Ralph DiClemente

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Professor of Social and Behavioral Sciences

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.

Education

BA, The City College of the City University of New York (CCNY), New York, NY

ScM, Behavioral Sciences, Harvard University, Cambridge, MA

PhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CA

Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions

Diabetes

HIV/AIDS

Implementation science

Influenza

Psychology

Publications

Impact of abuse history on adolescent African American women's current HIV/STD-associated behaviors and psychosocial mediators of HIV/STD risk

Brown, J. L., Young, A. M., Sales, J. M., DiClemente, R., Rose, E. S., & Wingood, G. M. (n.d.).

Publication year

2014

Journal title

Journal of Aggression, Maltreatment and Trauma

Volume

Issue

Page(s)

151-167

10.1080/10926771.2014.873511

Abstract

Abstract

This study examined if relationship power, sex refusal self-efficacy, or fear of condom negotiation mediated the relationship between abuse history and consistent condom use (CCU) among African American female adolescents (N = 593). Participants with an abuse history (58%) were less likely to report CCU. Women with an abuse history reported less relationship power and self-efficacy for refusing sex and more fear of condom negotiation, none of which independently or jointly mediated the association between abuse and CCU. Notably, history of abuse was associated with CCU across mediator models despite inclusion of psychosocial mediators. This study demonstrates the importance of understanding adolescents'condom use behaviors within the context of their life experiences, especially past abuse history.

Influence of sexual sensation-seeking on factors associated with risky sexual behaviour among African-American female adolescents

Ritchwood, T. D., Penn, D. C., DiClemente, R., Rose, E. S., & Sales, J. M. (n.d.).

Publication year

2014

Journal title

Sexual Health

Volume

Issue

Page(s)

540-546

10.1071/SH14075

Abstract

Abstract

Background The identification of antecedents to sexual risk among youth is critical to the development and dissemination of multilevel interventions. Therefore, the aim of the present study was to examine the effect of sexual sensation-seeking on partner age, partner communication, and the sexual attitudes and behaviours of African-American female youth. Methods: This study examined survey data collected by audio computer-assisted self-interviews from 701 young African-American females between 14 and 20 years of age. The survey consisted of items designed to measure adolescents' sexual risk and preventive behaviours. Results: The results of this study suggest that sexual sensation-seeking is associated with condom use among adolescent African-American females. For adolescents who reported greater sexual sensation-seeking, lower levels of sexual happiness were associated with a decreased likelihood of condom use at last intercourse (β≤1.01, P≤0.05). For those reporting lower levels of sexual sensation-seeking, greater sexual enjoyment was associated with a greater likelihood of condom use at last intercourse (β≤0.93, P≤0.01). Adolescents with younger sexual partners and lower levels of sexual sensation-seeking reported a higher proportion of condom use in the past 6 months (β≤0.70, P≤0.01). Higher partner communication self-efficacy and decreasing levels of sexual sensation-seeking were associated with fewer lifetime sexual partners (β≤-0.54, P≤0.05). Conclusions: Future research should address the impact of these variables on adolescent relationship dynamics and sexual decision-making.

Interaction Between 5-HTTLPR Polymorphism and Abuse History on Adolescent African-American Females' Condom Use Behavior Following Participation in an HIV Prevention Intervention

Sales, J. M., DiClemente, R., Brody, G. H., Philibert, R. A., & Rose, E. (n.d.).

Publication year

2014

Journal title

Prevention Science

Volume

Issue

Page(s)

257-267

10.1007/s11121-013-0378-6

Abstract

Abstract

Not everyone exposed to an efficacious human immunodeficiency virus (HIV) intervention will reduce sexual risk behaviors, yet little is known about factors associated with "failure to change" high-risk sexual behaviors post-intervention. History of abuse and polymorphisms in the serotonin transporter gene (5-HTT) may be associated with non-change. The current study sought to identify genetic, life history, and psychosocial factors associated with adolescents' failure to change condom use behaviors post-participation in an HIV prevention intervention. A sub-set of participants from a clinic-based sample of adolescent African-American females (N = 254) enrolled in a randomized trial of an HIV-prevention was utilized for the current study. Forty-four percent did not increase their condom use from baseline levels 6 months after participating in the sexually transmitted infection (STI)/HIV prevention intervention. In multivariable logistic regression analysis, an interaction between abuse and 5-HTTLPR group was significantly associated with non-change status, along with partner communication frequency scores at follow-up. Follow-up tests found that having a history of abuse was significantly associated with greater odds of non-change in condom use post-intervention for only those with the s allele. For those with ll allele, participants with higher partner communication frequency scores were at decreased odds of non-change in condom use post-intervention. Thus, STI/HIV interventions for adolescent females may consider providing a more in-depth discussion and instruction on how to manage and overcome fear or anxiety related to being assertive in sexual decisions or sexual situations. Doing so may improve the efficacy of STI/HIV prevention programs for adolescent women who have experienced abuse in their lifetime.

Internalizing symptoms and safe sex intentions among adolescents in mental health treatment : Personal factors as mediators

DiClemente, R. (n.d.).

Publication year

2014

Journal title

Children and Youth Services Review

Volume

Page(s)

177-185

10.1016/j.childyouth.2014.07.023

Abstract

Abstract

Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N. =. 893, M age. =. 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.

Language and Love : Generation Y Comes of Age Online

Jenssen, B. P., Gray, N. J., Harvey, K., DiClemente, R., & Klein, J. D. (n.d.).

Publication year

2014

Journal title

SAGE Open

Volume

Issue

10.1177/2158244014525894

Abstract

Abstract

Social networking sites (SNS) provide adolescents with opportunities for content generation on a wide range of social issues, providing unique insight into the psychosocial development of adolescence. We explored SNS webpages viewed by a random sample of adolescents during the initial uptake of SNS use (2005) to describe their general language use. Adolescents aged 14 to 17 with home Internet access were recruited using list-assisted random digit dialing methods. All SNS (MySpace) webpages viewed by participants were captured, and a large, structured set of texts (text corpus) was created from the profiles and message boards therein. Using concordance software, word frequency and keyword associations were analyzed. The 346 participants viewed approximately 28,000 MySpace pages, yielding a 1,147,432-word text corpus. Profile sections presented information about the content creator, while message boards focused more on short conversations with recipients. The most common content word was the term love. Profile owners would profess their love for activities, such as dancing, partying, or shopping, followed by their love for family, friends, and significant others. SNS offer teens an opportunity to describe and share feelings about people, places, and things connected to a range of activities and social contacts within their online and offline environments. Better understanding of SNS can offer strategies to adolescents and health care providers for insight into what connects young people in a community.

Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females

Steiner, R. J., Swartzendruber, A. L., Rose, E., & DiClemente, R. (n.d.).

Publication year

2014

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

601-604

10.1097/OLQ.0000000000000188

Abstract

Abstract

Among 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.

Overcoming the triad of rural health disparities : How local culture, lack of economic opportunity, and geographic location instigate health disparities

Thomas, T. L., DiClemente, R., & Snell, S. (n.d.).

Publication year

2014

Journal title

Health Education Journal

Volume

Issue

Page(s)

285-294

10.1177/0017896912471049

Abstract

Abstract

Objective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. Methods: We critically profile each component of the deterministic triad in shaping current healthrelated disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice. Results: The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. Conclusion: The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.

Project STYLE : A multisite RCT for HIV prevention among youths in mental health treatment

Brown, L. K., Hadley, W., Donenberg, G. R., DiClemente, R., Lescano, C., Lang, D. M., Crosby, R., Barker, D., & Oster, D. (n.d.).

Publication year

2014

Journal title

Psychiatric Services

Volume

Issue

Page(s)

338-344

10.1176/appi.ps.201300095

Abstract

Abstract

Objective: The study examined the efficacy of family-based and adolescentonly HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. Methods: A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. Results: Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p

Safety and acceptability of couples HIV testing and counseling for us men who have sex with men : A randomized prevention study

Sullivan, P. S., White, D., Rosenberg, E. S., Barnes, J., Jones, J., Dasgupta, S., O'Hara, B., Scales, L., Salazar, L. F., Wingood, G., DiClemente, R., Wall, K. M., Hoff, C., Gratzer, B., Allen, S., & Stephenson, R. (n.d.).

Publication year

2014

Journal title

Journal of the International Association of Providers of AIDS Care

Volume

Issue

Page(s)

135-144

10.1177/2325957413500534

Abstract

Abstract

We tested a couples HIV testing and counseling (CHTC) intervention with male couples in Atlanta by randomizing eligible couples to receive either CHTC or separate individual voluntary HIV counseling and testing (iVCT). To evaluate the acceptability and safety of CHTC, main outcomes were satisfaction with the intervention and the proportions of couples reporting intimate partner violence (IPV) and relationship dissolution after the service. The results indicated that the service was very acceptable to men (median 7-item index of satisfaction was 34 for CHTC and 35 for iVCT, P =.4). There was no difference in either incident IPV (22% versus 17% for CHTC and iVCT, respectively, P =.6) or relationship dissolution (42% versus 51% for CHTC and iVCT, respectively, P =.5). Based on the preliminary data, CHTC is safe for male couples, and it is equally acceptable to iVCT for men who have main partners.

Social discrimination and resiliency are not associated with differences in prevalent HIV infection in black and white men who have sex with men

Peterson, J. L., Bakeman, R., Sullivan, P., Millett, G. A., Rosenberg, E., Salazar, L., DiClemente, R., Cooper, H., Kelley, C. F., Mulligan, M. J., Frew, P., & Del Rio, C. (n.d.).

Publication year

2014

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

Issue

Page(s)

538-543

10.1097/QAI.0000000000000203

Abstract

Abstract

OBJECTIVES: To examine the associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white men who have sex with men (MSM). METHODS: The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA, designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Participants were recruited irrespective of HIV serostatus from community-based venues and from Internet advertisements and were tested for HIV. We assessed respondents' demographics, whether they had engaged in unprotected anal intercourse (UAI) within the past 6 months, and attitudes about perceived homophobia, perceived racism, and personal resiliency. RESULTS: Compared with white MSM, black MSM were less likely to report UAI in the past 6 months [odds ratio (OR): 0.59, confidence interval (CI): 0.44 to 0.80], more likely to be HIV positive (OR: 5.05, CI: 3.52 to 7.25), and - among those HIV positive - more likely to report not being aware of their HIV infection (OR: 2.58, CI: 1.18 to 5.65). Greater perceived racism was associated with UAI in the black sample (partial odds ratio: 1.48, CI: 1.10 to 1.99). Overall, perceived homophobia, perceived racism, and resilience were not associated with prevalent HIV infection in our samples. Greater resilience was associated with less perceived homophobia in both black and white samples (Spearman r = -0.27, P < 0.001, for both). CONCLUSION: Future studies of social discrimination at the institutional and network level, than at the individual level, may explain differences in HIV infection in black and white MSM.

Socioeconomic-related risk and sexually transmitted infection among African-American adolescent females

Sales, J. M., Smearman, E. L., Swartzendruber, A., Brown, J. L., Brody, G., & DiClemente, R. (n.d.).

Publication year

2014

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

698-704

10.1016/j.jadohealth.2014.05.005

Abstract

Abstract

Purpose Virtually no studies have examined the potential role that chronic stress, particularly the stress associated with socioeconomic status (SES) strain, may play on sexually transmitted infection (STI) risk. This study examined the association between SES-related risk at baseline to STI acquisition and reinfection over 36 months of follow-up.Methods Six hundred twenty-seven African-American female adolescents, ages 14-20 years, recruited from sexual health clinics in Atlanta, GA, participated in a randomized controlled HIV prevention trial and returned for at least one follow-up assessment. Following baseline assessment, six waves of data collection occurred prospectively over 36 months. Chronic SES-related risk was assessed as a sum of yes-no exposure to seven risk indicators. Laboratory-confirmed tests for Chlamydia trachomatis and Neisseria gonorrhoeae were performed at each follow-up.Results In multivariable regression analysis, SES-related risk significantly predicted STI acquisition over 36 months (adjusted odds ratio = 1.22) and STI reinfection (adjusted odds ratio = 1.16) above and beyond other known correlates of STI.Conclusions Findings demonstrate that SES-related risk was predictive of both STI acquisition and reinfection among young African-American females. They are consistent with propositions that some health disparities observed in adulthood may be linked to earlier chronically stress-inducing life experiences, particularly experiences associated with low SES conditions. Although various explanations exist for the observed connection between SES-related risk and subsequent STI acquisition and/or reinfection across 36 months of follow-up, these findings highlight the need for further research to elucidate the exact pathway(s) by which SES-related risk influences later STI acquisition to refine STI prevention interventions for this population.

Telling truth from Ys : An evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy

Rosenbaum, J. E., Zenilman, J., Melendez, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).

Publication year

2014

Journal title

Sexually transmitted infections

Volume

Issue

Page(s)

479-484

10.1136/sextrans-2013-051315

Abstract

Abstract

Results At the 3 surveys, 30%, 20% and 15% of adolescents who reported always using condoms tested positive for semen exposure. At 6 month follow-up, 20.4% and 16.2% of the adolescents who underreported semen exposure reported pregnancy, a higher pregnancy rate than accurate reporters of semen exposure, even accurate reporters who reported never using condoms (14.2% and 11.8%). Under-reporters of semen exposure were 3.23 (95% CI (1.61, 6.45)) times as likely to become pregnant at 6-month follow-up and 2.21 (0.94, 5.20) times as likely to become pregnant at 12-month follow-up as accurate reporters who reported not using contraception, adjusting for self-reported coital frequency.Conclusions Adolescents who under-report semen exposure may be at uniquely high risk for unplanned pregnancy and STIs, and may also under-report coital frequency. Condom efficacy trials that rely on self-report may yield inaccurate results. Adapted to a clinical setting, the Y-chromosome PCR could alert women to incorrect or inconsistent condom use.Objectives Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents' reports of condom use and predict subsequent pregnancy.Methods The sample comprised 715 sexually active African-American female adolescents, ages 15-21 years. At baseline, 6 months and 12 months, participants completed a 40-min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted pregnancy from semen exposure under-report using multivariate regression controlling for oral contraception, reported condom use and coital frequency.

The impact of alcohol use on HIV/STI intervention efficacy in predicting sexually transmitted infections among young African-American women

Seth, P., Wingood, G. M., Robinson, L. S., & DiClemente, R. (n.d.).

Publication year

2014

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

747-751

10.1007/s10461-013-0555-4

Abstract

Abstract

The impact of alcohol use on the efficacy of an HIV/STI intervention designed for young African-American women in predicting STIs was examined. Eight hundred forty-eight African-American women, 18-29 years, were randomly assigned to either the HIV/STI intervention or a control condition. Participants were assessed on alcohol use and provided two vaginal swab specimens for STI testing. Women in the intervention who consumed alcohol were less likely to test STI-positive than women in the control and abstainers (AOR = 2.47, 95 % CI = 1.01-6.22). STI risk factors may vary across different populations. Further research on heavy drinking and HIV intervention efficacy is needed.

The prevalence of undiagnosed HIV serodiscordance among male couples presenting for HIV testing

Sullivan, 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

2014

Journal title

Archives of Sexual Behavior

Volume

Issue

Page(s)

173-180

10.1007/s10508-013-0214-x

Abstract

Abstract

In 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. (n.d.).

Publication year

2014

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

465-466

10.1016/j.jadohealth.2014.07.017

Abstract

Abstract

Towards an integrated framework for accelerating the end of the global HIV epidemic among young people

DiClemente, R., & Jackson, J. M. (n.d.).

Publication year

2014

Journal title

Sex Education

Volume

Issue

Page(s)

609-621

10.1080/14681811.2014.901214

Abstract

Abstract

For 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.

Towards an integrated framework for accelerating the end of the global HIV epidemic among young people

DiClemente, R., & Jackson, J. M. (n.d.).

Publication year

2014

Journal title

Sex Education

Volume

Issue

Page(s)

609-621

10.1080/14681811.2014.901214

Abstract

Abstract

Understanding racial HIV/STI disparities in black and white men who have sex with men : A multilevel approach

Sullivan, 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

2014

Journal title

PloS one

Volume

Issue

10.1371/journal.pone.0090514

Abstract

Abstract

Background: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

Young, A. M., Halgin, D. S., DiClemente, R., Sterk, C. E., & Havens, J. R. (n.d.).

Publication year

2014

Journal title

PloS one

Volume

Issue

10.1371/journal.pone.0101047

Abstract

Abstract

Background: 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

Fleming, P. J., Andes, K. L., & DiClemente, R. (n.d.).

Publication year

2013

Journal title

Culture, Health and Sexuality

Volume

Issue

Page(s)

652-666

10.1080/13691058.2013.779027

Abstract

Abstract

Young 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

Voisin, D. R., Hotton, A. L., Tan, K., & DiClemente, R. (n.d.).

Publication year

2013

Journal title

Children and Youth Services Review

Volume

Issue

Page(s)

1440-1446

10.1016/j.childyouth.2013.05.019

Abstract

Abstract

This 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

Voisin, D. R., Tan, K., & DiClemente, R. (n.d.).

Publication year

2013

Journal title

Journal of health psychology

Volume

Issue

Page(s)

1582-1587

10.1177/1359105312465916

Abstract

Abstract

This 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

Voisin, D. R., Tan, K., & DiClemente, R. (n.d.).

Publication year

2013

Journal title

AIDS Education and Prevention

Volume

Issue

Page(s)

124-134

10.1521/aeap.2013.25.2.124

Abstract

Abstract

Sexual 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., Metzger, D., & Blank, M. (n.d.).

Publication year

2013

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

Issue

SUPPL. 1

Page(s)

S108-S113

10.1097/QAI.0b013e318291fff4

Abstract

Abstract

Adoption 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

DiClemente, R., Bradley, E., Davis, T. L., Brown, J. L., Ukuku, M., Sales, J. M., Rose, E. S., & Wingood, G. M. (n.d.).

Publication year

2013

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

Issue

SUPPL. 1

Page(s)

S66-S71

10.1097/QAI.0b013e318292014f

Abstract

Abstract

Although 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.

Ralph DiClemente