The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their ownseroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV–negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV–positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.
Abstract The purpose of this exploratory study was to develop, implement, and evaluate a pilot HIV prevention intervention with one of the most mobile of U.S.-Mexico transborder populations: Mexican/Latino migrant day laborers (MDLs). Intervention development was informed by preliminary research that included an HIV risk survey of over a hundred MDLs, and a focus group to explore the topic of HIV in the lives of MDLs. Both quantitative and qualitative methods were used to evaluate the intervention, and to identify some of the contextual characteristics of HIV risk factors in the MDL experience. For example, the most frequent theme revealed by qualitative analysis was the stressful and vulnerable state of desesperacion [desperation], resulting from earning too little money, that participants linked to deviating from their migration goals and succumbing to alcohol and drug use, and risky sex. While empirical results are limited by the small sample of convenience (N = 23), lack of a control group, and loss of about half of the sample by one month followup evaluation, findings were encouragingly consistent with intervention goals: Post-intervention data revealed what appear to be substantial gains in carrying condoms (e.g., from 43% to 83%) as well as in knowledge of proper condom use. Further, frequency of sex with risky sex partners decreased in general, while condom use was reported for all sexual encounters assessed during post-evaluation. The theoretical framework used to guide the intervention, a hybrid of the Health Belief Model and Friere's model of participatory education, included visual triggers composed of customized Mexican lottery game cards to elicit discussion of HIV risk and prevention in the MDL experience.
Background: Addressing alcohol harm in prisons can potentially reduce the risk of re-offending, and costs to society, whilst tackling health inequalities.Health savings of £4.3 m and crime savings of £100 m per year can be a result of appropriate alcohol interventions.Prison therefore offers an opportunity for the identification, response and/or referral to treatment for those male remand prisoners who are consuming alcohol above recommended levels.There is however, limited evidence for the effectiveness, optimum timing of delivery, recommended length, content, implementation and economic benefit of Alcohol Brief Interventions (ABI) in the prison setting for male remand prisoners.As part of the PRISM-A study, we aimed to explore the 'elements' of an acceptable ABI for delivery, experiences of engagement with services/health professionals about alcohol use, alongside barriers and facilitators to implementation within the prison setting for male remand prisoners.Materials and methods: Twenty-four in-depth interviews were conducted with adult male remand prisoners at one Scottish prison (n = 12) and one English prison (n = 12).A focus group at each of the prison sites was held with key stakeholders (e.g.prison nurses, prison officers, voluntary alcohol/addiction services, health service managers and commissioners).Thematic analysis techniques utilizing NViVo 10 were employed.Results: A thematic content analysis of the interviews consistently highlighted that the majority of prisoners reflected about the connection between alcohol consumption and criminal offending, particularly in relation to offenses involving physical assaults.They also expressed motivation to change their alcohol consumption.Both prisoner interviews and focus groups with stakeholders (N = 2), indicated the value of continuous follow-up support outside of the prison system and also the need to address the lack of stable social environments, which is often associated with alcohol and drug consumption.Stakeholders further identified organizational barriers to the delivery of ABI, such as limited funding and manageable workloads. Conclusions:The importance of interpersonal trust indicated that intervention delivery by external organizations and nurses were favored in comparison to intervention delivery by prison staff and peer-prisoners.
Digital health interventions using hybrid delivery models may offer efficient alternatives to traditional behavioral counseling by addressing obstacles of time, resources, and knowledge. Using a computer-facilitated 5As (ask, advise, assess, assist, arrange) model as an example (CF5As), we aimed to identify factors from the perspectives of primary care providers and clinical staff that were likely to influence introduction of digital technology and a CF5As smoking cessation counseling intervention. In the CF5As model, patients self-administer a tablet intervention that provides 5As smoking cessation counseling, produces patient and provider handouts recommending next steps, and is followed by a patient-provider encounter to reinforce key cessation messages, provide assistance, and arrange follow-up. Semi-structured in-person interviews of administrative and clinical staff and primary care providers from three primary care clinics. Thirty-five interviews were completed (12 administrative staff, ten clinical staff, and 13 primary care providers). Twelve were from an academic internal medicine practice, 12 from a public hospital academic general medicine clinic, and 11 from a public hospital HIV clinic. Most were women (91 %); mean age (SD) was 42 years (11.1). Perceived usefulness of the CF5As focused on its relevance for various health behavior counseling purposes, potential gains in counseling efficiency, confidentiality of data collection, occupying patients while waiting, and serving as a cue to action. Perceived ease of use was viewed to depend on the ability to accommodate: clinic workflow; heavy patient volumes; and patient characterisitics, e.g., low literacy. Social norms potentially affecting implementation included beliefs in the promise/burden of technology, priority of smoking cessation counseling relative to other patient needs, and perception of CF5As as just "one more thing to do" in an overburdened system. The most frequently cited facilitating conditions were staffing levels and smoking cessation resources and training; the most cited hindering factors were visit time constraints and patients' complex health care needs. Integrating CF5As and other technology-enhanced behavioral counseling interventions in primary care requires flexibility to accommodate work flow and perceptions of overload in dynamic environments. Identifying factors that promote and hinder CF5As adoption could inform implementation of other CF behavioral health interventions in primary care.
An improved apparatus has been designed and built for use in precise positioning and pressing of a microchip onto a substrate (which could, optionally, be another microchip) for the purpose of indium-bump bonding. The apparatus (see figure) includes the following: A stereomicroscope, A stage for precise positioning of the microchip in rotation angle (theta) about the nominally vertical pressing axis and in translation along two nominally horizontal coordinate axes (x and y), and An actuator system that causes a bonding tip to press the microchip against the substrate with a precisely controlled force. In operation, the microscope and the stage are used to position the microchip under the bonding tip and to align the indium bumps on the chip and the substrate, then the actuator system is used to apply a prescribed bonding force for a prescribed time. The improved apparatus supplants a partly similar prior apparatus that operated with less precision and repeatability, producing inconsistent and unreliable bonds. Results of the use of the prior apparatus included broken microchips, uneven bonds, and bonds characterized, variously, by overcompression or undercompression. In that apparatus, the bonding force was generated and controlled by use of a micrometer head positioned over the center of a spring-loaded scale, and the force was applied to the microchip via the scale, which was equipped for digital readout of the force. The inconsistency of results was attributed to the following causes: It was not possible to control the bonding force with sufficient precision or repeatability. Particularly troublesome was the inability to control the force at levels less than the weight of 150 g. Excessive compliance in the spring-loaded scale, combined with deviations from parallelarity of the substrate and bonding-tip surfaces, gave rise to nonuniformity in the pressure applied to the microchip, thereby generating excessive stresses and deformations in the microchip. In the improved apparatus, the bonding tip and the components that hold the substrate and the microchip are more rigid and precise than in the prior apparatus, so as to ensure less deviation from parallelarity of the bonding-tip and substrate surfaces, thereby ensuring more nearly uniform distribution of bonding force over the area of the microchip. The bonding force is now applied through, and measured by, a load cell that makes it possible to exert finer control over the force. The force can be set at any value between 0 and the weight of 800 g in increments of 0.2 g.
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