Browsing by Author "Jaiswal, Jessica"
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Item Challenges to Providing Integrated HIV Prevention in Substance Use Treatment Settings: Frontline Staff Perspectives on HIV and Sex-Related, Education, Communication and Stigma(Taylor & Francis, 2023-10-11) Jaiswal, Jessica; Griffin, Marybec; LoSchiavo, Caleb; Cox, Amanda; Hascher, Kevin; Dunlap, Kandyce; Walters, Suzan; Burton, Wanda Martin; Grini, Benjamin; Mumba, Merci; Eaton, EllenIntroduction Substance use treatment settings can play a critical role in ending the HIV epidemic. Community-based methadone clinics are potentially useful sites to offer biomedical HIV prevention, but little is known about how clinicians and other clinic staff communicate with patients about sexual behavior and HIV-related topics. Methods Thirty semi-structured interviews were conducted at two methadone clinics in Northern New Jersey. Participants included medical providers (physicians, RNs, DNPs), methadone counselors, intake coordinators, lab technicians, and other auxiliary staff members. Results: Three major themes were identified: (1) HIV education is primarily provided by external organizations, (2) there is limited staff-patient communication around HIV and sexual behaviors, and (3) HIV stigma is prevalent among staff and patients. Conclusion To implement PrEP in methadone treatment settings, clinic staff must be able to engage in non-judgmental communication about HIV and sex with patients. Additionally, federal and state funding for HIV prevention in substance use treatment settings must be prioritized to enable clinics to access the necessary training and resources.Item Coping Among Black College Women: A Transformative Study of Gendered Racism(Wiley, 2024) Burton, Wanda Martin; Ezemenaka, Christina; Jaiswal, Jessica; Guyotte, Kelly W.; Sanders, Angelica M.Black women in the United States are placed at higher risk for mental health challenges, including distress and depression, due to structural inequities. Black college women enrolled in predominantly White institutions may be particularly exposed to stressors related to gendered racism, but there is limited knowledge about this population's coping strategies. A cross‐sectional survey and focus group were utilized to understand and disrupt participants’ experiences of gendered racism. In phase one, a survey assessing coping strategies and mental health outcomes was conducted with 168 Black women enrolled at a predominantly White institution in the southeastern United States. Logistic regression results indicated that several coping strategies including behavioral disengagement, self‐blame, self‐distraction, denial, and positive reframing were significantly associated with depression and psychological distress, all p< 0.05. Phase two included a single focus group with a subset of the sample from phase one. The focus group findings supplemented the survey results, suggesting education (more accurately consciousness‐raising) as a foundational theme that seemed to create space for humor and social support as coping subthemes and created a transformative space where participants spoke openly about gendered racism. Findings from this study highlight the societal underpinnings that shape Black college women's experiences of gendered racism. College settings should endeavor to provide formal and informal support for Black women to minimize the harms related to gendered racism.Item Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress(Taylor & Francis, 2022-10-13) Burton, Wanda Martin; Paschal, Angelica M.; Jaiswal, Jessica; Leeper, James D.; Birch, David A.Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N=164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.Item Healthcare experiences of urban young adult lesbians(Sage, 2020) Griffin, Marybec; Jaiswal, Jessica; Krytusa, Dawn; Krause, Kristen D.; Kapadia, Farzana; Halkitis, Perry N.; Rutgers State University New Brunswick; Rutgers State University Newark; University of Alabama Tuscaloosa; Rutgers State University Medical Center; New York University; NYU Langone Medical CenterPurpose: This cross-sectional study of young adult lesbians explores their healthcare experiences including having a primary care provider, forgone care, knowledge of where to obtain Pap testing, and sexually transmitted infection testing. Methods: Quantitative surveys were conducted at lesbian, gay, bisexual, and transgender venues and events with a sample of 100 young adult lesbians in New York City between June and October 2016. Using the Andersen model of healthcare access, this study examined associations between sociodemographic characteristics and healthcare experiences using multivariable logistic regression models. Results: Having a primary care provider was associated with having health insurance (adjusted odds ratio (AOR) = 4.9, p < 0.05). Both insurance (AOR = 0.2, p < 0.05) and employment (AOR = 0.2, p < 0.05) status were protective against foregone care among young adult lesbians. Disclosure of sexual orientation to a provider improved knowledge of where to access Pap testing (AOR = 7.5, p < 0.05). Disclosure of sexual orientation to friends and family improved knowledge of where to access sexually transmitted infection testing (AOR = 3.6, p < 0.05). Conclusion: Socioeconomic factors are significantly associated with healthcare access among young adult lesbians in New York City. Maintaining non-discrimination protections for both healthcare services and insurance coverage are important for this population. In addition, financial subsidies that lower the cost of health insurance coverage may also help improve healthcare access among young adult lesbians.Item I Don't Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois(MDPI, 2023) Walters, Suzan M.; Felsher, Marisa; Frank, David; Jaiswal, Jessica; Townsend, Tarlise; Muncan, Brandon; Bennett, Alex S.; Friedman, Samuel R.; Jenkins, Wiley; Pho, Mai T.; Fletcher, Scott; Ompad, Danielle C.; New York University; Jefferson University; University of Alabama Tuscaloosa; State University of New York (SUNY) Stony Brook; Stony Brook University Hospital; Southern Illinois University; University of ChicagoBackground: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. Methods: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. Results: Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. Conclusions: People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.Item Logistical Facilitators and Barriers to PrEP Implementation in Methadone Clinic Settings: Provider and Staff Perspectives(Lippincott Williams & Wilkins, 2022) Jaiswal, Jessica; Griffin, Marybec; Hascher, Kevin; Cox, Amanda B.; Dunlap, Kandyce; Walters, Suzan; LoSchiavo, Caleb; Burton, Wanda M.; Mumba, Mercy; University of Alabama Tuscaloosa; Yale University; Rutgers State University New Brunswick; New York UniversityObjectives The purpose of this study was to examine the feasibility of implementing pre-exposure prophylaxis (PrEP), a daily oral medication for human immunodeficiency virus (HIV) prevention, in methadone clinics. Methods Medical and nonmedical staff (n = 30) at 2 methadone clinics in Northern New Jersey were qualitatively interviewed about various aspects of substance use treatment, clinical operations, and HIV risk and prevention among their patient populations. Audio-recorded interviews were professionally transcribed, then coded and analyzed by the research team. Results Themes surrounding the viability of PrEP implementation emerged for both logistical facilitators and barriers. Facilitators included availability of prescribing clinicians, ability to conduct lab testing on-site, and availability of existing hepatitis C programs as a blueprint for PrEP management. Barriers included increased provider burden, financial concerns, and perceptions that PrEP provision is outside the clinic's treatment scope. Conclusions Although staff expressed willingness and potential ability to provide PrEP, they identified barriers regarding insurance reimbursement, limited funding, and concerns that PrEP would extend the clinic's treatment scope. However, given the enabling factors such as availability of providers and existing clinical infrastructure, providing PrEP could increase clinic revenue through insurance reimbursement and federal funding for PrEP-related services. Clinic-level education is needed for clinical and nonclinical staff to better understand the logistics of implementing PrEP, particularly regarding prescribing practices, billing and insurance concerns, and the essential nature of HIV prevention as a critical component of substance use treatment.Item Medical Mistrust and Trust Among Sexual Minority Men(University of Alabama Libraries, 2022) Cox, Amanda; Jaiswal, Jessica; Wind, Stefanie; University of Alabama TuscaloosaBackground: Medical mistrust and trust significantly impact a variety of health behaviors and outcomes, widening health inequities among minoritized populations. While medical mistrust has been extensively studied, particularly among Black men, less is known about medical mistrust among sexual minority men (SMM). Additionally, research on medical trust is limited as most studies examine medical mistrust.This dissertation examines medical mistrust and trust in a sample of racially and ethnically diverse young sexual minority men (SMM; e.g., gay, queer, bisexual, and other men who have sex with men) in three ways: 1) to validate a scale commonly used to measure mistrust (Group-Based Medical Mistrust [GBMMS] and Group-Based Medical Mistrust-Sexual Orientation and Gender Minority [GBMMS-SGM]), 2) to examine medical mistrust within SMM by racial and ethnic group, 3) to validate Trust in Physician Scale (TIPS) among SMM. As such, this dissertation contains three articles.Methods: The GBMMS, GBMMS-SGM, and TIPS scales' factor structure were evaluated using Principal Axis Factoring (PAF) with a promax (oblique) rotation. To assess and compare medical mistrust among SMM, a one-way multivariate analysis of variance (MANOVA) was conducted to examine variations in race-based medical mistrust (GBMMS scores) and medical mistrust attributed to sexual/gender minority group status (GBMMS-SGM scores) by race (Black, Latinx, White, “Other”). One-way ANOVAs were conducted separately for each scale to examine pair-wise differences in GBMMS and GBMMS-SGM scores between race and ethnic groups. Results: The GBMMS, GBMMS-SGM, and TIPS scales are valid and reliable measures for evaluating medical mistrust among this population. Additionally, this study found significant differences in race-based medical mistrust by race and that there may be meaningful differences in medical mistrust attributed to sexual/gender minority status by race. Conclusion: This dissertation provides the first validation of mistrust and trust-related scales among SMM. This study also demonstrates the need for more research examining the many facets of medical mistrust and trust among SMM. These findings can be used to develop culturally sensitive and appropriate programs and interventions that focus on addressing barriers to healthcare utilization for SMM and other minorized populations.Item Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort Study(Springer, 2020) Jaiswal, Jessica; LoSchiavo, Caleb; Maiolatesi, Anthony; Kapadia, Farzana; Halkitis, Perry N.; University of Alabama Tuscaloosa; Rutgers State University Newark; Rutgers State University New Brunswick; Yale University; New York UniversityHuman papillomavirus (HPV) is the most common sexually transmitted infection among adults in the United States, and can cause several types of cancer. This is of particular concern for sexual minority men, as their increased risk of HIV acquisition increases risk for HPV and HPV-associated cancers, particularly when coupled with low rates of HPV vaccination. As part of a larger study of the syndemic of HIV, substance use, and mental health among young sexual minority men in New York City, we sought to explore what sexual minority men know about HPV and the HPV vaccine, along with their experiences have been communicating about the virus and vaccine. We interviewed 38 young sexual minority men with diverse sociodemographic characteristics and identified three main themes: low knowledge about HPV infection and vaccination, highly gendered misconceptions about HPV only affecting women, and lack of communication from healthcare providers about HPV. The prevalence of incorrect HPV knowledge, coupled with inadequate education and vaccination in healthcare settings, indicates a missed opportunity for HPV prevention in a high-risk and high-need population.Item PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure(Springer, 2022) Walters, Suzan M.; Frank, David; Van Ham, Brent; Jaiswal, Jessica; Muncan, Brandon; Earnshaw, Valerie; Schneider, John; Friedman, Samuel R.; Ompad, Danielle C.; New York University; Southern Illinois University; University of Alabama Tuscaloosa; State University of New York (SUNY) Stony Brook; Stony Brook University Hospital; University of Delaware; University of ChicagoPre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.Item A Qualitative Exploration of Self-Care Behaviors for Disease and Symptom Management Among College Students with Type 1 Diabetes Mellitus(University of Alabama Libraries, 2023) McFadden, Ny'Nika; Wilkerson, Amanda H.Although only 2.5% of college students have been diagnosed with Type 1 Diabetes Mellitus (T1DM), the effects of inadequate management can lead to hospitalizations, additional development of chronic health conditions, and early mortality. Therefore, T1DM self-care behaviors (e.g., administering insulin, monitoring blood glucose) must be performed to minimize disease exacerbations. Previous research has shown that college students with T1DM are improperly administering insulin and infrequently monitoring their blood glucose levels. Though previous research has utilized quantitative and qualitative methods to examine T1DM self-care behaviors among college students with T1DM, the literature is limited on disease and symptom management experiences among college students with T1DM. Therefore, this qualitative study used the middle-range theory of self-care of chronic illness integration of symptoms as a theoretical framework to conceptualize and explore T1DM self-care behaviors utilized for disease and symptom management. Participants engaged in self-care maintenance through carrying supplies, inserting consumed carbohydrates into their medical device, checking blood glucose, administering insulin, and engaging in physical activity. Self-care monitoring behaviors included recording and tracking changes to their blood glucose. Self-care management behaviors consisted of adjusting insulin rates, changing pump/pod sites, and consulting with their provider. Symptom management findings were physiological awareness and technology alerts to determine that symptoms were present (i.e., symptom detection). Symptom interpretation experiences included analyzing blood glucose trends and examining the situational causes of their blood glucose changing. Symptom response experiences consisted of immediately responding to hypoglycemia and situational responses to hyperglycemia. Barriers and facilitators that impacted T1DM self-care behaviors included barriers such as 1) diabetes burnout, 2) college lifestyle, 3) difficulty receiving medical supplies, 4) insurance limitations, and the facilitators consisted of 1) years of experience, 2) tangible support with supplies, 3) emotional support for disease and symptom management, 4) informational support for disease management, and 5) technology assistance for disease and symptom management. Findings from this study can be used for future interventions for college students with T1DM, and can guide healthcare professionals, health education and promotion practitioners, and family, friends, and romantic partners on how to support disease and symptom management among full-time college students.Item Sex in the Time of COVID-19: Patterns of Sexual Behavior Among LGBTQ plus Individuals in the US(Springer, 2022) Griffin, Marybec; Jaiswal, Jessica; Martino, Richard J.; LoSchiavo, Caleb; Comer-Carruthers, Camilla; Krause, Kristen D.; Stults, Christopher B.; Halkitis, Perry N.; Rutgers State University New Brunswick; University of Alabama Tuscaloosa; Yale University; Baruch College (CUNY)The SARS-CoV-2 virus, the pathogen which causes COVID-19, has left an indelible impact on the daily lives of individuals in the USA. This study sought to explore the sexual behaviors among people in the LGBTQ+ population at the onset of the pandemic. Behaviors were explored across sub-groups of the population. The study employed data from an internet survey about the impact of COVID-19 on LGBTQ+ identified individuals conducted between May and July 2020. The final sample was comprised of 1090 participants from across the USA. Overall, sexual activity and the number of sexual partners decreased after March 13, 2020 (as compared to before this date) across all sexual orientation groups; however, living situation and partnership status supported sexual activity. Gay and bisexual men living with a partner or a spouse (AOR = 2.20, p = .023) and those living with a non-romantic roommate or friend (AOR = 2.88, p = .004) reported more sexual activity. For both cisgender lesbian and bisexual women and transgender and non-binary individuals, those who were married or in a domestic partnership (AOR = 4.54, p < .001; AOR = 9.97, p < .001, respectively) and those in a committed relationship (AOR = 3.54, p = .001; AOR = 8.46, p < .001, respectively) reported more sexual activity. Additionally, cisgender lesbian and bisexual women living with their partner or spouse (AOR = 2.14, p = .044) reported more sexual activity. When examining the number of sexual partners, cisgender lesbian and bisexual women and transgender and non-binary individuals in a committed relationship (AOR = 0.31, p < 0.001; AOR = 0.26, p = .004, respectively) and those living with a partner or spouse (AOR = 0.30, p = .002; AOR = 0.25, p = .028, respectively) were less likely to report two or more sexual partners. Examining the changes in sexual activity and number of sexual partners helps us better identify the effects of COVID-19 on intimate relationships and sexual behaviors. Furthermore, this study may help develop clinical best practices to facilitate risk-reduction strategies for LGBTQ+ populations when engaging in sexual activity within a communicable disease framework. Current guidance on sexual activity within a pandemic has created a unique opportunity for sex-positive public health messaging that protects individual health while also offering a framework for conversations about risk mitigation that is applicable for both COVID-19 and STI/HIV prevention.Item Towards a More Inclusive and Dynamic Understanding of Medical Mistrust Informed by Science(Routledge, 2019) Jaiswal, Jessica; Halkitis, Perry N.; University of Alabama Tuscaloosa; Rutgers State University New Brunswick; Yale University; Rutgers State University Medical Center; Rutgers State University CamdenMistrust of medical advances and the medical professions continues to persist, and is perhaps increasing. The popular press has documented the growing number of parents globally whose concerns around childhood vaccination, albeit based on faulty scientific information, has led to the anti-vax movement which has already resulted in outbreaks of measles in various parts of the U.S. In recent years, the AIDS Healthcare Foundation has increased speculation and mistrust with regard to the denialism of the effectiveness of pre-exposure prophylaxis (PrEP) to avert HIV infections, again based on misinformation. However, in other cases, medical mistrust reflects the very real historical and ongoing injustices experienced by socially and economically marginalized groups. Whether the genesis of the mistrust is based on fact or fallacy, the results may be similar. There are myriad negative consequences associated with medical mistrust, including lower utilization of healthcare and poorer management of health conditions. Mistrust is thought to provide a partial explanation for staggering health disparities, particularly among Black and African American people, and much of the public health and medical literature cites the infamous Tuskegee Study as a main catalyst for this persistent health-related mistrust among people of color and other groups who experience social and economic vulnerability. While mistrust is often referred to as a phenomenon existing within an individual or community, we must rethink this conceptualization and instead locate mistrust as a phenomenon created by and existing within a system that creates, sustains and reinforces racism, classism, homophobia and transphobia, and stigma. The purpose of this article is to briefly address the state of the medical mistrust literature, and to provide a summary of the articles included in this special issue on medical mistrust. Although the scholarship in this issue addresses diverse methodologies, outcomes and populations, they share a message: social inequality drives mistrust.Item Whose Responsibility Is It to Dismantle Medical Mistrust? Future Directions for Researchers and Health Care Providers(Routledge, 2019) Jaiswal, Jessica; University of Alabama Tuscaloosa; Rutgers State University New Brunswick; New York University; Yale UniversityMedical mistrust persists and appears to be growing. The public health literature on medical mistrust has largely focused on mistrust among Black and African American populations due to legacies of abuse and mistreatment, such as the infamous Tuskegee Syphilis Study. However, research is now emerging that explores mistrust among various populations and in varying contexts, and the literature now largely emphasizes the role of ongoing, present-day social and economic inequalities in shaping and sustaining mistrust, particularly among populations who experience staggering health disparities. This special issue showcased nine articles exploring medical mistrust among diverse populations, exploring a wide array of topics and spanning myriad methodologies. In addition to a rigorous systematic review of the literature, this issue covers several critical subareas of the health disparities literature, including preventative health screenings among Black men, discrimination and cultural factors among rural Latinx communities, health care satisfaction among Latina immigrant women, the complex relationship between HIV testing and "conspiracy beliefs" among Black populations, pre-exposure prophylaxis use among transgender women, the impacts of mass incarceration on HIV care, eHealth interventions to address chronic diseases among sexual minority men of color, and participatory research to engage underserved populations as co-researchers. The purpose of this article is to provide a brief summary of the nine manuscripts in this special issue and to outline some recommendations and future directions for research on medical mistrust.