2009 — 2010 |
Calabrese, Sarah K. |
F31Activity Code Description: To provide predoctoral individuals with supervised research training in specified health and health-related areas leading toward the research degree (e.g., Ph.D.). |
Cultural Scripts Influencing Hiv Prevention Among African American Women @ George Washington University
DESCRIPTION (provided by applicant): The African American female population is profoundly and disproportionately affected by HIV/AIDS and other sexually transmitted epidemics. Despite comprising less than 14% of the female population in 2005 (U.S. Census Bureau, 2008) Black women represented approximately 64% of all U.S. women living with HIV/AIDS, the majority of whom contracted the HIV virus through heterosexual contact (CDC, 2008). In Washington, DC in particular, the disparity is even more striking: between 2001 and 2006, Black women accounted for 92% of all reported HIV cases among women (Government of the District of Colombia Department of Health, 2007). In light of these alarming statistics, an enhanced understanding of the impact of sociocultural factors specific to women of this ethnic group on their participation in unsafe sexual behavior is of utmost importance. Recent literature has emphasized the role of culturally transmitted guidelines and expectations about sexual behavior in perpetuating the epidemic among this population, suggesting that such specifications encourage unsafe sexual practices (Stephens &Phillips, 2003). However, the relationship of such expecations to African American women's perceived capacity to assert themselves in enacting sexual safety (e.g., by enforcing condom use or refusing unwanted sex) is lacking empirical attention. The purpose of the proposed study is to address this gap in the literature by developing a measure of sexual expectations and examining the relationship of such expectations to sexual self-concept and sexual self-efficacy within a sample of HIV-positive and high-risk, HIV-negative African American women living in the Washington, DC metropolitan area. Researchers at The George Washington University will collaborate with the Women's Interagency HIV Study (WIHS) to access the targeted population. A sample of approximately 191 African American women between the ages of 21 and 69, approximately three quarters of whom are HIV-positive, will be recruited from the existing WIHS sample. Participant interviews (n=8) and a focus group comprised of 8 women will inform instrument development, and quantitative measures will be administered to 175 women in paper-and-pencil, self-report format during regularly scheduled WIHS clinic visits. PUBLIC HEALTH RELEVANCE: The proposed study is of public health importance in that it will clarify barriers to sexual safety among African American women, a vulnerable and underserved population at high risk for contracting and transmitting the HIV virus. Findings will be useful in informing the development of culturally appropriate intervention programs targeting this group, ultimately aiding the effort to combat the HIV/AIDS epidemic within and beyond the African American community.
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2014 — 2017 |
Calabrese, Sarah K. |
K01Activity Code Description: For support of a scientist, committed to research, in need of both advanced research training and additional experience. |
Intervention to Promote Prep Awareness and Equitable Prescription Among Providers
DESCRIPTION (provided by applicant): Over thirty years into the United States epidemic, social disparities in HIV prevalence persist, with Black Americans, and Black men who have sex with men (MSM) in particular, disproportionately affected. Intensifying HIV prevention efforts in communities of high prevalence as well as maximizing the dissemination and impact of effective interventions are among the top national priorities for addressing HIV.1,2 The proposed training plan in this Mentored Research Scientist Development Award (K01) application will provide the essential knowledge and skills that the principal investigator, Sarah K. Calabrese, PhD, needs to launch a productive career in research targeting these public health imperatives. Further, the research conducted throughout the course of this award would contribute meaningfully to the successful delivery of pre-exposure prophylaxis (PrEP, i.e., oral antiretroviral medication for HIV prevention) in real-world clinical practice and could have far-reaching implications for equitable access across social lines. PrEP is a cutting-edge biomedical advancement that received United States Food and Drug Administration approval for prescription in July of 2012, sparking a push for its implementation in health care settings throughout the country. There has been mounting recognition of the need for provider training and education about PrEP3-7 and some discussion of cultural sensitivity being a component thereof,5 but minimal attention paid explicitly to the risk of disparate prescription practices. Documented discrimination in the prescription of antiretroviral medication for treatment purposes as well as preliminary evidence of biases in clinical judgment surrounding PrEP pose a call to action; the proposed research aims to address this call via the development and pilot testing of a single-session, group-based PrEP Awareness + Discrimination Prevention intervention for healthcare providers. The intervention will serve the dual purpose of increasing knowledge about PrEP among providers and averting discriminatory prescription practices using evidence-based strategies derived from social-cognitive psychology. The project will include a comprehensive needs assessment, including eight focus groups with potential PrEP providers from diverse clinical settings (n=48-64), six focus groups with Black MSM at risk for HIV acquisition (i.e., potential PrEP users; n=36-48), key informant interviews with healthcare providers who have experience prescribing PrEP (n=20), and a national quantitative survey of physicians (n=350). The intervention will be pilot tested in a two-armed randomized controlled trial with 80 healthcare providers seeking continuing medical education. The project will yield an intervention manual with detailed curriculum and supporting materials as well as preliminary indicators of intervention feasibility, acceptability, and effectiveness, setting the stage for future refinement and evaluation in the context of a larger-scale randomized controlled trial. The training acquired by Dr. Calabrese via this timely and innovative research project, in combination with formal coursework, focused workshops, academic conferences, manuscript preparation, grant-writing, one-on-one mentorship, and other research activities, will target the following three training objectives: (1) to gain mastery in the discipline of social-cognitive psychology on the topics of stereotyping, prejudice, and discrimination and to obtain training in measurement of implicit bias, (2) to gain expertise in intervention development, implementation, and evaluation, and (3) to enhance statistical analysis skills for application to planned research. Dr. Calabrese will be mentored primarily by John F. Dovidio, PhD, at Yale University, with additional mentoring from Nathan B. Hansen, PhD (Yale University), Kenneth H. Mayer, MD (Harvard Medical School/The Fenway Institute), Joseph R. Betancourt, MD, MPH (Harvard Medical School), and Manya Magnus, PhD, MPH (George Washington University). Dr. Calabrese's training through the proposed K01 award will round out her expertise and fully prepare her for a career as an independent research scientist in the field of HIV prevention.
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