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 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)
465-466Towards an integrated framework for accelerating the end of the global HIV epidemic among young people
AbstractDiClemente, R. J., & Jackson, J. M. (n.d.).Publication year
2014Journal title
Sex EducationVolume
14Issue
5Page(s)
609-621AbstractFor decades, the HIV epidemic has exacted an enormous toll worldwide. However, trend analyses have discerned significant declines in the overall prevalence of HIV over the last two decades. More recently, advances in biomedical, behavioural, and structural interventions offer considerable promise in the battle against generalised epidemics. Despite advances in the prevention of transmission and new infections, morbidity and mortality of HIV among young people remains a considerable concern for individuals, couples, families, communities, practitioners, and policy-makers around the globe. To accelerate the end of the global HIV epidemic among young people, we must merge existing efficacious interventions with more novel, cost-effective implementation strategies to develop integrated, multi-level combination interventions. The benefits of conceptualising the HIV epidemic more broadly and adopting ecological frameworks for the development of HIV prevention programmes are critical.Understanding 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.A longitudinal examination of sexually transmitted infection/HIV prevention knowledge and sexually transmitted infections among African-American adolescent females
AbstractVoisin, D. R., Tan, K., & Diclemente, R. J. (n.d.).Publication year
2013Journal title
Journal of health psychologyVolume
18Issue
12Page(s)
1582-1587AbstractThis study examines whether sexually transmitted infection prevention knowledge predicts the acquisition of biologically confirmed sexually transmitted infections among African-American adolescent females. A total of 715 females were recruited from public health clinics in Atlanta, Georgia, and using audio computer-assisted self-interview technology, we assessed for demographics, sexually transmitted infection prevention knowledge, risky sexual behaviors, and sexually transmitted infections. After controlling for demographics and prior risky sexual behaviors, participants with high prevention knowledge were 0.09 times less likely to report sexually transmitted infections, and those with multiple sexual partners were 1.3 times more likely to report sexually transmitted infections. Our findings suggest that the promotion of accurate sexually transmitted prevention knowledge is critical especially among females with multiple sex partners.A longitudinal examination of the relationship between sexual sensation seeking and STI-related risk factors among African American females
AbstractVoisin, D. R., Tan, K., & Diclemente, R. J. (n.d.).Publication year
2013Journal title
AIDS Education and PreventionVolume
25Issue
2Page(s)
124-134AbstractSexual sensation seeking has been correlated with STI-related risk factors in numerous cross sectional studies. However, no current studies have examined whether sexual sensation seeking is longitudinally related to a broad spectrum of STI-related factors such as consistent condom use, number of sexual partners, frequency of partner sexual communication, self-efficacy to refuse sex, and fear of condom negotiation. We explored these relationships over a 12-month period among a sample of 715 African American females attending three STI clinics in Georgia that were recruited into a larger randomized clinic intervention study. Utilizing A-CASI technology to assess all self-reported measures and employing general estimation equations while controlling for age, peer norms, school enrollment and employment, major results indicated that higher sexual sensation seeking predicted lower percent of condom use in the last 14 and 60 days, lower consistent condom use and a higher number of lifetime sexual partners. Additionally, higher sexual sensation seeking predicted lower partner sexual communication, diminished self-efficacy to refuse sex, and a higher fear of condom negotiation. Findings suggest that STI/HIV prevention/intervention programs should assess for and target sexual sensation seeking behaviors in such efforts.A new paradigm for optimizing HIV intervention synergy: The role of interdependence in integrating HIV prevention interventions
Wingood, G. M., Rubtsova, A., DiClemente, R. J., Metzger, D., & Blank, M. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S108-S113Adoption and implementation of a computer-delivered HIV/STD risk-reduction intervention for African American adolescent females seeking services at county health departments: Implementation optimization is urgently needed
AbstractDiClemente, R. J., Bradley, E., Davis, T. L., Brown, J. L., Ukuku, M., Sales, J. M., Rose, E. S., & Wingood, G. M. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S66-S71AbstractAlthough group-delivered HIV/sexually transmitted disease (STD) risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across 8 participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding, and surmounting barriers that hamper timely and efficient implementation of technology- delivered HIV/STD risk-reduction interventions in county public health clinics.African-American men's exposure to music videos and their sexual attitudes and risk behaviour
AbstractDiclemente, R. J., Alexander, A. O., Braxton, N. D., Ricks, J. M., & Seth, P. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
3Page(s)
279-281AbstractBackground Media is a social determinant of HIV and sexually transmissible infection (STI) risk. However, limited empirical data have examined men's media exposure and their sexual attitudes and behaviour towards women. Methods: Eighty heterosexual African-American men were assessed on their exposure to music videos, sexual attitudes and behaviour. They also were tested for STIs. Results: Findings indicated that men influenced by music videos reported more sexual adventurism, more condom barriers, more lifetime sexual partners, more condom request refusals, substance abuse and a history of incarceration. Conclusions: Further longitudinal research is needed to better understand this relationship and to address the role of media in HIV and STI prevention interventions.An opportunity for cancer prevention during preadolescence and adolescence: Stopping human papillomavirus (HPV)-related cancer through HPV vaccination
AbstractThomas, T. L., Strickland, O., Diclemente, R., & Higgins, M. (n.d.).Publication year
2013Journal title
Journal of Adolescent HealthVolume
52Issue
5Page(s)
S60-S68AbstractObjective: We conducted a descriptive study of the correlates of refusal and acceptance of human papillomavirus (HPV) vaccination by rural parents of preadolescent and adolescent children. We hypothesized that the correlates of parents who allow their children aged 9 to 13 years to get the HPV vaccine and those of parents who do not allow vaccination would differ significantly. Methods: This cross-sectional study was implemented during the school years 2009-2011 in the elementary and middle schools of three rural counties in Georgia. Parents were recruited at school functions to complete an anonymous validated survey. Results: Parents who chose to vaccinate their children or intended to vaccinate were twice as likely to be from a race other than African American and 2.7 times more likely to have a religion other than Baptist. Using stepwise logistic regression and after adjustment for race and religion, we found that parents who had vaccinated or intended to vaccinate had significantly higher scores on perceived barriers (1.02 times more likely to vaccinate) and lower scores on perceived benefits (1.01 times more likely to vaccinate) (model p <.001). Conclusions: The results suggest that healthcare providers in rural areas can increase HPV vaccine uptake and reduce HPV-related cancers by using a multifaceted approach to educating their patients within the context of the patients' cultural values, geographic location, and economic situation. Such an approach could dispel misinformation and increase vaccine uptake.Application of audio computer-assisted self-interviews to collect self-reported health data: An overview
AbstractBrown, J. L., Swartzendruber, A., & Diclemente, R. J. (n.d.).Publication year
2013Journal title
Caries researchVolume
47Page(s)
40-45AbstractFor assessment of sensitive health behaviors (e.g., sexual behavior, violent behaviors, substance use), research is typically limited to an examination of self-reports of past behavior. Audio computer-assisted self-interviews (ACASI) may enhance the validity of self-report data in research and clinical settings by reducing measurement bias. This paper provides an introduction to ACASI for collection of self-reported health data. The potential benefits and cost-effectiveness of ACASI use in research and clinical settings are reviewed. We then review the theoretical underpinnings that may underlie differential reporting of health behaviors between assessment modalities. Next, we highlight studies that have investigated differences in self-reported health behaviors between assessment modalities. Lastly, we summarize potential applications of ACASI assessments within clinical settings.Applying the Dynamic Social Systems Model to HIV Prevention in a Rural African Context: The Maasai and the Esoto Dance
AbstractSiegler, A. J., Mbwambo, J. K., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Health Education and BehaviorVolume
40Issue
6Page(s)
683-693AbstractThis study applied the Dynamic Social Systems Model (DSSM) to the issue of HIV risk among the Maasai tribe of Tanzania, using data from a cross-sectional, cluster survey among 370 randomly selected participants from Ngorongoro and Siha Districts. A culturally appropriate survey instrument was developed to explore traditions reportedly coadunate with sexual partnership, including "wife sharing", fertility rituals, and various traditional dances. One dance, esoto, accounted for more than two thirds of participants' lifetime sexual partners (n = 10.5). The DSSM, combining structural and systems theories, was applied to systematize complex multilevel factors regarding esoto practice. Participants reported multifaceted beliefs regarding esoto; a majority viewed the dance as exciting and essential, yet most men feared social stigma and three quarters of women had experienced physical punishment for nonattendance. In multivariate logistic regression, esoto attendance was predicted by female gender (adjusted odds ratio [AOR] = 4.67, 95% confidence interval [CI] = 1.6-13.2), higher positive beliefs regarding esoto (AOR = 2.84, 95% CI = 1.9-4.2), and Maasai life cycle events (AOR = 0.06, 95% CI = 0.01-0.47). The DSSM proved useful for characterizing esoto and for revealing feedback loops that maintain esoto, thus indicating avenues for future interventions.Arousability as a predictor of sexual risk behaviours in African-American adolescent women
AbstractWood, J. R., Milhausen, R. R., Sales, J. M., Graham, C. A., Sanders, S. A., Diclemente, R. J., & Wingood, G. M. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
2Page(s)
160-165AbstractThis study examined the impact of sexual excitation (arousability) on sexual risk-taking behaviours in a community sample of African-American adolescent women. A sample of 701 African-American adolescent women completed measures examining their propensity for sexual arousal, impulsivity and sexual behaviour. Compared with women with a lower propensity for sexual arousability, women with a higher propensity reported a greater number of sexual partners, more inconsistent condom use, a greater likelihood of having engaged in sexual intercourse with 'risky' partners, and sex while high on alcohol or drugs. These results indicate that women who have a greater propensity to become sexually aroused in a variety of situations may be at a greater risk for contracting HIV or sexually transmissible infections relative to women with a lower propensity for arousal. This suggests that individual differences in the propensity to become sexually aroused should be considered when developing intervention approaches targeting young African-American women.Comparative effectiveness of a faith-based HIV intervention for African American women: Importance of enhancing religious social capital
AbstractWingood, G. M., Robinson, L. S. R., Braxton, N. D., Er, D. L., Conner, A. C., Renfro, T. L., Rubtsova, A. A., Hardin, J. W., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
12Page(s)
2226-2233AbstractObjectives. We assessed the effectiveness of P4 for Women, a faith-based HIV intervention. Methods. We used a 2-arm comparative effectiveness trial involving 134 African American women aged 18 to 34 years to compare the effectiveness of the Centers for Disease Control and Prevention-defined evidence-based Sisters Informing Sisters about Topics on AIDS (SISTA) HIV intervention with P4 for Women, an adapted faith-based version of SISTA. Participants were recruited from a large black church in Atlanta, Georgia, and completed assessments at baseline and follow-up. Results. Both SISTA and P4 forWomen had statistically significant effects on this study's primary outcome-consistent condom use in the past 90 days-as well as other sexual behaviors. However, P4 for Women also had statistically significant effects on the number of weeks women were abstinent, on all psychosocial mediators, and most noteworthy, on all measures of religious social capital. Results were achieved by enhancing structural social capital through ministry participation, religious values and norms, linking trust and by reducing negative religious coping. High intervention attendance may indicate the feasibility of conducting faith-based HIV prevention research for African American women. Conclusions. P4 for Women enhanced abstinence and safer sex practices as well as religious social capital, and was more acceptable than SISTA. Such efforts may assist faith leaders in responding to the HIV epidemic in African American women.Correctional facilities as partners in reducing HIV disparities
AbstractRich, J. D., DiClemente, R., Levy, J., Lyda, K., Ruiz, M. S., Rosen, D. L., & Dumont, D. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S49-S53AbstractThe United States now has the highest incarceration rate in the world. The majority of prison and jail inmates come from predominantly nonwhite and medically underserved communities. Although incarceration has adverse effects on both individual and community health, prisons and jails have also been used successfully as venues to provide health services to people with HIV who frequently lack stable health care. We review demographic trends shaping the difficulties in providing care to incarcerated people with HIV and recommend the Centers for AIDS Research Collaboration on HIV in Corrections as a model of interdisciplinary collaboration in addressing those difficulties.Determinants of health-related behaviors in adolescence
DiClemente, R. J., Brown, J. L., & Davis, T. L. (n.d.). In Handbook of Adolescent Health Psychology (1–).Publication year
2013Page(s)
107-127Effects of Promoting Health Among Teens on Dietary, Physical Activity, and Substance Use Knowledge and Behaviors for African American Adolescents
AbstractKerr, J. C., Valois, R. F., Farber, N. B., Vanable, P. A., DiClemente, R. J., Salazar, L., Brown, L. K., Carey, M. P., Romer, D., Stanton, B., Jemmott, J. B., Jemmott, L. S., Spencer, A. M., & Annang, L. (n.d.).Publication year
2013Journal title
American Journal of Health EducationVolume
44Issue
4Page(s)
191-202AbstractAfrican Americans are disproportionately affected by cardiovascular disease and cancer. Health promotion interventions hold promise for reducing health disparities. Purpose Promoting Health Among Teens (PHAT) is a brief, culturally tailored health education intervention to decrease cardiovascular disease and cancer risk for African Americans. This study evaluated the effects of PHAT for African American adolescents ages 14 to 17 in 4 eastern cities in the United States. Methods A randomized controlled design (N = 1654) was used to determine differences in health knowledge, diet, physical activity, and substance use behaviors between PHAT participants and a sexual health promotion control group. Data were collected at baseline and at 3, 6, and 12 months postintervention. Growth curve modeling was used to detect differences in health knowledge, dietary behaviors, physical activity, and substance use between PHAT and control group participants. Results PHAT participants had significantly greater knowledge gains but modest behavior changes compared to control group participants. Discussion PHAT is a promising intervention to increase knowledge and address selected health behaviors in African American youth. Translation to Health Education Practice Future attempts to execute PHAT should continue its emphasis on knowledge building while increasing intervention dosage and modifying length of time for intervention sessions.Efficacy of an HIV intervention in reducing high-risk human papillomavirus, nonviral sexually transmitted infections, and concurrency among African American women: A randomized-controlled trial
AbstractWingood, G. M., DiClemente, R. J., Robinson-Simpson, L., Lang, D. L., Caliendo, A., & Hardin, J. W. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S36-S43AbstractObjective: This trial evaluated the efficacy of an HIV-intervention condition, relative to a health-promotion condition, in reducing incidence of nonviral sexually transmitted infections (STIs; Chlamydia, gonorrhea, and trichomoniasis), oncogenic human papillomavirus (HPV) subtypes 16 and 18, sexual concurrency, and other HIV-associated behaviors over a 12-month period. Design: Randomized-controlled trial. Data analysts blinded to treatment allocation. Setting: Kaiser Permanente, GA. Subjects: A random sample of 848 African American women. Intervention: The two 4-hour HIV intervention sessions were based on Social Cognitive Theory and the Theory of Gender and Power. The intervention was designed to enhance participants' selfsufficiency and attitudes and skills associated with condom use. The HIV intervention also encouraged STI testing and treatment of male sex partners and reducing vaginal douching and individual and male partner concurrency. Main Outcome Measure: Incident nonviral STIs. Results: In generalized estimating equations' analyses, over the 12-month follow-up, participants in the HIV intervention, relative to the comparison, were less likely to have nonviral incident STIs (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.40 to 0.96; P = 0.033) and incident high-risk HPV infection (OR = 0.37; 95% CI: 0.18 to 0.77; P = 0.008) or concurrent male sex partners (OR = 0.55; 95% CI: 0.37 to 0.83; P = 0.005). In addition, intervention participants were less likely to report multiple male sex partners, more likely to use condoms during oral sex, more likely to inform their main partner of their STI test results, encourage their main partner to seek STI testing, report that their main partner was treated for STIs, and report not douching. Conclusions: This is the first trial to demonstrate that an HIV intervention can achieve reductions in nonviral STIs, high-risk HPV, and individual concurrency.Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: Results of a randomized-controlled trial
AbstractWingood, G. M., Reddy, P., Lang, D. L., Saleh-Onoya, D., Braxton, N., Sifunda, S., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Page(s)
S59-S65AbstractBackground: The HIV epidemic has a devastating impact among South African women. The current study evaluated the efficacy of SISTA South Africa, a culturally congruent HIV intervention for isiXhosa women in South Africa, which was adapted from SISTA, an HIV intervention for African American women. Methods: A randomized-controlled trial recruited 342 isiXhosa women aged 18-35 years. Participants were randomized to the general health comparison or the SISTA South Africa intervention. Xhosa-speaking peer health educators tailored the SISTA South Africa curriculum, while maintaining the core elements of the original SISTA intervention. Participants completed assessments at baseline and 6 months follow-up. Results: Relative to participants in the comparison, participants in the HIV intervention reduced the frequency of unprotected vaginal intercourse acts (adjusted mean difference = 1.06; P = 0.02), were more likely to report not desiring dry sex (adjusted odds ratio = 0.229; 95% confidence interval = 0.10 to 0.47; P = 0.0001), and were more likely to perceive that their main sexual partner did not desire dry sex (adjusted odds ratio = 0.24; 95% confidence interval = 0.11 to 0.52; P = 0.0001). In addition, women randomized to the intervention also reported an increase in HIV knowledge, greater relationship control, and had more opposing attitudes toward HIV stigma. The HIV intervention did not reduce sexually transmitted infection incidence. Conclusions: This trial demonstrates that an HIV intervention, which is adapted to enhance its gender and cultural relevance for rural isiXhosa women, can reduce self-reported sexual risk behaviors and enhance mediators of HIV among this vulnerable population.Factors associated with sexual arousal, sexual sensation seeking and sexual satisfaction among female African American adolescents
AbstractSales, J. M., Smearman, E. L., Brody, G. H., Milhausen, R., Philibert, R. A., & DiClemente, R. J. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
6Page(s)
512-521AbstractBackground: Sexuality-related constructs, such as sexual arousal, sexual sensation seeking (SSS) and sexual satisfaction, have been related to sexual behaviours that place one at risk of adverse consequences, such as sexually transmissible infections, HIV and unintended pregnancy. The biopsychosocial model posits an array of factors, ranging from social environmental factors to biological and psychological predispositions, that may be associated with these sexuality constructs in adolescents. Methods: Female African Americans aged 14-20 years were recruited from reproductive health clinics for an HIV intervention. Baseline survey and follow-up DNA data (n=304) were used to assess biological, psychological and social environmental associations with the sexuality constructs of arousal, SSS and sexual satisfaction. Results: Multivariate linear regression analysis revealed that a higher depressive symptom rating was associated with higher arousability, whereas short serotonin transporter gene allele(s) status was associated with lower arousability. Impulsivity and perceived peer norms supportive of unsafe sexual behaviours were associated with increased SSS, whereas short serotonin transporter gene allele(s) status was associated with lower SSS. Higher social support was associated with higher levels of sexual satisfaction, whereas short serotonin transporter gene allele(s) status was associated with lower satisfaction. The sexuality constructs were also significantly related to the number of sex partners, the frequency of vaginal sex and the number of unprotected vaginal sex acts in the past 6 months. Conclusions: The findings emphasise the importance of understanding biopsychosocial factors, including the role of serotonin as an indicator of natural variations in sexual inclination and behaviours, that influence sexuality constructs, which, in turn, are associated with sexual behaviours, to allow further refinement of sexual health clinical services and programs and promote the development of healthy sexuality. Journal compilationGang Norms and Risky Sex Among Adolescents With a History of Detention
AbstractKing, K. M., Voisin, D. R., & DiClemente, R. J. (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.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. J., & 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.