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Search Results: 1 - 10 of 400729 matches for " Wendee M. Wechsberg "
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Adapting an evidence-based HIV prevention intervention for pregnant African-American women in substance abuse treatment
Wendee M Wechsberg,Felicia A Browne,Winona Poulton,et al
Substance Abuse and Rehabilitation , 2011,
Abstract: Wendee M Wechsberg1, Felicia A Browne1, Winona Poulton1, Rachel Middlesteadt Ellerson1, Ashley Simons-Rudolph1, Deborah Haller2, 1RTI International,* Research Triangle Park, NC, USA; 2Columbia University College of Physicians and Surgeons, New York, NY, USA, *RTI International is a trade name of Research Triangle InstituteAbstract: An adaptation of an evidence-based, woman-focused intervention designed to reduce HIV risk behaviors was conducted for pregnant, African-American women in substance abuse treatment in North Carolina. The intervention adaptation process included focus groups, expert panels, and the filming of women who spoke about their experiences with pregnancy, drug use, sex risk behaviors, HIV testing and treatment, need for substance abuse treatment, violence, and victimization. The assessment instrument was adapted for pregnant women and the intervention was organized into a 4-session PowerPoint presentation, with an additional session if a woman tested positive for HIV. All sessions and assessment instrument were installed on laptop computers for portability in treatment programs. We pilot tested our adaptation with 59 pregnant African-American women who had used an illicit drug within the past year and were enrolled in substance abuse treatment. At baseline, 41% were currently homeless, 76% were unemployed, 90% had not planned their current pregnancy, and approximately 70% reported drug use since finding out about the pregnancy. This sample of participants rated the intervention sessions and were highly satisfied with their experience, resulting in a mean satisfaction score of 6.5 out of 7. Pregnant African-American women who use drugs need substance abuse treatment that they do not currently access. Woman-focused HIV interventions help to address intersecting risk behaviors and need for treatment prevalent among this vulnerable group.Keywords: African-American woman, HIV prevention pregnancy, drug use, violence, sexual risk
Factors That Influence HIV Risk among Hispanic Female Immigrants and Their Implications for HIV Prevention Interventions
Amy M. Hernandez,William A. Zule,Rhonda S. Karg,Felicia A. Browne,Wendee M. Wechsberg
International Journal of Family Medicine , 2012, DOI: 10.1155/2012/876381
Abstract: Hispanics are the fastest growing minority group in North Carolina with increasing incidence of HIV infection. Gender roles, cultural expectations, and acculturation of women may explain some of Hispanic women’s risks. The perspectives of Hispanic female immigrants and community-based providers were sought to identify services they offer, understand HIV risk factors, and support the adaptation of a best-evidence HIV behavioural intervention for Hispanic women. Two sets of focus groups were conducted to explicate risks and the opportunities to reach women or couples and the feasibility to conduct HIV prevention in an acceptable manner. Salient findings were that Hispanic female immigrants lacked accurate HIV/AIDS and STI knowledge and that traditional gender roles shaped issues surrounding sexual behaviour and HIV risks, as well as condom use, partner communication, and multiple sexual partnerships. Intervention implications are discussed such as developing and adapting culturally appropriate HIV prevention interventions for Hispanics that address gender roles and partner communication. 1. Introduction Hispanics are the fastest growing minority group in the United States and in the state of North Carolina [1–3]. As the Hispanic population has grown in North Carolina, so have the HIV cases among them. Eight percent of newly diagnosed HIV cases in North Carolina in 2008 were among Hispanics [4]. HIV prevalence among Hispanics in North Carolina was 3.7 times higher than among non-Hispanic whites, and among Hispanic women it was 4 times higher than among non-Hispanic white women [4]. While Hispanic women are disproportionately affected by HIV and sexually transmitted infections in the USA, paradoxically they tend to report lower levels of HIV risk behaviours than African-American and non-Hispanic white women [5, 6]. This raises questions regarding why these rates are higher. One possible factor might be related to Hispanic cultural norms surrounding gender roles. Several of these norms may influence behaviour in ways that affect HIV risk and limit Hispanics’ understanding of risk and the manner in which they communicate about it. The cultural norm for men known as “machismo” describes the role of the Hispanic man in his family and in society [7, 8]. While there are positive aspects to machismo, other elements of it such as the belief in male dominance and an emphasis on male sexual prowess are used by some men to justify sexual encounters outside of their primary relationship [9, 10]. The cultural norm for Hispanic women, “Marianismo,” strongly encourages
HIV Sexual and Drug-Use Risk in Drug-Dependent Pregnant Patients in Comprehensive Drug Treatment
Hendrée E. Jones,Wendee M. Wechsberg,Kevin E. O'Grady,Michelle Tuten
International Journal of Family Medicine , 2011, DOI: 10.1155/2011/872638
Abstract: This secondary analysis study investigated HIV sexual and drug-use risk in drug-dependent pregnant patients over the first month postrandomization to reinforcement-based treatment (RBT) ( ) or usual care (UC) ( ). Analysis of primary outcomes had indicated that RBT participants spent significantly longer time in treatment and recovery housing than UC participants. The present study examined the ability of 9 risk markers—age, race, estimated gestational age at treatment entry, lifetime substance abuse treatment episodes, history of prostitution charges, history of serious depression, current heroin injection status, current housing status, and current partner substance use—to predict changes in HIV risks. Sexual risk declined for participant subgroups with prostitution-charge histories and unstable housing. Drug-use risk declined for heroin injectors and nondepressed participants. A relationship was found between number of lifetime drug treatment episodes and sexual and drug-use risk. The role of risk markers in the response of drug-dependent pregnant women to drug treatment require attention. 1. Introduction Substance-abusing women in their reproductive years have relatively high HIV seroprevalence rates [1]. Perinatal transmission of HIV accounts for 90% of pediatric HIV infection [2]. Thus, women with substance use disorders who are also pregnant are an important population to reach for both preventive interventions and treatment [3]. Drug abuse treatment itself has been shown to serve as a protective factor for HIV drug use risks and has been shown to prevent HIV in nonpregnant patients. These results come primarily through reduction of HIV drug-risk behavior [4, 5]. As yet these same results have not been reported in pregnant women. Moreover, to the best of our knowledge, the use of drug abuse treatment to reduce HIV sexual risk behaviors has been inconsistent in nonpregnant patients and has not been shown in pregnant women. Although comprehensive addiction treatment programs for substance-abusing pregnant women have been shown to result in improved maternal and neonatal outcomes compared to no treatment [6], considerably less attention has been focused on examining the impact that comprehensive drug abuse treatment provided during pregnancy may have on reducing HIV sexual and drug-risk behaviors. In fact, to our knowledge, no empirical study has examined the extent to which comprehensive treatment for drug dependence given to drug-dependent pregnant women can reduce either or both primary sources of HIV risk (that is, sexual and drug-risk
African-American crack abusers and drug treatment initiation: barriers and effects of a pretreatment intervention
Wendee M Wechsberg, William A Zule, Kara S Riehman, Winnie K Luseno, Wendy KK Lam
Substance Abuse Treatment, Prevention, and Policy , 2007, DOI: 10.1186/1747-597x-2-10
Abstract: Using street outreach, 443 African-American crack users were recruited in North Carolina and randomly assigned to either the pretreatment intervention or control group.At 3-month follow-up, both groups significantly reduced their crack use but the intervention group participants were more likely to have initiated treatment.The intervention helped motivate change but structural barriers to treatment remained keeping actual admissions low. Policy makers may be interested in these pretreatment sites as an alternative to treatment for short term outcomes.Sociocultural factors may pose significant barriers for drug abusers seeking health care or substance abuse treatment. These barriers may be particularly problematic for some African-Americans and other disadvantaged populations. To help reduce the negative behaviors and outcomes associated with substance abuse and dependence, new intervention models need to be developed that specifically address the sociocultural environment of ethnic minorities [1]. Moreover, recent research has recognized the need to enhance understanding of crack cocaine dependence and how crack abusers interact with the substance abuse treatment system [2].Crack is a cheaper and smokable form of cocaine that became widely available in the mid-1980s, and it continues to be a public health problem in the United States. Crack use is present among all ethnic groups [3], but it is most common among African-Americans residing in low-income inner-city neighborhoods [4-7]. Findings from the 2001 National Household Survey on Drug Abuse (NHSDA) indicated that African-Americans made up 12% of the U.S. population, but they represented 19% of individuals who had used crack in the past year [8]. In addition, crack dependence rates are reported to be higher among African-Americans than among Hispanics or Whites [4]. Furthermore, cocaine-related emergency room episodes and overdose deaths were more common among African-Americans than any other racial/ethnic group
Initial Feasibility and Acceptability of a Comprehensive Intervention for Methamphetamine-Using Pregnant Women in South Africa
Hendrée E. Jones,Bronwyn Myers,Kevin E. O’Grady,Stefan Gebhardt,Gerhard B. Theron,Wendee M. Wechsberg
Psychiatry Journal , 2014, DOI: 10.1155/2014/929767
Abstract: The purpose of the present study was to determine the feasibility, acceptability, and initial efficacy of a women-focused intervention addressing methamphetamine use and HIV sexual risk among pregnant women in Cape Town, South Africa. A two-group randomized pilot study was conducted, comparing a women-focused intervention for methamphetamine use and related sexual risk behaviors to a psychoeducational condition. Participants were pregnant women who used methamphetamine regularly, had unprotected sex in the prior month, and were HIV-negative. Primary maternal outcomes were methamphetamine use in the past 30 days, frequency of unprotected sexual acts in the past 30 days, and number of antenatal obstetrical appointments attended. Primary neonatal outcomes were length of hospital stay, birth weight, and gestational age at delivery. Of the 57 women initially potentially eligible, only 4 declined to participate. Of the 36 women who were eligible and enrolled, 92% completed all four intervention sessions. Women in both conditions significantly reduced their methamphetamine use and number of unprotected sex acts. Therefore, delivering comprehensive interventions to address methamphetamine use and HIV risk behaviors among methamphetamine-using pregnant women is feasible in South Africa. Further testing of these interventions is needed to address methamphetamine use in this vulnerable population. 1. Introduction Substance use during pregnancy is a critical health care concern. In Cape Town, South Africa, high rates of methamphetamine use have been found among women of childbearing age [1–3], including pregnant women [4]. Methamphetamine use is associated with several deleterious short- and long-term physical and psychological effects. A wide variety of physical effects have been associated with methamphetamine use, including respiratory and cardiac problems, palpitations, tremors, convulsions, stroke, and an increased risk of death [5]. Furthermore, its use is associated with risky sexual activities that place women at risk for acquiring HIV [1, 3, 6]. Psychological effects can be pronounced and include hallucinations, delusions, paranoia, and amphetamine psychosis [7]. Methamphetamine use has a high dependence risk and an extended withdrawal period, with frequent relapse. Prenatal stimulant exposure has been associated with being born small for gestational age [8], a risk factor for later developmental problems [9, 10] and poorer neurobehavioral outcomes [11]. Nonetheless, there are no substance use treatment models in South Africa that are tailored to address
Pregnant and Nonpregnant Women in Cape Town, South Africa: Drug Use, Sexual Behavior, and the Need for Comprehensive Services
Hendrée E. Jones,Felicia A. Browne,Bronwyn J. Myers,Tara Carney,Rachel Middlesteadt Ellerson,Tracy L. Kline,Winona Poulton,William A. Zule,Wendee M. Wechsberg
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/353410
Abstract: The multiple risks associated with methamphetamine use are of serious concern for women. These risks and consequences are magnified during pregnancy. This secondary analysis of a parent study compared 26 pregnant to 356 nonpregnant women in Cape Town, South Africa, on selected demographic, psychosocial, and HIV-risk domains to identify their treatment service needs. Proportionally, more pregnant than nonpregnant women are using methamphetamine, =.01, although a very high rate of women used methamphetamine. Women reported similar monthly rates of sexual intercourse, but pregnant women were significantly less likely to report condom use, <.0001, maintaining their risky behavior. Both groups reported elevated Center for Epidemiological Studies Depression Scale CES-D means, suggesting a need for depression treatment. Results demonstrate a pervasive need for women's comprehensive treatment, regardless of pregnancy status. Moreover, findings support the urgent need for women-focused and pregnancy-specific treatment services for methamphetamine use. Finally, a job-skills training/employment component focus is suggested.
Initial Feasibility of a Woman-Focused Intervention for Pregnant African-American Women
Hendrée E. Jones,Nancy D. Berkman,Tracy L. Kline,Rachel Middlesteadt Ellerson,Felicia A. Browne,Winona Poulton,Wendee M. Wechsberg
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/389285
Abstract: African-American women who use crack are vulnerable to HIV because of the complex social circumstances in which they live. Drug-abuse treatment for these women during pregnancy may provide time for changing risk behaviors. This paper examines the initial 6-month feasibility of a women-focused HIV intervention, the Women's CoOp, adapted for pregnant women, relative to treatment-as-usual among 59 pregnant African-American women enrolled in drug-abuse treatment. At treatment entry, the women were largely homeless, unemployed, practicing unsafe sex, and involved in violence. Results indicated marked reductions in homelessness, use of cocaine and illegal drugs, involvement in physical violence, and an increase in knowledge of HIV from baseline to 6-month followup for both conditions. Findings suggest that the Women's CoOp intervention could be successfully adapted to treat this hard-to-reach population. Future studies should examine the efficacy of the pregnancy-adapted Women's CoOp for women not enrolled in drug-abuse treatment.
Substance abuse, treatment needs and access among female sex workers and non-sex workers in Pretoria, South Africa
Wendee M Wechsberg, Li-Tzy Wu, William A Zule, Charles D Parry, Felicia A Browne, Winnie K Luseno, Tracy Kline, Amanda Gentry
Substance Abuse Treatment, Prevention, and Policy , 2009, DOI: 10.1186/1747-597x-4-11
Abstract: Women who reported alcohol use and recently engaging in sex work or unprotected sex were recruited for a randomized study. The study sample (N = 506) comprised 335 FSW and 171 female non-SW from Pretoria and surrounding areas. Self-reported data about alcohol and other drug use as well as treatment needs and access were collected from participants before they entered a brief intervention.As compared with female non-SW, FSW were found to have a greater likelihood of having a past year diagnosis of alcohol or other drug abuse or dependence, having a family member with a history of alcohol or other drug abuse, having been physically abused, having used alcohol before age 18, and having a history of marijuana use. In addition, the FSW were more likely to perceive that they had alcohol or other drug problems, and that they had a need for treatment and a desire to go for treatment. Less than 20% of participants in either group had any awareness of alcohol and drug treatment programs, with only 3% of the FSW and 2% of the non-SW reporting that they tried but were unable to enter treatment in the past year.FSW need and want substance abuse treatment services but they often have difficulty accessing services. The study findings suggest that barriers within the South African treatment system need to be addressed to facilitate access for substance-using FSW. Ongoing research is needed to inform policy change that fosters widespread educational efforts and sustainable, accessible, woman-sensitive services to ultimately break the cycle for current and future generations of at-risk South African women.South Africa has one of the highest levels of alcohol consumption per adult drinker in the world [1]. In 2000, estimates indicated that alcohol use contributed to 7% of disability adjusted life years lost in South Africa, ranking third out of 17 risk factors studied [2]. Among patients in specialized substance abuse treatment centers, alcohol is the primary substance of abuse report
Double jeopardy--drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial
Wendee M Wechsberg, Evgeny Krupitsky, Tatiana Romanova, Edwin Zvartau, Tracy L Kline, Felicia A Browne, Rachel Ellerson, Georgiy Bobashev, William A Zule, Hendrée E Jones
Substance Abuse Treatment, Prevention, and Policy , 2012, DOI: 10.1186/1747-597x-7-1
Abstract: Women (N = 100) were randomized into one of two one-hour long intervention conditions--the Woman-Focused intervention (n = 51) or a time and attention-matched Nutrition control condition (n = 49).The results showed that 57% of the participants had been told that they were HIV-positive. At 3-month follow-up, both groups showed reduced levels of injecting frequency. However, participants in the Woman-Focused intervention reported, on average, a lower frequency of partner impairment at last sex act and a lower average number of unprotected vaginal sex acts with their main sex partner than the Nutrition condition.The findings suggest that improvements in sexual risk reduction are possible for these at-risk women and that more comprehensive treatment is needed to address HIV and drug risks in this vulnerable population.Russia is an emerging epicenter of the global HIV epidemic [1], accounting for 66% of all newly registered HIV cases in Eastern Europe and Eurasia [2]. The geographical nexus of Russia's HIV epidemic is St. Petersburg, with an HIV prevalence rate of 30-47% among injecting drug users (IDUs) [3]. Additionally, 80-90% of the HIV cases in St. Petersburg are associated with IDUs, many of whom are unaware of their HIV status [4-6]. Further, HIV morbidity is reported to be highest among IDUs in St. Petersburg [7].In earlier studies, Russian women in general and female IDUs in particular appeared to be at high risk of HIV, but HIV prevalence among them was relatively low [8,9]. However, between 1996 and 2006, the number of HIV-infected women increased rapidly from 29% to 44% [2,9]. In St. Petersburg, HIV prevalence among female IDUs was estimated to be 20% [10]. Consequently, there is a critical need to address the HIV risks of female IDUs [11-13].Because of the multifaceted risks women face, they are at high risk for contracting and spreading HIV. For example, sharing contaminated injecting equipment and sexual transmission are the main causes of HIV infection fo
Initial Feasibility of a Woman-Focused Intervention for Pregnant African-American Women
Hendrée E. Jones,Nancy D. Berkman,Tracy L. Kline,Rachel Middlesteadt Ellerson,Felicia A. Browne,Winona Poulton,Wendee M. Wechsberg
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/389285
Abstract: African-American women who use crack are vulnerable to HIV because of the complex social circumstances in which they live. Drug-abuse treatment for these women during pregnancy may provide time for changing risk behaviors. This paper examines the initial 6-month feasibility of a women-focused HIV intervention, the Women's CoOp, adapted for pregnant women, relative to treatment-as-usual among 59 pregnant African-American women enrolled in drug-abuse treatment. At treatment entry, the women were largely homeless, unemployed, practicing unsafe sex, and involved in violence. Results indicated marked reductions in homelessness, use of cocaine and illegal drugs, involvement in physical violence, and an increase in knowledge of HIV from baseline to 6-month followup for both conditions. Findings suggest that the Women's CoOp intervention could be successfully adapted to treat this hard-to-reach population. Future studies should examine the efficacy of the pregnancy-adapted Women's CoOp for women not enrolled in drug-abuse treatment. 1. Introduction The risk of contracting HIV is one of the most devastating health threats African-American women who use crack cocaine face. HIV prevalence rates among African-American women range from a low rate of 1.7% among noninjecting drug users who do not trade sex to a high rate of 54% among homeless African-American women, many of whom trade sex for drugs and survival items [1–5]. Crack cocaine use also has been repeatedly associated with increased sexual activity; if the sex is unprotected, unplanned pregnancies and HIV can result [6, 7]. African-American women who use crack are vulnerable to HIV because of the complex social circumstances in which they live. These social circumstances may produce situations where these women engage in multiple high-risk HIV behaviors [8]. Furthermore, the combination of crack, alcohol use, and sexual-risk behaviors (e.g., trading sex for drugs or survival items, inconsistent condom use, multiple partners) place African-American women at greater risk for HIV infection than other drug-using groups [9]. Many of these crack-using African-American women lack self-sufficiency, rely on public assistance for long durations, are often unstably housed, experience repeated episodes of homelessness, have no or scanty employment records, lack education and job skills, and live in poverty [9–15]. The lives of substance-using African-American women also are often characterized by inflicting or being a victim of violence, crime, childhood and current sexual, physical, and emotional victimization, as well
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