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Open Access Publications from the University of California

Scholarly Works (38 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2010)
Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.
    Cover page: Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2016)

    Background: Despite improved availability of antiretrovirals (ARVs) in sub-Saharan Africa (SSA), vertical HIV transmission continues to result in thousands of HIV-infected infants each year. Contributing to this are barriers to accessing medications and health services that women encounter throughout their reproductive lifespans. This includes before pregnancy (contraceptive non-use), during pregnancy (ARV non-adherence), peripartum (non-hospital deliveries), and postpartum (infant ARV non-use) periods. This dissertation sought to evaluate barriers to preventing vertical HIV transmission throughout women’s reproductive lifespans.

    Objectives: Specific aims include: 1) assessing associations between gender equitable attitudes and dual contraceptive use among couples with HIV; 2) evaluating the association between maternal ARV adherence and infant ARV administration; and 3) enumerating patient costs of accessing infant HIV care.

    Methods: Data from three studies were used to achieve these objectives. Aim 1 used cross-sectional data collected from 103 couples in Kenya. Aim 2 used data from a cross-sectional survey (n=384) and focus group discussions (FGDs) (n=6, 5-9 participants each) conducted with HIV-positive mothers in Uganda. Aim 3 used cross-sectional and FGD data from 49 HIV-positive mothers in Uganda.

    Results: Aim 1 findings demonstrated that female and male partner gender equitable attitudes significantly interacted to influence dual contraceptive use (AOR: 1.02, 95% CI: 1.01-1.04). Aim 2 findings showed that infant ARV administration was significantly associated with lack of maternal ARV adherence (AOR: 3.55, 95% CI: 1.36-9.26) and maternal attendance in a support group (AOR: 2.50, 95% CI: 1.06-5.83). FGDs supported these quantitative findings, explaining how support group attendance facilitated ARV administration, while poor ARV health messaging contributed to lack of administration. Finally, aim 3 findings showed that the cost of attending one HIV clinic visit averaged $5.46 USD (SD=$3.63), which is equivalent to 3-4 days’ income. FGDs identified that transportation costs, informal service charges, and opportunity costs contributed to this expense.

    Conclusions: These results contribute to our understanding of influences on prevention of vertical HIV transmission in SSA. Several recommendations for intervention and further research were identified, including increasing male partner inclusion in reproductive healthcare and improving support for women with HIV. Additionally, cost analyses are needed to support policies assuring access to vertical HIV prevention programs.

      Cover page: Maternal Influences on Vertical Transmission of HIV in Kenya and Uganda
      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2024)

      ABSTRACT OF THE DISSERTATION

      Shifting Gears: Examining the role of COVID-19 on DUI TreatmentParticipants, Providers, and Organizations

      by

      Melanie A. Barker

      Doctor of Philosophy in Interdisciplinary Research on Substance Use

      University of California San Diego, 2024San Diego State University, 2024

      Professor Jamila K. Stockman, ChairProfessor María Luisa Zúñiga, Co-Chair

      Background: A plethora of emerging research has demonstrated the unparalleled burden COVID-19 has placed on individuals, healthcare providers, and organizations, the effects of which still linger. To date, research exploring COVID-19 impacts has focused on access, program-level impacts, and Telehealth service delivery across other SUD levels of care, but has not specifically addressed the California Driving Under the Influence (DUI) treatment system, which is unique in its fee-for-service structure, serving a primarily mandated treatment population. This dissertation addresses this research gap. Methods: This dissertation employed a multi-method/level approach. Chapter 1 used a secondary analysis of data collected from n=3309 enrollees to examine changes in reach during COVID-19. Chapter 2, guided by the Job Demands-Resources Model, used a mixed-methods approach assessed (n=56) providers’ work experiences during COVID using a pretest-posttest design for repeated measures collected concurrently for three time periods: Pre-COVID-19 (June 15, 2019—March 15, 2020), Early-COVID-19 (June 15, 2020—March 15, 2021) and Late-COVID (June 15, 2021—March 15, 2022). A focus-group of (n=5) providers provided depth and convergence. Chapter 3, guided by PRISM, used a qualitative approach to explore determinants and strategies to address those barriers for the effective implementation and sustainability of DUI treatment. Results: Findings demonstrated serious treatment disruptions, declining enrollments and related threats to sustainability, and stark changes in reach. Those enrolling during COVID-19 had greater odds of identifying as Latino and Spanish-language preference; and were non-hazardous alcohol/low-level drug users (Chapter 1). Providers and Organizations experienced increases in job demands (e.g. changing tasks), adaptation (e.g., technical skills) and human resource challenges during COVID-19 inadequately balanced with resources (Chapters 2 and 3). Conclusions: Findings illustrate the need for fostering organizational resilience (e.g., building human resource capacity), bridging the digital divide, and institutionalizing implementation adaptations.

       

        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2021)

        Background

        Individuals who have experienced repeat sexual violence victimization face adverse mental and physical health outcomes, including immune and stress response functioning. We aim to further understand repeat sexual violence victimization to develop responsive and appropriate treatment for survivors of sexual violence.

        Methods

        We present the immunological and contextual findings of a participant (N = 1) who experienced repeat sexual violence victimization during her enrollment in The THRIVE Study, a prospective case-control study of women aged 14-45 years, who have experienced recent consensual vaginal penetration ("controls") or forced vaginal penetration ("cases"). Participants complete a survey, HIV/sexually transmitted infection, and pregnancy testing, blood sampling for C-reactive protein and adrenocorticotrophic hormone, collection of cervicovaginal fluid for immunological biomarkers, and self-collection of saliva samples for cortisol measurements, across study visits (Baseline, 1, and 3 months).

        Results

        The case study participant, aged 18 years upon enrollment, experienced sexual trauma before four of five study visits. Trends in the mental health indicators demonstrate reciprocal fluctuations in adverse mental health and resilience in accordance with revictimization and circumstantial changes. Suppressed immune biomarkers appear to correlate with increased adverse mental health, while mental health recovery trends with immunological recovery. The participant presents with dysregulated hypothalamic-pituitary-adrenal axis diurnal profile.

        Conclusions

        This profile illustrates the intra-individual biobehavioral impact of experience with revictimization over the course of 6 months, capturing experiences that are rarely studied either longitudinally or with the depth of the current research. The findings underscore the value of monitoring cervicovaginal immune functioning and hypothalamic-pituitary-adrenal axis dysregulation in coordination with changes in mental health over the course of repeated sexual trauma.
          Cover page: The biobehavioral impacts of sexual violence: Findings from an acute repeat survivor of vaginal rape
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2021)
            Cover page: What the HIV Pandemic Experience Can Teach the United States About the COVID-19 Response
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2023)

            Background

            We implemented a mentored research education and training program for underrepresented minorities (URMs) and Black, Indigenous, and People of Color (BIPOC) predoctoral and postdoctoral fellows called San Diego SUN (SD SUN): Supporting and Uplifting New and Diverse Scientists in HIV Research. The SD SUN program aimed to prepare fellows for an academic career trajectory in HIV science focused on ameliorating HIV-related disparities in communities of color.

            Setting

            The program leveraged a strong interinstitutional collaboration between San Diego State University and the University of California, San Diego, that share commitments to diversity, equity, and inclusion and an established history of training programs for URM/BIPOC investigators.

            Methods

            During a 9-month training period, launched in February 2022, fellows supported by a mentoring team completed ten 3-hour training sessions (core curriculum) and a mentored research project. The curriculum included seminars on building skills for a productive academic research career and reflective discussions around issues uniquely faced by URM/BIPOC investigators. Standardized measures developed for Center for AIDS Research Diversity, Equity, and Inclusion Pipeline Initiative (eg, around benefits gained) were used to evaluate the program.

            Results

            Six fellows participated in the SD SUN program. The results demonstrated a successful first year. Fellows were highly engaged and reported positive experiences, satisfaction with their mentor(s), various benefits gained from the program, and gains in numerous skillsets.

            Conclusions

            Challenges were faced during implementation (eg, teaching grant writing to fellows at different skill levels). Time constraints were reported by some faculty mentors with limited bandwidth. We describe insights and solutions to the major challenges to sustaining the successful SD SUN program.
              Cover page: Supporting and Uplifting New and Diverse Scientists in HIV Research (San Diego SUN): A Research Education and Training Program to Promote the Success of Black, Indigenous, and People of Color Predoctoral and Postdoctoral Fellows
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2019)

              Background

              Black women disproportionately suffer from violence and its subsequent mental health outcomes. Increasing levels of perceived stress are associated with greater symptoms of depression and post-traumatic stress disorder (PTSD). Social support and resilience can potentially mediate the negative consequences of perceived stress on women's mental health. This study assesses the association between perceived stress and mental health outcomes among Black women. In addition, this study examines social support and resilience as mediators of association between perceived stress and mental health.

              Methods

              Black women residing in Baltimore, MD (n = 310) were recruited from STD clinics into a retrospective cohort study (2013-2018) on sexual assault and HIV risk. Social support and resilience served as coping variables and were assessed as mediators in the associations between perceived stress and mental health. Analyses were stratified by exposure to sexual violence in adulthood.

              Results

              Almost half of our sample (46%) experienced severe depression and about one-third (27%) experienced severe PTSD. Resilience partially mediated the association between perceived stress and severe depressive symptoms among exposed women. Social support partially mediated the association between perceived stress and severe PTSD symptoms among exposed women.

              Limitations

              Since this is a cross-sectional analysis, we are unable to determine the temporal relationship between outcome and exposure variables. The CES-D-10 and NSESSS are scales that measure the severity of depressive and PTSD symptoms, respectively, and are not clinical diagnoses.

              Conclusion

              There is a critical need to develop interventions focused on reducing the burden of stress on mental health.
                Cover page: Perceived stress and mental health: The mediating roles of social support and resilience among black women exposed to sexual violence
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2016)
                We examined African American women's experiences of communication with their male intimate partners a couple of hours before and after an incident of unwanted sex. We also examined women's experiences of disclosure following an incident of unwanted sex. Semi-structured qualitative interviews were conducted with a community-based sample of sexually active African American women (n = 19) reporting at least one incident of sexual coercion (i.e., being pressured into unwanted sex without consent) by an intimate male partner since the age of 18. Our analysis was guided by "the sexual division of power" from Connell's (1987) theory of gender and power. Data were analyzed inductively by examining the interviews for common themes in the following domains: communication before the unwanted sex, communication after the unwanted sex, and disclosure to others. Men pressured partners for unwanted sex through verbal and non-verbal tactics, ranging from pestering and blunt requests for sex to verbal bullying and violence. Many women responded by clearly saying no. However, many women also described eventually ceasing to resist their partners and engaging in unwanted sex. After the unwanted sex, men actively and passively avoided discussing the incident. Although many women discussed the unwanted sex with family and friends, less women disclosed to trained professionals. In some cases, women did not discuss the incident with anyone at all. These findings indicate that, when addressing sexual violence against women, there is a need to target men as well as the norms of masculinity that underpin physical and sexual violence against women.
                  Cover page: “Come on Baby. You Know I Love You”: African American Women’s Experiences of Communication with Male Partners and Disclosure in the Context of Unwanted Sex
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2015)

                  Background

                  Hostage-taking, an overlooked phenomenon in public health, constitutes a severe form of intimate partner violence and may be a precursor to female homicide within relationships characterized by substance use. Criminal justice studies indicate that most hostage incidents are male-driven events with more than half of all cases associated with a prior history of violence and substance use. Methamphetamine use increases a woman's risk of partner violence, with methamphetamine-using individuals being up to nine times more likely to commit homicide. As homicide is the most lethal outcome of partner violence and methamphetamine use, this study aims to characterize the potential role of hostage-taking within these intersecting epidemics.

                  Methods

                  Methamphetamine-using women enrolled in an HIV behavioural intervention trial (FASTLANE-II) who reported experiences of partner violence were purposively selected to participate in qualitative sub-studies (Women's Study I & II). Twenty-nine women, ages 26-57, participated in semi-structured interviews that discussed relationship dynamics, partner violence, drug use and sexual practices.

                  Results

                  Findings indicated four cases of women being held hostage by a partner, with two women describing two separate hostage experiences. Women discussed partner jealousy, drug withdrawal symptoms, heightened emotional states from methamphetamine use, and escalating violent incidents as factors leading up to hostage-taking. Factors influencing lack of reporting incidents to law enforcement included having a criminal record, fear of partner retaliation, and intentions to terminate the relationship when the partner is incarcerated.

                  Conclusion

                  Educating women on the warning signs of hostage-taking within the context of methamphetamine use and promoting behaviour change among male perpetrators can contribute to reducing the risk of homicide. Furthermore, bridging the gap between health services and law enforcement agencies and providing comprehensive services that address the needs of methamphetamine-using women in violent relationships can prevent or minimize potential harm to vulnerable women.
                    Cover page: Live to tell: Narratives of methamphetamine-using women taken hostage by their intimate partners in San Diego, CA
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2023)
                    Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.
                      Cover page: Engagement of Sexual Violence Survivors in Research: Trauma-Informed Research in the THRIVE Study
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