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Luu M, Haardörfer R, Nehl E, Escoffery C, Sales J. Factors associated with intention of HIV testing among Asian American men: a path analysis. J Behav Med 2024; 47:849-863. [PMID: 38980458 DOI: 10.1007/s10865-024-00502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/01/2024] [Indexed: 07/10/2024]
Abstract
Research has pointed to myriad cultural and socio-psychological factors associated with HIV testing, such as acculturation, social norms about HIV testing, masculinity, homonegativity, and constructs from the Theory of Planned Behavior. However, the interrelationships of these factors on the intentions of HIV testing among the population of Asian American men remains unknown. A dataset of 425 Asian American men in the U.S., collected online with convenience sampling method during 2020-2021, was analyzed to test a conceptual framework that aimed to fill this gap. Results from a path model with two endogenous variables (homonegativity and HIV testing intention) indicated that perceived social norms about HIV testing, attitude about HIV testing, and perceived HIV risk had directandindirect relationships with the intentions of HIV testing in the study population. However, social norms about HIV testing and perceived HIV risk showed stronger direct effects (standardized estimates = 0.37 and 0.34, respectively, p-value < 0.001). Additionally, we found that the relationships of these factors with HIV testing intention were also mediated by homonegativity. Findings from this study advance our understanding of pathways of associations between a host of cultural and socio-psychological factors with HIV testing intention among an understudied population - Asian American men. Our results will help inform the development of future intervention programs to increase HIV testing in this population.
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Affiliation(s)
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, USA
| | - Eric Nehl
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, USA
| | - Jessica Sales
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, USA
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Gázquez-López M, Álvarez-Serrano MA, Martín-Salvador A, Pérez-Morente MÁ, García-García I, González-García A, Martínez-García E. Attitudes towards people living with HIV/AIDS through the EAPVVS-E: A descriptive analysis in nursing students. NURSE EDUCATION TODAY 2024; 144:106418. [PMID: 39316862 DOI: 10.1016/j.nedt.2024.106418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Despite advances in antiretroviral treatment, stigma towards people with HIV/AIDS continues to exist. Nursing students, as future key players in health care, must advocate for the elimination of stigma through education, empathy and the creation of a supportive environment. This holistic approach is crucial to improving their quality of life and moving towards the eradication of HIV/AIDS. AIM To identify nursing students' attitudes towards people living with HIV or AIDS and their relationship with sociodemographic and academic-cultural variables of the participants. DESIGN A cross-sectional study was performed. SETTINGS The research was carried out in the Nursing Degree of the Faculty of Health Sciences of the Ceuta Campus of the University of Granada. PARTICIPANTS Convenience sampling was used to recruit 284 students of the degree in Nursing. METHODS Data were collected voluntarily and on an anonymous basis, using the "Attitudes Towards People Living with HIV/AIDS Scale in Nursing Students". Bivariate and multivariate analyses were performed. RESULTS Factors 1 (Professional Practice), 2 (Social Integration) and 3 (Partner and Family) exhibited mean scores considered to be favourable attitudes (>4 points). In contrast, Factor 4, called Benevolent Stigma, had a mean score of 3.68 ± 0.97. Religious beliefs, academic year, sexual orientation, academic practices and age are considered influential variables in the different factors. CONCLUSIONS Nursing students present attitudes with favourable scores. However, these results highlight the importance of influencing the different factors, especially in the second year of the Bachelor's Degree in Nursing in our sample. Thus, an educational intervention in this area would be necessary to reinforce the values of humanised care.
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Affiliation(s)
- María Gázquez-López
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | | | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; Virgen de las Nieves University Hospital, 18014 Granada, Spain
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Cruz Neto J, Maia AC, de Siqueira Holanda VM, de Sousa AR, de Lima Carvalho CM, Brasil EGM, da Silva KA, Mendes IAC, de Sousa ÁFL. From HIV to Mpox: Socio-discursive Analysis of Communicable Diseases, Stigma, and Pathologization in Sexual Minorities in Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02968-5. [PMID: 39227499 DOI: 10.1007/s10508-024-02968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 09/05/2024]
Abstract
Discrimination and stigma are significant barriers to healthcare for the LGBTQIAPN+ community, necessitating a deeper analysis of their sociocultural causes. There is a notable gap in the literature regarding the understanding of socio-discursive representations and their impact on the stigmatization and pathologization of sexual minorities in the context of communicable diseases. This study aims to discuss the understanding of the sociodiscursive aspects of the health-disease process, particularly in stigmatized infectious diseases affecting the LGBTQIAPN+ community. The focus is on examining how news articles, or the set of analyzed texts (corpus), shape these perceptions. We conducted documentary research with a qualitative and discursive approach using news articles retrieved from Google NewsⓇ about diseases affecting the LGBTQIAPN+ population from 2011 to 2022. The analysis was based on critical discourse analysis, processed using MAXQDA and IRAMUTEQ software. The identified representations predominantly align with biomedical ideology, manifesting in a discourse that normalizes and medicalizes (normative-curative discourse), and notable for its pathologizing and stigmatizing nature. Six classes were found: Ethical professional dilemmas facing stigma, infection and contamination of the LGBT+ population, prejudice and discrimination in the form of information, stigma related to sexual behavior/orientation, Vulnerability and stigma related to infectious diseases, and strategies for minimizing health risk/stigma for the LGBT+ public. The most relevant analytical categories were related to infectious diseases and sexual identity. These themes were identified, indicating that media representations reinforce stigma and maintain unequal health practices (verticalization) for the LGBT+ community. Understanding these patterns within a broader historical context is crucial for promoting health education and strategies that challenge internalized prejudice. The need to reformulate cultural norms and develop health information and education policies is urgent. These policies should be led by professionals with a comprehensive and humanized vision, addressing the diverse needs of the LGBT+ population.
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Affiliation(s)
- João Cruz Neto
- Graduate Program in Nursing, College of Nursing, Federal University of Ceará, Rua Alexandre Baraúna, 1115, Rodolfo Teófilo/Fortaleza, CE, CEP 60430-160, Brazil.
| | - Amanda Cavalcante Maia
- Graduate Program in Nursing, University of International Integration of Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
| | | | - Anderson Reis de Sousa
- Graduate Program in Nursing and Health, Brazilian Nursing Association, Director of Professional Practice and Nursing Work Development, School of Nursing, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Eysler Gonçalves Maia Brasil
- Graduate Program in Nursing, University of International Integration of Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
| | | | | | - Álvaro Francisco Lopes de Sousa
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, Nova University of Lisbon, Lisbon, Portugal
- Institute of Teaching and Research, Sírio-Libanese Hospital, São Paulo, São Paulo, Brazil
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Krause KD, Lewis K, Scrofani S, Guo TY, Goulbourne D, Halkitis PN. Health Behaviors and Experiences of LGBTQ + Individuals during 2022 Mpox Outbreak: Findings from the QVax Study. J Community Health 2024:10.1007/s10900-024-01383-0. [PMID: 39183233 DOI: 10.1007/s10900-024-01383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/27/2024]
Abstract
The 2022 global outbreak of Mpox (formerly named Monkeypox) disproportionately impacted lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations, with a significant impact on sexual minority men. A cross-sectional survey was conducted among LGBTQ + adults living in New Jersey and New York to examine vaccination behaviors for Mpox. We sought out to understand the health experiences and behaviors of the population during the initial outbreak. This analysis included a subset of participants (n = 253) who completed the survey after the onset of the Mpox outbreak in May 2022. We examined awareness of and concerns about Mpox, willingness to vaccinate, as well as vaccination access and vaccination uptake. Our findings indicate that white, cisgender, gay men, as well as employed individuals, had the highest rates of vaccination for Mpox. Those with higher levels of concern about the virus were both more likely to be vaccinated and to report difficulty securing an appointment. Overall, our findings reinforce the health disparities in the population, demonstrating as with many other health conditions that white and economically stable individuals have advantages in accessing care.
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Affiliation(s)
- Kristen D Krause
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA.
- Department of Urban-Global Health, School of Public Health, Rutgers University, Newark, NJ, USA.
| | - Kendra Lewis
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
| | - Stephan Scrofani
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
| | - Tiffany Y Guo
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Davin Goulbourne
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
- Department of Public Health, Montclair State University, Montclair, NJ, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
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Ferreira-Filho ES, Lerner T, Soares-Júnior JM, Baracat EC. Gynecologic health care for LGBTQIA+ people. Int J Gynaecol Obstet 2024. [PMID: 39118470 DOI: 10.1002/ijgo.15844] [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: 02/12/2024] [Revised: 07/09/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024]
Abstract
Gender relations are a set of socially determined norms and rules that assign values, characteristics, and expectations to individuals based on their biological sex. These aspects also influence the clinician-patient relationship, since it has been for a long time based on cisheteronormativity. However, this attitude alienated the LGBTQIA+ community from health services. Global and specific gynecologic care needs to be offered to the LGBTQIA+ population, which has demands for sexual and reproductive health care. In this narrative review, we bring conceptual aspects, gender identity and expression, sexual history, screening for cancer and other care to the community.
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Affiliation(s)
| | - Theo Lerner
- Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
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Wu E, Lee YG, Vinogradov V, Zhakupova G, Mergenova G, Davis A, Paine EA, Hunt T, Reeder K, Primbetova S, Terlikbayeva A, Laughney C, Chang M, Baiserkin B, Abishev A, Tukeyev M, Abdraimov S, Denebayeva A, Kasymbekova S, Tazhibayeva G, Kozhakhmet M. Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.01.24311235. [PMID: 39132483 PMCID: PMC11312675 DOI: 10.1101/2024.08.01.24311235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Importance HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates. Objective To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan. Design We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022. Setting We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent. Participants Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities. Intervention The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community. Main outcome measures Received an HIV test in the prior six months. Results There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city (AOR=1.08, 95% CI=1.05-1.12; p<.001). Conclusions The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM. Trial Registration This trial is registered with clinicaltrials.gov (NCT02786615). Funding National Institute on Drug Abuse (NIDA), grant number R01DA040513.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Yong Gun Lee
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | - Alissa Davis
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Emily A. Paine
- Department of Psychiatry, Columbia University, New York, NY USA; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Kelsey Reeder
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | | | | | - Caitlin Laughney
- Department of Psychiatry, Columbia University, New York, NY USA; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY, USA
| | - Mingway Chang
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
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Davis A, Rosenthal SL, Tucker JD, Balabekova O, Nyblade L, Sun Y, Gryazev D, Lunze K, Landers SE, Tang W, Kuskulov A, Gulyayev V, Terlikbayeva A, Primbetova S, Mergenova G. A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan. J Int AIDS Soc 2024; 27 Suppl 3:e26314. [PMID: 39030847 PMCID: PMC11258447 DOI: 10.1002/jia2.26314] [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: 02/21/2024] [Accepted: 06/04/2024] [Indexed: 07/22/2024] Open
Abstract
INTRODUCTION Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study. METHODS From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13-19 or 20-29 years) and judged by a panel composed of AYA (n = 23), healthcare professionals (n = 12), and representatives from the local government and non-governmental organizations (n = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding. RESULTS We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (n = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (n = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (n = 36/96, 37.5%), image (n = 28/96, 29.2%) and text (n = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations. CONCLUSIONS Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex health and social challenges facing communities today.
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Affiliation(s)
- Alissa Davis
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Susan L. Rosenthal
- Department of PediatricsColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
- Clinical Research Department, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
| | - Olga Balabekova
- Global Health Research Center of Central AsiaAlmatyKazakhstan
| | - Laura Nyblade
- Research Triangle InstituteResearch Triangle ParkChapel HillNorth CarolinaUSA
| | - Yihang Sun
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Denis Gryazev
- Global Health Research Center of Central AsiaAlmatyKazakhstan
| | - Karsten Lunze
- Section of General Internal Medicine, Department of MedicineBoston Medical CenterBostonMassachusettsUSA
- Chobanian and Avedisian School of MedicineBoston UniversityBostonMassachusettsUSA
| | - Sara E. Landers
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Weiming Tang
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Azamat Kuskulov
- School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Valera Gulyayev
- Global Health Research Center of Central AsiaAlmatyKazakhstan
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Laughney CI, Lee YG, Mergenova G, Vinogradov V, Zhakupova G, Paine EA, Primbetova S, Terlikbayeva A, Wu E. Earlier Sexual Debut and Anti-Gay Victimization Among Men Who Have Sex With Men (MSM) in Kazakhstan. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:10795-10813. [PMID: 37272025 DOI: 10.1177/08862605231176800] [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: 06/06/2023]
Abstract
Limited research has examined predictors of anti-gay victimization among men who have sex with men (MSM), despite anti-gay violence continuing to be a global problem. We conducted a secondary analysis of data from structured interviews with 600 MSM adults to examine anti-gay victimization and earlier sexual debut among MSM in Kazakhstan. Multiple linear regression was used to test for associations between earlier sexual debut-categorized as age of sexual onset between 13 and 15 years of age and prior to 13 years old, with ages 16 and older as the reference group-and recent and lifetime anti-gay victimization. Adjusted logistic regression models were used to assess earlier sexual debut and specific types of victimization. The majority of MSM reported lifetime (89%) or recent (68%) experiences of anti-gay victimization. Earlier sexual debut prior to 13 years of age was significantly associated with greater number of types of lifetime and recent reports of anti-gay victimization. Among specific types of anti-gay victimization, earlier sexual debut was associated with higher odds of experiencing verbal, physical, and sexual violence. Anti-gay violence in Kazakhstan is a significant and prevalent public health issue. Future research and clinical interventions addressing anti-gay victimization among MSM populations should consider the lifetime and current implications of consensual and non-consensual childhood and adolescent sexual experiences.
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Affiliation(s)
| | - Yong Gun Lee
- Columbia School of Social Work, New York, NY, USA
| | | | | | | | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Elwin Wu
- Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Wu E, Lee YG, Vinogradov V, Kali S, Yelkeyev A, Goddard-Eckrich DA, Dasgupta A, Hess L. Intervention Adaptation and Implementation Method for Real-World Constraints and Using New Technologies. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:562-570. [PMID: 37575669 PMCID: PMC10419326 DOI: 10.1177/10497315221120605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose Rigorous adaptation methods are needed to revise existing evidence-based behavioral interventions for implementation for new target populations, revised/updated outcomes, new delivery modalities, recent advances, and new technologies. We describe an adaptation method designed to overcome the real-world challenges of having very limited existing expertise, resources, and time. Method This adaptation method and accompanying visualization tool ("Deconstruction/Reconstruction Matrix") preserves theoretical mechanisms of behavior change, accounts for challenges in utilizing new technologies, and strengthens clinical processes, with an emphasis on safety. Results The adaptation of an in-person HIV behavioral intervention for sexual and gender diverse men in Kazakhstan to one delivered remotely via telecommunication and social media technologies exemplifies the process and strengths of the method, concomitantly resulting in recommendations for adaptation and implementation of mobile health (mHealth) and digital health interventions. Discussion This method allows researchers and clinicians to adapt interventions rapidly and rigorously and to benefit from new technologies.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Yong Gun Lee
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Sultana Kali
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Aidar Yelkeyev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Anindita Dasgupta
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | - Leona Hess
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Laughney CI, Lee YG, Mergenova G, Vinogradov V, Zhakupova G, Paine EA, Primbetova S, Terlikbayeva A, Wu E. Earlier Sexual Debut and Exchange Sex among Men Who Have Sex with Men (MSM) in Kazakhstan. JOURNAL OF SEX RESEARCH 2023; 60:919-924. [PMID: 36657067 PMCID: PMC10354213 DOI: 10.1080/00224499.2023.2167064] [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: 05/10/2023]
Abstract
Limited research has examined prevalence rates and associations related to exchange sex behaviors among gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan. This study aimed to examine associations between earlier sexual debuts and lifetime exchange sex behaviors among Kazakhstani MSM. Using data from a National Institute on Drug Abuse-funded Human Immunodeficiency Virus (HIV) prevention trial, we conducted a secondary analysis of self-reported data from 766 adult cisgender MSM in Kazakhstan, who completed structured screening interviews. Earlier sexual debuts were measured as age of sexual onset prior to 16 years old with ages 16 and older as the reference group. Logistic regression models were used to estimate associations between earlier sexual debuts and lifetime reports of buying or selling sex for resources, with covariance adjustment for sociodemographic characteristics. The study findings indicated that, among our sample of MSM in Kazakhstan, 23% had sold sex, and 26% had bought sex in their lifetime. Kazakhstani MSM who reported an earlier sexual debut had significantly higher odds of ever selling or buying sex in their lifetime. Future research should examine how consensual and non-consensual sexual activities during childhood and adolescence relate to exchange sex behaviors and risk among MSM.
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Affiliation(s)
| | - Yong Gun Lee
- Social Intervention Group, Columbia School of Social Work, New York, NY, 10027, USA
| | | | | | | | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, 10027, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Bilibayeva G, Ospanova D, Nurkerimova A, Kussainova F, Tukeev M, Shokybaeva M, Tanabayeva S, Fakhradiyev I, Saliev T. Epidemiological Analysis of HIV/AIDS in Kazakhstan During 2018-2020. J Res Health Sci 2023; 23:e00580. [PMID: 37571951 PMCID: PMC10422132 DOI: 10.34172/jrhs.2023.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) is a severe threat to public health everywhere, including the Central Asian region and Kazakhstan. The aim of the study was to conduct an epidemiological analysis of newly diagnosed cases of HIV infection during 2018-2020. STUDY DESIGN A case series study. METHODS A descriptive analysis of national data on registered cases of HIV in Kazakhstan was conducted, and demographic information was collected and studied accordingly. The analysis of the influence of age, period, and cohort was performed using the age-period-cohort method. RESULTS Based on the results, men prevailed (68.5%) among all cases of HIV infection (n=1235). Sexual transmission during heterosexual contact was higher in females (88.9%, P=0.005), and the number of new cases as a result of homosexual contact was higher in men (23.0%, P=0.087). In addition, the parenteral route of HIV transmission cases prevailed among men (27.5%, P=0.001), and intravenous drug administration was more common among males (27.4%, P=0.01). Moreover, 68.5% of men and 33.2% of women had a low therapy adherence. In men, the risk of HIV prevalence increased after 32.5 years (deviation [Dv]: 0.134, 95% confidence interval [CI]=0.096 to 0.364). At the age of 37.5 years, there was an increase (Dv: 0.852, 95% CI=0.626 to 1.079) in HIV prevalence. However, no peaks were observed in women. CONCLUSION Our findings indicated a rise in the prevalence of HIV infection in Kazakhstan. Men aged 37 and older were identified as the risk category. Eventually, inadequate adherence to treatment was observed in HIV/acquired immunodeficiency syndrome patients.
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Affiliation(s)
| | | | | | | | - Marat Tukeev
- Center for Prevention and Control of AIDS, Almaty, Kazakhstan
| | | | - Shynar Tanabayeva
- S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Ildar Fakhradiyev
- S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Timur Saliev
- S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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Paine EA, Lee YG, Mergenova G, Vinogradov V, Laughney CI, Davis A, Terlikbayeva A, Primbetova S, Hunt T, Wu E. Compounding vulnerabilities: victimization and discrimination is associated with COVID-19 disruptions to HIV-related care among gay, bisexual, and other men and transgender and nonbinary people who have sex with men in Kazakhstan. AIDS Care 2023; 35:651-657. [PMID: 36628449 PMCID: PMC10159880 DOI: 10.1080/09540121.2022.2148956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Gay, bisexual, and other men and transgender and nonbinary people who have sex with men (MSM and TSM) are disproportionately impacted by the HIV epidemic in Kazakhstan. MSM and TSM in Kazakhstan also face high levels of discrimination and victimization, known barriers to engagement in HIV prevention and care. We examined data from surveys with 455 MSM and TSM collected May -- October 2020 to determine whether access to HIV testing and treatment was disproportionately limited among those exposed to victimization and discrimination during the early COVID-19 pandemic. Odds of reporting COVID-19 disruptions to HIV-related care access were significantly higher (OR: 1.96; 95% CI: 1.25-3.06; P = .003) among those who experienced recent sexual or gender-based victimization, and recent discrimination (OR: 2.93; 95% CI: 1.65-5.23; P < .001), compared to those who did not experience victimization or discrimination, respectively. Odds of reporting disruptions among those who experienced both victimization and discrimination were significantly higher (OR: 3.59; 95% CI: 1.88-6.86; P < .001) compared to those who experienced neither . Associations remained significant after adjustment for potentially confounding factors. Findings suggest the COVID-19 pandemic is compounding vulnerability among MSM and TSM in Kazakhstan - highlighting need for intervention efforts targeting the most marginalized groups.
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Affiliation(s)
- Emily Allen Paine
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Yong Gun Lee
- Columbia University School of Social Work, New York, NY, USA
| | | | | | | | - Alissa Davis
- Columbia University School of Social Work, New York, NY, USA
| | | | | | - Timothy Hunt
- Columbia University School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Elwin Wu
- Columbia University School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Yu B, Feng C, Yang X, Wang Z, Zou H, Jia P, Yang S. Roles of Social Capital in the Association Between Internalized Homophobia and Condomless Sex Among Men Who Have Sex With Men in Southwest China: A Four-Way Decomposition. Int J Public Health 2023; 68:1605202. [PMID: 36743343 PMCID: PMC9894890 DOI: 10.3389/ijph.2023.1605202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives: This study examined whether social capital (SC) mediated the association between internalized homophobia (IH) and condomless sex among men who have sex with men (MSM), with the interaction of SC and IH considered. Methods: A cross-sectional study was conducted between November 2018 and April 2019 in Sichuan Province, China. A total of 540 participants were recruited to investigate their IH, SC, and condomless sex. A four-way decomposition of causal mediation analysis was used to test SC's roles in the association between IH and condomless sex. Results: Condomless sex was prevalent (46.7%) among the participants, which was significantly associated with IH [odds ratio (OR) = 1.70] and SC (OR = 0.55). A direct effect [excess risk ratio (RR = 0.32)] and an indirect effect (excess RR = 0.16) of SC were found to be significant in the association between IH and condomless sex. Heterogeneities in effects were observed when taking the SC's domains (e.g., individual and family-based SC) as mediators. SC's effects were significant only in the homosexual subgroup. Conclusion: IH-based intervention with consideration of SC can be tailored to MSM to decrease condomless sex and curb the spread of HIV, especially for the homosexual subgroup.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xue Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China,Department of Health Management Center, Clinical Medical College and Affiliated Hospital, Chengdu University, Chengdu, China,*Correspondence: Shujuan Yang,
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Fatores associados ao óbito por HIV/Aids. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Lee YG, Zhakupova G, Vinogradov V, Paine EA, Laughney CI, Reeder K, Davis A, Hunt T, Mergenova G, Primbetova S, Terlikbayeva A, Wu E. Polydrug Use, Sexual Risk, and HIV Testing Among Cisgender Gay, Bisexual, and Other Men and Transgender and Nonbinary Individuals Who Have Sex With Men in Kazakhstan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:413-426. [PMID: 36181500 PMCID: PMC10662254 DOI: 10.1521/aeap.2022.34.5.413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study examined substance use and sexual risk correlates of HIV testing among cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men in Kazakhstan. We analyzed baseline data from an HIV prevention trial collected prior to intervention deployment (N = 304). Multivariable logistic regression analyses revealed that lifetime HIV testing was positively associated with poly-drug use (AOR = 4.4, 95% CI [2.0, 9.9]) and negatively with sexual risk (AOR = 0.4, 95% CI [0.2, 1.0]). Similarly, recent HIV testing was positively associated with polydrug use (AOR = 2.7, 95% CI [1.4, 5.2]) and negatively with sexual risk (AOR = 0.5, 95% CI [0.3, 0.9]). Current HIV testing was negatively associated with sexual risk (AOR = 0.6, 95% CI [0.3. 0.9]). Findings support the value of integrating drug treatment with HIV testing among MSM and TSM in Kazakhstan.
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Affiliation(s)
- Yong Gun Lee
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Gulnara Zhakupova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Vitaliy Vinogradov
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York Psychiatric Institute, New York, New York, USA
| | | | - Kelsey Reeder
- Columbia University School of Social Work, New York, New York, USA
| | - Alissa Davis
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Gaukhar Mergenova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Sholpan Primbetova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Lee JI, Chang YP, Tsai CS, Yen CF. Internalized Sexual Stigma among Lesbian, Gay, and Bisexual Individuals in Taiwan: Its Related Factors and Association with Mental Health Problems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042427. [PMID: 35206614 PMCID: PMC8872568 DOI: 10.3390/ijerph19042427] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
Internalized sexual stigma (ISS) is one of the major issues that can compromise the health of sexual minority populations. This quantitative study aimed to examine: (1) the relationships of individual factors (gender, age, education level, sexual orientation, and age of identification of sexual orientation) and perceived family support with ISS; and (2) the associations of ISS with mood problems and the moderating effects of gender on the associations among Taiwanese young adult lesbian, gay, and bisexual (LGB) individuals. In total, 500 male and 500 female young adult LGB individuals aged between 20 and 30 years participated in this study. The experience of ISS, individual (e.g., gender, age, education level, sexual orientation, and age of identification of sexual orientation) and environmental factors (perceived family), mood problems (e.g., anxiety and depression) were collected. The individual and environmental factors related to ISS and the associations of ISS with mood problems were examined using multivariate linear regression analysis. The results indicated that gender, sexual orientation, age of identification of sexual orientation, and perceived family support were significantly associated with all or some dimensions of ISS in LGB individuals. Various dimensions of ISS had different relationships with anxiety and depression. Gender had moderating effects on the association between the identity dimension of ISS and sexual orientation as well as between the social discomfort dimension of ISS and anxiety. Various dimensions of ISS among LGB individuals should be routinely assessed by mental health service units. Intervention programs should be provided for LGB individuals, especially those with factors related to ISS.
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Affiliation(s)
- Jia-In Lee
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan;
- Department of Psychiatry, School of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14260, USA;
| | - Ching-Shu Tsai
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (C.-S.T.); (C.-F.Y.); Tel.: +886-7-7317-123 (ext. 8751) (C.-S.T.); +886-7-3124-941 (C.-F.Y.)
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan;
- Department of Psychiatry, School of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (C.-S.T.); (C.-F.Y.); Tel.: +886-7-7317-123 (ext. 8751) (C.-S.T.); +886-7-3124-941 (C.-F.Y.)
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Lyu H, Zhou Y, Dai W, Zhen S, Huang S, Zhou L, Huang L, Tang W. Solidarity and HIV Testing Willingness During the COVID-19 Epidemic: A Study Among Men Who Have Sex With Men in China. Front Public Health 2021; 9:752965. [PMID: 34957014 PMCID: PMC8695798 DOI: 10.3389/fpubh.2021.752965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Solidarity, such as community connectedness and social cohesion, may be useful in improving HIV testing uptake among men who have sex with men (MSM). This study aimed to evaluate the impact of solidarity on HIV testing before the coronavirus disease 2019 (COVID-19) and HIV testing willingness during COVID-19 among MSM in China. Materials and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and solidarity items' information from the participants. We first used factor analysis to reveal the principal component of the solidarity items and then used logistic regression to study the impact of solidarity on HIV testing, by adjusting the possible confounding factors, such as age and education. Results: Social cohesion and community connectedness were revealed by the factor analysis. MSM with high community connectedness were more willing to undergo HIV testing before the epidemic adjusted by age [odds ratio (OR): 1.07, 95% CI: 1.01-1.13]. The community connectedness was also related to the willingness of HIV testing during the epidemic, with adjustments of 1.09 (95% CI: 1.03-1.15). People who did not test for HIV before the COVID-19 epidemic were more willing to have the HIV test during the epidemic, which was correlated with the community connectedness, and the OR value was 1.14 (95%: 1.03-1.25). Conclusion: A high level of community connectedness helped to increase the HIV testing rate before COVID-19 and the willingness of HIV testing during the epidemic among MSM. Strategies can strengthen the role of the community in the management and service of MSM.
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Affiliation(s)
- Hang Lyu
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Wencan Dai
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | | | - Shanzi Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Lanlan Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Liqun Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
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