Steven A Safren
Datos Biográficos
| ID | 205652 |
|---|---|
| NOMBRE | Steven A Safren |
| NOMBRES | Steven A |
| APELLIDO | Safren |
| FIRMA | SAFREN S A |
| AFILIACIONES | University of Miami |
| ORCID | 0000-0002-0121-0806 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 195 |
| TOTAL DE CITAS | 157 |
| TOTAL COMO AUTOR | 195 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1999 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 7 |
Employment as HIV Prevention
Differences in Methamphetamine Use, Self-Reported Impact, and HIV-Related Outcomes by Gender and Sexual Orientation in a Multisite U.S. Cohort of People with HIV in Care
Implementation Determinants of Scaling up and Disseminating HIV-Prevention and Treatment Services to Latino MSM in Three Ending the HIV Epidemic Priority Jurisdictions
SOMOS Alianza is a strategic alliance of HIV service implementers, HIV researchers, and community members from three jurisdictions: Miami, Florida, Orlando, Florida, and San Juan, Puerto Rico. Because of high HIV incidence among Latino men who have sex with men (LMSM), improved implementation of evidence-based HIV services is needed. We sought to identify determinants influencing the reach of HIV services to LMSM in these jurisdictions. Using the…
Towards a Better Understanding of HIV Prevention Knowledge Among Latino MSM
Latino men who have sex with men (LMSM) are disproportionately affected by HIV in the United States. Despite advances in HIV prevention options, LMSM have inequitably low access to knowledge about HIV, HIV testing, and pre-exposure prophylaxis (PrEP), contributing to disparities in prevention service use. We first identified subgroups of LMSM ( N = 290) based on their patterns of knowledge related to HIV prevention by using latent class analysis.…
Differentiating Exposure From Consequence
Persons living with HIV (PLWH) are disproportionately exposed to traumatic events, which are associated with posttraumatic psychological distress and impaired HIV-related health outcomes (e.g., antiretroviral non-adherence, HIV viremia, lower CD4 count). Prior literature has not adequately differentiated the effects of trauma and posttraumatic distress on HIV-related health outcomes. This study examined longitudinal data of trauma exposure and po…
What makes peers credible? A qualitative analysis to operationalize peer credibility in HIV-prevention and treatment programs for Latino MSM
The potential of peers to be effective in delivering HIV interventions is linked at least in part to the degree to which they are perceived as credible sources of HIV-related information. This study aimed to operationalize qualities that would make a LMSM peer implementer credible. We conducted a qualitative analysis of semi-structured interviews with 20 LMSM and focus groups with 11 HIV service implementers. The parent study collected formative …
Linear growth modeling of religious coping and social support among Black women living with HIV in the context of the Covid-19 pandemic
Among Black women living with HIV (BWLWH) the current study aimed to quantitatively assess changes in religious coping and social support over time via linear growth modeling (LGM). BWLWH (N = 276) provided longitudinal survey data on demographics, religious coping, and social support across fourteen study visits (between 2019 and 2024) at three-month intervals in the Southeastern United States. Religious coping and social support mean scores flu…
Implementation Determinants of PrEP and Behavioral Health Treatment Referral among HIV Test Counselors
Pre-exposure prophylaxis (PrEP), an effective biomedical prevention intervention, is not sufficiently reaching populations experiencing high HIV incidence. Behavioral health (BH) treatment addressing mental health and substance use similarly requires increased reach to HIV-affected populations. HIV testing is an opportunity to refer individuals to PrEP and BH treatment. This study, conducted in Miami-Dade County, FL, a domestic HIV epicenter, aim…
Streamlining Stigma Measurement
The HIV Stigma Scale (HSS) is a 40-item psychometrically sound measure capturing four domains of perceived stigma. A 25-item version has been validated in South India. However, the HSS has not been validated among pregnant women with HIV (WWH) in South Africa, a population facing significant stigma. Moreover, they could benefit from the abridged measure to be more efficiently connected to related interventions. Analyzing data from a sample of pre…
Testing for Measurement Invariance (MI)
Assessing measurement invariance and the interplay of discrimination, microaggressions, and resilience among Black women living with HIV (BWLWH) across time utilizing latent class and repeated measure analysis may provide novel insights. A total of 151 BWLWH in a southeastern U.S. city completed surveys focused on multiple forms of microaggressions and discrimination (race, gender, sexual orientation, or HIV-related) and resilience factors (socia…
Exploring Latino cultural factors from the perspective of sexual minority men in the USA
Existing research on Latino cultural factors mainly focuses on gender and nationality, often overlooking sexual orientation and giving limited attention to the experiences of Latino sexual minority men in the United States of America (USA). This study addressed this gap by exploring how sexual minority men identify, describe and experience Latino cultural factors. Between April and December 2019, semi-structured interviews were conducted with 28 …
Development and preliminary inter-rater reliability of the new PROOF tool to measure fidelity of problem-solving therapy for depression delivered by non-specialists in a low-resource African setting
Problem-solving therapy (PST) is a brief psychological intervention often implemented for depression. Currently, there are no tools with well-evidenced reliability to measure PST fidelity. This pilot study aimed to measure the inter-rater reliability and agreement of the Pro blem-S o lving Therapy F idelity (PROOF) scale, comprising binary 14-item adherence and an 8-item competence subscales. Transcripts were from the TENDAI trial, a Zimbabwe-bas…
The impact of syndemic burden, age, and sexual minority status on internalized HIV stigma among people living with HIV in South Florida
Internalized HIV stigma has been associated with several poor mental and physical health outcomes among people living with HIV (PLWH); yet, little research has explored how internalized HIV stigma may be affected by syndemic burden. This study sought to examine the relationship between syndemic conditions and HIV stigma over and above the potential effects of two social determinants of health, age and sexual minority status, using a linear regres…
A qualitative exploration of how to support PrEP adherence among young men who have sex with men
New HIV infections disproportionately affect young men who have sex with men (YMSM). PrEP is effective in preventing HIV acquisition; however, adherence is critical and is often suboptimal among YMSM. Interventions addressing the unique PrEP adherence challenges faced by YMSM are needed. We conducted qualitative interviews with 20 HIV-negative, YMSM (ages 15-24) with a PrEP indication and 11 healthcare professionals to inform adaption of a PrEP a…
Peer ambassador stories
Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We condu…
Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in a…
The salience of structural barriers and behavioral health problems to ART adherence in people receiving HIV primary care in South Africa
Multilevel factors (individual and structural) influence adherence to antiretroviral therapy, particularly in high HIV prevalence areas such as South Africa. The present study examined the relative importance of structural barriers to HIV care and behavioral health factors, depression and alcohol use, in Khayelitsha, Cape Town, South Africa. People receiving HIV care in six primary care clinics in Khayelitsha (N = 194) completed the Center for Ep…
Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era
A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV
Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease …
Increases in employment over six months following Khanya
Factor Structure and Measurement Invariance of the Cultural Attitudes Toward Healthcare and Mental Illness Questionnaire Among Latino Sexual Minority Men
Mental health disparities among Latino sexual minority men (LSMM) are exacerbated by un(der)treated mental health needs. This study sought to establish the factor structure of the Cultural Attitudes Toward Healthcare and Mental Illness Questionnaire (CAHMIQ) and examine measurement invariance across nativity (born in vs. outside the continental U.S.). Participants included 290 LSMM in South Florida. Confirmatory factor analysis examined the facto…
Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami
Chronic pain and substance use disorders among older sexual minority men living with HIV
HIV continues to be a critical health issue for sexual minority men (SMM) in the USA. Chronic pain is common in individuals with HIV, including older SMM, and is associated with substance use behaviors. This cross-sectional study sought to address a gap in the literature by characterizing interrelationships among chronic pain, substance use disorders (SUDs), medication adherence, and engagement in HIV care among older (≥50) SMM living with HIV an…
Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men
Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration h…
Intersectional stigma and gender non-affirmation hinder HIV care engagement among transgender women living with HIV in India
Among transgender women living with HIV (TGWLH) in India, little is understood about the mechanisms through which multiple intersecting stigmas impact HIV care engagement, or intervention strategies that might mitigate this impact. We conducted focus groups with TGWLH (N = 30) in three Indian cities and analysed data using theoretical frameworks related to HIV stigma, gender affirmation, and syndemics. Findings revealed that enacted and anticipat…
Effect of Same-Sex Marriage Laws on Health Care Use and Expenditures in Sexual Minority Men
Objectives. We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of same-sex marriage laws in Massachusetts in 2003. Methods. We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts. Results. In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically …
Street Workers and Internet Escorts
Complexity of Childhood Sexual Abuse
Garnering an In-depth Understanding of Men Who Have Sex with Men in Chennai, India
High Prevalence of Multiple Syndemic Conditions Associated with Sexual Risk Behavior and HIV Infection Among a Large Sample of Spanish- and Portuguese-Speaking Men Who Have Sex with Men in Latin Ameri…
What Makes a Respondent-Driven Sampling “Seed” Productive? Example of Finding At-Risk Massachusetts Men Who Have Sex with Men
Mental Health Concerns of Gay and Bisexual Men Seeking Mental Health Services
Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large n…
Body Dissatisfaction Among Sexual Minority Men
Still I rise
Culturally adapted interventions are needed to improve the health of BWLWH by enhancing coping strategies for the multiple adversities they face and promoting self-validation, self-primacy, and self-care in spite of adversities. (PsycINFO Database Record
Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men
Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020
Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumati…
Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth
Medication adherence among youth living with HIV (28%-69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14-24 years) and analyzed transcripts using the c…
Muscularity disturbance and methamphetamine use among HIV-infected men who have sex with men
Let’s Hook Up When the Pandemic is Over
COVID-19 led to substantial changes in individuals' lives due to preventive measures, including social distancing and "stay at home" orders. One type of social interaction likely impacted is intimacy and sexual relationships. Sexual minority men have long navigated the impact of another pandemic, HIV, on their sexual lives. This study explored the impact of COVID-19 on Latinx sexual minority men's (LSMM) sexual behaviors in South Florida, an HIV …
Factors associated with resilience among Black women living with HIV and histories of trauma
In the United States, Black women living with HIV face various individual (e.g. trauma) and structural (e.g. racism) adversities. However, resilience is understudied among Black women living with HIV. A total of 100 Black women living with HIV in the United States completed measures of resilience, general self-efficacy, self-esteem, post-traumatic growth, trauma symptoms, trauma-related cognitions, and depressive symptoms. Regressions controlling…
Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV
Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/Aids in Zimbabwe
Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitati…
Building Program Acceptability
There is growing interest in integrating HIV prevention counseling for HIV-infected gay and bisexual men into HIV primary care. HIV-infected peers and professionally trained prevention case managers (PCMs) have been used to provide prevention counseling services. The current qualitative study seeks to examine participant perceptions of the acceptability of HIV-infected peer counselors and of trained prevention case managers from the perspective o…
A Relational Framework for Engaging Latino Sexual Minority Men in Sexual and Behavioral Health Research
Longitudinal Effects of Syndemics on HIV-Positive Sexual Minority Men’s Sexual Health Behaviors
The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women
Skin Cancer Risk Behaviors Among US Men
The current study assessed skin cancer risk behaviors by sexual orientation in a nationally representative prospective sample of US men (n = 1767), sampled at ages 16 and 29 years. At age 16 years, sexual minority men were 3.9 times as likely as heterosexual men to indoor tan. Participants did not significantly differ in the use of sunscreen or the frequency of outdoor tanning. Thus, sexual minority men might be an at-risk group for developing sk…
A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa
Depression is prevalent among people living with HIV in South Africa and interferes with adherence to antiretroviral therapy. This study evaluated a nurse-delivered, cognitive behavioral therapy intervention for adherence and depression among antiretroviral therapy users with depression in South Africa ( n = 14). Primary outcomes were depression, antiretroviral therapy adherence, feasibility, and acceptability. Findings support robust improvement…
The Cost and Intensity of Behavioral Interventions to Promote HIV Treatment for Prevention Among HIV-Positive Men Who Have Sex with Men
Examining the Correspondence Between Relationship Identity and Actual Sexual Risk Behavior Among HIV-Positive Men Who Have Sex with Men
Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents.
In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychosocial predictors of present distress, significant dif…
Psychometric properties of the Liebowitz Social Anxiety Scale
Background. The present study provides data on the reliability, validity and treatment sensitivity of the Liebowitz Social Anxiety Scale (LSAS), one of the most commonly used clinician-administered scales for the assessment of social phobia. Method. Three hundred and eighty-two patients from several studies of the treatment of social phobia were evaluated. An independent assessor administered the LSAS to each patient prior to the initiation of tr…
Two strategies to increase adherence to HIV antiretroviral medication
Use of an on-line pager system to increase adherence to antiretroviral medications
Adherence to antiretroviral therapy is critical for treatment success. Antiretroviral therapy typically requires multiple pills at multiple dosing times. To address this, we tested the feasibility, utility, and efficacy of a customizable reminder system using pagers, which were programmed using web-based technology, to increase and maintain proper adherence in patients with pre-existing adherence problems. After a two-week monitoring period with …
ART adherence, demographic variables and CD4 outcome among HIV-positive patients on antiretroviral therapy in Chennai, India
This is an analysis of available chart data recorded by HIV counselors and physicians on patient adherence and CD4 count in 304 patients with HIV who were prescribed antiretroviral therapy (ART) in Chennai, India. HIV counselors had categorized the majority of patients' adherence as 'regular' (74.3%), with a significant minority being categorized as 'irregular' (17.8%), or 'recently missed some doses' (6.9%). Those categorized as 'irregular' had …
Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic
This study examined the association of appointment nonadherence to markers of disease severity using one year of demographic and health information on 995 individuals with HIV in primary care at an urban community health centre. At the latest visit, 106 of 946 valid cases (11.2%) had a CD4 less than or equal to 200, and 454 of 936 valid cases (48.5%) had detectable plasma HIV RNA (greater than 50 copies/ml). Using logistic regression, appointment…
MSM in HIV-Prevention Trials are Sexual Partners With Each Other
Domains of Life Satisfaction Among Patients Living With HIV
Perceptions About the Acceptability of Assessments of HIV Medication Adherence in Lilongwe, Malawi and Chennai, India
Optimal Recall Period and Response Task for Self-Reported HIV Medication Adherence
Developing an HIV-Prevention Intervention for HIV-Infected Men Who Have Sex with Men in HIV Care
Study participation as a social group influencing sexual behaviours in an HIV-prevention trial for men who have sex with men
Perceived group membership, perceptions about accompanying group norms and the degree to which a person identifies with a social group are predictive of a wide range of human behaviours. Behavioural clinical trials in general, and HIV-prevention intervention trials in particular, however, have not examined the degree to which individuals who join a large behavioural study (and hence, a group) may, in an unanticipated way, develop a sense of socia…
Differential HIV Risk Behavior among Men who have Sex with Men Seeking Health-Related Mobile Van Services at Diverse Gay-Specific Venues
Latinos and HIV/Aids
Depressive Symptoms, Utilization of Mental Health Care, Substance Use and Sexual Risk Among Young Men Who have Sex with Men in EXPLORE
Street Workers and Internet Escorts
Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men
Mental Health Concerns of Gay and Bisexual Men Seeking Mental Health Services
Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large n…
A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.
OBJECTIVE: To evaluate cognitive-behavioral therapy to enhance medication adherence and reduce depression (CBT-AD) in individuals with HIV. DESIGN: A two arm, randomized, controlled, cross-over trial comparing CBT-AD to enhanced treatment as usual only (ETAU). ETAU, which both groups received, included a single-session intervention for adherence and a letter to the patient's provider documenting her or his continued depression. The intervention g…
Preexposure Antiretroviral Prophylaxis Attitudes in High-Risk Boston Area Men Who Report Having Sex With Men
BACKGROUND: Preexposure prophylaxis (PrEP) could protect individuals engaging in repeated high-risk behaviors from HIV infection. Understanding the demographic and behavioral predictors of intent-to-use PrEP may prove useful to identify clinical trial participants. METHODS: In 2007, 227 HIV-uninfected men who report having sex with men (MSM) recruited through modified respondent-driven sampling completed an interviewer-administered survey assessi…
Childhood Sexual Abuse Is Highly Associated With HIV Risk-Taking Behavior and Infection Among MSM in the EXPLORE Study
BACKGROUND: Previous studies have found high rates of childhood sexual abuse (CSA) among US men who have sex with men (MSM). CSA history has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV acquisition and transmission. The present analysis is the first to examine the longitudinal association between CSA and HIV infection, unprotected anal sex, and serodiscordant unprotect…
Stressful or traumatic life events, post-traumatic stress disorder (PTSD) symptoms, and HIV sexual risk taking among men who have sex with men
The present study assessed the presence of post-traumatic stress disorder (PTSD) symptoms in response to stressful or traumatic life events and their impact on HIV risk behaviors and associated psychosocial variables among men who have sex with men (MSM). Participants (n=189; 60% HIV-infected) who were recruited by notices posted in a community health clinic and via a modified respondent-driven sampling technique completed a behavioral assessment…
Mental Health and HIV Risk in Men Who Have Sex With Men
Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems su…
“We fear the police, and the police fear us”
Ukraine has one of the most severe HIV/AIDS epidemics in Europe, with an estimated 1.63% of the population living with HIV/AIDS in 2007. Injection drug use (IDU) remains the predominant mode of transmission in Kiev - the capital and largest city. Prior reports suggest that the HIV infection rate among IDUs in Kiev reaches 33%, and many have poor and inequitable access to highly active antiretroviral therapy (HAART). Among those with access to HAA…
Discussion of Sexual Risk Behavior in HIV Care is Infrequent and Appears Ineffectual
Medicine (180 obras) · HIV/AIDS Research and Interventions (166 obras) · Psychiatry (141 obras) · Psychology (136 obras) · Clinical Psychology (101 obras) · Family medicine (97 obras) · Public health (96 obras) · HIV, Drug Use, Sexual Risk (88 obras) · Human immunodeficiency virus (HIV (86 obras) · Health psychology (74 obras)