Stephen Weiss - Academia.edu (original) (raw)

Papers by Stephen Weiss

Journal of Behavioral Medicine, 1979

This article compares behavioral and biological approaches to hypertension, highlights some of th... more This article compares behavioral and biological approaches to hypertension, highlights some of the practical, semantic, and theoretical issues involved, and attempts a constructive, behavioral medicine integration of these approaches. The major behavioral approaches to hypertension are described, with a focus on their conceptual limitations as stimulants to research into psychobiological mechanisms. A biobehavioral systems analysis of hypertension is outlined, emphasizing

International journal of sexual health : official journal of the World Association for Sexual Health, Jan 23, 2015

This cross-sectional study examined African American and Hispanic women's (N = 1,509) self-re... more This cross-sectional study examined African American and Hispanic women's (N = 1,509) self-reports of unwanted forced sex and its association with behavioral and mental health outcomes after the event. Twenty percent of the women had experienced forced sex (1st occurrence at age 15 years or younger for 10%, 1st occurrence at older than 15 years of age for 10%). Regardless of when forced sex 1st occurred, women were more likely to have engaged in unprotected vaginal and anal sex, to have had multiple unprotected sex partners, to have sexually transmitted infections, to have reported binge drinking and illicit drug use, and to exhibit distress and have received mental health counseling. Forced sex may have wide-ranging behavioral and mental health consequences years later.

Hispanic health care international : the official journal of the National Association of Hispanic Nurses, 2011

This study explored feelings and attitudes with regard to HIV and sexual health among 82 monoling... more This study explored feelings and attitudes with regard to HIV and sexual health among 82 monolingual Spanish-speaking, HIV-positive (n = 30) and at-risk women (n = 52), participating in the NOW en Español Project-a cognitive behavioral sexual risk-reduction intervention in Miami, Florida. Hispanic cultural values and beliefs, such as machismo, marianismo, and sexual silence, emerged throughout the intervention as important determinants of sexual behavior. Recommendations for integrating these culture-specific issues in sexual health interventions for Hispanic women are provided.

Health promotion perspectives, 2013

HIV in India is transmitted primarily by heterosexual contact. The present study sought to test t... more HIV in India is transmitted primarily by heterosexual contact. The present study sought to test the feasibility of a group HIV/STI risk re-duction intervention among heterosexual couples in India. Focus groups and key informant interviews were used in 2008 to cul-turally tailor the intervention. Thirty sexually active and HIV/STI negative cou-ples were enrolled and assessed regarding risk behavior and sexual barrier accept-ability. Gender-concordant group sessions used cognitive behavioral strategies for HIV/STI prevention. At baseline, male condom use was low (36%); no participants re-ported use of female condoms or vaginal gels. HIV knowledge was low; women had more HIV knowledge and more positive attitudes towards con-dom use than men. Post-intervention, willingness to use all barrier products (t = 10.0, P< .001) and intentions to avoid risk behavior increased (t = 5.62, P< .001). This study illustrates the feasibility of utilizing a group interven-tion to enhance HIV/STI r...

Translational behavioral medicine, 2011

Translational research can take many forms: bench to bedside, across cultural groups, across geog... more Translational research can take many forms: bench to bedside, across cultural groups, across geographical boundaries, among others. This case study will share how we addressed all three "translational" issues using two evidence-based studies (USA, Zambia) to illustrate these "roads less traveled." Our implementation and dissemination efforts were anchored by the "train the trainer" strategy, and the Glasgow RE-AIM model provided programmatic guideposts and direction. Keeping all stakeholders (scientific, community, political) involved in the implementation and dissemination process was an essential, perhaps determining factor in the success of the translation process.

Hispanic health care international : the official journal of the National Association of Hispanic Nurses, 2012

The objectives of this study were assessment of the prevalence of male circumcision (MC) among pa... more The objectives of this study were assessment of the prevalence of male circumcision (MC) among patients attending the Miami-Dade County (MDC) sexually transmitted diseases (STDs) clinic and exploration of attitudes of MC among Hispanic STD clinic attendees. Prevalence of MC was assessed by a review of 500 clinic records. Attitudes toward MC were explored during focus group sessions. The overall rate of MC was 27%. Men associated acceptability of MC with sexual performance, their partner's anticipated responses to MC, and scientific proof of STD protection; whereas women focused on experiences with previous partners and hygiene. We found a low rate of circumcision in males attending the MDC STD clinic. Approximately half of the Hispanic men and women in focus groups also found MC acceptable or desirable.

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2008

Low literacy and cognitive impairment have each been separately identified as risks for non-adher... more Low literacy and cognitive impairment have each been separately identified as risks for non-adherence in HIV infection. However, no studies to date have evaluated these skill deficits in combination. We therefore characterized the nature of literacy and cognitive skills in a sample of HIV-positive injecting drug users and assessed their combined effects on adherence. A community-recruited sample of 57 HIV-positive

International journal of women's health, 2011

THE PRINCIPAL OBJECTIVE OF THESE MULTISITE STUDIES (FLORIDA, NEW YORK, NEW JERSEY: epicenters for... more THE PRINCIPAL OBJECTIVE OF THESE MULTISITE STUDIES (FLORIDA, NEW YORK, NEW JERSEY: epicenters for human immunodeficiency virus [HIV] among women) was to develop and implement effective combinations of behavioral interventions to optimize the health status of the most neglected and understudied population affected by the acquired immunodeficiency syndrome (AIDS) epidemic in the United States: poor women of color living with HIV. The two studies enrolled nearly 900 women randomly assigned to "high intensity" (cognitive-behavioral stress management training combined with expressive-supportive therapy [CBSM]+ group) or "low intensity" (individual psychoeducational program) treatment conditions over a period of 9 years. The initial study of the stress management and relaxation training/expressive-supportive therapy (SMART/EST) Women's Project (SWP I) focused on reducing depression and anxiety, as well as improving self-efficacy and overall quality of life for wome...

Journal of the International Association of Providers of AIDS Care, Jan 20, 2014

Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were ... more Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were assessed regarding the knowledge and awareness of non-AIDS conditions associated with HIV infection. Questionnaires were administered before and after a brief information session on non-AIDS conditions associated with HIV infection. Participants included men (n = 46) and women (n = 51). Prior to the information session, at baseline, only 34% of the participants were worried about HIV infection. Most participants (82%) agreed that HIV could be treated with antiretroviral therapy (ART), while only 38% were aware that HIV-associated conditions cannot be easily treated with ART. After the information session, almost all participants reported they were concerned regarding the risk of HIV infection. High-risk patients may have limited knowledge about the consequences of HIV infection beyond the traditional AIDS-associated conditions. Increased awareness of these less known consequences of HIV ...

HIV/AIDS (Auckland, N.Z.), 2014

The objective of this pilot study was to explore the knowledge of and preferences regarding effec... more The objective of this pilot study was to explore the knowledge of and preferences regarding effective biomedical interventions among high risk individuals attending a sexually transmitted diseases clinic, and to examine the effect of a brief information intervention on preference. Participants completed a baseline assessment, attended a presentation on human immunodeficiency virus (HIV) prevention methods, and completed a postintervention assessment. Outcome measures included: demographics and sexual risk factors, self-perceived HIV risk, and knowledge and attitudes regarding new biomedical methods of HIV prevention. After the baseline evaluation, participants were provided with information on new biomedical prevention strategies. Participants were given the option to review the information by reading a pamphlet or by viewing a brief video containing the same information. Participants (n=97) were female (n=51) and male (n=46). At baseline, only a small minority of participants were aware of the newer biomedical strategies to prevent HIV infection. Postintervention, 40% endorsed having heard about the use of HIV medications to prevent HIV infection; 72% had heard that male circumcision can decrease the risk of acquiring HIV infection in men; and 73% endorsed knowledge of the potential role of microbicides in decreasing the risk of acquiring HIV. Following the intervention, the most preferred prevention method was male condoms, followed by preexposure prophylaxis, and microbicides. The least preferred methods were male circumcision and female condoms. This study provides preliminary information on knowledge and attitudes regarding newer biomedical interventions to protect against HIV infection.

Translational behavioral medicine, 2014

The scale-up of HIV treatment programs in sub-Saharan Africa necessitates creative solutions that... more The scale-up of HIV treatment programs in sub-Saharan Africa necessitates creative solutions that do not further burden the health system to meet global initiatives in prevention and care. This study assessed the work environment and impact of providing a behavioral risk reduction intervention in six community health centers (CHCs) in Lusaka, Zambia; opportunities and challenges to long-term program sustainability were identified. CHC staff participants (n = 82) were assessed on perceived clinic burden, job satisfaction, and burnout before and after implementation of the intervention. High levels of clinic burden were identified; however, no increase in perceived clinic burden or staff burnout was associated with providing the intervention. The intervention was sustained at the majority of CHCs and also adopted at additional clinics. Behavioral interventions can be successfully implemented and maintained in resource-poor settings. Creative strategies to overcome structural and econo...

Journal of the International Association of Providers of AIDS Care

Adherence to antiretroviral therapy (ART) is essential to optimize HIV treatment outcomes. Among ... more Adherence to antiretroviral therapy (ART) is essential to optimize HIV treatment outcomes. Among individuals on ART, targeted peer support has been found to support adherence. This study of Zambian heterosexual couples living with HIV examined whether partners would exert a positive influence on each other's adherence, and compared adherence between couples in which either one or both members were on ART. Couples (n = 446 participants), in which either or both member were on ART were assessed at baseline, 6 and 12 months. Most participants (64%, n = 263) were on ART; overall, uptake of ART increased to 74% at 12 months. At baseline, 76% reported near perfect adherence; at 6 and 12 months, 66% and 70% were adherent, respectively. A regression analysis indicated that the decline in adherence did not differ between those couples in which one or both partners were on ART [F (2, 624) = 0.37, p = .692]. Pairwise comparison indicated that adherence primarily decreased between baseline ...

International Journal of Behavioral Medicine, 2014

Sub-Saharan Africa has the highest global prevalence of HIV, and the prevention of transmission b... more Sub-Saharan Africa has the highest global prevalence of HIV, and the prevention of transmission between HIV-seropositive and -serodiscordant sexual partners is a critical component of HIV prevention efforts. Behavioral interventions that have demonstrated efficacy in reducing risk behaviors associated with HIV transmission and infection and have been translated, or adapted, to a variety of settings. This manuscript examined implementation of behavioral interventions within resource limited health care delivery settings, and their adoption and integration within service programs to achieve sustainability. The CDC/Partner Program, an evidence-based risk reduction intervention, was implemented in Community Health Centers (CHCs) in Zambia using a staged technology transfer process, the Training the Trainers Model. Provincial workshops and training workshops on the provision of the intervention were used to establish a cadre of trainers to provide on-site intervention facilitators capable of ultimately providing coverage to over 300 CHCs. CHC staff provided the intervention to clinic attendees in four provinces over 4 years while also training new facilitators. The implementation process addressed multi-level issues within the context of training, consultants, decision making, administration, and evaluation as well as practical considerations surrounding travel, training, staff compensation and ongoing quality assurance. The majority of challenges to implementation and maintenance were addressed and resolved, with the exception of structural limitations related to restricted resources for personnel and funding. Strengths of the program included its collaborative structure, active program leadership, commitment and support at the provincial level, the use of task shifting by existing clinic staff, the train the trainer model and ongoing quality control. Enhanced infrastructure is needed in for future implementation, such as training centers within each province, certified expert coaches and annual workshops and system changes to ensure available staff.

Journal of Psychosomatic Research, 2003

Objective: We tested the effects of a 10-week group-based cognitive–behavioral stress management/... more Objective: We tested the effects of a 10-week group-based cognitive–behavioral stress management/expressive–supportive therapy intervention (CBSM+) and a time-matched individual psychoeducational condition for 330 women with AIDS reporting moderate to poor baseline quality of life (QOL). The goal of this study was to examine treatment effects on total QOL and 11 QOL domains from baseline to post-intervention follow-up. Methods: Participants were

Journal of Global Infectious Diseases, 2012

Background: Sexually transmitted infections (STIs) remain an important public health issue in sub... more Background: Sexually transmitted infections (STIs) remain an important public health issue in sub-Saharan Africa. STIs in HIV-positive women are associated not only with gynecological complications but with increased risk of HIV transmission to HIV-negative partners and newborns. Aims: The aims of this study are to determine the prevalence of chlamydia (CT) and gonorrhea (GC) and examine the demographic characteristics and risk behaviors associated with these STIs in a group of HIV-positive women in Lusaka, Zambia. Settings and Design: Crosssectional study of a sample of HIV-infected women enrolled in two large studies conducted in urban Lusaka, Zambia. Materials and Methods: HIV-seropositive women (n = 292) were assessed for demographic and behavioral risk factors and tested for CT and GC. Univariate analysis was used to determine the demographic characteristics and risk behaviors associated with having CT or GC. Results: The identified prevalence of CT was 1% and of GC was 1.4%. There was an association of CT/ GC with the use of alcohol before sex (OR = 9.I, CI = 0.59-0.15, P = 0.03). Conclusions: Rates of CT and GC are described in this sample of HIV-positive women. While being in HIV care may serve to increase medical care and condom use, alcohol use should be addressed in this population.