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Stonbraker S, Sanabria G, Tagliaferri Rael C, George M, Amesty S, Abraído-Lanza AF, Rowell-Cunsolo T, Centi S, McNair B, Bakken S, Schnall R. A pilot test of an infographic-based health communication intervention to enhance patient education among Latino persons with HIV. J Am Med Inform Assoc 2024; 31:329-341. [PMID: 37615971 PMCID: PMC10797274 DOI: 10.1093/jamia/ocad157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To pilot test an infographic-based health communication intervention that our team rigorously designed and explore whether its implementation leads to better health outcomes among Latino persons with HIV (PWH). MATERIALS AND METHODS Latino PWH (N = 30) living in New York City received the intervention during health education sessions at 3 study visits that occurred approximately 3 months apart. At each visit, participants completed baseline or follow-up assessments and laboratory data were extracted from patient charts. We assessed 6 outcomes (HIV-related knowledge, self-efficacy to manage HIV, adherence to antiretroviral therapy, CD4 count, viral load, and current and overall health status) selected according to a conceptual model that describes pathways through which communication influences health outcomes. We assessed changes in outcomes over time using quantile and generalized linear regression models controlling for the coronavirus disease 2019 (COVID-19) research pause and new patient status (new/established) at the time of enrollment. RESULTS Most participants were male (60%) and Spanish-speaking (60%); 40% of participants identified as Mixed Race/Mestizo, 13.3% as Black, 13.3% as White, and 33.3% as "other" race. Outcome measures generally improved after the second intervention exposure. Following the third intervention exposure (after the COVID-19 research pause), only the improvements in HIV-related knowledge and current health status were statistically significant. DISCUSSION AND CONCLUSION Our infographic-based health communication intervention may lead to better health outcomes among Latino PWH, but larger trials are needed to establish efficacy. From this work, we contribute suggestions for effective infographic use for patient-provider communication to enhance patient education in clinical settings.
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Affiliation(s)
- Samantha Stonbraker
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gabriella Sanabria
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Maureen George
- School of Nursing, Columbia University, New York, New York, USA
| | - Silvia Amesty
- Department of Medical Humanities and Ethics Columbia University Irving Medical Center, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - Tawandra Rowell-Cunsolo
- Sandra Rosenbaum School of Social Work, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Sophia Centi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bryan McNair
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA
- Department of Medical Humanities and Ethics Columbia University Irving Medical Center, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
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Sternberg CA, Daniel EV, Marcelin D, Chery MJ, Maddy K, Richard D, Thomas T, Ravix J, Warner J, Titus M, Francois A, Borick J, Feaster DJ, Doblecki-Lewis S, Jones DL, Alcaide ML, Dale SK. Bon Sante (Good Health): Factors Influencing PrEP Use Among Haitians/Haitian Americans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01834-9. [PMID: 38019373 DOI: 10.1007/s40615-023-01834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The HIV/AIDS epidemic has disproportionately affected Black individuals in the USA, and this health disparity has increased over time. Despite the effectiveness of pre-exposure prophylaxis (PrEP) as a prevention tool for HIV, there are disparities in its use, and uptake of this intervention remains low among racial and ethnic minorities, including Haitians/Haitian Americans. In this study, factors influencing PrEP use among Haitians/Haitian Americans in Miami, FL, are explored to provide necessary data to address disparities. METHODS The research team collaborated with local organizations to recruit 30 individuals (Haitians/Haitian Americans) between February 4 and October 1, 2021, and conducted semi-structured interviews. All interviews were audio-recorded and transcribed, and NVivo® was used to analyze the transcripts for emergent themes. RESULTS The study sample comprised 30 adults of Haitian descent in Miami, FL (50% female, approximately 67% with a high school education or more, mean age = 43.7 ± 13 years, and 74.2% born in Haiti). Four primary themes emerged from the analysis: (1) limited PrEP awareness, (2) underutilization of PrEP, (3) inadequate discussion of HIV prevention strategies, and (4) PrEP delivery encompassing barriers and facilitators for PrEP delivery and promotion strategies. CONCLUSION This study indicated that there is a critical need to increase Haitians/Haitian Americans' knowledge regarding PrEP. Health communication interventions tailored specifically for Haitians/Haitian Americans that target stigma, attitudes toward HIV, and risk perception may be significant in increasing PrEP in this population.
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Affiliation(s)
- Candice A Sternberg
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street #858, Miami, FL, 33136, USA.
| | - E Valerie Daniel
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Dora Marcelin
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Maurice Junior Chery
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Krisna Maddy
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danelle Richard
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tanya Thomas
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jovanka Ravix
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Warner
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Micaelle Titus
- Community Health and Empowerment Network, Miami, FL, USA
| | | | - Joseph Borick
- Miami Veteran's Affairs Medical Center, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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3
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Kerani RP, Lugg A, Berzins B, Gaye O, Lipira LE, Bundy C, Kwakwa H, Holmes KK, Golden MR. Post-migration HIV acquisition among african immigrants in the U.S. J Immigr Minor Health 2022; 24:1459-1468. [PMID: 35415766 PMCID: PMC9554041 DOI: 10.1007/s10903-022-01356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND African immigrants in the U.S. are more likely to have a late HIV diagnosis than U.S.-born people, potentially leading to onward transmission. We sought to determine the proportion of African-born people living with HIV (APLWH) who (1) had tested HIV negative prior to diagnosis, and (2) likely acquired HIV in the U.S. METHODS We interviewed APLWH from 2014 to 2017 and estimated the proportion with post-migration HIV acquisition based on clinical data, HIV testing history, immigration date, and behavioral data. RESULTS Of 179 participants, 113 (63%) were women. Less than half (44%) reported a negative HIV test prior to diagnosis. Among 142 (79%) participants with sufficient data to evaluate post-migration HIV acquisition, we estimate that 29% acquired HIV post-migration. Most APLWH acquire HIV prior to immigration. DISCUSSION Approximately one-quarter of APLWH acquire HIV post-migration and HIV testing is infrequent, highlighting the need for prevention efforts for African immigrants in the U.S.
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Affiliation(s)
- Roxanne P Kerani
- Department of Medicine, University of Washington, Seattle, WA, United States.
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, United States.
- Department of Epidemiology, University of Washington, Seattle, WA, United States.
- Center for AIDS and STD, Harborview Medical Center, 325 9th Ave, Box 359932, 98104, Seattle, WA, United States.
| | - Amanda Lugg
- African Services Committee, New York, NY, United States
| | - Baiba Berzins
- Division of Infectious Diseases, Northwestern University, Evanston, IL, United States
| | - Oumar Gaye
- Philadelphia Department of Public Health, Philadelphia, PA, United States
| | - Lauren E Lipira
- Department of Health Services, University of Washington, Seattle, WA , United States
- Oregon Health Authority and the Regional Research Institute, Portland State University, Portland, OR, United States
| | - Camille Bundy
- Division of Infectious Diseases, Northwestern University, Evanston, IL, United States
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Helena Kwakwa
- Philadelphia Department of Public Health, Philadelphia, PA, United States
| | - King K Holmes
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, United States
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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4
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Nguyen VT, Jatta A, Mayer R, Meier JL. Evaluation of Undiagnosed HIV Estimates Computed from the CD4 Depletion Model in a Rural, Medium-low HIV Prevalence State. AIDS Behav 2022; 26:613-622. [PMID: 34355286 DOI: 10.1007/s10461-021-03419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/25/2022]
Abstract
The CD4 depletion model estimates diagnosis delays by approximating infection date from CD4 T-cell count at diagnosis, and back-calculation can compute the proportion of undiagnosed PLWHA. The model assumes the immigration of PLWHA to the U.S. is negligible and counts as a transmission event, which may be impractical outside high prevalence states. Duration of U.S. residency among foreign-born PLWHA and diagnosis delays were compared. The impact on estimates of undiagnosed PLWHA was tested through simulation with different proportions of foreign-born people assumed to have acquired HIV abroad. In 67% of foreign-born people, the mean (SD) years of delay (9.9 (6.3)) exceeded the duration of U.S. residency (2.0 (1.9)). Additionally, inaccuracies in the estimates for proportions of undiagnosed PLWHA were pronounced when foreign-born people who acquired HIV abroad comprised 30% of diagnoses. The CD4 model inadvertently misclassified some diagnoses as in-state transmission events. Consequently, simulated results demonstrated inaccuracies and unstable calculations.
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Affiliation(s)
- V T Nguyen
- College of Public Health, University of Iowa, Iowa City, IA, USA.
- VA Connecticut Health Care System, West Haven, CT, USA.
- Yale University, Epidemiology & Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
| | - A Jatta
- Iowa Department of Public Health, Bureau of HIV, STD, and Hepatitis, Des Moines, IA, USA
| | - R Mayer
- Iowa Department of Public Health, Bureau of HIV, STD, and Hepatitis, Des Moines, IA, USA
| | - J L Meier
- College of Public Health, University of Iowa, Iowa City, IA, USA
- College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
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5
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Murphy D, Philpot S, Brown G, Prestage G. Domestic mobility and experiences of disconnection from sexual health care among gay and bisexual men in Australia: insights from a qualitative study. Sex Health 2021; 18:508-511. [PMID: 34915979 DOI: 10.1071/sh21191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous research on mobility and HIV acquisition among gay and bisexual men (GBM) has focused on: (1) changed sexual practices in the context of travel; and (2) the association between migration and increased HIV risk. To date, little attention has been given to continuity of sexual health and HIV-prevention services in the context of relocating between different cities or regions within the same country. METHODS Drawing on in-depth interviews with 17 GBM recently diagnosed with HIV, we explored these men's access to sexual health care in the period prior to diagnosis. RESULTS At least five of these 17 men's accounts provided examples of becoming disconnected from sexual health care because of mobility within Australia. For some men, this disconnection from care also included loss of access to pre-exposure prophylaxis (PrEP). In all these men's accounts, reconnection with services only came about at the time of seeking the HIV test associated with their diagnosis. The fact that men who had previously been well connected to sexual health services (as indicated by early uptake of PrEP, or regular HIV/STI testing) did not easily access similar services after relocating suggest that there are other factors - such as the social and physical environment - that have an important bearing on retention in sexual health care. CONCLUSIONS There is a need for more comprehensive data collection related to mobility in order to ascertain its relative importance. Regarding policy and practice, there are also opportunities for a more formalised process for interstate referral of clients of sexual health services.
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Affiliation(s)
- Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Steven Philpot
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Graham Brown
- Centre for Social Impact, UNSW Sydney, Sydney, NSW 2052, Australia
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Gousse Y, Wilson TE, McFarlane D, Browne RC, Fraser M, Yusim D, Stewart M, Salifu MO, Joseph MA. HIV Testing Correlates: U.S. and Foreign Born High-Risk Black Heterosexual Men. J Immigr Minor Health 2021; 23:1145-1151. [PMID: 33507520 PMCID: PMC9796172 DOI: 10.1007/s10903-021-01140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/30/2022]
Abstract
In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors among Black heterosexual men in Brooklyn, New York. Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33 years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.
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Affiliation(s)
- Yolene Gousse
- Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY, USA,Brooklyn Health Disparities Center, Brooklyn, NY, USA,Department of Pharmacy Administration and Public Health, Dr. Andrew J. Bartilucci Center, St. John’s University, 8000 Utopia Parkway, New York, NY 11439, USA
| | - Tracey E. Wilson
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Davin McFarlane
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Special Treatment and Research Program, College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Marilyn Fraser
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Arthur Ashe Institute for Urban Health, Brooklyn, NY, USA
| | - Diana Yusim
- Baystate Medical Center, Springield, MA, USA
| | - Mark Stewart
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,School of Graduate Studies, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Moro O. Salifu
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Division of Nephrology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael A. Joseph
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Munck HNM, Qvist T, Helleberg M, Kaye PS, Pichon F, Cowan S. At-Risk Groups of Men Who Have Sex With Men Can Be Reached Through Community-Based HIV Testing in Denmark. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:439-449. [PMID: 34369829 DOI: 10.1521/aeap.2021.33.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study evaluates whether the community-based HIV testing clinic Checkpoint could reach at-risk groups of men who have sex with men (MSM) and link patients to care. A prospective observational study of all Checkpoint visits during 2013-2016 and a retrospective registry study of all MSM diagnosed with HIV in Denmark during the same period were conducted. One percent of the 9,074 tests in Checkpoint were HIV-positive, accounting for 19% of all new HIV diagnoses among MSM in Denmark. Checkpoint testers reported frequent condomless anal sex. Two percent of migrant Checkpoint testers were HIV-positive compared to 1 % among Danish MSM. HIV-positive MSM identified through Checkpoint were significantly younger, more of them were migrant, and a smaller proportion were late testers compared to those testing through the conventional health care system. Checkpoint reaches at-risk populations of MSM and links patients successfully to care.
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Affiliation(s)
| | - Tavs Qvist
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Susan Cowan
- Department of Sexually Transmitted Infections and Blood-Borne Viruses, Statens Serum Institut, Copenhagen, Denmark
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Tordoff DM, Buskin S, Lechtenberg R, Golden MR, Kerani RP, Herbeck JT. Combining traditional and molecular epidemiology methods to quantify local HIV transmission among foreign-born residents. AIDS 2021; 35:655-664. [PMID: 33315589 PMCID: PMC7904617 DOI: 10.1097/qad.0000000000002783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We evaluated the ability for molecular epidemiology to augment traditional HIV surveillance beyond the detection of clusters for outbreak investigation. To do this, we address a question of interest to Public Health - Seattle and King County: what proportion of HIV diagnoses among people born outside of the United States are acquired locally? DESIGN King County residents diagnosed with HIV, 2010-2018. METHODS We linked HIV-1 pol gene sequences to demographic information obtained from the National HIV Surveillance System, Public Health - Seattle and King County case investigation and partner services interviews. We determined the likely location of HIV acquisition based on HIV testing, travel histories and cluster-based molecular analyses. RESULTS Among 2409 people diagnosed with HIV, 798 (33%) were born outside of the United States. We inferred the location of acquisition for 77% of people born outside of the United States: 26% likely acquired HIV locally in King County (of whom 69% were MSM, 16% heterosexual), and 51% likely acquired HIV outside of King County (primarily outside of the United States). Of this 77% of people for whom we inferred the location of HIV acquisition, 45% were determined using traditional epidemiology methods and an additional 32% were inferred using molecular epidemiology methods. CONCLUSION We found that the National HIV Surveillance System misclassified the majority of HIV-infected foreign-born residents as 'new' local infections, and that these cases contribute to an overestimate of local incidence. Our findings highlight how molecular epidemiology can augment traditional HIV surveillance activities and provide useful information to local health jurisdictions beyond molecular cluster detection.
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Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology
- International Clinical Research Center, Department of Global Health, University of Washington
| | - Susan Buskin
- Department of Epidemiology
- HIV/STD Program, Public Health – Seattle & King County
| | | | - Matthew R. Golden
- Department of Epidemiology
- HIV/STD Program, Public Health – Seattle & King County
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Roxanne P. Kerani
- Department of Epidemiology
- HIV/STD Program, Public Health – Seattle & King County
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua T. Herbeck
- International Clinical Research Center, Department of Global Health, University of Washington
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Correlates of Casual Sex Amidst Vulnerability to HIV Among ACB Heterosexual Men in Ottawa and Windsor, Ontario Canada. J Racial Ethn Health Disparities 2021; 9:444-455. [PMID: 33559111 PMCID: PMC7870027 DOI: 10.1007/s40615-021-00975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/23/2022]
Abstract
Heterosexual exposure is the second highest means of HIV transmission; and African, Caribbean, and Black (ACB) men face greater risks. Black men can reduce the disproportionately high HIV prevalence in their communities by changing their socially misconstrued masculine role. We analysed factors predisposing heterosexual ACB men to risky sexual behaviour, particularly multiple casual sex partnerships in Ottawa and Windsor, Ontario, Canada. We employed quantitative datasets from a broader mixed methods study within hierarchical logistic regression model to determine the association between psychosocial factors and casual sex partnerships. The model controlled for city level clustering effect and sociodemographic factors. Precisely 55.0% (n = 52) of men in Windsor and 70.2% (n = 99) in Ottawa had one or more casual sex partners within the past year. Some of them (Windsor, 32.1% [n = 18], and Ottawa, 34.3% [n = 36]) used condom always. HIV knowledge (OR = 0.80, p < 0.01, CI = 0.67/0.95) and pro-Black community attitudes (OR = 0.72, p < 0.05, CI = 0.56/0.94) decreased the odds of casual sex partnerships, while traditional masculinity scores (OR = 1.21, p < 0.05, CI = 1.01/1.46) increased it. The behavioural factors jointly predicted casual sex more than sociodemographic variables and city of residence. We conclude that heterosexual ACB men are predisposed to casual sex partnerships at differing magnitude across cities, and this may constitute a risk factor for HIV exposure. Hence, propagation of HIV knowledge, community attitudes and reconstruction of masculine ideology among ACB men, with due attention to geopolitical differences in city of residence, are recommended.
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10
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Kerani RP, Satcher Johnson A, Buskin SE, Rao D, Golden MR, Hu X, Hall HI. The Epidemiology of HIV Among People Born Outside the United States, 2010-2017. Public Health Rep 2020; 135:611-620. [PMID: 32805191 DOI: 10.1177/0033354920942623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although some studies have reported a higher incidence of HIV infection among non-US-born people than among US-born people, national data on this topic are scarce. We compared the epidemiology of HIV infection between US-born and non-US-born residents of the United States and examined the characteristics of non-US-born people with diagnosed HIV infection by region of birth (ROB). METHODS We used a cross-sectional study design to produce national, population-based data describing HIV infection among US-born and non-US-born people. We analyzed National HIV Surveillance System data for people with HIV infection diagnosed during 2010-2017 and reported to the Centers for Disease Control and Prevention (CDC). We compared data on demographic characteristics, transmission risk category, and stage 3 infection (AIDS) classification within 3 months of HIV diagnosis, by nativity and ROB. RESULTS During 2010-2017, 328 317 children and adult US residents were diagnosed with HIV infection and were reported to CDC: 214 973 (65.5%) were US-born, 50 301 (15.3%) were non-US-born, and 63 043 (19.2%) were missing data on country of birth. After adjusting for missing country of birth, 266 147 (81.1%) people were US-born and 62 170 (18.9%) were non-US-born. This group accounted for 15 928 of 65 645 (24.2%) HIV diagnoses among girls and women and 46 242 of 262 672 (17.6%) HIV diagnoses among boys and men. A larger percentage of non-US-born people than US-born people had stage 3 infection (AIDS) at HIV diagnosis (31.2% vs 23.9%). Among non-US-born people with HIV diagnoses, 19 876 (39.5%) resided in the South. CONCLUSIONS Characterizing non-US-born people with HIV infection is essential for developing effective HIV interventions, particularly in areas with large immigrant populations.
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Affiliation(s)
- Roxanne P Kerani
- 7284 Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA.,7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Buskin
- 7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- 7284 Department of Global Health, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- 7284 Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA.,7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Xiaohong Hu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Irene Hall
- Division of HIV/AIDS 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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11
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Adedimeji A, Shi Q, Haddad L, Holman S, Edmonds A, Weber K, Kassaye S, Karim R, Bolivar H, Reid M, Kempf M, Golub E, Hoover DR, Anastos K. Women from afar: an observational study of demographic characteristics and mortality among foreign-born women living with HIV in the Women's Interagency HIV Study (WIHS) in the United States 1994-2016. J Int AIDS Soc 2020; 23:e25486. [PMID: 32437092 PMCID: PMC7241263 DOI: 10.1002/jia2.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Foreign-born persons comprise ~13% of the US population. Immigrants, especially women, often face a complex set of social and structural factors that negatively impact health outcomes including greater risk of HIV infection. We described socio-demographic, clinical and immunological characteristics and AIDs and non-AIDS death among foreign-born women living with HIV (FBWLWH) participating in the US Women's Interagency HIV Study (WIHS) in the US from 1994 to 2016. We hypothesized that FBW will experience higher AIDS-related mortality compared to US-born women (USBW). METHODS The WIHS is a multicenter prospective observational cohort study of mostly women living with HIV (WLWH). The primary exposure in this analysis, which focused on 3626 WLWH, was self-reported country of birth collapsed into foreign-born and US born. We assessed the association of birthplace with categorized demographic, clinical and immunological characteristics, and AIDS/non-AIDS mortality of WLWH, using chi-squared tests. Proportional hazard models examined the association of birthplace with time from enrolment to AIDS and non-AIDS death. RESULTS Of the 628 FBW, 13% were born in Africa, 29% in the Caribbean and 49% in Latin America. We observed significant differences by HIV status in socio-demographic, clinical and immunological characteristics and mortality. For both AIDS and non-AIDS caused deaths FBW WLWH had lower rates of death. Adjusting for year of study enrolment and other demographic/clinical characteristics mitigated FBW's statistical survival advantage in AIDS deaths Relative Hazard (RH = 0.91 p = 0.53), but did not substantively change the survival advantage in non-AIDS deaths RH = 0.33, p < 0.0001). CONCLUSION Foreign-born WLWH exhibited demographic, clinical and immunological characteristics that are significantly different compared with women born in the US or US territory. After adjusting for these characteristics, the FB WLWH had a significantly lower hazard of non-AIDS but not AIDS mortality compared to women born in the US or a US territory. These findings of non-increased mortality can help inform models of care to optimize treatment outcomes among FBWLWH in the United States.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
| | - Qiuhu Shi
- Department of Epidemiology and Community HealthSchool of Health Sciences and PracticeNew York Medical CollegeValhallaNYUSA
| | - Lisa Haddad
- Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaGAUSA
| | - Susan Holman
- State University of New YorkDownstate Medical CenterBrooklynNYUSA
| | - Andrew Edmonds
- Department of EpidemiologyThe University of North Carolina at Chapel HillNCUSA
| | | | - Seble Kassaye
- Department of Infectious DiseasesGeorgetown UniversityWashingtonDCUSA
| | - Roksana Karim
- Division of Disease Prevention, Policy and Global HealthKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Michael Reid
- Institute of Global Health SciencesDivision of HIV, Infectious Disease and Global MedicineUniversity of California at San FranciscoCAUSA
| | - Mirjam‐Colette Kempf
- Schools of Nursing, Public Health and MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Elizabeth Golub
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
- Department of MedicineMontefiore Medical CenterBronxNYUSA
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12
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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13
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HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence. Curr Opin Infect Dis 2019; 31:25-32. [PMID: 29095720 DOI: 10.1097/qco.0000000000000415] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Migrants living in high-income countries are disproportionately affected by HIV infection and frequently have characteristics associated with poor HIV clinical outcomes. HIV epidemiology among migrants is influenced by changes in migration patterns and variations in transmission risk behaviors. Here we review the recently published literature on known HIV outcomes among migrants from low-income and middle-income countries living in high-income countries. RECENT FINDINGS High proportions of migrants acquire HIV after migration, and this group frequently presents to care late. Once established in care, migrants are often more likely to experience worse HIV treatment outcomes compared with native populations. Multiple individual and structural factors influence HIV diagnosis and treatment outcomes among migrants, including disruption of social networks, increased sexual risk behaviors, communication barriers, limited access to care, and stigma. Few studies have examined interventions targeted at improving HIV outcomes among migrants. SUMMARY Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.
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Oliphant SM, Donaldson LP. A Community-Based Participatory Approach to Understanding HIV/AIDS in the Ethiopian Community. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:557-569. [PMID: 31264535 DOI: 10.1080/19371918.2019.1635944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The rate of HIV/AIDS in Washington, D.C remains at epidemic levels and is most prevalent in the black community, with foreign-born blacks accounting for an increasing proportion of HIV infections in the Washington DC area. The Ethiopian community is among the subgroups that are especially impacted by HIV/AIDS. Yet, seldom does research on the epidemiology of HIV/AIDS break data into diverse subgroups, accounting for the distinct needs based on cultural or ethnic differences. This paper reports on the qualitative findings from a community participatory action research study that involved interviewing 60 Ethiopian-immigrants and nine community-based providers about their attitudes toward HIV/AIDS, and to elicit their ideas about how to improve HIV/AIDS prevention, promotion, and treatment approaches targeting the Ethiopian community. Findings show that stigma remains the largest barrier to accessing HIV/AIDS treatment among Ethiopians in the Washington, D.C. area. Therefore, strategies to reduce HIV/AIDS must address stigmatizing beliefs and be met with cultural sensitivity when developing community prevention and treatment outreach programs designed to reduce HIV/AIDS among Ethiopians.
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Affiliation(s)
| | - Linda Plitt Donaldson
- National Catholic School of Social Service, Catholic University of America , Washington , DC , USA
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15
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Ross J, Akiyama MJ, Slawek D, Stella J, Nichols K, Bekele M, Cunningham CO, Blackstock OJ. Undocumented African Immigrants' Experiences of HIV Testing and Linkage to Care. AIDS Patient Care STDS 2019; 33:336-341. [PMID: 31194578 DOI: 10.1089/apc.2019.0036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the United States, undocumented African immigrants living with HIV enter care late, potentially leading to adverse individual and population health outcomes, yet little is known about the specific experiences of HIV diagnosis and linkage to care among this population. We conducted individual, semi-structured interviews with adults who were undocumented African immigrants living with HIV in New York City. Interviews explored perspectives regarding individual, social, institutional, and societal barriers and facilitators of HIV testing and linkage to care. Of 14 participants from 9 different African countries, 9 were women and the median age was 44 years (interquartile range: 42-50). Participants described fear of discovery by immigration authorities as a substantial barrier to HIV testing and linking to initial medical appointments. Actual and perceived structural barriers to both testing and care linkage included difficulty obtaining health insurance and a belief that undocumented immigrants are ineligible for any health services. Participants also expressed reluctance to be tested because of HIV-related stigma within the immigrant communities that they heavily relied on. After diagnosis, however, participants overwhelmingly described a positive role of health and social service providers in facilitating linkage to HIV care. Concerns about immigration status and HIV-related stigma are significant barriers to HIV testing and linkage to care among undocumented African immigrants. Multilevel efforts to reduce stigma and increase awareness of available services could enhance rates of HIV testing and care linkage in this population.
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Affiliation(s)
- Jonathan Ross
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Matthew J. Akiyama
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Deepika Slawek
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jennifer Stella
- Division of Hospital Medicine, Zuckerberg San Francisco General/University of California, San Francisco, San Francisco, California
| | - Kim Nichols
- African Services Committee, New York, New York
| | | | - Chinazo O. Cunningham
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Oni J. Blackstock
- New York City Department of Health and Mental Hygiene, New York, New York
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16
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Demeke HB, Johnson AS, Wu B, Nwangwu-Ike N, King H, Dean HD. Differences Between U.S.-Born and Non-U.S.-Born Black Adults Reported with Diagnosed HIV Infection: United States, 2008-2014. J Immigr Minor Health 2019; 21:30-38. [PMID: 29374815 DOI: 10.1007/s10903-018-0699-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite improvements in its treatment, HIV infection continues to affect Blacks disproportionally. Using National HIV Surveillance System data from 50 U.S. states and the District of Columbia, we examined demographic and epidemiologic differences between U.S.-born and non-U.S.-born Black adults. Of 110,452 Black adults reported with diagnosed HIV during 2008-2014 with complete country of birth information, 11.1% were non-U.S.-born. Non-U.S.-born were more likely to be older, female, have HIV infection attributed to heterosexual contact, have been diagnosed late, and live in the northeastern U.S. region. During 2014, the HIV diagnosis rate among African-born Black females was 1.4 times the rate of U.S.-born Black males, 2 times the rate of African-born Black males, and 5.3 times the rate of U.S.-born Black females. We elucidate the differences between U.S.-born and non-U.S.-born Blacks on which to base culturally appropriate HIV-prevention programs and policies.
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Affiliation(s)
- Hanna B Demeke
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE., Mail Stop E-07, Atlanta, GA, 30329, USA.
| | - Anna S Johnson
- Division of HIV/AIDS Prevention (DHAP) at NCHHSTP, CDC, Atlanta, GA, USA
| | - Baohua Wu
- DHAP, NCHHSTP, CDC, Atlanta, GA, USA
| | | | - Hope King
- Division of Viral Hepatitis, NCHHSTP, CDC, Atlanta, GA, USA
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17
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Sexual Migration and HIV Risk in a Sample of Brazilian, Colombian and Dominican Immigrant MSM Living in New York City. J Immigr Minor Health 2019; 21:115-122. [PMID: 29497902 DOI: 10.1007/s10903-018-0716-7] [Citation(s) in RCA: 5] [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
We examined motivations for migration to the United States (US) among 482 Brazilian, Colombian, and Dominican men who have sex with men (MSM). Participants' most common reason for migration was to improve their financial situation (49%), followed by sexual migration in order to affirm their sexual orientation (40%). Fewer endorsed sexual migration motivated by avoiding persecution due to being gay (13%). We conducted further analyses among 276 participants who migrated after age 15 and were HIV-negative at the time of migration. We hypothesized that sexual migration would be associated with greater likelihood of HIV acquisition post-migration. Hierarchical logistic regression analysis indicated that sexual migration motivated by avoiding persecution due to being gay was associated with increased odds of contracting HIV after arrival in the US whereas sexual migration to lead a gay life was not. Our findings highlight the importance of addressing the negative impact of anti-gay discrimination in countries of origin.
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18
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Kerani RP, Herbeck JT, Buskin SE, Dombrowksi JC, Bennett A, Barash E, Barbee LA, Golden MR. Evidence of Local HIV Transmission in the African Community of King County, Washington. J Immigr Minor Health 2018; 19:891-896. [PMID: 27395379 DOI: 10.1007/s10903-016-0458-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the frequency of ongoing HIV transmission within U.S. African immigrant communities. We used HIV surveillance and partner services data to describe African-born persons newly reported with HIV infection in King County (KC), WA from 1/1/2010 to 12/31/2013. We performed phylogenetic clustering analysis of HIV-1 pol to identify putative transmission events within this population. From 2010 to 2013, 1148 KC adults were reported with HIV, including 102 (9 %) born in Africa. Forty-one African-born cases were interviewed and reported diagnosis after arrival in the U.S. Fourteen (34 %) reported ≥1 negative test prior to diagnosis, and 9 (26 %) reported ≥1 negative test after U.S. arrival. Pol genotypes were available for seven of these nine. For two of these seven, a KC case was the nearest phylogenetic neighbor; two others were infected with subtype B virus. We found substantial evidence of ongoing HIV transmission in the African community of KC.
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Affiliation(s)
- Roxanne P Kerani
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan E Buskin
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julia C Dombrowksi
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Amy Bennett
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Elizabeth Barash
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Lindley A Barbee
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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From Structural Analysis to Pragmatic Action: The Meso-level Modifiable Social Determinants of HIV Vulnerability for Labor Migrants. SOCIAL ASPECTS OF HIV 2018. [DOI: 10.1007/978-3-319-63522-4_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Barrington C, Gandhi A, Gill A, Villa Torres L, Brietzke MP, Hightow-Weidman L. Social networks, migration, and HIV testing among Latinos in a new immigrant destination: Insights from a qualitative study. Glob Public Health 2017; 13:1507-1519. [PMID: 29199546 DOI: 10.1080/17441692.2017.1409783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Latinos in the U.S. are disproportionately affected by HIV and are more likely than non-Latinos to present with a late diagnosis, which delays engagement in HIV care and treatment. Social networks may provide normative influence and social support for HIV testing, but a contextualised understanding of networks is needed in order to maximise these social resources. We conducted qualitative interviews with foreign-born Latino men and transgender women (n = 17) in a new immigrant destination to explore their social networks. Most participants described having smaller social networks after migrating. Networks included both local and transnational ties, but most participants had few close ties. Contextual factors including stigma and geographic dispersion limited the re-construction of networks with close ties after migration. HIV testing was not a common topic of discussion with social network ties. Efforts to improve early uptake of HIV testing among Latino immigrants may benefit from engaging with social networks, but such efforts need to address how the context in which networks operate enables access to testing.
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Affiliation(s)
- Clare Barrington
- a Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,b Carolina Population Center , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Anisha Gandhi
- c New York City Department of Health and Mental Hygiene , Queens , NY , USA.,d Department of Sociomedical Sciences, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Adrienne Gill
- a Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Laura Villa Torres
- a Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Maria Priscila Brietzke
- a Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Lisa Hightow-Weidman
- a Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,e School of Medicine, Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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21
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Abstract
BACKGROUND In the United States (US), foreign-born persons are disproportionately affected by HIV and differ epidemiologically from US-born persons with diagnosed HIV infection. Understanding HIV transmission dynamics among foreign-born persons is important to guide HIV prevention efforts for these populations. We conducted molecular transmission network analysis to describe HIV transmission dynamics among foreign-born persons with diagnosed HIV. METHODS Using HIV-1 polymerase nucleotide sequences reported to the US National HIV Surveillance System for persons with diagnosed HIV infection during 2001-2013, we constructed a genetic distance-based transmission network using HIV-TRACE and examined the birth region of potential transmission partners in this network. RESULTS Of 77,686 people, 12,064 (16%) were foreign born. Overall, 28% of foreign-born persons linked to at least one other person in the transmission network. Of potential transmission partners, 62% were born in the United States, 31% were born in the same region as the foreign-born person, and 7% were born in another region of the world. Most transmission partners of male foreign-born persons (63%) were born in the United States, whereas most transmission partners of female foreign-borns (57%) were born in their same world region. DISCUSSION These finding suggests that a majority of HIV infections among foreign-born persons in our network occurred after immigrating to the United States. Efforts to prevent HIV infection among foreign-born persons in the United States should include information of the transmission networks in which these individuals acquire or transmit HIV to develop more targeted HIV prevention interventions.
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Ross J, Hanna DB, Felsen UR, Cunningham CO, Patel VV. Emerging from the database shadows: characterizing undocumented immigrants in a large cohort of HIV-infected persons. AIDS Care 2017; 29:1491-1498. [PMID: 28343404 DOI: 10.1080/09540121.2017.1307921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about how HIV affects undocumented immigrants despite social and structural factors that may place them at risk of poor HIV outcomes. Our understanding of the clinical epidemiology of HIV-infected undocumented immigrants is limited by the challenges of determining undocumented immigration status in large data sets. We developed an algorithm to predict undocumented status using social security number (SSN) and insurance data. We retrospectively applied this algorithm to a cohort of HIV-infected adults receiving care at a large urban healthcare system who attended at least one HIV-related outpatient visit from 1997 to 2013, classifying patients as "screened undocumented" or "documented". We then reviewed the medical records of screened undocumented patients, classifying those whose records contained evidence of undocumented status as "undocumented per medical chart" (charted undocumented). Bivariate measures of association were used to identify demographic and clinical characteristics associated with undocumented immigrant status. Of 7593 patients, 205 (2.7%) were classified as undocumented by the algorithm. Compared to documented patients, undocumented patients were younger at entry to care (mean 38.5 years vs. 40.6 years, p < 0.05), less likely to be female (33.2% vs. 43.1%, p < 0.01), less likely to report injection drug use as their primary HIV risk factor (3.4% vs. 18.0%, p < 0.001), and had lower median CD4 count at entry to care (288 vs. 339 cells/mm3, p < 0.01). After medical record review, we re-classified 104 patients (50.7%) as charted undocumented. Demographic and clinical characteristics of charted undocumented did not differ substantially from screened undocumented. Our algorithm allowed us to identify and clinically characterize undocumented immigrants within an HIV-infected population, though it overestimated the prevalence of patients who were undocumented.
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Affiliation(s)
- Jonathan Ross
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center , Bronx , USA
| | - David B Hanna
- b Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , USA
| | - Uriel R Felsen
- c Division of Infectious Diseases, Department of Medicine , Montefiore Medical Center , Bronx , USA
| | - Chinazo O Cunningham
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center , Bronx , USA
| | - Viraj V Patel
- a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center , Bronx , USA
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Afulani PA, Torres JM, Sudhinaraset M, Asunka J. Transnational ties and the health of sub-Saharan African migrants: The moderating role of gender and family separation. Soc Sci Med 2016; 168:63-71. [PMID: 27639482 DOI: 10.1016/j.socscimed.2016.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/02/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022]
Abstract
Recent scholarship has focused on the role that cross-border social and economic ties play in shaping health outcomes for migrant populations. Nevertheless, the extant empirical work on this topic has paid little attention to the health impacts of cross-border separation from close family members. In this paper we examine the association between cross-border ties-and cross-border separation-with the health of sub-Saharan African (SSA) migrant adults living in metropolitan France using data from the nationally representative "Trajectoire et Origines" survey (n = 1980 SSA migrants). In logistic regression analyses we find that remitting money and having a child abroad are each associated with poor health among women, but not men. The effect of remittances on health is also modified by the location of one's children: remittance sending is associated with poor health only for SSA-migrants separated from their children. These findings underscore the importance of examining both cross-border connection and cross-border separation in studies of immigrant health, and also underscore the heterogeneous relationships between cross-border ties and health for men and women. This is the first study to our knowledge that examines the relationship between cross-border ties and health for migrants in Europe, with a focus on SSA-migrants in France. These findings have important implications for the health of the growing immigrant and refugee populations in Europe and around the globe.
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Affiliation(s)
- Patience A Afulani
- School of Medicine, University of California, San Francisco, United States.
| | - Jacqueline M Torres
- Center for Health and Community, University of California, San Francisco, United States
| | - May Sudhinaraset
- School of Medicine, University of California, San Francisco, United States
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Leung MR, Chin JJ, Petrescu-Prahova M. Involving immigrant religious organizations in HIV/AIDS prevention: The role of bonding and bridging social capital. Soc Sci Med 2016; 162:201-9. [PMID: 27372709 DOI: 10.1016/j.socscimed.2016.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
Immigrant religious organizations in the United States are uniquely positioned to address critical issues beyond religion because of their moral, social and cultural prominence in community life. Increasingly, religious organizations have taken on a leadership role around health issues such as decreasing HIV/AIDS stigma and misinformation. However, there are barriers for some religious leaders and organizations in adopting new health programs, especially if the issue is seen as controversial. Our study examines how social network structures among religious members influence organizational acceptance of new information or controversial ideas, like HIV/AIDS. Using social network analysis methods on data from 2841 contacts in 20 immigrant Chinese Buddhist temples and Christian churches in New York City, we tested whether an immigrant religious organization's likelihood of being involved in HIV/AIDS activities was associated with the presence of bonding or bridging social capital. These two forms of social capital have been found to mediate the levels of exposure and openness to new ideas. We found HIV/AIDS-involved religious organizations were more likely to have lower levels of bonding social capital as indicated by members having fewer ties and fewer demographic attributes in common. We also found HIV/AIDS-involved religious organizations were more likely to have higher levels of bridging social capital as indicated by members having significantly more ties to people outside of their organization. Our study highlights the importance of looking beyond religion type and leadership attributes to social network structures among members in order to better explain organization-level receptiveness to HIV/AIDS involvement.
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Affiliation(s)
- ManChui R Leung
- Sociology, School of Public Health, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195, United States.
| | - John J Chin
- Urban Affairs and Planning, Hunter College, City University of New York, 695 Park Avenue, W1611, New York, NY 10065, United States.
| | - Miruna Petrescu-Prahova
- School of Public Health, Health Promotion Research Center, University of Washington, 1107 NE 45th St., Suite 200, Seattle, WA 98105, United States.
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Myers TR, Lin X, Skarbinski J. Antiretroviral Therapy and Viral Suppression Among Foreign-Born HIV-Infected Persons Receiving Medical Care in the United States: A Complex Sample, Cross-Sectional Survey. Medicine (Baltimore) 2016; 95:e3051. [PMID: 26986128 PMCID: PMC4839909 DOI: 10.1097/md.0000000000003051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Immigrants to the United States are more likely to be diagnosed with human immunodeficiency virus (HIV) infection compared with native-born persons. Navigating access to healthcare in the United States can be challenging for foreign-born persons, and HIV treatment outcomes may be suboptimal for these persons. We compared characteristics of and assessed disparities in clinical outcomes of foreign-born persons in care for HIV in the United States. The Medical Monitoring Project is a complex sample, cross-sectional survey designed to be nationally representative of HIV-infected adults receiving medical care in the United States. Using data from 2009, 2010, and 2011, we conducted descriptive analyses and multivariable logistic regression to assess associations between foreign-born status and antiretroviral therapy (ART) prescription, and between foreign-born status and viral suppression. In all, 13.4% of HIV-infected persons were self-identified as foreign-born; the most common regions of birth were Central America and Mexico (45.4%) and the Caribbean (16.0%). Nearly 90% of foreign-born persons were diagnosed with HIV after entry into the United States. Compared with US-born persons, foreign-born persons were more likely to be younger, Hispanic, less educated, and uninsured. The prevalence of ART prescription (prevalence ratio 1.00; 95% confidence interval 0.98-1.02) was not significantly different between foreign-born and US-born persons. A higher percentage of foreign-born persons achieved viral suppression compared with US-born persons (prevalence ratio 1.05; 95% confidence interval 1.00-1.09). No major disparities in ART prescription and viral suppression were found between foreign-born and US-born HIV-infected persons receiving medical care, despite higher percentages being uninsured.
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Affiliation(s)
- Tanya R Myers
- From the Division of Healthcare Quality and Promotion (TRM); and Division of HIV/AIDS Prevention (XL, JS); and Epidemic Intelligence Service (XL), Centers for Disease Control and Prevention, Atlanta, GA
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