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Andrawis A, Tapa J, Vlaev I, Read D, Schmidtke KA, Chow EPF, Lee D, Fairley CK, Ong JJ. Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review. Curr HIV/AIDS Rep 2022; 19:358-374. [PMID: 35930186 PMCID: PMC9508055 DOI: 10.1007/s11904-022-00615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This scoping review summarises the literature on HIV prevention and management interventions utilizing behavioural economic principles encapsulated in the MINDSPACE framework. RECENT FINDINGS MINDSPACE is an acronym developed by the UK's behavioural insights team to summarise nine key influences on human behaviour: Messenger, Incentives, Norms, Default, Salience, Priming, Affect, Commitment, and Ego. These effects have been used in various settings to design interventions that encourage positive behaviours. Currently, over 200 institutionalised behavioural insight teams exist internationally, which may draw upon the MINDSPACE framework to inform policy and improve public services. To date, it is not clear how behavioural insights have been applied to HIV prevention and management interventions. After screening 899 studies for eligibility, 124 were included in the final review. We identified examples of interventions that utilised all the MINDSPACE effects in a variety of settings and among various populations. Studies from high-income countries were most common (n = 54) and incentives were the most frequently applied effect (n = 100). The MINDSPACE framework is a useful tool to consider how behavioural science principles can be applied in future HIV prevention and management interventions. Creating nudges to enhance the design of HIV prevention and management interventions can help people make better choices as we strive to end the HIV/AIDS pandemic by 2030.
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Affiliation(s)
- Alexsandra Andrawis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - James Tapa
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ivo Vlaev
- Warwick Business School, Coventry, UK
| | | | | | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- , Carlton, Australia
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Glick JL, Jivapong B, Russo R, Pelaez D, Piser R, Footer K, Sherman SG. Cultivating PEARL (Promoting Empowerment and Risk Reduction): Formative Research for a PrEP Intervention Among Female Sex Workers in Baltimore, Maryland. AIDS Behav 2022; 26:2664-2675. [PMID: 35124751 PMCID: PMC9885761 DOI: 10.1007/s10461-022-03600-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a vital component of comprehensive HIV prevention among female sex workers (FSW). There are limited PrEP interventions targeting FSW in the U.S., who have high HIV risk. Formative research was conducted to inform PEARL (Promoting Empowerment And Risk Reduction), a PrEP intervention for FSW in Baltimore, MD, including a community forum, key informant interviews with providers, and focus group discussions with FSW. FSW and providers acknowledged challenges to building rapport and establishing continuity in care settings. FSW reported low PrEP awareness, with high interest once aware. FSW and providers reported uptake barriers including perceived financial issues, lack of PrEP awareness, and mistrust of the pharmaceutical industry. Concerns were raised about substance use and daily PrEP adherence. Developing a tailored PrEP intervention for FSW necessitates multiple perspectives (e.g. FSW, service providers). Resumen La profilaxis preexposición (PrEP) es un componente vital de la prevención integral del VIH para las trabajadoras sexuales (TSF). En los Estados Unidos, hay pocas intervenciones de PrEP dirigidas a las TSF, quienes experiencian un riesgo elevado de contraer el VIH. Se realizó una investigación formativa para informar a PEARL (Promoción del empoderamiento y la reducción de riesgos), una intervención de PrEP para TSF en Baltimore, MD-la cual incluyó un foro comunitario, entrevistas con proveedores de servicios a las TSF y discusiones entre grupos focales de TSF. TSF y proveedores de servicio reconocieron los retos de mantener buenas relaciones y establecer continuidad en los servicios de salud. TSF exhibieron conocimiento limitado sobre la PrEP, pero expresaron gran interés en la PrEP después de estar informadas. TSF y los proveedores de servicios hablaron de barreras aceptando a la PrEP, incluyendo problemas financieros percibidos, falta de conocimiento sobre la PrEP y desconfianza en la industria farmacéutica. Se expresaron preocupaciones sobre el uso de sustancias y la adherencia diaria a la PrEP. El desarrollo de una intervención de PrEP personalizada para TSF requiere varias perspectivas (por ejemplo, TSF, proveedores de servicios).
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Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Belinda Jivapong
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rienna Russo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rebecca Piser
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Vélez-Grau C, El-Bassel N, McCrimmon T, Chang M, Terlikbayeva A, Primbetova S, Mergenova G, Witte SS. Suicidal ideation among women who engage in sex work and have a history of drug use in Kazakhstan. MENTAL HEALTH & PREVENTION 2021; 23:200208. [PMID: 38031555 PMCID: PMC10686267 DOI: 10.1016/j.mhp.2021.200208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Suicide rates in Kazakhstan rank fourth worldwide. Suicidal ideation is a strong predictor of death by suicide. Yet there is limited information about factors associated with suicidal ideation among women who engage in sex work (WESW) with a history of drug use. Guided by the Diathesis-Stress Theory of Suicide, this study examined the risk and protective factors associated with suicidal ideation among WESW in Kazakhstan. Data drew from the baseline assessments from a sample of four hundred women who participated in a cluster randomized control trial comparing a treatment arm which received a combination of HIV Risk Reduction (HIVRR) and microfinance intervention, and a control arm which received HIVRR alone. Multiple logistic regression models controlling for sociodemographic characteristics examined the effects of risk and protective factors on suicidal ideation. More than half of the participants (52.5%) reported suicidal ideation in the past seven days. Women with vulnerabilities such as child sexual abuse and harmful alcohol use and stressors such as stigma were more likely to think about suicide compared with those who did not. Keeping income from sex work was associated with a lower risk of suicidal ideation. HIV interventions targeting WESW and use drugs must include a mental health component to decrease the risk of suicidal ideation among this group. Women's ability to keep income from sex work suggests the potential to strengthen women's financial stability as a source of empowerment, which may in turn lessen the detrimental effects of childhood adversities and life stressors experienced by WESW.
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Affiliation(s)
- Carolina Vélez-Grau
- Silver School of Social Work, New York University, USA
- McSilver Institute for Poverty Policy and Research, USA 1 Washington Square N, New York, New York 10003, Unites States
| | - Nabila El-Bassel
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Tara McCrimmon
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Mingway Chang
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Sholpan Primbetova
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Gaukhar Mergenova
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Susan S Witte
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
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El‐Bassel N, McCrimmon T, Mergenova G, Chang M, Terlikbayeva A, Primbetova S, Kuskulov A, Baiserkin B, Denebayeva A, Kurmetova K, Witte SS. A cluster-randomized controlled trial of a combination HIV risk reduction and microfinance intervention for female sex workers who use drugs in Kazakhstan. J Int AIDS Soc 2021; 24:e25682. [PMID: 33955170 PMCID: PMC8100396 DOI: 10.1002/jia2.25682] [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] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/19/2020] [Accepted: 02/05/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Female sex workers (FSW) who use drugs are a key population at risk of HIV in Kazakhstan, and face multiple structural barriers to HIV prevention. More research is needed on the role of structural interventions such as microfinance (MF) in reducing HIV risk. This paper describes the results of a cluster-randomized controlled trial to test the efficacy of a combination HIVRR + MF intervention in reducing biologically confirmed STIs and HIV risk behaviours. METHODS This study took place from May 2015 to October 2018 in two cities in Kazakhstan. We screened 763 participants for eligibility and enrolled 354 FSW who use drugs. Participants were randomized in cohorts to receive either a four-session HIVRR intervention, or that same intervention plus 30 additional sessions of financial literacy training, vocational training and asset-building through a matched-savings programme. Repeated behavioural and biological assessments were conducted at baseline, 3-, 6- and 12-months post-intervention. Biological and behavioural primary outcomes included HIV/STI incidence, sexual risk behaviours and drug use risk behaviours, evaluated over the 12-month period. RESULTS Over the 12-month follow-up period, few differences in study outcomes were noted between arms. There was only one newly-detected HIV case, and study arms did not significantly differ on any STI incidence. At post-intervention assessments compared to baseline, both HIVRR and HIVRR + MF participants significantly reduced sexual and drug use risk behaviours, and showed improvements in financial outcomes, condom use attitudes and self-efficacy, social support, and access to medical care. In addition, HIVRR + MF participants showed a 72% greater reduction in the number of unprotected sex acts with paying partners at the six-month assessment (IRR = IRR = 0.28, 95% CI = 0.08, 0.92), and a 10% greater reduction in the proportion of income from sex work at the three-month assessment (b = -0.10, 95% CI = -0.17, -0.02) than HIVRR participants did. HIVRR + MF participants also showed significantly improved performance on financial self-efficacy compared to HIVRR over the 12-month follow-up period. CONCLUSIONS Compared to a combination HIVRR + MF intervention, a robust HIVRR intervention alone may be sufficient to reduce sexual and drug risk behaviours among FSW who use drugs. There may be structural limitations to the promise of microfinance for HIV risk reduction among this population.
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Affiliation(s)
- Nabila El‐Bassel
- Global Health Research Center of Central AsiaColumbia University School of Social WorkNew YorkNYUSA
| | - Tara McCrimmon
- Global Health Research Center of Central AsiaColumbia University School of Social WorkNew YorkNYUSA
| | | | - Mingway Chang
- Global Health Research Center of Central AsiaColumbia University School of Social WorkNew YorkNYUSA
| | | | | | | | - Bauyrzhan Baiserkin
- Kazakh Scientific Center for Dermatology and Infectious DiseasesAlmatyKazakhstan
| | - Alfiya Denebayeva
- Almaty City Center of the Prevention and Control of AIDSAlmatyKazakhstan
| | - Kulpan Kurmetova
- Temirtau BranchKaraganda Oblast Center for the Prevention and Control of AIDSTemirtauKazakhstan
| | - Susan S. Witte
- Global Health Research Center of Central AsiaColumbia University School of Social WorkNew YorkNYUSA
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Artenie AA, Fortier E, Sylvestre MP, Høj SB, Minoyan N, Gauvin L, Jutras-Aswad D, Bruneau J. Socioeconomic stability is associated with lower injection frequency among people with distinct trajectories of injection drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103205. [PMID: 33839598 DOI: 10.1016/j.drugpo.2021.103205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how socioeconomic circumstances relate to injection frequencies among people who inject drugs (PWID) with diverse trajectories of injection. We aimed to characterize trajectories of injection drug use in a community-based sample of PWID over 7.5 years and to investigate the extent to which two modifiable factors reflecting socioeconomic stability-stable housing and stable income-relate to injection frequencies across distinct trajectories. METHODS HEPCO is an open, prospective cohort study of PWID living in Montréal with repeated follow-up at three-month or one-year intervals. Self-reported data on injection frequency, housing and income are collected at each visit. Injection frequency was defined as the number of injection days (0-30), reported for each of the past three months. Using group-based trajectory modeling, we first estimated average trajectories of injection frequency. Then, we estimated the trajectory group-specific average shift upward or downward associated with periods of stable housing and stable income relative to periods when these conditions were unstable. RESULTS Based on 19,527 injection frequency observations accrued by 529 participants followed over 2011-2019 (18.3% female, median age: 41), we identified five trajectories of injection frequency: three characterized by sustained injection at different frequencies (28% infrequent; 19% fluctuating; 19% frequent), one by a gradual decline (12%), and another by cessation (28%). Periods of stable housing and stable income were each independently associated with a lower injection frequency, on average, in all five trajectory groups (2.2-7.5 fewer injection days/month, depending on the factor and trajectory group). CONCLUSION Trajectories of injection drug use frequency were diverse and long-lasting for many PWID. Despite this diversity, socioeconomic stability was consistently associated with a lower injection frequency, emphasizing the close relationship between access to fundamental necessities and injection patterns in all PWID, irrespective of whether they are on a path to cessation or sustained injecting.
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Affiliation(s)
- Andreea Adelina Artenie
- Population Health Sciences, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, UK
| | - Emmanuel Fortier
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Family and Emergency Medicine, Université de Montréal, 2900, Édouard-Montpetit Boulevard, Montréal, Québec H3T 1J4, Canada
| | - Marie-Pierre Sylvestre
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Park Ave, Montréal, Québec H3N 1X9, Canada
| | - Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Park Ave, Montréal, Québec H3N 1X9, Canada
| | - Lise Gauvin
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Park Ave, Montréal, Québec H3N 1X9, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Psychiatry, Université de Montréal, 2900, Édouard-Montpetit Boulevard, Montréal, Québec H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Family and Emergency Medicine, Université de Montréal, 2900, Édouard-Montpetit Boulevard, Montréal, Québec H3T 1J4, Canada.
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Srinivas ML, Ritchwood TD, Zhang TP, Li J, Tucker JD. Social innovation in sexual health: a scoping review towards ending the HIV epidemic. Sex Health 2021; 18:5-12. [PMID: 33632381 DOI: 10.1071/sh20030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022]
Abstract
As donor financial support decreases, ending the HIV epidemic in Asia will require novel and sustainable approaches. Social innovation, a community-engaged process that links social change and health improvement, may be useful for helping to end the HIV epidemic in Asia. A scoping review to examine social innovation strategies in sexual health for the Asian region was conducted. The research identified focused on three types of social innovation: (1) microfinance; (2) social entrepreneurship; and (3) social enterprise. Microfinance provides financial opportunities (e.g. banking services, job opportunities) to spur local entrepreneurship and healthier behaviours. Social entrepreneurship uses business principles and tools (e.g. crowdsourcing, human-centred design) to improve health. Social enterprise is a business with a social mission. Further research is needed to measure the efficacy and cost-effectiveness of social innovation strategies in improving HIV services.
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Affiliation(s)
- Megan L Srinivas
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Bioinformatics, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599, USA; and Corresponding author.
| | - Tiarney D Ritchwood
- Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914, Durham, NC 27710, USA
| | - Tiange P Zhang
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Jingjing Li
- Social Entrepreneurship to Spur Health (SESH), No. 2 Lujing Road, Guangzhou, 510095, China; and University of North Carolina-Project China, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Bioinformatics, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599, USA; and University of North Carolina-Project China, No. 2 Lujing Road, Guangzhou, 510095, China; and International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, 202, LSHTM, 15-17 Tavistock Place, London, WC1E 7HT, UK
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Jennings Mayo-Wilson L, Coleman J, Timbo F, Latkin C, Torres Brown ER, Butler AI, Conserve DF, Glass NE. Acceptability of a feasibility randomized clinical trial of a microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices (EMERGE) in young adults: a mixed methods assessment. BMC Public Health 2020; 20:1846. [PMID: 33267860 PMCID: PMC7709242 DOI: 10.1186/s12889-020-09904-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acceptability is a critical requisite in establishing feasibility when planning a larger effectiveness trial. This study assessed the acceptability of conducting a feasibility randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults, aged 18 to 24, in Baltimore, Maryland. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. METHODS Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19). The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Qualitative and quantitative post-intervention, in-person interviews were used in addition to process documentation of study methods. RESULTS Our results found that the study design and interventions showed promise for being acceptable to economically-vulnerable African-American young adults. The largely positive endorsement suggested that factors contributing to acceptability included perceived economic potential, sexual health education, convenience, incentives, and encouraging, personalized feedback to participants. Barriers to acceptability for some participants included low cell phone connectivity, perceived payment delays, small cohort size, and disappointment with one's randomization assignment to comparison group. Use of peer referral, network, or wait-list designs, in addition to online options may enhance acceptability in a future definitive trial. Expanding administrative and mentoring support may improve overall experience. CONCLUSION Microenterprise interventions are acceptable ways of providing young adults with important financial and sexual health content to address HIV risks associated with economic vulnerability. TRIAL REGISTRATION ClinicalTrials.gov. NCT03766165 . Registered 04 December 2018.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405 USA
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Jessica Coleman
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fatmata Timbo
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Carl Latkin
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Elizabeth R. Torres Brown
- HEBCAC Youth Opportunity (YO!) Program, Johns Hopkins University School of Medicine, 1212 N. Wolfe Street, Baltimore, MD USA
| | - Anthony I. Butler
- AIRS, Inc., Empire Homes of Maryland, Inc., City Steps, 1800 N Charles Street, 7th Floor, Baltimore, MD USA
| | - Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Green Street, Columbia, SC 29208 USA
| | - Nancy E. Glass
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe Street, Baltimore, MD USA
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD USA
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Desai S, Misra M, Das A, Singh RJ, Sehgal M, Gram L, Kumar N, Prost A. Community interventions with women's groups to improve women's and children's health in India: a mixed-methods systematic review of effects, enablers and barriers. BMJ Glob Health 2020; 5:e003304. [PMID: 33328199 PMCID: PMC7745316 DOI: 10.1136/bmjgh-2020-003304] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION India is home to over 6 million women's groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women's and children's health. METHODS We did a mixed-methods systematic review of quantitative and qualitative studies on women's groups in India to examine effects on women and children's health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women's group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics. FINDINGS We screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women's groups can improve perinatal practices, neonatal survival, immunisation rates and women's and children's dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities' capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints. CONCLUSION Interventions with women's groups can improve women's and children's health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities' capabilities. TRIAL REGISTRATION NUMBER The review was registered with PROSPERO: CRD42019130633.
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Affiliation(s)
- Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | | | | | | | | | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Neha Kumar
- International Food Policy Research Institute, Washington, DC, USA
| | - Audrey Prost
- University College London Institute of Child Health, London, UK
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Jennings Mayo-Wilson L, Coleman J, Timbo F, Ssewamala FM, Linnemayr S, Yi GT, Kang BA, Johnson MW, Yenokyan G, Dodge B, Glass NE. Microenterprise Intervention to Reduce Sexual Risk Behaviors and Increase Employment and HIV Preventive Practices Among Economically-Vulnerable African-American Young Adults (EMERGE): A Feasibility Randomized Clinical Trial. AIDS Behav 2020; 24:3545-3561. [PMID: 32494942 PMCID: PMC7667139 DOI: 10.1007/s10461-020-02931-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement.Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Science, 1025 E. 7th Street, Bloomington, IN USA
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Jessica Coleman
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fatmata Timbo
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fred M. Ssewamala
- The Brown School, Washington University in St. Louis, Goldfarb, One Brookings, Drive, St. Louis, MO USA
| | | | - Grace T. Yi
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Bee-Ah Kang
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Matthew W. Johnson
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5510 Nathan Shock Drive, Baltimore, MD USA
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe Street, Baltimore, MD USA
| | - Brian Dodge
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Nancy E. Glass
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD USA
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Quaife M, Lépine A, Deering K, Terris-Prestholt F, Beattie T, Isac S, Paranjape RS, Vickerman P. The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India. Health Policy Plan 2020; 34:784-791. [PMID: 31603470 PMCID: PMC6913694 DOI: 10.1093/heapol/czz100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/26/2022] Open
Abstract
There is some evidence that female sex workers (FSWs) receive greater earnings for providing unprotected sex. In 2003, the landscape of the fight against HIV/AIDS dramatically changed in India with the introduction of Avahan, the largest HIV prevention programme implemented globally. Using a unique, cross-sectional bio-behavioural dataset from 3591 FSWs located in the four Indian states where Avahan was implemented, we estimate the economic loss faced by FSWs who always use condoms. We estimate the causal effect of condom use on the price charged during the last paid sexual intercourse using the random targeting of Avahan as an instrumental variable. Results indicate that FSWs who always use condoms face an income loss of 65% (INR125, US$2.60) per sex act compared to peers providing unprotected sex, consistent with our expectations. The main finding confirms that clients have a preference for unprotected sex and that policies aiming at changing clients’ preferences and at improving the bargaining power of FSWs are required to limit the spread of HIV.
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Affiliation(s)
- Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurélia Lépine
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Deering
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Shajy Isac
- Monitoring and Evaluation, Research and Special Studies, Karnataka Health Promotion Trust, Rajajinagar, Bangalore, India.,Department of Community Health Sciences, Center for Global Public Health, University of Manitoba, Canada
| | | | - Peter Vickerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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Fonner VA, Mbwambo J, Kennedy CE, Kerrigan D, Sweat MD. Do Sexual Partners Talk to Each Other About HIV? Exploring Factors Associated with HIV-Related Partner Communication Among Men and Women in Tanzania. AIDS Behav 2020; 24:891-902. [PMID: 31165394 DOI: 10.1007/s10461-019-02550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Communication between sexual partners is an important component of HIV prevention and occurs within a broader context of socio-culturally defined gender norms and dynamics. We analyzed cross-sectional data from a community-based random sample of men and women living in Kisarawe, Tanzania to understand factors related to partner communication about HIV. Bivariate and multivariate logistic regression analyses, disaggregated by gender, included variables at the individual-, relational-, and community-levels. Individuals who knew their HIV-positive status prior to the study were excluded as the focus was on risk communication, not HIV status disclosure. Of 524 participants, 129 women (43.3%) and 96 men (42.5%) reported HIV-related communication with their most recent sexual partner. For women but not men, individual-level socioeconomic factors-including education, possession of a household radio, and employment-and relational-level factors-including partner age and type-were significantly associated with partner communication. At the community level, being socially engaged was positively correlated with partner communication across genders (aOR = 2.02, 95% CI 1.05-3.89, p = 0.03 for men and aOR = 1.74, 95% CI 1.03-2.95, p = 0.04 for women). For women, having less discriminatory attitudes toward people living with HIV and favorable perceived norms of HIV-related communication were significantly associated with partner communication. For men, agreeing that women should be allowed to work outside the home was significantly correlated with partner communication (aOR = 6.02, 95% CI 2.23-16.24, p < 0.001). Findings suggest a link between gender dynamics and partner communication, with individual and relational factors being associated with communication for women and community-level factors being associated with communication for both genders.
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Patel SK, Mukherjee S, Mahapatra B, Battala M, Jayaram M, Kumta S, Atmavilas Y, Saggurti N. Enhancing financial security of female sex workers through a community-led intervention in India: Evidence from a longitudinal survey. PLoS One 2019; 14:e0223961. [PMID: 31639161 PMCID: PMC6804955 DOI: 10.1371/journal.pone.0223961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction Community-led organizations (COs) have been an integral part of HIV prevention programs to address the socio-economic and structural vulnerabilities faced by female sex workers (FSWs). The current study examines whether strengthening of community-led organizations and community collectivization have been instrumental in reducing the financial vulnerability and empowering FSWs in terms of their self-efficacy, confidence, and individual agency in India. Data and methods This study used a panel data of 2085 FSWs selected from 38 COs across five states of India. Two rounds of data (Round 1 in 2015 and Round 2 in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security, community collectivization, and individual empowerment. Results There was a significant improvement in CO strength and community collectivization from Round 1 to Round 2. High CO strength has led to improved financial security among FSWs (R2: 85% vs. R1: 51%, AOR: 2.5; 95% CI: 1.5–4.1) from Round 1 to Round 2. High collective efficacy and community ownership have improved the financial security of FSWs during the inter-survey period. Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy, and individual agency) among FSWs. Conclusions Institutional strengthening and community mobilization programs are key to address the structural issues and the decrease of financial vulnerability among FSWs. In addition, enhanced financial security is very important to sustain or improve the individual empowerment of FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment.
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Affiliation(s)
| | | | | | | | | | - Sameer Kumta
- Bill & Melinda Gates Foundation, New Delhi, India
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Walcott M, Kempf MC, Merlin JS, Nunn A, Turan JM. Perceived Value of Microenterprise for Low-Income Women Living with HIV in Alabama. AIDS Behav 2019; 23:276-286. [PMID: 31586283 DOI: 10.1007/s10461-019-02656-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We characterized the potential benefits and risks of participating in a microenterprise program targeting low-income women living with HIV (WLWH) in Alabama; and described potential mechanisms through which microenterprise programs could influence sexual risk behaviors and engagement in HIV care. Fourteen stakeholders and 46 WLWH (89% African American) participated in the qualitative study. Data were collected using in-depth interviews (stakeholders) and focus group discussions (WLWH). NVivo qualitative software was used for the management and analysis of the data. The data revealed four main mechanisms through which microenterprise programs could potentially improve health outcomes: (1) social support and encouragement from other women, (2) improvement in self-esteem, (3) creating structure in the women's lives, and (4) financial strengthening. Potential risks included unwanted disclosure of HV status, stigma and loss of insurance benefits. Microenterprise programs have the potential to be acceptable and may contribute to improved health and social outcomes among low-income WLWH in Alabama.
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Affiliation(s)
- Melonie Walcott
- Department of Public Health, Hartwick College, 1 Hartwick Dr., Oneonta, NY, 13820, USA.
| | - Mirjam-Colette Kempf
- School of Nursing, Public Health and Medicine, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL, 35294-1210, USA
| | - Jessica S Merlin
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Amy Nunn
- Brown University and the Rhode Island Public Health Institute, Brown University, Providence, RI, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
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Ssewamala FM, Sensoy Bahar O, Tozan Y, Nabunya P, Mayo-Wilson LJ, Kiyingi J, Kagaayi J, Bellamy S, McKay MM, Witte SS. A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial. BMC Womens Health 2019; 19:111. [PMID: 31419968 PMCID: PMC6697981 DOI: 10.1186/s12905-019-0807-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda. METHODS This three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences. DISCUSSION When WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention's efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT03583541 .
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Affiliation(s)
- Fred M Ssewamala
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Yesim Tozan
- College of Global Public Health, New York University, New York City, NY, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | | | - Joshua Kiyingi
- International Center for Child Health and Development, Masaka, Uganda
| | | | | | - Mary M McKay
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Susan S Witte
- Columbia University School of Social Work, New York City, NY, USA
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15
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Mayo-Wilson LJ, Glass NE, Ssewamala FM, Linnemayr S, Coleman J, Timbo F, Johnson MW, Davoust M, Labrique A, Yenokyan G, Dodge B, Latkin C. Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial. Trials 2019; 20:439. [PMID: 31315685 PMCID: PMC6637550 DOI: 10.1186/s13063-019-3529-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages (“nudges”) that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. Methods/design In total, 40 young adults who are African-American, aged 18–24, live in Baltimore City, have experienced at least one episode of homelessness in the last 12 months, are unemployed or underemployed (fewer than 10 h per week), are not enrolled in school, own a cell phone with text messaging, and report at least one episode of unprotected or unsafe sex in the prior 12 months will be recruited from two community-based organizations providing residential supportive services to urban youth. Participants will undergo a 3-week run-in period and thereafter be randomly assigned to one of two groups with active interventions for 20 weeks. The first group (“comparison”) will receive text messages with information on job openings. The second group (“experimental”) will receive text messages with information on job openings plus information on HIV prevention and business educational sessions, a mentored apprenticeship, and a start-up grant, and business and HIV prevention text messages based on principles from behavioral economics. The two primary outcomes relate to the feasibility of conducting a larger trial. Secondary outcomes relate to employment, sexual risk behaviors, and HIV preventive practices. All participants will be assessed using an in-person questionnaire at pre-intervention (prior to randomization) and at 3 weeks post-intervention. To obtain repeated, longitudinal measures, participants will be assessed weekly using text message surveys from pre-intervention up to 3 weeks post-intervention. Discussion This study will be one of the first U.S.-based feasibility randomized clinical trials of an HIV prevention microenterprise intervention for economically-vulnerable African-American young adults. The findings will inform whether and how to conduct a larger efficacy trial for HIV risk reduction in this population. Trial registration ClinicalTrials.gov, NCT03766165. Registered on 4 December 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3529-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA. .,Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, USA.
| | - Nancy E Glass
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD, USA
| | - Fred M Ssewamala
- Washington University in St. Louis, The Brown School, Goldfarb, One Brookings, Drive, St. Louis, MO, USA
| | | | - Jessica Coleman
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Fatmata Timbo
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Matthew W Johnson
- Behavioral Pharmacology Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, USA
| | - Melissa Davoust
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Alain Labrique
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Brian Dodge
- Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 737, Baltimore, MD, USA
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Duvendack M, Mader P. Impact of financial inclusion in low- and middle-income countries: A systematic review of reviews. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1012. [PMID: 37131469 PMCID: PMC8356488 DOI: 10.4073/csr.2019.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Maren Duvendack
- School of International DevelopmentUniversity of East AngliaNorwichNR4 7TJUK
| | - Philip Mader
- Institute of Development StudiesUniversity of SussexBrightonEast SussexBN19REUK
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Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan. AIDS Behav 2019; 23:1-14. [PMID: 30194502 DOI: 10.1007/s10461-018-2268-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.
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Coupland H, Page K, Stein E, Carrico A, Evans J, Dixon T, Sokunny M, Phou M, Maher L. Structural interventions and social suffering: Responding to amphetamine-type stimulant use among female entertainment and sex workers in Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 64:70-78. [PMID: 30583088 DOI: 10.1016/j.drugpo.2018.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination. METHODS Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory. RESULTS In addition to increasing occupational functionality, ATS were used to control pervasive feelings of 'sadness' in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use. CONCLUSION In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
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Affiliation(s)
- Heidi Coupland
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; Drug Health Services, Sydney Local Health District & Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Centre, Albuquerque, NM, USA.
| | - Ellen Stein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, Florida, USA.
| | - Jennifer Evans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Thomas Dixon
- Faculty of Law, The University of Sydney, Sydney, Australia.
| | | | - Maly Phou
- FHI360 Cambodia, Phnom Penh, Cambodia.
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; The Burnet Institute, Melbourne, Australia.
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Microfinance for women at high risk for HIV in Kazakhstan: study protocol for a cluster-randomized controlled trial. Trials 2018; 19:187. [PMID: 29558982 PMCID: PMC5859522 DOI: 10.1186/s13063-018-2566-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Among women at high risk for HIV and other sexually transmitted diseases (STIs), gender and economic issues limit the impact of behavioral prevention strategies. Women in Kazakhstan with dual risks of sex trading and drug use face elevated risk for HIV and STIs and may benefit from an economic empowerment intervention which combines HIV-risk reduction (HIVRR) education with financial skills-building and asset-building to promote reduced reliance on sex trading for income. METHODS/DESIGN The study employs a two-arm, cluster-randomized controlled trial (c-RCT) design. We will use cluster randomization to assign 350 women in approximately 50 cohorts to a traditional four-session HIV-risk-reduction intervention combined with a six-session financial literacy intervention, enrollment in a 24-session vocational training program and receipt of matched savings (HIVRR+MF); or to the four-session HIV-risk-reduction intervention alone (HIVRR). Repeated behavioral and biological assessments will be conducted at baseline, then at 6, 9, and 15 months post randomization/session 1. DISCUSSION This study responds to an identified need in the academic literature for rigorous testing of structural interventions, including combination microfinance and HIV-prevention interventions. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02406482 . Registered on 30 March 2015.
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Acceptability of a microfinance-based empowerment intervention for transgender and cisgender women sex workers in Greater Kuala Lumpur, Malaysia. J Int AIDS Soc 2017; 20:21723. [PMID: 28782331 PMCID: PMC5577685 DOI: 10.7448/ias.20.1.21723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cisgender and transgender woman sex workers (CWSWs and TWSWs, respectively) are key populations in Malaysia with higher HIV-prevalence than that of the general population. Given the impact economic instability can have on HIV transmission in these populations, novel HIV prevention interventions that reduce poverty may reduce HIV incidence and improve linkage and retention to care for those already living with HIV. We examine the feasibility of a microfinance-based HIV prevention intervention among CWSW and TWSWs in Greater Kuala Lumpur, Malaysia. Methods: We conducted 35 in-depth interviews to examine the acceptability of a microfinance-based HIV prevention intervention, focusing on: (1) participants’ readiness to engage in other occupations and the types of jobs in which they were interested in; (2) their level of interest in the components of the potential intervention, including training on financial literacy and vocational education; and (3) possible barriers and facilitators to the successful completion of the intervention. Using grounded theory as a framework of analysis, transcripts were analysed through Nvivo 11. Results: Participants were on average 41 years old, slightly less than half (48%) were married, and more than half (52%) identified as Muslim. Participants express high motivation to seek employment in other professions as they perceived sex work as not a “proper job” with opportunities for career growth but rather as a short-term option offering an unstable form of income. Participants wanted to develop their own small enterprise. Most participants expressed a high level of interest in microfinance intervention and training to enable them to enter a new profession. Possible barriers to intervention participation included time, stigma, and a lack of resources. Conclusion: Findings indicate that a microfinance intervention is acceptable and desirable for CWSWs and TWSWs in urban Malaysian contexts as participants reported that they were ready to engage in alternative forms of income generation.
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Offringa R, Tsai LC, Aira T, Riedel M, Witte SS. Personal and Financial Risk Typologies Among Women Who Engage in Sex Work in Mongolia: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1857-1866. [PMID: 27473070 PMCID: PMC5276798 DOI: 10.1007/s10508-016-0824-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 04/12/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
Women engaged in sex work bear a disproportionate burden of HIV infection worldwide, particularly in low- to middle-income countries. Stakeholders interested in promoting prevention and treatment programs are challenged to efficiently and effectively target heterogeneous groups of women. This problem is particularly difficult because it is nearly impossible to know how those groups are composed a priori. Although grouping based on individual variables (e.g., age or place of solicitation) can describe a sample of women engaged in sex work, selecting these variables requires a strong intuitive understanding of the population. Furthermore, this approach is difficult to quantify and has the potential to reinforce preconceived notions, rather than generate new information. We aimed to investigate groupings of women engaged in sex work. The data were collected from a sample of 204 women who were referred to an HIV prevention intervention in Ulaanbaatar, Mongolia. Latent class analysis was used to create subgroups of women engaged in sex work, based on personal and financial risk factors. This analysis found three latent classes, representing unique response pattern profiles of personal and financial risk. The current study approached typology research in a novel, more empirical way and provided a description of different subgroups, which may respond differently to HIV risk interventions.
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Affiliation(s)
- Reid Offringa
- Columbia University School of Social Work, New York, NY, USA
| | - Laura Cordisco Tsai
- Department of Social Work, George Mason University, 10340 Democracy Lane, Fairfax, VA, 22030, USA.
| | | | - Marion Riedel
- Columbia University School of Social Work, New York, NY, USA
| | - Susan S Witte
- Columbia University School of Social Work, New York, NY, USA
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Zakaras JM, Weiser SD, Hatcher AM, Weke E, Burger RL, Cohen CR, Bukusi EA, Dworkin SL. A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1121-1133. [PMID: 27507020 PMCID: PMC5299074 DOI: 10.1007/s10508-016-0828-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/01/2016] [Accepted: 07/28/2016] [Indexed: 06/02/2023]
Abstract
Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya. In the current study, we drew upon longitudinal, in-depth interviews with 45 intervention participants and nine control participants (N = 54) in order to examine the impacts of the intervention on gendered power and sexual risk reduction among both women and men. Female and male participants in the intervention described positive changes in sexual practices and gendered power dynamics as a result of intervention participation. Changes included reduced sexual risk behaviors, improved gender-related power dynamics, and enhanced quality of intimate relationships. These findings illuminate how a multisectoral agricultural intervention may affect inequitable gender relations and secondary transmission risk. Further research is needed to explore how to best leverage agricultural interventions to address the important intersections between poverty and inequitable gender relations that shape HIV risks.
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Affiliation(s)
- Jennifer M Zakaras
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Abigail M Hatcher
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Shari L Dworkin
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA.
- UCSF School of Nursing, 3333 California Street, LHTS #455, San Francisco, CA, 94118, USA.
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Gibbs A, Jacobson J, Kerr Wilson A. A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours. Glob Health Action 2017; 10:1290427. [PMID: 28467193 PMCID: PMC5645712 DOI: 10.1080/16549716.2017.1290427] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/31/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) and HIV are co-occurring global epidemics, with similar root causes of gender and economic inequalities. Economic interventions have become a central approach to preventing IPV and HIV. OBJECTIVE/METHODS We undertook a comprehensive scoping review of published evaluations of economic interventions that sought to prevent IPV and/or HIV risk behaviours. RESULTS Forty-five separate analyses of interventions met our criteria. Broadly, unconditional cash transfer interventions showed either flat or positive outcomes; economic strengthening interventions had mixed outcomes, with some negative, flat and positive results reported; interventions combining economic strengthening and gender transformative interventions tended to have positive outcomes. CONCLUSIONS The review highlighted a number of gaps. Specifically, there were limited studies evaluating the impact of economic interventions on female sex workers, young women, and men. In addition, there were missed opportunities, with many evaluations only reporting either IPV- or HIV-related outcomes, rather than both, despite overlaps.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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Tsai LC, Carlson CE, Aira T, Norcini Pala A, Riedel M, Witte SS. The impact of a microsavings intervention on reducing violence against women engaged in sex work: a randomized controlled study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:27. [PMID: 27793147 PMCID: PMC5086041 DOI: 10.1186/s12914-016-0101-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/15/2016] [Indexed: 11/10/2022]
Abstract
Background Women who engage in sex work are at risk for experiencing violence from numerous perpetrators, including paying partners. Empirical evidence has shown mixed results regarding the impact of participation in microfinance interventions on women’s experiences of violence, with some studies demonstrating reductions in intimate partner violence (IPV) and others showing heightened risk for IPV. The current study reports on the impact of participation in a microsavings intervention on experiences of paying partner violence among women engaged in sex work in Mongolia. Methods Between 2011 and 2013, we conducted a two-arm, non-blinded randomized controlled trial (RCT) comparing an HIV/STI risk reduction intervention (HIVSRR) (control condition) to a combined microsavings and HIVSRR intervention (treatment condition). Eligible women (aged 18 or older, reported having engaged in unprotected sex with paying partner in past 90 days, expressed interest in microsavings intervention) were invited to participate. One hundred seven were randomized, including 50 in the control and 57 in the treatment condition. Participants completed assessments at baseline, immediate post-test following HIVSRR, and at 3-months and 6-months after completion of the treatment group intervention. Outcomes for the current study include any violence (physical and/or sexual), sexual violence, and physical violence from paying partners in the past 90 days. Results An intention-to-treat approach was utilized. Linear growth models revealed significant reductions over time in both conditions for any violence (β = −0.867, p < 0.001), physical violence (β = −0.0923, p < 0.001), and sexual violence (β = −1.639, p = 0.001) from paying partners. No significant differences between groups were found for any violence (β = 0.118, p = 0.389), physical violence (β = 0.091, p = 0.792), or sexual violence (β = 0.379, p = 0.114) from paying partners. Conclusions Microsavings participation did not significantly impact women’s risk for paying partner violence. Qualitative research is recommended to understand the cause for reductions in paying partner violence in both study conditions. Trial registration Evaluating a Microfinance Intervention for High Risk Women in Mongolia; NCT01861431; May 20, 2013.
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Affiliation(s)
- Laura Cordisco Tsai
- George Mason University College of Health and Human Services, MSN 1F8, Fairfax, VA, 22030, USA. .,Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Catherine E Carlson
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Toivgoo Aira
- Wellspring NGO, Zorig Foundation Building, Peace Avenue 9A, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Andrea Norcini Pala
- Columbia University, HIV Center for Clinical Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, 10032, USA
| | - Marion Riedel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Susan S Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
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Surratt HL, O'Grady CL, Kurtz SP, Buttram ME, Levi-Minzi MA. HIV testing and engagement in care among highly vulnerable female sex workers: implications for treatment as prevention models. J Health Care Poor Underserved 2016; 25:1360-78. [PMID: 25130245 DOI: 10.1353/hpu.2014.0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although emerging Treatment as Prevention models can be effective in reducing HIV incidence among high-risk populations, many HIV infected individuals remain undiagnosed or fail to engage in HIV care. METHODS This study examined the factors associated with HIV testing and care among a population of substance using female sex workers. RESULTS Recent HIV testing was associated with higher education level, having a regular health care provider or clinic, recent crack use, and higher sexual risk behaviors; HIV treatment utilization was associated with higher levels of social support, having a regular health care provider or clinic, housing stability and insurance coverage. Qualitative data revealed HIV-related stigma, denial, social isolation, and substance use as barriers to HIV testing and treatment; social support and accessibility of services were key enablers. CONCLUSIONS Improving HIV testing and linkage to treatment among female sex workers will require structural initiatives to reduce stigma and increase service seeking support.
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O'Malley TL, Burke JG. A systematic review of microfinance and women's health literature: Directions for future research. Glob Public Health 2016; 12:1433-1460. [PMID: 27080539 DOI: 10.1080/17441692.2016.1170181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While growing evidence suggests that microfinance is an effective approach for improved women's health, a significant gap remains in our understanding. The objective of this review is to synthesise the findings from published literature focused on microfinance and health issues particularly affecting women, including HIV/AIDS, reproductive health, mental health, and violence. Forty-one articles that examine the impact of microfinance participation on women's health were identified through a systematic search of electronic databases, coded using a structured abstraction form, and synthesised. Review results indicate that the impact of microfinance on women's health is an area in great need of research and publication attention. Varied quality and reporting in the identified articles restricted the ability to draw concrete conclusions regarding the relationship between microfinance participation and women's health, but led to the identification of current gaps in existing published research. Future research should work to address the recommendations provided in order to offer additional evidence to better understand the use of microfinance programming as a structural intervention to improve women's health.
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Affiliation(s)
- T L O'Malley
- a Department of Behavioral and Community Health Sciences, Graduate School of Public Heath , University of Pittsburgh , Pittsburgh , PA , USA
| | - J G Burke
- a Department of Behavioral and Community Health Sciences, Graduate School of Public Heath , University of Pittsburgh , Pittsburgh , PA , USA
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Parcesepe AM, L Engle KL, Martin SL, Green S, Sinkele W, Suchindran C, Speizer IS, Mwarogo P, Kingola N. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial. Drug Alcohol Depend 2016; 161:21-8. [PMID: 26872880 PMCID: PMC4936780 DOI: 10.1016/j.drugalcdep.2015.12.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. DESIGN Randomized controlled trial. SETTING HIV prevention drop-in centers in Mombasa, Kenya. PARTICIPANTS 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). INTERVENTION 6 session alcohol harm reduction intervention. COMPARATOR 6 session non-alcohol related nutrition intervention. MEASUREMENTS In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. FINDINGS The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. CONCLUSIONS The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.
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Affiliation(s)
- Angela M Parcesepe
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States.
| | - Kelly L L Engle
- FHI 360, 359 Blackwell St., Durham, NC 27701, United States; Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, United States
| | - Sandra L Martin
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Sherri Green
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), PO Box 21761 Ngong Road, 00505 Nairobi, Kenya
| | - Chirayath Suchindran
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Rosenau Hall, Chapel Hill, NC, United States
| | - Ilene S Speizer
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Peter Mwarogo
- FHI 360, The Chancery 2nd and 3rd Floor Valley Road, PO Box 38835-00623, Nairobi, Kenya
| | - Nzioki Kingola
- International Center for Reproductive Health, PO Box 91109, Mombasa, Kenya
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Sileo KM, Kintu M, Chanes-Mora P, Kiene SM. "Such Behaviors Are Not in My Home Village, I Got Them Here": A Qualitative Study of the Influence of Contextual Factors on Alcohol and HIV Risk Behaviors in a Fishing Community on Lake Victoria, Uganda. AIDS Behav 2016; 20:537-47. [PMID: 25921303 PMCID: PMC4626436 DOI: 10.1007/s10461-015-1077-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In Uganda, elevated HIV prevalence in fishing communities along Lake Victoria have been attributed in part to heavy alcohol use, but qualitative research is needed to understand the contextual factors influencing alcohol and sexual risk. Eight focus group discussions were conducted (n = 50; 23 male, 27 female) in Gerenge, Uganda with five occupational groups: fishermen, fishmongers, alcohol-sellers, commercial sex workers, and restaurant owners. Data was analyzed using content analysis. Alcohol use was prevalent and said to influence risky sex. Sex-related alcohol expectancies and occupational factors influenced individuals to drink during sex and structural factors related to the built environment, economy, and policy were identified as key contributors to both alcohol use and sexual risk in general. The findings highlight alcohol reduction as an important component of HIV/AIDS prevention and suggest structural interventions should be prioritized in this context.
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Affiliation(s)
- Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
| | - Paola Chanes-Mora
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.
- Alcohol Research Center on HIV, Brown University School of Public Health, Providence, RI, USA.
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Jennings L, Ssewamala FM, Nabunya P. Effect of savings-led economic empowerment on HIV preventive practices among orphaned adolescents in rural Uganda: results from the Suubi-Maka randomized experiment. AIDS Care 2015; 28:273-82. [PMID: 26548549 DOI: 10.1080/09540121.2015.1109585] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US12.32, ±1.12, p < .001) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group (p < .001). The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home (ΔT1-T0 = +14.9, p < .001), pursue vocational training (ΔT1-T0 = +8.8, p < .01), and start a business (T1-T0 = +6.7, p < .01). Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores (b = +0.19, ±0.09, p < .05), most commonly toward perceived risk of HIV (95.8%, n = 159), sexual abstinence or postponement (91.6%, n = 152), and consistent condom use (93.4%, n = 144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR = 2.017, 95%CI: 1.43-2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.
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Affiliation(s)
- Larissa Jennings
- a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Fred M Ssewamala
- b International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA
| | - Proscovia Nabunya
- c School of Social Service Administration , University of Chicago , Chicago , IL , USA
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Abad N, Baack BN, O'Leary A, Mizuno Y, Herbst JH, Lyles CM. A Systematic Review of HIV and STI Behavior Change Interventions for Female Sex Workers in the United States. AIDS Behav 2015; 19:1701-19. [PMID: 25711295 DOI: 10.1007/s10461-015-1013-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The lives of female sex workers (FSW) in the US are typically marked by substance abuse, violence, trauma, and poverty. These factors place FSW at risk for acquiring and transmitting HIV and other sexually transmitted infections (STIs). The purpose of this systematic review is to examine HIV/STI interventions conducted in the US that aim to reduce sexual- or drug-related risk behavior among FSW. Eighteen studies describing 19 unique interventions met our selection criteria: five exclusively targeted FSW, two reported stratified data for FSW, and 12 included at least 50 % FSW. Results indicate that 15 interventions provided HIV/STI information, 13 provided substance abuse prevention information, and few included content tailored to specific needs of FSW. Our findings suggest that current HIV/STI prevention efforts in the US do not adequately address the needs of FSW. Interventions are needed to address issues facing FSW in order to reduce HIV/STI transmission in this high-risk group.
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Affiliation(s)
- Neetu Abad
- Division of STD Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-44, Atlanta, GA, 30333, USA,
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Witte SS, Aira T, Tsai LC, Riedel M, Offringa R, Chang M, El-Bassel N, Ssewamala F. Efficacy of a savings-led microfinance intervention to reduce sexual risk for HIV among women engaged in sex work: a randomized clinical trial. Am J Public Health 2015; 105:e95-102. [PMID: 25602889 DOI: 10.2105/ajph.2014.302291] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested whether a structural intervention combining savings-led microfinance and HIV prevention components would achieve enhanced reductions in sexual risk among women engaging in street-based sex work in Ulaanbaatar, Mongolia, compared with an HIV prevention intervention alone. METHODS Between November 2011 and August 2012, we randomized 107 eligible women who completed baseline assessments to either a 4-session HIV sexual risk reduction intervention (HIVSRR) alone (n=50) or a 34-session HIVSRR plus a savings-led microfinance intervention (n=57). At 3- and 6-month follow-up assessments, participants reported unprotected acts of vaginal intercourse with paying partners and number of paying partners with whom they engaged in sexual intercourse in the previous 90 days. Using Poisson and zero-inflated Poisson model regressions, we examined the effects of assignment to treatment versus control condition on outcomes. RESULTS At 6-month follow-up, the HIVSRR plus microfinance participants reported significantly fewer paying sexual partners and were more likely to report zero unprotected vaginal sex acts with paying sexual partners. CONCLUSIONS Findings advance the HIV prevention repertoire for women, demonstrating that risk reduction may be achieved through a structural intervention that relies on asset building, including savings, and alternatives to income from sex work.
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Affiliation(s)
- Susan S Witte
- Susan Witte, Laura Cordisco Tsai, Marion Riedel, Reid Offringa, Mingway Chang, Nabila El-Bassel, and Fred Ssewamala are with the School of Social Work, Columbia University, New York, NY. Susan Witte, Nabila El-Bassel, and Mingway Chang are also with the Global Health Research Center of Central Asia, Columbia University, New York. Toivgoo Aira is with Wellspring, Ulaanbaatar, Mongolia, and the Global Health Research Center of Central Asia, Columbia University, New York
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Wilson B, Critelli FM, Rittner BA. Transnational responses to commercial sexual exploitation: A comprehensive review of interventions. WOMENS STUDIES INTERNATIONAL FORUM 2015. [DOI: 10.1016/j.wsif.2014.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Remme M, Siapka M, Vassall A, Heise L, Jacobi J, Ahumada C, Gay J, Watts C. The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review. J Int AIDS Soc 2014; 17:19228. [PMID: 25373519 PMCID: PMC4221500 DOI: 10.7448/ias.17.1.19228] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. METHODS Effective intervention models were identified from an existing evidence review ("what works for women"). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. RESULTS Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. CONCLUSIONS There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.
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Affiliation(s)
- Michelle Remme
- Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK;
| | - Mariana Siapka
- Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lori Heise
- Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Jantine Jacobi
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Claudia Ahumada
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Jill Gay
- Health Policy Project, Futures Group, Washington, DC, USA
| | - Charlotte Watts
- Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK
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Jennings L. Do men need empowering too? A systematic review of entrepreneurial education and microenterprise development on health disparities among inner-city black male youth. J Urban Health 2014; 91:836-50. [PMID: 25135594 PMCID: PMC4199443 DOI: 10.1007/s11524-014-9898-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Economic strengthening through entrepreneurial and microenterprise development has been shown to mitigate poverty-based health disparities in developing countries. Yet, little is known regarding the impact of similar approaches on disadvantaged U.S. populations, particularly inner-city African-American male youth disproportionately affected by poverty, unemployment, and adverse health outcomes. A systematic literature review was conducted to guide programming and research in this area. Eligible studies were those published in English from 2003 to 2014 which evaluated an entrepreneurial and microenterprise initiative targeting inner-city youth, aged 15 to 24, and which did not exclude male participants. Peer-reviewed publications were identified from two electronic bibliographic databases. A manual search was conducted among web-based gray literature and registered trials not yet published. Among the 26 papers retrieved for review, six met the inclusion criteria and were retained for analysis. None of the 16 registered microenterprise trials were being conducted among disadvantaged populations in the U.S. The available literature suggests that entrepreneurial and microenterprise programs can positively impact youth's economic and psychosocial functioning and result in healthier decision-making. Young black men specifically benefited from increased autonomy, engagement, and risk avoidance. However, such programs are vastly underutilized among U.S. minority youth, and the current evidence is insufficiently descriptive or rigorous to draw definitive conclusions. Many programs described challenges in securing adequate resources, recruiting minority male youth, and sustaining community buy-in. There is an urgent need to increase implementation and evaluation efforts, using innovative and rigorous designs, to improve the low status of greater numbers of African-American male youth.
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Affiliation(s)
- Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA,
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Urada LA, Silverman JG, Cordisco Tsai L, Morisky DE. Underage youth trading sex in the Philippines: trafficking and HIV risk. AIDS Care 2014; 26:1586-91. [PMID: 25068199 DOI: 10.1080/09540121.2014.936818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the socio-structural sexual health risks of female youth (aged 14-17) working in bar/spa venues and brothels in the Philippines, compared to their older counterparts. Aside from this study, few female sex work studies have interviewed youth under 18. On four southern Philippines islands, 770 female sex workers (FSWs), aged 14-48, were recruited from bar/spa venues and brothels to participate in a socio-structural HIV prevention study. Controlling for the effects of a larger HIV prevention intervention study involving 1484 female bar/spa workers, the minors, compared to older FSWs, had less education (AOR: 0.81, CI: 0.70-0.94), less children (AOR: 0.19, CI: 0.10-0.37), and were more likely to work in illegal brothels (AOR: 4.60, CI: 1.66-12.75) and to be high on drugs during sex (AOR: 2.26, CI: 1.39-3.67). It was less likely that anyone talked to them about HIV prevention (AOR: 0.32, CI: 0.15-0.72), but more likely they were recruited by venue owners (AOR: 5.67, 1.56-20.56) and were told by their managers to have sex without a condom (AOR: 6.80, CI: 2.06-22.39). Results suggest a need for organizational and policy level interventions to protect adolescent females from working in unsafe environments in the Philippines and to prevent youth from being recruited into high-risk situations.
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Affiliation(s)
- Lianne A Urada
- a Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
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The association between neighborhood residential rehabilitation and injection drug use in Baltimore, Maryland, 2000-2011. Health Place 2014; 28:142-9. [PMID: 24840154 DOI: 10.1016/j.healthplace.2014.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 04/13/2014] [Accepted: 04/17/2014] [Indexed: 02/05/2023]
Abstract
This study utilized multilevel cross-classified models to longitudinally assess the association between neighborhood residential rehabilitation and injection drug use. We also assessed whether relocating between neighborhoods of varying levels of residential rehabilitation was associated with injection drug use. Residential rehabilitation was categorized into three groups (e.g. low, moderate, high), and lagged one visit to ensure temporality. After adjusting for neighborhood and individual-level factors, residence in a neighborhood with moderate residential rehabilitation was associated with a 23% reduction in injection drug use [AOR=0.77; 95% CI (0.67,0.87)]; residence in a neighborhood with high residential rehabilitation was associated with a 26% reduction in injection drug use [AOR=0.74; 95% CI (0.61,0.91)]. Continuous residence within neighborhoods with moderate/high rehabilitation, and relocating to neighborhoods with moderate/high rehabilitation, were associated with a lower likelihood of injection drug use. Additional studies are needed to understand the mechanisms behind these relationships.
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Outcomes of a behavioral intervention to reduce HIV risk among drug-involved female sex workers. AIDS Behav 2014; 18:726-39. [PMID: 24558098 DOI: 10.1007/s10461-014-0723-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although street-based female sex workers (FSWs) are highly vulnerable to HIV, they often lack access to needed health services and medical care. This paper reports the results of a recently completed randomized intervention trial for FSWs in Miami, Florida, which tested the relative efficacy of two case management interventions that aimed to link underserved FSWs with health services and to reduce risk behaviors for HIV. Participants were recruited using targeted sampling strategies and were randomly assigned to: a Strengths-Based/Professional Only (PO) or a Strengths-Based/Professional-Peer condition (PP). Follow-up data were collected 3 and 6 months post-baseline. Outcome analyses indicated that both intervention groups displayed significant reductions in HIV risk behaviors and significant increases in services utilization; the Professional-Peer condition provided no added benefit. HIV seropositive FSWs responded particularly well to the interventions, suggesting the utility of brief strengths-based case management interventions for this population in future initiatives.
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Urada LA, Simmons J. A collaborative methodology for investigating the ethical conduct of research on female sex workers in the Philippines. J Empir Res Hum Res Ethics 2014; 9:41-5. [PMID: 24572082 PMCID: PMC4065172 DOI: 10.1525/jer.2014.9.1.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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"There is hunger in my community": a qualitative study of food security as a cyclical force in sex work in Swaziland. BMC Public Health 2014; 14:79. [PMID: 24460989 PMCID: PMC3905928 DOI: 10.1186/1471-2458-14-79] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/11/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Swaziland has the highest HIV prevalence in the world - 32% of adults are currently living with HIV - and many Swazis are chronically food insecure - in 2011 one in four Swazis required food aid from the World Food Programme. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy (ART) adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. METHODS In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers. RESULTS Hunger was a major and consistent theme in our informants' lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access "healthy" foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession. CONCLUSIONS Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider poverty alleviation, and address social and policy level changes are necessary and likely to have the greatest success.
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Microenterprise development interventions for sexual risk reduction: a systematic review. AIDS Behav 2013; 17:2864-77. [PMID: 23963497 DOI: 10.1007/s10461-013-0582-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Comprehensive interventions that address both individual and structural determinants associated with HIV/STI risk are gaining increasing attention over the past decade. Microenterprise development offers an appealing model for HIV prevention by addressing poverty and gender equality. This study systematically reviewed the effects of microenterprise development interventions on HIV/STI incidence and sexual risk behaviors. Microenterprise development was defined as developing small business capacity among individuals to alleviate poverty. Seven eligible research studies representing five interventions were identified and included in this review. All of the studies targeted women, and three focused on sex workers. None measured biomarker outcomes. All three sex worker studies showed significant reduction in sexual risk behaviors when compared to the control group. Non-sex worker studies showed limited changes in sexual risk behavior. This review indicates the potential utility of microenterprise development in HIV risk reduction programs. More research is needed to determine how microenterprise development can be effectively incorporated in comprehensive HIV control strategies.
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Kennedy CE, Fonner VA, O'Reilly KR, Sweat MD. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention. AIDS Care 2013; 26:659-73. [PMID: 24107189 DOI: 10.1080/09540121.2013.845287] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these interventions may have important effects on outcomes beyond HIV prevention. Further studies examining not only HIV-related outcomes but also causal pathways and intermediate variables, are needed. Additional studies among men are also needed.
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Affiliation(s)
- Caitlin E Kennedy
- a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Ingabire MC, Mitchell K, Veldhuijzen N, Umulisa MM, Nyinawabega J, Kestelyn E, Van Steijn M, Van De Wijgert J, Pool R. Joining and leaving sex work: experiences of women in Kigali, Rwanda. CULTURE, HEALTH & SEXUALITY 2012; 14:1037-1047. [PMID: 22937751 DOI: 10.1080/13691058.2012.713120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although sex work can bring significant economic benefit there are serious downsides, not least vulnerability to adverse sexual health outcomes. Focus-groups discussions and in-depth interviews were conducted with 70 female sex workers to explore the context in which they started sex work, their motivations to leave, and their experiences of trying to leave. The pathway to becoming a sex worker was underscored by poverty, with disruptive events leading to increasing vulnerability and increasingly difficult life choices. A sizeable minority of women became sex workers while working as house-girls, a position associated with financial, physical and sexual vulnerability. The majority of participants were still working as sex workers, citing financial reasons for not leaving. Motivations to leave sex work included experiencing a frightening incident, peer pressure and concerns about dependent children. Those who left often described a change in their financial circumstances that enabled them to leave. Some had left but had returned to sex work following a financial crisis or because they found their new life too hard. House-girls are particularly vulnerable and therefore an appropriate focus for prevention. Programmes assisting women to leave need to include financial safety nets so that a time of financial difficulty does not necessitate a return to sex work.
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Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS 2012; 7:326-31. [PMID: 22498480 DOI: 10.1097/coh.0b013e3283536ab2] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article examines the dual HIV and sexually transmitted infection (STI) risk behaviors engaged in by women who use or inject drugs; the individual, social, and structural drivers of HIV and STI risk; prevention strategies; and the implications for multilevel, combined, sex-specific HIV prevention strategies. RECENT FINDINGS Women who use or inject drugs, especially female sex workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other STIs. In countries with HIV prevalence higher than 20% among injecting drug users (IDUs), female IDUs have slightly higher HIV prevalence than male IDUs. Women who use or inject drugs face multilevel drivers that increase their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral HIV prevention strategies for this population, most prevention studies have not sufficiently targeted dyadic, social, and structural levels. Few recent advances in biomedical HIV prevention have focused on women who use drugs and their unique needs. SUMMARY HIV prevention strategies and services need to address the unique and multilevel drivers that increase the vulnerabilities to HIV, HCV, and STIs among women who use drugs including those who engage in sex work. Scaling-up and improving access to multilevel and combined HIV prevention strategies for these women is central to combating the HIV epidemic.
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Wariki WMV, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane Database Syst Rev 2012; 2012:CD005272. [PMID: 22336811 PMCID: PMC11345029 DOI: 10.1002/14651858.cd005272.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various interventions have been adopted to reduce HIV transmission among sex workers and their clients but the effectiveness of these strategies has yet to be investigated using meta-analytic techniques. OBJECTIVES To evaluate the effectiveness of behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane HIV/AIDS group specialized register, the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, Dissertation Abstract International (DAI), EMBASE, LILACS, BIOSIS, SciSearch, INDMED, Proquest, and various South Asian abstracting databases were included in the database list. The publication sites of the World Health Organization, the US Centers for Disease Control and Prevention, and other international research and non-governmental organizations also appeared in the database list. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs examining the effects on HIV transmission risk of different behavioral interventions or comparing behavioral interventions with no intervention, where described any one of the outcome measures, such as HIV incidence and prevalence, STI incidence and prevalence, change in self-reported of condom use, and other HIV-related outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed trials, extracted data and assessed the risk bias. Heterogeneity amongst trials was also tested. MAIN RESULTS A total of 13 trials with 8,698 participants were included. Primary outcomes (HIV and STI prevalence and incidence) were reported in seven trials. Of these, HIV incidence was reported in only three trials. After a 6-month follow-up assessment, there was no evidence that social cognitive behavioral intervention was effective in reducing HIV incidence (RR 0.12, 95% CI 0.01 to 2.22). However, there was a reduction in HIV incidence at 3-month follow-up assessment of promotion of female and male condom (RR 0.07, 95% CI 0.00 to 1.38). Social cognitive interventions and promotion of female and male condom use were significantly reduced STIs incidence (RR 0.57, 95% CI 0.34 to 0.96) and (RR 0.63, 95% CI 0.45 to 0.88), respectively. Secondary outcomes were identified in 13 trials. Meta-analyses showed evidence that interventions to promote the use of female and male condoms do reduce non-condom use (RR 0.83, 95% CI 0.65 to 1.05) compared to promotion of male condoms alone, and that social cognitive interventions reduced drug use among sex workers (RR 0.65, 95% CI 0.36 to 1.16) compared to standard care. AUTHORS' CONCLUSIONS Available evidence nevertheless suggests that compared with standard care or no intervention, behavioral interventions are effective in reducing HIV and the incidence of STIs amongst female sex workers (FSWs). Given the benefits of social cognitive theory and the promotion of condom use in reducing HIV/STI and the public health need to control transmission amongst FSWs, there is a clear finding in favour of behavioral interventions. However, it should be recognized that there is a lack of information about most other outcomes and target populations, and that all of the trials were conducted in low- and middle-income countries.
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Affiliation(s)
- Windy M V Wariki
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Tsai LC, Witte SS, Aira T, Altantsetseg B, Riedel M. Piloting a Savings-Led Microfinance Intervention with Women Engaging in Sex Work in Mongolia: Further Innovation for HIV Risk Reduction. ACTA ACUST UNITED AC 2011; 5:26-32. [PMID: 24900163 PMCID: PMC4041298 DOI: 10.2174/1874291201105010026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This paper describes a pilot study testing the feasibility of an innovative savings-led microfinance intervention in increasing the economic empowerment and reducing the sexual risk behavior of women engaging in sex work in Mongolia. Women’s economic vulnerability may increase their risk for HIV by compromising their ability to negotiate safer sex with partners and heightening the likelihood they will exchange sex for survival. Microfinance has been considered a potentially powerful structural HIV prevention strategy with women conducting sex work, as diversification of income sources may increase women’s capacity to negotiate safer transactional sex. With 50% of all reported female HIV cases in Mongolia detected among women engaging in sex work, direct prevention intervention with women conducting sex work represents an opportunity to prevent a potentially rapid increase in HIV infection in urban Mongolia. The piloted intervention consisted of a matched savings program in which matched savings could be used for business development or vocational education, combined with financial literacy and business development training for women engaging in sex work. Results of the pilot demonstrate participants’ increased confidence in their ability to manage finances, greater hope for pursuing vocational goals, moderate knowledge gains regarding financial literacy, and an initial transition from sex work to alternative income generation for five out of nine participants. The pilot findings highlight the potential for such an intervention and the need for a clinical trial testing the efficacy of savings-led microfinance programs in reducing HIV risk for women engaging in sex work in Mongolia.
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Affiliation(s)
- Laura Cordisco Tsai
- Global Health Research Center of Central Asia and Social Intervention Group, Columbia University, New York, USA
| | - Susan S Witte
- Global Health Research Center of Central Asia and Social Intervention Group, Columbia University, New York, USA
| | - Toivgoo Aira
- Wellspring NGO and Global Health Research Center of Central Asia, Ulaanbaatar, Mongolia
| | - Batsukh Altantsetseg
- Wellspring NGO and Global Health Research Center of Central Asia, Ulaanbaatar, Mongolia
| | - Marion Riedel
- Columbia University School of Social Work, New York, USA
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Liu SH, Srikrishnan AK, Zelaya CE, Solomon S, Celentano DD, Sherman SG. Measuring perceived stigma in female sex workers in Chennai, India. AIDS Care 2011; 23:619-27. [PMID: 21293991 DOI: 10.1080/09540121.2010.525606] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although sex work is highly stigmatized throughout the world, a limited body of research has examined stigma among female sex workers (FSWs). We developed a Sex Worker Stigma (SWS) Index to measure perceived stigma among 150 FSWs in Chennai, India. These women were at a median age of 35 years and reported, on average, having engaged in sex work for nine out of the previous 12 months. The two-factor structure of the index was verified in both exploratory and confirmatory factor analyses with acceptable goodness of fit. The final 10-item index comprises of two domains of perceived stigma from the community and perceived stigma from one's family. Cronbach's α coefficients were 0.87 and 0.88 for each domain, respectively. In regression analysis, we found that income from jobs other than sex work was correlated with decreased levels of perceived stigma from both the community (β = - 0.16; 95% CI: -0.30 and -0.02) and the family (β = - 0.24; 95% CI: -0.40 and -0.07); prior experience of accessing health care system increased perceived stigma from the community while heavier financial responsibility for the family was associated with lower perceived stigma from women's family. With the proposed SWS Index, we have a valid and reliable metric to document and track levels of perceived stigma among FSWs to assess the impact of stigma reduction interventions.
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Affiliation(s)
- Su-Hsun Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Condom nonuse among female sex workers in Chennai, India. Int J Gynaecol Obstet 2011; 114:156-7. [PMID: 21669420 DOI: 10.1016/j.ijgo.2011.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/07/2011] [Accepted: 04/27/2011] [Indexed: 11/22/2022]
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Albarracin D, Tannenbaum MB, Glasman LR, Rothman AJ. Modeling structural, dyadic, and individual factors: the inclusion and exclusion model of HIV related behavior. AIDS Behav 2010; 14:239-49. [PMID: 20848306 DOI: 10.1007/s10461-010-9801-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Changing HIV-related behaviors requires addressing the individual, dyadic, and structural influences that shape them. This supplement of AIDS & Behavior presents frameworks that integrate these three influences on behavior. Concepts from these frameworks were selected to model the processes by which structural factors affect individual HIV-related behavior. In the Inclusion/Exclusion Model, material and symbolic inclusions and exclusions (sharing versus denying resources) regulate individuals' ability and motivation to detect, prevent, and treat HIV. Structural interventions create inclusions that increase one's ability or motivation to perform these behaviors or exclusions that hinder one's ability or motivation to execute counterproductive behaviors. The need to expand research regarding multilevel influences on HIV-related behavior is also discussed, particularly concerning further understanding of sustained behavior change and effective dissemination of evidence-based intervention strategies.
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