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
Feasibility, acceptability, and short-term impact of a brief sexually transmitted infection intervention targeting U.S. Military personnel and family members
AbstractKunz, A., Moodley, A., Colby, D. J., Soltis, M., Robb-McGrath, W., Fairchok, A., Faestel, P., Jungels, A., Bender, A. A., Kamau, E., Wingood, G., DiClemente, R., & Scott, P. T. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1AbstractBackground: Over the past 10 years, incidence of sexually transmitted infections (STIs) has increased to record numbers in the United States, with the most significant increases observed among adolescents and young adults. The US military, where the majority of active duty personnel are 18–30 years old, has seen similar increases. However, the US military does not yet have a standardized, service-wide program for STI education and prevention. Methods: The KISS intervention (Knocking out Infections through Safer-sex and Screening) was adapted from an evidence-based intervention endorsed by the US Centers for Disease Control and Prevention and consisted of a one-time, small group session. Content included STI/HIV knowledge and prevention, condom use skills, and interpersonal communication techniques. The intervention was pilot tested for feasibility and acceptability among a population of service members and medical beneficiaries at Joint Base Lewis-McChord in Washington state. Results: A total of 79 participants aged 18–30 years were consented to participate in the pilot study and met entry criteria, 66/79 (82.5%) attended the intervention session, and 46/66 (69.7%) returned at 3 months for the final follow-up assessment. The intervention sessions included 31 male (47.0%) and 35 female (53.0%) participants. Almost all participants felt comfortable discussing sexual issues in the group sessions, reported that they intended to practice safer sex after the intervention, and would also recommend the intervention to friends. Knowledge about STI/HIV prevention significantly increased after the intervention, and intervention effects were maintained at 3 months. About one-fifth of participants tested positive for N. gonorrhea or C. trachomatis infection at enrollment, while none had recurrent STIs at the final visit. Use of both male and female condoms increased after the intervention. Conclusions: The KISS intervention was feasible to implement in the military setting and was acceptable to the active duty service members and other medical beneficiaries who participated in the pilot project. Further studies are needed to determine if the KISS intervention, or others, effectively decrease STI incidence in active duty personnel and would be appropriate for more widespread implementation. Trial Registration: Retrospectively registered as the pilot phase of clinicaltrials.gov NCT04547413, “Prospective Cohort Trial to Assess Acceptability and Efficacy of an Adapted STI/HIV Intervention Behavioral Intervention Program in a Population of US Army Personnel and Their Medical Beneficiaries—Execution Phase”.Focusing national institutes of health HIV/AIDS research for maximum population impact
AbstractWalensky, R. P., Carpenter, C. J., Auerbach, J. D., Agosto-Rosario, M., Averitt, D., Bartlett, J. G., Curran, J. W., DiClemente, R., El-Sadr, W., Haase, A., Hillier, S., Holmes, K. K., & Volberding, P. A. (n.d.).Publication year
2015Journal title
Clinical Infectious DiseasesVolume
60Issue
6Page(s)
937-940AbstractProgress in advancing research on the pathophysiology, prevention, treatment, and impact of human immunodeficiency virus (HIV) is threatened by the decaying purchasing power of National Institutes of Health (NIH) dollars. A working group of the NIH Office of AIDS Research Advisory Council was charged by the NIH Director with developing a focused and concise blueprint to guide the use of limited funding over the next few years. Science priorities outlined by the working group and reported here are intended to maximally address individuals, groups, and settings most affected by the epidemic, and to redress shortcomings in realizing population- level HIV prevention, treatment, and eradication goals. Optimizing these priorities requires that traditional silos-defined by topic focus and by scientific discipline-be dissolved and that structural issues affecting the pipeline of new investigators and the ability of the Office of AIDS Research to fulfill its role of steward of the NIH HIV/AIDS research program be directly addressed.Food insecurity among households with children during the COVID-19 pandemic : results from a study among social media users across the United States
AbstractParekh, N., Ali, S. H., O’Connor, J., Tozan, Y., Jones, A. M., Capasso, A., Foreman, J., & DiClemente, R. (n.d.).Publication year
2021Journal title
Nutrition JournalVolume
20Issue
1AbstractBackground: In the United States, approximately 11% of households were food insecure prior to the COVID-19 pandemic. The present study aims to describe the prevalence of food insecurity among adults and households with children living in the United States during the pandemic. Methods: This study utilized social media as a recruitment platform to administer an original online survey on demographics and COVID-related food insecurity. The survey was disseminated through an advertisement campaign on Facebook and affiliated platforms. Food insecurity was assessed with a validated six-item United States Department of Agriculture (USDA) Household Food Security Survey Module, which was used to create a six-point numerical food security score, where a higher score indicates lower food security. Individual-level participant demographic information was also collected. Logistic regressions (low/very-low compared with high/marginal food security) were performed to generate adjusted odds ratios (AOR) and 95%CIs for food insecurity and select demographic characteristics. Results: Advertisements reached 250,701 individuals and resulted in 5,606 complete surveys. Overall, 14.7% of participants self-identified as having low or very low food security in their households, with higher prevalence (17.5%) among households with children. Unemployment (AOR:1.76, 95%CI:1.09–2.80), high school or lower education (AOR:2.25, 95%CI:1.29–3.90), and low income (AOR[$30,000-$50,000]:5.87, 95%CI:3.35–10.37; AOR[< $30,000]:10.61, 95%CI:5.50–20.80) were associated with higher odds of food insecurity in multivariable models among households with children (and the whole sample). Conclusions: These data indicate exacerbation of food insecurity during the pandemic. The study will be instrumental in guiding additional research and time-sensitive interventions targeted towards vulnerable food insecure subgroups.Frequency of alcohol use and its association with STD/HIV-related risk practices, attitudes and knowledge among an African-American community-recruited sample
AbstractMorrison, T. C., DiClemente, R., Wingood, G. M., & Collins, C. (n.d.).Publication year
1998Journal title
International Journal of STD and AIDSVolume
9Issue
10Page(s)
608-612AbstractThe aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an African-American community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol (n = 201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age = 37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use self-efficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices.Frequency of sex after an intervention to decrease sexual risk-taking among African-American adolescent girls : Results of a randomized, controlled clinical trial
AbstractMilhausen, R. R., DiClemente, R., Lang, D. L., Spitalnick, J. S., Sales, J. M., & Hardin, J. W. (n.d.).Publication year
2008Journal title
Sex EducationVolume
8Issue
1Page(s)
47-57AbstractMany controversies surround sex education in the United States. One particular issue of contention is whether comprehensive sexuality education increases frequency of sexual intercourse among program participants. The current investigation examined frequency of vaginal sexual intercourse in a sample of 522 sexually experienced African-American adolescent females between the ages of 14 and 18 (mean = 16.0 years, standard deviation = 1.22). Participants were a part of a randomized, controlled trial evaluating the efficacy of a comprehensive sexuality education intervention. Data collection occurred at baseline and at 6-month and 12-month follow-up. Participants were recruited from four community health agencies in the Birmingham, Alabama area. Results indicate no significant differences in the frequency of sex between the HIV intervention group and the general health-promotion comparison group at any time point: baseline to 6-month assessment, 6-month to 12-month assessment, or over the entire 12-month follow-up period. These findings reiterate the value of hierarchical messages in sex education curricula that inform adolescents that abstinence is the most effective way to prevent sexually transmitted disease infection, while encouraging adolescents who choose to have sex to use condoms correctly and consistently, and teaching them the skills to do so.Future directions for HIV prevention research : Charting a prevention science research agenda
AbstractDiClemente, R., Wingood, G. M., Blank, M. B., & Metzger, D. S. (n.d.).Publication year
2008Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
47Issue
SUPPL. 1Page(s)
S47-S48Abstract~Gang involvement and the health of African American female adolescents.
AbstractWingood, G. M., DiClemente, R., Crosby, R., Harrington, K., Davies, S. L., & Hook, E. W. (n.d.).Publication year
2002Journal title
PediatricsVolume
110Issue
5Page(s)
e57AbstractOBJECTIVE: To examine the association between gang involvement and female adolescents' health. METHODS: African American adolescent females (N = 522) completed a survey that assessed their history of gang involvement and health behaviors and provided specimens that were analyzed for marijuana use and sexually transmitted diseases. RESULTS: In logistic regression analyses, adolescents with a history of gang involvement were more likely to have been expelled from school (odds ratio [OR]: 3.6), be a binge drinker (OR: 3.3), have a positive toxicologic test for marijuana (OR: 2.6), have been in 3 or more fights in the past 6 months (OR: 3.8), have a nonmonogamous partner (OR: 2.4), and test positive for Trichomonas vaginalis (OR: 2.2) and Neisseria gonorrhoeae (OR: 3.6). CONCLUSION: This study extends the current research on risk behaviors associated with gang involvement to include biological markers for substance use and sexual health outcomes, namely, marijuana use and sexually transmitted diseases.Gang Norms and Risky Sex Among Adolescents With a History of Detention
AbstractKing, K. M., Voisin, D. R., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Social Service ResearchVolume
39Issue
4Page(s)
545-551AbstractPrior studies have examined whether or not belonging to a gang was associated with risky sexual behaviors. However, the literature has yet to explore whether it is not just gang membership but gang norms that are associated with risky sex, which was the primary aim of this study. Audio computer-assisted self-interviewing technology was used to collect data from a convenience sample of 136 adolescent detainees who reported gang involvement. Demographics, gang norms, and risky sexual behaviors occurring in the 2 months prior to being detained were assessed. Multiple logistic regression models controlling for demographics documented that adolescents who reported high-risk gang norms were significantly more likely to: have sex while high on drugs, have sex with a partner who was high on drugs, have group sex, and report condom breakage or leakage during a sexual encounter, compared with those with low-risk gang norms. Results suggest that the norms present within gangs infer added sexual risks. Future research should assess how risk norms differ across various gangs. Sexually transmitted infection prevention approaches should target youth who belong to gangs that promote risky norms given that conventions exist on a continuum.Gardasil for guys : Correlates of intent to be vaccinated
AbstractCrosby, R. A., DiClemente, R., Salazar, L. F., Nash, R., & Younge, S. (n.d.).Publication year
2011Journal title
Journal of Men's HealthVolume
8Issue
2Page(s)
119-125AbstractBackground: The lack of post Food and Drug Administration (FDA)-approval acceptance studies among males aged 18-26 years is problematic relative to the design of human papillomavirus (HPV) vaccine promotion programs designed to target males. Accordingly this study identified correlates of intention to receive the HPV vaccine among young men. Methods: Young men (n= 150) were recruited from two university campuses in the southern United States. Men completed an audio computer-assisted self administered interview assessing their beliefs, attitudes, and intent to receive the vaccine, newly approved for males. Bivariate associations between various measures and men's intent to be vaccinated in the next 12 months were assessed using t-tests. Measures achieving bivariate significance were entered into a regression model. Results: In the regression model, those reporting oral-genital sex were more likely to have positive intent (β = 0.32, t= 4.20, P= 0.0001). Those classified as having a relatively higher perceived susceptibility to HPV were more likely to have positive intent (β = 0.19, t= 2.53, P= 0.013). Finally, intent was associated with agreement/disagreement to the statement that " the HPV vaccine is so new that I should wait awhile before deciding about getting vaccinated" (β = 0.19, t= 2.49, P= 0.014). Those not agreeing were more likely to have positive intent. Conclusion: Young men who have had oral-genital sex and those with greater perceptions of susceptibility to HPV may have greater intent to receive the HPV vaccine. A barrier reducing their intention for vaccination may be the relatively new introduction of this vaccine to the male population.Gender based violence as a risk factor for HIV-associated risk behaviors among female sex workers in Armenia
AbstractLang, D. L., Salazar, L. F., DiClemente, R., & Markosyan, K. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
2Page(s)
551-558AbstractThis cross-sectional study identified the prevalence of gender based violence (GBV) and examined its association with sexual risk behavior among female sex workers (FSWs). Among 120 participants between ages 20 and 52, a total of 56.7 % reported lifetime GBV. Multivariate analyses revealed that GBV was significantly associated with inconsistent condom use, unprotected sex, condom misuse, fear of client reaction to requests of condom use, self-reported history of STIs, and earlier age of initiation of sex work. GBV must be considered an urgent public health priority among FSWs in Armenia. Interventions addressing FSWs, in addition to targeting skill-based, sexual risk reduction must also introduce a discourse among FSWs, sexual partners, clients and community members about the role of GBV in HIV-associated risk behaviors and infection. Structural level initiatives must address economic opportunities for women, health-sector policies and responses to FSWs' health needs, law enforcement training and societal norms toward women.Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment
AbstractSeth, P., Lang, D. L., DiClemente, R., Braxton, N. D., Crosby, R. A., Brown, L. K., Hadley, W., & Donenberg, G. R. (n.d.).Publication year
2012Journal title
Sexual HealthVolume
9Issue
3Page(s)
240-246AbstractBackground Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. Methods: Three hundred and seventy nine sexually active adolescents, aged 1318 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. Results: After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)≤3.2, P≤0.0001), obtain their HIV test results (AOR≤2.9, P≤0.03), refuse sex out of fear for STI acquisition (AOR≤1.7, P≤0.04), or avoid a situation that might lead to sex (AOR≤2.4, P≤0.001), and were less likely to have a casual sex partner (AOR≤0.40, P≤0.002). Additionally, females were more likely to report inconsistent condom use (AOR≤2.60, P≤0.001) and have a STI (AOR≤9.1, P≤0.0001) than their male counterparts. Conclusions: Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.Gender-related correlates and predictors of consistent condom use among young adult African-American women : A prospective analysis
AbstractDiClemente, R., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
1998Journal title
International Journal of STD and AIDSVolume
9Issue
3Page(s)
139-145AbstractThe present study examined the correlates of consistent condom use among African-American women and prospectively evaluated the stability of these significant variables to predict consistent condom use at 3-month follow-up. A sample of 128 African-American women, 18-29 years of age completed a baseline interview and 3 months later completed a similar follow-up interview (n = 100). Compared to women who were inconsistent condom users, women who were consistent condom users were more likely to: have high assertive communication skills (OR = 13), desire not becoming pregnant (OR = 8.6), have high sexual self-control over condom use (OR = 7.6), perceive having control over their partners' use of condoms (OR = 6.6), be younger (OR = 5.8), and report having a partner that was not committed to the relationship (OR = 3.3). Prospective analyses identified baseline level of condom use as the best predictor of condom use at 3-month follow-up. Women who were consistent condom users at baseline were 6.3 times as likely to be consistent condom users at 3-month follow-up. In conclusion, HIV prevention programmes for women need to be gender specific and need to be implemented before high-risk behaviours are established and may be more difficult to modify.Genetic sensitivity to emotional cues, racial discrimination and depressive symptoms among African–American adolescent females
AbstractSales, J. M., Brown, J. L., Swartzendruber, A. L., Smearman, E. L., Brody, G. H., & DiClemente, R. (n.d.).Publication year
2015Journal title
Frontiers in PsychologyVolume
6AbstractPsychosocial stress, including stress resulting from racial discrimination (RD), has been associated with elevated depressive symptoms. However, individuals vary in their reactivity to stress, with some variability resulting from genetic differences. Specifically, genetic variation within the linked promoter region of the serotonin transporter gene (5-HTTLPR) is related to heightened reactivity to emotional environmental cues. Likewise, variations within this region may interact with stressful life events (e.g., discrimination) to influence depressive symptoms, but this has not been empirically examined in prior studies. The objective of this study was to examine whether variation in the 5-HTTLPR gene interacts with RD to predict depressive symptoms among a sample of African–American adolescent females. Participants were 304 African–American adolescent females enrolled in a sexually transmitted disease prevention trial. Participants completed a baseline survey assessing psychosocial factors including RD (low vs. high) and depressive symptomatology (low vs. high) and provided a saliva sample for genotyping the risk polymorphism 5-HTTLPR (s allele present vs. not present). In a logistic regression model adjusting for psychosocial correlates of depressive symptoms, an interaction between RD and 5-HTTLPR group was significantly associated with depressive symptomatology (AOR = 3.79, 95% CI: 1.20–11.98, p = 0.02). Follow-up tests found that high RD was significantly associated with greater odds of high depressive symptoms only for participants with the s allele. RD and 5-HTTLPR status interact to differentially impact depressive symptoms among African–American adolescent females. Efforts to decrease depression among minority youth should include interventions which address RD and strengthen factors (e.g., coping, emotion regulation, building support systems) which protect youth from the psychological costs of discrimination.Health care service use and sexual communication : Past experience and future intention of high-risk male adolescents
AbstractRoberts, J., Boker, J. R., Oh, M. K., & DiClemente, R. (n.d.).Publication year
2000Journal title
Journal of Adolescent HealthVolume
27Issue
5Page(s)
298-301AbstractHigh-risk male adolescents were surveyed to collect data to be used to develop strategies to enhance communication with their partners about sexually transmitted diseases (STDs). Participants were concerned about acquiring an STD from their partner, and reported an increased likelihood of communicating about STD-related issues when confidential health care was available. Copyright (C) 2000 Society for Adolescent Medicine.Health promotion strategies for prevention of human immunodeficiency virus infection among minority adolescents
AbstractDiClemente, R., & Houston-Hamilton, A. (n.d.).Publication year
1989Journal title
Health EducationVolume
20Issue
5Page(s)
39-43Abstract~Health Risk Behavior Among Justice Involved Male and Female Youth : Exploratory, Multi-Group Latent Class Analysis
AbstractDembo, R., Faber, J., Cristiano, J., DiClemente, R., Krupa, J. M., Terminello, A., & Wareham, J. (n.d.).Publication year
2017Journal title
Substance Use and MisuseVolume
52Issue
13Page(s)
1751-1764AbstractBackground: Youth involved in the juvenile justice system experience a disproportionate prevalence of serious mental health issues, substance abuse, and are at an increased risk of engaging in risky sexual practices. Gender differences exist, with girls at a markedly greater risk of acquiring a sexually transmitted disease. Objectives: The present study seeks to determine if there are subgroups of male and female youth who differ in their health risk behavior. If so, do any male or female subgroups at different levels of health risk differ in regard to their sociodemographic and psychological factors, and finally, what are intervention/service delivery implications of these differences. Methods: Youth were participants in an innovative health service at a centralized intake facility located in a large southeastern U.S. city. Latent class analysis and multinomial logistic regression is utilized to examine the heterogeneity of health risk behaviors across gender groups in a sample of 777 newly arrested youth. Results: Results indicate a three class solution provided the optimal fit with the data for each gender group: a Lower Health Risk group, a Higher Health Risk group, and a Highest Health Risk group. Multinomial logistic regression analysis identified significant sociodemographic and depression effects among both male and female youth. Conclusions/Importance: Youth characterized by risky sexually behavior, elevated depression, and drug involvement should be the focus of integrated intervention services. This study documents the critical need for front end, juvenile justice intake facilities to provide behavioral and public health screening, with treatment follow-up, on newly arrested youth.Health risk factors among detained adolescent females
AbstractCrosby, R., Salazar, L. F., DiClemente, R., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (n.d.).Publication year
2004Journal title
American journal of preventive medicineVolume
27Issue
5Page(s)
404-410AbstractTo identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities. Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted. Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (pHeavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV : A Multilevel Analysis
AbstractCapasso, A., Brown, J. L., Safonova, P., Belyakov, N., Rassokhin, V., & DiClemente, R. (n.d.).Publication year
2021Journal title
AIDS and BehaviorVolume
25Issue
11Page(s)
3734-3742AbstractAlcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18–35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = − 81, − 2; z = − 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.Hepatitis B vaccination in a high risk MSM population : The need for vaccine education [4]
AbstractDiClemente, R., Rhodes, S. D., DiClemente, R. J., Yee, L. J., & Hergenrather, K. C. (n.d.).Publication year
2000Journal title
Sexually transmitted infectionsVolume
76Issue
5Page(s)
408-409Abstract~Heterogeneity of Sexual Risk Profiles Among Juvenile Justice-Involved African American Girls
AbstractLogan-Greene, P., Bascug, E. W., DiClemente, R., & Voisin, D. R. (n.d.).Publication year
2021Journal title
Child and Youth Care ForumVolume
50Issue
4Page(s)
653-677AbstractBackground: Juvenile justice-involved African American girls are considered uniformly high-risk for adverse sexual health outcomes such as sexually transmitted infections (STIs) and pregnancy; however, their sexual health statuses may be more complex. Objective: The present study assessed whether diverse subgroups of sexual risk exist and explored variations by socio-contextual indicators and sexual health outcomes. Method: The sample consisted of 188 detained African American adolescent girls. Six key sexual risk model indicators were selected for latent class analysis: early sex initiation, unprotected sex, high number of sex partners, sex while intoxicated, having sex with a recently incarcerated partner, and trading sex. Results: Results revealed a four-class solution: “Lowest Risk” (40.3%), with relatively low endorsement of sexual risk items; “Precocious Debut” (19.5%), with early sexual initiation and highest number of sex partners; “Delayed Risk” (30.3%), with later sexual debut but elevated unprotected sex and number of sex partners; and “Highest Risk” (9.9%), with the highest proportions on most indicators, but lower numbers of sex partners compared to Precocious Debut. Classes differed significantly on sexual health outcomes and demographic, neighborhood, peer, family, and individual factors. High Risk, Precocious Debut, and Delayed Risk were associated with greater prevalence of STIs. Lowest Risk and Precocious Debut classes had fewer prior pregnancies. Lowest Risk girls were significantly lower on a range of risk outcomes. Conclusions: Heterogeneous profiles of sexual risk may inform future prevention and interventions for at-risk or detained African American girls.High prevalence of asymptomatic STDs in incarcerated minority male youth : A case for screening
AbstractPack, R. P., DiClemente, R., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2000Journal title
Sexually Transmitted DiseasesVolume
27Issue
3Page(s)
175-177AbstractBackground and Objectives: To assess STD prevalence among a sample of incarcerated minority male youth in a southern US city. Methods: A consecutive entrant, cross-sectional study of 284 minority males 14 to 18 years was performed. All adolescents were screened for gonorrhea and chlamydia using ligase chain reaction tests. Results: Eighteen percent of youth were identified as having either gonorrhea, chlamydia, or both. Approximately 84% of those with sexually transmitted diseases (STDs) self- reported having no symptoms. Failure to use condoms in the past month was significantly associated with a positive test result for STDs (odds ratio = 1.9, 95% CI = 1.1-3.3). Conclusions: The findings indicate an urgent need for routine STD screening and STD-prevention programs for adolescent males in detention facilities. A study of 284 detained black male adolescents revealed 18% prevalence of gonorrhea, chlamydia, or both. Approximately 84% of those with sexually transmitted diseases self-reported not having symptoms.HIV and symptoms of depression are independently associated with impaired glucocorticoid signaling
AbstractBekhbat, M., Mehta, C. C., Kelly, S. D., Vester, A., Ofotokun, I., Felger, J., Wingood, G., Anastos, K., Gustafson, D. R., Kassaye, S., Milam, J., Aouizerat, B., Weber, K., Golub, E. T., Moore, M. F., DiClemente, R., Fischl, M., Kempf, M. C., Maki, P., & Neigh, G. N. (n.d.).Publication year
2018Journal title
PsychoneuroendocrinologyVolume
96Page(s)
118-125AbstractChronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.HIV discrimination and the health of women living with HIV
AbstractWingood, G. M., DiClemente, R., Mikhail, I., McCree, D. H., Davies, S. L., Hardin, J. W., Harris Peterson, S., Hook, E. W., & Saag, M. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2-3Page(s)
99-112AbstractWomen living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/ AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.HIV knowledge and behaviors of incarcerated youth : A comparison of high and low risk locales
AbstractLanier, M. M., DiClemente, R., & Horan, P. F. (n.d.).Publication year
1991Journal title
Journal of Criminal JusticeVolume
19Issue
3Page(s)
257-262AbstractIncarcerated adolescents comprise a group at high risk of HIV infection because they engage in substantially more HIV-related sexual and drug behaviors than the general adolescent population. There is, however, little information on similarities and differences between adolescents incarcerated in high AIDS-prevalence geographic areas with those from low AIDS-prevalence areas. This study compared adolescents incarcerated in juvenile detention facilities in San Francisco (N = 113) and Alabama (N = 393) with respect to HIV-related knowledge, attitudes, and risk behaviors. While findings indicated that the two groups' overall knowledge levels were relatively similar, adolescents in San Francisco reported a higher prevalence of risk behaviors. These findings are discussed in terms of the development and implementation of HIV prevention programs specifically targeted toward incarcerated youths and stressing adoption of realistic risk-reduction strategies.HIV knowledge and its contribution to sexual health behaviors of low-income African American adolescents
AbstractSwenson, R. R., Rizzo, C. J., Brown, L. K., Vanable, P. A., Carey, M. P., Valois, R. F., DiClemente, R., & Romer, D. (n.d.).Publication year
2010Journal title
Journal of the National Medical AssociationVolume
102Issue
12Page(s)
1173-1182AbstractObjectives: Although many factors contribute to racial disparities in human immunodeficiency virus (HIV)/AIDS among young African Americans, knowledge is a particularly modifiable factor. However, little information has been published about the current HIV knowledge of African American teens or to what extent knowledge independently contributes to their sexual behavior and health. This study aimed to describe the level of knowledge among this at-risk population and determine whether knowledge contributes to variance in sexual behavior and health beyond that of sociodemographic and psychological factors. Methods: African American adolescents (n = 1658) were recruited in 2 northeastern and 2 southeastern US cities (74% eligible for free or reduced-price school lunch). Analyses utilized data gathered from adolescents using an audio computer-assisted self-interview program. Results: On average, participants answered only 50% of HIV knowledge items correctly and were least accurate concerning effective condom use and HIV testing. Controlling for associated sociodemographic and psychological factors, greater knowledge was associated with sexual experience and, among experienced adolescents, with sexually transmitted infection/HIV testing and - unexpectedly - less condom use. Conclusions: HIV knowledge, which is modifiable, is limited among at-risk African American adolescents and is an important contributor to sexual behavior and health. Findings indicate a need for more comprehensive HIV/AIDS education, particularly with regard to condom use and the benefits of routine sexually transmitted infection/HIV testing. Although knowledge might not be sufficiently protective in and of itself, having accurate information about HIV may benefit sexual health by impacting health-promoting attitudes necessary for successful engagement in health care-seeking behavior.