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Zhang W, Choi EPH, Fong DYT, Wong JYH. A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study. JMIR Public Health Surveill 2021; 7:e24269. [PMID: 33464220 PMCID: PMC7854030 DOI: 10.2196/24269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear. OBJECTIVE The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator. METHODS Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator. RESULTS The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: -0.80, 95% boot CI -1.67 to -0.36) but not in sexual minority women (indirect effect: -0.33, 95% boot CI -0.86 to 0.31). CONCLUSIONS The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion.
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Affiliation(s)
- Wen Zhang
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Daniel Yee-Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Janet Yuen-Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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van den Berg JJ, Gamarel KE, Westfall AO, Fortenberry JD, Hosek SG, Wilson CM, Lally MA. Transmission Risk Among Youth Living With HIV in the U.S. J Adolesc Health 2020; 67:61-68. [PMID: 32169529 PMCID: PMC7311228 DOI: 10.1016/j.jadohealth.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/14/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE HIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to assess potential differences in transmission risk of HIV and other STIs among YLWH to inform subsequent HIV and STI prevention efforts. METHODS A cohort of 600 HIV behaviorally infected youth aged 13-24 years who were engaged in medical care completed an audio computer-assisted self-interview including questions about demographics, HIV disclosure, mental health, substance use, and sexual behaviors and beliefs. HIV viral loads and the presence of other STIs were abstracted from medical records. A viral load <200 copies/mL was considered undetectable. Univariate and bivariate analyses were conducted to examine differences by viral load and STIs. RESULTS Participants were categorized into four groups: (1) undetectable without STIs (55.2%); (2) undetectable with STIs (14.2%); (3) detectable without STIs (22.8%); and (4) detectable with STIs (7.8%). In comparison to the other three groups, youth in the undetectable group with STIs reported more favorable sexual risk reduction attitudes and beliefs, internet use for finding sex partners, anal sex with male partners, and condomless anal sex with male partners. CONCLUSIONS YLWH with undetectable viral loads and other STIs engaged in higher risk behaviors. To realize the promise of the messaging campaign, undetectable = untransmittable, efforts must focus on sustained viral suppression and prevention of STIs among YLWH.
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Affiliation(s)
- Jacob J van den Berg
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Andrew O Westfall
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sybil G Hosek
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Craig M Wilson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Michelle A Lally
- Lifespan Hospital Systems and Alpert Medical School of Brown University, Providence, Rhode Island
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Gursahaney PR, Cordes S, Ofotokun I, Wall KM, Jamieson DJ, Haddad LB. Factors associated with condom use among HIV-positive women living in Atlanta, Georgia. PLoS One 2019; 14:e0225406. [PMID: 31834885 PMCID: PMC6910822 DOI: 10.1371/journal.pone.0225406] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Consistent condom use is essential to reducing heterosexual transmission of HIV. African Americans are disproportionately affected by HIV in the United States despite comprising a small percentage of the population. Our objectives were to evaluate factors associated with self-reported condom use in a cohort of predominantly African American women receiving HIV care in Atlanta, Georgia. Methods A cross-sectional study of reproductive knowledge, attitudes, and practices among adult, sexually-active, HIV-positive women attending the Grady Infectious Disease Clinic in Atlanta, Georgia was conducted from July, 2013 to November, 2014 to evaluate factors associated with self-reported condom use. Primary outcomes included: condom use at last vaginal intercourse and consistent condom use with vaginal intercourse over the last six months. Descriptive, bivariable, and multivariable logistic regression analyses were performed. Results Of 187 women enrolled, 170 reported having vaginal intercourse in the last six months. Seventy-four percent used condoms at last vaginal intercourse, whereas 53% reported consistent condom use over the last six months. In adjusted analyses, factors associated with condom use at last intercourse included decreased frequency of sex, no history of drug use, and confidence to discuss condom use with sexual partners (p<0.05). Factors associated with consistent condom use in the past six months were older age, being single/dating, and confidence to discuss condom use with sexual partners. History of drug use, having HIV-positive partners, and unprotected anal intercourse were associated with inconsistent use (p<0.05). Conclusions Improved strategies are needed to educate women on the importance of safe sexual practices and condom negotiation. Healthcare providers should strive to have an open dialogue with patients about condom use, whether they engage in anal sex, and its risks.
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Affiliation(s)
- Priya R. Gursahaney
- University of Cincinnati College of Medicine, Department of Obstetrics and Gynecology, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Sarah Cordes
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Ighovwerha Ofotokun
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, Georgia, United States of America
| | - Kristin M. Wall
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, United States of America
| | - Denise J. Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Lisa B. Haddad
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
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Hope MO, Lee DB, Hsieh HF, Hurd NM, Sparks HL, Zimmerman MA. Violence Exposure and Sexual Risk Behaviors for African American Adolescent Girls: The Protective Role of Natural Mentorship and Organizational Religious Involvement. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:241-254. [PMID: 31206754 DOI: 10.1002/ajcp.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
African American adolescent girls are at increased risk of being exposed to community violence and being diagnosed with a sexually transmitted infection. Fewer studies, however, have examined the protective roles of natural mentorship and organizational religious involvement as potential moderators that could lessen the effects of violence exposure on health risk behavior. Data from 273 African American ninth grade girls were used to test hypothesized independent and moderated-moderation models. Results suggest that natural mentorship and religious involvement were protective for girls who reported at least one mentor and moderate to high levels of religious involvement. Our findings may be relevant for community stakeholders and organizations that directly interact with religious institutions and community programs that focus on outreach to African American adolescent girls.
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Affiliation(s)
- Meredith O Hope
- Center for Research on Ethnicity, Culture, and Health, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel B Lee
- Children's Minnesota Research Institute, Children's Minnesota Hospitals and Clinics, Minneapolis, Minnesota, USA
| | - Hsing-Fang Hsieh
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Noelle M Hurd
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Haley L Sparks
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Mota NP, Turner S, Taillieu T, Garcés I, Magid K, Sethi J, Struck S, El-Gabalawy R, Afifi TO. Trauma Exposure, DSM-5 Post-Traumatic Stress Disorder, and Sexual Risk Outcomes. Am J Prev Med 2019; 56:215-223. [PMID: 30553694 DOI: 10.1016/j.amepre.2018.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The current study examined associations between DSM-5 post-traumatic stress disorder (PTSD) and three sexual risk outcomes: presence of a sexually transmitted disease/infection, frequency of condom use, and sex with a known user of injection drugs. METHODS Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, analyzed 2017), a nationally representative survey of non-institutionalized U.S. adults aged ≥18 years. Sexual outcomes and trauma exposure were assessed via self-report, and PTSD was assessed using a validated structured interview. Logistic and multinomial regression analyses examined associations between PTSD, PTSD symptom clusters, trauma type, and each sexual outcome. RESULTS Lifetime PTSD was associated with increased odds of having a past-year sexually transmitted disease/infection and sex with a known injection drug user (AOR=1.54 and 1.74, respectively); fewer intrusion symptoms were associated with sometimes/fairly often condom use relative to very often. Reporting of adult sexual assault, assaultive violence, and other trauma as one's worst event was associated with increased odds of a past-year sexually transmitted disease/infection (AOR range, 1.69-4.56), whereas child maltreatment was associated with using condoms never/almost never in the past 12 months (AOR=1.40). No other significant findings emerged. CONCLUSIONS The current study demonstrates an association between certain trauma exposures, PTSD symptoms, and an increased likelihood of sexual risk outcomes. Clinicians working with individuals with PTSD symptoms, particularly those who have been exposed to interpersonal trauma, should screen for the presence of these sequelae.
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Affiliation(s)
- Natalie P Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Sarah Turner
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Applied Health Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Isabel Garcés
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kirby Magid
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Japandeep Sethi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shannon Struck
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Wang Z, Lau JTF, Wang Q, Mo PKH. Prevalence of and Factors Associated With Inconsistent Condom Use With HIV-Discordant Male Regular Sex Partners Among HIV-Infected Women in China. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:339-349. [PMID: 30703336 DOI: 10.1080/0092623x.2018.1526835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study was to investigate the prevalence and associated factors of inconsistent condom use with HIV-discordant regular male sex partners (RP: defined as their husband or steady boyfriends) in the last six months among HIV-infected women in China. We interviewed 256 HIV-infected women who currently had at least one HIV-discordant RP and had had sexual intercourse with such RP since diagnosis. The prevalence of inconsistent condom use with HIV-discordant RP was 48.4%. Associated factors included perceptions related to condom use and perceived competence in communicating with HIV-discordant RP regarding condom use.
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Affiliation(s)
- Zixin Wang
- a Centre for Health Behaviours Research, JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong SAR , China
- b Shenzhen Research Institute , The Chinese University of Hong Kong , Shenzhen , China
| | - Joseph T F Lau
- a Centre for Health Behaviours Research, JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong SAR , China
- b Shenzhen Research Institute , The Chinese University of Hong Kong , Shenzhen , China
| | - Qian Wang
- c Department of Prevention of Mother to Child Transmission of Disease, National Center for Women and Children's Health , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Phoenix K H Mo
- a Centre for Health Behaviours Research, JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong SAR , China
- b Shenzhen Research Institute , The Chinese University of Hong Kong , Shenzhen , China
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Brown JL, Haddad LB, Gause NK, Cordes S, Bess C, King CC, Hatfield-Timajchy K, Chakraborty R, Kourtis AP. Examining the contraceptive decisions of young, HIV-infected women: A qualitative study. Women Health 2018; 59:305-317. [PMID: 29624125 DOI: 10.1080/03630242.2018.1452836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study qualitatively examined factors that influenced contraceptive choices in a sample of young, HIV-infected women. Individual qualitative interviews were conducted among 30 vertically and horizontally HIV-infected women (n = 26 African American) from the ages of 14 to 24 years (Mean age = 20.9 years). We recruited sample groups with the following characteristics: (a) current contraceptive/condom use with ≥1 child (n = 11); (b) current contraceptive/condom use with no children (n = 12); and (c) no current contraceptive/condom use with no children (n = 7). A semi-structured interview guide was used to ask participants about factors influencing past and current contraceptive choices. Individual interviews were digitally recorded and transcribed verbatim; analyses to identify core themes were informed by the Grounded Theoretical approach. Young, HIV-infected women did not identify their HIV serostatus or disease-related concerns as influential in their contraceptive decisions. However, they reported that recommendations from health-care providers and input from family and friends influenced their contraceptive choices. They also considered a particular method's advantages (e.g., menstrual cycle improvements) and disadvantages (e.g., increased pill burden) when selecting a method. Findings suggested that HIV-infected young women's contraceptive decisions were influenced by factors other than those related to their infection.
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Affiliation(s)
- Jennifer L Brown
- a Department of Psychiatry & Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Lisa B Haddad
- b Department of Gynecology & Obstetrics , Emory University School of Medicine , Atlanta , Georgia , USA
| | - Nicole K Gause
- c Department of Psychology , University of Cincinnati , Cincinnati , Ohio , USA
| | - Sarah Cordes
- b Department of Gynecology & Obstetrics , Emory University School of Medicine , Atlanta , Georgia , USA
| | - Cecilia Bess
- d Department of Psychological Sciences , Texas Tech University , Lubbock , Texas , USA
| | - Caroline C King
- e Division of Reproductive Health , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - Kendra Hatfield-Timajchy
- e Division of Reproductive Health , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - Rana Chakraborty
- f Department of Pediatrics, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , Georgia , USA
| | - Athena P Kourtis
- e Division of Reproductive Health , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
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Haddad LB, Tang JH, Krashin J, Ng'ambi W, Tweya H, Samala B, Chiwoko J, Chaweza T, Hosseinipour MC, Lathrop E, Jamieson DJ, Phiri S. Factors associated with condom use among men and women living with HIV in Lilongwe, Malawi: a cross-sectional study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:1-12. [PMID: 29248899 PMCID: PMC6283329 DOI: 10.1136/bmjsrh-2017-101825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/11/2017] [Accepted: 10/25/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Understanding the influences on condom use among men and women living with HIV is critical to tailoring sexually transmitted infection/HIV prevention efforts. METHODS This is a sub-analysis of a cross-sectional survey including 255 women and 220 men who were sexually active, HIV-positive, and attending HIV care visits in Lilongwe, Malawi. We estimated adjusted prevalence ratios (aPRs) to evaluate for factors associated with consistent condom use (always using condoms in the past month) and use at last coitus for men and women in separate models. RESULTS Among women: 38% and 55% reported consistent condom use and condom use at last coitus, respectively. For women, consistent use and use at last coitus were positively associated with the ability to refuse sex without condoms and shared decision-making compared with making the decision alone regarding condom use, and negatively associated with desire for children in the future. Consistent use also increased with longer antiretroviral therapy (ART) use (≥1 year compared with no ART use). Among men: 51% and 69% reported consistent condom use and condom use at last coitus, respectively. For men, the ability to refuse sex without condoms was associated with consistent use and use at last coitus, and believing that condoms should be used with other contraception was associated with consistent use. CONCLUSIONS Our findings demonstrate ongoing low condom utilisation among HIV-positive individuals, and highlight that ART and contraceptive use do not deter condom use. Efforts to increase condom utilisation must recognise individual-level factors that influence use and should focus on relationship dynamics and promotion of empowerment and self-efficacy.
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Affiliation(s)
- Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Tang
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jamie Krashin
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Hannock Tweya
- Kamuzu Central Hospital, The Lighthouse Trust, Lilongwe, Malawi
| | | | - Jane Chiwoko
- Kamuzu Central Hospital, The Lighthouse Trust, Lilongwe, Malawi
| | - Thomas Chaweza
- Kamuzu Central Hospital, The Lighthouse Trust, Lilongwe, Malawi
| | | | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sam Phiri
- Kamuzu Central Hospital, The Lighthouse Trust, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Hill DC, Stein LAR, Rossi JS, Magill M, Clarke JG. Intimate violence as it relates to risky sexual behavior among at-risk females. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2017; 10:619-627. [PMID: 28981312 DOI: 10.1037/tra0000316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Rates of sexually transmitted infections (STIs) among adolescents are on the rise. The majority of adolescents who contract STIs do so through risky sexual behavior. Previous literature has identified multiple correlates of risky sexual behaviors among adolescents, including physical and sexual victimization, mental health concerns, and substance use. Few studies, however, have examined these relationships together in a comprehensive model. The primary purpose of this study was to examine whether relationship violence was related to risky sexual behavior, and whether mental health symptoms and substance use mediated this relationship. METHOD A cross-sectional design was used, and adolescent females (N = 179), recruited from social service agencies, were 18.9 years old on average and were 37.2% White, 19.3% Black, 37.9% multiracial, and 5.6% other. RESULTS Regression results revealed that females who were physically assaulted and sexually victimized by their intimate partners did engage in more sex without condoms. Mediational analyses indicated that PTSD symptoms significantly influenced the relationship between (1) physical assault and risky sexual behavior and (2) sexual victimization and risky sexual behavior. CONCLUSION Contrary to expectations, PTSD may act to reduce risk perhaps by reducing interest in sex. It is important to address victimization, PTSD, and sexual risk in young women. More work is needed to understand these complex relationships using longitudinal designs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - L A R Stein
- Department of Psychology, University of Rhode Island
| | | | - Molly Magill
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Jennifer G Clarke
- Brown University Center for Primary Care and Prevention at Memorial Hospital of Rhode Island
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Brickman C, Propert KJ, Voytek C, Metzger D, Gross R. Association Between Depression and Condom Use Differs by Sexual Behavior Group in Patients with HIV. AIDS Behav 2017; 21:1676-1683. [PMID: 27878639 DOI: 10.1007/s10461-016-1610-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Identifying a relationship between depression and sexual risk behavior in HIV-infected patients could establish a mechanism to enhance prevention efforts. We conducted a cross-sectional analysis using data from the University of Pennsylvania Center for AIDS Research and used ordinal logistic regression to measure the association between depression and non-condom use. 716 men who have sex with men (MSM), 262 heterosexual men and 277 heterosexual women were included. The association between depression and non-condom use was strongest in heterosexual men with and without HIV-infected regular partners (OR 8.53, 95% CI 1.18-61.89 and OR 2.30, 95% CI 0.99-5.36 respectively), but absent in heterosexual women regardless of partner. Although the OR was low in MSM overall, an association was detected in MSM without HIV-infected regular partners (OR 2.44, 95% CI 1.39-4.31). In conclusion, we demonstrated an association between depression and non-condom use driven by heterosexual men and MSM without HIV-infected regular partners. Sexual risk should be addressed when intervening on depressive symptoms in these subgroups.
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Affiliation(s)
- Cristina Brickman
- Division of Infectious Diseases, University of California San Francisco, 513 Parnassus Ave Medical Room S380, San Francisco, CA, 94143, USA.
| | | | | | | | - Robert Gross
- University of Pennsylvania, Philadelphia, PA, USA
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Robinson S, Gardner S, Loutfy M, Light L, Tharao W, Rourke SB, Burchell AN. Sexual behaviors among women living with HIV in Ontario, Canada. AIDS Care 2016; 29:587-592. [PMID: 27607586 DOI: 10.1080/09540121.2016.1226477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Understanding the sexual activities and partnerships of women living with human immunodeficiency virus (HIV) remains important to promote healthy sexuality and to reduce the transmission of HIV and other sexually transmitted infections. We described sexual behaviors of women living with HIV enrolled in an ongoing study in Ontario, Canada. Data were available from 582 women who self-completed a sexual behavior questionnaire between 2010 and 2012. Nearly half (46.1%) of women reported a sexual partner in the preceding three months; women less likely to be sexually active were older, Black/African, separated, divorced, widowed, single, and unemployed. Most sexually active women had one partner (76.4%), a regular partner (75.9%), male (96.2%) partner(s), and partners who were HIV-negative or unknown HIV status (75.2%). Women were more likely to use a condom with HIV-negative/status unknown partners (81.3%) than with HIV-positive partners (58.6%; p = .008). Only 8.0% of sexually active women reported condomless sex with a discordant HIV-negative/status unknown partner when their viral load was detectable. Overall, most women living with HIV were sexually inactive or engaged in sexual activities that were low risk for HIV transmission.
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Affiliation(s)
- Samantha Robinson
- a The Ontario HIV Treatment Network , Toronto , ON , Canada.,b Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - Sandra Gardner
- b Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.,c Baycrest Health Sciences , Toronto , ON , Canada
| | - Mona Loutfy
- b Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.,d Women's College Research Institute, Women's College Hospital , University of Toronto , Toronto , ON
| | - Lucia Light
- a The Ontario HIV Treatment Network , Toronto , ON , Canada
| | - Wangari Tharao
- e Women's Health in Women's Hands , Community Health Centre , Toronto , ON , Canada
| | - Sean B Rourke
- a The Ontario HIV Treatment Network , Toronto , ON , Canada.,f Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,g Centre for Urban Health Solutions , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , ON , Canada
| | - Ann N Burchell
- b Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.,g Centre for Urban Health Solutions , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , ON , Canada.,h Department of Family and Community Medicine , St. Michael's Hospital , Toronto , ON , Canada
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Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health 2015; 106:e1-e23. [PMID: 26562123 DOI: 10.2105/ajph.2015.302905] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. OBJECTIVES We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. SEARCH METHODS We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. SELECTION CRITERIA We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. DATA COLLECTION AND ANALYSIS Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. RESULTS Searches yielded 5528 references from which we included 152 studies, representing 139,757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. CONCLUSIONS Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.
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Affiliation(s)
- Angela A Aidala
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Michael G Wilson
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Virginia Shubert
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - David Gogolishvili
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Jason Globerman
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sergio Rueda
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Anne K Bozack
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Maria Caban
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sean B Rourke
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
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Collins ML, Baiardi JM, Tate NH, Rouen PA. Exploration of Social, Environmental, and Familial Influences on the Sexual Health Practices of Urban African American Adolescents. West J Nurs Res 2014; 37:1441-57. [PMID: 24942775 DOI: 10.1177/0193945914539794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite efforts to examine social influences and provide interventions that lead to safer sexual practices for African American (AA) adolescent girls, statistics have demonstrated this population continues to have the highest rates of teen pregnancy and sexually transmitted infections (STIs) including HIV when compared with adolescent girls of other races. Guided by the principles of Black Feminist Thought and Photovoice and focus group methodology, this descriptive study aimed to discover the social realities influencing a group of eight AA adolescent girls aged 15 to 19 years. Data from individual interviews and a focus group session were collected from November 11, 2012, to February 1, 2013. Analysis of selected photographs, interviews, and focus group conversations through a feminist lens suggests AA adolescents of low socioeconomic status continue to foster racial and mental inferiority stereotypes by using their sexuality as a bargaining tool for acceptance, value, and even love.
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Schwartz RM, Weber KM, Schechter GE, Connors NC, Gousse Y, Young MA, Cohen MH. Psychosocial correlates of gender-based violence among HIV-infected and HIV-uninfected women in three US cities. AIDS Patient Care STDS 2014; 28:260-7. [PMID: 24724987 DOI: 10.1089/apc.2013.0342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gender-based violence (GBV) is common among women with and at risk for HIV, yet little is known about the GBV associated psychological factors that could be modifiable through behavioral interventions. The current study examined the associations between some of these psychological factors (i.e., hopelessness, consideration of future consequences, self esteem), mental health symptoms, substance abuse, and GBV among a sample of 736 HIV-infected and sociodemographically similar uninfected participants in the Women's Interagency HIV Study (WIHS). Results indicated high rates of lifetime GBV among the sample (58%), as well as high rates of childhood sexual abuse (CSA) (22.2%). HIV-infected women were more likely to be hopeless and to experience lower consideration of future consequences as compared to uninfected women. Multivariable analysis indicated that current non-injection drug use and a history of injection drug use were the main correlates of GBV and CSA, even when other psychosocial variables were included in analytic models. Being born outside of the US reduced the likelihood of GBV and CSA. Future research directions and intervention implications are discussed.
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Affiliation(s)
- Rebecca M. Schwartz
- Department of Population Health, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York
| | - Kathleen M. Weber
- Core Center, Cook County Health and Hospital System, Chicago, Illinois
| | - Gabrielle E. Schechter
- STAR Health Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Nina C. Connors
- STAR Health Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Yolene Gousse
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | - Mary A. Young
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia
| | - Mardge H. Cohen
- Core Center, Cook County Health and Hospital System, Chicago, Illinois
- Departments of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
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Carter MW, Kraft JM, Hatfield-Timajchy K, Snead MC, Ozeryansky L, Fasula AM, Koenig LJ, Kourtis AP. The reproductive health behaviors of HIV-infected young women in the United States: A literature review. AIDS Patient Care STDS 2013; 27:669-80. [PMID: 24320012 DOI: 10.1089/apc.2013.0208] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-infected young women in the United States have important reproductive health needs that are made more complex by their HIV status. We searched Pubmed and relevant bibliographies to identify 32 articles published from 2001 to July 2012 that described the prevalence, correlates, and characteristics of the sexual activity, relationships, pregnancy intentions, HIV status disclosure, and contraceptive and condom use among US HIV-infected adolescents and young women. Our synthesis of those articles found that, like youth not infected with HIV, substantial proportions of HIV-infected youth were sexually active, and most sought romantic or sexual relationships, though their serostatus may have affected the pace of physical and emotional intimacy. Disclosure was difficult, and large proportions of HIV-infected youth had not disclosed their serostatus to recent partners. A few studies suggest that most HIV-infected young women hoped to have children in the future, but many wanted to avoid pregnancy until later. Only one study described contraceptive use among this population in detail and found that condoms were a primary method of contraception. The results point to substantial gaps in published research, particularly in the areas of pregnancy intentions and contraceptive use. Much more needs to be done in research and health services to better understand and meet the complex health needs of HIV-infected young women.
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Affiliation(s)
| | - Joan M. Kraft
- Center for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Amy M. Fasula
- Center for Disease Control and Prevention, Atlanta, Georgia
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Inconsistent condom use among HIV-positive women in the "Treatment as Prevention Era": data from the Italian DIDI study. J Int AIDS Soc 2013; 16:18591. [PMID: 24135086 PMCID: PMC3798584 DOI: 10.7448/ias.16.1.18591] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/26/2013] [Accepted: 08/14/2013] [Indexed: 12/04/2022] Open
Abstract
Introduction Translation of the evidence regarding the protective role of highly active antiretroviral therapy (HAART) on HIV sexual transmission rates into sexual behaviour patterns of HIV-infected subjects remains largely unexplored. This study aims to describe frequency of self-reported condom use among women living with HIV in Italy and to investigate the variables associated with inconsistent condom use (ICU). Methods DIDI (Donne con Infezione Da HIV) is an Italian multicentre study based on a questionnaire survey performed during November 2010 and February 2011. Women-reported frequency of condom use was dichotomized in “always” versus “at times”/“never” (ICU). Results Among 343 women, prevalence of ICU was 44.3%. Women declared a stable partnership with an HIV-negative (38%) and with an HIV-positive person (43%), or an occasional sexual partner (19%). Among the 194 women engaged in a stable HIV-negative or an occasional partnership, 51% reported fear of infecting the partner. Nonetheless, 43% did not disclose HIV-positive status. Less than 5% of women used contraceptive methods other than condoms. At multivariable analysis, variables associated with ICU in the subgroup of women with a stable HIV-negative or an occasional HIV-unknown partner were: having an occasional partner (AOR 3.51, 95% confidence interval [CI] 1.44–8.54, p=0.005), and reporting fear of infecting the sexual partner (AOR 3.20, 95% CI 1.43–7.16, p=0.004). Current use of HAART together with virological control in plasma level did not predict ICU after adjusting for demographic, behavioural and HIV-related factors. With regard to socio-demographic factors, lower education was the only variable significantly associated with ICU in the multivariate analysis (AOR 2.27, 95% CI 1.07–4.82, p=0.03). No association was found between high adherence to HAART and ICU after adjusting for potential confounders (AOR 0.89, 95% CI 0.39–2.01, p=0.78). Conclusions Currently in Italy, the use of HAART with undetectable HIV RNA in plasma as well as antiretroviral adherence is not associated with a specific condom use pattern in women living with HIV and engaged with a sero-discordant or an HIV-unknown partner. This might suggest that the awareness of the protective role of antiretroviral treatment on HIV sexual transmission is still limited among HIV-infected persons, at least in this country.
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Clum GA, Czaplicki L, Andrinopoulos K, Muessig K, Hamvas L, Ellen, and the Adolescent Medicine JM. Strategies and outcomes of HIV status disclosure in HIV-positive young women with abuse histories. AIDS Patient Care STDS 2013; 27:191-200. [PMID: 23596649 DOI: 10.1089/apc.2012.0441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings.
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Affiliation(s)
- Gretchen A. Clum
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | | | - L. Hamvas
- Washington University, St. Louis, Missouri
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Jones DJ, Lewis T, Litrownik A, Thompson R, Proctor LJ, Isbell P, Dubowitz H, English D, Jones B, Nagin D, Runyan D. Linking childhood sexual abuse and early adolescent risk behavior: the intervening role of internalizing and externalizing problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:139-50. [PMID: 22752719 PMCID: PMC3479370 DOI: 10.1007/s10802-012-9656-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A robust literature links childhood sexual abuse (CSA) to later substance use and sexual risk behavior; yet, relatively little empirical attention has been devoted to identifying the mechanisms linking CSA to risky behavior among youth, with even less work examining such processes in boys. With the aim of addressing this gap in the literature, the current study examined the indirect effect of childhood sexual abuse (CSA; from age 2 to 12) trajectory group on risky behavior at age 14 (alcohol use & sexual intercourse) via the intervening role of caregiver-reported internalizing and externalizing problems at age 12. Analyses were conducted with a subsample of youth (n = 657 sexual intercourse; n = 667 alcohol use) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a multisite prospective study of youth at risk for maltreatment. For boys and girls, there was an indirect effect from CSA to sexual intercourse through externalizing problems. The same pattern emerged for alcohol use, but only for girls. Findings did not support an indirect path through internalizing problems for either boys or girls for either outcome. Findings suggest more focal targets for prevention efforts aimed at maintaining the health and safety of maltreated boys and girls during the adolescent transition.
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Affiliation(s)
- Deborah J Jones
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Gómez CA. Preventing HIV in U.S. women and girls: a call for social action. Womens Health Issues 2012; 21:S287-94. [PMID: 22055680 DOI: 10.1016/j.whi.2011.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/30/2022]
Abstract
Successes in HIV prevention efforts in the U.S. have resulted in drastic reductions in the number of new infections in the U.S. among white gay men and injection drug users, a stabilization in overall annual rates of new HIV infections, and near eradication of mother-to child transmission of HIV. Despite this remarkable progress, the proportion of AIDS cases in women has slowly, quietly, and steadily increased from 7% in 1985 to 25% in 2008. The fact the prevention efforts have not reduced HIV spread among women suggests that targeting the individual behaviors of women to prevent HIV acquisition is not a sufficiently effective public health strategy. Interventions that more broadly address the needs of women and their families, and address the contextual factors in which HIV risk occurs are more likely to lead to measurable and sustainable progress. Over the past 30 years, we have seen the U.S. HIV epidemic in women become similar to patterns of HIV risk among women in the developing world. In 2009, 85% of women who acquired HIV became infected through sex with a man and the majority (83%) of them were non-white women. Efforts to understand these immense disparities and create gender-responsive strategies must be a priority within our National HIV/AIDS Strategy.
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Affiliation(s)
- Cynthia A Gómez
- Health Equity Institute, San Francisco State University, San Francisco, California 94132, USA.
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Van Devanter N, Duncan A, Birnbaum J, Burrell-Piggott T, Siegel K. Gender Power Inequality and Continued Sexual Risk Behavior among Racial/Ethnic Minority Adolescent and Young Adult Women Living with HIV. JOURNAL OF AIDS & CLINICAL RESEARCH 2011:003. [PMID: 23101031 PMCID: PMC3478669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Adolescent and young adult minority women account for approximately 20% of new cases of HIV in this age group each year in the United States. It is vital to understand factors that influence sexual risk behavior in this population in order to prevent secondary transmission of HIV. As part of a larger qualitative study of youths living with HIV, in- depth interviews were conducted with 26 Black and Latina young women aged 16 to 24 years, infected with HIV through heterosexual transmission. The study explored factors related to continued unprotected sex with male partners. Since learning of their HIV infection, 23% reported multiple episodes of unprotected vaginal and/or anal sex, 27% reported condom use for some but not all of the time, 42% reported condom use all of the time and 7% were not sexually active. Among the highest risk participants partner refusal to use a condom, having the same HIV sero-status as partner, negative attitudes toward condoms, beliefs about HIV transmission, and fear of disclosure to new partners were associated with risky sex. The data suggests that more research is needed to develop more intensive interventions that address the role of gender power inequity for this sub-set of young women living with HIV.
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Affiliation(s)
- Nancy Van Devanter
- Associate Professor, New York University, College of Nursing, 726 Broadway, Room 1049, New York, USA
| | - Alexandra Duncan
- Post-Doctoral Fellow, Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, 111 Market Place, Suite 850, Room 8541, Baltimore, USA
| | - Jeffrey Birnbaum
- Associate Professor, SUNY Downstate Medical Center, Department of Pediatrics & Master of Public Health Program, 450 Clarkson Avenue, Box 1241, Brooklyn, USA
| | - Tiphani Burrell-Piggott
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 W. 168th Street, 5th Floor, New York, USA
| | - Karolynn Siegel
- Professor, Columbia University Mailman School of Public Health, Center for the Psychosocial Study of Health & Illness, 722 W. 168th Street, Room 909, New York, USA
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