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Pollock L, Warren M, Levison J. Missed Opportunities for HIV Prevention in Perinatal Care Settings in the United States. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:680046. [PMID: 36304042 PMCID: PMC9580717 DOI: 10.3389/frph.2021.680046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Universal opt-out HIV screening in pregnancy is an essential intervention toward eliminating perinatal HIV transmission in the US. However, it fails to identify pregnant people who are HIV negative at the time of testing but are at ongoing risk for HIV acquisition. Those of us involved in caring for women living with HIV are acutely aware of the many diagnoses of HIV that might have been prevented if only a partner had been tested for HIV or preexposure prophylaxis (PrEP) had been offered to a patient. This perspective article will review current recommendations and evidence-based interventions to evaluate missed opportunities for HIV prevention in US perinatal care settings. We identified three barriers to implementation of HIV prevention strategies during pregnancy and breastfeeding: (1) HIV risk for women is underestimated and poorly defined in clinical practice; (2) Partner testing is challenging and implementation studies in the US are lacking; and (3) PrEP remains underutilized. In March 2020, the National Perinatal HIV Hotline convened a group of clinicians and researchers specializing in perinatal HIV care to a case-based discussion of missed opportunities in perinatal HIV prevention. From our review of the literature via PubMed search as well as expert opinions gathered in this discussion, we make recommendations for addressing these barriers.
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Affiliation(s)
- Lealah Pollock
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Lealah Pollock
| | - Marliese Warren
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Judy Levison
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
- Judy Levison
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102
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Hendrickson ZM, Leddy AM, Galai N, Beckham SW, Davis W, Mbwambo JK, Likindikoki S, Kerrigan DL. Mobility for sex work and recent experiences of gender-based violence among female sex workers in Iringa, Tanzania: A longitudinal analysis. PLoS One 2021; 16:e0252728. [PMID: 34081739 PMCID: PMC8174717 DOI: 10.1371/journal.pone.0252728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
Female sex workers are highly mobile, which may influence their risk of experiencing physical and sexual violence. However, there remains a paucity of research, particularly longitudinal, from Sub-Saharan Africa exploring mobility and gender-based violence among female sex workers. To address this gap, this study examined the longitudinal relationship between work-related mobility and recent experience of physical or sexual gender-based violence from a client or partner among female sex workers in Iringa, Tanzania. A secondary data analysis was conducted using baseline and 18-month follow-up data from Project Shikamana, a community empowerment-based combination HIV prevention intervention. Responses from 387 female sex workers aged 18 years and older participating in both baseline and follow-up were analyzed. Unadjusted and adjusted Poisson regression models with robust variance estimations, accounting for clustering of female sex workers' responses over time, were fit. Final models adjusted for socio-demographic characteristics and aspects of participants' living situations and work environments. Recent physical or sexual violence from a client or partner was common (baseline: 40%; follow-up: 29%). Twenty-six percent of female sex workers at baseline, and 11% at follow-up, had recently traveled outside of Iringa for sex work. In the final adjusted longitudinal model, female sex workers recently mobile for sex work had a 25% increased risk of any recent experience of physical or sexual gender-based violence when compared with their non-mobile counterparts (adjusted incidence rate ratio: 1.25; 95% CI: 1.03-1.53; p<0.05). Interventions must identify ways-such as mobile support services, linkages and referrals to health and other social services while traveling, or the use of mobile or digital technology-to address mobile female sex workers' unique needs while traveling. Future quantitative and qualitative research is needed to understand the context of female sex workers' mobility and how and why mobility influences risk environments and experiences of gender-based violence.
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Affiliation(s)
- Zoé Mistrale Hendrickson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Anna M. Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Jessie K. Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna L. Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
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103
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Leis M, McDermott M, Koziarz A, Szadkowski L, Kariri A, Beattie TS, Kaul R, Kimani J. Intimate partner and client-perpetrated violence are associated with reduced HIV pre-exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross-sectional study of female sex workers from Nairobi, Kenya. J Int AIDS Soc 2021; 24 Suppl 2:e25711. [PMID: 34164924 PMCID: PMC8222843 DOI: 10.1002/jia2.25711] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION UNAIDS has identified female sex workers (FSW) as a key HIV at-risk population. FSW disproportionately experience gender-based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre-exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client-perpetrated violence against FSW, mental health outcomes and PrEP use. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client-perpetrated violence, and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 56.8% (125/220) reported depression (PHQ-9 ≥ 10) and 39.1% (86/220) reported anxiety (GAD-7 ≥ 10). Only 41.4% (91/220) reported optimal use of PrEP (taken correctly six to seven days/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12 months (90%, 198/220). Any recent IPV was frequent (78.7%, 129/164), particularly emotional IPV (66.5%, 109/164), as was any client-perpetrated violence in the past 12 months (80.9%, 178/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, p = 0.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, p = 0.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client-perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, p = 0.01) was associated with decreased PrEP use, whereas client-perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, p = 0.02). CONCLUSIONS There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client-perpetrated emotional violence was associated with PrEP non-use. Interventions to reduce gender-based violence may independently enhance HIV prevention and reduce the mental health burden in this community.
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Affiliation(s)
- Maria Leis
- Department of MedicineUniversity of TorontoTorontoCanada
| | | | - Alex Koziarz
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Leah Szadkowski
- Biostatistics Research UnitUniversity Health NetworkTorontoCanada
| | - Antony Kariri
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
| | - Tara S Beattie
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonEngland
| | - Rupert Kaul
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Joshua Kimani
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
- Department of Medical MicrobiologyUniversity of ManitobaManitobaCanada
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104
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Agot K, Wango GN, Obonyo B, Thirumurthy H. HIV Self-Testing Can Be Liberating to HIV-Positive Women and Their Sexual Partners: A Qualitative Study in Kisumu, Western Kenya. J Int Assoc Provid AIDS Care 2021; 19:2325958220919230. [PMID: 32347143 PMCID: PMC7236088 DOI: 10.1177/2325958220919230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Nearly half of Kenyan men with HIV-positive partners do not know their partner’s
status. We carried out a qualitative substudy to explore the experiences of a sample of
HIV-positive women when distributing HIV self-tests (HIVST) to their sexual
partners. Methods: HIV-positive women were invited for in-depth interviews to share their experiences in
offering HIVST to their partners and how self-testing impacted their relationships. Results: Two hundred ninety-seven women were randomized to HIVST, 12 of whom self-reported being
HIV positive and 11 participated in the interview. Self-testing procedures and
interpretation of results were well understood. Participants were strategic in
approaching their partners, thus avoided partner violence. Couple testing was high,
which strengthened relationships, improved condom use, and empowered women to make joint
decisions concerning their health. Conclusions: Giving HIV-positive women HIVST kits to distribute to their male partners is feasible
and safe. Providers who have challenges reaching male partners with testing should
consider HIVST.
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Affiliation(s)
- Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Gift-Noelle Wango
- Nyanza Initiative for Girls Education and Empowerment, Kisumu, Kenya
| | | | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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105
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Meskele M, Khuzwayo N, Taylor M. Mapping the evidence of intimate partner violence among women living with HIV/AIDS in sub-Saharan Africa: a scoping review. BMJ Open 2021; 11:e041326. [PMID: 33980513 PMCID: PMC8118063 DOI: 10.1136/bmjopen-2020-041326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The present study undertakes a scoping review aimed to map the evidence of intimate partner violence (IPV) against women living with HIV/AIDS in Africa. DESIGN We used the online database to identify papers published from 1 January 2009 to 1 April 2019, from which we selected 21 articles from Uganda, Nigeria, Kenya, South Africa, Zambia, Ethiopia, Cameroon, Tanzania and Swaziland that used IPV as an outcome variable among women living with HIV/AIDS. DATA SOURCES PubMed, MEDLINE, EBSCO host, Google Scholar. ELIGIBILITY CRITERIA We included women who were aged 15 years and above, living with HIV/AIDS in sub-Saharan Africa. DATA EXTRACTION AND SYNTHESIS We conducted the abstract screening with two independent reviewers. We also performed full-text screening. We used the six methodological frameworks proposed by Arksey and O'Malley. The Mixed Method Appraisal Tool was used to determine the quality of the studies. We used NVIVO software V.12 to undertake a thematic analysis. RESULTS Of the studies, the majority, 57.1%, reported cross-sectional results. In comparison, 23.8% examined qualitative studies, 9.5% were clinical trials, 4.8% were cohort studies and the remaining 4.8% covered grey literature. This review revealed evidence of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure influences IPV, proof of the association of sociodemographic characteristics with IPV and implications for practice. Moreover, the review revealed that following the serostatus disclosure, there is evidence of heightened risk for IPV. CONCLUSIONS This study found evidence of IPV among women living with HIV/AIDS. The HIV-positive women were at considerable risk of IPV after disclosure of their serostatus to a male partner. Therefore, further research is needed to promote action to reduce IPV among HIV-positive and HIV-negative women and to determine healthcare workers' IPV screening experience.
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Affiliation(s)
- Mengistu Meskele
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Nelisiwe Khuzwayo
- School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Myra Taylor
- Public Health Medicine, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
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106
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Aldous AM, Joy C, Daniels J, Jais M, Simmens SJ, Magnus M, Roberts A, Connors K, Capozzi B, Mohamed H, Juzumaite M, Devore H, Moriarty T, Hatch Schultz C, Zumer M, Simon G, Ghosh M. Recent sexual violence exposure is associated with immune biomarkers of HIV susceptibility in women. Am J Reprod Immunol 2021; 86:e13432. [PMID: 33894020 DOI: 10.1111/aji.13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022] Open
Abstract
PROBLEM HIV/AIDS and sexual violence act synergistically and compromise women's health. Yet, immuno-biological mechanisms linking sexual violence and increased HIV susceptibility are poorly understood. METHODS We conducted a cross-sectional pilot study of HIV-uninfected women, comparing 13 women exposed to forced vaginal penetration within the past 12 weeks (Exposed) with 25 Non-Exposed women. ELISA assays were conducted for 49 biomarkers associated with HIV pathogenesis in plasma and cervicovaginal lavage (CVL). Differences between Exposed and Non-Exposed were analyzed by linear and logistic regression, using propensity score weighting to control for age, race, socioeconomic status, menstrual cycle, and contraceptive use. RESULTS In CVL, Exposed women had significantly reduced chemokines MIP-3α (p < .01), MCP-1 (p < .01), and anti-HIV/wound-healing thrombospondin-1 (p = .03). They also had significantly increased inflammatory cytokine IL-1α (p < 0.01) and were more likely to have detectable wound-healing PDGF (p = .02). In plasma, Exposed women had reduced chemokines MIP-3α (p < .01) and IL-8 (p < .01), anti-inflammatory cytokine TGF-β (p = .02), anti-HIV/antimicrobial HBD-2 (p = .02), and wound-healing MMP-1 (p = 0.02). They also had increased thrombospondin-1 (p < .01) and Cathepsin B (p = .01). After applying the stringent method of false discovery rate adjustment, differences for IL-1α (p = .05) and MCP-1 (p = .03) in CVL and MIP-3α (p = .03) in plasma remained significant. CONCLUSIONS We report systemic and mucosal immune dysregulation in women exposed to sexual violence. As these biomarkers have been associated with HIV pathogenesis, dysregulation may increase HIV susceptibility.
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Affiliation(s)
- Annette M Aldous
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Christopher Joy
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jason Daniels
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Mariel Jais
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Samuel J Simmens
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Afsoon Roberts
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Kaleigh Connors
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Brendan Capozzi
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Hani Mohamed
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Monika Juzumaite
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Heather Devore
- District of Columbia Forensic Nurse Examiners, Washington, DC, USA
| | | | | | - Maria Zumer
- Medical Faculty Associates, Inc., The George Washington University, Washington, DC, USA
| | - Gary Simon
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Mimi Ghosh
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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107
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Blackstock OJ, Platt J, Golub SA, Anakaraonye AR, Norton BL, Walters SM, Sevelius JM, Cunningham CO. A Pilot Study to Evaluate a Novel Pre-exposure Prophylaxis Peer Outreach and Navigation Intervention for Women at High Risk for HIV Infection. AIDS Behav 2021; 25:1411-1422. [PMID: 32748159 PMCID: PMC8284566 DOI: 10.1007/s10461-020-02979-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pre-exposure prophylaxis (PrEP) uptake remains woefully low among U.S. women at high risk for HIV acquisition. We evaluated a pilot intervention which involved Peers providing brief PrEP education and counseling at mobile syringe exchange sites and at sex worker and syringe exchange drop-in centers followed by navigation to PrEP care. Peers recruited English-proficient, self-identified women (i.e., cisgender and transgender women and persons with other transfeminine identities) over a 3-month period and delivered the intervention to 52 HIV-negative/status unknown participants. Thirty-eight participants (73.1%) reported PrEP interest, 27 (51.9%) accepted the offer of a PrEP appointment, 13 (25.0%) scheduled a PrEP appointment, 3 (5.8%) attended an initial PrEP appointment, and none were prescribed PrEP. We found a gap between PrEP interest and connecting women to PrEP care. Further study is needed to understand this gap, including exploring innovative approaches to delivering PrEP care to women at highest risk for HIV.
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Affiliation(s)
- Oni J Blackstock
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
| | - Joey Platt
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Amarachi R Anakaraonye
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Brianna L Norton
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Suzan M Walters
- Center for Drug Use and HIV/HCV Research, NYU Rory Meyers College of Nursing, New York, NY, USA
| | - Jae M Sevelius
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
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108
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Biomndo BC, Bergmann A, Lahmann N, Atwoli L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS One 2021; 16:e0249813. [PMID: 33882084 PMCID: PMC8059826 DOI: 10.1371/journal.pone.0249813] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV's association with poor ART adherence. We investigate this association among a broad group of women. METHODS We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. RESULTS The participants' mean age was 38.6 (range: 18-69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72-80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34-0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31-0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34-0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. CONCLUSION IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.
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Affiliation(s)
- Bornice C. Biomndo
- Institute of Health and Nursing Science, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nils Lahmann
- Clinic for Geriatrics and Geriatric Medicine, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Medical College East Africa, Aga Khan University, Nairobi, Kenya
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109
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Transactional Sex, Alcohol Use and Intimate Partner Violence Against Women in the Rakai Region of Uganda. AIDS Behav 2021; 25:1144-1158. [PMID: 33128109 DOI: 10.1007/s10461-020-03069-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/30/2023]
Abstract
Transactional sex (TS) is prevalent in sub-Saharan Africa. Women's engagement in TS is linked with HIV infection; little is known about the relationship between TS, intimate partner violence (IPV) and alcohol use-established HIV risk behaviors. Using modified Poisson regression, we assessed associations between TS and physical, verbal and sexual IPV among 8248 women (15-49 years) who participated in the Rakai Community Cohort Study across forty communities in Uganda. An interaction term assessed moderation between alcohol use and TS and no significant interaction effects were found. In adjusted analysis, alcohol use and TS were significantly associated with all forms of IPV. In stratified analysis, TS was only associated with IPV in agrarian communities; alcohol use was not associated with physical IPV in trade communities or sexual IPV in trade and fishing communities. Identifying differences in IPV risk factors by community type is critical for the development of tailored interventions.
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110
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Sa M, C R, Ml M, Lr S, J TM, S J, X S, Rs G, Sa S, K D, K H, R M, Mj M, M O, A G, D W, Ai S. Examining the gender composition of drug injecting initiation events: A mixed methods investigation of three North American contexts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103056. [PMID: 33310638 PMCID: PMC8046711 DOI: 10.1016/j.drugpo.2020.103056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gender influences the health and social risks faced by individuals initiating drug injecting. Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred. METHODS The PReventing Injecting by Modifying Existing Responses (PRIMER) study pooled data from three prospective community-recruited cohorts of people who inject drugs (PWID) in San Diego, USA, Vancouver, Canada, and Tijuana, Mexico. A qualitative subsample provided narrative data on their experiences of, and the contexts for, injection initiation events. Guided by Rhodes' risk environment framework, we examined the gender composition of initiation events stratified by city, and analyzed qualitative data using abductive thematic analyses. RESULTS Among 2,622 PWID (Tijuana: n = 531; San Diego: n = 352; Vancouver: n = 1,739), 112 (4.3%) reported providing initiation assistance to injection-naïve individuals in the previous six months. The proportion of gender concordant (e.g., male-male) initiation pairs varied, (χ2 = 10.32, p <0.001) with greater than expected concordance among pairs in Tijuana compared with those in Vancouver or San Diego. Sixty-one interviews provided context for the discrepancy across sites by highlighting the gendered injection initiation risk environments of prison/jail detention in Tijuana, intimate partnerships in San Diego, and overdose risk in Vancouver. CONCLUSIONS These results highlight how gender influences injection initiation events within spatial, social, and economic risk environments, and how this influence varies across settings. These findings can inform interventions to reduce the risk of injection initiation and related harms.
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Affiliation(s)
- Meyers Sa
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Rafful C
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
| | - Mittal Ml
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, Mexico
| | - Smith Lr
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Tirado-Muñoz J
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jain S
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Sun X
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Garfein Rs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Strathdee Sa
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - DeBeck K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - Hayashi K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - McNeil R
- School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, United States
| | - Milloy Mj
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9 Canada
| | - Olding M
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada
| | - Guise A
- Addison House, Guy's Hospital, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Werb D
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - Scheim Ai
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
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Cavanaugh CE, Harvey J, Alexander KA, Saraczewski S, Campbell JC. Assessing Domestic Violence Shelter Workers Views and Practices Pertaining to HIV Prevention Services for Women Residing in Domestic Violence Shelters. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP3964-NP3981. [PMID: 29926757 PMCID: PMC6502696 DOI: 10.1177/0886260518781802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a need for studies to assess domestic violence (DV) shelter workers views about brief HIV prevention interventions for shelter residents to improve these workers' provision of HIV prevention interventions to shelter residents. This mixed methods study assessed DV shelter workers' views about the following: (a) the need for and appropriateness of HIV prevention services within DV shelters, (b) the utility (i.e., acceptability, systems support, understanding, and feasibility) of an HIV Risk Assessment and Safety Plan (HIV RASP) for women in DV shelters, and (c) suggested changes to or concerns about using the HIV RASP. Workers from DV shelters located in the 10 states in the United States with the highest rates of HIV reviewed the HIV RASP and answered survey questions about it including the Usage Rating Profile-Intervention (URP-I) Questionnaire and two open-ended questions. Although workers felt it was appropriate to provide HIV prevention interventions within DV shelters, only 23% reported that HIV prevention interventions had ever been implemented at their shelter and only 42% had provided residents with educational brochures about HIV prevention. Workers generally agreed that the HIV RASP was acceptable, understandable, and feasible. They somewhat disagreed about their ability to implement the tool independently. Findings suggest that little progress has been made in engaging DV shelter workers in HIV prevention efforts for residents during the past decade and reveal ways to improve the HIV RASP and overcome barriers to implementing it. The study findings may be used to help reduce gaps between the science and practice of HIV prevention for abused women.
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Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, Wekesa P, Sheira L, Frongillo EA, Bukusi EA. Food Insecurity and Intimate Partner Violence Among HIV-Positive Individuals in Rural Kenya. Am J Prev Med 2021; 60:563-568. [PMID: 33012622 PMCID: PMC7987870 DOI: 10.1016/j.amepre.2020.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Intimate partner violence and food insecurity are both structural drivers of HIV acquisition, care, and treatment, but little is known about how the 2 conditions intersect in the lives of those already living with HIV. METHODS This study examined cross-sectional baseline data (collected in January 2016-December 2017) from an ongoing trial in southwestern Kenya. Trained interviewers asked enrolled participants living with HIV aged 18-60 years about household food insecurity (using the Household Food Insecurity Access Scale), intimate partner violence (using an adapted WHO multicountry study instrument), and sociodemographics. Negative binomial regression was used to examine the association between food insecurity and partner violence victimization (among women) or perpetration (among men). Secondary data were analyzed in August 2019-March 2020. RESULTS Of 720 participants, more than half of women reported experiencing intimate partner violence (57.6%) and most men reported perpetrating it (58.4%). Participants reporting any partner violence had higher Household Food Insecurity Access Scale scores (21.8) compared with those reporting no violence (21.3, p=0.02). Each categorical change in food insecurity (mild, moderate, severe) was associated with a 41% increased risk of an additional partner violence episode. In models controlling for relationship status, wealth, season of interview (lean versus not lean), and baseline physical health, each 1-point increase in food insecurity was associated with a 6% higher risk of violence victimization among women and 4% greater risk of men perpetrating partner violence. CONCLUSIONS This study highlights the interconnected nature of intimate partner violence and food insecurity among women and men living with HIV. This relationship suggests that enhancing food security may be a useful intervention strategy to prevent intimate partner violence and improve HIV-related health outcomes.
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Affiliation(s)
- Abigail M Hatcher
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California; Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Jill Hagey
- Department of Medicine, Duke University, Durham, North Carolina
| | - Elly Weke
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Pauline Wekesa
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, Washington; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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Hui V, Constantino RE. The association between life satisfaction, emotional support, and perceived health among women who experienced intimate Partner violence (IPV) - 2007 behavioral risk factor surveillance system. BMC Public Health 2021; 21:641. [PMID: 33794819 PMCID: PMC8015742 DOI: 10.1186/s12889-021-10665-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a pressing phenomenon whose consequences are associated with severe physical and mental health outcomes. Every minute, around 24 people in the United States are raped, physically injured, or emotionally abused by their intimate partner. Although having experienced IPV is not modifiable, emotional support is a protective factor to prevent victims from committing suicide. The psychological state of IPV victims is critical in post-traumatic events and this is evidenced in numerous qualitative interviews. Therefore, the objective of this study is to explore the association between IPV with emotional support, life satisfaction, and perceived health status in the United States. METHODS This study analyzed the data from the 2007 Behavioral Risk Factor Surveillance System. Univariate analyses, multivariable logistic regression analyses, and ordinal logistic regression analyses were used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with IPV. Analyses were conducted using SPSS version 25. RESULTS The analyses show that there is a strong association between IPV experience and emotional support (AOR:1.810; 95% CI = 1.626-2.015). Participants who had either physical violence or unwanted sex with an intimate partner in the past 12 months have 2.28 higher odds to receive less emotional support and 2.05 higher odds to perceive poor life satisfaction. Also, participants who reported experiencing IPV were associated with (AOR: 3.12; 95% CI =2.68-3.62) times the odds of having ≥6 days more mentally unhealthy days in a month. For perceived health outcomes, people who had been threatened with violence by a sex partner have 1.74 (95% CI =1.54-1.96) times the odds of having poor perceived general health status. IPV survivors have 3.12 (95% CI =2.68-3.62) times the odds of having ≥6 days more mentally unhealthy days in a month. CONCLUSIONS People reported with any IPV experience are more likely to receive less emotional support, perceive dissatisfaction in life, and poor health outcomes. This study shows the need for policies centered on the development of interventions that focus on mental health for those who have experienced IPV.
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Affiliation(s)
- Vivian Hui
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Rose Eva Constantino
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Kovensky R, Khurana A, Guyer S, Leve LD. Childhood Adversity, Impulsivity, and HIV Knowledge as Predictors of Sexual Risk Outcomes in At-Risk Female Youth. ADOLESCENTS 2021; 1:56-69. [PMID: 33954297 DOI: 10.3390/adolescents1010006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sexual risk behavior in adolescence can lead to adverse health consequences, particularly for female youth. Most interventions focus on imparting knowledge about the consequences of such behaviors, even though little research has examined whether increasing such knowledge results in desired behavioral changes. Further, individual factors such as impulsivity and childhood adversity might moderate this relationship. We examined associations between HIV knowledge and sexual risk behavior and condom use efficacy in a sample of 122 at-risk females, aged 13-18. HIV knowledge was unrelated to sexual risk behavior, but positively related to condom use efficacy. Impulsivity and childhood adversity had direct effects, with no interaction effects. Increasing HIV knowledge may play an important role in promoting proximal predictors of safer sex practices.
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Affiliation(s)
- Rachel Kovensky
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR 97403, USA
| | - Atika Khurana
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR 97403, USA
- Prevention Science Institute, University of Oregon, Eugene, OR 97403, USA
| | - Sally Guyer
- Prevention Science Institute, University of Oregon, Eugene, OR 97403, USA
| | - Leslie D Leve
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR 97403, USA
- Prevention Science Institute, University of Oregon, Eugene, OR 97403, USA
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Fiorentino M, Eubanks A, Coulaud PJ, Couderc C, Keita BD, Anoma C, Dah E, Mensah E, Maradan G, Bourrelly M, Riegel L, Rojas-Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Homonegativity, sexual violence and condom use with women in men who have sex with men and women in West Africa. AIDS 2021; 35:681-687. [PMID: 33306548 DOI: 10.1097/qad.0000000000002782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aimed to explore longitudinal interactions between homonegativity and sexual behaviors with female partners among HIV-negative West African men who have sex with men and women (MSMW). DESIGN AND METHOD The community-based cohort CohMSM ANRS 12324 - Expertise France enrolled MSM in Togo, Burkina Faso, Côte d'Ivoire and Mali. Sociobehavioral data were collected every 6 months. Using 30-month follow-up data, a multiprobit analysis was performed to investigate the relationship between psychosocial and behavioral variables ex-ante (t - 1) and ex-post (t). RESULTS MSMW (n = 326) accounted for half of all participants in CohMSM. They reported inconsistent condom use with women in 39% of visits. Perceived and internalized homonegativity at t - 1 tended to lead to sexual violence toward women at t (P < 0.1), which was associated with inconsistent condom use with them at t (P < 0.05). CONCLUSION Given the high HIV prevalence in West African MSM, widespread condom-less sex with women in MSMW, and the aggravating effect of social and internalized homonegativity, more research in the MSMW subpopulation is needed to assess the risk of HIV bridging to women and to design support activities.
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Affiliation(s)
- Marion Fiorentino
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | - August Eubanks
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | - Pierre-Julien Coulaud
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | | | | | | | - Elias Dah
- Association African Solidarité, Ouagadougou
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Gwenaëlle Maradan
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | - Michel Bourrelly
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | | | | | - Issifou Yaya
- IRD, INSERM, Univ Montpellier, TransVIHMI, Montpellier, France
| | - Bruno Spire
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | | | - Luis Sagaon-Teyssier
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
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Abrahams N, Mhlongo S, Dunkle K, Chirwa E, Lombard C, Seedat S, Kengne AP, Myers B, Peer N, Garcia-Moreno C, Jewkes R. Increase in HIV incidence in women exposed to rape. AIDS 2021; 35:633-642. [PMID: 33264114 PMCID: PMC7924974 DOI: 10.1097/qad.0000000000002779] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the incidence of HIV acquisition in women postrape compared with a cohort of women who had not been raped. DESIGN A prospective cohort study. METHODS The Rape Impact Cohort Evaluation study based in Durban, South Africa, enrolled women aged 16-40 years from postrape care services, and a control group of women from Primary Healthcare services. Women who were HIV negative at baseline (441 in the rape-exposed group and 578 in the control group) were followed for 12-36 months with assessments every 3 months in the first year and every 6 months thereafter. Multivariable Cox regression models adjusted for baseline and time varying covariates were used to investigate the effect of rape exposure on HIV incidence over follow-up. RESULTS Eighty-six women acquired HIV during 1605.5 total person-years of follow-up, with an incident rate of 6.6 per 100 person-years [95% confidence interval (CI): 4.8-9.1] among the rape exposed group and 4.7 per 100 person-years (95% CI: 3.5-6.2) among control group. After controlling for confounders (age, previous trauma, social support, perceived stress, multiple partners and transactional sex with a casual partner), women exposed to rape had a 60% increased risk of acquiring HIV [adjusted hazard ratio: 1.59 (95% CI: 1.01-2.48)] compared with those not exposed. Survival analysis showed difference in HIV incident occurred after month 9. CONCLUSION Rape is a long-term risk factor for HIV acquisition. Rape survivors need both immediate and long-term HIV prevention and care.
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Affiliation(s)
- Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town
| | - Soraya Seedat
- Anxiety and Stress Disorder Unit, University of Stellenbosch, Stellenbosch
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council
| | - Claudia Garcia-Moreno
- Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council
- Intramural Research Directorate, South African Medical Research Council, Cape Town
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Colombini M, Scorgie F, Stangl A, Harvey S, Ramskin L, Khoza N, Mashauri E, Baron D, Lees S, Kapiga S, Watts C, Delany-Moretlwe S. Exploring the feasibility and acceptability of integrating screening for gender-based violence into HIV counselling and testing for adolescent girls and young women in Tanzania and South Africa. BMC Public Health 2021; 21:433. [PMID: 33658000 PMCID: PMC7927237 DOI: 10.1186/s12889-021-10454-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) undermines HIV prevention and treatment cascades, particularly among women who report partner violence. Screening for violence during HIV testing, and prior to offering pre-exposure prophylaxis (PrEP) to HIV uninfected women, provides an opportunity to identify those at heightened HIV risk and greater potential for non-adherence or early discontinuation of PrEP. The paper describes our experience with offering integrated GBV screening and referral as part of HIV counselling and testing. This component was implemented within EMPOWER, a demonstration project offering combination HIV prevention, including daily oral PrEP, to young women in South Africa and Tanzania. METHODS Between February 2017 and March 2018, a process evaluation was conducted to explore views, experiences and practices of stakeholders (study participants and study clinical staff) during implementation of the GBV screening component. This article assesses the feasibility and acceptability of the approach from multiple stakeholder perspectives, drawing on counselling session observations (n = 10), in-depth interviews with participants aged 16-24 (n = 39) and clinical staff (n = 13), and notes from debriefings with counsellors. Study process data were also collected (e.g. number of women screened and referred). Following a thematic inductive approach, qualitative data were analysed using qualitative software (NVivo 11). RESULTS Findings show that 31% of young women screened positive for GBV and only 10% requested referrals. Overall, study participants accessing PrEP were amenable to being asked about violence during HIV risk assessment, as this offered the opportunity to find emotional relief and seek help, although a few found this traumatic. In both sites, the sensitive and empathetic approach of the staff helped mitigate distress of GBV disclosure. In general, the delivery of GBV screening in HCT proved to be feasible, provided that the basic principles of confidentiality, staff empathy, and absence of judgment were observed. However, uptake of linkage to further care remained low in both sites. CONCLUSION Most stakeholders found GBV screening acceptable and feasible. Key principles that should be in place for young women to be asked safely about GBV during HIV counselling and testing included respect for confidentiality, a youth-friendly and non-judgmental environment, and a functioning referral network.
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Affiliation(s)
- Manuela Colombini
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Fiona Scorgie
- grid.11951.3d0000 0004 1937 1135Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Anne Stangl
- grid.419324.90000 0004 0508 0388International Center for Research on Women, Washington, DC USA
| | - Sheila Harvey
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Lethabo Ramskin
- grid.11951.3d0000 0004 1937 1135Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Nomhle Khoza
- grid.11951.3d0000 0004 1937 1135Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Emma Mashauri
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Deborah Baron
- grid.11951.3d0000 0004 1937 1135Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
| | - Shelley Lees
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Saidi Kapiga
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
- grid.8991.90000 0004 0425 469XDepartment of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Watts
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Sinead Delany-Moretlwe
- grid.11951.3d0000 0004 1937 1135Wits Reproductive Health Institute, Witwatersrand University, Johannesburg, South Africa
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Medina‐Marino A, Daniels J, Bezuidenhout D, Peters R, Farirai T, Slabbert J, Guloba G, Johnson S, Bekker L, Nkhwashu N. Outcomes from a multimodal, at-scale community-based HIV counselling and testing programme in twelve high HIV burden districts in South Africa. J Int AIDS Soc 2021; 24:e25678. [PMID: 33709542 PMCID: PMC7952633 DOI: 10.1002/jia2.25678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Facility-based HIV testing services (HTS) have been less acceptable and accessible by adolescents, men and key populations in South Africa. Community-based HIV counselling and testing (CBCT) modalities, including mobile unit and home-based testing, have been proposed to decrease barriers to HIV testing uptake. CBCT modalities and approaches may be differentially acceptable to men and women based on age. Implementation of multimodal CBCT services may improve HIV testing rates among adolescents and men, and support the roll-out of prevention services. METHODS A cross-sectional analysis was conducted using aggregate, routine programmatic data collected from 1 October 2015 through 31 March 2017 from a multimodal, at-scale CBCT programme implemented in 12 high-burden districts throughout South Africa. Data collection tools were aligned to reporting standards for the National Department of Health and donor requirements. HIV testing rates (i.e. number of tests performed per 100,000 population using South African census data) and testing proportions by modality were stratified by sex, age groups and heath districts. Descriptive statistics were performed using STATA 13.0. RESULTS Overall, 944,487 tests were performed during the 1.5-year testing period reported. More tests were conducted among females than males (53.6% vs. 46.4%). Overall, 8206 tests per 100,000 population (95% CI: 8190.2 to 8221.9) were performed; female-to-male (F:M) testing ratio was 1.11. Testing rates were highest among young women age 20 to 24 years (16,328.4; 95% CI: 16,237.9 to 16,419.1) and adolescent girls aged 15 to 19 years (12,817.0; 95% CI: 12,727.9 to 12,906.6). Home-based testing accounted for 61.3% of HIV tests, followed by near-home mobile unit testing (30.2%) and workplace mobile unit testing (4.7%). More women received HTS via home-based testing (F:M ratio = 1.29), whereas more men accessed work-place mobile testing (M:F ratio = 1.35). No sex differential was observed among those accessing near-home mobile testing (F:M ratio = 0.98). CONCLUSIONS Concurrent implementation of multiple, targeted CBCT modalities can reduce sex disparities in HIV testing in South Africa. Given the acceptability and accessibility of these CBCT services to adolescent girls and young women, evident from their high testing rates, leveraging community-based services delivery platforms to increase access to HIV prevention services, including pre-exposure prophylaxis (PrEP), should be considered.
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Affiliation(s)
- Andrew Medina‐Marino
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
| | - Joseph Daniels
- Department of Psychiatry and Human BehaviorsCharles R. Drew University of Medicine and ScienceLos AngelesCAUSA
| | - Dana Bezuidenhout
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
| | - Remco Peters
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
| | - Thato Farirai
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Jean Slabbert
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Geoffrey Guloba
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Suzanne Johnson
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Linda‐Gail Bekker
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Nkhensani Nkhwashu
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
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Delabre RM, Bernier A, Sánchez F, Vilotitch A, Chanos S, Cosmaro ML, Langanke H, Mey C, James C, Duken SB, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. "Yes, I'm interested in taking PrEP!": PrEP interest among women respondents to the European community-based survey "Flash! PrEP in Europe". PLoS One 2021; 16:e0246037. [PMID: 33596225 PMCID: PMC7888674 DOI: 10.1371/journal.pone.0246037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection, including women. However, data regarding PrEP interest among women is lacking, particularly in Europe. Factors associated with interest in using PrEP were assessed among women respondents to the Flash! PrEP in Europe (FPIE) survey. This community-based cross-sectional study, conducted in 12 European countries, aimed to assess PrEP knowledge and interest. “High objective risk” (HOR) was assessed using established risk criteria following EACS and CDC guidelines. Factors associated with interest in using PrEP were assessed in univariable and multivariable logistic regression models. Among 678 women, 12.5% (n = 85) were considered at HOR, 46.8% (n = 317) indicated prior PrEP knowledge and 18.0% (n = 122) reported interest in using PrEP. Among women at HOR, 40.0% (n = 34) were interested in PrEP. Factors significantly associated with PrEP interest in the final multivariable model were: younger age (18–29 years) (aOR 1.91[95CI: 1.07; 3.41]), bad self-perceived financial status (1.84[1.09; 3.11]), migrant status (south to north) (2.87[1.05; 7.89]), single or dating relationship status (1.93[1.23; 3.03]), sexual abuse history (1.86[1.17; 2.97]), “rather high”/ “high” self-perceived HIV risk (3.21[1.32; 7.81]), and HOR (2.49[1.42; 4.35]). These results show that women at HOR and those who perceived themselves to be at high risk are interested in using PrEP. There is a critical need for targeted information and improved access to PrEP to increase uptake of this HIV prevention tool to meet PrEP interest among women.
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Affiliation(s)
- Rosemary M. Delabre
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- * E-mail:
| | - Adeline Bernier
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
| | - Flor Sánchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Antoine Vilotitch
- 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
| | | | | | - Harriet Langanke
- GSSG–Gemeinnützige Stiftung Sexualität und Gesundheit, Cologne, Germany
| | | | - Cary James
- Terrence Higgins Trust, London, United Kingdom
| | | | | | | | - Kai J. Jonas
- Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- AIDES, Pantin, France
| | - Daniela Rojas Castro
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
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Meffert SM, Neylan TC, McCulloch CE, Blum K, Cohen CR, Bukusi EA, Verdeli H, Markowitz JC, Kahn JG, Bukusi D, Thirumurthy H, Rota G, Rota R, Oketch G, Opiyo E, Ongeri L. Interpersonal psychotherapy delivered by nonspecialists for depression and posttraumatic stress disorder among Kenyan HIV-positive women affected by gender-based violence: Randomized controlled trial. PLoS Med 2021; 18:e1003468. [PMID: 33428625 PMCID: PMC7799784 DOI: 10.1371/journal.pmed.1003468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND HIV-positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world's majority of HIV-positive women live and prevalence of GBV is high. METHODS AND FINDINGS We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV-positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months. Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03). Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (-6.9 [-12.2, -1.5], p = 0.01), and nonsignificantly reduced work absenteeism (-3.35 [-6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (-2.79 [-5.42, -0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed. CONCLUSIONS IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV-positive women's mental health, functioning, and GBV (IPV) exposure, compared to controls. TRIAL REGISTRATION Clinical Trials Identifier NCT02320799.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - Charles E. McCulloch
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, California, United States of America
| | - Kelly Blum
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, UCSF, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Helen Verdeli
- Teachers College, Columbia University, New York, New York, United States of America
| | - John C. Markowitz
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, and Global Health Economics Consortium, UCSF, San Francisco, California, United States of America
| | - David Bukusi
- Department of Psychiatry, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Ray Rota
- University of Nairobi, Nairobi, Kenya
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Westmoreland DA, Gorbach P, Holloway IW, Arah OA, Javanbakht M. Individual and Partnership Factors Associated with Heterosexual Anal Intercourse Among Attendees of Public Sexually Transmitted Disease Clinics in Los Angeles County. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:347-358. [PMID: 33175271 PMCID: PMC7880871 DOI: 10.1007/s10508-020-01831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 07/25/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
Heterosexual anal intercourse (HAI) is an understudied sexual behavior and poses unique challenges to the prevention of sexually transmitted diseases (STDs). This study aimed to explore individual and partnership characteristics associated with HAI. This study used data collected from 243 young people who attended STD clinics in Los Angeles County between April 2012 and May 2014. Participants reported on sexual behaviors with their last three sexual partners. Hierarchical, mixed effects, repeated-measures analyses were used to assess partner-level (demographic) and individual-level (demographic and behavioral) factors associated with recent (past 6 months) HAI. Thirty-two percent of participants (n = 243) reported HAI with at least one recent sex partner, and 49% reported ever having anal intercourse (AI). After adjusting for demographic characteristics, HAI was more than twice as likely to occur in relationships (n = 503) lasting more than a year compared to relationships lasting less than one month. HAI was also more likely to occur in relationships where intimate partner violence (IPV) was reported either as IPV initiated by the respondent (aOR = 2.18, 95% CI 1.08-4.41) or IPV initiated by the partner (aOR = 2.38, 95% CI 1.27-4.47). Among our participants, a substantial proportion reported HAI in the recent past 6 months and nearly half reported lifetime AI. Notably, our results indicate the importance of relationship contexts for people engaging in HAI and highlight the increased risk of STD/HIV transmission in the context of relationships with intimate partner violence victimization and perpetration.
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Affiliation(s)
- Drew A Westmoreland
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, Room 626, New York, NY, 10027, USA.
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Sharma M, Kariithi E, Kemunto E, Otieno G, Lagat H, Wamuti B, Obongo C, Macharia P, Masyuko S, Bosire R, Mugambi M, Weiner B, Farquhar C. High Acceptability of Assisted Partner Notification Services Among HIV-Positive Females in Kenya: Results From an Ongoing Implementation Study. J Acquir Immune Defic Syndr 2021; 86:56-61. [PMID: 33044322 PMCID: PMC8214933 DOI: 10.1097/qai.0000000000002527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Assisted partner services (aPS) involves notification and HIV testing for sexual partners of persons diagnosed HIV-positive (index clients). Because the impact of aPS is contingent on high acceptance, we assessed characteristics and reasons for nonenrollment among female index clients in an ongoing scale-up project. METHODS We analyzed data from HIV-positive females offered aPS in 31 facilities from May 2018 to August 2019. We compared sociodemographic characteristics by aPS enrollment (accepted, refused, and ineligible) and used multivariate binomial regression to assess associations between demographics and refusal. RESULTS Twenty-four thousand four hundred eighteen females received HIV testing and 1050 (4.3%) tested HIV-positive; 839 females enrolled in aPS (80%), 59 refused (6%), and 152 were ineligible (14%). APS uptake did not differ by age, testing history, or testing type (provider initiated vs. client initiated). Females refusing aPS were more likely to have completed secondary school [adjusted relative risk (aRR) 2.03, 95% confidence interval (CI): 1.13 to 2.82] and be divorced/separated (aRR: 3.09, 95% CI: 1.39 to 6.86) or single (aRR: 2.66, 95% CI: 1.31 to 5.42) compared with married/cohabitating. Reasons for refusing aPS included not feeling emotionally ready (31%) and reporting no sexual partners in past 3 years (22%). Reasons for ineligibility included fear or risk of intimate partner violence (9%), previous HIV diagnosis (9%), or insufficient time for aPS provision (3%). CONCLUSIONS APS has high acceptability among HIV-positive females regardless of age or testing history. More counseling may be needed to increase uptake among females with higher education and those who are separated/single. Follow-up for females not emotionally ready or who had insufficient time for aPS in their clinic visit can improve coverage.
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Affiliation(s)
- Monisha Sharma
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | | | - Beatrice Wamuti
- Department of Global Health, University of Washington, Seattle, USA
| | | | - Paul Macharia
- Ministry of Health-National AIDS and STI Control Program, Nairobi, Kenya
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, USA
- Ministry of Health-National AIDS and STI Control Program, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mary Mugambi
- Ministry of Health-National AIDS and STI Control Program, Nairobi, Kenya
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle USA
- Department of Epidemiology, University of Washington, Seattle USA
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Miller L, Morar N, Kapiga S, Ramjee G, Hayes R. Prevention, Partners, and Power Imbalances: Women's Views on How Male Partners Affected Their Adherence to Vaginal Microbicide Gels During HIV Prevention Trials in Africa. J Acquir Immune Defic Syndr 2020; 85:458-465. [PMID: 33136745 PMCID: PMC7993915 DOI: 10.1097/qai.0000000000002463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low adherence has contributed to disappointing results for trials testing vaginal microbicides for HIV prevention. This study engaged former gel trial participants to understand the reasons behind low adherence and seek suggestions on how to improve products and adherence to microbicides. This analysis examines the impact of participant perceptions of male partners on participant adherence and suggestions on how to address those issues. METHODS Eight focus group discussion workshops were conducted with 46 former microbicide trial participants in South Africa and Tanzania. Participants provided feedback on why women join trials, barriers to using gels and reporting adherence accurately, and how adherence and adherence reporting can be improved. RESULTS Participants reported that male partners can affect women's ability to use gels. For some, the lubricating effects caused relationship conflicts due to suspicion of male partners about infidelity. Needing to provide sex to partners on demand was a barrier to gel use. Participants suggested a gel formulation which was thicker and less noticeable, and explicit male partner engagement to enhance understanding of the purpose of the gels. CONCLUSIONS The imbalance of power in intimate relationships affects the ability of women to use microbicides as directed. To improve adherence to HIV prevention methods within trials and for successful rollout of proven HIV prevention methods in populations, it is important that the complicated dynamics of sex and relationships be taken into greater consideration and that women receive targeted support to navigate product use and communication within the context of these gender dynamics.
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Affiliation(s)
- Lori Miller
- London School of Hygiene and Tropical Medicine, London, United Kingdom;
| | - Neetha Morar
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa;
| | - Saidi Kapiga
- London School of Hygiene and Tropical Medicine, London, United Kingdom;
- Mwanza Intervention Trials Unit, Mwanza, Tanzania; and
| | | | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom;
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Arévalo-Mora L. [Women victims of intimate partner violence in the context of HIV infection in the city of Bogotá. Phase I, 2017]. ACTA ACUST UNITED AC 2020; 21:34-41. [PMID: 33206924 DOI: 10.15446/rsap.v21n1.74119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/22/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To establish the prevalence and characteristics of violence against women living with human immunodeficiency virus infection and to explore factors associated with violence in an HIV care program in the city of Bogotá in 2017. MATERIALS AND METHODS Analytical cross-sectional study design that identified characteristics associated with violence against women living with HIV in the city of Bogotá. RESULTS Of the 223 women surveyed, 33.6% (95%CI 27-40%) experienced intimate partner violence of any type, physical or non-physical, only physical violence 21.9% (95% CI 16-27%), and non-physical violence 31.8% (95% CI 26-38%). Non-physical partner violence was found to be related to being separated or in a consensual union (32.4 and 28.2%, respectively, p=0.000), to a nuclear family composition (42.3% p=0.041), or to 100% economic contribution of the woman in the household (33.8% p=0.001). On the other hand, physical violence is more frequent in separated women (46.9%, p=0.000), in couples with children (89.8%, p=0.042), in single-parent families (49%, p=0.000), in single women (42.9%, p=0.013), and in women who make 100% economic contribution at home (38.8%, p=38.8). CONCLUSIONS The results related to intimate partner violence in these women suggest that screening should be done to detect violence as part of post-HIV counseling, and that violence should be addressed as a routine part of HIV treatment and care to improve the quality of life for women living with HIV.
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Affiliation(s)
- Leonardo Arévalo-Mora
- LA: MD. Especialista en Epidemiología. M. Sc. Salud Sexual y Reproductiva. Centro de Expertos para Atención Integral CEPAIN IPS. Bogotá, Colombia.
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Hershow RB, Bhadra M, Mai NVT, Sripaipan T, Ha TV, Go VF. A Qualitative Study With Women Living With HIV on Perceived Gender Norms and Experiences of Intimate Partner Violence in Northern Vietnam. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:5905-5925. [PMID: 29294869 DOI: 10.1177/0886260517724834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although the prevalence of intimate partner violence (IPV) in Southeast Asia is one of the highest in the world, IPV remains understudied in the region, especially among women living with HIV (WLWH). This study aims to understand how gender and violence norms influence how WLWH interpret and prioritize violence as a health issue. We also explore whether HIV disclosure was seen as a trigger for IPV. We conducted in-depth interviews with 20 WLWH (median age = 35.5 years; range = 28-54 years) in northern Vietnam. Participants were recruited from an outpatient antiretroviral treatment (ART) clinic. Semi-structured interviews were transcribed, translated, and analyzed to identify themes using a gender-focused theoretical framework. Twelve participants reported experiencing IPV by their current or former husbands, most of which occurred before their HIV diagnoses. Only one participant felt her HIV status was a factor for the IPV she experienced; the remaining participants did not explicitly link IPV and HIV. None expressed fear or experience of IPV after disclosing to their husbands. When asked about a woman's role in society, the majority spoke about the responsibility to build family harmony by doing housework, raising children, making a steady income, and being faithful to her husband. Participants viewed marital conflict as the woman's problem to avoid by acting docile or to resolve peacefully by bearing violence quietly. Almost all reported contracting HIV from their husbands. Regardless of whether their children were infected (n = 8) or not (n = 10), participants spoke about being compelled to initiate and adhere to ART to care for their children emotionally and financially. In the context of Vietnamese gender norms, participants expressed low urgency for help-seeking after experiencing IPV and high urgency for help-seeking after being diagnosed with HIV. Multilevel interventions are needed to shift social norms around acceptability of IPV.
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Affiliation(s)
| | | | | | | | - Tran Viet Ha
- The University of North Carolina at Chapel Hill, USA
| | - Vivian F Go
- The University of North Carolina at Chapel Hill, USA
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Yemeke TT, Sikkema KJ, Watt MH, Ciya N, Robertson C, Joska JA. Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:4842-4862. [PMID: 29294819 PMCID: PMC5936676 DOI: 10.1177/0886260517718186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. The goal of this study was to examine the prevalence of traumatic experiences and mental health distress among women in an HIV clinic in Cape Town, South Africa, and to explore the acceptability of routine screening in this setting. Seventy HIV positive women were screened following referral from health care workers in the clinic. Among the participants, 51% reported a history of sexual abuse and 75% reported physical intimate partner violence (physical IPV). Among all participants, 36% met screening criteria for depression; among those with traumatic experiences (n = 57), 70% met screening criteria for posttraumatic stress disorder (PTSD). Compared with reporting no sexual abuse or physical IPV, having experienced both sexual abuse and physical IPV was significantly associated with higher odds of depression, while reporting either sexual abuse or physical IPV individually was not significantly associated with increased odds of depression. Among women reporting sexual abuse, 61% were disclosing their experience for the first time during the screening; 31% of women with physical IPV experience were disclosing for the first time. Overall, 98% of participants thought screening should be routine and extended to all women as part of clinic care. Screening women for sexual abuse and physical IPV may be an important component of ensuring HIV care engagement.
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Larsen A, Kinuthia J, Lagat H, Sila J, Abuna F, Kohler P, John-Stewart G, Pintye J. Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya. Int J STD AIDS 2020; 31:652-664. [PMID: 32538330 DOI: 10.1177/0956462420920423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed prevalence of human immunodeficiency virus (HIV) risk behaviors and depressive symptoms among adolescent girls and young women (AGYW) aged 15-24 years attending four public family planning clinics in Western Kenya from January to June 2019. Moderate-to-severe depression (MSD) was defined as a Center for Epidemiologic Studies Depression Scale (CESD-10) score ≥10. Among 487 AGYW, the median age was 22 years (interquartile range 20-23), and 59 (12%) AGYW reported MSD. MSD was more prevalent among AGYW without a current partner (p = 0.001) and associated with HIV risk factors including partner ≥10 years older, recent transactional sex, forced sex, intimate partner violence, and alcohol use (each p ≤ 0.005). Thirty-four percent of AGYW with MSD had a high HIV risk score corresponding to 5 to 15 incident HIV cases per 100 person-years. Overlapping high prevalence of depression and HIV risk among AGYW underscores the need for integrated mental health and HIV services in family planning clinics.
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Affiliation(s)
- Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, USA.,Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,University of Washington, Department of Medicine, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
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Shirley-Beavan S, Roig A, Burke-Shyne N, Daniels C, Csak R. Women and barriers to harm reduction services: a literature review and initial findings from a qualitative study in Barcelona, Spain. Harm Reduct J 2020; 17:78. [PMID: 33076931 PMCID: PMC7574529 DOI: 10.1186/s12954-020-00429-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that are available suggest that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; and a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life changing and life affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.
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Affiliation(s)
| | - Aura Roig
- Metzineres. Environments of Shelter for Womxn Who Use Drugs Surviving Violence, c/o ICEERS, Carrer de Sepúlveda, 65, Oficina 2, 08015, Barcelona, Spain
| | | | - Colleen Daniels
- Harm Reduction International, 61 Mansell Street, London, E1 8AN, UK
| | - Robert Csak
- Harm Reduction International, 61 Mansell Street, London, E1 8AN, UK
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Hershow RB, Reyes HLM, Ha TV, Chander G, Mai NVT, Sripaipan T, Frangakis C, Dowdy DW, Latkin C, Hutton HE, Pettifor A, Maman S, Go VF. Alcohol use, depressive symptoms, and intimate partner violence perpetration: A longitudinal analysis among men with HIV in northern Vietnam. PLoS One 2020; 15:e0240674. [PMID: 33064780 PMCID: PMC7567346 DOI: 10.1371/journal.pone.0240674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background While the link between alcohol use and male-perpetrated intimate partner violence (IPV) has been well-established, research is needed to test whether psychosocial factors interact with alcohol use to exacerbate IPV perpetration. We tested whether depressive symptoms influenced the strength and/or direction of the alcohol-IPV relationship among men with HIV in Vietnam. Methods This study is a secondary analysis using data from a randomized controlled trial conducted in Thai Nguyen, Vietnam. Participants were clinic patients with HIV and hazardous alcohol use. Questionnaires were administered at baseline, three, six, and 12 months. Alcohol use was assessed as proportion of days alcohol abstinent. Analyses were restricted to males who reported being married/cohabitating at baseline (N = 313). Multilevel growth models were used to test whether time-varying depressive symptoms modified the time-varying effect of alcohol use on IPV perpetration. Results Time-varying depressive symptoms modified the effect of proportion of days alcohol abstinent on IPV perpetration. However, the pattern of effect modification was not as expected, as reporting depressive symptoms weakened the alcohol-IPV relationship. At times when participants screened negative for depressive symptoms, those who reported higher proportion of days alcohol abstinent than usual had significantly lower odds of IPV perpetration (Odds Ratio [OR] = 0.17, 95% Confidence Interval 0.06, 0.45, p = 0.0004). At times when participants screened positive for depressive symptoms, there was no observed effect of alcohol use on IPV perpetration (OR = 4.28, 95% CI 0.80, 22.78, p = 0.09). Conclusion The findings highlight the complex nature of the alcohol-IPV relationship and the need to investigate the intersection between hazardous drinking, mental health, and IPV. Men who concurrently report depressive symptoms and heightened alcohol use may be socially isolated from an intimate partner or experiencing fatigue, leading to less alcohol-related IPV perpetration. Mental health interventions addressing depression and alcohol misuse integrated into HIV services may reduce IPV perpetration.
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Affiliation(s)
- Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - H. Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tran Viet Ha
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Yen Hoa Health Clinic, University of North Carolina Vietnam, Hanoi, Vietnam
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Constantine Frangakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David W. Dowdy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Carl Latkin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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131
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Cork C, White R, Noel P, Bergin N. Randomized Controlled Trials of Interventions Addressing Intimate Partner Violence in Sub-Saharan Africa: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:643-659. [PMID: 29962286 PMCID: PMC7197024 DOI: 10.1177/1524838018784585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) perpetrated by males is the most prevalent form of violence against women across the globe. A systematic review was carried out to identify published randomized controlled trials of interventions aiming to prevent or reduce IPV in Sub-Saharan Africa. Details were sought on the interventions, outcomes, and risk of bias in evaluations. METHODS Articles were identified by searching MEDLINE, Embase, Web of Science, and PsycInfo. The search included terms pertaining to IPV, the research design, and the target geographical region. To be included, studies needed to have assessed the impact of an intervention on reported incidence, prevalence of IPV, or measures of related attitudes and behaviors. Fifteen papers were included in the final review. Risk of bias was evaluated using the Cochrane Library "Risk of Bias" tool. RESULTS Findings suggest that interventions have the potential to reduce IPV-related behaviors and attitudes. Certain types of IPV were more amenable to change than others. Higher levels of efficacy were identified in interventions that had longer follow-up, addressed IPV as a main aim, and occurred at the community level or multiple levels of the social ecology. CONCLUSIONS Findings should be interpreted in light of varying risks of bias. Suggestions are made for future research and practice.
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Affiliation(s)
- Cliodhna Cork
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ross White
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Pia Noel
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Niamh Bergin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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132
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External Factors Associated With Community Cohesion in Women Living With HIV. J Assoc Nurses AIDS Care 2020; 31:137-144. [PMID: 31498166 DOI: 10.1097/jnc.0000000000000123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although community cohesion has been identified as a protective factor associated with positive health outcomes, less is known about factors that increase community cohesion for women living with HIV (WLWH). We examined risk/protective factors associated with community cohesion in WLWH (N = 56) in the US Mid-South (Mage = 41.2 years, SD = 9.01). Participants completed hour-long interviews. Hierarchical linear regression modeling was used to examine factors associated with community cohesion. The final model was significant, F(5, 50) = 6.42, p < .001, adj. R = 33%; greater social support (b = .38, p < .01) and resilience (b = .27, p < .05) were significantly associated with better community cohesion. Given the protective benefits of community connectedness, findings suggest that nurses and community providers work with WLWH to harness friend- and family-support networks. In addition, strategies to enhance access to resilience resources would enable WLWH to recover from adversity.
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133
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Geller RJ, Decker MR, Adedimeji AA, Weber KM, Kassaye S, Taylor TN, Cohen J, Adimora AA, Haddad LB, Fischl M, Cunningham S, Golub ET. A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018. J Womens Health (Larchmt) 2020; 29:1256-1267. [PMID: 32996812 DOI: 10.1089/jwh.2019.7972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.
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Affiliation(s)
- Ruth J Geller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Tonya N Taylor
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sarah Cunningham
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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134
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Trauma-Informed Practices to Address Intersections Between HIV and Intimate Partner Violence Among Women: Perspective of Community Service Providers. J Assoc Nurses AIDS Care 2020; 31:176-189. [PMID: 32058333 DOI: 10.1097/jnc.0000000000000163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current study aimed to document intervention practices, challenges, and training needs concerning the intersections between HIV and intimate partner violence (IPV) among community service providers (n = 12). A direct content analysis using the Trauma-Informed Approach was performed. Results revealed that community service providers need to create a safe, trusting, and mutually collaborative environment in which the intersections between HIV and IPV trauma are recognized, screened, and discussed with women. These results also highlight the need to consolidate partnerships between HIV and IPV organizations to provide relevant services that consider traumatic experiences. Overall, these findings support the urgent need to develop, implement, and evaluate targeted community interventions that jointly address HIV and IPV.
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135
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Gichane MW, Wamoyi J, Atkins K, Balvanz P, Maman S, Majani E, Pettifor A. The influence of cash transfers on engagement in transactional sex and partner choice among adolescent girls and young women in Northwest Tanzania. CULTURE, HEALTH & SEXUALITY 2020; 24:1-15. [PMID: 32935625 DOI: 10.1080/13691058.2020.1811890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
Cash transfers are theorised to reduce adolescent girls and young women's economic vulnerability and engagement in transactional sex; however, the processes involved remain unclear. We conducted longitudinal cross-sectional, and narrative timeline in-depth interviews with young women aged 15-23 years in northern Tanzania enrolled in a cash transfer intervention. We analysed data using a thematic approach guided by the transactional sex framework. We summarised data and compared findings to the domains of the framework. Participants reported relationships in the 'sex and material expression of love' domain characterised by emotional intimacy and loose ties between material support and sex, and the 'sex for basic needs' domain characterised by limited emotional intimacy, economic vulnerability, and a clear exchange between material support and sex. Some participants expressed that cash transfers provided business capital and savings which enabled them to decrease 'sex for basic needs'. Cash transfers influenced transactional sex engagement by altering partner selection criteria such as from an emphasis on what men could provide to a focus on relationship stability. Findings suggest that cash transfers have the potential to reduce young women's transactional relationships motivated by economic vulnerability.
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Affiliation(s)
- Margaret W Gichane
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Kaitlyn Atkins
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter Balvanz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | | | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA
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136
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Agents of change: Comparing HIV-related risk behavior of people attending ART clinics in Dar es Salaam with members of their social networks. PLoS One 2020; 15:e0238240. [PMID: 32886666 PMCID: PMC7473570 DOI: 10.1371/journal.pone.0238240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/12/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of the study is to compare sociodemographic characteristics, psychosocial factors, HIV knowledge and risk behaviors of people living with HIV (PLH) and their social network members (NMs) to inform HIV prevention programs that engage PLH as prevention educators in their communities. We compared baseline characteristics of PLH enrolled in an intervention to become HIV prevention Change Agents (CAs) (n = 458) and 602 NMs they recruited. CAs and NMs responded to questionnaires through a computer-driven interface with Audio Computer-Assisted Self Interview (ACASI) software. Although NMs scored higher on socio-economic status, self-esteem and general self-efficacy, they had lower HIV knowledge (AOR 1.5; 95% CI: 1.1–2.1), greater inconsistent condom use (AOR 3.2; 95% CI: 2.4–4.9), and recent experience as perpetrators of physical (AOR 2.5; 95% CI: 1.2–5.1) or sexual (AOR 4.1; 95% CI: 1.4–12.7) intimate partner violence; and as victims of physical (AOR 1.5; 95% CI: 1.0–2.3) or sexual (AOR 2.2; 95% CI: 1.3–3.8) forms of violence than CAs. Higher HIV knowledge and lower sexual risk behaviors among CAs suggest PLH’s potential as communicators of HIV prevention information to NMs. CAs’ training should also focus on improving self-esteem, general self-efficacy and social support to increase their potential effectiveness as HIV prevention educators and enhance their own overall health and well-being.
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137
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Hershow RB, Ha TV, Sripaipan T, Latkin C, Hutton HE, Chander G, Bui Q, Nguyen VQ, Frangakis C, Go VF. Perpetration of Intimate Partner Violence Among Men Living with HIV in Northern Vietnam. AIDS Behav 2020; 24:2555-2571. [PMID: 32078077 DOI: 10.1007/s10461-020-02813-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We examined the prevalence of intimate partner violence (IPV) perpetration and characteristics of HIV-infected male perpetrators. The cross-sectional study was conducted in Vietnam with male antiretroviral treatment clients (N = 1099; mean age = 40.2 years). Bivariable associations were tested between psychological or physical/sexual IPV perpetration in the last 12 months and sociodemographic, psychosocial, and sexual behavioral factors using prevalence ratios. Factors significant at p < 0.10 were entered in multivariable models for each IPV outcome using a modified Poisson approach. Results showed 15.6% (N = 171/1099) reported perpetrating psychological IPV and 7.6% (N = 84/1099) perpetrating physical/sexual IPV in the last 12 months. HIV risk behaviors, including hazardous drinking and multiple sexual partners, having witnessed interparental violence as a child, and depressive symptoms were associated with perpetrating IPV. HIV interventions targeting HIV-infected men in Vietnam should intervene on IPV perpetration by addressing the co-occurring factors of sexual risk, depression, alcohol use, and child maltreatment that are correlated with IPV.
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Affiliation(s)
- Rebecca B Hershow
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | | | - Teerada Sripaipan
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Constantine Frangakis
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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138
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Severe intimate partner violence is associated with all-cause mortality among women living with HIV. AIDS 2020; 34:1549-1558. [PMID: 32675565 DOI: 10.1097/qad.0000000000002581] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the independent association between intimate partner violence (IPV) severity and all-cause mortality among women living with HIV (WLHIV). DESIGN Cross-sectional questionnaire linked to longitudinal vital statistics data. METHODS We examined the lifetime prevalence of IPV and age-standardized all-cause mortality rates by IPV severity reported by WLHIV. Lifetime IPV (emotional/verbal, physical, or sexual) severity was assessed as a categorical variable: no history of any IPV (none); experienced one or two forms of IPV (moderate); or experienced all three forms of IPV (severe IPV). Two separate logistic regression models examined associations between any IPV (vs. none) as well as IPV severity (none vs. moderate, severe) and all-cause mortality. RESULTS At the time of interview (2007-2010), 260 participants self-identified as women with a median (Q1-Q3) age of 41 years (35-46). Of these women, the majority were unemployed (85%), 59% reported any IPV and 24% reported severe IPV. Of the 252 women followed until 31 December 2017, 25% (n = 63) died. Age-standardized all-cause mortality rates for WLHIV who experienced severe IPV were two-times higher than women with no history of IPV (44.7 per 1000 woman-years vs. 20.9 per 1000 woman-years). After adjustment for confounding, experiences of severe IPV (vs. none) were significantly associated with all-cause mortality (aOR = 2.42, 95% CI = 1.03-5.70). CONCLUSION Although we found that any lifetime experience of IPV was not associated with all-cause mortality, women ever experiencing severe IPV were significantly more likely to die during the study period. This may suggest a need for increased trauma- and violence-aware approaches.
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139
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Ryan NE, El Ayadi AM. A call for a gender-responsive, intersectional approach to address COVID-19. Glob Public Health 2020; 15:1404-1412. [DOI: 10.1080/17441692.2020.1791214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nessa E. Ryan
- Program in Public Health, University of California, Irvine, CA, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Alison M. El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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140
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Hershow RB, Reyes HLM, Ha TV, Chander G, Mai NVT, Sripaipan T, Frangakis C, Dowdy DW, Latkin C, Hutton HE, Pettifor A, Maman S, Go VF. Longitudinal analysis of alcohol use and intimate partner violence perpetration among men with HIV in northern Vietnam. Drug Alcohol Depend 2020; 213:108098. [PMID: 32563847 PMCID: PMC7372834 DOI: 10.1016/j.drugalcdep.2020.108098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol use is a known risk factor for male-perpetrated intimate partner violence (IPV), although few studies have been conducted globally and among men with HIV (MWH). We estimated the longitudinal effects of alcohol use on IPV perpetration among MWH. METHODS This study is a secondary analysis of randomized controlled trial data among male and female antiretroviral treatment patients with hazardous alcohol use in Thai Nguyen, Vietnam. Analyses were restricted to male participants who were married/cohabitating (N = 313). Alcohol use was assessed as proportion days alcohol abstinent, heavy drinking, and alcohol use disorder (AUD) using the Timeline Followback and Mini International Neuropsychiatric Interview questionnaire. Multilevel modeling was used to estimate the effects of higher versus lower average alcohol use on IPV perpetration (between-person effects) and the effects of time-specific deviations in alcohol use on IPV perpetration (within-person effects). RESULTS Participants with higher average proportion days alcohol abstinent had decreased odds of IPV perpetration (adjusted Odds Ratio [aOR] = 0.43, p = 0.03) and those with higher average heavy drinking and AUD had increased odds of IPV perpetration (Heavy drinking: aOR = 1.05, p = 0.002; AUD: aOR = 4.74, p < 0.0001). Time-specific increases in proportion days alcohol abstinent were associated with decreased odds of IPV perpetration (aOR = 0.39, p = 0.02) and time-specific increases in AUD were associated with increased odds of IPV perpetration (aOR = 2.95, p = 0.001). Within-person effects for heavy drinking were non-significant. CONCLUSIONS Alcohol use is associated with IPV perpetration among Vietnamese men with HIV. In this context, AUD and frequent drinking are stronger correlates of IPV perpetration as compared to heavy drinking.
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Affiliation(s)
- Rebecca B Hershow
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - H Luz McNaughton Reyes
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Tran Viet Ha
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Hanoi, Viet Nam
| | - Geetanjali Chander
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Nguyen Vu Tuyet Mai
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Hanoi, Viet Nam
| | - Teerada Sripaipan
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Constantine Frangakis
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - David W Dowdy
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Audrey Pettifor
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Suzanne Maman
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Vivian F Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
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141
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Tsuyuki K, Stockman JK, Knauth D, J Catabay C, He F, Al-Alusi NA, Pilecco FB, Jain S, Barbosa RM. Typologies of violence against women in Brazil: A latent class analysis of how violence and HIV intersect. Glob Public Health 2020; 15:1639-1654. [PMID: 32515274 DOI: 10.1080/17441692.2020.1767675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We address the limited understanding around the overlap between violence and HIV in Brazil. Data was from two clinic-based samples of HIV-positive (n = 1534) and HIV-negative women (n = 1589) in São Paulo and Porto Alegre. We conducted latent class analysis and identified violence typologies by type of violence, life course timing, frequency, and perpetrator, stratified by city and HIV-status. Overall, HIV-positive women experienced more lifetime physical and sexual violence than HIV-negative women. Twelve unique violence latent classes were identified. In São Paulo, HIV-positive women were likely to have endured physical violence several times (Conditional Probability [CP]: 0.80) by an intimate partner (CP: 0.85), and sexual violence several times (CP: 0.46) by an intimate partner (CP: 0.62). In Porto Alegre, HIV-positive women endured physical violence several times (CP: 0.80) by an intimate partner (CP: 0.70) during childhood/adolescence (CP: 0.48), and sexual violence several times (CP: 0.54) by an intimate partner (CP: 0.60). Findings inform interventions to educate around gender equity, violence, and the health effects of violence including HIV, integrate HIV and violence services, and improve the provision of bio-medical HIV prevention among HIV-negative women who experience violence.
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Affiliation(s)
- Kiyomi Tsuyuki
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Daniela Knauth
- Department of Social Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christina J Catabay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Feng He
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Noor A Al-Alusi
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Flavia Bulegon Pilecco
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sonia Jain
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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142
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Leblanc NM, Alexander K, Carter S, Crean H, Ingram L, Kobie J, McMahon J. The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center. ACTA ACUST UNITED AC 2020; 1:132-142. [PMID: 32617533 PMCID: PMC7325490 DOI: 10.1089/whr.2019.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | - Kamila Alexander
- Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Hugh Crean
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | | | - James Kobie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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143
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Abstract
OBJECTIVE Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care. DESIGN Retrospective analysis. METHODS The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI). RESULTS The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78). CONCLUSION We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.
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144
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O'Malley TL, Hawk ME, Egan JE, Krier SE, Burke JG. Intimate Partner Violence and Pre-exposure Prophylaxis (PrEP): A Rapid Review of Current Evidence for Women's HIV Prevention. AIDS Behav 2020; 24:1342-1357. [PMID: 31776819 DOI: 10.1007/s10461-019-02743-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a valued component of HIV prevention and increasing attention is focusing on women's PrEP use. Common HIV prevention options (e.g., condoms) remain underused and fail to consider the context of intimate partner violence (IPV). PrEP presents an opportunity to expand viable options for women. A systematic rapid review using key word searches of PubMed and proceedings from six national and international conferences related to HIV, women's health, or interpersonal violence identified nine studies which met set inclusion criteria. Studies were coded using a structured abstraction form and summarized according to relevant themes. IPV was found to have implications on women's interest and willingness to use PrEP, partner interference or interruptions in PrEP use, and adherence. Findings indicate a dearth of research on women's PrEP use and IPV and highlight the urgency for research, public heath practice, and policy attention around the HIV risk context and needs of women who experience IPV.
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Affiliation(s)
- Teagen L O'Malley
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 3520 Fifth Avenue, Suite 400, Pittsburgh, PA, 15213, USA.
| | - Mary E Hawk
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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145
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Cavanaugh C, Kapij A. A Brief Report on the Association between Dissociation During Sex and Condom Use Self-Efficacy Among Women Residing in Domestic Violence Shelters. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 32:171-176. [PMID: 32788947 PMCID: PMC7416723 DOI: 10.1080/19317611.2020.1749209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Female survivors of intimate partner violence have greater risk for contracting HIV/STI's and experiencing dissociation. However, no studies have examined the association between dissociation and condom use self-efficacy in this population. This study explored whether dissociation during sex was negatively associated with condom use self-efficacy. METHODS Thirty-five women (88% African American) who were residing in domestic violence shelters in the United States completed questionnaires. RESULTS There was a negative correlation between dissociative experiences during sex and condom use self-efficacy, r = -.62, n=35, p< .01. CONCLUSIONS Findings suggest that dissociation during sex interferes with abused women's condom use self-efficacy.
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146
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Trabold N, McMahon J, Alsobrooks S, Whitney S, Mittal M. A Systematic Review of Intimate Partner Violence Interventions: State of the Field and Implications for Practitioners. TRAUMA, VIOLENCE & ABUSE 2020; 21:311-325. [PMID: 29649966 DOI: 10.1177/1524838018767934] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intimate partner violence (IPV) victimization is a global public health issue and has serious consequences of women's health. While scholars and researchers have made some progress in addressing IPV and its impact across different levels of care, there is a paucity of intervention research in this area. For example, we know little about which intervention models work best for particular groups of IPV survivors. Previous reviews have concluded there is insufficient evidence to recommend specific treatment options for victims, but they have also been limited in scope of target populations or have employed narrow eligibility criteria. This systematic review examined the efficacy and effectiveness of interventions for victims of IPV related to physical and mental health and revictimization. Three large databases were searched and articles were selected using specified criteria. Fifty-seven articles met inclusion criteria. Results indicate that both empowerment-based advocacy and cognitively focused clinical interventions demonstrate positive outcomes on the vast sequelae of violence in the context of an intimate relationship. The heterogeneity of intervention approaches and frameworks makes comparisons across studies challenging, but this review demonstrates that interventions focused on problem-solving/solution seeking, enhanced choice making and the alteration in distorted self-thinking and perception are promising in facilitating and maintaining positive physical and mental health changes for women who experience violence.
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Affiliation(s)
- Nicole Trabold
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - James McMahon
- University of Rochester School of Nursing, Rochester, NY, USA
| | | | | | - Mona Mittal
- University of Maryland School of Public Health, College Park, MD, USA
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147
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Gebrekristos LT, Groves AK, McNaughton Reyes L, Maman S, Moodley D. IPV victimization in pregnancy increases postpartum STI incidence among adolescent mothers in Durban, South Africa. AIDS Care 2020; 32:193-197. [PMID: 32193964 DOI: 10.1080/09540121.2020.1742871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Women, and specifically, adolescents, are at high risk of HIV and STIs during the postpartum period. Biological and behavioral factors contribute to adolescents' susceptibility. However, the influence of behavioral factors, like intimate partner violence (IPV), on postpartum STI acquisition has been understudied. The study's purpose is to determine whether IPV victimization during pregnancy predicts incident STIs in the first 6 months postpartum. Adolescent mothers (14-19 years) were recruited at a township hospital's maternity ward near Durban. Adolescent mothers who were HIV-negative and had no laboratory-diagnosed STIs at baseline (6 weeks postpartum) were included in the analysis (n = 61). We used a modified Poisson regression with robust standard errors to assess differences in postpartum STI risk by IPV victimization during pregnancy controlling for covariates. At baseline, 25 (41%) adolescent mothers reported IPV victimization during pregnancy. Adolescent mothers who reported IPV during pregnancy were at higher risk of receiving an STI diagnoses at 6 months postpartum (aRR: 4.43; 95% CI: 1.31-14.97). Our findings heighten understanding of HIV risk among a vulnerable subset of adolescent girls: adolescent mothers. Non-combined interventions that help young mothers and their partners navigate partnership dynamics to reduce IPV and STIs are needed to reduce HIV risk.
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Affiliation(s)
- Luwam T Gebrekristos
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Luz McNaughton Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal Nelson R. Mandela School of Medicine, Durban, South Africa
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148
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Sia D, Nguemeleu Tchouaket É, Hajizadeh M, Karemere H, Onadja Y, Nandi A. The effect of gender inequality on HIV incidence in Sub-Saharan Africa. Public Health 2020; 182:56-63. [PMID: 32179289 DOI: 10.1016/j.puhe.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to quantify the extent to which country-level trends in HIV incidence in Sub-Saharan Africa (SSA) were influenced by gender inequalities, measured by gender gaps in educational attainment, income, and a Gender Inequality Index (GII). STUDY DESIGN We examined the relation between gender inequality and HIV incidence using country-level panel data from 24 SSA countries for the period between 2000 and 2016. METHODS Our goal was to estimate the relation between within-country changes in gender inequality and HIV incidence. We compared results from fixed effects and random effects models for estimating the effect of gender inequalities on changes in HIV incidence. Based on the results of the Hausman test, the fixed effects model was selected as the preferred approach. RESULTS HIV incidence decreased by nearly one-half over the period from 2000 to 2016. We estimated that a one percent increase in the GII was associated with a 1.6 percent increase in HIV incidence (95% confidence interval = [0.21%; 3.00%]), after adjusting by country-level socio-economic and governance variables. CONCLUSIONS Our study suggests that addressing gender inequalities is a potential strategy to reduce HIV incidence in the SSA region. To control HIV infection, policymakers and public health practitioners should support relevant interventions for promoting gender equality. Further work is needed to identify specific interventions to improve gender inequality and to examine their impacts on changes in HIV incidence.
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Affiliation(s)
- D Sia
- Départment des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Canada.
| | - É Nguemeleu Tchouaket
- Départment des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Canada.
| | - M Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - H Karemere
- Department of Public Health, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
| | - Y Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Ouaga 1 Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
| | - A Nandi
- Institute for Health and Social Policy & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada.
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149
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Chow EHY, Tiwari A. Addressing the Needs of Abused Chinese Women Through a Community-Based Participatory Approach. J Nurs Scholarsh 2020; 52:242-249. [PMID: 32154988 DOI: 10.1111/jnu.12546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Intimate partner violence against women is a priority global health issue. It has had serious negative consequences on women's health and has led to huge burdens on the community. Numerous interventions have been demonstrated to have positive effects, and the majority of them have been developed using a top-down approach. However, the specific needs of abused Chinese women have not been fully addressed; incorporating women's input seems to be an essential element for the success of any intervention. This article describes the experiences and success in using a community-based participatory approach (CBPA) to develop a culturally appropriate intervention for abused Chinese women in order to address their multifaceted needs. DESIGN A CBPA was adopted in this study to develop a culturally appropriate intervention in order to address the multifaceted needs of abused Chinese women. METHODS A core group of six participants (three abused Chinese women, one researcher, and two social workers who provided community services for abused Chinese women) was formed in a local community center in Hong Kong. The three Chinese women were recruited from the local community center, and according to the Abuse Assessment Screen they had been in an intimate relationship in the preceding 12 months and had been abused by an intimate partner. FINDINGS Three core group meetings were conducted over 6 weeks for intervention development. An integrated multicomponent intervention was developed, comprising a four-part, women-centered program called "Women-centred, we are with you." The program was implemented and completed over 4 months (October 2015 to January 2016). Eighteen abused Chinese women participated in the intervention. CONCLUSIONS A CBPA provides actual empowerment spirit for abused Chinese women. This approach was well accepted by the women and enabled them to develop more culturally appropriate interventions in fulfilling their specify needs. CLINICAL RELEVANCE Researchers can consider using a CBPA to develop and tailor a culturally appropriate intervention for groups such as abused Chinese women in order to improve their health and eliminate disparities by addressing their specific and multifaceted needs.
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Affiliation(s)
| | - Agnes Tiwari
- Head of School, School of Nursing, Hong Kong Sanatorium & Hospital Limited, Wong Chuk Hang, Hong Kong
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150
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Willie TC, Keene DE, Stockman JK, Alexander KA, Calabrese SK, Kershaw TS. Intimate Partner Violence Influences Women's Engagement in the Early Stages of the HIV Pre-exposure Prophylaxis (PrEP) Care Continuum: Using Doubly Robust Estimation. AIDS Behav 2020; 24:560-567. [PMID: 30915581 DOI: 10.1007/s10461-019-02469-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Intimate partner violence (IPV) is associated with pre-exposure prophylaxis (PrEP) acceptability among US women, but whether IPV influences other steps along the PrEP care continuum remains unclear. This study estimated the causal effects of IPV on the early stages of the PrEP care continuum using doubly robust (DR) estimation (statistical method allowing causal inference in non-randomized studies). Data were collected (2017-2018) from a cohort study of 124 US women without and 94 women with IPV experiences in the past 6 months (N = 218). Of the 218 women, 12.4% were worried about getting HIV, 22.9% knew of PrEP, 32.1% intended to use PrEP, and 40.4% preferred an "invisible" PrEP modality. IPV predicts HIV-related worry (DR estimate = 0.139, SE = 0.049, p = 0.004). IPV causes women to be more concerned about contracting HIV. Women experiencing IPV are worried about HIV, but this population may need trauma-informed approaches to help facilitate their PrEP interest and intentions.
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Affiliation(s)
- Tiara C Willie
- Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Danya E Keene
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kamila A Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Rm 417, Baltimore, MD, 21205, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Trace S Kershaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
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