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Watson L, Haley D, Turpin R, Ma T, Nguyen QC, Mittal M, Dyer T. Exploring Psychosocial and Structural Syndemic Effects as Predictors of HIV Risk Behaviors Among Black Women (HPTN 064). J Womens Health (Larchmt) 2024; 33:816-826. [PMID: 38501235 DOI: 10.1089/jwh.2023.0458] [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] [Indexed: 03/20/2024] Open
Abstract
Background: Syndemic models have been used in previous studies exploring HIV-related outcomes; however, these models do not fully consider intersecting psychosocial (e.g., substance use, depressive symptoms) and structural factors (unstable housing, concentrated housing vacancy) that influence the lived experiences of women. Therefore, there is a need to explore the syndemic effects of psychosocial and structural factors on HIV risk behaviors to better explain the multilevel factors shaping HIV disparities among black women. Methods: This analysis uses baseline data (May 2009-August 2010) from non-Hispanic black women enrolled in the HIV Prevention Trials Network 064 Women's Seroincidence Study (HPTN 064) and the American Community Survey 5-year estimates from 2007 to 2011. Three parameterizations of syndemic factors were applied in this analysis a cumulative syndemic index, three syndemic groups reflecting the level of influence (psychosocial syndemic group, participant-level structural syndemic group, and a neighborhood-level structural syndemic group), and syndemic factor groups. Clustered mixed effects log-binomial analyses measured the relationship of each syndemic parameterization on HIV risk behaviors in 1,347 black women enrolled in HPTN 064. Results: A higher syndemic score was significantly associated with increased prevalence of unknown HIV status of the last male sex partner (adjusted prevalence ratio (aPR) = 1.07, 95% confidence interval or CI 1.04-1.10), involvement in exchange sex (aPR = 1.17, 95% CI: 1.14-1.20), and multiple sex partners (aPR = 1.07, 95% CI: 1.06-1.09) in the last 6 months. A dose-response relationship was observed between the number of syndemic groups and HIV risk behaviors, therefore, being in multiple syndemic groups was significantly associated with increased prevalence of reporting HIV risk behaviors compared with being in one syndemic group. In addition, being in all three syndemic groups was associated with increased prevalence of unknown HIV status of the last male sex partner (aPR = 1.67, 95% CI: 1.43-1.95) and multiple sex partners (aPR = 1.53, 95% CI: 1.36-1.72). Conclusions: Findings highlight syndemic factors influence the lived experiences of black women.
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Affiliation(s)
- Lakeshia Watson
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Danielle Haley
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Quynh C Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Mona Mittal
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
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Jennings Mayo-Wilson L, Peterson SK, Kiyingi J, Nabunya P, Sensoy Bahar O, Yang LS, Witte SS, Ssewamala FM. Examining Cash Expenditures and Associated HIV-Related Behaviors Using Financial Diaries in Women Employed by Sex Work in Rural Uganda: Findings from the Kyaterekera Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5612. [PMID: 37174132 PMCID: PMC10178413 DOI: 10.3390/ijerph20095612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Women employed by sex work (WESW) have a high risk of human immunodeficiency virus (HIV) infection and experience economic barriers in accessing care. However, few studies have described their financial lives and the relationship between expenditures and HIV-related behaviors. METHODS This exploratory study used financial diaries to collect expenditure and income data from WESW in Uganda over 6 months. Data were collected as part of a larger trial that tested the efficacy of an HIV prevention intervention method. Descriptive statistics were used to quantify women's income, relative expenditures, and negative cash balances. Bivariate and multivariate logistic regressions were used to examine the odds of sexual risk behavior or use of HIV medications for several cash scenarios. RESULTS A total of 163 WESW were enrolled; the participants mean age was 32 years old. Sex work was the sole source of employment for most WESW (99%); their average monthly income was $62.32. Food accounted for the highest proportion of spending (44%) followed by sex work (20%) and housing expenditures (11%). WESW spent the least on health care (5%). Expenditures accounted for a large but variable proportion of these women's income (56% to 101%). Most WESW (74%) experienced a negative cash balance. Some also reported high sex work (28%), health care (24%), and education (28%) costs. The prevalence of condomless sex (77%) and sex with drugs/alcohol (70%) was high compared to use of ART/PrEP (Antiretroviral therapy/Pre-exposure prophylaxis) medications (45%). Women's cash expenditures were not statistically significantly associated with HIV-related behaviors. However, the exploratory study observed a consistent null trend of lower odds of condomless sex (adjusted odds ratio (AOR) = 0.70, 95% confidence interval (CI): 0.28-1.70), sex with drugs/alcohol (AOR = 0.93, 95% CI: 0.42-2.05), and use of ART/PrEP (AOR = 0.80, 95% CI: 0.39-1.67) among women who experienced a negative cash balance versus those who did not. Similar trends were observed for other cash scenarios. CONCLUSION Financial diaries are a feasible tool to assess the economic lives of vulnerable women. Despite having paid work, most WESW encountered a myriad of financial challenges with limited spending on HIV prevention. Financial protections and additional income-generating activities may improve their status. More robust research is needed to understand the potentially complex relationship between income, expenditures, and HIV risk among vulnerable sex workers.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of Health Behavior, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Summer K. Peterson
- Department of Health Behavior, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
- International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
- International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
- International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda
| | - Lyla S. Yang
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA
| | - Susan S. Witte
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
- International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda
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Awareness of HIV serostatus by sex partners of women living with HIV in North-Central Nigeria: correlates and predictive analyses. J Biosoc Sci 2022; 54:572-582. [PMID: 34162450 PMCID: PMC8702574 DOI: 10.1017/s0021932021000262] [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: 01/03/2023]
Abstract
Non-communication of HIV status among sex partners is a notable hurdle in halting transmission, largely due to socio-cultural factors. This study aimed to predict the determinants of male partners' awareness of women's serostatus. A total of 8825 women of reproductive age living with HIV who were clients at five comprehensive HIV treatment centres in Benue State, North-Central Nigeria were surveyed between June and December 2017, and 6655 reported having a sexual partner at the time of the survey selected for analysis. A regression model was used to estimate the determinants of male partner awareness of serostatus from the perspective of women. Conditional marginal analyses were conducted to evaluate the marginal effects of identified predictors on the probability of outcomes. Partners of married women were found to have greater odds of being aware of their spouse's serostatus (adjusted OR (aOR): 3.20; 95%CI: 2.13-4.81) than non-married partners. Similarly, the odds of male partner awareness increased with the years women had been on antiretroviral therapy (aOR: 1.13; 95%CI: 1.07-1.20). The probability of partners of married respondents being aware of their spouse's HIV serostatus was 97%. The conditional marginal effects of being educated to primary or higher level were 1.2 (95% CI: -0.2 to 2.7) and 1.8 (95% CI: 0.09-3.4) percentage points higher respectively when compared with women with no formal education. Being unemployed or being a trader significantly decreased the probability of partners being aware of respondents' serostatus when compared with farmers; conditional marginal effects of -6.7 (95% CI: -12.0 to -1.4) and -3.9 (95% CI: -5.7 to -2.2) percentage points, respectively. The study found that relationship status and girl-child education are factors that can improve communication of HIV status to sex partners. Policies and interventions aimed at improving the social determinants of health, and social support for healthy communications in relationships, are recommended to reduce HIV transmission between sex partners.
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Ojikutu BO, Mayer KH. Hidden in Plain Sight: Identifying Women Living in the United States Who Could Benefit From HIV Preexposure Prophylaxis. J Infect Dis 2021; 222:1428-1431. [PMID: 31549150 DOI: 10.1093/infdis/jiz416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/12/2019] [Indexed: 01/12/2023] Open
Abstract
HIV preexposure prophylaxis (PrEP) with oral tenofovir/emtricitabine is an effective means of decreasing human immunodeficiency virus (HIV) acquisition among women. However, few women are prescribed and are taking PrEP. This article offers perspectives on barriers to use and strategies to increase uptake among women.
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Affiliation(s)
- B O Ojikutu
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Infectious Disease Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - K H Mayer
- Harvard Medical School, Boston, Massachusetts.,The Fenway Institute, Boston, Massachusetts.,Department of Medicine, Beth Israel Lahey Health, Boston, Massachusetts
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Reducing HIV Risk Behaviors Among Black Women Living With and Without HIV/AIDS in the U.S.: A Systematic Review. AIDS Behav 2021; 25:732-747. [PMID: 32918639 DOI: 10.1007/s10461-020-03029-3] [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] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
This systematic review provides an examination of the status of HIV/AIDS prevention interventions for Black, heterosexual women in the U.S. from 2012 to 2019. Using PRISMA guidelines, 28 interventions were identified. Over half of the interventions were: conducted in the southern region of the U.S.; evaluated using a randomized controlled trial; focused on adults; used a group-based intervention delivery; were behaviorally focused and theoretically driven. None included biomedical strategies of PrEP, nPEP, and TasP. Few interventions included adolescent or aging Black women; none included their sex/romantic partners. Future studies dedicated to addressing the specific needs of subpopulations of Black, heterosexual women may provide opportunities to expand and/or tailor current and future HIV/AIDS prevention interventions, including offering participants with options to choose which, and the level of involvement, of their sex/romantic partner(s) in their sexual health decision-making. While strides to improve HIV prevention efforts with Black, heterosexual women have occurred, more is needed.
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Ojikutu BO, Amutah-Onukagha N, Mahoney TF, Tibbitt C, Dale SD, Mayer KH, Bogart LM. HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States. AIDS Behav 2020; 24:2927-2934. [PMID: 32239358 DOI: 10.1007/s10461-020-02843-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative cross-sectional survey. Among NSHBC participants, 522 were women and 347 (69.0%) reported HIV risk factors. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The HIV-Related Medical Mistrust Scale item: "there is a cure for HIV, but the government is withholding it from the poor" was independently associated with higher PrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention.
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Affiliation(s)
- B O Ojikutu
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard School of Medicine, Boston, MA, USA.
| | | | - T F Mahoney
- School of Public Health, Boston University, Boston, MA, USA
| | - C Tibbitt
- Tufts University School of Medicine, Boston, MA, USA
| | - S D Dale
- University of Miami Medical Center, Miami, FL, USA
| | - K H Mayer
- The Fenway Institute, Boston, MA, USA
- Beth Israel Lahey Medical Center, Boston, MA, USA
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Leblanc NM, Alexander K, Carter S, Crean H, Ingram L, Kobie J, McMahon J. The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center. ACTA ACUST UNITED AC 2020; 1:132-142. [PMID: 32617533 PMCID: PMC7325490 DOI: 10.1089/whr.2019.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | - Kamila Alexander
- Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Hugh Crean
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | | | - James Kobie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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Loosier PS, Haderxhanaj L, Beltran O, Hogben M. Food Insecurity and Risk Indicators for Sexually Transmitted Infection Among Sexually Active Persons Aged 15-44, National Survey of Family Growth, 2011-2017. Public Health Rep 2020; 135:270-281. [PMID: 32031921 DOI: 10.1177/0033354920904063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Food insecurity is linked to poor sexual health outcomes, especially among persons engaged in sexual behaviors that are associated with the risk of acquiring sexually transmitted infections (STIs). We examined this link using nationally representative data. METHODS We used data on adolescents and adults aged 15-44 who reported sexual activity in the past year from 6 years (September 2011-September 2017) of cross-sectional, weighted public-use data from the National Survey of Family Growth. We compared data on persons who did and did not report food insecurity, accounting for demographic characteristics, markers of poverty, and past-year STI risk indicators (ie, engaged in 1 of 4 high-risk activities or diagnosed with chlamydia or gonorrhea). RESULTS Respondents who reported at least 1 past-year STI risk indicator were significantly more likely to report food insecurity (females: adjusted risk ratio [ARR] = 1.63; 95% confidence interval [CI], 1.35-1.97; P < .001; males: ARR = 1.46; 95% CI, 1.16-1.85) than respondents who did not report food insecurity. This finding was independent of the association between food insecurity and markers of poverty (≤100% federal poverty level [females: ARR = 1.46; 95% CI, 1.23-1.72; P < .001; males: ARR = 1.81; 95% CI, 1.49-2.20; P < .001]; if the respondent or someone in the household had received Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program benefits in the past year [females: ARR = 3.37; 95% CI, 2.81-4.02; P < .001; males: ARR = 3.27; 95% CI, 2.76-3.87; P < .001]). Sex with opposite- and same-sex partners in the past year was significantly associated with food insecurity (females: ARR = 1.44; 95% CI, 1.11-1.85; P = .01; males: ARR = 1.99; 95% CI, 1.15-3.42; P = .02). CONCLUSIONS Food insecurity should be considered a social determinant of health independent of poverty, and its effect on persons at highest risk for STIs, including HIV, should be considered when planning interventions designed to decrease engagement in higher-risk sexual behaviors.
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Affiliation(s)
- Penny S Loosier
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura Haderxhanaj
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Oscar Beltran
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Hogben
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Almirol EA, McNulty MC, Schmitt J, Eavou R, Taylor M, Tobin A, Ramirez K, Glick N, Stamos M, Schuette S, Ridgway JP, Pitrak D. Gender Differences in HIV Testing, Diagnosis, and Linkage to Care in Healthcare Settings: Identifying African American Women with HIV in Chicago. AIDS Patient Care STDS 2018; 32:399-407. [PMID: 30277816 DOI: 10.1089/apc.2018.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Women account for 25% of all people living with HIV and 19% of new diagnoses in the United States. African American (AA) women are disproportionately affected. Yet, differences in the care continuum entry are not well understood between patient populations and healthcare sites. We aim to examine gender differences in diagnosis and linkage to care (LTC) in the Expanded HIV Testing and Linkage to Care (X-TLC) program within healthcare settings. Data were collected from 14 sites on the South and West sides of Chicago. Multivariate logistic regression analysis was used to determine the differences in HIV diagnoses and LTC by gender and HIV status. From 2011 to 2016, X-TLC performed 281,017 HIV tests; 63.7% of those tested were women. Overall HIV seroprevalence was 0.57%, and nearly one third (29.4%) of HIV-positive patients identified were cisgender women. Of newly diagnosed HIV-positive women, 89% were AA. 58.5% of new diagnoses in women were made at acute care hospitals, with the remainder at community health centers. Women who were newly diagnosed had a higher baseline CD4 count at diagnosis compared with men. Overall, women had lower odds of LTC compared with men (adjusted odds ratio = 0.58, 95% confidence interval 0.44-0.78) when controlling for patient demographics and newly versus previously diagnosed HIV status. Thus, interventions that focus on optimizing entry into the care continuum for AA women need to be explored.
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Affiliation(s)
- Ellen A. Almirol
- Global Center for Children and Families, UCLA Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Moira C. McNulty
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - Jessica Schmitt
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - Rebecca Eavou
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - Michelle Taylor
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - Audra Tobin
- Public Health Institute of Metropolitan, Chicago, Chicago, Illinois
| | - Kimberly Ramirez
- Division of Infectious Diseases, Mt. Sinai Hospital, Chicago, Illinois
| | - Nancy Glick
- Division of Infectious Diseases, Mt. Sinai Hospital, Chicago, Illinois
| | - Madison Stamos
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | | | - Jessica P. Ridgway
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - David Pitrak
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
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Pellowski JA, Huedo-Medina TB, Kalichman SC. Food Insecurity, Substance Use, and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1899-1907. [PMID: 28429158 PMCID: PMC5650554 DOI: 10.1007/s10508-017-0942-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/02/2023]
Abstract
People living with HIV in poverty have limited tangible and mental resources coupled with competing demands for these resources. Competing demands require individuals to make choices that may be beneficial to them in the short term but not in the long term. Past research has shown that food insecurity is related to sexual risk behaviors among people living with HIV. Individuals who are food insecure may sell sex in order to obtain food or lack of food may lead to a depletion of mental resources to negotiate safe sex. Substance use may also create additional constraints on these already limited resources. The current study tested the relation between food insecurity and day-level sexual risk behavior and the possible mediating role that alcohol/substance use may play. Men and women living with HIV were enrolled in a 28-day prospective study between October 2012 and April 2014 in which they completed daily text message surveys regarding their sex behaviors and substance/alcohol use in the context of sex. A total of 796 participants reported sex on 3894 days. On days in which sex occurred, baseline food insecurity was negatively associated with daily condom use. There was also a significant effect of substance use in the context of sex on the rates of change in condom use over time, and this interaction between substance use and time was a partial mediator of the relation between food insecurity and condom use. Gender did not moderate this mediation. Situation-specific alcohol and drug use should be integrated into interventions that target food insecurity and HIV prevention.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, 2nd Floor, Providence, RI, 02903, USA.
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences and Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Kiertiburanakul S, Wongprasit P, Phuphuakrat A, Chotiprasitsakul D, Sungkanuparph S. Prevalence of HIV infection, access to HIV care, and response to antiretroviral therapy among partners of HIV-infected individuals in Thailand. PLoS One 2018; 13:e0198654. [PMID: 29949594 PMCID: PMC6021083 DOI: 10.1371/journal.pone.0198654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 04/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background Health care providers usually focus on index HIV-infected patients and seldom obtain information from their partners. We aimed to determine HIV-preventative measures among couples, the prevalence of HIV infection, and treatment outcomes of partners. Methods This cross-sectional study was conducted in two hospital settings, a university hospital in Bangkok and a general hospital in northeastern Thailand, from January 2011-October 2015. Factors associated with serodiscordant relationships were determined by logistic regression. Results A total of 393 couples were enrolled for analysis; 156 (39.7%) were serodiscordant. The median relationship duration of serodiscordant couples was shorter than that of seroconcordant couples (6.4 years vs 11.6 years, p < 0.001). Of 237 HIV-infected partners, 17.7% had AIDS-defining illness, the median nadir CD4 count (interquartile range) was 240 (96–427) cells/mm3, 83.5% received antiretroviral therapy (ART), 98.3% had adherence > 95%, 90.3% had undetectable HIV RNA, and 22.9% had a prior history of treatment failure. There was no significant difference in condom usage in the prior 30 days between serodiscordant and seroconcordant couples. Factors of index HIV-infected patients associated with serodiscordant relationships were younger age (odds ratio [OR] 1.04 per 5 years; 95% confidence interval [CI] 1.01–1.06), receiving care at the general hospital (OR 1.73; 95% CI 1.08–2.78), a shorter duration of relationship (OR 1.04 per year; 95% CI 1.01–1.07), a higher nadir CD4 count (OR 1.06 per 50 cells/mm3; 95% CI 1.1–1.13), and not receiving a protease inhibitor-based regimen (OR 2.04; 95% CI 1.06–3.96). Conclusions A high number of serodiscordant couples was determined. Partners’ information should be retrieved as a holistic approach. Interventions for minimizing HIV transmission within serodiscordant couples should be evaluated and implemented.
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Affiliation(s)
- Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
- * E-mail:
| | | | - Angsana Phuphuakrat
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Darunee Chotiprasitsakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
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Vermund SH, Hamilton EL, Griffith SB, Jennings L, Dyer TV, Mayer K, Wheeler D. Recruitment of Underrepresented Minority Researchers into HIV Prevention Research: The HIV Prevention Trials Network Scholars Program. AIDS Res Hum Retroviruses 2018; 34:171-177. [PMID: 29145745 PMCID: PMC5806068 DOI: 10.1089/aid.2017.0093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Most U.S. investigators in the HIV Prevention Trials Network (HPTN) have been of majority race/ethnicity and sexual orientation. Research participants, in contrast, have been disproportionately from racial/ethnic minorities and men who have sex with men (MSM), reflecting the U.S. epidemic. We initiated and subsequently evaluated the HPTN Scholars Program that mentors early career investigators from underrepresented minority groups. Scholars were affiliated with the HPTN for 12-18 months, mentored by a senior researcher to analyze HPTN study data. Participation in scientific committees, trainings, protocol teams, and advisory groups was facilitated, followed by evaluative exit surveys. Twenty-six trainees have produced 17 peer-reviewed articles to date. Research topics typically explored health disparities and HIV prevention among black and Hispanic MSM and at-risk black women. Most scholars (81% in the first five cohorts) continued HIV research after program completion. Alumni reported program-related career benefits and subsequent funding successes. Their feedback also suggested that we must improve the scholars' abilities to engage new research protocols that are developed within the network. Mentored engagement can nurture the professional development of young researchers from racial/ethnic and sexual minority communities. Minority scientists can benefit from training and mentoring within research consortia, whereas the network research benefits from perspectives of underrepresented minority scientists.
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Affiliation(s)
- Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | | | | | - Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Typhanye V. Dyer
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
| | - Kenneth Mayer
- Fenway Health, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Darrell Wheeler
- School of Social Welfare, University at Albany State University of New York, Albany, New York
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Aaron E, Blum C, Seidman D, Hoyt MJ, Simone J, Sullivan M, Smith DK. Optimizing Delivery of HIV Preexposure Prophylaxis for Women in the United States. AIDS Patient Care STDS 2018; 32:16-23. [PMID: 29323558 PMCID: PMC5756936 DOI: 10.1089/apc.2017.0201] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Preexposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, it is underutilized among women who are at risk for acquisition of HIV. Women comprise one in five HIV diagnoses in the United States, and significant racial disparities in new HIV diagnoses persist. The rate of new HIV diagnoses among black and African American women in 2015 was 16 times greater than that of white women. These disparities highlight the importance of HIV prevention strategies for women, including the use of PrEP. PrEP is the first highly effective HIV prevention method available to women that is entirely within their control. However, because so few women who may benefit from PrEP are aware of it, few women's healthcare providers offer PrEP to their patients, PrEP has not yet achieved its potential to reduce HIV infections in women. This article describes individual and systemic barriers for women related to the uptake of PrEP services; explains how providers can identify women at risk for HIV; reviews how to provide PrEP to women; and outlines client-centered models for HIV prevention services. Better access to culturally acceptable and affordable medical and social services may offer support to women for consistent and ongoing use of PrEP. This discussion may be used to inform HIV prevention activities for women and guide interventions to decrease racial/ethnic disparities in rates of HIV infection among US women.
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Affiliation(s)
- Erika Aaron
- Drexel University College of Medicine, Division of ID/HIV Medicine, Philadelphia, Pennsylvania
| | - Cori Blum
- Howard Brown Health Center, Chicago, Illinois
| | - Dominika Seidman
- San Francisco General Hospital, University of California San Francisco, Department of OB/GYN, Reproductive Services, San Francisco, California
| | - Mary Jo Hoyt
- Francois-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Joanne Simone
- Francois-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Meg Sullivan
- Boston University School of Medicine, Boston, Massachusetts
| | - Dawn K. Smith
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Graves SK, Little SJ, Hoenigl M. Risk profile and HIV testing outcomes of women undergoing community-based testing in San Diego 2008-2014. Sci Rep 2017; 7:42183. [PMID: 28165056 PMCID: PMC5292713 DOI: 10.1038/srep42183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/06/2017] [Indexed: 11/09/2022] Open
Abstract
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing.
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Affiliation(s)
- Susannah K. Graves
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
| | - Susan J. Little
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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15
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Frew PM, Parker K, Vo L, Haley D, O'Leary A, Diallo DD, Golin CE, Kuo I, Soto-Torres L, Wang J, Adimora AA, Randall LA, Del Rio C, Hodder S. Socioecological factors influencing women's HIV risk in the United States: qualitative findings from the women's HIV SeroIncidence study (HPTN 064). BMC Public Health 2016; 16:803. [PMID: 27530401 PMCID: PMC4988035 DOI: 10.1186/s12889-016-3364-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. Methods We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18–44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices. Results The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. Conclusions Multilevel syndemic factors contribute to women’s vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk. Trial registration Clinicaltrials.gov, NCT00995176
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Affiliation(s)
- Paula M Frew
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA. .,Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA. .,Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA. .,Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA.
| | - Kimberly Parker
- Department of Health Studies, Texas Woman's University, CFO Bldg - 1007, PO Box 425499, Denton, TX, 76204, USA
| | - Linda Vo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA
| | - Danielle Haley
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA
| | - Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | | | - Carol E Golin
- Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Washington, DC, USA
| | - Jing Wang
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA
| | - Laura A Randall
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA.,Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.,Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA
| | - Sally Hodder
- West Virginia University School of Medicine, One Medical Center Drive, HSC-South 2244, Morgantown, WV, 26506, USA
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Elion R, Coleman M. The preexposure prophylaxis revolution: from clinical trials to routine practice: implementation view from the USA. Curr Opin HIV AIDS 2016; 11:67-73. [PMID: 26599165 PMCID: PMC4670271 DOI: 10.1097/coh.0000000000000222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This article describes the use of tenofovir/emtricitabine (Truvada) as prevention for exposure to HIV [preexposure prophylaxis (PrEP)] infection in the USA. The use of PrEP and the challenges of implementation are very instructive as other countries adopt this intervention and it becomes a fundamental part of worldwide efforts for HIV prevention and much can be learned from the first 3 years in the USA. RECENT FINDINGS Randomized trials and demonstration projects have shown the benefits of PrEP for men and women who are at risk for HIV. Numerous studies have showed that the level of prevention is excellent when the drug is taken at least four times weekly, once adequate levels are obtained. However, adherence remains a critical issue as well as tailoring delivery models for specific populations. Six recent studies are discussed, that support excellent efficacy and significantly support PrEP as a means of prevention. These projects have shown high acceptance of PrEP with excellent adherence by individuals demonstrated by those at risk remaining free of HIV over extended periods of time. SUMMARY The USA faces three significant challenges in scaling up PrEP. The first challenge in implementation in the USA is to get individuals to recognize the actual risks that their behaviors represent and to engage with providers to address these issues. The second challenge is getting a population of providers to recognize the exact same issues and offer PrEP in a compassionate, nonjudgmental fashion. The third challenge is identifying the set of providers and locations to scale-up the response in a timely, cost-effective fashion.
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Affiliation(s)
- Richard Elion
- aGeorge Washington University School of Medicine bWhitman Walker Health, Washington, District of Columbia, USA
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