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
The Relationship Between Male Gang Involvement and Psychosocial Risks for their Female Juvenile Justice Partners with Non-gang Involvement Histories
AbstractKing, K. M., Voisin, D. R., & DiClemente, R. (n.d.).Publication year
2015Journal title
Journal of Child and Family StudiesVolume
24Issue
9Page(s)
2555-2559AbstractThis article examines whether adolescent females involved in the juvenile justice system, who were never gang members but have had boyfriends who were gang members, are at higher risk for negative psychological, relationship and sexual risk outcomes compared to their counterparts. Data were collected from a convenience sample of African American adolescent females involved in the juvenile justice system, age 13–17, currently incarcerated in a short-term detention facility in Georgia (N = 137). Multiple logistic regression models controlling for age and SES documented that having a gang-involved boyfriend was associated with a greater risk for emotional and physical abuse, depression, PTSD, drug use, diminished perceived life chances and a variety of sexual risk predictors, such as decreased relationship control, partner infidelity, shorter time to sex with a casual sexual partner and reduced likelihood of HIV testing. These findings suggest that these women should be included in early prevention and intervention initiatives traditionally targeted at youth involved in gangs.Use of Dual Methods for Protection from Unintended Pregnancy and Sexually Transmitted Diseases in Adolescent African American Women
AbstractKottke, M., Whiteman, M. K., Kraft, J. M., Goedken, P., Wiener, J., Kourtis, A. P., & DiClemente, R. (n.d.).Publication year
2015Journal title
Journal of Pediatric and Adolescent GynecologyVolume
28Issue
6Page(s)
543-548AbstractStudy Objective: To characterize factors associated with dual method contraceptive use in a sample of adolescent women. Design, Setting, Participants, Interventions, and Main Outcome Measures: We conducted a cross-sectional survey of sexually active African American women aged 14-19 years who attended an urban Title X clinic in Georgia in 2012 (N = 350). Participants completed a computerized survey to assess contraceptive and condom use during the past 2 sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device and a condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (vs use of no methods or less effective methods alone; eg, withdrawal) and select characteristics. Results: Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.26-4.18), negative attitude toward pregnancy (aOR, 2.25; 95% CI, 1.19-4.28), and a mother who gave birth as a teen (aOR, 2.34; 95% CI, 1.21-4.52) were associated with higher odds of dual method use. Having no health insurance (aOR, 0.39; 95% CI, 0.18-0.82), 4 or more lifetime sexual partners (aOR, 0.42; 95% CI, 0.22-0.78), sex at least weekly (aOR, 0.54; 95% CI, 0.29-0.99), and agreeing to monogamy with the most recent partner (aOR, 0.40; 95% CI, 0.16-0.96) were associated with decreased odds of dual method use. Conclusion: Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.Validation of the Sexual Communication Self-Efficacy Scale
AbstractQuinn-Nilas, C., Milhausen, R. R., Breuer, R., Bailey, J., Pavlou, M., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2015Journal title
Health Education and BehaviorVolume
43Issue
2Page(s)
165-171AbstractThis study assessed a newly developed Sexual Communication Self-Efficacy Scale designed to measure the sexual communication self-efficacy of adolescent men and women. Three-hundred and seventy-four U.K. adolescents completed this new scale, along with several other validity measures. Factor analysis revealed that the Sexual Communication Self-Efficacy Scale consisted of five underlying factors: contraception communication, positive sexual messages, negative sexual messages, sexual history, and condom negotiation. These factors demonstrated high internal consistency and presents evidence to support construct validity. This scale may have utility in assessing the effectiveness of interventions designed to enhance sexual communication and sexual health behaviors among young people.Acceptability of condoms, circumcision and PrEP among young black men who have sex with men : A descriptive study based on effectiveness and cost
AbstractCrosby, R. A., Geter, A., DiClemente, R., & Salazar, L. F. (n.d.).Publication year
2014Journal title
VaccinesVolume
2Issue
1Page(s)
129-137AbstractThe current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States : An application of the ADAPT-ITT framework
AbstractSullivan, P. S., Stephenson, R., Grazter, B., Wingood, G., DiClemente, R., Allen, S., Hoff, C., Salazar, L., Scales, L., Montgomery, J., Schwartz, A., Barnes, J., & Grabbe, K. (n.d.).Publication year
2014Journal title
SpringerPlusVolume
3Issue
1Page(s)
1-13AbstractTo respond to the need for new HIV prevention services for men who have sex with men (MSM) in the United States, and to respond to new data on the key role of main partnerships in US MSM epidemics, we sought to develop a new service for joint HIV testing of male couples. We used the ADAPT-ITT framework to guide our work. From May 2009 to July 2013, a multiphase process was undertaken to identify an appropriate service as the basis for adaptation, collect data to inform the adaptation, adapt the testing service, develop training materials, test the adapted service, and scale up and evaluate the initial version of the service. We chose to base our adaptation on an African couples HIV testing service that was developed in the 1980s and has been widely disseminated in low- and middle-income countries. Our adaptation was informed by qualitative data collections from MSM and HIV counselors, multiple online surveys of MSM, information gathering from key stakeholders, and theater testing of the adapted service with MSM and HIV counselors. Results of initial testing indicate that the adapted service is highly acceptable to MSM and to HIV counselors, that there are no evident harms (e.g., intimate partner violence, relationship dissolution) associated with the service, and that the service identifies a substantial number of HIV serodiscordant male couples. The story of the development and scale-up of the adapted service illustrates how multiple public and foundation funding sources can collaborate to bring a prevention adaptation from concept to public health application, touching on research, program evaluation, implementation science, and public health program delivery. The result of this process is an adapted couples HIV testing approach, with training materials and handoff from academic partners to public health for assessment of effectiveness and consideration of the potential benefits of implementation; further work is needed to optimally adapt the African couples testing service for use with male-female couples in the United States.Added benefits : reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention
AbstractBrown, J. L., Sales, J. M., Swartzendruber, A. L., Eriksen, M. D., DiClemente, R., & Rose, E. S. (n.d.).Publication year
2014Journal title
Journal of Behavioral MedicineVolume
37Issue
5Page(s)
912-920AbstractAdolescents experience elevated depressive symptoms which health promotion interventions may reduce. This study investigated whether HIV prevention trial participation decreased depressive symptoms among African-American female adolescents. Adolescents (N = 701; M age = 17.6) first received a group-delivered HIV prevention intervention and then either 12 sexual health (intervention condition) or 12 general health (comparison condition) phone counseling contacts over 24 months. ACASI assessments were conducted at baseline, and at 6-, 12-, 18-, and 24-months post-baseline. Linear generalized estimating equations were used to detect percent relative change in depressive symptoms. Participants reported a 2.7 % decrease in depressive symptoms (p = 0.001) at each assessment. Intervention participants endorsed an additional 3.6 % decrease in depressive symptoms (p = 0.058). Trial participation was associated with reduced depressive symptomatology, particularly among those receiving personalized sexual health counseling. HIV prevention interventions may benefit from incorporating additional content to address adolescents’ mental health needs.Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment
AbstractHadley, W., Barker, D. H., Lescano, C. M., Stewart, A. J., Affleck, K., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2014Journal title
Journal of HIV/AIDS and Social ServicesVolume
13Issue
2Page(s)
198-213AbstractThe authors' aims were to assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment. Adolescents (N = 893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy, and condom use intentions. Two structural equation models were used to test the study hypotheses: one for sexually active youth and one for nonactive youth. For nonactive youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use. These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes but depend on previous sexual experience.Combination HIV Prevention Interventions : The Potential of Integrated Behavioral and Biomedical Approaches
AbstractBrown, J. L., Sales, J. M., & DiClemente, R. (n.d.).Publication year
2014Journal title
Current HIV/AIDS ReportsVolume
11Issue
4Page(s)
363-375AbstractCombination HIV prevention interventions that integrate efficacious behavioral and biomedical strategies offer the potential to reduce new HIV infections. We overview the efficacy data for three biomedical HIV prevention approaches, namely microbicides, pre-exposure prophylaxis (PrEP), and HIV vaccination; review factors associated with differential acceptability and uptake of these methods; and suggest strategies to optimize the effectiveness and dissemination of combination HIV prevention approaches. A narrative review was conducted highlighting key efficacy data for microbicides, PrEP, and an HIV vaccination and summarizing acceptability data for each of the three biomedical HIV prevention approaches. Recommendations for the integration and dissemination of combined behavioral and biomedical HIV prevention approaches are provided. To date, microbicides and an HIV vaccination have demonstrated limited efficacy for the prevention of HIV. However, PrEP has demonstrated efficacy in reducing HIV incident infections. A diverse array of factors influences both hypothetical willingness and actual usage of each biomedical prevention method. Strategies to effectively integrate and evaluate combination HIV prevention interventions are urgently needed.Correlates of gang involvement and health-related factors among African American females with a detention history
AbstractVoisin, D. R., King, K. M., DiClemente, R., & Carry, M. (n.d.).Publication year
2014Journal title
Children and Youth Services ReviewVolume
44Page(s)
120-125AbstractBackground: Prior studies have assessed relationships between gang membership and health-related factors. However, the existing literature has largely failed to consider how individual and broader social contextual factors might be related to such gang involvement among African American females. Thus, the aim of the present study was to identify empirically driven correlates of gang involvement and then better understand the relationship between gang membership and health-related behaviors for African American females, after controlling for covariates of gang involvement. Methods: Data were collected from a convenience sample of detained African American adolescents females, between the ages of 13-17, currently incarcerated in a short-term detention facility in Atlanta, Georgia (n= 188). After obtaining written informed assent and parental permission, participants answered survey questions using A-CASI procedures that assessed socio-contextual factors and health-related behaviors. Results: Multiple logistic regression models controlling for age and SES documented that low self-esteem, emotional dysregulation, trauma history, deviant peers, low parental monitoring, infrequent parental communication, housing instability and poor neighborhood quality were correlates of gang involvement. In addition, multiple linear and logistic regression models, controlling for these constructs, revealed that gang involvement was independently associated with lower STD prevention knowledge, a higher likelihood of having a gang-involved boyfriend, a greater risk of having current casual sexual partnerships, higher rates of substance abuse, higher incidences of condom misuse and a lower likelihood of ever having been tested for HIV. Conclusions: These results provide information that can help service providers target certain profiles of African American females who may be at risk for joining gangs and address the health risk behaviors that may be associated with such memberships.Correlates of incident trichomonas vaginalis infections among African American female adolescents
AbstractSwartzendruber, A., Sales, J. M., Brown, J. L., DiClemente, R., & Rose, E. S. (n.d.).Publication year
2014Journal title
Sexually Transmitted DiseasesVolume
41Issue
4Page(s)
240-245AbstractBACKGROUND: Trichomonas vaginalis is the most common curable sexually transmitted infection associated with adverse reproductive health and pregnancy outcomes and may amplify HIV transmission. The objective was to identify correlates of incident T. vaginalis infections among African American adolescent girls. METHODS: Data were collected via audio computer-assisted self-interviews at baseline and every 6 months for 18 months from 701 African American girls (14-20 years) in an HIV prevention trial. At each assessment, self-collected vaginal swabs were assayed for T. vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Generalized estimating equations assessed associations between incident T. vaginalis infection and sociodemographic characteristics, substance use, partner-level factors, sexual risk behaviors, douching, and other sexually transmitted infections. RESULTS: Of 605 (86.3%) participants who completed at least 1 follow-up assessment, an incident T. vaginalis infection was detected among 20.0% (n = 121). Factors associated with incident infection in adjusted analysis included the following: cigarette smoking (adjusted odds ratio [AOR], 1.66; 95% confidence interval [CI], 1.04-2.64), using alcohol on an increasing number of days in the past 3 months (AOR, 1.02; 95% CI, 1.00-1.04), acquisition of C. trachomatis (AOR, 2.27; 95% CI, 1.40-3.69) or N. gonorrhoeae (AOR, 5.71; 95% CI, 2.97-11.02), and T. vaginalis infection at the previous assessment (AOR, 3.16; 95% CI, 1.96-5.07). CONCLUSIONS: Incident T. vaginalis infections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services. The benefits of rescreening, screening adolescents screened for or infected with C. trachomatis or N. gonorrhoeae, and associations between substance use and T. vaginalis acquisition warrant further investigation.Correlates of inconsistent refusal of unprotected sex among Armenian female sex workers
AbstractMarkosyan, K., Lang, D. L., & DiClemente, R. (n.d.).Publication year
2014Journal title
AIDS Research and TreatmentVolume
2014AbstractThis cross-sectional study assessed the prevalence and correlates of inconsistent refusal of unprotected sex among female sex workers (FSWs) in Armenia. One hundred and eighteen street-based FSWs between the ages of 20 and 52 completed a questionnaire assessing FSWs' demographic, psychosocial, and behavioral characteristics. A total of 52.5% (n = 62) of FSWs reported inconsistent refusal of unprotected sex with clients in the past 3 months. Logistic regression analysis controlling for participants' age and education revealed that perceiving more barriers toward condom use (AOR = 1.1; P < 0.01), reporting more types of abuse (AOR = 2.1; P < 0.01), and setting lower fees for service (AOR = 0.9; P = 0.02) significantly predicted inconsistent refusal of unprotected sex. HIV-risk-reduction behavioral interventions tailored to FSWs working in Yerevan Armenia should address the factors identified in this study toward the goal of enhancing refusal of unprotected sex and ultimately preventing acquisition of sexually transmitted infections (STIs) including HIV.Development and preliminary evaluation of a behavioural HIV-prevention programme for teenage girls of Latino descent in the USA
AbstractDavidson, T. M., Lopez, C. M., Saulson, R., Borkman, A. L., Soltis, K., Ruggiero, K. J., de Arellano, M., Wingood, G. M., DiClemente, R., & Danielson, C. K. (n.d.).Publication year
2014Journal title
Culture, Health and SexualityVolume
16Issue
5Page(s)
533-546AbstractNational data suggests that teenage girls of Latino descent in the USA are disproportionately affected by HIV, with the US Centers for Disease Control and Prevention reporting the rate of new infections being approximately four times higher compared to White women of comparable age. This paper highlights the need for an effective single-sex HIV-prevention programme for teenage girls of Latino descent and describes the development and preliminary evaluation of Chicas Healing, Informing, Living and Empowering (CHILE), a culturally-tailored, HIV-prevention programme exclusively for teenage girls of Latino descent that was adapted from Sisters Informing, Healing, Living and Empowering (SiHLE), an evidence-based HIV- prevention program that is culturally tailored for African American young women. Theatre testing, a pre-testing methodology to assess consumer response to a demonstration of a product, was utilised to evaluate the relevance and utility of the HIV programme as well as opportunities for the integration of cultural constructs. Future directions for the evaluation of CHILE are discussed.Development, Theoretical Framework, and Evaluation of a Parent and Teacher–Delivered Intervention on Adolescent Vaccination
AbstractGargano, L. M., Herbert, N. L., Painter, J. E., Sales, J. M., Vogt, T. M., Morfaw, C., Jones, L. D., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2014Journal title
Health promotion practiceVolume
15Issue
4Page(s)
556-567AbstractThe Advisory Committee on Immunization Practices recommended immunization schedule for adolescents includes three vaccines (tetanus, diphtheria, and acellular pertussis [Tdap]; human papillomavirus [HPV] vaccine; and meningococcal conjugate vaccine [MCV4]) and an annual influenza vaccination. Given the increasing number of recommended vaccines for adolescents and health and economic costs associated with nonvaccination, it is imperative that effective strategies for increasing vaccination rates among adolescents are developed. This article describes the development, theoretical framework, and initial first-year evaluation of an intervention designed to promote vaccine acceptance among a middle and high school–based sample of adolescents and their parents in eastern Georgia. Adolescents, parents, and teachers were active participants in the development of the intervention. The intervention, which consisted of a brochure for parents and a teacher-delivered curriculum for adolescents, was guided by constructs from the health belief model and theory of reasoned action. Evaluation results indicated that our intervention development methods were successful in creating a brochure that met cultural relevance and the literacy needs of parents. We also demonstrated an increase in student knowledge of and positive attitudes toward vaccines. To our knowledge, this study is the first to extensively engage middle and high school students, parents, and teachers in the design and implementation of key theory-based educational components of a school-based, teacher-delivered adolescent vaccination intervention.Differences in Sexual Risk Behaviors Between Lower and Higher Frequency Alcohol-Using African-American Adolescent Females
AbstractSales, J. M., Monahan, J. L., Brooks, C., DiClemente, R., Rose, E., & Samp, J. A. (n.d.).Publication year
2014Journal title
Current HIV ResearchVolume
12Issue
4Page(s)
276-281AbstractBackground: To examine differences between lower and higher frequency alcohol users in sexual behaviors and psychosocial correlates of risk for HIV among young African-American females. Methods: Data were collected from sexually active African-American females aged 15-20 years, seeking services at a STD clinic in Atlanta, GA, to assess sexual behavior, correlates of risk, and a non-disease biological marker of unprotected vaginal sex. Results: Number of drinking occasions was significantly related to three of four psychosocial correlates and with all selfreporting sexual behavior measures. Also, heavier drinking per occasion was associated with the presence of semen in vaginal fluid. Conclusion: Non-abuse levels of drinking were related to increased sexual risk-taking in this sample of young African- American females. Incorporating messages about the intersection of alcohol use and sexual decision making into HIV/STD prevention programs would strengthen STD prevention messaging in this vulnerable population.Differential sensitivity to prevention programming : A dopaminergic polymorphism-enhanced prevention effect on protective parenting and adolescent substance use
AbstractBrody, G. H., Chen, Y. f., Beach, S. R., Kogan, S. M., Yu, T., DiClemente, R., Wingood, G. M., Windle, M., & Philibert, R. A. (n.d.).Publication year
2014Journal title
Health PsychologyVolume
33Issue
2Page(s)
182-191AbstractObjective: The purpose of this study was to investigate a genetic moderation effect of dopamine receptor-4 gene (DRD4) alleles that have 7 or more repeats on the efficacy of a preventive intervention to deter rural African American adolescents' substance use. Methods: Adolescents (N = 502, M age = 16 years) were assigned randomly to the Strong African American Families-Teen (SAAF-T) program or to a control condition and were followed for 22 months. Adolescents provided data on substance use, and both adolescents and their primary caregivers provided data on intervention-targeted protective parenting practices. Results: Male adolescents who carried at least one allele of DRD4 with 7 or more repeats who were assigned to the control condition evinced more substance use across 22 months than did (a) carriers of at least one allele of DRD4 with 7 or more repeats who were assigned to SAAF-T or (b) adolescents assigned to either condition who carried two alleles of DRD4 with 6 or fewer repeats. These findings were mediated by DRD4 × SAAF-T interaction effects on increases in intervention-targeted protective parenting practices, a mediated moderation effect. Conclusions: The results imply that prevention effects on health-relevant outcomes for genetically susceptible individuals, such as carriers of at least one allele of DRD4 with 7 or more repeats, may be underestimated.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., & DiClemente, 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., 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
Obstetrical and Gynecological SurveyVolume
69Issue
12Page(s)
737-739Abstract~Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents : A randomized clinical trial
AbstractDiClemente, R., 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., 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.Erratum : Clarification of "impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines" (Human Vaccines & Immunotherapeutics (2014) 9 (2627-33) DOI: 10.4161/ hv.25823)
AbstractGargano, L. M., Herbert, N., Painter, J. E., Sales, J. M., Morfaw, C., Rask, K., Murray, D., DiClemente, R., & Hughes, J. (n.d.).Publication year
2014Journal title
Human Vaccines and ImmunotherapeuticsVolume
10Issue
9Page(s)
2631Abstract~Erratum to : Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: an application of the ADAPT-ITT framework
AbstractSullivan, P. S., Stephenson, R., Gratzer, B., Wingood, G., DiClemente, R., Allen, S., Hoff, C., Salazar, L., Scales, L., Montgomery, J., Schwartz, A., Barnes, J., & Grabbe, K. (n.d.).Publication year
2014Journal title
SpringerPlusVolume
3Issue
1Page(s)
1Abstract~HIV vaccine acceptability among high-risk drug users in Appalachia : A cross-sectional study
AbstractYoung, A. M., DiClemente, R., 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. (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., 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.