network level, than at the individual level, may explain differences in HIV infection in black and white MSM.Socioeconomic-related risk and sexually transmitted infection among African-American adolescent females
AbstractSales, J. M., Smearman, E. L., Swartzendruber, A., Brown, J. L., Brody, G., & Diclemente, R. J. (n.d.).Publication year
2014Journal title
Journal of Adolescent HealthVolume
55Issue
5Page(s)
698-704AbstractPurpose Virtually no studies have examined the potential role that chronic stress, particularly the stress associated with socioeconomic status (SES) strain, may play on sexually transmitted infection (STI) risk. This study examined the association between SES-related risk at baseline to STI acquisition and reinfection over 36 months of follow-up.Methods Six hundred twenty-seven African-American female adolescents, ages 14-20 years, recruited from sexual health clinics in Atlanta, GA, participated in a randomized controlled HIV prevention trial and returned for at least one follow-up assessment. Following baseline assessment, six waves of data collection occurred prospectively over 36 months. Chronic SES-related risk was assessed as a sum of yes-no exposure to seven risk indicators. Laboratory-confirmed tests for Chlamydia trachomatis and Neisseria gonorrhoeae were performed at each follow-up.Results In multivariable regression analysis, SES-related risk significantly predicted STI acquisition over 36 months (adjusted odds ratio = 1.22) and STI reinfection (adjusted odds ratio = 1.16) above and beyond other known correlates of STI.Conclusions Findings demonstrate that SES-related risk was predictive of both STI acquisition and reinfection among young African-American females. They are consistent with propositions that some health disparities observed in adulthood may be linked to earlier chronically stress-inducing life experiences, particularly experiences associated with low SES conditions. Although various explanations exist for the observed connection between SES-related risk and subsequent STI acquisition and/or reinfection across 36 months of follow-up, these findings highlight the need for further research to elucidate the exact pathway(s) by which SES-related risk influences later STI acquisition to refine STI prevention interventions for this population.Telling truth from Ys: An evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy
AbstractRosenbaum, J. E., Zenilman, J., Melendez, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).Publication year
2014Journal title
Sexually transmitted infectionsVolume
90Issue
6Page(s)
479-484AbstractResults At the 3 surveys, 30%, 20% and 15% of adolescents who reported always using condoms tested positive for semen exposure. At 6 month follow-up, 20.4% and 16.2% of the adolescents who underreported semen exposure reported pregnancy, a higher pregnancy rate than accurate reporters of semen exposure, even accurate reporters who reported never using condoms (14.2% and 11.8%). Under-reporters of semen exposure were 3.23 (95% CI (1.61, 6.45)) times as likely to become pregnant at 6-month follow-up and 2.21 (0.94, 5.20) times as likely to become pregnant at 12-month follow-up as accurate reporters who reported not using contraception, adjusting for self-reported coital frequency.Conclusions Adolescents who under-report semen exposure may be at uniquely high risk for unplanned pregnancy and STIs, and may also under-report coital frequency. Condom efficacy trials that rely on self-report may yield inaccurate results. Adapted to a clinical setting, the Y-chromosome PCR could alert women to incorrect or inconsistent condom use.Objectives Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents' reports of condom use and predict subsequent pregnancy.Methods The sample comprised 715 sexually active African-American female adolescents, ages 15-21 years. At baseline, 6 months and 12 months, participants completed a 40-min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted pregnancy from semen exposure under-report using multivariate regression controlling for oral contraception, reported condom use and coital frequency.The impact of alcohol use on HIV/STI intervention efficacy in predicting sexually transmitted infections among young African-American women
AbstractSeth, P., Wingood, G. M., Robinson, L. S., & Diclemente, R. J. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
4Page(s)
747-751AbstractThe impact of alcohol use on the efficacy of an HIV/STI intervention designed for young African-American women in predicting STIs was examined. Eight hundred forty-eight African-American women, 18-29 years, were randomly assigned to either the HIV/STI intervention or a control condition. Participants were assessed on alcohol use and provided two vaginal swab specimens for STI testing. Women in the intervention who consumed alcohol were less likely to test STI-positive than women in the control and abstainers (AOR = 2.47, 95 % CI = 1.01-6.22). STI risk factors may vary across different populations. Further research on heavy drinking and HIV intervention efficacy is needed.The prevalence of undiagnosed HIV serodiscordance among male couples presenting for HIV testing
AbstractSullivan, P. S., Wall, K. M., O’Hara, B., Jones, J., Barnes, J., Diclemente, R., Hoff, C., Scales, L., Salazar, L. F., Sanchez, T., White, D., Wingood, G., Allen, S., & Stephenson, R. (n.d.).Publication year
2014Journal title
Archives of Sexual BehaviorVolume
43Issue
1Page(s)
173-180AbstractIn the United States, a substantial proportion of HIV transmissions among men who have sex with men (MSM) arise from main sex partners. Couples voluntary HIV testing and counseling (CHTC) is used in many parts of the world with male-female couples, but CHTC has historically not been available in the U.S. and few data exist about the extent of HIV serodiscordance among U.S. male couples. We tested partners in 95 Atlanta male couples (190 men) for HIV. Eligible men were in a relationship for ≥3 months and were not known to be HIV-positive. We calculated the prevalence of couples that were seroconcordant HIV-negative, seroconcordant HIV-positive, or HIV serodiscordant. We evaluated differences in the prevalence of HIV serodiscordance by several dyadic characteristics (e.g.; duration of relationship, sexual agreements, and history of anal intercourse in the relationship). Overall, among 190 men tested for HIV, 11 % (n = 20) were newly identified as HIV-positive. Among the 95 couples, 81 % (n = 77) were concordant HIV-negative, 17 % (n = 16) were HIV serodiscordant, and 2 % (n = 2) were concordant HIV-positive. Serodiscordance was not significantly associated with any evaluated dyadic characteristic. The prevalence of undiagnosed HIV serodiscordance among male couples in Atlanta is high. Offering testing to male couples may attract men with a high HIV seropositivity rate to utilize testing services. Based on the global evidence base for CHTC with heterosexual couples and the current evidence of substantial undiagnosed HIV serodiscordance among U.S. MSM, we recommend scale-up of CHTC services for MSM, with ongoing evaluation of acceptability and couples' serostatus outcomes.Time-varying risk behaviors among adolescents: Implications for enhancing the effectiveness of sexual risk reduction interventions
Coyle, K. K., & DiClemente, R. J. (n.d.).Publication year
2014Journal title
Journal of Adolescent HealthVolume
55Issue
4Page(s)
465-466Understanding racial HIV/STI disparities in black and white men who have sex with men: A multilevel approach
AbstractSullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A., Salazar, L. F., Frew, P., Wingood, G., DiClemente, R., Del Rio, C., Mulligan, M., & Sanchez, T. H. (n.d.).Publication year
2014Journal title
PloS oneVolume
9Issue
3AbstractBackground:The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework. Methods and Findings:From July 2010-Decemeber 2012, 803 men (454 black, 349 white) were recruited through venuebased and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.54.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/μL) than white (577 cells/μL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates. Conclusions:Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively.Will HIV vaccination reshape HIV risk behavior networks? A social network analysis of drug users' anticipated risk compensation
AbstractYoung, A. M., Halgin, D. S., DiClemente, R. J., Sterk, C. E., & Havens, J. R. (n.d.).Publication year
2014Journal title
PloS oneVolume
9Issue
7AbstractBackground: An HIV vaccine could substantially impact the epidemic. However, risk compensation (RC), or post-vaccination increase in risk behavior, could present a major challenge. The methodology used in previous studies of risk compensation has been almost exclusively individual-level in focus, and has not explored how increased risk behavior could affect the connectivity of risk networks. This study examined the impact of anticipated HIV vaccine-related RC on the structure of high-risk drug users' sexual and injection risk network. Methods: A sample of 433 rural drug users in the US provided data on their risk relationships (i.e., those involving recent unprotected sex and/or injection equipment sharing). Dyad-specific data were collected on likelihood of increasing/ initiating risk behavior if they, their partner, or they and their partner received an HIV vaccine. Using these data and social network analysis, a "post-vaccination network" was constructed and compared to the current network on measures relevant to HIV transmission, including network size, cohesiveness (e.g., diameter, component structure, density), and centrality. Results: Participants reported 488 risk relationships. Few reported an intention to decrease condom use or increase equipment sharing (4% and 1%, respectively). RC intent was reported in 30 existing risk relationships and vaccination was anticipated to elicit the formation of five new relationships. RC resulted in a 5% increase in risk network size (n = 142 to n = 149) and a significant increase in network density. The initiation of risk relationships resulted in the connection of otherwise disconnected network components, with the largest doubling in size from five to ten. Conclusions: This study demonstrates a new methodological approach to studying RC and reveals that behavior change following HIV vaccination could potentially impact risk network connectivity. These data will be valuable in parameterizing future network models that can determine if network-level change precipitated by RC would appreciably impact the vaccine's population-level effectiveness.'But I'm not like that': Young men's navigation of normative masculinities in a marginalised urban community in Paraguay
AbstractFleming, P. J., Andes, K. L., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Culture, Health and SexualityVolume
15Issue
6Page(s)
652-666AbstractYoung men often define themselves and their masculine identity through romantic and sexual relationships, and their resulting sexual decisions can affect their successful transition into adulthood, as well as STI, HIV and pregnancy rates. This paper looks at how young Paraguayan men's peer groups, family and masculine identity formation influence their behaviours in sexual and romantic relationships. In Asunción, Paraguay, we conducted five focus-group discussions (FGDs) examining neighbourhood norms in 2010, with male peer groups ranging in age from 14 to 19 years. We then interviewed half the members from each peer group to examine their relationships with friends, family and young women and their beliefs about existing gender norms. Young men described two types of masculine norms, 'partner/provider' and macho, and two types of romantic relationships, 'casual' and 'formal'. The language used to describe each spectrum of behaviours was often concordant and highlights the connection between masculine norms and romantic relationships. The perceived norms for the neighbourhood were more macho than the young men's reported behaviours. Norms cannot change unless young men speak out about their non-normative behaviours. This provides evidence for more research on the formation, meaning and transformation of male gender norms.A longitudinal examination of risk and protective factors associated with drug use and unsafe sex among young African American females
AbstractVoisin, D. R., Hotton, A. L., Tan, K., & DiClemente, R. (n.d.).Publication year
2013Journal title
Children and Youth Services ReviewVolume
35Issue
9Page(s)
1440-1446AbstractThis study prospectively examined associations among multiple theoretically informed risk (e.g., depression, sexual sensation seeking, and risky peers norms) and protective factors (e.g., social support, STI knowledge, and refusal to have sex self efficacy) on unsafe sex among 715 African American adolescent females aged 15-21 who participated in an STI/HIV prevention intervention. Generalized estimating equation models were used to assess associations between baseline characteristics and sexual risk over a 12-month follow-up period. Overall risk in this population was high: at baseline, nearly a third of women reported sex under the influence of alcohol or substances; ≥ 2 partners for vaginal sex, and casual sex partners in the 60. days prior to baseline, and nearly 75% of those reporting vaginal sex used condoms inconsistently. In multivariable analysis, when risk and protective factors were simultaneously considered, higher levels of sexual sensation seeking were associated with having multiple sex partners and inconsistent condom use. Greater perception of risky peer norms was associated with a higher risk of having sex under the influence of alcohol or drugs. In addition, higher sex refusal self-efficacy was protective against having multiple; casual; and concurrent sex partners. Incorporating these salient factors into prevention programs may be critical to the development of targeted interventions for this population.