Medicine and Health Sciences Commons^™

Sheprep: Examining The Influence Of The Messaging And The Messenger Associated With Prep Uptake Among African American Women, Christian C. Spears

Electronic Theses and Dissertations

African American Women (AAW) make up less than 15% of the female population in the United States but account for over 50% of new HIV diagnoses among females. This largely preventable health disparity can be mitigated by advocating and prescribing Pre-exposure Prophylaxis (PrEP), a preventive HIV medication, to persons at risk. Despite advances in medication options, there are less than 13% of Black people who could benefit from having been prescribed PrEP, and limited research and promotion on the effectiveness of PrEP for AAW. The “ShePrEP Study” aimed to assess awareness, perceptions, and receptivity toward PrEP among AAW. This study …

Perspectives On The Use Of Molecular Hiv Data For Public Health, Margaret Watson

Electronic Theses and Dissertations

Background. Effective HIV treatment and pre-exposure prophylaxis can drastically reduce the risk of acquiring HIV and prevent most future transmission, but these advances are not accessible to many who could most benefit from them. Advances in use of molecular sequence data to inform prevention efforts, paired with supportive interventions, have the potential to identify clusters of rapid HIV transmission and focus prevention resources toward areas of highest need. Although molecular cluster detection has been successfully used in other areas of public health, advocates for people with HIV have raised concerns about the application of this approach because of HIV …

Investigating The Pi3k/Akt/Atm Pathway, Telomeric Dna Damage, T Cell Death, And Crispr/Cas9-Mediated Gene Editing During Acute And Chronic Hiv Infection, Sushant Khanal

Electronic Theses and Dissertations

Human Immunodeficiency Virus (HIV) infection initiates major metabolic and cell- survival complications. Anti-retroviral therapy (ART) is the current approach to suppress active HIV replication to a level of undetected viral load, but it is not a curative approach. Newer and sophisticated gene editing technologies could indeed be a potent antiviral therapy to achieve a clinical sterilization/cure of HIV infection. Chronic HIV patients, even under a successful ART regimen, exhibit a low-grade inflammation, immune senescence, premature aging, telomeric DNA attrition, T cell apoptosis, and cellular homeostasis. In this dissertation, we investigated CD4 T cell homeostasis, degree of T cell apoptosis, an …

Hiv And The African American Church: Millennial Faith Leader's Perspectives., Kelsey Leann Burton

Electronic Theses and Dissertations

African Americans are disproportionately impacted by HIV compared to other racial groups. Stigma surrounding HIV has created challenges for effective HIV prevention and stigma reduction programs. The African American church has been criticized for its slow and stigmatizing response to the HIV epidemic. Despite this, African American faith leaders play significant roles in guiding the perspective of the community. Numerous studies examine African American pastors’, faith leaders’, and ministers’ perspective about HIV and other HIV-related topics. However, there is no research that specifically examines young African American pastors’ perspectives of addressing HIV, stigma, and prevention. The purpose of this dissertation …

Std Prevention: An Educational Intervention For Exotic Dancers, Maria Delurdes Dehoyos

Electronic Theses and Dissertations

The Centers for Disease Control and prevention reported nearly 2.3 million STD cases diagnosed in 2017, and the number is continuing to rise. San Antonio, Texas, is ranked third in the state of Texas with the highest STD rates and leading in the state with congenital syphilis. There is an increased risk for contracting STDs working in the sex industry. There are little to no studies pertaining to any educational interventions offered to exotic dancers to increase personal knowledge on STDs. This research has focused on an educational intervention offered by a nurse practitioner to exotic dancers in two adults-only …

A Novel Approach To Hiv Prevention: Understanding Multi-Level Influences On Hiv Pre-Exposure Prophylaxis (Prep) Uptake And Outreach Among African Americans., Suur Debrah Ayangeakaa

Electronic Theses and Dissertations

This dissertation examined and provided basis for addressing factors related to HIV pre-exposure prophylaxis (PrEP) engagement, outreach, and uptake among high-risk African American youth groups in Louisville, KY. This qualitative dissertation study was designed through the lens of an interpretive framework of social constructivism which holds that multiple realities and interpretations exist and are socially constructed through the lived experiences of individuals and their interactions with others. Thus, lived experiences of various African American youth groups in Louisville as well as key informants of AIDS service organizations (ASOs) across the U.S. (including Louisville) were explored to develop a deeper understanding …

Electrospun Fibers And Nanoparticles For The Prevention Of Sexually Transmitted Infections., Kevin Michael Tyo

Electronic Theses and Dissertations

Human immunodeficiency virus-1 (HIV-1) and herpes simplex virus 2 (HSV-2) affect hundreds of millions of people worldwide, with women disproportionately impacted by these infections. Currently, only oral pre-exposure prophylaxis (PrEP) is approved specifically for the prevention of HIV-1, but is challenged with adverse side effects associated with long-term use. Topical delivery platforms, such as gels and films, deliver agents directly to the female reproductive tract, but are limited in providing transient-release. The technology of polymeric electrospun fibers may serve as alternative topical delivery platform to the female reproductive tract. In these studies, we fabricated electrospun fibers comprised of different polymers …

Role Of Atm In T Cell Dysfunction During Chronic Viral Infections, Juan Zhao

Electronic Theses and Dissertations

Hepatitis C virus (HCV) or human immunodeficiency virus (HIV) infection leads to a phenomenon of inflammaging, in which chronic infection or inflammation induces an immune aged phenotype with T cell dysfunction. Thus, HCV or HIV infection has been deemed as a model to study the mechanisms of T cell infammaging and viral persistence in humans. In this dissertation, T cell homeostasis, DNA damage and repair machineries were investigated in patients with chronic HCV or HIV infection at risk for inflammaging. We found a significant depletion in CD4 T cells, which was correlated with their apoptosis in chronically HCV/HIVinfected patients, compared …

Development Of A Lectin-Fc Fusion Protein With Antiviral And Anti-Cancer Activity., Matthew William Dent

Electronic Theses and Dissertations

This thesis describes the development of a novel lectin-Fc fusion protein and its antiviral and anti-cancer activity. The molecule, Avaren-Fc (AvFc), is a fusion of a variant of the actinomycete lectin actinohivin (Avaren) and the Fc region of human IgG1, and is selective for the terminal α1,2-mannose residues found at the ends of high-mannose-type glycans that can be found on the surface of certain heavily glycosylated viruses and cancer cells. Here, AvFc was found to be able to neutralize simian immunodeficiency virus as well as Hepatitis C virus with nanomolar IC₅₀ values. Furthermore, AvFc recognizes a number of cell …

Stigma In The Post Crisis Age: External Barriers To Accessing Hiv Treatment, Internalized Trauma, And Strategies Of Support In Orlando, Florida, Julian Cerrell Nilsson

Electronic Theses and Dissertations

In 2017, The CDC (center for disease control and prevention) released a memo confirming popular medical opinion that an HIV positive person with an undetectable viral load was unable to transmit the HIV virus. While treatment and prevention options are advancing, this advancement may not translate directly into reduced stigma, which is produced and reproduced by external barriers to accessing healthcare, and internalized by HIV positive people as emotional trauma. This research explores the relationship between the availability of contemporary resources for the treatment and prevention of HIV/AIDS, and the environment of stigma experienced by positive gay and bisexual men …

Hiv Integrase Inhibitor Pharmacogenetics And Clinical Outcomes: An Exploratory Association Study, Derek E. Murrell

Electronic Theses and Dissertations

As HIV is now primarily a chronic condition, treatment is given life-long with changes as necessitated by alterations in tolerability and efficacy. Thus, personalized medicine may be useful in the prevention of unnecessary drug exposure and avoidable side effects. Three of the four currently available HIV integrase strand transfer inhibitors (INSTIs), raltegravir, elvitegravir, and dolutegravir, are widely utilized antiretrovirals in the USA and exhibit variations in outcomes among subjects. To interrogate differences among subjects receiving these drugs, we investigated the association of several single nucleotide polymorphisms (SNPs) with drug exposure, clinical outcomes, and subject-reported adverse events. HIV+ adults (≥18 years …

Hiv-Related Knowledge, Attitudes, And Behaviors In Two Low Resource Settings, Candice Lynn Collins

Electronic Theses and Dissertations

Two Human Immunodeficiency Virus (HIV) outbreaks occurred almost simultaneously in the United States (US) (2014-2015) and in Cambodia (2015). Information is lacking on HIV-related knowledge, stigmatizing attitudes, and high-risk behaviors (KAB) among the general population, which may affect the transmission of HIV and lead to outbreaks. The current study aimed to: 1) assess KAB among the general population in a high-risk county in the US, 2) analyze KAB among the general population of Cambodia, and 3) compare KAB across samples from a high-risk county in Northeast Tennessee and a province in Cambodia. Tennessee data were collected in 2017 and Cambodian …

Exploring Psychosocial Factors And Sexual Risk Behavior Of Men Who Have Sex With Men In The United States Military: Project Minds, Erin Jordan

Electronic Theses and Dissertations

Statement of the Problem: Men who have sex with men (MSM) are at disproportionate risk for HIV infection. While many studies have examined psychosocial factors associated with HIV risk among MSM, few have focused specifically on MSM in the military. The purpose of this exploratory study is to examine ways in which specific psychosocial factors are associated with sexual risk behaviors among MSM in the military.

Methods: Data were collected from 63 MSM who were active duty military personnel or veterans in the Southeastern US. Participants were recruited from geosocial mobile applications, social media platforms, and military LGBT organizations. Logistic …

The Stigma Effect: The Role Of Internalized Racism And Internalized Homophobia In Risky Sexual Behavior Among Black Gay Men, Darren Lovell Whitfield

Electronic Theses and Dissertations

Black gay, bisexual, queer, and same-gender-loving (GBQSGL) men account for less than 1% of US population, yet account for 36% of all new HIV infections. While, Black GBQSGL men experience higher rates of HIV infection compared to other gay, bisexual, and men who have sex with men (MSM) from other racial groups, they are no more likely to report engaging in condomless anal sex (CAS). These findings suggest that one possible explanation is that the context of sexual behavior for Black GBQSGL men may be riskier because of the prevalence of HIV in the community. Furthermore, research suggests that racism …

The Influence Of Race And Gender On Hiv Risk Behaviors In High School Students In The Southern States Of The United States, Malendie T. Gaines

Electronic Theses and Dissertations

The incidence of the Human Immunodeficiency Virus (HIV) is highest in the southern states of the United States (US), with adolescents in this region being one of the most affected populations in the country. A limited amount of information is available on adolescent HIV risk behaviors in the southern states, specifically focusing on race and gender. The purpose of this study was to use the Centers for Disease Control and Prevention’s National Youth Risk Behaviors Survey (YRBS) for high school students in the southern states for 2011 and 2013 to examine the influence of race and gender on 1) early …

Evaluation Of A Quality Management Initiative And Hiv Ambulatory Services Performance In Thailand, Meemon Natthani

Electronic Theses and Dissertations

The accomplishment of pilot implementation of the HIVQUAL-T model, an innovative HIV care quality management tool, has led to an authoritative decision to scale up the use of the model nationwide in Thailand. However, the level of implementing this model varies across target hospitals. Some hospitals have fully adopted the model by conducting quality improvement (QI) activities following performance measurement (PM) results while others have partially adopted only PM or have not used this model at all. The differential level of implementation could be a contributing factor accounting for discrepancies in the quality of care across different HIV ambulatory care …

Trends In International Compulsory Licensing Of Pharmaceuticals Since The Institution Of The Trade-Related Aspects Of Intellectual Property Protection (Trips) Agreement, Reed F. Beall

Electronic Theses and Dissertations

The Trade-related Aspects of Intellectual Property Rights (TRIPS) Agreement went into effect for World Trade Organization (WTO) members in 1995. The agreement defines minimum standards of patent protection that must eventually be observed by all signatories. TRIPS includes "compulsory licensing", a policy that allows for states under certain conditions to permit the use of a patented innovation without the consent of the patent holder. This paper considers instances of compulsory licenses (CLs) aimed to increase access to pharmaceuticals during urgent public health scenarios. The WTO maintains no registry of CLs; therefore, this research is an effort to catalog as many …

Retrocyclin Rc-101 Overcomes Cationic Mutations On The Heptad Repeat 2 Of Hiv-1 Gp41, Christopher Fuhrman

Electronic Theses and Dissertations

Retrocyclin RC-101, a θ-defensin with lectin-like properties, potently inhibits infection by many HIV-1 subtypes by binding to the heptad repeat (HR)-2 region of gp41 and preventing six-helix bundle formation. In the present study, we used in silico computational exploration to identify residues of HR2 that interacted with RC-101 and then analyzed the HIV-1 Sequence Database at LANL for residue variations in the HR1 and HR2 segments that could plausibly impart in vivo resistance. Docking RC-101 to gp41 peptides in silico confirmed its strong preference for HR2 over HR1, and implicated residues crucial for its ability to bind HR2. We mutagenized …

Hiv Tat Protein Activates Endothelial Cells Through Nfκb And Map Kinase Pathways., Jason L. Henry

Electronic Theses and Dissertations

HIV infection has been shown to predispose patients to accelerated development of heart disease. One mechanism for this pathology may involve endothelial activation either by HIV itself or by its secreted proteins, gp120 (a viral envelope protein) and tat (a protein that upregulates transcription of viral genes). We have studied the effects of gp120 and tat on signaling and production of inflammatory cytokines by Human Pulmonary Artery Endothelial Cells (HPAEC). HPAEC were stimulated at varying time points with combinations of gp120, tat, and monokines (IL-1β and TNFα). Cell lysate fractions were analyzed for MAP Kinase activity and NFκB activation, and …