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African-born immigrants and refugees have HIV infection rates six times higher than any other min... more African-born immigrants and refugees have HIV infection rates six times higher than any other minority groups in the United States. Despite the increase in the population size and diversity of Somali immigrants and refugees in the United States, Somalis are one of the medically underserved population subgroups in this region. The lack of aggregate HIV infection rates among African-born immigrants, for example, Somali refugees, is a cause for alarm and calls for more research to be conducted in this subgroup. The purpose of this article was to examine contextually relevant HIV prevention strategies that will enhance HIV prevention among Somali immigrant/refugee young adults in the United States. Using the grounded theory approach, a convenience sample of 27 immigrant/refugee young adults was recruited in central Ohio. Recommendations for potential HIV prevention strategies emerged under two main categories: (1) internal community resources and (2) external platforms. Study findings support a collaborative approach involving community leaders (parents, elders, religious leaders) and educational (schools), media, and healthcare settings to tailor HIV prevention strategies that meet the needs of the priority group.

Despite the high prevalence of risky sexual behavior among college students, HIV risk perception ... more Despite the high prevalence of risky sexual behavior among college students, HIV risk perception in this population remains low. Overall, there is a dearth of studies examining HIV risk perception among college students. We examined HIV risk perception among college students at a University in the Midwest. Students enrolled in undergraduate and graduate courses were recruited for this pilot study (n = 200). The outcome of interest was perceived HIV risk perception. Descriptive and inferential statistical analyses were utilized to examine the association between HIV risk perception and four measures namely: perceived severity of/susceptibility to HIV, perceived benefits of safe sex, perceived barriers to safe sex and self-efficacy, measured using validated instruments. Overall, greater proportion of students perceived that they are not at risk of HIV infection (81.5 %). Participants had high scores for all measures, except for perceived barriers to safe sex [mean score (standard deviation) 24.5 (15.3)]. The multivariable model showed a statistically significant negative association between composite severity of/susceptibility to HIV/AIDS score and moderate perceived HIV risk (OR, 95 % confidence interval) (0.96, 0.93–0.99, p = 0.04). In addition, the odds of having moderate perceived HIV risk were higher among students who currently have a dating partner compared to students who currently do not have a dating partner (3.19, 1.24–8.18, p = 0.01). College level HIV prevention efforts should continue to address HIV risk. Additional research examining risk perception in a much larger, and more diverse, student population is needed.

ABSTRACT In Kenya, there was a reported decline in HIV incidence and prevalence among those aged ... more ABSTRACT In Kenya, there was a reported decline in HIV incidence and prevalence among those aged 15 to 64 years and children. Despite the decline, closer assessment of psychosocial issues like depression, contextual factors (family and community), and social support is necessary given the likely impact on overall health and HIV prevention. This paper examines an association between symptoms of depression and social support on overall health among HIV-positive participants recruited from an HIV clinic in Kenya. Descriptive statistics and logistic regression analyses were utilized. Findings reveal that compared to those with minimal depression (referent category) participants with mild, moderate, moderately severe/severe depression had higher odds of having poor health, respectively. For social support, compared with participants with no social support (referent category), participants with high social support had lower odds of having poor overall health in both unadjusted and multivariable-adjusted models. In conclusion, this study suggests that HIV clinics and interventions need to focus more on the psychological and/or mental health status of HIV-infected individuals while providing avenues such as social support groups that can be a buffer against the negative impact of HIV infection, depression on overall health outcomes.

In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. ... more In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. HIV-positive individuals are likely to internalize stigma, may suffer from psychosocial issues, or engage in maladaptive behaviors to cope with the diagnosis. Internalized stigma stems from fear of stigmatization also known as felt stigma. The current study examined the impact of HIV felt stigma on overall health and success of HIV prevention behaviors among 370 participants living with HIV and receiving care at an urban HIV clinic in Kenya. An 18-item instrument was cross culturally adapted to measure felt stigma. Descriptive and logistic regression analyses examined the data. Findings indicate that 25.9% (n = 96) of participants who reported experiencing high levels of felt stigma related to other people's attitudes toward their condition, ostracizing, and a disruption of their personal life, were likely to not adhere to prescribed HIV medication and not disclose their HIV serostatus to one other person. Those who also experienced felt stigma related to a disruption of their personal lives while mediated by depression were likely to report poor overall health. Findings support having HIV clinics and interventions develop relevant HIV prevention strategies that focus on the emerging dimensions of felt stigma which can significantly impact disclosure of serostatus, medication adherence, and overall health.

Psychometric properties of an 18-item HIV felt stigma questionnaire were evaluated utilizing data... more Psychometric properties of an 18-item HIV felt stigma questionnaire were evaluated utilizing data collected from a diverse ethnic and socioeconomic group of 370 people living with HIV/AIDS and receiving HIV/AIDS-related health services at an HIV clinic in Kenya. Factor analyses revealed a four factor solution (public attitudes, ostracize, discrimination, personal life disrupted) based on the Scree plot with explained variance of 44% that had Eigen values greater than 1.00. The retained felt stigma items revealed a Cronbach's alpha coefficient of 0.828, while the four factors had coefficient alphas ranging from 0.675 to 0.799. The adapted retained questionnaire was deemed a practical guide for measuring felt stigma in a Kenyan cultural context to necessitate provision of the most effective HIV-related mental health services to individuals living with HIV in Kenya.

The present study reports on the results of a 2.5-year college-wide, coordinated intervention tha... more The present study reports on the results of a 2.5-year college-wide, coordinated intervention that was implemented from June 2007 to December 2009 to reduce the amount and frequency of students' alcohol consumption. Design: Quasi-experimental design that used a one-group (freshmen living on campus) pretest/posttest design (N = 6,815 in 2007-2008 and N = 7,550 in 2008-2009) with a pseudo comparison group (nonfreshmen living off campus). Setting: Indiana University-Bloomington, USA. Method: The social-ecological framework, a multi-tiered strategy that considers the individual, the social milieu, and the environment, was used to guide the selection and implementation of interventions in a university setting to target individuals, the student population, the college, and the surrounding community to reduce high-risk drinking. Freshmen, who were mandated to live on campus, comprised the intervention group while non-freshmen living off campus comprised the pseudo comparison group that received only the environmental-level intervention. Results: A larger decrease was observed in the amount and frequency of alcohol consumption in freshmen than in non-freshmen for the intervention period (mean drinks consumed per week: −15.9% versus −7.5%; percentage of students who drank at least once a week: −17.5% versus −6.7%; and binge drinking: −12.2% versus −1.0%). Conclusion: An ecologically guided campus-wide intervention that is multi-tiered appears to be effective in reducing drinking behaviour.

African-born immigrants and refugees have HIV infection rates six times higher than any other min... more African-born immigrants and refugees have HIV infection rates six times higher than any other minority groups in the United States. Despite the increase in the population size and diversity of Somali immigrants and refugees in the United States, Somalis are one of the medically underserved population subgroups in this region. The lack of aggregate HIV infection rates among African-born immigrants, for example, Somali refugees, is a cause for alarm and calls for more research to be conducted in this subgroup. The purpose of this article was to examine contextually relevant HIV prevention strategies that will enhance HIV prevention among Somali immigrant/refugee young adults in the United States. Using the grounded theory approach, a convenience sample of 27 immigrant/refugee young adults was recruited in central Ohio. Recommendations for potential HIV prevention strategies emerged under two main categories: (1) internal community resources and (2) external platforms. Study findings support a collaborative approach involving community leaders (parents, elders, religious leaders) and educational (schools), media, and healthcare settings to tailor HIV prevention strategies that meet the needs of the priority group.

Despite the high prevalence of risky sexual behavior among college students, HIV risk perception ... more Despite the high prevalence of risky sexual behavior among college students, HIV risk perception in this population remains low. Overall, there is a dearth of studies examining HIV risk perception among college students. We examined HIV risk perception among college students at a University in the Midwest. Students enrolled in undergraduate and graduate courses were recruited for this pilot study (n = 200). The outcome of interest was perceived HIV risk perception. Descriptive and inferential statistical analyses were utilized to examine the association between HIV risk perception and four measures namely: perceived severity of/susceptibility to HIV, perceived benefits of safe sex, perceived barriers to safe sex and self-efficacy, measured using validated instruments. Overall, greater proportion of students perceived that they are not at risk of HIV infection (81.5 %). Participants had high scores for all measures, except for perceived barriers to safe sex [mean score (standard deviation) 24.5 (15.3)]. The multivariable model showed a statistically significant negative association between composite severity of/susceptibility to HIV/AIDS score and moderate perceived HIV risk (OR, 95 % confidence interval) (0.96, 0.93–0.99, p = 0.04). In addition, the odds of having moderate perceived HIV risk were higher among students who currently have a dating partner compared to students who currently do not have a dating partner (3.19, 1.24–8.18, p = 0.01). College level HIV prevention efforts should continue to address HIV risk. Additional research examining risk perception in a much larger, and more diverse, student population is needed.

ABSTRACT In Kenya, there was a reported decline in HIV incidence and prevalence among those aged ... more ABSTRACT In Kenya, there was a reported decline in HIV incidence and prevalence among those aged 15 to 64 years and children. Despite the decline, closer assessment of psychosocial issues like depression, contextual factors (family and community), and social support is necessary given the likely impact on overall health and HIV prevention. This paper examines an association between symptoms of depression and social support on overall health among HIV-positive participants recruited from an HIV clinic in Kenya. Descriptive statistics and logistic regression analyses were utilized. Findings reveal that compared to those with minimal depression (referent category) participants with mild, moderate, moderately severe/severe depression had higher odds of having poor health, respectively. For social support, compared with participants with no social support (referent category), participants with high social support had lower odds of having poor overall health in both unadjusted and multivariable-adjusted models. In conclusion, this study suggests that HIV clinics and interventions need to focus more on the psychological and/or mental health status of HIV-infected individuals while providing avenues such as social support groups that can be a buffer against the negative impact of HIV infection, depression on overall health outcomes.

In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. ... more In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. HIV-positive individuals are likely to internalize stigma, may suffer from psychosocial issues, or engage in maladaptive behaviors to cope with the diagnosis. Internalized stigma stems from fear of stigmatization also known as felt stigma. The current study examined the impact of HIV felt stigma on overall health and success of HIV prevention behaviors among 370 participants living with HIV and receiving care at an urban HIV clinic in Kenya. An 18-item instrument was cross culturally adapted to measure felt stigma. Descriptive and logistic regression analyses examined the data. Findings indicate that 25.9% (n = 96) of participants who reported experiencing high levels of felt stigma related to other people's attitudes toward their condition, ostracizing, and a disruption of their personal life, were likely to not adhere to prescribed HIV medication and not disclose their HIV serostatus to one other person. Those who also experienced felt stigma related to a disruption of their personal lives while mediated by depression were likely to report poor overall health. Findings support having HIV clinics and interventions develop relevant HIV prevention strategies that focus on the emerging dimensions of felt stigma which can significantly impact disclosure of serostatus, medication adherence, and overall health.

Psychometric properties of an 18-item HIV felt stigma questionnaire were evaluated utilizing data... more Psychometric properties of an 18-item HIV felt stigma questionnaire were evaluated utilizing data collected from a diverse ethnic and socioeconomic group of 370 people living with HIV/AIDS and receiving HIV/AIDS-related health services at an HIV clinic in Kenya. Factor analyses revealed a four factor solution (public attitudes, ostracize, discrimination, personal life disrupted) based on the Scree plot with explained variance of 44% that had Eigen values greater than 1.00. The retained felt stigma items revealed a Cronbach's alpha coefficient of 0.828, while the four factors had coefficient alphas ranging from 0.675 to 0.799. The adapted retained questionnaire was deemed a practical guide for measuring felt stigma in a Kenyan cultural context to necessitate provision of the most effective HIV-related mental health services to individuals living with HIV in Kenya.

The present study reports on the results of a 2.5-year college-wide, coordinated intervention tha... more The present study reports on the results of a 2.5-year college-wide, coordinated intervention that was implemented from June 2007 to December 2009 to reduce the amount and frequency of students' alcohol consumption. Design: Quasi-experimental design that used a one-group (freshmen living on campus) pretest/posttest design (N = 6,815 in 2007-2008 and N = 7,550 in 2008-2009) with a pseudo comparison group (nonfreshmen living off campus). Setting: Indiana University-Bloomington, USA. Method: The social-ecological framework, a multi-tiered strategy that considers the individual, the social milieu, and the environment, was used to guide the selection and implementation of interventions in a university setting to target individuals, the student population, the college, and the surrounding community to reduce high-risk drinking. Freshmen, who were mandated to live on campus, comprised the intervention group while non-freshmen living off campus comprised the pseudo comparison group that received only the environmental-level intervention. Results: A larger decrease was observed in the amount and frequency of alcohol consumption in freshmen than in non-freshmen for the intervention period (mean drinks consumed per week: −15.9% versus −7.5%; percentage of students who drank at least once a week: −17.5% versus −6.7%; and binge drinking: −12.2% versus −1.0%). Conclusion: An ecologically guided campus-wide intervention that is multi-tiered appears to be effective in reducing drinking behaviour.