Prevention of vertical transmission of HIV has evolved over the past two decades. Although public... more Prevention of vertical transmission of HIV has evolved over the past two decades. Although public health agencies advocate for male involvement in such interventions, their role in the prevention of vertical transmission of HIV remains limited. This study aims to explore the role of men in antenatal care and prevention of vertical transmission of HIV in the Gambella region of Ethiopia. The study was conducted among the Nuer and Anuak communities in Gambella region. Participants included female antenatal care attendees at two health centers, men who were husbands, local health extension workers of the catchment villages, and health care providers and managers. Data were collected using focus group discussions, in-depth interviews, and key informant interviews. Recordings were transcribed, coded, and analysed using thematic approaches. MAXQDA version 11 was used to facilitate data organization and reduction. Findings showed that men in Gambella are not expected to accompany their wive...
Background Resilience is a commonly used construct in substance use and mental health research. Y... more Background Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships. This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience. Methods WWUD-SS (N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). WWUD-SS were queried about re...
This study explored how mentoring begins and the benefits provided for African American sexual an... more This study explored how mentoring begins and the benefits provided for African American sexual and/or gender minority (SGM) youth. Participants were mentors and mentees living in three Mid-Atlantic cities. Mentees (ages 15–21, n = 14) identified as African American; cisgender male, transgender female, or non-binary assigned male; and had sexual interest in men. Mentor participants (ages 18+, n = 13) mentored such youth. Qualitative in-depth interviews were conducted with mentoring relationship partners (both partners did not necessarily participate). All interviews were audio-recorded, transcribed, and imported into Atlas.ti. Using a basic interpretive qualitative analysis, a codebook was developed through inductive and deductive techniques. Analysis focused on mentees’ and mentors’ descriptions and interpretations about how they formed a mentoring relationship and any observed benefits that arose. Themes showed mentoring relationships were formed through introductions via social ci...
Abstract: Despite increasing recent emphasis on the social and structural determinants of HIV-rel... more Abstract: Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the indi-vidual–structural spectrum, (2) to map out and compare the character-istics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly cont...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2021
Background: Sexual relationships among adolescent girls and young women (AGYW) are influenced by ... more Background: Sexual relationships among adolescent girls and young women (AGYW) are influenced by social, economic, and gender dynamics. Understanding AGYW's different relationship types and their implications for HIV risk is important for development of tailored interventions. We sought to identify relationship typologies among AGYW and their impact on uptake of HIV prevention interventions. Methods: From May 2018 to February 2019, 2200 HIV-negative AGYW (ages 16–24) in Johannesburg, South Africa, participated in an HIV prevention intervention involving distribution of HIV self-test kits to their male partners. AGYW were also offered pre-exposure prophylaxis. At baseline, AGYW completed a questionnaire, and outcomes were assessed for 3 months. We used latent class analysis to identify relationship types and mixture modeling to estimate the impact of relationship type on engagement in prevention interventions. Results: We identified 3 relationship types: “stable, empowered relati...
Background Mentoring can promote positive youth development. Owing to social and structural facto... more Background Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. Objective This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors’ knowledge of and confidence in talking about HIV prevention and related topics with mentees. Methods Following consent, ...
BACKGROUND Public health has begun using social media forums such as Reddit to enhance surveillan... more BACKGROUND Public health has begun using social media forums such as Reddit to enhance surveillance and modernize interventions for young people. The current study's objective was to examine Reddit posts about the HBO series Euphoria to identify show themes that resonate with adolescent and young adult viewers in order to inform future social media interventions. METHODS Reddit comments in the r/television community from June to August 2019 were downloaded. Following filtering, 725 comments were analyzed and coded using a codebook and ATLAS.ti. Coded comments were analyzed for themes relevant to Redditor substance use, reactions to Euphoria and the main character (Rue), and mental health concerns. RESULTS During their discussion of the show, Redditors disclosed both personal recreational and prescription drug use, including substance use to cope with mental illness symptoms. There were approximately equal numbers of comments with positive and negative reactions to the show overall and to the main character, Rue. Redditors often found Euphoria's storyline and portrayed events to be relatable and realistic to the experience of young people who use drugs, as well as sometimes triggering. Overall, Redditors thought Rue accurately depicted an individual's struggle with a substance use disorder. CONCLUSIONS This exploratory study highlights how television and social media can contribute to young peoples' understanding of substance use disorders and mental health. Findings could inform the design of social media interventions for adolescents and young adults on a variety of substance use issues, including stigma and the interconnectedness of substance use and mental health challenges.
Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are... more Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are inadequate, mostly due to the cost and burden of collecting in-person population-level estimates. High-income countries regularly use phone-based surveys, and with increasing mobile phone subscription in developing countries, mobile phone surveys (MPS) could complement in-person surveys in LMICs. We compared the representativeness and prevalence estimates of two MPS (i.e., interactive voice response (IVR) and computer-assisted telephone interview (CATI)) with a nationally representative household survey in Bangladesh–the STEPwise approach to NCD risk factor surveillance (STEPs) 2018. This cross-sectional study included 18-69-year-old respondents. CATI and IVR recruitments were done by random digit dialing, while STEPs used multistage cluster sampling design. The prevalence of NCD risk factors related to tobacco, alcohol, diet, and hypertension was reported and compared by prevalence dif...
Introduction Although interactive voice response (IVR) is a promising mobile phone survey (MPS) m... more Introduction Although interactive voice response (IVR) is a promising mobile phone survey (MPS) method for public health data collection in low- and middle-income countries (LMICs), participation rates for this method remain lower than traditional methods. This study tested whether using different introductory messages increases the participation rates of IVR surveys in two LMICs, Bangladesh and Uganda. Methods We conducted two randomized, controlled micro-trials using fully-automated random digit dialing to test the impact of (1) the gender of the speaker recording the survey (i.e., survey voice); and (2) the valence of the invitation to participate in the survey (i.e., survey introduction) on response and cooperation rates. Participants indicated their consent by using the keypad of cellphones. Four study arms were compared: (1) male and informational (MI); (2) female and information (FI); (3) male and motivational (MM); and (4) female and motivational (FM). Results Bangladesh and...
Objective: The association between explicit and implicit psychological measures might be affected... more Objective: The association between explicit and implicit psychological measures might be affected by the similarity of the assessment method and by the overlap of the components of the constructs being assessed. This study examined the association between condom use barriers and explicit and implicit measurements of condom use and the moderating role of sexual intercourse in these associations. Design: This was a cross sectional correlational study. An analysis of baseline data from a randomized controlled trial including 149 university students was included. Main measures: These included a questionnaire assessing condom use barriers, an implicit condom use test (a structured semi-projective test), and an explicit condom use question. Hierarchical regressions and correlations were examined in the full sample and by groups of participants with and without sexual intercourse. Results: In those without sexual intercourse, all barriers sub-scales were significantly and negatively correl...
Prevention of vertical transmission of HIV has evolved over the past two decades. Although public... more Prevention of vertical transmission of HIV has evolved over the past two decades. Although public health agencies advocate for male involvement in such interventions, their role in the prevention of vertical transmission of HIV remains limited. This study aims to explore the role of men in antenatal care and prevention of vertical transmission of HIV in the Gambella region of Ethiopia. The study was conducted among the Nuer and Anuak communities in Gambella region. Participants included female antenatal care attendees at two health centers, men who were husbands, local health extension workers of the catchment villages, and health care providers and managers. Data were collected using focus group discussions, in-depth interviews, and key informant interviews. Recordings were transcribed, coded, and analysed using thematic approaches. MAXQDA version 11 was used to facilitate data organization and reduction. Findings showed that men in Gambella are not expected to accompany their wive...
Background Resilience is a commonly used construct in substance use and mental health research. Y... more Background Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships. This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience. Methods WWUD-SS (N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). WWUD-SS were queried about re...
This study explored how mentoring begins and the benefits provided for African American sexual an... more This study explored how mentoring begins and the benefits provided for African American sexual and/or gender minority (SGM) youth. Participants were mentors and mentees living in three Mid-Atlantic cities. Mentees (ages 15–21, n = 14) identified as African American; cisgender male, transgender female, or non-binary assigned male; and had sexual interest in men. Mentor participants (ages 18+, n = 13) mentored such youth. Qualitative in-depth interviews were conducted with mentoring relationship partners (both partners did not necessarily participate). All interviews were audio-recorded, transcribed, and imported into Atlas.ti. Using a basic interpretive qualitative analysis, a codebook was developed through inductive and deductive techniques. Analysis focused on mentees’ and mentors’ descriptions and interpretations about how they formed a mentoring relationship and any observed benefits that arose. Themes showed mentoring relationships were formed through introductions via social ci...
Abstract: Despite increasing recent emphasis on the social and structural determinants of HIV-rel... more Abstract: Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the indi-vidual–structural spectrum, (2) to map out and compare the character-istics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly cont...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2021
Background: Sexual relationships among adolescent girls and young women (AGYW) are influenced by ... more Background: Sexual relationships among adolescent girls and young women (AGYW) are influenced by social, economic, and gender dynamics. Understanding AGYW's different relationship types and their implications for HIV risk is important for development of tailored interventions. We sought to identify relationship typologies among AGYW and their impact on uptake of HIV prevention interventions. Methods: From May 2018 to February 2019, 2200 HIV-negative AGYW (ages 16–24) in Johannesburg, South Africa, participated in an HIV prevention intervention involving distribution of HIV self-test kits to their male partners. AGYW were also offered pre-exposure prophylaxis. At baseline, AGYW completed a questionnaire, and outcomes were assessed for 3 months. We used latent class analysis to identify relationship types and mixture modeling to estimate the impact of relationship type on engagement in prevention interventions. Results: We identified 3 relationship types: “stable, empowered relati...
Background Mentoring can promote positive youth development. Owing to social and structural facto... more Background Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. Objective This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors’ knowledge of and confidence in talking about HIV prevention and related topics with mentees. Methods Following consent, ...
BACKGROUND Public health has begun using social media forums such as Reddit to enhance surveillan... more BACKGROUND Public health has begun using social media forums such as Reddit to enhance surveillance and modernize interventions for young people. The current study's objective was to examine Reddit posts about the HBO series Euphoria to identify show themes that resonate with adolescent and young adult viewers in order to inform future social media interventions. METHODS Reddit comments in the r/television community from June to August 2019 were downloaded. Following filtering, 725 comments were analyzed and coded using a codebook and ATLAS.ti. Coded comments were analyzed for themes relevant to Redditor substance use, reactions to Euphoria and the main character (Rue), and mental health concerns. RESULTS During their discussion of the show, Redditors disclosed both personal recreational and prescription drug use, including substance use to cope with mental illness symptoms. There were approximately equal numbers of comments with positive and negative reactions to the show overall and to the main character, Rue. Redditors often found Euphoria's storyline and portrayed events to be relatable and realistic to the experience of young people who use drugs, as well as sometimes triggering. Overall, Redditors thought Rue accurately depicted an individual's struggle with a substance use disorder. CONCLUSIONS This exploratory study highlights how television and social media can contribute to young peoples' understanding of substance use disorders and mental health. Findings could inform the design of social media interventions for adolescents and young adults on a variety of substance use issues, including stigma and the interconnectedness of substance use and mental health challenges.
Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are... more Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are inadequate, mostly due to the cost and burden of collecting in-person population-level estimates. High-income countries regularly use phone-based surveys, and with increasing mobile phone subscription in developing countries, mobile phone surveys (MPS) could complement in-person surveys in LMICs. We compared the representativeness and prevalence estimates of two MPS (i.e., interactive voice response (IVR) and computer-assisted telephone interview (CATI)) with a nationally representative household survey in Bangladesh–the STEPwise approach to NCD risk factor surveillance (STEPs) 2018. This cross-sectional study included 18-69-year-old respondents. CATI and IVR recruitments were done by random digit dialing, while STEPs used multistage cluster sampling design. The prevalence of NCD risk factors related to tobacco, alcohol, diet, and hypertension was reported and compared by prevalence dif...
Introduction Although interactive voice response (IVR) is a promising mobile phone survey (MPS) m... more Introduction Although interactive voice response (IVR) is a promising mobile phone survey (MPS) method for public health data collection in low- and middle-income countries (LMICs), participation rates for this method remain lower than traditional methods. This study tested whether using different introductory messages increases the participation rates of IVR surveys in two LMICs, Bangladesh and Uganda. Methods We conducted two randomized, controlled micro-trials using fully-automated random digit dialing to test the impact of (1) the gender of the speaker recording the survey (i.e., survey voice); and (2) the valence of the invitation to participate in the survey (i.e., survey introduction) on response and cooperation rates. Participants indicated their consent by using the keypad of cellphones. Four study arms were compared: (1) male and informational (MI); (2) female and information (FI); (3) male and motivational (MM); and (4) female and motivational (FM). Results Bangladesh and...
Objective: The association between explicit and implicit psychological measures might be affected... more Objective: The association between explicit and implicit psychological measures might be affected by the similarity of the assessment method and by the overlap of the components of the constructs being assessed. This study examined the association between condom use barriers and explicit and implicit measurements of condom use and the moderating role of sexual intercourse in these associations. Design: This was a cross sectional correlational study. An analysis of baseline data from a randomized controlled trial including 149 university students was included. Main measures: These included a questionnaire assessing condom use barriers, an implicit condom use test (a structured semi-projective test), and an explicit condom use question. Hierarchical regressions and correlations were examined in the full sample and by groups of participants with and without sexual intercourse. Results: In those without sexual intercourse, all barriers sub-scales were significantly and negatively correl...
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Papers by Michelle Kaufman