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Bond KT, Yoon IS, Houang ST, Downing MJ, Grov C, Hirshfield S. Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based U.S. Sample of Men Who Have Sex with Men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:255-267. [PMID: 31814855 PMCID: PMC6897531 DOI: 10.1007/s13178-018-0366-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Demographic, behavioral, and structural factors among four mutually exclusive transactional sex categories were assessed in an online sample of 7217 sexually active US men who have sex with men (MSM): (1) No Trade Sex group (87%); (2) Sellers, accepting money or drugs for sex (5%); (3) Buyers, giving money or drugs for sex (6%); and (4) Sellers and Buyers, accepting and giving money or drugs for sex (2%). Separate multivariable logistic regressions compared men who did not report past 60-day transactional sex with men in the three transactional sex groups. Sellers were more likely to report being black or Asian (versus white), low income, a recent STI diagnosis, six or more recent male anal sex partners, and polydrug use. Buyers were more likely to report being older, higher income, urban residence, incarceration history, a recent STI diagnosis, and having non-main sex partners. Sellers and Buyers were more likely to report a higher income, incarceration history, six or more recent male anal sex partners, and polydrug use. Findings suggest that public health policy and HIV prevention harm reduction strategies should address the distinct sexual and behavioral risk patterns among MSM who engage in transactional sex based on payment direction.
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Affiliation(s)
- Keosha T. Bond
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | - Irene S. Yoon
- L2 Gartner, Research and Strategy Team, New York, NY, USA
| | - Steven T. Houang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Wu ZL, Guan GY, Zhao JH, Ma XM, Wang XM, Yang DZ, Cao M, Rawle DJ. Dynamic Characteristics and HIV Infection of Men who have Sex with Men from 2011 to 2017 in Yinchuan, Ningxia, China. Curr HIV Res 2019; 16:364-373. [PMID: 30659545 PMCID: PMC6446446 DOI: 10.2174/1570162x17666190119094035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Ningxia Hui Autonomous Region, an important area for ethnic Hui settlement in Northwest China, is a low HIV prevalence region. However, HIV infection rates among men who have sex with men (MSM) in Ningxia have increased to an alarming level, despite scale-up of control measures in recent years. This study aimed to understand the demographical and sexual behavior dynamics of MSM and to explore the factors associated with HIV infection. METHODS Annual cross-sectional surveys were carried out among MSM during 2011~2017 in Yinchuan, the capital city of Ningxia. Information regarding social demographics, sexual behavior and HIV prevention knowledge was collected. Blood samples were taken for HIV, HCV serological and genetic analysis, and syphilis serological analysis. The dynamic trend was analyzed with trend χ2 test and factors associated with HIV infection were identified by multivariate logistic regression analysis. RESULTS The study found a decreasing trend for mean age of the MSM population over the study period. MSMs with a college education or higher increased significantly, while the proportions that were in a marriage significantly decreased over the study period. The rate of HIV positive among MSM increased during the study period (p<0.05), however, the rate of recently diagnosed infections decreased from 2012 (p<0.05). Overall, a very high proportion (98%) of MSM had basic knowledge of HIV prevention, however, only approximately 40% of them used condoms consistently during anal sex with male partners. Unprotected anal sex was identified as a risk factor associated with HIV infection, as was syphilis infection. Local residency status and MSM who received intervention and detection services were the factors that decreased HIV infection risk. Sequence analysis identified the HIV-1 CRF55_01B subtype from MSM for the first time in Yinchuan. CONCLUSION The reduction of recent HIV diagnoses is an encouraging sign of successful HIV control measures in MSM in Ningxia. The finding that a high proportion of MSM had knowledge of HIV prevention but still conducted unprotected sex highlights the need for further control measures to change unsafe sexual practices among MSM.
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Affiliation(s)
- Zhong-Lan Wu
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Guang-Yu Guan
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Jian-Hua Zhao
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Xue-Min Ma
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Xue-Min Wang
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Dong-Zhi Yang
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Min Cao
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Daniel J Rawle
- Department of Cell and Molecular Biology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
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103
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Race K, Lea T, Murphy D, Pienaar K. The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men. Sex Health 2019; 14:42-50. [PMID: 27712616 DOI: 10.1071/sh16080] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
Abstract
There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation - and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the sexual health of gay and MSM with any degree of certainty. This article outlines some of the conditions most likely to mediate such futures in the medium term. Public funding for lesbian, gay, bisexual, transgender and queer drug issues should not remain restricted to questions of HIV prevention and sexual health. It should be expanded to equip sexual health and AOD service providers with the cultural and sexual literacy to mitigate stigma and allow them to respond constructively to drug problems among sexual and gender minorities as a matter of priority.
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Affiliation(s)
- Kane Race
- Gender & Cultural Studies, University of Sydney, SOPHI A14, University of Sydney, Sydney, NSW 2006, Australia
| | - Toby Lea
- Centre for Social Research in Health, The University of New South Wales, John Goodsell Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Dean Murphy
- Centre for Social Research in Health, The University of New South Wales, John Goodsell Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Kiran Pienaar
- National Drug Research Institute, Curtin University, Suite 6, 19-35 Gertrude Street, Fitzroy, Vic. 3065, Australia
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104
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Javanbakht M, Ragsdale A, Shoptaw S, Gorbach PM. Transactional Sex among Men Who Have Sex with Men: Differences by Substance Use and HIV Status. J Urban Health 2019; 96:429-441. [PMID: 30136249 PMCID: PMC6565772 DOI: 10.1007/s11524-018-0309-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Exchanging money, drugs, and other goods for sex has been associated with sexual risk behaviors and increased STIs/HIV. While female sex work is well described, data on men who exchange sex for money or goods are more limited. This paper examined the prevalence and correlates of transactional sex among young men who have sex with men, especially focusing on substance use and HIV status. We conducted a cohort study of 511 participants recruited between August 2014 and December 2017 in Los Angeles, CA. Eligible participants were: (1) between 18 and 45 years of age; (2) male; and (3) if HIV-negative, reported condomless anal intercourse with a male partner in the past 6 months. By design, half were HIV-positive and half HIV-negative. At baseline and semi-annual follow-up visits, computer-assisted self-interviews were used to collect information on demographics, sexual behaviors including transactional sex which was defined as exchange of money, drugs, or a place to stay for anal intercourse. Laboratory testing was conducted for current STI/HIV status. The average age of participants was 31.4 years with 43% identifying as African American, followed by 36% as Hispanic/Latino. The prevalence of recent transactional sex across 1486 study visits was 17% (n = 255), with 74% of those reporting exchanging sex for drugs. The prevalence of transactional sex was higher among those who reported unstable housing (32 vs. 11%; p value < .01), concurrent sexual partnerships (26 vs. 9%; p value < .01), and transgender sex partners (40 vs. 15%; p value < .01). Those who reported receiving money, drugs, or shelter for sex were also more likely to report giving money, drugs, shelter for sex than men who did not report exchange sex (77 vs. 11%; p value < .01). Based on multivariable analyses after adjusting for age and race/ethnicity, HIV viral load was independently associated with transactional sex [adjusted odds ratio (AOR) = 1.4; 95% confidence interval (CI) 1.1-1.7) per log10 increase]. Additionally, those testing positive for an STI were nearly twice as likely to report transactional sex as compared to those without STIs (AOR = 1.9; 95% CI 1.2-3.5). These findings underscore the relatively high prevalence of transactional sex and its potential role in ongoing HIV transmission among this cohort of high-risk HIV-negative and HIV-positive men who have sex with men.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Box 951772, CHS 46-082, Los Angeles, CA, 90095-1772, USA.
| | - Amy Ragsdale
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Box 951772, CHS 46-082, Los Angeles, CA, 90095-1772, USA
| | - Steven Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Box 951772, CHS 46-082, Los Angeles, CA, 90095-1772, USA
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Kapanda L, Jumbe V, Izugbara C, Muula AS. Healthcare providers' attitudes towards care for men who have sex with men (MSM) in Malawi. BMC Health Serv Res 2019; 19:316. [PMID: 31101107 PMCID: PMC6525370 DOI: 10.1186/s12913-019-4104-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/16/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are a priority group in Malawi's national response to Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). There are limited data on service providers' acceptability to deliver appropriate sexual health services in relation to HIV prevention, care and treatment targeting the MSM. We assessed attitudes of healthcare providers already working, health professions students and faculty at health professions training institutions regarding the provision of MSM focused HIV related health services. METHODS We conducted a qualitative study between April and May 2017 in Lilongwe, Malawi. We purposively recruited 15 participants (5 health service providers, 5 health professions students and 5 faculty of tertiary health training institutions) among whom individual in-depth interviews were conducted. Interviews were audio recorded, transcribed and analysed thematically. RESULTS Participants recognized MSM as having health needs and rights. Participants generally expressed willingness to deliver appropriate healthcare because they perceived this as their professional responsibility. Participants suggested that it was the responsibility for MSM to disclose their sexual orientation and or preferences when they access care such that healthcare providers better anticipate their care needs. They suggested a need to increase the availability of MSM-centered and friendly health services as well as trained providers that are non-judgmental, non-discriminatory and have respect for people's right to health care access. CONCLUSION Despite widespread poor attitudes against MSM in Malawi, health service providers and health professions students and faculty accepted and were willing to provide MSM-focused health services. The acceptability and willingness of health service providers, health professions students and faculty to provide health services to MSM offer hope and scope for efforts to strengthen the delivery of health services and quality of care to MSM in Malawi.
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Affiliation(s)
- Lester Kapanda
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine - University of Malawi, Blantyre, Malawi
| | - Vincent Jumbe
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Adamson S. Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine - University of Malawi, Blantyre, Malawi
- Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM) – College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Mathematical Sciences, Chancellor College, University of Malawi, Zomba, Malawi
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106
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Mgbako O, Park SH, Mayer KH, Schneider JA, Goedel WC, Hambrick HR, Duncan DT. Transactional Sex and Preferences for Pre-Exposure Prophylaxis (PrEP) Administration Modalities Among Men Who Have Sex With Men (MSM). JOURNAL OF SEX RESEARCH 2019; 56:650-658. [PMID: 29634362 PMCID: PMC6179954 DOI: 10.1080/00224499.2018.1449190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an important biomedical human immunodeficiency virus (HIV) prevention tool gaining more popularity among Parisian men who have sex with men (MSM) who engage in transactional sex. This study examines the knowledge of, and willingness to use, different modalities of PrEP among this subgroup. Broadcast advertisements were placed on a geosocial-networking smartphone application with a link to a Web-based survey during three 24-hour periods in October 2016. Modified Poisson regression models were used to assess the association between engagement in transactional sex and preferences for each of these PrEP modalities. A total of 444 respondents were included. About 14% reported engagement in transactional sex. In all, 90% of MSM who engaged in transactional sex were knowledgeable of daily oral PrEP, while 13.3% were knowledgeable about long-acting injectable PrEP or penile or rectal microbicides. They were more likely to be aware of long-acting injectable PrEP (aRR = 2.52, 95% CI = 1.16 to 5.47) and willing to use daily oral PrEP (aRR = 1.48; 95% CI = 1.11 to 1.98) or long-acting injectable PrEP (aRR = 1.40; 95% CI = 1.09 to 1.81) than MSM who had not engaged in transactional sex. Long-acting injectable PrEP may be an important HIV-prevention option for MSM who engage in transactional sex if this modality is proven effective.
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Affiliation(s)
- Ofole Mgbako
- Department of Internal Medicine, School of Medicine, New York
University, New York, New York
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Kenneth H. Mayer
- Departments of Medicine and Global Health and Population, Harvard
Medical School and Harvard T.H. Chan School of Public Health, and Fenway Health,
Boston, Massachusetts
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, School of
Medicine, University of Chicago, Chicago, Illinois
- Chicago Center for HIV Elimination, University of Chicago, Chicago,
Illinois
| | - William C. Goedel
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - H. Rhodes Hambrick
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Dustin T. Duncan
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
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107
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Kounta CH, Sagaon-Teyssier L, Coulaud PJ, Mora M, Maradan G, Bourrelly M, Keita AA, Yoro SAB, Anoma C, Coulibaly C, Dah ETT, Agbomadji S, Mensah E, Bernier A, Couderc C, Dembélé Keita B, Laurent C, Spire B. Male clients of male sex workers in West Africa: A neglected high-risk population. PLoS One 2019; 14:e0212245. [PMID: 31042757 PMCID: PMC6493710 DOI: 10.1371/journal.pone.0212245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022] Open
Abstract
Research on male clients of male sex workers (MCMSW) has been neglected for a long time globally. We aimed to characterize MCMSW and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Our study focused on HIV-negative men who have sex with other men (MSM), recruited between 06/2015 and 01/2018 by a team of trained peer educators. Scheduled study visits at 6, 12 and 18 months included medical examinations, HIV screening, risk-reduction counselling and face-to-face interviews to collect information on their sociodemographic characteristics, sexual behaviours, and HIV risk-reduction strategies (HIV-RRS). Three stigmatization sub-scores were constructed (experienced, perceived and internalized). Mixed-effects logistic regression was used for data analysis. Of the 280 participants recruited at baseline, 238, 211 and 118, respectively, had a follow-up visit at 6, 12 and 18 months. Over a total of 847 visits, 47 transactional sex (TS) encounters were reported by 38 MCMSW (13.6%). Of the latter, only one participant reported systematic TS (2.6%), 18 (47.4%) stopped reporting TS after baseline, while 6 (15.8%) reported TS after baseline. Thirteen participants (34.2%) reported occasional TS. After adjusting for country of study and age, the following self-reported factors were associated with a greater likelihood of being MCMSW: protected anal sex, exclusively insertive anal sex with male sexual partners, avoidance of sex after consuming psychoactive products and experiencing stigmatization (all during the previous 6 months). The majority of MCMSW in this study practiced HIV-RRS with male sexual partners, including engaging in protected anal sex, avoidance of sex when consuming psychoactive products, and practising exclusively insertive anal sex.
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Affiliation(s)
- Cheick Haïballa Kounta
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- * E-mail:
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre-Julien Coulaud
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | | | | | | | - Elias Ter Tiero Dah
- Association Africaine Solidarité, Ouagadougou, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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Bazzi AR, Yotebieng K, Otticha S, Rota G, Agot K, Ohaga S, Syvertsen JL. PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya. J Int AIDS Soc 2019; 22:e25266. [PMID: 30983147 PMCID: PMC6462807 DOI: 10.1002/jia2.25266] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/05/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Female and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre-exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention. METHODS From 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences. RESULTS Among 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past-month alcohol use and 91% of women and 82% of men reported past-month drug use. Violence was pervasive, with most women and men reporting past-year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non-stigmatizing PrEP delivery initiatives designed with input from sex workers. CONCLUSIONS Through a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.
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Affiliation(s)
- Angela R Bazzi
- Department of Community Health SciencesBoston University School of Public HealthBostonMAUSA
| | - Kelly Yotebieng
- Department of AnthropologyOhio State UniversityColumbusOHUSA
| | | | - Grace Rota
- Kenya Medical Research InstituteKisumuKenya
| | - Kawango Agot
- Impact Research & Development OrganizationKisumuKenya
| | - Spala Ohaga
- Impact Research & Development OrganizationKisumuKenya
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109
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Rich RS, Leventhal A, Sheffer R, Mor Z. Risky sexual behavior and sexually transmitted infections among men who have sex with men and purchase sex attending an Israeli sexually transmitted infection clinic. Int J STD AIDS 2019; 31:236-243. [PMID: 30890117 DOI: 10.1177/0956462419830856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Men who have sex with men (MSM) and purchase sex (MPS) are a sub-group potentially at high risk for acquiring and transmitting sexually transmitted infections (STIs). This is a hard-to-reach population resulting in a scarcity of studies covering the issue. This cross-sectional study aimed to assess the association between purchasing sex and high-risk behaviors related to HIV/STI transmission and appraise the STI prevalence among MSM. All MSM who attended the STI clinic in Tel Aviv between 2003 and 2010 were included. Demographics, behavioral, clinical, and laboratory data were compared between MPS and non-MPS to identify high-risk sexual behaviors and STI prevalence associated with purchasing sex. Of the first visits of 2694 MSM who attended the STI clinic during the study period, 151 (5.6%) paid for sex. MPS were more commonly older and married than non-MPS. MPS were more likely to engage in behaviors associated with high risk for HIV/STI transmission, including infrequent condom use during anal sex, substance use during sex, and selling sex themselves. MPS had a higher STI prevalence than non-MPS, although this was not statistically significant ( p = 0.05). These findings highlight the need to establish culturally tailored interventions for MPS addressing the potential risks associated with purchasing sex.
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Affiliation(s)
- Rivka S Rich
- Ministry of Health, Public Health Services, Jerusalem, Israel.,School of Public Health, Hebrew University, Jerusalem, Israel
| | - Alex Leventhal
- School of Public Health, Hebrew University, Jerusalem, Israel
| | | | - Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.,School of Health Science, Ashkelon Academic College, Ashkelon, Israel
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110
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Putnis N, Burr J. Evidence or stereotype? Health inequalities and representations of sex workers in health publications in England. Health (London) 2019; 24:665-683. [PMID: 30854902 DOI: 10.1177/1363459319833242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The health of sex workers is considerably influenced by their position in society and by the marginalisation and stigmatisation they face worldwide. They are frequently criminalised and labelled as deviant, disordered or 'vulnerable': stereotypes that simplify and misrepresent their realities. Sex work policies create social and structural barriers, creating dangerous work environments and exacerbating significant health inequalities. Health organisations and their policies play an important role in highlighting inequalities and guiding health systems in reducing them. In this article, we use a document analysis design to analyse how and when sex workers are depicted in policies and publications by English national health organisations: National Health Service (NHS) England, Public Health England and the National Institute for Health and Care Excellence, along with the UK Department of Health. We find that sex workers are largely absent in these documents and, when present, are depicted not using evidence, but simplistically with moralistic undertones. The dichotomous constructions found in these texts: vulnerable yet also criminal 'prostitute' reflect wider political and social constructions of sex working women. This not only obscures their realities but also homogenises, blames and stigmatises, ultimately doing the opposite of what these organisations purport to do: it damages their health and well-being.
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111
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Ulanja MB, Lyons C, Ketende S, Stahlman S, Diouf D, Kouamé A, Ezouatchi R, Bamba A, Drame F, Liestman B, Baral S. The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:11. [PMID: 30832673 PMCID: PMC6399955 DOI: 10.1186/s12914-019-0186-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. METHODS 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. RESULTS Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. CONCLUSION Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
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Affiliation(s)
- Mark B Ulanja
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sosthenes Ketende
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shauna Stahlman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | | | | | | | | | - Ben Liestman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Programme National de Lutte contre le Sida, Ministère de la Santé et de la Lutte contre le Sida, Abidjan, Côte d'Ivoire.
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Argento E, Goldenberg S, Shannon K. Preventing sexually transmitted and blood borne infections (STBBIs) among sex workers: a critical review of the evidence on determinants and interventions in high-income countries. BMC Infect Dis 2019; 19:212. [PMID: 30832596 PMCID: PMC6399876 DOI: 10.1186/s12879-019-3694-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
Background Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries. Methods We searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited. Results Research demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted. Conclusions The high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.
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Affiliation(s)
- Elena Argento
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Shira Goldenberg
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Department of Medicine, University of British Columbia, Centre for Gender & Sexual Health Equity, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.
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113
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[Data on the sexual health of providers and clients of sexual services for men who have sex with men in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 60:958-970. [PMID: 28741190 DOI: 10.1007/s00103-017-2589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about the sexual health of male providers and clients of transactional sex. The data of participants of the European MSM Internet Survey (EMIS-DE; N = 50,086) who live in Germany were analysed. The outcomes were testing for and diagnoses of HIV and other sexually transmitted infections (STIs), partner numbers, illicit drug use, and sexual happiness in two populations: (1) men who offered and (2) men who paid for transactional sex in the past 12 months.In the age group of under 30 years (n = 19,138), providers of sexual services (escorts) were compared with non-providers; in the age group of 30 years and above (n = 30,948), we compared men who paid for sexual services with those who did not. We applied univariable and multinomial, multivariable logistic regression analyses in both age groups.Of those under the age of 30, 8% (n = 1529) had been paid for sex in the last 12 months, of which 49% were only paid once or twice. Escorts had lower educational achievements, lived more commonly in large cities, were more often born abroad, self-defined less frequently as gay, and were more frequently single. They reported higher numbers of sex partners, more drug use, and more sexual happiness. Escorts were more frequently tested for HIV and STIs, and among the tested, more diagnoses of HIV and STIs were reported, but those with HIV were less likely to be treated.Among those over 30 years, 11% (n = 3334) had paid for sex, the majority (58%) only once or twice. Payers were older, lived more commonly in large cities, and were more likely to be single, bisexual, or living with a woman. Clients used more illicit drugs, sexual enhancement drugs, and sedatives, but reported less sexual happiness. They were less likely to be tested for HIV and STIs.
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114
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Qiao S, Yuk-Ha Tsang E, Wilkinson JS, Lipeleke F, Li X. "In Zimbabwe there is nothing for us": sex work and vulnerability of HIV infection among male sex workers in Zimbabwe. AIDS Care 2019; 31:1124-1130. [PMID: 30700143 DOI: 10.1080/09540121.2019.1574334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Male sex workers (MSWs) in Zimbabwe are a vulnerable sub-group at risk of violence, abuse, and HIV infection. This qualitative study examines the practices of male sex workers and vulnerabilities to HIV infection based on interviews among 15 MSWs in Bulawayo. All the interviews were recorded, transcribed, and analyzed with the guidance of grounded theory. The transcripts were translated by the interviewer into English using NVivo 11.0 software for coding and analysis. The MSWs interviewed reported diverse backgrounds in sexual orientation and life situations, plus a variety of work settings, income levels and access to clients. Due to the illegal nature of sex work and the stigma of homosexuality, practices in the sex trade are often hidden and subtle to avoid exposure to the police. Some develop romantic relationships with regular clients, but more typically they suffer abuse, violence, and the threat of sexually transmitted diseases, including HIV. Most Zimbabwean MSWs are ill-informed and underestimate their vulnerability of HIV. The stigmatization and criminalization of homosexuality in Zimbabwe creates an environment where it is difficult for MSWs to protect themselves through consistent condom use and access to basic HIV prevention and care services.
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Affiliation(s)
- Shan Qiao
- a Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ) , University of South Carolina Arnold School of Public Health , Columbia , SC , USA
| | - Eileen Yuk-Ha Tsang
- b Department of Applied Social Sciences, College of Liberal Arts & Social Sciences , City University of Hong Kong , Hong Kong , People's Republic of China
| | - Jeffrey S Wilkinson
- c Sino-US College in Zhuhai, Beijing Institute of Technology , Zhuhai , People's Republic of China
| | - Freddy Lipeleke
- d South African Monitoring and Evaluation (SAMEA) , Cape Town , South Africa
| | - Xiaoming Li
- a Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ) , University of South Carolina Arnold School of Public Health , Columbia , SC , USA
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Meanley S, Tingler R, Chittamuru D, Bauermeister JA. Applying resilience theory models to contextualize economic-dependent partnerships as a risk factor for HIV among young men who have sex with men. AIDS Care 2019; 30:42-50. [PMID: 30626200 DOI: 10.1080/09540121.2018.1493185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Economic-dependent partnerships (EDP) are an understudied HIV risk correlate among young men who have sex with men (YMSM) in the U.S. We explored whether YMSM's psychological resilience buffered against the effect of socioeconomic disadvantage on EDPs, after accounting for other psychosocial risks. Data come from an observational study assessing YMSM's HIV vulnerabilities. We developed indices for socioeconomic disadvantage, psychosocial profiles, and cumulative promotive factors. Multivariable logistic regressions tested the main associations of these indices on EDPs. Protective models tested whether psychosocial profiles exacerbated and cumulative promotive factors buffered the effects of socioeconomic disadvantage on EDPs. 31% and 23% of YMSM reported EDPs with main and casual partners, respectively. For both outcomes, we found support for adjusted compensatory models. Socioeconomic disadvantage was associated with increased odds of EDPs with main (AOR = 1.45, p < .001) and casual (AOR = 1.47, p < .001) partners. Psychosocial profiles were also associated with increased odds of EDPs with main (AOR = 1.53, p = .001) and casual (AOR = 1.67, p < .001) partners. Cumulative promotive factors was associated with decreased odds of EDPs with main (AOR = 0.66, p = .003) and casual (AOR = 0.72, p = .035) partners. Our findings elucidate the need for multilevel interventions that provide opportunities for socioeconomic advancement and improve psychosocial/psychological functioning for at-risk YMSM.
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Affiliation(s)
- Steven Meanley
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Ryan Tingler
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Deepti Chittamuru
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Jose A Bauermeister
- a Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
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Queiroz AAFLN, Sousa ÁFLD, Matos MCB, Araújo TME, Reis RK, Moura MEB. Knowledge about HIV/AIDS and implications of establishing partnerships among Hornet® users. Rev Bras Enferm 2019; 71:1949-1955. [PMID: 30156682 DOI: 10.1590/0034-7167-2017-0409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/06/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the knowledge of men, who have sex with men who use geolocation-based dating software, about HIV/AIDS, and the implications of establishing partnerships. METHOD Descriptive study with 30 Hornet® users. The statements generated had statistical treatment in the IRaMuTeQ software, analyzed through the Descending Hierarchical Classification. RESULTS The sexual frequency in the last 30 days was 2.9 partners, of which 2.1 were found by the application, of which 63.3% reported having sex without condoms. There were four classes: Knowledge about HIV/AIDS prevention measures; PrEP/truvada as a measure of HIV/AIDS prevention; Risky behaviors in relation to HIV infection; Establishment of sexual partnerships through applications. CONCLUSION Hornet users have insufficient knowledge about HIV prevention measures, especially when discarding the male condom. The relationships established through the application are permeated by high individual vulnerability and behaviors that have potential exposure to the risk of HIV infection.
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Affiliation(s)
| | | | | | | | - Renata Karina Reis
- Universidade de São Paulo, School of Nursing of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
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Xu J, Yu H, Tang W, Leuba SI, Zhang J, Mao X, Wang H, Geng W, Jiang Y, Shang H. The Effect of Using Geosocial Networking Apps on the HIV Incidence Rate Among Men Who Have Sex With Men: Eighteen-Month Prospective Cohort Study in Shenyang, China. J Med Internet Res 2018; 20:e11303. [PMID: 30578225 PMCID: PMC6320406 DOI: 10.2196/11303] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/10/2018] [Accepted: 09/27/2018] [Indexed: 12/19/2022] Open
Abstract
Background Men who have sex with men (MSM) frequently seek partners through mobile apps (geosocial networking [GSN] apps). However, it is unclear whether GSN apps’ use is associated with the increase in HIV incidence among MSM. Objective The aim of this study was to clarify the characteristics of GSN apps’ users and to determine the association and putative mechanisms between GSN apps’ use behavior and HIV incidence. Methods We conducted an 18-month prospective cohort study of MSM in Shenyang, China, and the participants were surveyed every 3 months from March 2015 to December 2016. An in-person interview collected information on sociodemographics, GSN apps’ use, recreational drug use, and sexual behaviors. In addition, blood was drawn to test for HIV and syphilis. We used a multivariable Cox regression model to determine possible predictors for increased HIV incidence. Results Of the enrolled 686 HIV-negative MSM, 431 (431/686, 62.8%) were GSN apps’ users. Compared with GSN apps’ nonusers, GSN apps’ users were younger; had an earlier age of sexual debut; and in the past 3 months, were more likely to have used recreational drugs, more likely to have had 5 or more casual partners (CPs), more likely to have had group sex with males, and more likely to have had condomless anal intercourse (CAI) with male steady partners (SPs). In addition, 59.4% (256/431) of the GSN apps’ users were willing to accept HIV and AIDS prevention information push services through GSN apps. In total, 19 MSM seroconverted to HIV during the follow-up period; the HIV incidence density rate was 8.5 (95% CI 5.0-13.5) per 100 person-years (PY) among GSN apps’ users and 2.0 (95% CI 0.4-5.8) per 100 PY among nonusers. New HIV infections were independently associated with ever using GSN apps to seek male sexual partners (P=.04) and in the past 3 months, using recreational drugs (P=.048), having group sex with males (P=.01), and having CAI with male CPs (P=.02). Conclusions GSN apps’ use is associated with higher HIV incidence and may be mediated through recreational drug use and having multiple CPs. Researchers must develop an intervention propagated through GSN apps to reach this high-risk population to mitigate the HIV epidemic in the MSM community.
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Affiliation(s)
- Junjie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Huan Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Sequoia I Leuba
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xiang Mao
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongyi Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
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Wirtz AL, Yeh PT, Flath NL, Beyrer C, Dolan K. HIV and Viral Hepatitis Among Imprisoned Key Populations. Epidemiol Rev 2018; 40:12-26. [PMID: 29688317 DOI: 10.1093/epirev/mxy003] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 01/11/2018] [Indexed: 12/28/2022] Open
Abstract
Prisons and other closed facilities create opportunities for transmission of human immunodeficiency virus (HIV) and viral hepatitis during detention and after release. We conducted a systematic review and meta-analysis of peer-reviewed publications (2005-2015) to describe the prevalence of HIV, hepatitis C virus, and hepatitis B virus among key populations in prisons worldwide and to compare estimates of infection with those of other prison populations. Most data were reported for people who inject drugs (PWID; n = 72) and for men who have sex with men (MSM; n = 21); few data were reported on sex workers (SW; n = 6), or transgender women (n = 2). Publications were identified from 29 countries, predominantly middle- and high-income countries. Globally, PWID had 6 times the prevalence of HIV (pooled prevalence ratio (PPR) = 6.0, 95% CI: 3.8, 9.4), 8 times the prevalence of hepatitis C virus (PPR = 8.1, 95% CI: 6.4, 10.4), and 2 times the prevalence of hepatitis B virus (PPR = 2.0, 95% CI: 1.5, 2.7) compared with noninjecting prisoner populations. Among these articles, only those from Iran, Scotland, Spain, and Italy included the availability of methadone therapy; 2 articles included information on access to needle exchange programs by PWID detainees. HIV prevalence was more than 2 times higher among SW (PPR = 2.6, 95% CI: 2.2, 3.1) and 5 times higher among MSM (PPR = 5.3, 95% CI: 3.5, 7.9) compared with other prisoners. None of these articles reported HIV prevention coverage among SW or transgender women; 1 described HIV and sexually transmitted infection screening for MSM in prison. Prevention programs specific to key populations are important, particularly for populations that are criminalized and/or may cycle in and out of prison.
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Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ping T Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Natalie L Flath
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Baltimore City Health Department, Baltimore, Maryland
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kate Dolan
- University of New South Wales, Sydney, New South Wales, Australia
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Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med 2018; 15:e1002680. [PMID: 30532209 PMCID: PMC6289426 DOI: 10.1371/journal.pmed.1002680] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur. METHODS AND FINDINGS We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. CONCLUSIONS Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.
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Dunne EF, Pattanasin S, Chemnasiri T, Varangrat A, Raengsakulrach B, Wichuda S, Ungsedhapand C, Sirivongrangson P, Chitwarakorn A, Holtz TH. Selling and buying sex in the city: men who have sex with men in the Bangkok men who have sex with men Cohort Study. Int J STD AIDS 2018; 30:212-222. [PMID: 30360682 DOI: 10.1177/0956462418796440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe participants in the Bangkok Men who have sex with men Cohort Study (BMCS) who sold or bought sex. Men who have sex with men (MSM) and transgender women aged ≥18 years had HIV testing and behavioral data collected at enrollment and every four months. We evaluated report of receiving money or goods for sex (selling sex) or giving money or goods for sex (buying sex) at enrollment using logistic regression models; we also describe sex work over time, and HIV and syphilis incidence among those who report sex work. At enrollment, 511 (29.3%) of 1744 participants reported buying or selling sex. Factors associated with selling sex were young age, lower education, living alone or living with a friend, being unemployed, higher HIV knowledge, binge drinking and club drug use, a higher number of casual male partners, meeting sex partners at specific venues, having a foreign sex partner, and being HSV-1 seropositive. MSM aged 18-21 years who sold sex had an HIV incidence of 11.1 per 100 person-years (95% CI: 6.7-17.4). Almost one-third of participants from BMCS reported sex work at enrollment. Young men who sold sex had high HIV incidence and HIV prevention interventions are needed for this at-risk population in Bangkok, Thailand.
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Affiliation(s)
- Eileen F Dunne
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,2 Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarika Pattanasin
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Tareerat Chemnasiri
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Varangrat
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Boonyos Raengsakulrach
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Sukwicha Wichuda
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Chaiwat Ungsedhapand
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Anupong Chitwarakorn
- 3 Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Timothy H Holtz
- 1 HIV/STD Research Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,2 Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Underhill K, Guthrie KM, Colleran C, Calabrese SK, Operario D, Mayer KH. Temporal Fluctuations in Behavior, Perceived HIV Risk, and Willingness to Use Pre-Exposure Prophylaxis (PrEP). ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2109-2121. [PMID: 29327091 PMCID: PMC6041197 DOI: 10.1007/s10508-017-1100-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 07/25/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
Individual perceptions of HIV risk influence willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention. Among men who have sex with men (MSM) and male sex workers (MSWs), temporal or episodic changes in risk behavior may influence perceived risk and PrEP acceptability over time. We investigated fluctuations in perceived HIV risk and PrEP acceptability, comparing MSWs against MSM who do not engage in sex work. We conducted 8 focus groups (n = 38) and 56 individual interviews among MSM and MSWs in Providence, RI. Perceived HIV risk shaped willingness to use PrEP among both MSWs and MSM who did not engage in sex work, and risk perceptions changed over time depending on behavior. For MSWs, perceived risk cycled according to patterns of substance use and sex work activity. These cycles yielded an "access-interest paradox": an inverse relationship between willingness to use and ability to access PrEP. MSM who did not engage in sex work also reported temporal shifts in risk behavior, perceived risk, and willingness to use PrEP, but changes were unrelated to access. MSM attributed fluctuations to seasonal changes, vacations, partnerships, behavioral "phases," and episodic alcohol or drug use. Efforts to implement PrEP among MSM and street-based MSWs should address temporal changes in willingness to use PrEP, which are linked to perceived risk. Among MSWs, confronting the access-interest paradox may require intensive outreach during high-risk times and efforts to address low perceived risk during times of reduced sex work.
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Affiliation(s)
- Kristen Underhill
- Columbia Law School, Columbia University, 435 W 116th St., New York, NY, 10027, USA.
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Christopher Colleran
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, Washington, DC, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
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Matthen P, Lyons T, Taylor M, Jennex J, Anderson S, Jollimore J, Shannon K. "I walked into the industry for survival and came out of a closet": How gender and sexual identities shape sex work experiences among men, two spirit, and trans people in Vancouver. MEN AND MASCULINITIES 2018; 21:479-500. [PMID: 30636865 PMCID: PMC6326376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND/OBJECTIVES This paper seeks to examine how gender and sexual identities shape sex work experiences among men, two spirit, and/or trans people in Vancouver. METHODS In-depth, semi-structured interviews were conducted with men and trans people in Metro Vancouver from CHAPS (Community Health & HIV Assessment of Men Who Purchase and Sell Sex). An intersectional critical feminist perspective guided the thematic analysis of interview transcripts, and ATLAS.ti 7 was used to manage data analysis. RESULTS Three themes emerged from the data: (1) the diversity of sexual and gender identities among sex workers and clients, (2) the expression and exploration of sexual and gender identities through sex work, (3) the migration of sexual and gender minorities to urban centres to escape discrimination in their places of origin. DISCUSSION These findings complicate existing narratives of sex work, demonstrating the need for policies and services that reflect the diversity of sex work experiences.
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Affiliation(s)
- Premala Matthen
- Gender & Sexual Health Initiative, BC Centre for Excellence
in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Tara Lyons
- Gender & Sexual Health Initiative, BC Centre for Excellence
in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | | | - James Jennex
- HUSTLE, Health Initiative for Men, Vancouver, Canada
| | - Solanna Anderson
- Gender & Sexual Health Initiative, BC Centre for Excellence
in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | | | - Kate Shannon
- Gender & Sexual Health Initiative, BC Centre for Excellence
in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver,
Canada
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Logie CH, Lacombe-Duncan A, Kenny KS, Levermore K, Jones N, Baral SD, Wang Y, Marshall A, Newman PA. Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey. Glob Health Action 2018; 11:1424614. [PMID: 29338660 PMCID: PMC5774420 DOI: 10.1080/16549716.2018.1424614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Globally, men who have sex with men (MSM) experience social marginalization and criminalization that increase HIV vulnerability by constraining access to HIV prevention and care. People who sell sex also experience criminalization, rights violations, and violence, which elevate HIV exposure. MSM who sell sex may experience intersectional stigma and intensified social marginalization, yet have largely been overlooked in epidemiological and social HIV research. In Jamaica, where same sex practices and sex work are criminalized, scant research has investigated sex selling among MSM, including associations with HIV vulnerability. OBJECTIVE We aimed to examine social ecological factors associated with selling sex among MSM in Jamaica, including exchanging sex for money, shelter, food, transportation, or drugs/alcohol (past 12 months). METHODS We conducted a cross-sectional survey with a peer-driven sample of MSM in Kingston, Ocho Rios, and Montego Bay. Multivariable logistic regression analyses were conducted to estimate intrapersonal/individual, interpersonal/social, and structural factors associated with selling sex. RESULTS Among 556 MSM, one-third (n = 182; 32.7%) reported selling sex. In the final multivariable model, correlates of selling sex included: individual/intrapersonal (lower safer sex self-efficacy [AOR: 0.85, 95% CI: 0.77, 0.94]), interpersonal/social (concurrent partnerships [AOR: 5.52, 95% CI: 1.56, 19.53], a higher need for social support [AOR: 1.08, 95% CI: 1.03, 1.12], lifetime forced sex [AOR: 2.74, 95% 1.65, 4.55]) and structural-level factors (sexual stigma [AOR: 1.09, 95% CI: 1.04, 1.15], food insecurity [AOR: 2.38, 95% CI: 1.41, 4.02], housing insecurity [AOR: 1.94, 95% CI: 1.16, 3.26], no regular healthcare provider [AOR: 2.72, 95% CI: 1.60, 4.64]). CONCLUSIONS This study highlights social ecological correlates of selling sex among MSM in Jamaica, in particular elevated stigma and economic insecurity. Findings suggest that MSM in Jamaica who sell sex experience intensified social and structural HIV vulnerabilities that should be addressed in multi-level interventions to promote health and human rights.
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Affiliation(s)
- Carmen H Logie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Ashley Lacombe-Duncan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kathleen S Kenny
- c Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | | | - Stefan D Baral
- e Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ying Wang
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Annecka Marshall
- f Institute for Gender and Development Studies , Mona Campus, University of the West Indies , Kingston , Jamaica
| | - Peter A Newman
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
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Walters SM, Rivera AV, Reilly KH, Anderson BJ, Bolden B, Wogayehu A, Neaigus A, Braunstein S. Exchange Sex Among Persons Who Inject Drugs in the New York Metropolitan Area: The Importance of Local Context, Gender and Sexual Identity. AIDS Behav 2018; 22:2773-2787. [PMID: 29468492 DOI: 10.1007/s10461-018-2039-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exchanging sex for money or drugs is known to increase risk for HIV among persons who inject drugs (PWID). To better understand determinants of exchange sex among PWID we examined factors associated with exchange sex in the New York metropolitan area-defined as New York City (NYC), NY; Newark, NJ; and Long Island, NY-using data from the 2012 National HIV Behavioral Surveillance system cycle on injection drug use. Of the 1160 PWID in this analysis, 24% reported exchange sex, with differences in gender and sexual identity by location. In multivariable analysis gay/bisexual men, heterosexual women, and lesbian, gay, or bisexual (LGB) women were more likely to exchange sex compared to heterosexual men. Exchange sex was also associated with race/ethnicity, homelessness, incarceration, location, and non-injection crack and cocaine use. We find that heterosexual women and LGB women who injected drugs residing in Newark were more likely to report exchange sex compared to NYC. This study highlights how local conditions impact exchange sex.
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Affiliation(s)
- Suzan M Walters
- Department of Sociology, State University of New York at Stony Brook, 152-11 Union Turnpike Apt 3A, Flushing, Stony Brook, NY, 11367, USA.
| | - Alexis V Rivera
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA
| | - Kathleen H Reilly
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA
| | - Bridget J Anderson
- New York State Department of Health, Office of Public Health, Albany, NY, USA
| | - Barbara Bolden
- Division of HIV, STD and TB Services, New Jersey Department of Health, Trenton, NJ, USA
| | - Afework Wogayehu
- Division of HIV, STD and TB Services, New Jersey Department of Health, Trenton, NJ, USA
| | - Alan Neaigus
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA
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Enel P, Bonierbale M, Alexandre A, Guillet S, Cambau S, Brunel F, Chollier M, Baumstarck K, Auquier P. Sexual risk factors related to lack of HIV-screening in people attending erotic industry shows. AIDS Care 2018; 31:465-470. [PMID: 30149727 DOI: 10.1080/09540121.2018.1515468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The current aim of the fight against the HIV epidemic is to reduce the proportion of missed opportunities for HIV diagnosis. Erotic industry Shows (ES) were deemed to be appropriate events to organize awareness campaigns and to propose HIV Rapid Diagnostic Test (HIV-RDT) to people who are sexually active and likely to engage in unsafe sex practices. In 2015, a cross-sectional study in 4 ES was conducted to document the sexual risk factors associated with HIV-screening test approach and the proportion of positive HIV-RDT. Prevention booths were set up to offer HIV-screening to individuals ≥18 years volunteers for HIV-RDT and to respond to a validated anonymous self-reported questionnaire. In 4 ES, 943 participants were questioned and tested, mainly men (64%), young (mean age 30 years old), living as a couple (63.7%). A large majority (95.1%) reported sexual intercourse over the last year. The mean number of partners was 4.8. About 2/3 had unprotected sex. 37.5% had never been tested and had their first test during this campaign. The 430 participants who reported no previous HIV-testing during the last 5 years more frequently declared heterosexual intercourse (OR: 2.31), identifying as a male (OR: 1.82), having transactional sex (OR: 1.92), living as a couple (OR: 1.67), having fewer sexual partners (OR: 1.06) and being younger (OR = 1.02). Three people (0.32%) were tested positive for the HIV-RDT; linkage with care was ensured for confirmatory test. This innovative and original intervention showed for the first time the usefulness of HIV-screening and awareness campaigns, in fun and commercial backdrop event. Individuals who had never been HIV-tested and who had no intention of doing so before this campaign were reached and engaged. ES are potential new locations to get HIV information and screening, to tackle sexual health-related issues and reflect on sexual risk behaviors.
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Affiliation(s)
- Patricia Enel
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,b Center for Studies and Research on Health Services and Quality of Life EA3279 , Aix-Marseille University , Marseille , France
| | - Mireille Bonierbale
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,c University Interdisciplinary Association of Sexology, AIUS , Marseille , France
| | - Antonio Alexandre
- d Health Prevention National Association for Festive Venues , ENIPSE , Paris , France
| | - Sylvain Guillet
- d Health Prevention National Association for Festive Venues , ENIPSE , Paris , France
| | - Sébastien Cambau
- d Health Prevention National Association for Festive Venues , ENIPSE , Paris , France
| | - Florence Brunel
- e Infectious Diseases Unit , University Hospital of Edouard Herriot , Lyon , France
| | - Marie Chollier
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,c University Interdisciplinary Association of Sexology, AIUS , Marseille , France.,f Interdisciplinary Studies , Manchester Metropolitan University , Manchester , UK
| | - Karine Baumstarck
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,b Center for Studies and Research on Health Services and Quality of Life EA3279 , Aix-Marseille University , Marseille , France
| | - Pascal Auquier
- a Assistance Publique - Hôpitaux de Marseille , University Hospital Center , Marseille , France.,b Center for Studies and Research on Health Services and Quality of Life EA3279 , Aix-Marseille University , Marseille , France
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Shannon K, Crago AL, Baral SD, Bekker LG, Kerrigan D, Decker MR, Poteat T, Wirtz AL, Weir B, Boily MC, Butler J, Strathdee SA, Beyrer C. The global response and unmet actions for HIV and sex workers. Lancet 2018; 392:698-710. [PMID: 30037733 PMCID: PMC6384122 DOI: 10.1016/s0140-6736(18)31439-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/05/2023]
Abstract
Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5-11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. Although important progress has been made in biomedical interventions with pre-exposure prophylaxis and early ART feasibility and demonstration projects, limited coverage and retention suggest that sustained investment in community and structural interventions is required for sex workers to benefit from the preventive interventions and treatments that other key populations have. Evidence-based progress on full decriminalisation grounded in health and human rights-a key recommendation in our Lancet Series-has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.
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Affiliation(s)
- Kate Shannon
- Gender and Sexual Health Initiative, University of British Columbia, Vancouver, BC, Canada.
| | | | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Research Centre, University of Cape Town, Cape Town, South Africa
| | - Deanna Kerrigan
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Brian Weir
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
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127
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Shushtari ZJ, Hosseini SA, Sajjadi H, Salimi Y, Latkin C, Snijders TAB. Social network and HIV risk behaviors in female sex workers: a systematic review. BMC Public Health 2018; 18:1020. [PMID: 30115056 PMCID: PMC6097207 DOI: 10.1186/s12889-018-5944-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Social network characteristics have an important role in understanding HIV transmission among female sex workers. The purpose of this systematic review was to summarize and critically appraise the existing studies on the social network characteristics and HIV risk behaviors among female sex workers. Method A systematic review was performed using predefined eligibility criteria through searching electronic databases. Two independent reviewers assessed the methodological quality of studies. Results Nineteen papers met the eligible review criteria. The synthesized evidence suggests that characteristics of social networks, especially functional characteristics such as social support and social capital, are important constructs for understanding the HIV risk behaviors. Conclusions The findings of the present review enhance our understanding of the role of social network characteristics in HIV risk behaviors among female sex workers. However, the findings also highlighted a dearth of knowledge about the association of structural characteristics of social networks with HIV risk behaviors among female sex workers.
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Affiliation(s)
- Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran
| | - Seyed Ali Hosseini
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran.
| | - Homeira Sajjadi
- Social welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Yahya Salimi
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Carl Latkin
- Department of Health, Behavior and Society, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tom A B Snijders
- Department of Sociology, University of Groningen, 9712, TG Groningen, Netherlands.,Nuffield College, University of Oxford, Oxford, OX1 1NF, UK
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128
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Sosa-Rubí SG, Salinas-Rodríguez A, Montoya-Rodríguez AA, Galárraga O. The Relationship Between Psychological Temporal Perspective and HIV/STI Risk Behaviors Among Male Sex Workers in Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1551-1563. [PMID: 29380090 PMCID: PMC5955784 DOI: 10.1007/s10508-017-1123-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
Men who have sex with men (MSM) face a disproportionate burden of HIV incidence and HIV prevalence, particularly young men who have sex with men. The aim of this article was to analyze the relation between a psychological temporal perspective and HIV/sexually transmitted infection (STI) risk behaviors among male sex workers (MSWs), a potentially highly present-oriented group of MSM. A total sample of 326 MSWs were included and responded to a validated psychological scale: the Zimbardo's Time Perspective Inventory; they also reported how frequently they engaged in protective behaviors against HIV and other STI risks behaviors, including condom use with casual and regular partners, as well as prior HIV testing. We adjusted structural equation models to analyze the relation between a psychological temporal perspective and HIV/STI risk behaviors. We found that orientation toward the past was correlated with decreased condom use with casual partners (β = - 0.18; CI95% - 0.23, - 0.12). Future orientation was not associated with condom use with casual partners. Regarding condom use with regular partners, past and present orientation were related to lower likelihood of condom use (β = - 0.23; CI95% - 0.29, - 0.17; β = - 0.11; CI95% - 0.19, - 0.02), whereas future orientation increased the likelihood of condom use with regular partners (β = 0.40; CI95% 0.31, 0.50). Time orientation (past, present, or future) did not predict the probability of having an HIV test. The design of HIV/STI prevention programs among vulnerable populations, such as MSM and MSWs, should consider specific time-frame mechanisms that can importantly affect sexual risk behavior decisions.
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Affiliation(s)
- Sandra G Sosa-Rubí
- National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Aarón Salinas-Rodríguez
- National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
| | | | - Omar Galárraga
- Brown University School of Public Health, Providence, RI, USA
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Jacques-Aviñó C, Andrés AD, Roldán L, Fernández-Quevedo M, Olalla PGD, Díez E, Romaní O, Caylà JA. Male sex workers: between safe sex and risk. Ethnography in a gay sauna in Barcelona, Spain. CIENCIA & SAUDE COLETIVA 2018; 24:4707-4716. [PMID: 31778520 DOI: 10.1590/1413-812320182412.27842017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/11/2018] [Indexed: 12/26/2022] Open
Abstract
This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man's sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.
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Affiliation(s)
- Constanza Jacques-Aviñó
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
| | - Anna de Andrés
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
| | - Llanos Roldán
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
| | - Manuel Fernández-Quevedo
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
| | - Patricia García de Olalla
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
| | - Elia Díez
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
| | - Oriol Romaní
- Universitat Rovira i Virgili (URV), Tarragona, España
| | - Joan A Caylà
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona. Plaza Lesseps 1. 08023 Barcelona España.
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Kerr L, Kendall C, Guimarães MDC, Salani Mota R, Veras MA, Dourado I, Maria de Brito A, Merchan-Hamann E, Pontes AK, Leal AF, Knauth D, Castro ARCM, Macena RHM, Lima LNC, Oliveira LC, Cavalcantee MDS, Benzaken AS, Pereira G, Pimenta C, Pascom ARP, Bermudez XPD, Moreira RC, Brígido LFM, Camillo AC, McFarland W, Johnston LG. HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling. Medicine (Baltimore) 2018; 97:S9-S15. [PMID: 29794604 PMCID: PMC5991534 DOI: 10.1097/md.0000000000010573] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/05/2018] [Indexed: 12/11/2022] Open
Abstract
This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.
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Affiliation(s)
- Ligia Kerr
- Faculdade de Medicina, Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brasil
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA, Faculdade de Medicina da Universidade Federal do Ceará, Saúde Comunitária, Fortaleza, CE
| | | | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, CE
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA
| | | | - Edgar Merchan-Hamann
- Centro de Ciências da Saúde – Departamento de Saúde Coletiva, Universidade de Brasília Faculdade de Ciências da Saúde, Brasília
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS
| | | | | | | | | | | | | | - Gerson Pereira
- Departamento de IST e HIV/AIDS e Hepatites Virais, Ministério da Saúde, Brasília
| | - Cristina Pimenta
- Departamento de IST e HIV/AIDS e Hepatites Virais, Ministério da Saúde, Brasília
| | | | | | | | | | | | - Willi McFarland
- Center for Global Health, University of California, San Francisco, CA
| | - Lisa G. Johnston
- Tulane School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, New Orleans, LA, USA
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131
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Armstrong HL, Roth EA, Rich A, Lachowsky NJ, Cui Z, Sereda P, Card KG, Jollimore J, Howard T, Moore DM, Hogg RS. Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment. AIDS Care 2018; 30:1290-1297. [PMID: 29558813 DOI: 10.1080/09540121.2018.1454583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Previous research indicates that gay and bisexual men (GBM) have significantly more sexual partners than same-aged heterosexual men and women. As a result, some HIV intervention programs have focused on partner reduction. However, new research findings question the relevance of sexual partner number as a sexual risk measure for GBM given Treatment as Prevention (TasP) programs and new seroadaptive strategies which have led to lower GBM community viral load and new HIV prevention behaviors. To assess if sexual partner number continues to remain an important measure of sexual risk for GBM living in a city that actively promotes TasP as provincial policy, we analysed cross-sectional data from 719 GBM recruited through respondent-driven sampling in Vancouver, Canada. Multivariable negative binomial regression analysis showed that partner number was significantly associated with previously identified HIV risk factors including condomless anal intercourse with serodiscordant and/or unknown serostatus partners, using sex toys, attending group sex events, receiving money for sex, and sex drug use. These results indicate that sexual partner number remains an important proximate HIV risk measure. However, more nuanced measures of HIV treatment status and greater understanding of the possible causes of increased partner number among GBM are needed.
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Affiliation(s)
- Heather L Armstrong
- a Department of Medicine , University of British Columbia , Vancouver , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Eric Abella Roth
- c Centre for Addictions Research of British Columbia , University of Victoria , Victoria , Canada.,d Department of Anthropology , University of Victoria , Victoria , Canada
| | - Ashleigh Rich
- a Department of Medicine , University of British Columbia , Vancouver , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,e School of Public Health and Social Policy , University of Victoria , Victoria , Canada
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Paul Sereda
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Kiffer G Card
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,f Faculty of Health Sciences , Simon Fraser University , Vancouver , Canada
| | - Jody Jollimore
- g Community Based Research Centre for Gay Men's Health , Vancouver , Canada
| | - Terry Howard
- h Community Advisory Board, Momentum Health Study , Vancouver , Canada
| | - David M Moore
- a Department of Medicine , University of British Columbia , Vancouver , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Robert S Hogg
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,f Faculty of Health Sciences , Simon Fraser University , Vancouver , Canada
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132
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Saludes V, Folch C, Morales-Carmona A, Ferrer L, Fernàndez-López L, Muñoz R, Jiménez M, Loureiro E, Fernández-Dávila P, Bascuñana E, Casabona J, Martró E. Community-based screening of hepatitis C with a one-step RNA detection algorithm from dried-blood spots: Analysis of key populations in Barcelona, Spain. J Viral Hepat 2018; 25:236-244. [PMID: 29053912 DOI: 10.1111/jvh.12809] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/15/2017] [Indexed: 12/30/2022]
Abstract
Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N = 580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.
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Affiliation(s)
- V Saludes
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - C Folch
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | | | - L Ferrer
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - L Fernàndez-López
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - R Muñoz
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - M Jiménez
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain
| | - E Loureiro
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - P Fernández-Dávila
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain.,Research Department, Stop Sida, Barcelona, Spain
| | - E Bascuñana
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain
| | - J Casabona
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - E Martró
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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133
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Masvawure TB, Mantell JE, Tocco JU, Gichangi P, Restar A, Chabeda SV, Lafort Y, Sandfort TGM. Intentional and Unintentional Condom Breakage and Slippage in the Sexual Interactions of Female and Male Sex Workers and Clients in Mombasa, Kenya. AIDS Behav 2018; 22:637-648. [PMID: 28975484 DOI: 10.1007/s10461-017-1922-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to the direct actions of clients. Breakages and slippages fell into two main groups: those that were intentionally caused by clients and unintentional ones caused by inebriation, forceful thrusting during sex and incorrect or non-lubricant use. Participant responses included: stopping sex and replacing the damaged condoms, doing nothing, getting tested for HIV, using post-exposure prophylaxis and washing. Some sex workers also employed strategies to prevent the occurrence of condom breakages. Innovative client-oriented HIV prevention and risk-reduction interventions are therefore urgently needed. Additionally, sex workers should be equipped with skills to recognize and manage breakages.
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Affiliation(s)
- Tsitsi B Masvawure
- Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA.
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jack Ume Tocco
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya
- International Centre for Reproductive Health-Ghent University, Ghent, Belgium
- Department of Anatomy, University of Nairobi, Nairobi, Kenya
| | - Arjee Restar
- Brown School of Public Health, Brown University, Providence, RI, USA
| | | | - Yves Lafort
- International Centre for Reproductive Health-Ghent University, Ghent, Belgium
| | - Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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134
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Joseph HA, Pan Y, Mendoza M, Harawa NT, Lauby J, Hosek SG, Bluthenthal RN, Milnamow M, Fernandez MI, Jeffries WL, Belcher L, Millett GA. HIV Acquisition and Transmission Potential Among African American Men Who Have Sex with Men and Women in Three U.S. Cities. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:183-194. [PMID: 29124541 PMCID: PMC8386249 DOI: 10.1007/s10508-017-1052-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/14/2017] [Accepted: 07/24/2017] [Indexed: 06/02/2023]
Abstract
Black men who have sex with men and women (BMSMW) are at increased HIV risk, but few efficacious interventions meet their unique needs. Three HIV prevention interventions were evaluated with a common protocol. Baseline data were pooled to describe sexual behavior involving transmission risk with male, female, and male-to-female transgender partners and identify factors associated with transmission risk. BMSMW from Los Angeles, Philadelphia, and Chicago who reported sexual risk and bisexual behavior in the past year were recruited via modified chain referral sampling and community recruitment. Baseline assessments were conducted via audio computer-assisted interview and sexual behaviors assessed over the past 3 months. From December 2010 to November 2012, 584 BMSMW were enrolled across the three cities. More than half (55%) were recruited by other participants. Overall, the mean age was 43 years. Seventy-five percent reported an annual income <$10,000 and selling sex was prevalent (31%). Three-quarters identified as bisexual. Thirty-nine percent were HIV-positive. Among HIV-positive participants, 46% reported sex without condoms with HIV-negative or unknown male partners and 45% with HIV-negative or unknown female partners. Overall, factors associated with sex without condoms included network size, education, income, sexual orientation identification, HIV status, exchange sex, homonegativity, and social support. Findings support the need for enhanced HIV prevention efforts for this population. Future studies should examine contextual factors in addition to individual risk behaviors to inform the development and implementation of promising strategies to prevent HIV and promote the overall health and wellness of BMSMW and their sexual partners.
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Affiliation(s)
- Heather A Joseph
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Yi Pan
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Maria Mendoza
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Nina T Harawa
- College of Medicine, Charles Drew University, Los Angeles, CA, USA
| | - Jennifer Lauby
- Public Health Management Corporation, Philadelphia, PA, USA
| | - Sybil G Hosek
- Research Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Mary Milnamow
- Public Health Management Corporation, Philadelphia, PA, USA
| | | | | | - Lisa Belcher
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
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135
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Swahn MH, Buchongo P, Kasirye R. Risky Behaviors of Youth Living in the Slums of Kampala: A Closer Examination of Youth Participating in Vocational Training Programs. VULNERABLE CHILDREN AND YOUTH STUDIES 2018; 13:276-290. [PMID: 31452668 PMCID: PMC6709978 DOI: 10.1080/17450128.2018.1489168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Obtaining formal education is associated with a decreased risk of HIV transmission among youth in sub-Saharan Africa. However, little is known about the role vocational skills training programs may have on risk behaviors linked to HIV transmission among vulnerable youth in sub-Saharan Africa. This study examined the characteristics and risk behaviors among vulnerable youth who receive vocational skills training by a community-based organization. Empirical analyses were conducted using a cross-sectional survey administered in 2014 to youth (ages 12 to 18 years) in the slums of Kampala (N=1134). Five multivariable logistic regression models were computed to determine the association between participating in a vocational training program and self-reported risk behaviors pertaining to alcohol use, lack of condom use, sex with multiple partners, and transactional sex. In our study, 29.6% of youth attended a vocational training program. Our findings show that youth who participated in vocational training were more likely to report often feeling hopeful (AOR: 1.7; 95% CI: 1.1, 3.0) and less likely to report alcohol use (AOR: 0.4; 95% CI: 0.2, 0.7) than those not attending vocational training programs, in multivariable analyses. Overall, findings varied for males and females. These findings, while preliminary, indicate that self-reported behaviors associated with risk for HIV transmission vary in some respects for youth participating in vocational training versus those who do not. However, additional research is needed, as are evaluations of the benefits and potential impact of vocational training in both the short and long-term for vulnerable youth in resource-poor settings and with limited access to formal education.
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Affiliation(s)
- Monica H. Swahn
- Distinguished Professor, Division of Epidemiology and Biostatistics Partnership for Urban Health Research School of Public Health, Georgia State University 140 Decatur St. SE Atlanta, GA 30303,
| | - Portia Buchongo
- Georgia State University School of Public Health, 140 Decatur St. SE Atlanta, GA 30303
- Corresponding:
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136
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George PE, Bazo-Alvarez JC, Bayer AM. The Earning and Spending Habits of Male Sex Workers in Lima, Peru. SAGE OPEN 2018; 8:10.1177/2158244017753046. [PMID: 30221033 PMCID: PMC6138051 DOI: 10.1177/2158244017753046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Over the past decade, data have identified male sex work as a potentially viable economic decision; despite this, male sex workers (MSWs) continue to be perceived as group with access to few assets and resources. Using data from a pilot skills- building intervention for MSWs in Lima, Peru, an analysis of the economic characteristics of 209 MSWs is presented. The majority reported livable incomes with median earnings of US$250 per month, 83% earning above the urban poverty line. Interestingly, non-sex work was also an important source of income, especially for the high-earning MSWs. Spending data revealed that a large portion of income went to necessities (55%), luxuries (11%), and gifts (11%), with less toward savings (5%) and studies (1%). Such data on MSWs' earnings and spending, which suggest that a lack of overall income is not the MSW's main impediment to escaping poverty, could direct future poverty alleviation and health improvement programs in this key population.
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Affiliation(s)
- Paul E. George
- University of California, Los Angeles, USA
- Texas Children’s Hospital, Houston, USA
| | - Juan Carlos Bazo-Alvarez
- Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Perú
- Peruvian Research Institute of Educational and Social Psychology (PSYCOPERU), Lima, Peru
| | - Angela M. Bayer
- University of California, Los Angeles, USA
- Universidad Peruana Cayetano Heredia, Lima, Peru
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137
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Degtyar A, George PE, Mallma P, Diaz DA, Cárcamo C, Garcia PJ, Gorbach PM, Bayer AM. Sexual Risk, Behavior, and HIV Testing and Status among Male and Transgender Women Sex Workers and their Clients in Lima, Peru. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2018; 30:81-91. [PMID: 30224942 PMCID: PMC6138045 DOI: 10.1080/19317611.2018.1429514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES – To determine the socio-demographics, sexual practices, and HIV prevalence of male sex workers (MSWs), transwomen sex workers (TSWs), and their male clients in Lima, Peru. METHODS – Following ethnographic mapping of sex work venues, we revisited randomly selected venues to survey MSWs, TSWs and their clients. RESULTS – MSWs and TSW clients are more educated than MSW clients and TSWs. Only 50% of TSW clients have received HIV testing. Self-reported HIV positivity is highest among MSW clients and TSWs. CONCLUSION – Notable differences exist between MSWs and TSWs and their clients that can affect the health of these groups and warrant intervention.
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Affiliation(s)
- Aleksandra Degtyar
- David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Paul E George
- David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Patricia Mallma
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Peru
| | - David A Diaz
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Peru
| | - César Cárcamo
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Peru
| | - Patricia J Garcia
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Peru
| | - Pamina M Gorbach
- Fielding School of Public Health, University of California, Los Angeles, United States
| | - Angela M Bayer
- David Geffen School of Medicine, University of California, Los Angeles, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Peru
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138
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Zhang A, Yan J, Yang G, Tan X, Wang X, Tan S. Life satisfaction and its associated factors among money boys in China. Public Health 2017; 154:110-117. [PMID: 29220710 DOI: 10.1016/j.puhe.2017.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Money Boy (MB) is a unique term used in China referring to a specialized population of men who sell sex to other men. Life satisfaction can influence one's health-related behaviors. The aim of our study was to find out the situation of MBs' life satisfaction and its associated factors. STUDY DESIGN A cross-sectional study among MBs was conducted between July and December 2013 in Hunan province, China. METHODS Respondent-driven sampling method was used for recruitment, with the initial seven 'seeds' found from a gay dating website, and 234 participants were enrolled into the study. They were asked to complete a questionnaire about their demographic characteristics, work experience as MB, family environment, health-related behaviors, status of self-esteem, self-stigma, and perceived life satisfaction. Descriptive statistics and multiple linear regression analysis were applied. RESULTS There were 205 valid questionnaires collected. The results showed that MBs' life satisfaction score was 17.9 ± 6.3. The multiple linear regression model identified five factors correlated with MBs' life satisfaction. Three factors were found to be positively correlated with life satisfaction, consistent condom use with clients (β = 3.093, P = 0.010), interpersonal relationship (β = 1.027, P = 0.017), and self-esteem (β = 0.253, P = 0.005). And two factors were found to be negatively correlated with life satisfaction, seeking for clients through mommy's arrangement (β = -2.091, P = 0.019) and had ever gotten at least one kind of sexually transmitted disease (STDs) (β = -1.971, P = 0.034). CONCLUSIONS The present study contributed to a better understanding of MBs' life satisfaction and behavioral and other psychosocial features. It is suggested that comprehensive interventions involving behavioral and psychosocial health promotion approaches are needed for this population. Those programs will be more acceptable among this group and tend to be sustainable.
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Affiliation(s)
- A Zhang
- The 3rd Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, Hunan 410013, China
| | - J Yan
- The 3rd Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, Hunan 410013, China.
| | - G Yang
- The 3rd Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, Hunan 410013, China
| | - X Tan
- The 3rd Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, Hunan 410013, China
| | - X Wang
- The 3rd Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, Hunan 410013, China
| | - S Tan
- The 3rd Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, Hunan 410013, China
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139
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Srivastava A, Goldbach JT. Pathways to Male Transactional Sex in Mumbai, India. JOURNAL OF HOMOSEXUALITY 2017; 66:173-188. [PMID: 29077538 DOI: 10.1080/00918369.2017.1398018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article explores pathways to male transactional sex, focusing on entering, soliciting practices, role of pimps, client characteristics, and negotiations. Little scientific literature exists regarding male transactional sex in India, who represent a high-risk group for HIV infection. Case studies with 10 men who engage in transactional sex were conducted, who were recruited using purposive snowball sampling and interviewed at a social service organization. Participants differed in their sexual identity, sex roles, soliciting practices, and clients. Most of them listed economic crisis as their reason for entering transactional sex. Strategies to find clients included self-solicitation and referrals, while pimps played a major role in solicitation, negotiations, and events of crisis. The relationship among men who engage in transactional sex, pimps, and clients involves points of negotiation, opportunities, and limitations. HIV prevention should focus on identifying and addressing the groups' unique needs and working with pimps on risk-reduction strategies and crisis interventions.
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Affiliation(s)
- Ankur Srivastava
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , USA
| | - Jeremy T Goldbach
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , USA
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140
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Ferguson A, Shannon K, Butler J, Goldenberg SM. A comprehensive review of HIV/STI prevention and sexual and reproductive health services among sex Workers in Conflict-Affected Settings: call for an evidence- and rights-based approach in the humanitarian response. Confl Health 2017; 11:25. [PMID: 29213302 PMCID: PMC5713057 DOI: 10.1186/s13031-017-0124-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/04/2017] [Indexed: 11/24/2022] Open
Abstract
Background While the conditions in emergency humanitarian and conflict-affected settings often result in significant sex work economies, there is limited information on the social and structural conditions of sex work in these settings, and the impacts on HIV/STI prevention and access to sexual and reproductive health (SRH) services for sex workers. Our objective was to comprehensively review existing evidence on HIV/STI prevention and access to SRH services for sex workers in conflict-affected settings globally. Methods We conducted a comprehensive review of all peer review (both epidemiological and qualitative) and grey literature published in the last 15 years (2000–2015), focusing on 1) HIV/STI vulnerability or prevention, and/or 2) access to SRH services for sex workers in conflict-affected settings. Five databases were searched, using combinations of sex work, conflict/mobility, HIV/STI, and SRH service terms. Relevant peer-reviewed and grey literature were also hand-searched, and key papers were cross-referenced for additional material. Results Five hundred fifty one records were screened and 416 records reviewed. Of 33 records describing HIV/STI prevention and/or access to SRH services among sex workers in conflict-affected settings, 24 were from sub-Saharan Africa; 18 studies described the results of primary research (13 quantitative, 3 qualitative, 2 mixed-methods) and 15 were non-primary research (e.g., commentaries, policy reports, programmatic manuals). Available evidence indicated that within conflict-affected settings, SWs’ capacity to engage in HIV/STI prevention and access SRH services is severely undermined by social and structural determinants including widespread violence and human rights violations, the collapse of livelihoods and traditional social structures, high levels of displacement, and difficulties accessing already scant health services due to stigma, discrimination and criminalization. Discussion/Conclusions This review identified significant gaps in HIV/STI and SRH research, policy, and programming for conflict-affected sex workers, highlighting a critical gap in the humanitarian response. Sex worker-informed policies and interventions to promote HIV/STI prevention and access to HIV and SRH services using a rights-based approach are recommended, and further research on the degree to which conflict-affected sex workers are accessing HIV/STI and SRH services is recommended. A paradigm shift from the behavioural and biomedical approach to a human rights-based approach to HIV/STI prevention and SRH is strongly recommended.
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Affiliation(s)
- Alyssa Ferguson
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Jennifer Butler
- United Nations Population Fund (UNFPA), Eastern Europe and Central Asia Region (EECAR), Istanbul, Turkey
| | - Shira M Goldenberg
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada.,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, V5A 1S6 Canada.,Faculty of Health Sciences, Simon Fraser University, Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
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Galárraga O, Sosa-Rubí SG, Kuo C, Gozalo P, González A, Saavedra B, Gras-Allain N, Conde-Glez CJ, Olamendi-Portugal M, Mayer KH, Operario D. Punto Seguro: A Randomized Controlled Pilot Using Conditional Economic Incentives to Reduce Sexually Transmitted Infection Risks in Mexico. AIDS Behav 2017; 21:3440-3456. [PMID: 29110216 DOI: 10.1007/s10461-017-1960-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Randomized controlled pilot evaluated effect of conditional economic incentives (CEIs) on number of sex partners, condom use, and incident sexually transmitted infections (STIs) among male sex workers in Mexico City. Incentives were contingent on testing free of new curable STIs and/or clinic attendance. We assessed outcomes for n = 227 participants at 6 and 12 months (during active phase with incentives), and then at 18 months (with incentives removed). We used intention-to-treat and inverse probability weighting for the analysis. During active phase, CEIs increased clinic visits (10-13 percentage points) and increased condom use (10-15 percentage points) for CEI groups relative to controls. The effect on condom use was not sustained once CEIs were removed. CEIs did not have an effect on number of partners or incident STIs. Conditional incentives for male sex workers can increase linkage to care and retention and reduce some HIV/STI risks such as condomless sex, while incentives are in place.
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142
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Tan D, Holloway IW, Gildner J, Jauregui JC, Garcia Alvarez R, Guilamo-Ramos V. Alcohol Use and HIV Risk Within Social Networks of MSM Sex Workers in the Dominican Republic. AIDS Behav 2017; 21:216-227. [PMID: 28849279 PMCID: PMC5660652 DOI: 10.1007/s10461-017-1896-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To examine how alcohol-related HIV risk behaviors within MSM sex workers' social networks (SN) may be associated with individual risk behaviors, respondent-driven and venue-based sampling were used to collect demographic, behavioral and SN characteristics among MSM sex workers in Santo Domingo and Boca Chica (N = 220). The majority of participants reported problem drinking (71.0%) or alcohol use at their last sexual encounter (71.4%). Self-reported problem drinking was associated with SN characteristics (at least one member who recently got drunk aOR = 7.5, no religious/spiritual adviser aOR = 3.0, non-sexual network density aOR = 0.9), while self-reported alcohol use at last sex was associated with individual (drug use at last sex aOR = 4.4) and SN characteristics (at least one member with previous HIV/STI testing aOR = 4.7). Dominican MSM sex workers reported high alcohol use, which may increase their risk for HIV. A better understanding of SN factors associated with individual risk behaviors can help guide appropriate intervention development.
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Affiliation(s)
- Diane Tan
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 337 Charles Young Drive, Room 5243, Los Angeles, CA, USA.
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Jennifer Gildner
- UCLA Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA, USA
| | - Juan C Jauregui
- College of Letters and Science, University of California, Los Angeles, CA, USA
| | - Rafael Garcia Alvarez
- Instituto de Sexualidad Humana, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health (CLAFH), New York University, New York, NY, USA
- , Sosua, Dominican Republic
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143
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Lim SH, Mburu G, Bourne A, Pang J, Wickersham JA, Wei CKT, Yee IA, Wang B, Cassolato M, Azwa I. Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: Findings from an online survey. PLoS One 2017; 12:e0182838. [PMID: 28902857 PMCID: PMC5597127 DOI: 10.1371/journal.pone.0182838] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/25/2017] [Indexed: 12/02/2022] Open
Abstract
Objective We examined willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia. Methods An online survey of 990 MSM was conducted between March and April 2016. Eligibility criteria included being biological male, Malaysian citizen, 18 years of age or above, identifying as MSM, and being HIV negative or unknown status. Participants’ demographics, sexual and drug use behaviors, attitudes towards PrEP, and preferences regarding future access to PrEP were collected. Bivariate analysis and logistic regression were performed to determine factors associated with willingness to use PrEP. Results Fewer than half of participants (44%) knew about PrEP before completing the survey. Overall, 39% of the sample were willing to take PrEP. Multivariate logistic regression indicated that Malay men (AOR: 1.73, 95% CI:1.12, 2.70), having 2 or more male anal sex partners in the past 6 months (AOR: 1.98, 95% CI: 1.29, 3.05), previous knowledge of PrEP (AOR: 1.40, 95%CI: 1.06, 1.86), lack of confidence in practising safer sex (AOR: 1.36, 95% CI: 1.02, 1.81), and having ever paid for sex with a male partner (AOR: 1.39, 95% CI: 1.01, 1.91) were independently associated with greater willingness to use PrEP, while men who identified as heterosexual were less willing to use PrEP (AOR, 0.36, 95% CI: 0.13, 0.97). Majority of participants preferred to access PrEP at affordable cost below 100 Malaysian Ringgit (USD25) per month from community based organisations followed by private or government hospitals. Conclusions Overall, MSM in Malaysia reported a relatively low level of willingness to use PrEP, although willingness was higher among those previously aware of PrEP. There is a need to provide PrEP at affordable cost, increase demand and awareness of PrEP, and to provide access to this preventative medication via diverse, integrated and tailored sexual health services.
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Affiliation(s)
- Sin How Lim
- Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gitau Mburu
- Division of Health Research, University of Lancaster, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia.,Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joselyn Pang
- International Programs, Australian Federation of AIDS Organizations, Bangkok, Thailand
| | - Jeffrey A Wickersham
- Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America
| | | | | | - Bangyuan Wang
- Division of Health Research, University of Lancaster, United Kingdom
| | - Matteo Cassolato
- Division of Health Research, University of Lancaster, United Kingdom
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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144
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Abstract
This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive-unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive-unaware. In multivariable analysis, exchange sex was associated with being HIV-positive-unaware (aPR 1.34, 95 % CI 1.05-1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.
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145
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Chakrapani V, Newman PA, Shunmugam M, Mengle S, Nelson R, Rubincam C, Kumar P. "Like Holding an Umbrella Before It Rains": Acceptability of Future Rectal Microbicides Among Men Who Have Sex With Men in India-A Modified Technology Acceptance Model. QUALITATIVE HEALTH RESEARCH 2017; 27:1236-1248. [PMID: 28682740 DOI: 10.1177/1049732317697947] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Topical rectal microbicides (RMs) are a new prevention technology in development that aims to reduce the risk of HIV acquisition from anal sex. We examined RM acceptability among men who have sex with men (MSM) in India. We conducted a qualitative exploratory study guided by a modified Technology Acceptance Model, with 10 focus groups ( n = 61) of MSM and 10 key informant interviews. Data were explored using framework analysis. RM acceptability was influenced by technological contexts: perceived usefulness of RMs, perceived ease of use of RM and applicator, and habits around condom and lubricant use; individual and interpersonal contexts: perceived relevance and preferences for product formulation and dosing frequency; and MSM community/social contexts: perceived social approval, RM-related stigma, social support. Implementation of RMs for MSM in India may be supported by multi-level interventions that engage community-based organizations in destigmatizing and distributing RMs, ideally gel-based products that enable on-demand use before sex.
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Affiliation(s)
- Venkatesan Chakrapani
- 1 Centre for Sexuality and Health Research and Policy, Chennai, India
- 2 The Humsafar Trust, Mumbai, India
- 3 PostGraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Murali Shunmugam
- 1 Centre for Sexuality and Health Research and Policy, Chennai, India
| | | | - Ruban Nelson
- 1 Centre for Sexuality and Health Research and Policy, Chennai, India
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146
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Thomas B, Closson EF, Biello K, Menon S, Navakodi P, Dhanalakshmi A, Mayer KH, Safren SA, Mimiaga MJ. Development and Open Pilot Trial of an HIV-Prevention Intervention Integrating Mobile-Phone Technology for Male Sex Workers in Chennai, India. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1035-1046. [PMID: 26714684 PMCID: PMC5432404 DOI: 10.1007/s10508-015-0665-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/27/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
In India men who have sex with men and engage in sex work (i.e., male sex workers; MSW) have a high risk of transmitting HIV. Globally, sex workers have become more spatially mobile due to advances in mobile-phone technology. In 2012 in-depth qualitative feedback was garnered from 40 interviews with MSW and four focus groups with 35 key informants (KIs) who had expert knowledge of the local MSW community to inform the design of an HIV-prevention intervention among MSW in Chennai, India. All MSW were recruited during outreach by employees of a Chennai-based organization for MSM (men who have sex with men). The data were analyzed using a descriptive qualitative approach. MSW and KIs discussed the need for intervention content that went beyond basic HIV psychoeducation. They emphasized the importance of addressing psychological distress, alcohol-related risk, and sexual communication skills. Concerns were raised about confidentiality, privacy, and scheduling. Participants endorsed a combination of in-person and mobile-phone-delivered sessions as well as the integration of mobile-phone messaging. These findings served as the basis for the development of a theoretically driven, manual-based intervention incorporating mobile phones. An open pilot assessed the feasibility and acceptability of the intervention with eight MSW. Assessments and HIV testing were administered at baseline, 3, and 6 months post-baseline. Exit interviews were conducted at the conclusion of the intervention. Retention for session attendance and assessment follow-up was 100 %. There was a high level of acceptability for the format, structure, and content. These data show initial promise, feasibility, and acceptability of the intervention.
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Affiliation(s)
- Beena Thomas
- National Institute for Research in Tuberculosis, Chennai, India
| | - Elizabeth F Closson
- The Fenway Institute, Fenway Health, Boston, MA, USA
- London School of Hygiene and Tropical Medicine, London, UK
| | - Katie Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02903, USA
| | | | | | - A Dhanalakshmi
- National Institute for Research in Tuberculosis, Chennai, India
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, University of Miami, Coral Gables, FL, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02903, USA.
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147
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Bowring AL, Pasomsouk N, Hughes C, van Gemert C, Higgs P, Sychareun V, Hellard M, Power R. "We Might Get Some Free Beers": Experience and Motivation for Transactional Sex Among Behaviorally Bisexual Men in Vientiane, Laos. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1047-1059. [PMID: 27007470 DOI: 10.1007/s10508-016-0705-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 05/10/2023]
Abstract
People engaging in transactional sex are considered a key population for HIV prevention. Prior quantitative surveys demonstrated that behaviorally bisexual men in Vientiane, Laos commonly transact sex. In 2013, we conducted a qualitative study to explore behaviorally bisexual men's experience, motivations, and perceptions related to transactional sex in Vientiane. Behaviorally bisexual men were recruited from bars, nightclubs, and dormitories for five focus group discussions (FGDs) and 11 in-depth interviews (n = 31). Additionally, young women were recruited from a university, garment factory, and nightclub for four FGDs (n = 22). Transcripts were translated and thematically coded. Bisexual male participants most commonly described being paid for sex by male-to-female transgender people and buying sex from women. Both male and female participants reported that older, single women pay younger men for sex. Negotiation and direction of sexual transactions are influenced by age, attraction, and wealth. Common motivations for selling sex included the need for money to support family or fund school fees, material gain, or physical pleasure. Transactional sex was often opportunistic. Some behaviorally bisexual men reported selling sex in order to pay another more desirable sex partner or to buy gifts for their regular sex partner. Participants perceived high risk associated with intercourse with female sex workers but not with other transactional sex partners. Health interventions are needed to improve knowledge, risk perception, and health behaviors, but must recognize the diversity of transactional sex in Vientiane. Both physical and virtual settings may be appropriate for reaching behaviorally bisexual men and their partners.
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Affiliation(s)
- Anna L Bowring
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Chad Hughes
- Centre for International Health, Burnet Institute, Melbourne, Australia
| | - Caroline van Gemert
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Higgs
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Fitzroy, Melbourne, Australia
| | - Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert Power
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for International Health, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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148
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Crowell TA, Keshinro B, Baral SD, Schwartz SR, Stahlman S, Nowak RG, Adebajo S, Blattner WA, Charurat ME, Ake JA. Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria. J Int AIDS Soc 2017; 20:21489. [PMID: 28453241 PMCID: PMC5515015 DOI: 10.7448/ias.20.01.21489] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 04/06/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. METHODS Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV. RESULTS From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84-1.05]). CONCLUSION These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shauna Stahlman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
| | | | | | | | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - for the TRUST/RV368 Study Group
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Walter Reed Program-Nigeria, Abuja, Nigeria
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
- Population Council Nigeria, Abuja, Nigeria
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149
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Nyblade L, Reddy A, Mbote D, Kraemer J, Stockton M, Kemunto C, Krotki K, Morla J, Njuguna S, Dutta A, Barker C. The relationship between health worker stigma and uptake of HIV counseling and testing and utilization of non-HIV health services: the experience of male and female sex workers in Kenya. AIDS Care 2017; 29:1364-1372. [PMID: 28325068 DOI: 10.1080/09540121.2017.1307922] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The barrier HIV-stigma presents to the HIV treatment cascade is increasingly documented; however less is known about female and male sex worker engagement in and the influence of sex-work stigma on the HIV care continuum. While stigma occurs in all spheres of life, stigma within health services may be particularly detrimental to health seeking behaviors. Therefore, we present levels of sex-work stigma from healthcare workers (HCW) among male and female sex workers in Kenya, and explore the relationship between sex-work stigma and HIV counseling and testing. We also examine the relationship between sex-work stigma and utilization of non-HIV health services. A snowball sample of 497 female sex workers (FSW) and 232 male sex workers (MSW) across four sites was recruited through a modified respondent-driven sampling process. About 50% of both male and female sex workers reported anticipating verbal stigma from HCW while 72% of FSW and 54% of MSW reported experiencing at least one of seven measured forms of stigma from HCW. In general, stigma led to higher odds of reporting delay or avoidance of counseling and testing, as well as non-HIV specific services. Statistical significance of relationships varied across type of health service, type of stigma and gender. For example, anticipated stigma was not a significant predictor of delay or avoidance of health services for MSW; however, FSW who anticipated HCW stigma had significantly higher odds of avoiding (OR = 2.11) non-HIV services, compared to FSW who did not. This paper adds to the growing evidence of stigma as a roadblock in the HIV treatment cascade, as well as its undermining of the human right to health. While more attention is being paid to addressing HIV-stigma, it is equally important to address the key population stigma that often intersects with HIV-stigma.
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Affiliation(s)
- Laura Nyblade
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | - Aditi Reddy
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | | | - John Kraemer
- a Global Health Division, International Development Group , RTI International , Washington , USA.,c Department of Health Systems Administration , Georgetown University , Washington , USA
| | - Melissa Stockton
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | | | - Karol Krotki
- a Global Health Division, International Development Group , RTI International , Washington , USA
| | - Javier Morla
- a Global Health Division, International Development Group , RTI International , Washington , USA
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150
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Rahman R, Pinto RM, Wall MM. HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030294. [PMID: 28335444 PMCID: PMC5369130 DOI: 10.3390/ijerph14030294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills.
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Affiliation(s)
- Rahbel Rahman
- Department of Social Work, Community of College and Public Affairs, Binghamton University, 67 Washington St, Binghamton, NY 13902, USA.
| | - Rogério M Pinto
- School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI 48109, USA.
| | - Melanie M Wall
- Department of Biostatistics, Columbia University, 722 West 168th St. New York, NY 10032, USA.
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