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Discussion forum for Leilani Mitchell's boyfriend. Does Leilani Mitchell (New York Liberty, WNBA) have a boyfriend? Is she dating someone? Is she married?. The couple-based HIV testing and counseling intervention significantly reduced Leilani Torres, University of Rochester Medical Center, School of Nursing. Leilani Mitchell says her mum always wanted her to play for Australia despite being born in the United States and growing up in Washington.
HIV-serodiscordant couples were administered tailored content for all relevant components, and were also delivered additional components addressing antiretroviral therapy adherence for the infected partner and safe conception options and referrals for couples wishing to conceive. Appropriate informational videos can be selected for relevance to the population, or replaced with other media materials. The remaining components 5.
An additional optional component was developed for at-risk couples who were not HIV-serodiscordant and who were resolute in their opposition to condom use. Guided by our theoretical framework, most risk reduction components began by providing information designed to enable participants to recast their cost-reward assessment of the target behavior. First, the counselor provided community-level evidence e.
For example, the intervention content for at-risk couples who were not using condoms pre-action stage focused on behavior change e. Content for HIV-serodiscordant couples was also tailored to provide more precise information on risk of infection and the importance of adherence to ARV therapy for the positive partner.
Interactive exercises Upon completion of the relevant risk reduction components, all couples were delivered two counselor-mediated interactive sessions: Couples were informed that members in their community were surveyed on seven questions, and that the object of the game was to correctly guess which of several responses to each question was most commonly selected by members of their community.
An example question was: They were then asked to disclose their answers to one another, and the counselor revealed which response the community selected. The purpose of this exercise was to reveal within-dyad differences and similarities regarding perceived social norms related to gender roles and sexual behavior, as well as reinforce or challenge couples on their perceptions of community norms.
Counselors guided the discussion toward a normative framework supporting healthy decisions. The second interactive session involved practiced couple communication.
This method distinguishes the roles of speaker and listener, with a set of rules governing the conduct of each during communication. Guided by findings from qualitative interviews with couples, we adapted these rules for use with our target population, and formulated a set of Ten Good Communication Practices.
After introducing the exercise, the counselor briefly summarized each practice, while listing them on a white board.
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Two columns labeled with the first name of each member of the couple were added to the right of the list. The counselor then asked each member to rate their own communication skill for each of the ten practices.
The counselor must ensure that the discussion does not become overly contentious. Participants were then shown a five-minute video clip of a couple using good communication practices during a discussion. The content of the role-playing conversation was one of several scenarios selected by the counselor, or one that the couple had chosen.
The session ended with constructive, non-judgmental, advice by the counselor to improve communication. Described to participants during the introductory session, the Action Plan form is a document maintained by the counselor throughout the joint counseling session. Two copies of the plan were included in a packet given to the couple. Rapid HIV testing was available during the trial period of the intervention, but conventional testing was still in wide use. While the HIV-negative partner was being tested, the counselor used this time to initiate a brief discussion with the HIV-positive partner about potential risk behavior with secondary partners.
The counselor assured the client that any disclosures would be kept in strict confidence. The counselor then initiated a discussion about potential injecting partners, and the importance of using safe injection practices for injectors.
The discussion then turned to potential risk of transmission with secondary sex partners, and the importance of consistent condom use and ART adherence. The counselor then left the HIV-positive partner and engaged the HIV-negative partner in the medical room, with a similar discussion. It is essential that the two rooms are sufficiently private to ensure confidentiality and perceived confidentiality. Once specimen collection and secondary risk counseling were completed, appointments were scheduled for individual post-test results and counseling.
Follow-up appointments for post-test visits were made on an individual basis about 10 to 14 days after the initial intervention. Each member of the couple was allowed to schedule an appointment individually, or together with their partner, but all post-test sessions were conducted individually. In addition, the couple was asked to select a date for another couple-based HIV counseling and testing session in 6—12 months.
This was normalized by drawing a parallel with a bi-annual or annual physical exam. If the newly diagnosed client was accompanied by their partner, the client was given the option of immediately informing their partner with the assistance of the counselor or, alternatively, using the PNAP service or informing their partner in their own way. The second part of the post-test visit was to review the Action Plan from the prior joint couples counseling session.
In light of a newly diagnosed infection, the plan may have to be revised, but only after partner notification. The counselor must also judge whether the client is emotionally ready to discuss a revised plan. The counselor may ask to follow-up with the client or the couple to discuss this, as well as following up on the referrals at a later date.
For clients in which no newly diagnosed infections are revealed, the counselor reviewed and evaluated progress on the Action Plan from the prior couple-based session. A discussion was conducted around new or continuing barriers to healthy behaviors, and potential solutions and alternatives.
The remainder was performed by one female bilingual back-up counselor. The principal male counselor had over twenty years of experience in community outreach, case management, education, drug treatment, and HIV counseling.Interview with Leilani Mitchell after Mercury defeat Sun on July 5,2018
He was also a trained phlebotomist and performed biological specimen collection for HIV and hepatitis B and C anti-body screening. The back-up counselor had similar education and experience. Both interventionists received extensive training on the couple-based HIV-CT intervention and standard-of-care control using an interactive skills-building approach. Monthly project meetings were held in which counselors discussed, and received feedback on, emergent issues and challenges and their handling of various situations.
Fidelity assessments included a checklist based on the intervention manual and monitor notes. Adherence to protocols and intervention fidelity were discussed with counselors at monthly project meetings.
The average length of the relationship was 7. For men, condom use with secondary partners was: We estimated that the couple-based intervention prevented 3. Analysis indicated that this prevention gain was primarily due to reductions in receptive syringe sharing, both within and outside the relationship, as well as reductions in unprotected anal sex with primary partners.
There was also evidence of a decrease in unprotected vaginal sex with primary partners and in the number of secondary sex partners.
Common perspectives included a desire to be safe and healthy, an appreciation for the skill and personal attributes of the counselors, the benefit of having a neutral third party initiate a discussion about HIV and hepatitis risk, that the intervention was informative but also fun, and receiving a take-home packet of materials e.
Several couples expressed appreciation of the Eight-Step TLC component, which was regarded as a more realistic option than condom use for some. A small minority of participants thought the intervention was too long.
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The mean and median length of the couple-based interventions was two hours Std Dev: Two male participants assigned to the standard NIDA intervention reported relationship problems stemming from their participation in the study. One complained that his partner had not been truthful about her test results at post-test follow-up. The other reported that his partner became more insistent that he curtail his drug use practices and sexual activities with other partners.
Discussion The Harlem River Couples Project was the first randomized trial to demonstrate the risk reduction effectiveness of a couple-based HIV counseling and testing intervention among U. The intervention consisted of pre- and post-test counseling visits. The pre-test session concluded with individual HIV and hepatitis testing and prevention counseling addressing risk with secondary partners.
The randomized trial demonstrated the feasibility and effectiveness of conducting HIV counseling and testing with U. Perceptions of the intervention were positive among both clients and counselors. The two counselors indicated that the various components of the intervention flowed well and that they encountered no major psychological or other adverse events during intervention delivery. Delivery and evaluation of a couple-based HIV counseling and testing intervention was not without limitations.
Although couples were not directly paid to attend the HIV counseling and testing sessions, they were compensated for each assessment visit baseline, three-months and nine-months post-intervention and willingness to participate in the intervention was a criterion to enroll in the study.
Thus, we do not know whether couples would voluntarily attend couple-based HIV counseling and testing as an alternative to individual HIV-CT outside of a research context and in the absence of any monetary incentive. The mean age of women enrolled in the study was The older age of the sample is typical for HIV prevention studies involving drug users Semaan et al.
Another potential source of bias is the exclusion of women who self-reported feeling uncomfortable or threatened participating in a couple-based HIV prevention intervention. This exclusion criterion was implemented for ethical reasons but also because the intervention was not designed to address the needs of more volatile and violent relationships. Post-enrollment, participants who appeared intoxicated or high during a study visit were rescheduled, although this occurrence was rare. Counselors were also trained to recognize potentially abusive situations and how to handle them using conflict resolution tactics.
These factors might explain the low prevalence of self-reported couple discord and conflict stemming from participation in the intervention. The HIV counseling and testing mode of intervention delivery, although brief, has several important advantages over interventions involving multiple sessions, particularly for illicit drug users. HIV-CT is an existing health service that is already accessible and utilized by members of communities characterized by high HIV incidence and prevalence.
Moreover, the often chaotic and transient lives of drug users especially those who are out-of-treatment often preclude attendance at multiple intervention sessions over many weeks or months.
By contrast, HIV-CT consists of a single pre-test and testing session followed by a single post-test session. Participation is often initiated by clients seeking testing who are motivated to learn their HIV status.
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Further, a recent meta-analysis found that brief HIV prevention interventions were as effective as multi-session interventions for drug-users Meader et al. CDC guidelines recommend recurrent HIV counseling and testing at least annually for persons in high-risk categories Branson et al. Although the intervention was not tailored to any specific cultural, racial or ethnic group, the content and delivery of the intervention was community-focused i.
Indeed, as with most interventionist-lead programs, the attributes of the counselors were a key factor in the success of the couple-based approach. Both counselors were bilingual and had over a decade experience administering HIV prevention interventions and other related health and social services educational and counseling programs within the community. Interestingly, these feelings are not to do with the economy, but with expectations and social pressure: Our internal world is often in conflict with the world we occupy with others and society.
One client, now in her 20s, saw her father kill her mother when she was three years old. It seems she's never talked fully about it except to her current partner.
She also simply wanted to grieve for her mum. She's getting on with her life, and that's my aim: She told me that she felt more at peace and no longer felt the urge to self-harm. I used to be told, "Don't phone me at home because my husband doesn't know I see you", but that doesn't happen any more.
There have also been changes in what we know — for example, how a baby's brain develops and the huge effect nurturing by the mother or main carer has on the infant. On the one hand, I see women struggling with work, family and higher expectations of life. It's happening earlier, from around The number of clients using medication for depression and anxiety is much higher than it was 20 years ago.
A lot of doctors are misdiagnosing. A young woman whose father has died is grieving because of the horrendous experience. Here is a typical case of a woman torn between career and family. She wanted children, but didn't feel she could give up work, so went back. Then she felt under social pressure to have another child. But that child was more challenging. Then she started having panic attacks. After working at curbing the high demands she put on herself, then realistically looking at the situation, she resigned from her job and got something local and part-time.
As the culture has changed and women have become more independent, the idea that we can do it all has emerged. We can, but there's a huge price to pay, including its effects on the children. I'm seeing a lot of people who are struggling. Mothers juggling way too many balls — working, managing the finances and the family, and not feeling supported by anyone.
One client in his late 20s was working long hours and also doing a lot of childcare, getting his four-year-old son up in the morning, giving him breakfast and getting him to nursery. There's a lot of that self-sacrificing for Scotland feeling going on: We set him boundaries. He stopped taking his wife's calls at work and taking the child to nursery, clearly stating what he needed to do and what she needed to do.
In workplace counselling, I'm seeing a lot of stress. Social media addiction All illustrations: Paul Thurlby Darren Magee, psychotherapist, practising for four years, Belfast. Internet addiction is something I'm seeing a lot of. Not just pornography but social media: YouTube, online gambling, forums, it is addiction across the whole range. In the short term, we look at how to manage their addiction. There is a fear of asking for help: If you go back to the early 70s, when things were at their worst, a lot of people dealt with their difficulties with a bottle of whiskey.
The sectarian divide has never come into this consulting room. I have worked with people who describe themselves as ex-combatants — and I wouldn't say what side — but they come with much the same problems as any ex-service people. Relationship breakdown Janet Reibstein, psychologist and psychotherapist, practising for 35 years, Exeter.
I'm also seeing younger people. My clinic is for depression. Research shows that an intimate partner is most protective, but many good relationships — friends and family — are even better. They see me as more like a consultant who can be helpful. There's a lot of stress now surrounding work. Managers are finding it very stressful and everyone is much more scared about losing their jobs. I use the story of the boiling frog to explain their stress. Put it in tepid water and slowly turn up the heat, however, and it will stay there.
Stress is incremental and clients have become acclimatised. There's so much adrenaline that you have panic attacks, or get weepy, or can't sleep. It's a red warning light that you are in a dangerous situation.
Many clients present with almost identical symptoms and fears. Your brain associates that as a threat, and people feel that they are going crazy. If they relax, it can subside. I also encourage them to give their day boundaries, to limit their involvement, and to pass on to senior staff that adjustments need to be made.
I also signpost clients towards mindfulness techniques. If a client uses them daily for a couple of months, they can see the difference. Mindfulness is like a muscle: Clients become much more compassionate towards themselves.
A big contribution to anxiety and stress is negative self-image: With mindfulness, you won't ruminate so much and you have less fear of your thoughts.