As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d ) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patientcentered medical homes and chronic health homes; and ( f ) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts-intended audience, health problems, organizational and cultural settings-and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.

100 -111, 2003). In the present study, we attempted first to confirm whether the denatured albumins generally increase in conditions of oxidative stress and second to characterize the degradative process of the denatured albumin using primary cultured rat liver endothelial cells. We used five models of oxidative stress, including endotoxicosis, ischemic heart disease, diabetes, acute inflammation, and aging, and found that serum concentrations of D3 albumin correlate with the serum levels of thiobarbituric acid-reactive substance (R ϭ 0.87), whereas the concentrations of D2 albumin are 0.52. Ligand blot analysis showed that the D3 albumin binds to gp18 and gp30, which are known endothelial scavenger receptors for chemically denatured albumin. Primary cultured rat liver endothelial cells degraded the FITC-D3 albumin, and the degradation rate decreased to ϳ60% of control levels in response to anti-gp18 and anti-gp30 antibodies, respectively. An equimolar mixture of these antibodies produced an additive inhibitory effect on both uptake and degradation, resulting in levels ϳ20% those of the control. Furthermore, filipin and digitonin, inhibitors of the caveolae-related endocytic pathway, reduced the FITC-D3 albumin uptake and degradation to Ͻ20%. Laserscanning confocal microscopic observation supported these data regarding the uptake and degradation of D3 albumin. These results indicate that conformationally denatured D3 albumin occurs generally under oxidative stress and is degraded primarily via gp18-and gp30-mediated and caveolae-related endocytosis in liver endothelial cells. serum albumin; denaturation; scavenger receptor; caveolae EARLY IN VIVO STUDIES with radioisotope-labeled albumin have revealed the constant plasma half-life to be 2-2.5 days in rats (41). Conformationally altered albumin, however, is well known to show an extremely short half-life in circulating blood (31). Such changes in the degradation rate of serum albumin as well as of other serum proteins seem to occur under an individual degradative process, but the underlying mechanisms have not been clarified on a molecular basis. On the other hand, experimental data show that free radical species are responsible for conformational changes and fragmentation of protein molecules (12). Again, the elimination mechanisms for these denatured proteins from circulating blood and their degradative processes in the body remain unclear.Recently, several types of receptors that bind to modified albumin have been reported. These receptors include the following: gp18 and gp30, scavenger receptors for chemically modified albumin (47, 51); LOX-1, a lectin-like oxidized low-density lipoprotein receptor 1 (23); SREC, a scavenger receptor expressed by endothelial cells for modified LDL (1); FEEL-1 and FEEL-2 (also known as stabilin-1 or stabilin-2), endocytic receptors for advanced glycation end product (AGE) (20, 55); SR-A, a scavenger receptor class A for modified LDL (27, 28); RAGE, a receptor for AGE (33); OST-48, a 48-kDa member of the oligosaccharyltransfera...

Most HIV-infected inmates leave prison with a suppressed viral load; many, however, become disconnected from care and non-adherent to medications during reentry to community life. In this secondary data analysis of focus groups (N = 6) and in-depth interviews (N = 9) with 46 formerly incarcerated HIV-infected people during reentry, we used an inductive analytic approach to explore the interplay between individual, interpersonal, community, and structural factors and HIV management. Participants described barriers and facilitators to care engagement and adherence at each of these 4 levels, as well as a milieu of HIV and incarceration-related stigma and discrimination. The constellation of barriers and facilitators created competing demands and a sense of chaos in participants’ lives, which led them to address reentry-related basic needs (e.g., housing, food) before health care needs. Interventions that simultaneously address multiple levels, including augmenting employment and housing opportunities, enhancing social support, and reducing stigma, are needed.

Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI.Clinical trial registration number: NCT01450189.

Background Nonmedical prescription opioid use has been linked to hepatitis C virus (HCV) infection among people who inject drugs and with using high dead space syringes that retain more blood and transfer more HIV if shared. Little is known regarding its effects on sex risk behaviors. Objectives This paper examines event-level associations between nonmedical prescription opioid use and sharing high dead space syringes (injection risk) and unprotected intercourse (sex risk) behaviors. Methods We recruited 1,985 participants from two overlapping risk groups--drug users and men who have sex with men (MSM)—and their sex partners. Participants completed an interview that included event-level sex questions with recent sex partners and injection questions with recent injection partners. We used multivariable generalized estimating equations (GEE) to assess the associations between nonmedical prescription opioid use and unprotected intercourse during sexual encounters and sharing syringes during injection episodes, while adjusting for within-person correlations. Results When both partners used nonmedical prescription opioids, its use was independently associated with unprotected intercourse in sexual encounters (OR = 2.24; 95% CI = 1.12, 4.49). The use of nonmedical prescription opioids was also associated with sharing high dead space syringes during injection episodes (OR = 6.57; 95% CI = 1.63, 26.51). Conclusion Nonmedical prescription opioid use is associated with an increase in the risk of unprotected sex and sharing high dead space syringes. HIV and HCV prevention interventions for nonmedical prescription opioid users should address sex risk behaviors and encourage the use of acceptable low dead space needles and syringes.