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Foley JD, Klevens RM, O'Cleirigh C, Fitch C, Rodriguez SL, Batchelder A. Associations Between Health Insurance Coverage with HIV Detection and Prevention Behaviors Among Individuals with Undiagnosed HIV or at Increased Risk for HIV Infection in the USA. Int J Behav Med 2024; 31:764-771. [PMID: 37700150 DOI: 10.1007/s12529-023-10218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Improving HIV detection and prevention remains a critical public health initiative that requires policy-based solutions. This study sought to compare HIV detection/prevention behaviors before and after healthcare reform in Massachusetts, USA, among heterosexually active persons - the group with the highest reported number of undiagnosed HIV cases. The current study sought to (1) characterize differences in insurance coverage and HIV detection/prevention behaviors between cycles 1 (2006) to 5 (2019); (2) evaluate socio-demographic disparities in insurance coverage accounting for cycle; and (3) evaluate associations between health insurance coverage and HIV detection/prevention behaviors accounting for cycle and socio-demographics. METHODS This is a secondary analysis of the National HIV Behavioral Surveillance (NHBS) project: Boston HET cycle (i.e., made up of heterosexually active persons living in the Boston area) data. Descriptive, bivariate (e.g., chi-square), and multiple logistic and negative binomial loglink regression analyses were conducted. RESULTS In chi-square analyses with post hoc Bonferroni tests, the proportion of participants with current health insurance significantly increased from cycle 1 (77%) to cycle 2 (95%), p < .001. In the regression models that controlled for NHBS cycle, 1-year change in age (adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI] = 1.02, 1.05), female gender (aOR = 3.41, 95% CI = 2.48, 4.69), and change in education category (aOR = 1.19, 95% CI = 1.02, 1.39) were associated with a higher likelihood of having health insurance. In regression models that controlled for cycle, age, gender, and education, participants with health insurance were more likely than those without insurance to report seeing a medical provider in the past year (aOR = 3.49, 95% CI = 2.32, 4.66), ever having an HIV test (aOR = 1.52, 95% CI = 0.35, 2.69) and more frequent HIV testing in the past 2 years (incidence rate ratio [IRR] = 1.44, 95% = 1.14, 1.82). Participants with health insurance did not differ from those without insurance in number of vaginal condomless sex partners (IRR = 1.16, 95% CI = 0.95, 1.41) but did report more condomless anal sex partners in the past year (IRR = 1.97, 95% CI = 1.46, 2.65). CONCLUSIONS This study demonstrates how health insurance coverage is positively associated with HIV detection and prevention relevant to both US and international efforts to end the HIV epidemic.
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Affiliation(s)
- Jacklyn D Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 9th floor, Boston, MA, 02114, USA.
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA.
| | - R Monina Klevens
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, 02130, USA
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 9th floor, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
| | - Calvin Fitch
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 9th floor, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
| | | | - Abigail Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 9th floor, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social network strategies to distribute HIV self-testing kits: a global systematic review and network meta-analysis. J Int AIDS Soc 2024; 27:e26342. [PMID: 39048927 PMCID: PMC11269052 DOI: 10.1002/jia2.26342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). METHODS Using search terms related to social network interventions and HIVST, we searched five databases for trials published between 1st January 2010 and 30th June 2023. Outcomes included uptake of HIV testing, HIV prevalence and linkage to antiretroviral therapy (ART) or HIV care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). RESULTS Among the 4496 manuscripts identified, 39 studies fulfilled the inclusion criteria, including one quasi-experimental study, 22 randomized controlled trials and 16 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 16 studies) and peer educators (distributed to unknown peers, 8 studies). Among social networks, simulating the possibilities of ranking position, peer distribution had the highest uptake of HIV testing (84% probability), followed by partner distribution (80% probability) and peer educator distribution (74% probability). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.76, 95% CI 1.50-2.07, 10 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. DISCUSSION All of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Linkage to ART or HIV care remained comparable to facility-based testing across the three HIVST distribution strategies. CONCLUSIONS Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally. PROSPERO NUMBER CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- School of Public HealthSouthern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
| | - Fengshi Jing
- Faculty of Data ScienceCity University of MacauTaipaChina
| | - Chengxin Fan
- University of North Carolina Project – ChinaGuangzhouChina
- School of Public HealthNanjing Medical UniversityNanjingChina
| | - Yifan Dai
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- School of Public HealthSouthern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke‐NUS Medical SchoolSingapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and PreventionZhuhaiChina
| | - Hang Lv
- Zhuhai Center for Diseases Control and PreventionZhuhaiChina
| | - Xi He
- Zhuhai Xutong Voluntary Services CenterZhuhaiChina
| | - Dan Wu
- University of North Carolina Project – ChinaGuangzhouChina
- School of Public HealthNanjing Medical UniversityNanjingChina
- London School of Hygiene and Tropical MedicineLondonUK
| | - Joseph D. Tucker
- University of North Carolina Project – ChinaGuangzhouChina
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social Network Strategies to Distribute HIV Self-testing Kits: A Global Systematic Review and Network Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.05.23298135. [PMID: 37986939 PMCID: PMC10659482 DOI: 10.1101/2023.11.05.23298135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Introduction Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). Methods Using search terms related to social network interventions and HIVST, we searched five databases for trials published between January 1st, 2010, and June 30th, 2023. Outcomes included uptake of HIV testing, HIV seroconversion, and linkage to antiretroviral therapy (ART) or HIV Care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). Results and discussion Among the 3,745 manuscripts identified, 33 studies fulfilled the inclusion criteria, including one quasi-experimental study, 17 RCTs and 15 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 10 studies), and peer educators (distributed to unknown peers, 8 studies). The results showed that all of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Among social networks, peer distribution had the highest uptake of HIV testing (79% probability, SUCRA 0.92), followed by partner distribution (72% probability, SUCRA 0.71), and peer educator distribution (66% probability, SUCRA 0.29). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.45, 95% CI 1.05-2.02, 7 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. Linkage to ART or HIV Care remained comparable to facility-based testing across the three HIVST distribution strategies. Conclusions Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally.PROSPERO Number: CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Fengshi Jing
- Faculty of Data Science, City University of Macau, Taipa, Macao SAR, China
| | - Chengxin Fan
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Dai
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Hang Lv
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D. Tucker
- University of North Carolina Project – China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
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Yakubu K, Bowen P, Govender R. The influence of type of sexual partnership on male condom use: empirical evidence from the South African construction industry. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:185-200. [PMID: 37909699 DOI: 10.2989/16085906.2023.2265902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023]
Abstract
There are indications that gender has an effect on individual risk factors and pathways to HIV diagnoses and treatment. Furthermore, there is growing recognition that to improve HIV-related health outcomes for men, it is important to understand their experiences and perspectives. Perhaps because of the physical nature of construction work, the South African construction industry is dominated by men. Given that employed men are a hard-to-reach community population group, the construction workplace offers an ideal environment for data collection and delivery of non-health-facility-based HIV prevention and treatment interventions. Furthermore, workers in the construction industry have been identified as being at a heightened risk of acquiring HIV and AIDS because of work-related travel, the ubiquity of transactional sex around worker hostels and having an increased likelihood of multiple and concurrent sex partnerships. As a consequence, this study examines the association between condom use and sexual partnerships among men working in the construction industry. A purposive cross-sectional survey was used to collect data from 450 workers across 18 construction sites in the Western Cape province of South Africa. The types of sexual partnership had three categories: regular sex partnerships, casual sex partnerships and sex worker partnerships. Frequency of condom use was determined to be highest with casual sex partners (51.2%), followed by sex workers (40.6%) and regular sex partners (25.6%). Hierarchical multiple linear regression analysis was used to examine the demographic, experiential, behavioural and cognitive predictors of condom use across the three categories of sexual partnership. The results indicate that an individual's perception of control over condom use, and the perceived threat posed by HIV and AIDS are significantly associated with consistent condom use, even after accounting for differences in partner type. Implications of the findings are discussed, and directions for future research on the association between sexual partnerships and condom use are offered.
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Affiliation(s)
- Kamal Yakubu
- Nelson Mandela School of Public Governance, University of Cape Town, South Africa
| | - Paul Bowen
- Construction Economics and Management, University of Cape Town, South Africa
| | - Rajen Govender
- Nelson Mandela School of Public Governance, University of Cape Town, South Africa
- Medical Research Council of South Africa, Cape Town, South Africa
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Lee P, Docrat A. Prevalence and shared risk factors of HIV in three key populations in Vietnam: A systematic review and meta-analysis. Epidemiol Infect 2023; 151:e138. [PMID: 37525376 PMCID: PMC10540180 DOI: 10.1017/s0950268823001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
This study aims to estimate the prevalence of HIV among each of the three key populations in Vietnam: people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM) and quantify their shared risk factors for HIV infection through a systematic review and meta-analysis of recent literature (published in 2001-2017) in the relevant topics. A total of 17 studies consisting of 16,304 participants were selected in this review. The meta-analysis results revealed that the pooled prevalence estimates with 95% confidence intervals (CIs) among PWID, FSW, and MSM were: 0.293 (0.164, 0.421), 0.075 (0.060, 0.089), and 0.085 (0.044, 0.126), respectively. The findings also indicated that injecting drug use (OR: 9.88, 95%CI: 4.47-15.28), multiperson use of injecting equipment (OR: 2.91, 95%CI: 1.69, 4.17), and inconsistent condom use (OR: 2.11, 95%CI: 1.33, 2.90) were the shared risk factors for HIV infection among these population groups. The findings highlighted the importance of HIV prevention approaches to addressing the shared sexual and drug-related practices among the key populations in consideration of their overlapping social networks.
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Affiliation(s)
- Patricia Lee
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
- Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan
| | - Ashraf Docrat
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
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Khatri RB, Assefa Y, Durham J. Multidomain and multilevel strategies to improve equity in maternal and newborn health services in Nepal: perspectives of health managers and policymakers. Int J Equity Health 2023; 22:105. [PMID: 37237251 DOI: 10.1186/s12939-023-01905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Nepal has committed to achieving universal coverage of quality maternal and newborn health (MNH) services by 2030. Achieving this, however, requires urgently addressing the widening inequity gradient in MNH care utilisation. This qualitative study examined the multidomain systemic and organisational challenges, operating in multi-level health systems, that influence equitable access to MNH services in Nepal. METHODS Twenty-eight in-depth interviews were conducted with health policymakers and program managers to understand supply-side perspectives of drivers of inequity in MNH services. Braun and Clarke's thematic approach was employed in analysing the data. Themes were generated and explained using a multidomain (structural, intermediary, and health system) and multi-level (micro, meso and macro) analytical framework. RESULTS Participants identified underlying factors that intersect at the micro, meso and macro levels of the health system to create inequity in MNH services. Key challenges identified at the macro (federal) level included corruption and poor accountability, weak digital governance and institutionalisation of policies, politicisation of the health workforce, poor regulation of private MNH services, weak health management, and lack of integration of health in all policies. At the meso (provincial) level, identified factors included weak decentralisation, inadequate evidence-based planning, lack of contextualizing health services for the population, and non-health sector policies. Challenges at the micro (local) level were poor quality health care, inadequate empowerment in household decision making and lack of community participation. Structural drivers operated mostly at macro-level political factors; intermediary challenges were within the non-health sector but influenced supply and demand sides of health systems. CONCLUSIONS Multidomain systemic and organisational challenges, operating in multi-level health systems, influence the provision of equitable health services in Nepal. Policy reforms and institutional arrangements that align with the country's federalised health system are needed to narrow the gap. Such reform efforts should include policy and strategic reforms at the federal level, contextualisation of macro-policies at the provincial level, and context-specific health service delivery at the local level. Macro-level policies should be guided by political commitment and strong accountability, including a policy framework for regulating private health services. The decentralisation of power, resources, and institutions at the provincial level is essential for technical support to the local health systems. Integrating health in all policies and implementation is critical in addressing contextual social determinants of health.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Jo Durham
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Kabriku PC, Ansah EW, Hagan JE. Positive Status Disclosure and Sexual Risk Behavior Changes among People Living with HIV in the Northern Region of Ghana. Infect Dis Rep 2023; 15:255-266. [PMID: 37218817 DOI: 10.3390/idr15030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE To investigate sexual behavior changes adopted by People Living with Human Immunodeficiency Virus (PLHIV) on Antiretroviral therapy (ART) in the Northern Region of Ghana. METHODS We employed a cross-sectional survey with a questionnaire to collect data from 900 clients from 9 major ART centers within the region. Chi-square and logistic regression analyses were applied to the data. RESULTS More than 50% of PLHIV on ART use condoms, reduce sexual partners, practice abstinence, reduce unprotected sex with married/regular partners, and avoid casual sex. Fear of others getting to know patients' HIV-positive status (χ2 = 7.916, p = 0.005), stigma (χ2 = 5.201, p = 0.023), and fear of loss of family support (χ2 = 4.211, p = 0.040) significantly predict non-disclosure of HIV-positive status among the participants. Change in sexual behavior is influenced by the following: "to avoid spreading the disease to others" (R2 = 0.043, F (1, 898) = 40.237, p < 0.0005), "to avoid contracting other STIs" (R2 = 0.010, F (1, 898) = 8.937, p < 0.0005), "to live long" (R2 = 0.038, F (1, 898) = 35.816, p < 0.0005), "to hide HIV-positive status" (R2 = 0.038, F (1, 898) = 35.587, p < 0.0005), "to achieve good results from ART treatment" (R2 = 0.005, F (1, 898) = 4. 282, p < 0.05), and "to live a Godly life" (R2 = 0.023, F (1, 898) = 20. 880, p < 0.0005). CONCLUSIONS High self-disclosure rate of HIV-positive status was identified, with participants disclosing to their spouses or parents. Reasons for disclosure and non-disclosure differed from person to person.
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Affiliation(s)
| | - Edward Wilson Ansah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
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Vujcich D, Roberts M, Selway T, Nattabi B. The Application of Systems Thinking to the Prevention and Control of Sexually Transmissible Infections among Adolescents and Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5708. [PMID: 37174226 PMCID: PMC10178699 DOI: 10.3390/ijerph20095708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/20/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Systems thinking is a mechanism for making sense of complex systems that challenge linear explanations of cause-and-effect. While the prevention and control of sexually transmissible infections (STIs) has been identified as an area that may benefit from systems-level analyses, no review on the subject currently exists. The aim of this study is to conduct a scoping review to identify literature in which systems thinking has been applied to the prevention and control of STIs among adolescent and adult populations. Joanna Briggs Institute guidelines for the conduct of scoping reviews were followed. Five databases were searched for English-language studies published after 2011. A total of n = 6102 studies were screened against inclusion criteria and n = 70 were included in the review. The majority of studies (n = 34) were conducted in African nations. Few studies focused on priority sub-populations, and 93% were focused on HIV (n = 65). The most commonly applied systems thinking method was system dynamics modelling (n = 28). The review highlights areas for future research, including the need for more STI systems thinking studies focused on: (1) migrant and Indigenous populations; (2) conditions such as syphilis; and (3) innovations such as pre-exposure prophylaxis and at-home testing for HIV. The need for conceptual clarity around 'systems thinking' is also highlighted.
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Affiliation(s)
- Daniel Vujcich
- Western Australian Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, School of Population Health, Curtin University, Perth, WA 6102, Australia; (M.R.)
| | - Meagan Roberts
- Western Australian Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, School of Population Health, Curtin University, Perth, WA 6102, Australia; (M.R.)
| | - Tyler Selway
- Western Australian Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, School of Population Health, Curtin University, Perth, WA 6102, Australia; (M.R.)
| | - Barbara Nattabi
- School of Population and Global Health, University of Western Australia, Perth, WA 6009, Australia;
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Weinstein ER, Glynn TR, Simmons EM, Safren SA, Harkness A. Structural Life Instability and Factors Related to Latino Sexual Minority Men's Intention to Engage with Biomedical HIV-Prevention Services. AIDS Behav 2022; 26:3914-3924. [PMID: 35661015 PMCID: PMC9166207 DOI: 10.1007/s10461-022-03718-1] [Citation(s) in RCA: 1] [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] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Latino sexual minority men (LSMM) experience high rates of HIV and co-occurring health inequities. Structural and psychosocial factors may lead to mental health problems and decreased engagement with biomedical HIV-prevention behaviors. This cross-sectional study assessed the extent to which structural life instability is related to biomedical HIV-prevention services engagement (HIV-testing and PrEP uptake) indirectly through psychological distress among 290 LSMM living in Greater Miami. Using hybrid structural equation modeling, significant direct effects from structural life instability to psychological distress emerged, as did effects from psychological distress (i.e., depression and anxiety) to HIV-prevention engagement. Structural life instability had a significant indirect effect to HIV-prevention engagement via psychological distress. Findings show a possible mechanism explaining the relationship between structural life instability and biomedical HIV-prevention engagement among a group of LSMM, a subpopulation at increased susceptibility for HIV acquisition in an U.S. HIV epicenter.
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Affiliation(s)
| | - Tiffany R Glynn
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Ervin M Simmons
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Audrey Harkness
- Department of Psychology, University of Miami, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Doan LP, Nguyen LH, Auquier P, Boyer L, Fond G, Nguyen HT, Latkin CA, Vu GT, Hall BJ, Ho CSH, Ho RCM. Social network and HIV/AIDS: A bibliometric analysis of global literature. Front Public Health 2022; 10:1015023. [PMID: 36408016 PMCID: PMC9666395 DOI: 10.3389/fpubh.2022.1015023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Social networks (SN) shape HIV risk behaviors and transmission. This study was performed to quantify research development, patterns, and trends in the use of SN in the field of HIV/AIDS, and used Global publications extracted from the Web of Science Core Collection database. Networks of countries, research disciplines, and most frequently used terms were visualized. The Latent Dirichlet Allocation method was used for topic modeling. A linear regression model was utilized to identify the trend of research development. During the period 1991-2019, in a total of 5,698 publications, topics with the highest volume of publications consisted of (1) mental disorders (16.1%); (2) HIV/sexually transmitted infections prevalence in key populations (9.9%); and (3) HIV-related stigma (9.3%). Discrepancies in the geographical distribution of publications were also observed. This study highlighted (1) the rapid growth of publications on a wide range of topics regarding SN in the field of HIV/AIDS, and (2) the importance of SN in HIV prevention, treatment, and care. The findings of this study suggest the need for interventions using SN and the improvement of research capacity via regional collaborations to reduce the HIV burden in low- and middle-income countries.
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Affiliation(s)
- Linh Phuong Doan
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam,*Correspondence: Linh Phuong Doan
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Pascal Auquier
- Research Center on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Laurent Boyer
- Research Center on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Guillaume Fond
- Research Center on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Hien Thu Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Giang Thu Vu
- Center of Excellence in Health Services and System Research, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Brian J. Hall
- School of Global Public Health, New York University, New York, NY, United States
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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12
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Vasylyeva TI, Horyniak D, Bojorquez I, Pham MD. Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people. J Int AIDS Soc 2022; 25:e26031. [PMID: 36352546 PMCID: PMC9646984 DOI: 10.1002/jia2.26031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments. DISCUSSION HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations. CONCLUSIONS Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.
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Affiliation(s)
- Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Danielle's Horyniak
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Ietza Bojorquez
- Department of Population StudiesEl Colegio de la Frontera NorteTijuanaMexico
| | - Minh Duc Pham
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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13
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Kisler KA, Fletcher JB, Reback CJ. Peer Case Management Promoting Advancement Along the HIV Care Continuum Among Black Men Who Have Sex with Men Living with HIV: Building Brothers Up. AIDS Patient Care STDS 2022; 36:S46-S53. [PMID: 36178380 PMCID: PMC9529306 DOI: 10.1089/apc.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black men who have sex with men (BMSM) in the United States are at elevated risk for HIV relative to their heterosexual and/or non-BMSM counterparts, yet on average demonstrate suboptimal HIV care linkage and rates of HIV primary care retention. From October 2019 to December 2020, 69 adult (i.e., aged 18-65) BMSM enrolled in Building Brothers Up (2BU), a 6-session peer case management intervention delivered across 3 months and designed to improve retention in HIV primary care through to full viral suppression. Peer case management sessions included detailed assessment of participants' needs and barriers to treatment, which led to the development of a participant-centered treatment plan. All participants self-identified as Black, about three-quarters self-identified as gay (72.5%), and 46.4% reported an annual income of $5000 or less. A total of 69 participants enrolled in 2BU; however, multiply imputed chained equation logistic regressions were carried out on the final analytical data set (n = 40; 99 imputations) due to a large amount of COVID-19-related missing data. Although analyses of retention and achievement of viral suppression did not reach full significance, the probability of a Type-II hypothesis testing error was high, and viral load results (adjusted odds ratio = 1.56; 95% confidence interval = 0.94-2.60; p = 0.08) suggested that increased attendance to peer case management sessions may be associated with improved odds of achieving full viral suppression among BMSM. The significant impact of national race-related civil unrest and the COVID-19 pandemic on the target population during implementation of 2BU is underscored.
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Affiliation(s)
- Kimberly A. Kisler
- Friends Research Institute, Inc., Los Angeles, California, USA.,Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles, Los Angeles, California, USA.,Address correspondence to: Kimberly A. Kisler, PhD, MPH, Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | | | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, California, USA.,Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California, Los Angeles, Los Angeles, California, USA
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14
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Fields EJ, Hopfer S, Warren JR, BeLue R, Lebed J, Hecht ML. Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood. Vaccines (Basel) 2022; 10:vaccines10071126. [PMID: 35891290 PMCID: PMC9317585 DOI: 10.3390/vaccines10071126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.
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Affiliation(s)
- Emilia J. Fields
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
| | - Suellen Hopfer
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
- Correspondence: ; Tel.: +1-(949)-824-6996
| | - Jennifer R. Warren
- Department of Communication, Women and Gender Studies, African and African American Studies, George Mason University, Fairfax, VA 22030, USA;
| | - Rhonda BeLue
- Department of Public Health, University of Texas San Antonio, San Antonio, TX 78249, USA;
| | - Joel Lebed
- Planned Parenthood Southeastern Pennsylvania, Philadelphia, PA 19107, USA;
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15
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Lutete P, Matthews DW, Sabounchi NS, Paige MQ, Lounsbury DW, Rodriguez N, Echevarria N, Usher D, Walker JJ, Dickerson A, Hillesheim J, Frye V. Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender-Loving Men in New York City, 2020: System Dynamics Models. Am J Public Health 2022; 112:S444-S451. [PMID: 35763732 PMCID: PMC9241454 DOI: 10.2105/ajph.2022.306725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).
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Affiliation(s)
- Priscila Lutete
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - David W Matthews
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Nasim S Sabounchi
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Mark Q Paige
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - David W Lounsbury
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Noah Rodriguez
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Natalie Echevarria
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - DaShawn Usher
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Julian J Walker
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Alexis Dickerson
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Joseph Hillesheim
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Victoria Frye
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
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16
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Sebastian MP, Sarna A, Saraswati LR, Sharma V, Madan I, Tun W, Thior I. Planning for injecting drug use as a means to prevent risky injection behavior. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2077251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Avina Sarna
- HIV and AIDS Program, Population Council, India
| | | | - Vartika Sharma
- With Population Council at time of study, New Delhi, India
| | - Ira Madan
- Sahara Centre for Rehabilitation and Residential Care, New Delhi, India
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Becker TD, Poku OB, Chen X, Wong J, Mandavia A, Huang M, Chen Y, Huang D, Ngo H, Yang LH. The impact of China-to-US immigration on structural and cultural determinants of HIV-related stigma: implications for HIV care of Chinese immigrants. ETHNICITY & HEALTH 2022; 27:509-528. [PMID: 32668975 PMCID: PMC7854980 DOI: 10.1080/13557858.2020.1791316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Asian Americans have poor HIV-related outcomes, yet culturally salient barriers to care remain unclear, limiting development of targeted interventions for this group. We applied the 'what matters most' theory of stigma to identify structural and cultural factors that shape the nature of stigma before and after immigration from China to the US.Design: Semi-structured interviews were conducted with 16 immigrants to New York from China, recruited from an HIV clinic and community centers. Deductive followed by focal inductive qualitative analyses examined how Chinese cultural values (lian, guanxi, renqing) and structural factors influenced stigma before and after immigration.Results: In China, HIV stigma was felt through the loss of lian (moral status) and limited guanxi (social network) opportunities. A social structure characterized by limited HIV knowledge, discriminatory treatment from healthcare systems, and human rights violations impinged on the ability of people living with HIV to fulfill culturally valued goals. Upon moving to the US, positions of structural vulnerability shifted to enable maintenance of lian and formation of new guanxi, thus ameliorating aspects of stigma.Conclusions: HIV prevention and stigma reduction interventions among Chinese immigrants may be most effective by both addressing structural constraints and facilitating achievement of cultural values through clinical, peer, and group interventions.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ohemaa B Poku
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Xinlin Chen
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jeffrey Wong
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Amar Mandavia
- Teachers College, Columbia University, New York, NY, USA
| | - Minda Huang
- Department of Psychology, University of Hartford, West Hartford, CT, USA
| | - Yuqi Chen
- Department of Educational and Psychological Studies, University of Miami, Miami, FL, USA
| | - Debbie Huang
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hong Ngo
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Lawrence H Yang
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Social & Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
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18
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Scott D, Pereira NM, Harrison SE, Zarwell M, Sanasi-Bhola K, Poteat T. "In the Bible Belt:" The role of religion in HIV care and prevention for transgender people in the United States South. Health Place 2021; 70:102613. [PMID: 34186379 PMCID: PMC8922555 DOI: 10.1016/j.healthplace.2021.102613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/29/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
Within the United States South, the socio-religious norms that shape life for many residents may have public health implications. Drawing from 12 key informant interviews, this study explores the role of religious institutions in HIV care and prevention access among transgender people of color in Southern cities. Findings suggest that while religious anti-transgender stigma is pervasive, the regional importance of faith-based beliefs and institutions necessitates targeted faith-based initiatives for the population. Broadly, findings suggest regional environments may demand interventions that negotiate historically marginalizing relationships between at-risk groups and dominant cultural institutions.
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Affiliation(s)
- Darius Scott
- Department of Geography, Dartmouth College, Hanover, NH, 03755, USA.
| | - Nastacia M Pereira
- Department of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, USA
| | - Sayward E Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA; South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, USA
| | - Kamla Sanasi-Bhola
- Division of Infectious Diseases, Prisma Health/University of South Carolina, USA
| | - Tonia Poteat
- Center for Health Equity Research, University of North Carolina Chapel Hill, USA
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"Todo se trata de a quién conoces": Social Networks and Drug Use Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2021; 25:1276-1289. [PMID: 33201429 DOI: 10.1007/s10461-020-03094-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 12/30/2022]
Abstract
The purpose of this study was to characterize the social networks of female sex workers (FSWs) living with HIV in the Dominican Republic (DR) and to examine the association between daily drug use and network risk profile. The study employed a micro-longitudinal observational design using a 7-day mobile health (mHealth) daily diary to collect daily substance use behaviors and social network data was collected at study enrollment. A series of crude and adjusted modified log-Poisson repeated measures regression models with generalized estimating equations (GEE), clustering by individual with a compound symmetry working correlation structure were fit to estimate the relative risks and 95% confidence intervals. Controlling for individual level factors, findings revealed that FSWs with more network members who were drug users (≥ 3) and more network members who were sexual partners and also drugs users (≥ 2) were 8.89 (95% CI 2.62, 30.22) and 6.08 (95% CI 1.20, 30.92) times more likely to engage in daily drug use compared to women with small drug and sex and drug networks. Study findings demonstrate the role high risk networks have on risk behaviors. Results may be used to inform interventions that focus on modifying negative social ties, creating and/or improving existing positive support relationships, and integrating drug use harm reduction promotion within HIV treatment programs.
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Berendes S, Gubijev A, McCarthy OL, Palmer MJ, Wilson E, Free C. Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials. Sex Transm Infect 2021; 97:190-200. [PMID: 33452130 DOI: 10.1136/sextrans-2020-054853] [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: 10/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. OBJECTIVE To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. METHODS We searched seven databases and reference lists of 49 related reviews (January 1990-February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. RESULTS After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI -0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence. CONCLUSIONS Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.
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Affiliation(s)
- Sima Berendes
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona L McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Wilson
- Population, Policy & Practice Department, Faculty of Population Health Sciences, University College London GOS Institute of Child Health, London, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Tempalski B, Beane S, Cooper HLF, Friedman SR, McKetta SC, Ibragimov U, Williams LD, Stall R. Structural Determinants of Black MSM HIV Testing Coverage (2011-2016). AIDS Behav 2020; 24:2572-2587. [PMID: 32124108 PMCID: PMC7444860 DOI: 10.1007/s10461-020-02814-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over 30 years into the US HIV/AIDS epidemic, Black men who have sex with men (BMSM) continue to carry the highest burden of both HIV and AIDS cases. There is then, an urgent need to expand access to HIV prevention and treatment for all gay and bisexual men, underscoring the importance of the federal initiative 'Ending the Epidemic: A Plan for America'. This research examines structural factors associated with BMSM HIV testing coverage over time (2011-2016) in 85 US Metropolitan Statistical Areas (MSAs). We calculated MSA-specific annual measures of BMSM HIV testing coverage (2011-2016). Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition and organized support) were analyzed as possible predictors of coverage using multilevel modeling. Relationships between BMSM HIV testing and the following covariates were positive: rates of BMSM living with HIV (b = 0.28), percent of Black residents employed (b = 0.19), Black heterosexual testing rate (b = 0.46), health expenditures per capita (b = 0.16), ACT UP organization presence in 1992 (b = 0.19), and syringe service presence (b = 0.12). Hard drug arrest rates at baseline (b = - 0.21) and change since baseline (b = - 0.10) were inversely associated with the outcome. Need, resources availability, organized support and institutional opposition are important determinants of place associated with BMSM HIV testing coverage. Efforts to reduce HIV incidence and lessen AIDS-related disparities among BMSM in the US require improved and innovative HIV prevention approaches directed toward BMSM including a fuller understanding of structural factors that may influence place variation in BMSM testing patterns and risk behavior in places of high need.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Stephanie Beane
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Samuel R Friedman
- Department of Population Health, New York University, 550 First Avenue, New York, NY, 10016, USA
| | - Sarah C McKetta
- Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Umedjon Ibragimov
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, Chicago, IL, 60612, USA
| | - Ronald Stall
- University of Pittsburgh School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA
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McGee-Avila JK, Doose M, Nova J, Kumar R, Stroup AM, Tsui J. Patterns of HIV testing among women diagnosed with invasive cervical cancer in the New Jersey Medicaid Program. Cancer Causes Control 2020; 31:931-941. [PMID: 32803402 DOI: 10.1007/s10552-020-01333-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Practice-based guidelines recommend HIV testing during initial invasive cervical cancer (ICC) workup. Determinants of HIV testing during diagnosis of AIDS-defining cancers in vulnerable populations, where risk for HIV infection is higher, are under-explored. METHODS We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC. Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we evaluated HIV testing among 242 ICC cases diagnosed from 2012 to 2014 in ages 21-64 at (a) any point during Medicaid enrollment (2011-2014) and (b) during cancer workup 6 months pre ICC diagnosis to 6 months post ICC diagnosis. Logistic regression models identified factors associated with HIV testing. RESULTS Overall, 13% of women had a claim for HIV testing during ICC workup. Two-thirds (68%) of women did not have a claim for HIV testing (non-receipt of HIV testing) while enrolled in Medicaid. Hispanic/NH-API/Other women had lower odds of non-receipt of HIV testing compared with NH-Whites (OR: 0.40; 95% CI: 0.17-0.94). Higher odds of non-receipt of HIV testing were observed among cases with no STI testing (OR: 4.92; 95% CI 2.27-10.67) and < 1 year of Medicaid enrollment (OR: 3.07; 95% CI 1.14- 8.26) after adjusting for other factors. CONCLUSIONS Few women had HIV testing claims during ICC workup. Opportunities for optimal ICC care are informed by knowledge of HIV status. Further research should explore if lack of HIV testing claims during ICC workup is an accurate indicator of ICC care, and if so, to assess testing barriers during workup.
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Affiliation(s)
- Jennifer K McGee-Avila
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
- François-Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Michelle Doose
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jose Nova
- Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Rizie Kumar
- Department of Sociology, University of Maryland, College Park, College Park, MD, USA
| | - Antoinette M Stroup
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, USA
| | - Jennifer Tsui
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
- Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
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Watts GF, Kelley D, Wilson MM, Arts S, Mims J. Jurisdictional Coordination of Integrated HIV Prevention and Patient Care Planning and Implementation. J Int Assoc Provid AIDS Care 2020; 18:2325958219880532. [PMID: 31607234 PMCID: PMC6900614 DOI: 10.1177/2325958219880532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Jacksonville, Florida, provides services to persons living with the HIV. A federal call
for integrated HIV prevention and treatment was published on June 19, 2015. This study
unveils the principles that guided the local response to that call. Service providers have
not systematically engaged in strategic planning for system improvement, the absence of
which defines the boundaries and properties of the service system. Integration requires a
unifying strategy as it draws leaders from their respective silos. Directed leadership,
community-based participatory research, and action research provided a science-based
framework for integration. Quantitatively, one-third of the planning implementation
journey has elapsed, and 46% of the 75 planned activities have either reached fulfillment
or are ongoing. Another one-fourth is in progress and slightly more than one-fourth (28%)
are pending. Qualitatively, this study recorded 7 system-level changes. Progress to date
is a harbinger of future system-level changes.
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Affiliation(s)
- Graham Fitzgerald Watts
- City of Jacksonville, Social Services Division, Parks, Recreation and Community Services Department, Statesboro, GA, USA
| | - Deidre Kelley
- City of Jacksonville, Social Services Division, Parks, Recreation and Community Services Department, Statesboro, GA, USA
| | | | - Sandy Arts
- City of Jacksonville, Social Services Division, Parks, Recreation and Community Services Department, Statesboro, GA, USA
| | - Joseph Mims
- Florida Department of Health, Duval, Jacksonville, FL, USA
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Implementation of HIV Interventions Into Faith-Based Organizations: Models and Methodological Considerations. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S305-S313. [PMID: 31764268 DOI: 10.1097/qai.0000000000002221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implementation of evidence-based interventions aimed at reducing and treating HIV can have a wider spread if funneled through faith-based organizations. However, there is a paucity of frameworks or process models aimed at providing the best practices to implement HIV interventions into faith-based community organizations. SETTING Implementation framework and process model for African American faith settings. RESULTS Presented here is a systems multilevel implementation framework and implementation process model for integrating HIV interventions into faith-based organizations. We conclude with presentation of key methodological considerations and recommendations and discuss strategies for moving implementation science forward in faith-based organizations. CONCLUSION Because of their key role in the African American community, faith-based settings must be engaged in implementing evidence-based HIV interventions. Through use of a multilevel systems framework and process model, the methods and approaches of implementation science can be leveraged to encourage the spread of HIV interventions in the African American community.
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Magnus M, Edwards E, Dright A, Gilliam L, Brown A, Levy M, Sikka N, Siegel M, Criss V, Watson CC, Machtinger E, Kuo I. Development of a telehealth intervention to promote care-seeking among transgender women of color in Washington, DC. Public Health Nurs 2020; 37:262-271. [PMID: 32017202 DOI: 10.1111/phn.12709] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/21/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC-specific telehealth intervention to increase access to care. METHODS Formative qualitative semi-structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC ≥ 18 years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18 years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day-long meetings with TWC and stakeholders were convened to develop the intervention. RESULTS Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. CONCLUSIONS Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population-specific challenges to care. Further development of this model may be able to improve health outcomes among TWC.
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Affiliation(s)
- Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Elizabeth Edwards
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aurnell Dright
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Leandrea Gilliam
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Angela Brown
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Matthew Levy
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Neal Sikka
- Section of Innovative Practice, Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Marc Siegel
- Medical Faculty Associates, Inc, George Washington University, Washington, DC, USA
| | - Vittoria Criss
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Christopher Chauncey Watson
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Edwards Machtinger
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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26
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Hall BJ, Yang X, Huang L, Yi G, Chan EWW, Tucker JD, Latkin CA. Barriers and Facilitators of Rapid HIV and Syphilis Testing Uptake Among Filipino Transnational Migrants in China. AIDS Behav 2020; 24:418-427. [PMID: 30840160 DOI: 10.1007/s10461-019-02449-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transnational migrant workers are known to be at high risk for HIV/STIs. This study estimated the point prevalence of HIV/syphilis and examined correlates of HIV/syphilis testing uptake among female migrant domestic workers in Macao, China. Data was obtained from 1363 female Filipino domestic workers who were offered free rapid HIV and syphilis testing. A mixed methods analysis was undertaken to examine correlates of testing and themes about reasons for not testing. Among 1164 women tested, there were no cases of HIV/syphilis observed and 199 (14.6%) refused HIV/syphilis testing. Greater social integration (aOR 1.12; 95% CI 1.02-1.24), having more than one sexual partner (aOR 1.65; 95% CI 1.02-2.65), and longer working hours on the testing day (aOR 0.97; 95% CI 0.94-1.00), were associated with testing uptake. Among those who tested, the majority (> 70%) had never tested before, suggesting the need to improve testing outreach. Qualitative themes about reasons for not testing included low perceived need and insufficient time. Individual and structural testing barriers should be reduced to optimize HIV/STI testing in migrant populations.
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Wei L, Chen L, Zhang H, Yang Z, Liu S, Tan W, Xie W, Liu L, Zhao J, Cheng J. Relationship between gay app use and HIV testing among men who have sex with men in Shenzhen, China: a serial cross-sectional study. BMJ Open 2019; 9:e028933. [PMID: 31446409 PMCID: PMC6721534 DOI: 10.1136/bmjopen-2019-028933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate the relationship between gay app use and HIV testing among men who have sex with men (MSM). DESIGN Serial cross-sectional study. SETTING A newly well-developed city in China. PARTICIPANTS 4935 MSM were recruited through offline sampling methods from 2015 to 2017. PRIMARY AND SECONDARY OUTCOMES The primary outcome is the difference in HIV testing between app and non-app users. RESULTS 2872 (58.2%) and 2159 (43.7%) participated MSM had been tested for HIV within lifetime and the past year, respectively. Compared with non-app-using MSM, app-using MSM had a significantly higher prevalence of HIV testing within lifetime (adjusted OR (AOR): 1.48, 95% CI 1.27 to 1.72) and the past year (AOR: 1.36, 95% CI 1.18 to 1.57). App-using MSM were more likely to take an HIV test at the Centers for Disease Control and Prevention (AOR: 1.48, 95% CI 1.24 to 1.76) and community-based organisations (AOR: 1.71, 95% CI 1.44 to 2.03), but less often at gay venues (AOR: 0.49, 95% CI 0.37 to 0.63). Meanwhile, app-using MSM were more likely to take self-testing (AOR: 1.61, 95% CI 1.21 to 2.14). Predictors of HIV testing in the past year were: having an education level of college or higher (AOR: 1.29, 95% CI 1.01 to 1.65), being self-identified as a homosexual (AOR: 1.23, 95% CI 1.02 to 1.46), being recruited through clinic-based sampling (AOR: 1.30, 95% CI 1.06 to 1.60), using gay app (AOR: 1.49, 95% CI 1.21 to 1.83), engaging in group sex (AOR: 1.64, 95% CI 1.23 to 2.19), having received HIV-related service (AOR: 5.49, 95% CI 4.57 to 6.60), having a high level of HIV-related knowledge (AOR: 1.33, 95% CI 1.10 to 1.61) and high-risk perception (AOR: 2.95, 95% CI 1.40 to 6.23). CONCLUSIONS Gay app use was significantly associated with increased HIV testing among MSM hard to reach by traditional outreach. Therefore, it is imperative to expand HIV testing among non-app-using MSM. Continued efforts, innovative strategies and increased resource are highly needed to realise the first '90' target.
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Affiliation(s)
- Lan Wei
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Chen
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Haibo Zhang
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhengrong Yang
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shaochu Liu
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Tan
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Xie
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Liegang Liu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Zhao
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jinquan Cheng
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Wurm M, Neumann A, Wasem J, Biermann-Stallwitz J. Using the Lifeworld Approach to Improve HIV Testing. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:542-555. [PMID: 31282313 DOI: 10.1080/19371918.2019.1635943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Major guidelines for HIV recommend that testing should be provided in a way that is adapted to the lifeworld of groups at risk. However, precise definitions as to what adaption to the lifeworld means are missing. Therefore, this research project evaluated how the lifeworld approach can be operationalized in regard to HIV testing and how voluntary counseling and testing services can use this approach to improve efficacy. A survey for VCT providers in Germany showed a limited number of factors influencing the adaption to the lifeworld of groups at risk. The opening hours, the number of languages used in public relations, and the comfort of the waiting zone are important for all clients. For men who have sex with men, information material for use in social networks and peer volunteers are relevant. Intravenous drug users are concerned with participation, (low) costs, and counseling. For migrants, continuing staff training and anonymity are important.
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Affiliation(s)
- Michael Wurm
- a Institute for Health Care Management and Research, University of Duisburg-Essen , Essen , Germany
| | - Anja Neumann
- a Institute for Health Care Management and Research, University of Duisburg-Essen , Essen , Germany
| | - Jürgen Wasem
- a Institute for Health Care Management and Research, University of Duisburg-Essen , Essen , Germany
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Skovdal M. Facilitating engagement with PrEP and other HIV prevention technologies through practice-based combination prevention. J Int AIDS Soc 2019; 22 Suppl 4:e25294. [PMID: 31328412 PMCID: PMC6643071 DOI: 10.1002/jia2.25294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/08/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recent years have witnessed a rapid expansion of efficacious biomedical HIV prevention technologies. Promising as they may be, they are largely delivered through standard, clinic-based models, often in isolation from structural and behavioural interventions. This contributes to varied, and often poor, uptake and adherence. There is a critical need to develop analytical tools that can advance our understandings and responses to the combination of interventions that affect engagement with HIV prevention technologies. This commentary makes a call for practice-based combination HIV prevention analysis and action, and presents a tool to facilitate this challenging but crucial endeavour. DISCUSSION Models and frameworks for combination HIV prevention already exist, but the process of identifying precisely what multi-level factors that need to be considered as part of a combination of HIV interventions for particular populations and settings is unclear. Drawing on contemporary social practice theory, this paper develops a "table of questioning" to help interrogate the chain and combination of multi-level factors that shape engagement with HIV prevention technologies. The tool also supports an examination of other shared social practices, which at different levels, and in different ways, affect engagement with HIV prevention technologies. It facilitates an analysis of the range of factors and social practices that need to be synchronized in order to establish engagement with HIV prevention technologies as a possible and desirable thing to do. Such analysis can help uncover local hitherto un-identified issues and provide a platform for novel synergistic approaches for action that are not otherwise obvious. The tool is discussed in relation to PrEP among adolescent girls and young women in sub-Saharan Africa. CONCLUSIONS By treating engagement with HIV prevention technologies as a social practice and site of analysis and public health action, HIV prevention service planners and evaluators can identify and respond to the combination of factors and social practices that interact to form the context that supports or prohibits engagement with HIV prevention technologies for particular populations.
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Affiliation(s)
- Morten Skovdal
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
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30
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Quinn KG, Wolfe H, Vergeront J. "Don't Deny Yourself a Seat at the Table": Supporting the Leadership Development of MSM of Color in HIV Services. Health Promot Pract 2019; 21:838-848. [PMID: 31148482 DOI: 10.1177/1524839919850563] [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: 11/15/2022]
Abstract
AIDS service organizations have played a vital role in responding to the HIV epidemic, yet many are plagued by an underrepresentation of racial, ethnic, and sexual minorities in leadership positions. In response, the Wisconsin Department of Health Services, HIV Division, created the Wisconsin Health Leaders Fellowship program to provide training and skills to gay and bisexual men of color in HIV service organizations in Milwaukee, Wisconsin. The program was evaluated using in-depth pre- and post-Fellowship interviews with fellows, their agency preceptors, and Fellowship staff (n = 23 interviews). Results indicate that the Fellowship was successful at developing leadership skills and increasing the confidence of the fellows. However, findings revealed the need to address larger social and structural issues alongside supporting individuals in order to create effective, sustainable change. There is a need for cultural diversity trainings for organizational leaders, changes to organizational hiring and promotion practices, and improving opportunities for formal education for racial and ethnic minority men.
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Affiliation(s)
| | - Hester Wolfe
- Wisconsin Department of Health Services, Madison, WI, USA
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31
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Collazos F, Markle SL, Chavez L, Brugal MT, Aroca P, Wang Y, Hussain I, Alegría M. HIV Testing in Clinical and Community Settings for an International Sample of Latino Immigrants and Nonimmigrants. ACTA ACUST UNITED AC 2019; 7:59-75. [PMID: 30859017 DOI: 10.1037/lat0000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.
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Affiliation(s)
- Francisco Collazos
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM.,Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Isra Hussain
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
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Jiang H, Chen X, Li J, Tan Z, Cheng W, Yang Y. Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model. BMC Public Health 2019; 19:261. [PMID: 30832640 PMCID: PMC6399930 DOI: 10.1186/s12889-019-6593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/25/2019] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection in China. Correct and consistent condom use is one of the most effective strategies for preventing the spread of HIV. This study developed a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behavior among Chinese MSM. Methods A cross-sectional study was conducted to collect data using self-administered electronic questionnaire. Participants were recruited from HIV Voluntary Counseling and Testing clinics in six district Centers for Disease Control and Prevention in Guangzhou and two community-based HIV service centers (Lingnan Partners and Zhitong Charity) from May to September 2017. Structural equation modeling was performed to develop the modified IMB model with extended multilevel factors. Results Among the 976 MSM included, 52.05% had engaged in anal intercourse with a condom every time. The final modified IMB model fitted the data more ideally than the conventional model. The final modified IMB model revealed that behavioral skills positively contributed directly to condom use (β = 0.385, p < 0.001) and partially mediated the associations between information (β = 0.106, p = 0.005) and motivation (β = 0.390, p < 0.001) and condom use. Regarding the extended multilevel factors, education, income, receiving HIV prevention services, sexual partner seeking behavior, depression, intimate partner violence, and child sexual abuse had indirect impacts on condom use that were mediated by information, motivation, and/or behavioral skills (p < 0.05). All paths from the latent variable to the corresponding observed variables were statistically significant (p < 0.001). Conclusion The modified IMB model with extended multilevel factors could serve as a theoretical framework for behavioral interventions for condom use among Chinese MSM. Further prospective studies are needed to examine the predictive power of the modified IMB model. Electronic supplementary material The online version of this article (10.1186/s12889-019-6593-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Xiaobin Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Baiyun District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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Philip M, Shaka N, Selhore N. Need of structural interventions for linking people who inject drugs with antiretroviral treatment: A qualitative study. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1572806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mary Philip
- Department of Psychology, Ambo University, Ambo, Ethiopia
| | - Nimona Shaka
- Department of Psychology, Ambo University, Ambo, Ethiopia
| | - Neville Selhore
- Sahara Center for Rehabilitation and Residential Care, New Delhi, India
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Dickson-Gomez J, Glasman LA, Bodnar G, Murphy M. A social systems analysis of implementation of El Salvador's national HIV combination prevention: a research agenda for evaluating Global Health Initiatives. BMC Health Serv Res 2018; 18:848. [PMID: 30419904 PMCID: PMC6233270 DOI: 10.1186/s12913-018-3667-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
Background Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Methods We conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework. Results El Salvador’s national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH. In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions. Conclusions Overall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention’s potential impact. Electronic supplementary material The online version of this article (10.1186/s12913-018-3667-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Dickson-Gomez
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Laura A Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
| | - Molly Murphy
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav 2018; 22:3681-3691. [PMID: 29872999 PMCID: PMC6208917 DOI: 10.1007/s10461-018-2184-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are many challenges to accessing PrEP and thus low uptake in the United States. This review (2007–2017) of PrEP implementation identified barriers to PrEP and interventions to match those barriers. The final set of articles (n = 47) included content on cognitive aspects of HIV service providers and individuals at risk for infection, reviews, and case studies. Cognitive barriers and interventions regarding patients and providers included knowledge, attitudes, and beliefs about PrEP. The “purview paradox” was identified as a key barrier—HIV specialists often do not see HIV-negative patients, while primary care physicians, who often see uninfected patients, are not trained to provide PrEP. Healthcare systems barriers included lack of communication about, funding for, and access to PrEP. The intersection between PrEP-stigma, HIV-stigma, transphobia, homophobia, and disparities across gender, racial, and ethnic groups were identified; but few interventions addressed these barriers. We recommend multilevel interventions targeting barriers at multiple socioecological domains.
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Affiliation(s)
- Rogério M Pinto
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.
- University of Michigan School of Social Work, Room 2850, 1080 South University, Ann Arbor, MI, 48109, USA.
| | | | - Rita Melendez
- Sociology and Sexuality Studies, San Francisco State University, San Francisco, CA, USA
| | - Okeoma Mmeje
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Brear MR, Shabangu PN, Fisher JR, Hammarberg K, Keleher HM, Livingstone C. Health Capability Deprivations in a Rural Swazi Community: Understanding Complexity With Theoretically Informed, Qualitatively Driven, Mixed-Method Design, Participatory Action Research. QUALITATIVE HEALTH RESEARCH 2018; 28:1897-1909. [PMID: 29671375 DOI: 10.1177/1049732318768236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Comprehensive theories of health justice can supplement rights-based approaches like primary health care, by conceptualizing key terms, and systematizing knowledge about structural factors that influence health. Our aim was to use "health capability" as a theoretical lens for understanding how primary health care approaches might address structural factors impeding health in a rural Swazi community. We conducted abductive, interpretive, analysis of a mixed-method (QUAL+quan) data set about "health capability deprivations," generated through participatory action research. Four themes are discussed: illness and disease, unhealthy daily living environments, inability to move freely, and gendered expectations and norms. The analysis demonstrates that there were complex interrelationships between health capability deprivations, material and ideological deprivation prevented community members from aspiring to or securing their right to health, health capability theory can augment primary health care approaches and vice versa, and qualitatively driven, mixed-method research can generate unique insights about structural factors that influence health.
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Affiliation(s)
- Michelle R Brear
- 1 Monash University, Melbourne, Victoria, Australia
- 2 Swaziland Community Research Group, Manzini, Swaziland
- 3 University of the Free State, Qwaqwa campus, Phuthaditjhaba, South Africa
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Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods. AIDS Behav 2018; 22:1253-1264. [PMID: 29273945 DOI: 10.1007/s10461-017-1997-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.
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38
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Liu H. Can Burt's Theory of Structural Holes be Applied to Study Social Support Among Mid-Age Female Sex Workers? A Multi-Site Egocentric Network Study in China. AIDS Behav 2017; 21:3567-3577. [PMID: 28828738 DOI: 10.1007/s10461-017-1880-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The epidemic of HIV/AIDS continues to spread among older adults and mid-age female sex workers (FSWs) over 35 years old. We used egocentric network data collected from three study sites in China to examine the applicability of Burt's Theory of Social Holes to study social support among mid-age FSWs. Using respondent-driven sampling, 1245 eligible mid-age FSWs were interviewed. Network structural holes were measured by network constraint and effective size. Three types of social networks were identified: family networks, workplace networks, and non-FSW networks. A larger effective size was significantly associated with a higher level of social support [regression coefficient (β) 5.43-10.59] across the three study samples. In contrast, a greater constraint was significantly associated with a lower level of social support (β -9.33 to -66.76). This study documents the applicability of the Theory of Structural Holes in studying network support among marginalized populations, such as FSWs.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, 2234 School of Public Health Building, College Park, MD, 20742, USA.
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Brawner BM, Guthrie B, Stevens R, Taylor L, Eberhart M, Schensul JJ. Place Still Matters: Racial/Ethnic and Geographic Disparities in HIV Transmission and Disease Burden. J Urban Health 2017; 94:716-729. [PMID: 28879489 PMCID: PMC5610132 DOI: 10.1007/s11524-017-0198-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neighborhood-level structural interventions are needed to address HIV/AIDS in highly affected areas. To develop these interventions, we need a better understanding of contextual factors that drive the pandemic. We used multinomial logistic regression models to examine the relationship between census tract of current residence and mode of HIV transmission among HIV-positive cases. Compared to the predominantly white high HIV prevalence tract, both the predominantly black high and low HIV prevalence tracts had greater odds of transmission via injection drug use and heterosexual contact than male-to-male sexual contact. After adjusting for current age, gender, race/ethnicity, insurance status, and most recently recorded CD4 count, there was no statistically significant difference in mode of HIV transmission by census tract. However, heterosexual transmission and injection drug use remain key concerns for underserved populations. Blacks were seven times more likely than whites to have heterosexual versus male-to-male sexual contact. Those who had Medicaid or were uninsured (versus private insurance) were 23 and 14 times more likely, respectively, to have injection drug use than male-to-male sexual contact and 10 times more likely to have heterosexual contact than male-to-male sexual contact. These findings can inform larger studies for the development of neighborhood-level structural interventions.
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Affiliation(s)
- Bridgette M Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 419, Philadelphia, PA, USA.
| | - Barbara Guthrie
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Robin Stevens
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 419, Philadelphia, PA, USA
| | - Lynne Taylor
- Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, PA, USA
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Maimaiti R, Yuexin Z, Kejun P, Wubili M, Lalanne C, Duracinsky M, Andersson R. Assessment of Health-Related Quality of Life among People Living with HIV in Xinjiang, West China. J Int Assoc Provid AIDS Care 2017; 16:588-594. [PMID: 28874069 DOI: 10.1177/2325957417729752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In total, 679 HIV-positive patients from 4 clinics in Urumqi city were given structured questionnaires by the doctors or nurses treating them. Health-related quality of life (HRQL) was assessed using the Chinese Patient-Reported Outcome Quality of Life-HIV questionnaire versions in Mandarin and Uyghur. This tool has been used in other parts of China and several countries. Compared to France, Australia, United States, Brazil, Thailand, Cambodia, Senegal, and Central-Southern China (CS China), the HRQL was significantly lower among HIV-positive patients in Xinjiang, with regard to the dimension of treatment impact and general health score. The health concern was similar to Brazil and Cambodia but lower than other countries and CS China. Our findings showed high stigmatization: 86% of the patients were afraid to tell others they were HIV positive and 69% often felt or always felt depressed. Only 1% of the patients were on antidepressant treatment.
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Affiliation(s)
- Rena Maimaiti
- 1 Department of Prevention and Health Care, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Zhang Yuexin
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Pan Kejun
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Maimaitaili Wubili
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, PR China
| | - Christophe Lalanne
- 3 REMES-Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (ED 393), Unité de Méthodologie des critères d'évaluation (Patient-Reported Outcomes), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.,4 URC ECO/DRCD (Département de la Recherche Clinique et du Développement)-AP-HP Hôpital Fernand-Widal, Batiment Antoine Dubois, Porte 7bis 200 rue du faubourg Saint-Denis, AP-HP, Paris, France
| | - Martin Duracinsky
- 3 REMES-Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (ED 393), Unité de Méthodologie des critères d'évaluation (Patient-Reported Outcomes), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.,4 URC ECO/DRCD (Département de la Recherche Clinique et du Développement)-AP-HP Hôpital Fernand-Widal, Batiment Antoine Dubois, Porte 7bis 200 rue du faubourg Saint-Denis, AP-HP, Paris, France.,5 Service de Médecine Interne et de Maladies Infectieuses (Pr Delfraissy), Assistance Publique-Hopitaux de Paris (AP-HP) Hopital Bicetre, Leclerc, Le Kremlin-Bicetre Cedex, France
| | - Rune Andersson
- 6 Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
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Barman-Adhikari A, Craddock J, Bowen E, Das R, Rice E. The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617726080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data ( N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.
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Affiliation(s)
| | | | | | - Rohan Das
- Creighton University, Lincoln, NE, USA
| | - Eric Rice
- University of Southern California, Los Angeles, USA
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Shangase ZP, Tsoka-Gwegweni JM, Egbe CO. Barriers to Smoking Cessation Among Drug-Resistant Tuberculosis Patients in South Africa. Ann Glob Health 2017; 83:501-508. [PMID: 29221522 DOI: 10.1016/j.aogh.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) remains a significant cause of morbidity and mortality. The long-term health effects of smoking and the risk of adverse TB outcomes, including increased periods of infectiousness, have been reported among DR-TB patients in South Africa. OBJECTIVES This study aimed to identify the barriers to smoking cessation among DR-TB inpatients at a hospital in Durban, South Africa. METHODS A qualitative design using in-depth interviews with a purposive sample of 20 DR-TB inpatients was employed. The sample included 15 men and 5 women aged 18-70 years who self-identified as smokers. Open-ended questions were used to explore barriers militating against smoking cessation among this sample. Data were analyzed with the aid of the software QSR NVivo10. FINDINGS Personal and structural-level barriers (factors) to smoking cessation were identified. Personal factors included addiction and non-addiction-related barriers. Addiction-related barriers included smoking history, cravings for a cigarette, smoking as part of a daily routine, and failed quit attempts. Non-addiction-related barriers included lack of knowledge about quit strategies, psychosocial stress, lack of the willpower to quit smoking, and the influence of peers. Structural barriers included ineffective health education programs, lack of extramural activities when on admission in hospital leading to a lot of spare time, lack of smoking cessation interventions, and access to cigarettes within and around the hospital environment. Patients expressed interest in smoking cessation and conveyed their frustration at the lack of appropriate support to do so. CONCLUSIONS The findings reiterate the need for smoking cessation intervention to be incorporated as an integral component of DR-TB management in South Africa. Many patients expressed an interest in pharmacological aids and psychological support to help them to quit smoking. Additionally, offering extramural activities and enforcing smoke-free policies in hospital facilities will help to reduce patients' access to cigarettes while at the hospital.
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Affiliation(s)
- Zifikile Phindile Shangase
- School of Built Environment and Development Studies, Howard College, University of KwaZulu-Natal, Durban, South Africa.
| | - Joyce Mahlako Tsoka-Gwegweni
- School of Nursing & Public Health, College of Health Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa
| | - Catherine O Egbe
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
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Smith LR, Strathdee SA, Metzger D, Latkin C. Evaluating network-level predictors of behavior change among injection networks enrolled in the HPTN 037 randomized controlled trial. Drug Alcohol Depend 2017; 175:164-170. [PMID: 28433895 PMCID: PMC5494981 DOI: 10.1016/j.drugalcdep.2017.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/20/2017] [Accepted: 02/06/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about ways network-level factors that may influence the adoption of combination prevention behaviors among injection networks, or how network-oriented interventions might moderate this behavior change process. METHODS A total of 232 unique injection risk networks in Philadelphia, PA, were randomized to a peer educator network-oriented intervention or standard of care control arm. Network-level aggregates reflecting the injection networks' baseline substance use dynamics, social interactions, and the networks exposure to gender- and structural-related vulnerabilities were calculated and used to predict changes in the proportion of network members adopting safer injection practices at 6-month follow-up. RESULTS At follow-up, safer injection practices were observed among 46.31% of a network's members on average. In contrast, 25.7% of networks observed no change. Controlling for the effects of the intervention, significant network-level factors influencing network-level behavior change reflected larger sized injection networks (b=2.20, p=0.013) with a greater proportion of members who shared needles (b=0.29, p<0.001) and engaged in poly drug use at baseline (b=6.65, p=0.021). Changes in a network's safer injection practices were also observed for networks with fewer new network members (b=-0.31, p=0.008), and for networks whose members were proportionally less likely to have experienced incarceration (b=-0.20, p=0.012) or more likely to have been exposed to drug treatment (b=0.17, p=0.034) in the 6-months prior to baseline. A significant interaction suggested the intervention uniquely facilitated change in safer injection practices among female-only networks (b=-0.32, p=0.046). CONCLUSIONS Network-level factors offer insights into ways injection networks might be leveraged to promote combination prevention efforts.
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Affiliation(s)
- Laramie R. Smith
- Division of Global Public Health, University of California San Diego, La Jolla, United States, UCSD School of Medicine; 9500 Gilman Drive #0507, La Jolla, CA 92093-0507
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California San Diego, La Jolla, United States, UCSD School of Medicine; 9500 Gilman Drive #0507, La Jolla, CA 92093-0507
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania and The Treatment Research Institute, Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA.
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
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Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis. J Acquir Immune Defic Syndr 2017; 73:213-21. [PMID: 27632146 DOI: 10.1097/qai.0000000000001043] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. METHODS We conduct ecological analyses (ZIP code, N = 166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/μL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. RESULTS Overall, low to high political participation and social cohesion corresponded with significant (P < 0.0001) decreasing trends in late HIV diagnosis rates. Among men [relative risk (RR) = 0.66, 95% CI: (0.47 to 0.98)] and women [RR = 0.43, 95% CI: (0.28 to 0.67)], highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control [RR = 0.67, 95% CI: (0.48 to 0.93)] among men only and moderate social cohesion [RR = 0.71, 95% CI: (0.55 to 0.92)] among women only were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. DISCUSSION The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.
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Multiplex Competition, Collaboration, and Funding Networks Among Health and Social Organizations: Toward Organization-based HIV Interventions for Young Men Who Have Sex With Men. Med Care 2017; 55:102-110. [PMID: 27676400 DOI: 10.1097/mlr.0000000000000595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations. RESEARCH DESIGN The study data collection method was a survey of health and social organizations from 2013-2014 in 2 cities, Chicago, IL and Houston, TX. SUBJECTS Study participants were representatives from 138 health and social organizations. MEASURES Responses to survey questions were used to reconstruct competition, collaboration, and combined competition-collaboration networks. RESULTS While taking into consideration the collaborative relationships among organizations, we provide statistical evidence that organizations of similar type, similar social media use patterns, comparable patterns of funding, and similar network contexts tended to compete with one another. This competition was less likely to be accompanied by any sort of collaboration if the organizations shared common funding sources. CONCLUSIONS Competition that excludes potential collaboration may be detrimental to mobilizing the collective efforts that serve local YMSM communities. System-level interventions may provide promising approaches to scaling-up HIV prevention and treatment efforts so as to encourage organizations to form partnerships with otherwise competing providers.
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Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc 2017. [PMID: 28406270 PMCID: PMC5515028 DOI: 10.7448/ias.20.01/21372] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. METHODS MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. RESULTS 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). CONCLUSION HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
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Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc 2017; 20:21372. [PMID: 28406270 DOI: 10.7448/ias.20.01.21372] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. METHODS MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. RESULTS 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). CONCLUSION HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
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Voisin DR, Hotton AL, Schneider JA. The relationship between life stressors and drug and sexual behaviors among a population-based sample of young Black men who have sex with men in Chicago. AIDS Care 2017; 29:545-551. [PMID: 27590043 PMCID: PMC5577924 DOI: 10.1080/09540121.2016.1224303] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Younger Black men who have sex with men (YBMSM) have the highest rates of HIV incidence in the U.S. and are also exposed to high life stressors (e.g., unemployment, incarceration, and exposure to communality). This study assessed whether life stressors were related to drug use and sexual risk behaviors among a representative sample of YBMSM. The South Side of Chicago and selected adjacent suburbs represents the most populous contiguous Black community in the U.S. Over 10% of the estimated YBMSM population in this geographic region were sampled. Major findings indicated that higher life stress was significantly associated with greater odds of transactional sex (aOR = 2.19; 95% CI 1.09-4.39), substance use with sex with male and transgender partners (aOR = 1.62; 95% CI 1.09-2.39), marijuana (aOR = 2.65; 95% CI 1.43-4.90), crack/cocaine (aOR = 3.21; 95% CI 1.16-8.88), and prescription opioid use (aOR = 3.12; 95% CI 1.37-7.13). HIV approaches which focus on environmental stressors and employ a stress and coping framework may support the reduction of drug and sexual risk behaviors among YBMSM. Cognitive and social support approaches might be especially useful in this regard.
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Affiliation(s)
- Dexter R Voisin
- a School of Social Service Administration , University of Chicago , Chicago , IL , USA
| | - Anna L Hotton
- b School of Public Health , University of Illinois at Chicago , Chicago , IL , USA
| | - John A Schneider
- b School of Public Health , University of Illinois at Chicago , Chicago , IL , USA
- c Department of Public Health Sciences , University of Chicago , Chicago , IL , USA
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Ghosh D, Krishnan A, Gibson B, Brown SE, Latkin CA, Altice FL. Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review. AIDS Behav 2017; 21:1183-1207. [PMID: 27125244 DOI: 10.1007/s10461-016-1413-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.
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Affiliation(s)
- Debarchana Ghosh
- Department of Geography and Institute for Collaboration on Health Intervention and Prevention, University of Connecticut, 215 Glenbrook Road, AUST 421, U-4148, Storrs, CT, 06269, USA.
| | - Archana Krishnan
- Department of Communication, University at Albany, SUNY, Albany, NY, USA
| | - Britton Gibson
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Shan-Estelle Brown
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Epidemiology, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frederick L Altice
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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A Tailored Approach to Launch Community Coalitions Focused on Achieving Structural Changes: Lessons Learned From a HIV Prevention Mobilization Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21:546-55. [PMID: 26785397 DOI: 10.1097/phh.0000000000000182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition.
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