Medicine and Health Sciences Commons^™

Hiv-Related Stigma, Sexual And Gender Minority-Related Stigma, And Health Outcomes Among Msm Living With Hiv: Measurement, Impact, And Intersectionality, Tianyue Mi

Theses and Dissertations

Background: Many men who have sex with men (MSM) living with human immunodeficiency virus (HIV) experience suboptimal health outcomes compared to nonMSM males living with HIV, including a faster decline in CD4 count before initiating antiretroviral therapy (ART), slower immune recovery after initiating ART, more mental health problems, suboptimal ART adherence, and lower retention in care. MSM living with HIV are often exposed to multiple layered stigmas, including, but not limited to, stigma related to being infected with HIV and stigma related to sexual and gender minority (SGM) status. Although various scales of HIV-related stigma have been frequently used for …

Use Of Mobile Phones For Hiv Prevention And Testing Information Needs By Emerging Adult Male Population In Rural Kenya. A Qualitative Study, Augustine Boswony Kiplagat

Theses and Dissertations

Human Immunodeficiency virus (HIV) and Acquired Immunodeficiency disease syndrome (AIDS) among young people in Sub-Saharan Africa (SSA) is a serious public health issue which needs urgent cost-effective interventions locally, regionally, and internationally. HIV and AIDS is currently the leading cause of death among young people in SSA, calling for strategic HIV prevention approaches applicable to emerging adults. While most studies have focused on young women, studies focusing on emerging male adults are lacking. The purpose of this dissertation study was to develop an in-depth understanding of the needs, barriers, and facilitators of using mobile phone to access HIV prevention and …

Applying Health Stigma Framework To Examine The Mechanisms Of Hiv-Related Stigma On Clinical Outcomes, Chengbo Zeng

Theses and Dissertations

Background: HIV clinical outcomes including CD4 count, viral suppression, and health-related quality of life (HRQoL), are important indicators reflecting immunologic functioning, treatment efficacy, and overall health quality. However, due, in part, to HIV-related stigma, many people living with HIV (PLWH) experience suboptimal clinical outcomes. The Health Stigma Framework introduced the potentially distinct mechanisms underlying internalized, anticipated, enacted stigma and health outcomes through psycho-behavioral pathways. Based on this framework, this dissertation investigated the impacts and mechanisms of HIV-related stigma on clinical outcomes among PLWH in Guangxi, China from a longitudinal perspective. Methods: Data at baseline, 6-, 12-, 18- month follow-ups …

Evaluation Of A Clinic-Based Peer Navigation Program (Pnp) For African Americans Living With Hiv In South Carolina, Kimberly Butler Willis

Theses and Dissertations

Peer navigation programs have been identified as a potential motivator in care engagement and retention for patients living with HIV, although the data is inconsistent. HIV management requires important disease management considerations and innovative approaches for patient care. Medication advancements and technology have drastically improved care for most patients living with this chronic disease; yet African Americans contract, live with, and die because of HIV-related complications at disproportionately higher rates compared to their White peers.The purpose of this exploratory mixed-methods outcome evaluation is to: (1) determine if peer navigation is a viable intervention to improve three key HIV care metrics: …

Aging With Hiv In The United States: Trends And Impact Of Hospital Stays On Inpatient Resource Utilization, And Costs Of Care, 2003-2015, Khairul Alam Siddiqi

Theses and Dissertations

Background:

Due to advances in Antiretroviral Therapy (ART), people living with HIV (PLWH) live longer in the United States. Aging prolongs exposure to HIV and antiretroviral drugs, which could lead to an elevated risk of developing multiple age-related comorbidities [HIV Associated Non-AIDS (HANA) conditions], earlier for PLWH. Higher comorbidity burdens among older PLWH may require greater use of inpatient care, i.e., higher hospitalization, inpatient resource utilization, and costs. This study examined the trends and characteristics of comorbidities, resource utilization, and costs of hospital stays with HIV (HSWH) compared to hospital stays without HIV (HSWOH). We also assessed trends for resource …

Women’S Socio-Economic Empowerment And Uptake Of Hiv Testing In Ethiopia, Dawit Alemu

Theses and Dissertations

Introduction: Sub-Sahran Africa constitute two-thirds of all people living with HIV in the world. HIV infection rate is high in the continent with women comprising 56% of new HIV infections among adults 15 and older. Women 15 to 24 are the most affected constituting 66 % of new infections occurring among this age group. The purpose of this study was to examine how gender power relations between men and women affect health seeking behavior, particularly HIV testing, among Ethiopian women age15 to 49.

Methods: The Ethiopian Demographic and Health Survey (EDHS) from 2016 served as the data source for …

Hiv Care Location: An Evaluation Of Single Versus Multi Facility Utilization Of Hiv/Aids Care Services And Patient Health Outcomes And Clinical Indicators In South Carolina, Melanie Gwynn

Theses and Dissertations

Background: On the HIV/AIDS care continuum, the “retention in care” metric does not distinguish between single-facility (SF) or multi-clinic utilization (MC), also described as HIV care location (or type). SF utilization is vital as it has been linked optimal clinical outcomes among People Living with HIV/AIDS (PLWH). Published research detailing the prevalence of HIV care type and its association with health outcomes/clinical indicators, has been studied only in limited urban settings. Additionally, coinfections such as sexually transmitted infections (STIs), have yet to be evaluated as potential predictive factors for HIV care type.

Methods: A cross-sectional design was used …

Effects Of Human Dopamine Transporter (Dat) Mutations And Novel Allosteric Modulatory Compounds In Disrupting Hiv-1 Tat-Dat Protein Interaction, Pamela Marie P. Quizon

Theses and Dissertations

More than 37 million people are living with HIV worldwide. Despite the widespread use of antiretroviral therapy (ART), up to 70% of HIV-positive individuals suffer from cognitive and behavioral deficits collectively known as HIV-associated neurocognitive disorders (HAND). HIV-mediated damage to the dopaminergic system is a mediating factor in HAND. Dopamine (DA) transporter (DAT)-mediated reuptake is essential for maintaining DA homeostasis. Because most ART cannot efficiently cross the blood-brain barrier (BBB), the brain serves as a viral reservoir that facilitates the spread of infection to microglia and astrocytes. Infected cells shed viral proteins such as Tat, which plays a critical role …

Pre-Exposure Prophylaxis (Prep) For Hiv Prevention: A Mixed-Methods Study Of Sexual Risks And Knowledge, Perceptions, And Willingness Of Prep Use Among African American Women In The South, Jamie Troutman

Theses and Dissertations

There are approximately 1.1 million people living with HIV in United States, with nearly 40,000 new diagnoses annually. Significant regional and racial disparities are associated with HIV diagnoses — with the South experiencing the greatest burden of HIV and African American women accounting for 60% of new diagnoses among women. Pre-exposure prophylaxis (PrEP) has been designated as an effective tool to prevent HIV transmission among individuals who may be at risk of HIV infection. Earlier PrEP research has focused mainly on at-risk groups such as men who have sex with men (MSM). Previous PrEP research involving African American women included …

Cellular Mechanisms By Which Alcohol Promotes Hiv Protease Inhibitor-Induced Hepatotoxicity, Michael Hinton

Theses and Dissertations

CELLULAR MECHANISMS BY WHICH ALCOHOL PROMOTES HIV PROTEASE INHIBITOR-INDUCED HEPATOTOXICITY

Michael Hinton, B.S.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2019

Major Director: Huiping Zhou

Professor, Department of Microbiology and Immunology

The development of highly-active-antiretroviral therapy(HAART) has allowed management of HIV and extended the lives of those infected. Alcohol abuse, which is very common in HIV-1 infected patients, is one of the most important co-morbid risk factors for liver injury and has been associated with the occurrence of serious metabolic syndrome and subsequent discontinuation …

Developing An Evidence-Based Hiv Testing Message For Young African American Women, Melanie P. Moore

Theses and Dissertations

African American women have the highest rates of HIV infection among women of all racial/ethnic groups in the United States, and over 50% of HIV infected young adults are unaware of their infection. HIV testing is a cost-effective mechanism for reducing HIV transmission. Despite this, limited research has been devoted to developing interventions specifically promoting HIV testing. This two-part study proposed to address this gap through developing a culturally tailored HIV testing message aimed at increasing HIV test intentions among young African American women. Study 1 was a quantitative study that examined predictors of HIV testing history and future HIV …

Hiv In The United States: A Spatial Examination Of Testing And Outcomes, Sazid Shameem Khan

Theses and Dissertations

The main objectives of this dissertation were to provide a complete depiction of the prevalence of HIV across the United States and to assess HIV testing trends among various subpopulations. Additionally, we focused on measuring spatial access to HIV testing resources across the U.S. South, where HIV is rapidly becoming more burdensome and resources have historically been allocated disproportionately. We sought to identify disparate populations and locations that require further focus moving forward to stem the HIV epidemic. We utilized a variety of data sources such as the Behavioral Risk Factor Surveillance System (BRFSS) which was used to assess national …

The Association Between Sexual Risk Behaviors Of Latinos And Hiv Knowledge In South Carolina, Danielle Nicole Sill

Theses and Dissertations

HIV/AIDS inordinately impacts Hispanics/Latinos, which are the fastest growing minority group in the United States. 16,222 South Carolinians are infected with HIV, with 70 new cases being diagnosed each month. Few studies have been conducted to determine if HIV knowledge is associated with sexual risk behaviors in South Carolina. Bilingual/bicultural interviewers conducted a survey of Latinos living in the Pee Dee and Midlands regions of South Carolina. The survey consisted of questions regarding demographic characteristics, HIV knowledge, and sexual risk behaviors. We enrolled 203 participants in which 193 were eligible for our study (97 females and 96 males). We hypothesized …

The Utility Of Mobile Phones For Health Among Women Living With Hiv In Urban Malawi, Linda Marie Dietrich

Theses and Dissertations

The use of mobile phones are becoming ubiquitous with growing interest by healthcare providers to utilize mobile phone technology for various health-related applications, called mHealth. This is especially true in low-income countries such as those in sub-Saharan Africa. When implementing mHealth applications, it is important to understand the dynamic social, cultural and environmental factors where mHealth will be implemented to ensure that interventions developed are effective. A qualitative study to explore the sociotechnical factors experienced by women participating in an HIV support group in urban Malawi was conducted to enhance our understanding of women’s experience with mobile phone use and …

Age-Associated B Cell And T Helper Cell Dysfunction In Rhesus Macaques, Evan Knox Stalvig

Theses and Dissertations

The immune system undergoes drastic changes as we age, known as immunosenescence. An example of this is the dysfunction and subpopulation distribution changes of immune cells. Due to immunosenescence, the elderly have a higher risk of complications and rapid progression of new challenges to the immune system, including human immunodeficiency virus (HIV). In an effort to determine the mechanism of dysfunction of humoral immunity due to age, I compared B cell and T cell responses to non-specific, mitogenic stimuli between aged and young adult rhesus macaque peripheral blood mononuclear cells (PBMCs). Analysis by flow cytometry revealed several differences in B …

Functional And Phenotypic Analysis Of B- And T-Helper Cells In Rhesus Macaques And African Green Monkeys, Sahar Ali Alhakeem

Theses and Dissertations

Human immunodeficiency virus (HIV) is one of the most challenging infectious agents at the current time. To date, many vaccine trials have been conducted. However, there has not been a fully successful trial. This is due, in part, to the gap in knowledge of the protective immune response against HIV. African green monkeys (AGMs) serve as an interesting model to study immune protection in primate immunodeficiency virus infections due to their resistance to AIDS. Experimental SIV infection in rhesus macaques (RMs) resembles HIV infection in humans with chronic immune activation and progression to AIDS well characterized in both. Understanding the …

Enhancement Of The Placental Transmission Of Lopinavir Using A Transporter Targeted Prodrug Strategy, Meng Wang

Theses and Dissertations

Lopinavir (LPV) is a potent protease inhibitor specific for HIV-1. However, LPV has poor placental penetration due to substrate activity for efflux transporter by P-glycoprotein (P-gp). Since fatty acid transporters are highly expressed in the placenta during pregnancy, we designed fatty acid ester prodrug of lopinavir as substrates of fatty acid transporter in order to improve their uptake into placenta. Seven dicarboxylic acid esters of lopinavir have been made in our lab. The structures were characterized by ¹H-NMR, ¹³C-NMR, LC-MS/MS, HRMS, IR and melting points. After making the prodrugs, an LC-MS/MS method with high specificity and sensitivity, as …

The Influence Of Self-Reported Degree Of Masculinity/Femininity On Condom Use Among Black Men Who Have Sex With Men In The Deep South, Elizabeth D. Peeler

Theses and Dissertations

In the United States, 50,000 Americans are diagnosed with HIV each year (CDCa, 2014). The HIV/AIDS epidemic has had a particularly devastating impact on the southern U.S., especially the Deep South – Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina (Reif, Whetten, Wilson, McAllaster, Pence, Legrand, & Gong, 2014). The Deep South, while only composing of 36% of the national population, accounts for 50% of all people living with HIV/AIDS in the nation (Human Rights Watch, 2010). No other population has been hit harder than men who have sex with men (MSM; Prejean, Tang, & hall, 2013). Black MSM …

Women’S Hiv Prevention Study (Whips): A Proposal To Pilot Test An Hiv Intervention For Older African American Women Living With Hiv, Charsey Cherry

Theses and Dissertations

Despite improvements in treatments over the past 30 years, HIV /AIDS continues to be a major public health threat, particularly among sub-populations such as African American women. Midlife and older adults (those aged 40 years and over) are fast becoming a growing concern for HIV/AIDS infections, particularly older African American women. There has been limited research targeting midlife and older African American women living with HIV that aimed to reduce their transmission of HIV and promote them becoming prevention advocates. In response to this gap in the literature, a culturally tailored intervention guided by the IMB Model of behavior change …

What Inez Knows: A Qualitative, Longitudinal Case Study Of One Woman's Journey Through The Maze Of Living With Hiv And A Serious Mental Illness, Linda Austin

Theses and Dissertations

WHAT INEZ KNOWS: A QUALITATIVE, LONGITUDINAL CASE STUDY OF ONE WOMAN'S JOURNEY THROUGH THE MAZE OF LIVING WITH HIV AND A SERIOUS MENTAL ILLNESS

by

Linda Austin

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Professor Patricia E. Stevens

Although more than thirty years have passed since AIDS was first diagnosed in the U. S., the HIV/AIDS epidemic continues and the prevalence and incidence statistics remain alarming. Twenty-five percent of the people living with HIV in the United States are women, but only half of these women are in care and even fewer women (42%) have viral suppression. Women …

The Role Of P2x Receptors In Hiv And Opiate-Related Neurotoxicity, Mary Sorrell

Theses and Dissertations

Emerging evidence suggests that opioid drugs can exacerbate neuroAIDS. Microglia are the principal neuroimmune effectors thought to be responsible for neuron damage in HIV-infected individuals, and evidence suggests that drugs acting via opioid receptors in microglia aggravate the neuropathophysiological effects of HIV. The P2X family of ATP activated ligand-gated ion channels regulates key aspects of microglial function. In addition, opioid-dependent microglial activation has been reported to be mediated through P2X4 signaling, prompting us to investigate P2X receptors contribution to the neurotoxic effects of HIV and morphine. In vitro experiments showed treatment with TNP-ATP prevented the neurotoxic effects of morphine and/or …

Hiv And Opiates-Mediated Neurotoxicity: Gsk3Β Is A Potential Therapeutic Target, Ruturaj Masvekar

Theses and Dissertations

HIV-1 enters the CNS soon after initial systemic infection. HIV-1 can induce a wide range of neurological deficits, collectively known as HIV-1-associated neurocognitive disorders (HAND). Mature neurons are not infected by HIV-1; instead, infected and/or activated glial cells release various viral and cellular factors that induce direct and/or indirect neuronal toxicity, leading to HAND. Injection drug abuse is a significant risk factor for HIV-infection, and opiate drug abusers show increased HIV-neuropathology, even with anti-retroviral treatments. Our previous work has largely modeled HIV-neuropathology using the individual viral proteins Tat or gp120, with murine striatal neurons as targets. To model disease processes …

Gay Men And The Intentional Pursuit Of Hiv, Thomas James Loveless

Theses and Dissertations

Hidden deep within the gay male underground lives a small population of gay men who imagined the intentional pursuit of HIV as a means to some end. In terms of nursing care for such marginalized pockets of gay men, most nurses are unaware of their existence or lack sufficient knowledge and compassion to care for this population. Bug chaser is a metaphor used to describe the gay men who intentionally sought the bug--HIV infection. Essential to caring for these men is first discovering them, and then understanding them.

The purpose of this narrative study was to understand the life experiences …

Development Of Antagonists Targeting Chemokine Receptor Ccr5 And The Chemokine Receptor Ccr5 – Mu Opioid Receptor Heterodimer, Christopher Kent Arnatt

Theses and Dissertations

The chemokine receptor CCR5 (CCR5) plays an integral role within the inflammatory network of cells. Importantly, CCR5 is a mediator in several disease states and can be targeted using small molecule antagonists. Within this work, CCR5’s role in prostate cancer and HIV/AIDS has been exploited in order to develop potential therapeutics and probes. First, a series of novel compounds was designed by using pharmacophore-based drug design based upon known CCR5 antagonists and molecular modeling studies of the CCR5 receptor’s three-dimensional conformation. Once synthesized, these compounds were tested for their CCR5 antagonism and their anti-proliferative effects in several prostate cancer cell …

Bmi At Diagnosis And Its Association With Markers Of Hiv Disease Progression And Cardiovascular Disease Risk., Kelly Deshon Johnson

Theses and Dissertations

Highly active antiretroviral treatment (HAART) has transformed the state of human immunodeficiency virus (HIV) from acute to chronic. As a result, the long-term effect of HAART has caused weight gain among HIV-infected individuals, leading to an increased prevalence of overweight and obesity. Increased Body Mass Index (BMI) has been associated with adverse health outcomes in non-HIV and HIV populations, yet among HIV-infected individuals, a higher BMI at diagnosis offers a slower progression from HIV to AIDS. Pre-HAART, studies reported that obese HIV-infected individuals have higher increases in CD4 count over time. However post-HAART, some report that overweight HIV-infected individuals with …

Living With Hiv: Views Through The Blog, Linda Eastham

Theses and Dissertations

The purpose of this qualitative descriptive study was to develop a greater clarity of how HIV infected individuals live and work within the sphere of HIV infection as represented through unsolicited, personal narratives posted on blogs. Existing, single author, personal blogs were identified via a search engine. Blogs were defined as the blog author's postings and all responses, whether written by the blog author or a reader respondent. Inclusion and exclusion criteria were developed to respect indicators of bloggers' intentions for privacy, e.g., blogs which required a password were excluded. A total of 14 blogs met inclusion criteria. Actions to …

Regional Heterogeneity And Diversity Of Astrocytes In Response To Hiv-1 Proteins And Morphine, Wen Chen

Theses and Dissertations

HIV-infected individuals who abuse opiates have been found to have a higher incidence and a faster progression of HIV encephalitis. Astrocytes, the major support cells in the CNS, are known to play a critical role in the HIV neuropathy. Although astrocytes tend not to be productively infected by the HIV-1 virus, dysregulation of their pro- and anti- inflammatory cytokines/chemokines secretion is usually neurotoxic. Glutamate transport in astrocytes is reported to be impaired as well, which result in extrasynaptic excitatory neurotransmitter accumulation and over stimulation of postsynaptic neurons. It is long known that astrocytes from different brain regions have diverse responses …

Machismo As A Determinant For Hiv/Std Risk Behavior Among Latino Msm, Jacqueline L. Sears

Theses and Dissertations

Objective: Male-to-male sexual contact is the most common mode of transmission for HIV among Latino men. Psychosocial factors such as machismo, homophobic discrimination, and internalized homophobia have been hypothesized to greatly impact sexual behaviors among Latinos. However, studies investigating the relationship between these psychosocial factors and risky sexual behaviors are limited. This study examined the impact of machismo on risky sexual behaviors among Latino Male who have Sex with Men (MSM).Methods: This study utilized data collected from 254 Latino MSM in 1999 from selected cities within Virginia. The analysis focused on respondent demographic characteristics, psychosocial factors, acculturation, and sexual risky …

Lack Of Knowledge Of Mother-To-Child Transmission In Kenya Among Women Ages 15-49, Nisha Warrier

Theses and Dissertations

Purpose: The epidemic of mother-to-child transmission (MTCT) of HIV/AIDS in resource-poor countries is dramatic; it is responsible for nearly 90% of childhood infections. The primary purpose of analysis was to understand the distribution of factors and their association with lack of knowledge of MTCT in Kenya. In parallel, another aim was to identify the relationship between media, particularly frequency of radio exposure, and lack of knowledge.Methods: This study used the 2003 Kenya Demographic and Health Survey (DHS) collected for 8,195 women, ages 15-49. Descriptive analysis, univariate analysis, and logistic regression were completed on SPSS 14 software.Results: In the sample, 1151 …

Factors Associated With High Sexual Risk Behavior In Single Women, Thomas B. M. Leecost

Theses and Dissertations

Objective: This study was to identify factors associated with High Sexual Risk Behavior (HSRB) in single Afro American women seen in an Epidemiology/Sexual transmitted disease (EPID/STD) Clinic in Richmond, Virginia from January 2006 through April 2006.Method: Participants were 154 single women (no history of marriage) between the ages of 18-30 visiting the EPID/STD clinic for the first time.Demographic information was obtained from their records. A volunteer interview was given that contained 101 variables to evaluate for High Sexual Risk Behavior (HSRB). HSRB was defined to response 'yes' to the question, "During the past 3 months did you have sex with …