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The Relationship Between HIV Preexposure Prophylaxis Use and Laboratory-Confirmed Bacterial Sexually Transmitted Infection Positivity Among a Diverse, Multi-City Cohort of Sexually Active Sexual and Gender Minorities in the United States
Get PDFThe presence of chlamydia, gonorrhea, or syphilis infection is a significant risk factor for HIV acquisition and transmission and disproportionately impacts men who have sex with men (MSM) and transgender women. While HIV preexposure prophylaxis (PrEP) reduces HIV risk, its use may influence sexual behaviors, potentially increasing sexually transmitted infection (STI) exposure. Conversely, PrEP users are often more engaged in care, regularly screened and treated for STIs, and may access other prevention tools such as doxycycline postexposure prophylaxis. Studies on the relationship between PrEP use and STIs have shown mixed results. This cross-sectional analysis included 392 participants (381 cisgender MSM; 11 transgender women) enrolled in the US-based Multicenter AIDS Cohort Study/WIHS Combined Cohort Study between 2021 and 2024 who were sexually active in the year prior to STI testing and HIV negative at their most recent study visit. We assessed whether bacterial STI positivity (i.e., laboratory-confirmed chlamydia and gonorrhea at the urethral, pharyngeal, and/or rectal sites and/or current/past syphilis infection) differed by current PrEP use (yes/no). Multi-variable logistic regression models included sociodemographic and behavioral covariates that were associated with bacterial STI positivity at p < 0.05, with the most parsimonious models selected based on the lowest Akaike Information Criterion. Overall, 32.7% reported current PrEP use. Syphilis was the most prevalent STI (6.8%), followed by chlamydia (3.2%) and gonorrhea (2.1%); 11.7% of PrEP users tested positive for at least one STI, compared with 6.1% of non-PrEP users. Among PrEP users, 37.9% reported stopping or decreasing condom use, and 31.6% reported an increased number of sex partners after initiating PrEP. In both bivariate and multi-variable models, PrEP use was associated with higher odds of gonorrhea positivity (adjusted odds ratio = 4.70, 95% confidence interval [CI]: 1.10-20.04, p = 0.037) and greater odds of being positive for at least one STI (crude odds ratio = 1.94, 95% CI: 1.06-3.90, p = 0.041). No significant differences were observed for chlamydia and syphilis by PrEP use status. Overall, these findings suggest that current PrEP users (vs. non-PrEP users) have an increased odds of bacterial STI positivity, particularly gonorrhea, in a diverse, multi-city cohort of HIV negative, sexually active MSM and transgender women in the United States PrEP remains highly effective in preventing HIV, and our results underscore the importance of integrated sexual health services that support ongoing STI screening and prevention alongside PrEP use among sexual and gender minorities
Health service delivery in 3 districts of Zambia, 2025
No full textThese data were collected at healthcare facilities (n=34) in 3 districts of Zambia in April-May 2025. We performed an assessment of facility water, sanitation, and hygiene (WASH) services, types of services provided, availability of medical equipment and essential medicines, and whether the facility was affected by foreign aid funding cuts. We also surveyed individual staff (n=330) about their experiences at the facility and changes that may have arisen from recent funding cuts
Polygenic Predisposition, Multifaceted Family Protection, and Mental Health Development from Middle to Late Adulthood: A National Life Course Gene–Environment Study
Get PDFDepression is one of the most prevalent mental health conditions in middle and late adulthood, contributing substantially to morbidity, mortality, and reduced quality of life. However, limited research has examined the mechanisms linking genetic predisposition and early protective environments to long-term mental health trajectories. Guided by a life course health development perspective, this study investigated how depression polygenic scores (G) and protective childhood family environments (E) interplay to shape depressive symptom trajectories from mid- to late adulthood. We analyzed longitudinal data of 14 waves from the Health and Retirement Study (1994–2020; N = 4817), estimating linear mixed-effects models of depressive symptoms using the validated CES-D scale. Early protective environments were measured by indicators of family structure stability, non-abusive and substance-free parenting, positive parent–child relationships, and parental support. Results showed that genetic predisposition and protective family environments jointly influence depression trajectories across the life course. Specifically, individuals with both low genetic risk and high environmental protection had the lowest depressive symptoms over time. Importantly, when only one favorable factor was present, protective family environments offered a stronger lifelong benefit than low genetic risk. These findings extend prior research by demonstrating that supportive childhood environments can mitigate genetic vulnerability, shaping healthier long-term mental health trajectories. This work underscores the need for early family-based interventions to reduce depression risk, enhance resilience, and promote longevity
Trends and characteristics during 17 years of naloxone distribution and administration through an overdose prevention program in Pittsburgh, Pennsylvania
Get PDFObjective Describe time trends during 17.5 years of community-based naloxone distribution Methods Analysis of administrative records from a harm reduction program in Pittsburgh, Pennsylvania, USA, collected during encounters for overdose education, naloxone dispensing and refills. Monthly time trends were analyzed using segmented regression. Programmatic context aided interpretation of quantitative findings. We also evaluated impacts of 2014 state legislation loosening naloxone prescribing requirements and providing Good Samaritan protections.ResultsFrom July 2005 to January 2023 there were 16,904 service encounters by 7,582 unique participants, resulting in 70,234 naloxone doses dispensed, with 5,521 overdose response events (OREs), utilizing 8,756 naloxone doses. After legislation, new participants increased from 10.4 to 65.9 per month. New participants tended to be older (46 vs. 37 years), female (58% to 35%), White race, and more likely to be family/friends as opposed to people who use drugs themselves. Consequently, ORE per participant fell from 1.46 to 0.47 in the year after enactment. On average, 1.63 (95% CI: 1.60, 1.65) naloxone doses were administered per ORE, which did not change substantially over 17 years (χ2 = 0.28, 3 df, p = 0.60) during evolution from prescription opioids, to heroin, to illicitly manufactured fentanyl. In 98.0% of OREs the person who experienced overdose “was okay”, i.e., survived. Emergency medical services were called in 16% of OREs overall, but <7% since 2019. There were 106 more emesis events per 1,000 OREs with 4 mg nasal spray compared to intramuscular injection; and 48 per 1,000 more reports of anger. Titration of intramuscular naloxone was associated with lower rates of adverse events. Conclusions While state legislation created the environment for expansion, reaching previously underserved communities required intentional new programmatic development and outreach. Long-term consistency of <2 doses per ORE, high survival rate, and robust utilization all lend confidence in prioritizing naloxone distribution directly to people who use drugs and their social networks. Trial registration: This investigation was pre-registered https://osf.io/b2f4
MACRO-LEVEL DETERMINANTS OF MEDIA TRUST: EXAMINING THE INFLUENCE OF POLITICAL SYSTEMS AND PRESS FREEDOM OVER MEDIA TRUST IN A GLOBAL CONTEXT
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This study explores how a country’s political system and level of press freedom influence generalized media trust which refers to the public’s institutional trust in news media. Using data from the 2024 Reuters Digital News Report, the Freedom House 2023 Democracy Index, and the 2024 World Press Freedom Index, Hierarchical Linear Modeling was applied to examine correlations between these factors. While democracy and press freedom were strongly correlated, neither showed a statistically significant relationship with media trust. A composite index and ANOVA tests also failed to identify these institutional factors as strong predictors. Post-hoc visualizations highlighted the data’s outlier countries like Kenya, Hong Kong, and Greece, which upon further examination revealed that other factors -such as political influence, economic pressures, media ownership, and perceptions of journalistic credibility - may more directly shape media trust. The study concludes that media trust is influenced by the macro factors of political system and press freedom, but the influence is not entirely explanatory to the context-dependent nature of media trust. It recommends future research integrating further macro-level indicators - namely a contemporary index of media ownership structures - to introduce another binary of analysis.Bachelor of Art
Seed Capital: Opium Production and Investment Fixes in the Bengal Monopoly, 1842-1880
Get PDF In the nineteenth century, a tiny island off the coast of Europe reached the height of its power by prosecuting a drug trade halfway across the world. From 1842 to 1880, Britain imposed a system of colonial rule over India built on the export of opium to China, leveraging the sticky substance to serve a system of accumulation which fueled both its central position in global finance and its growth as an industrial power. This thesis charts the path of opium from its central role following the First Opium War’s end in 1842 to its position in the late Victorian period as a nearly invisible subcurrent in a broader system of imperial subjugation. The system left the Indian subcontinent, especially the opium-producing regions of Bihar and Benares in northern Bengal, economically dependent on Britain as a producer of cash crops and impoverished through a form of coercive production.Bachelor of Art
Making Your Misery Our Myth: An Analysis of the Diverse Perspectives on the Armenian Genocide in the West & Beyond
Get PDFThis thesis examines the Armenian Genocide as a case study in how separate groups perceive crimes against humanity. This thesis seeks to broaden the discussion of Armenian Genocide recognition and denial to go beyond typical binary discussions. Charting the genocide from the late 19th century through the late 20th century this thesis finds that Western sympathies for the Armenian people were often rooted in racist and hypocritical humanitarian messaging which contributed greatly to anti-colonial ambivalences and hesitance to allege genocide against the Ottoman Empire. By focusing on public intellectuals throughout the Western and non-Western world this thesis seeks to paint recognition, sympathy, ambivalence, and denial as a full spectrum of perspectives often motivated by racial lenses and biases towards the opposing side. By highlighting the diverse perspectives on the Armenian Genocide as a case study this thesis seeks to highlight the various ways people arrive at a spectrum of views on issues as existential and controversial as genocide to create room for future discourse which does not obstruct the humanitarian purpose. Bachelor of Art
Floods of Asheville: Comparative Analysis of Hurricane Helene, the ‘Great Flood’ of 1916 and Others
Get PDFThis thesis investigates the growing vulnerability of mountainous regions to extreme flooding events in a changing climate, with a focus on Western North Carolina and the record-breaking impacts of Hurricane Helene in 2024. Using the HEC-HMS modeling software, this study simulates flood flows across the Swannanoa River Basin to compare the hydrologic impacts of Helene with previous historic floods, including the 1916 Great Flood and Hurricanes Fred, Frances, and Ivan. While the model performs well under calibration with Hurricane Helene, its limited ability to generalize across storms underscores the challenge of modeling floods in complex mountainous terrain. Importantly, scaled simulations highlight how relatively small changes in rainfall intensity can dramatically alter flood magnitude.Bachelor of Art
Social Camouflaging and Depression in a Sample of Sexual Minority Autistic Adults
Get PDFSocial camouflaging is a well-documented phenomenon in autistic individuals, particularly in women and girls (Tubío-Fungueiriño et al. 2021). Individuals camouflage to conceal stigmatized autistic traits, including repetitive behaviors, vocal expression, and restricted interests, and identity concealment is associated with poor mental health outcomes in some studies of both autistic adults and sexual minorities (SMs; Bernardin et al., 2021; Pachankis et al., 2020). Studies have found higher rates of LGBT identity among autistic individuals (George & Stokes 2017), but no research exists on relationships between social camouflaging and well-being in these populations. The present study examines how social camouflaging predicts depressive symptoms among autistic SMs. Autistic adults (N =139) with no co-occurring intellectual disability completed an anonymous online survey that included measures of SM status, autistic traits, social camouflaging behaviors, “outness,” and recent depressive symptoms. Results demonstrated that with autistic traits as a predictor, non-heterosexual orientation negatively moderated associations with (1) camouflaging and (2) depressive symptoms in this sample. Additionally, assimilation (a subtype of social camouflaging) mediated the relationship between orientation and depressive symptoms. Taken together, these findings imply that openness about identity and/or access to affinity groups could have a protective effect against depressive symptoms among sexual minority autistic adults. Further research on multiply marginalized autistic communities is necessary to understand the role of identity disclosure and assimilation in well-being.
Keywords: autism spectrum disorder, social camouflaging, sexual minorities, depression, assimilation Bachelor of Art
Approaches to the Exercise of Presidential Regulatory Review
Get PDFThis thesis illustrates the evolution of presidential regulatory review as a political and bureaucratic tool in the twenty-first century. A comprehensive analysis of congressional testimony, executive policy documents, and public reporting reveals processes by which review has become increasingly influential and politicized. It further offers a Dispositional–Operational Model explaining different approaches to regulatory governance.
The Office of Information and Regulatory Affairs (OIRA) emerged in the early 1980s in response to the growing burden of federal regulation and critiques of agency capture. The office audits regulatory analyses prior to the promulgation of proposed and final rules and coordinates regulatory planning across agencies. While evidence-based analysis remains central to OIRA’s work, the process has been criticized for emboldening industry groups’ influence and undercutting agency autonomy. This thesis provides a baseline for understanding institutional history and policy nuances by identifying the hard authorities and soft influences exercised by OIRA and the development of policy practices over time.
OIRA governance methods materialize as a function of Administrators’ dispositional and operational tendencies. The office may either operate as formalist, deferring to structures of empirical analysis and review processes, or as functionalist, working primarily through informal and influential channels as an extension of presidential power. OIRA leadership may demonstrate dispositional restraint, averse to change in the office’s scope and function, or dispositional disruptiveness, which is more tolerant of departures from institutional norms. This project concludes with considerations for safeguarding OIRA autonomy and ensuring congressional oversight and proposes a division of review and policy responsibilities into separate White House offices to protect robust analysis and ensure presidential oversight of the bureaucracy. Bachelor of Art