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Ribeiro LCS, Freitas MIDF, Paiva MS. Representations about sexuality of people diagnosed late with HIV infection. Rev Bras Enferm 2021; 74:e20201028. [PMID: 34320144 DOI: 10.1590/0034-7167-2020-1028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand the representations about sexuality of people diagnosed late with HIV infection and its implications in the delayed search for diagnosis. METHODS this is a qualitative study, whose theoretical and methodological framework was Social Representation Theory. The research was carried out with 18 people diagnosed late with HIV infection through an open interview. For data analysis, Structural Narration Analysis was used, with support from MAXQDA 12®. RESULTS representations about sexuality contributed to delayed diagnosis, such as trust in a fixed partnership, sexual intercourse is natural, sexuality as a taboo, search for pleasure in sexual intercourse, regardless of risks, denial of risk for HIV infection. FINAL CONSIDERATIONS representations about sexuality participate in a web of stereotypes and riskier ways of living, which contribute to delayed diagnosis. Sexual health education remains necessary and essential throughout people's lives.
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Abstract
Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1-5), mean age was 25 (SD = 6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2(df = 1) = 11.07, p = .001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR] = 0.62 (95% CI 0.39-0.97), p = 0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.
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Gibbs SE, Kusunoki Y, Moreau C. Sexual Activity and Weekly Contraceptive Discontinuation and Selection Among Young Adult Women in Michigan. JOURNAL OF SEX RESEARCH 2019; 56:977-984. [PMID: 30632833 PMCID: PMC6625930 DOI: 10.1080/00224499.2018.1556239] [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] [Indexed: 06/09/2023]
Abstract
Understanding young women's contraceptive and pregnancy prevention behaviors is important for helping women and their partners control if and when they have children. Prior research on associations between patterns of sexual activity and contraceptive behaviors is limited. We assessed the influence of recent sexual activity on discontinuation and selection of specific contraceptive methods. We used weekly data from the Relationship Dynamics and Social Life (RDSL) study, a longitudinal 2.5-year population-based project that sampled woman ages 18 and 19 (N = 1,003) in one Michigan county. We estimated logistic and multinomial regression models that accounted for clustering of weekly observations within partnerships and women. Weekly discontinuation of longer-acting methods declined with increasing sexual activity in the past month, as did discontinuation of shorter-acting hormonal methods. Sexual activity was associated with decreased selection of condoms relative to other methods. Future research into life events that lead to changes in the frequency of sexual activity may provide insight into times when women are at risk of contraceptive discontinuation. These findings underscore the importance of anticipatory guidance in contraceptive counseling so that when women change their contraceptive behavior they are equipped in advance with resources to make safe transitions between methods.
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Affiliation(s)
- Susannah E. Gibbs
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205
- Present address: College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR 97331
| | - Yasamin Kusunoki
- School of Nursing, Department of Systems, Populations and Leadership, Institute for Social Research, Population Studies Center and Survey Research Center, University of Michigan, 400 North Ingalls Building Room 4156, Ann Arbor, MI 48109-5482
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205
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Gibbs SE, Kusunoki Y, Colantuoni E, Moreau C. Sexual activity and weekly contraceptive use among young adult women in Michigan. Population Studies 2019; 73:233-245. [PMID: 30721643 DOI: 10.1080/00324728.2018.1552985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Past studies on the influence of sexual activity on contraceptive behaviours are inconclusive, relying heavily on cross-sectional data. We used a population-based longitudinal sample of young women in Michigan to evaluate weekly associations between sexual activity and contraceptive use at three levels of measurement: comparing between women, among individual women's partnerships, and from week to week within partnerships. We used multinomial logistic regression accounting for correlations within partnerships and women. Relative to use of least effective methods, weekly sexual activity was significantly associated with increased use of condoms, pills, and highly effective methods. For pills and highly effective methods, partnership-, woman-, and week-level effects were similar. For condoms, there was no significant woman-level effect. Evidence of immediate effects of sexual activity on contraceptive use highlights the importance of longitudinal data. These dynamics may be diluted or missed altogether when relying on cross-sectional data approaches that compare groups of individuals.
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Stopka TJ, Brinkley-Rubinstein L, Johnson K, Chan PA, Hutcheson M, Crosby R, Burke D, Mena L, Nunn A. HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South. JMIR Public Health Surveill 2018; 4:e35. [PMID: 29615383 PMCID: PMC5904450 DOI: 10.2196/publichealth.8773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/21/2018] [Accepted: 02/04/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. OBJECTIVE The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. METHODS We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. RESULTS There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92). CONCLUSIONS We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
- Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
| | - Kendra Johnson
- Mississippi State Department of Health, Jackson, MS, United States
| | - Philip A Chan
- School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Brown University, Providence, RI, United States
| | - Marga Hutcheson
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
| | - Richard Crosby
- College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Deirdre Burke
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
| | - Leandro Mena
- John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Amy Nunn
- School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Brown University, Providence, RI, United States
- Rhode Island Public Health Institute, Providence, RI, United States
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Hill MJ, Holt M, Hanscom B, Wang Z, Cardenas-Turanzas M, Latkin C. Gender and race as correlates of high risk sex behaviors among injection drug users at risk for HIV enrolled in the HPTN 037 study. Drug Alcohol Depend 2018; 183:267-274. [PMID: 29316523 PMCID: PMC5803307 DOI: 10.1016/j.drugalcdep.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sexual contact has been shown to be a major mode of HIV transmission among people who inject drugs (PWID). This study examined gender and racial differences among PWID' sexual risk behaviors from the perspective of sexual scripts. METHODS 696 PWID enrolled from Philadelphia on HPTN 037 were classified as engaging in high-risk sex behaviors if they reported having sex in the past 30 days and condomless sex with a non-primary partner, giving/receiving sex for money, or multiple partners. A multivariable logistic regression model was used to assess associations between demographic factors and high risk sex. RESULTS Findings of the multivariable regression analysis demonstrated that being White (OR = 0.52, p < 0.001) and male (OR = 0.59, p = 0.002) were protective of high risk sex, while homelessness (OR = 1.7, p = 0.005), and being single (OR = 1.83, p = 0.006) were positively associated with high risk sex. African American (AA) women were 1.7 times more likely to report high-risk sex than AA men (p = 0.002), 3.28 times more likely than White men (p < 0.001), and 1.93 times more likely than White women (p < 0.001). CONCLUSIONS Since AA women report high-risk sex behaviors more than other demographic groups, behavioral interventions for HIV risk reduction among PWID may benefit from focusing on sex-risk reduction among AA women.
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Affiliation(s)
- Mandy J. Hill
- McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Michael Holt
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Brett Hanscom
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Zhe Wang
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | | | - Carl Latkin
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Mathews C, Kalichman MO, Laubscher R, Hutchison C, Nkoko K, Lurie M, Kalichman SC. Sexual relationships, intimate partner violence and STI partner notification in Cape Town, South Africa: an observational study. Sex Transm Infect 2017; 94:144-150. [PMID: 29191815 PMCID: PMC5870461 DOI: 10.1136/sextrans-2017-053434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/11/2017] [Indexed: 11/10/2022] Open
Abstract
Objectives We aimed to identify individual and sexual partnership characteristics associated with partner notification (PN) among people with STI. We hypothesised that PN would be less likely in more casual sexual partnerships and in partnerships with intimate partner violence (IPV). Methods We conducted an observational study among the first 330 patients with STI enrolled in a trial of a behavioural intervention to reduce STI incidence, at a clinic in a poor, Cape Town community. We included 195 index patients (those reporting STI symptoms), and conducted longitudinal analyses using participant-completed questionnaires on the day of diagnosis and 2 weeks later. Using partnership data for five recent sexual partners, we assessed factors associated with reported PN with logistic regressions, adjusting for repeated measurements on the same participant for each partner. Results The sample included 99 males with 303 partners and 96 females with 158 partners. Males reported perpetrating IPV in 46.2% of partnerships. Females reported being IPV victims in 53.2% of partnerships. Males notified 58.1%, females 75.4% of partners during the 2 weeks following diagnosis. Type of partner was an independent correlate of PN for males and females, with the odds of PN lower in more casual partnerships. For males, reporting physical IPV perpetration in the partnership was an independent correlate of PN. For females, there was no association between IPV victimisation in a partnership and PN. Conclusions Efforts to decrease the pool of infectious partners need to have a strong focus on the promotion of PN in casual relationships and one-night stands. IPV was not identified as a barrier to PN. In future, we need to investigate the association between IPV with an objective measure of PN success such as partner testing or treatment, or index patient reinfection. Clinical trial registration PACTR201606001682364; Pre-results.
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Affiliation(s)
- Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Cameron Hutchison
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Koena Nkoko
- City of Cape Town Health Department, Cape Town, South Africa
| | - Mark Lurie
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
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Carlos S, Lopez-Del Burgo C, Burgueño E, Martinez-Gonzalez MA, Osorio A, Ndarabu A, Passabosc C, de Irala J. Male condom use, multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC). AIDS Care 2016; 29:772-781. [PMID: 27852108 DOI: 10.1080/09540121.2016.1258450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case-control study. From December 2010 until June 2012, 1630 participants aged 15-49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and 'any condom use' (OR = 2.99; 95%CI: 2.14-4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR = 3.58, 95%CI:2.31-5.56) than the association found between never condom use and HIV (OR = 3.38, 95%CI:1.15-9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.
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Affiliation(s)
- Silvia Carlos
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
| | - Cristina Lopez-Del Burgo
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
| | - Eduardo Burgueño
- d CEFA-Monkole , Kinshasa , Democratic Republic of the Congo.,e Department of Family Medicine and Primary Health Care , UPC - Protestant University in Congo, Kinshasa , Democratic Republic of the Congo
| | - Miguel Angel Martinez-Gonzalez
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,f CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Spanish Government (ISCIII) , Madrid , Spain
| | - Alfonso Osorio
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain.,g School of Education and Psychology , University of Navarra , Pamplona , Spain
| | - Adolphe Ndarabu
- h Monkole Hospital , Kinshasa, Democratic Republic of the Congo
| | - Clément Passabosc
- i Department of Ophthalmology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Jokin de Irala
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
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