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Shen Z, Tan Z, Ge L, Wang Y, Xing X, Sang W, Cai G. The global burden of lymphoma: estimates from the Global Burden of Disease 2019 study. Public Health 2024; 226:199-206. [PMID: 38086101 DOI: 10.1016/j.puhe.2023.11.023] [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: 07/25/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The aim of this study was to describe the global trends in the burden of lymphoma from 1990 to 2019. STUDY DESIGN The data used in this study were from the Global Burden of Disease 2019 study. METHODS This study described the age-standardised rates of incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of lymphoma (non-Hodgkin and Hodgkin's lymphoma, NHL and HL, respectively) annually from 1990 to 2019, stratified by sociodemographic index (SDI) and 21 world regions. The estimated annual percentage changes in these indexes were calculated. RESULTS In 2019, the age-standardised rates of HL per 100,000 population were lower than those of NHL in terms of incidence (1.1 vs 6.7 per 100,000 person-years, respectively) and prevalence (0.3 vs 5.7 per 100,000 person-years, respectively) but not mortality (21.6 vs 3.2 per 100,000 person-years, respectively). From 1999 to 2019, the global incidence of HL decreased and the incidence of NHL increased, and the prevalence of both HL and NHL increased, but the mortality rates decreased. When stratified by SDI, the incidence of HL decreased in all but middle-SDI regions, the mortality rate of HL decreased in all regions, and both the incidence and mortality rate of NHL increased in all but high-SDI regions. The prevalence of HL and NHL increased in all SDI regions, especially in middle-SDI regions. YLLs and DALYs of HL in all SDI regions and those of NHL in high-SDI regions decreased. YLDs slightly increased in middle- to high-SDI regions. CONCLUSIONS Lymphoma remains a major public health issue, and better prevention, precise identification, and promising treatments are vitally important.
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Affiliation(s)
- Z Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Z Tan
- Research Center of Health Policy and Health Management, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - L Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Y Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - X Xing
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - W Sang
- Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, China.
| | - G Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, 7000, Australia.
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Gesualdo C, Larsen H, Garcia P. Inclusion of a Parental Component in a Sports-Based HIV Prevention Program for Dominican Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6141. [PMID: 37372728 DOI: 10.3390/ijerph20126141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Underprivileged youth in the Dominican Republic (DR) are at high risk of acquiring the human immunodeficiency virus (HIV). Protective parenting practices may inhibit sexual risk-taking. OBJECTIVE We investigated whether parental involvement in a sports-based HIV prevention program increased self-efficacy to prevent HIV and safe sex behavior among Dominican youth. METHOD The study had a quasi-experimental design with repeated measures. N = 90 participants between 13 and 24 years of age participated in the program through two different trainings, UNICA and A Ganar, both of which had an experimental (i.e., program with parental component) and a control (i.e., program without parental component) condition. RESULTS Self-efficacy to prevent HIV significantly increased among participants in the experimental condition of UNICA. Self-efficacy for safe sex increased among sexually active participants in the experimental condition of A Ganar. Implications for Impact: These findings are important to meet the United Nations' Sustainable Development Goal of good health and wellbeing, as they suggest that parental involvement in sports-based HIV prevention programs can enhance their positive effects for increasing youth's self-efficacy to practice HIV-preventive behaviors. Randomized control trials and longitudinal studies are needed.
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Affiliation(s)
- Chrys Gesualdo
- Department of Developmental Psychology, Philipps University, 35032 Marburg, Germany
| | - Helle Larsen
- Department of Developmental Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
| | - Pilar Garcia
- Department of Educational and Developmental Psychology, University of Valencia, 46010 Valencia, Spain
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Bluemer-Miroite S, Potter K, Blanton E, Simmonds G, Mitchell C, Barnaby K, Zeribi KA, Babb D, Skyers N, O'Malley G, Anderson C. “Nothing for Us Without Us”: An Evaluation of Patient Engagement in an HIV Care Improvement Collaborative in the Caribbean. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00390. [PMID: 36332062 PMCID: PMC9242602 DOI: 10.9745/ghsp-d-21-00390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
This evaluation suggests that it is both possible and valuable to include patients as partners in quality improvement efforts, especially when resources must be prioritized for the highest impact efforts. Patient engagement in the improvement process is particularly powerful when addressing illnesses that may be stigmatized such as HIV. Introduction: Patient engagement is increasingly recognized as a key strategy to promote patient-centered care and accelerate health care improvements. Ensuring patient participation in improvement efforts is particularly important with stigmatized illnesses and marginalized populations. Despite the attention it has garnered, patient engagement is still not widely implemented and has not been well documented in global health literature. Methods: We implemented a patient-engagement strategy to involve people living with HIV in quality improvement efforts. As part of the Caribbean Regional Quality Improvement Collaborative, quality improvement teams from Barbados (1 team), Jamaica (20 teams), Suriname (3 teams), and Trinidad and Tobago (2 teams) engaged health care providers from care facilities and people living with HIV to serve as community representatives (CRs) to lead the improvement efforts alongside them. This strategy was evaluated via a mixed method design that included 2 rounds of semistructured, in-depth interviews with patients and providers. Results: Findings suggest that the patient engagement strategy had several key strengths: it promoted the collection, use, and appreciation of patient input to inform health care improvements at the facility level; facilitated the empowerment of CRs; enhanced mutual understanding and empathy between CRs and providers; and helped to dispel HIV stigma and discrimination in health care settings. Moreover, both health care providers and CRs reported that CR opinions and perspectives are as important as providers' and that CR participation in the improvement process was beneficial.
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Affiliation(s)
| | | | | | - Georgia Simmonds
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | - Conrad Mitchell
- International Training and Education Center for Health, Port of Spain, Trinidad and Tobago
| | - Kenyatta Barnaby
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | | | - Dale Babb
- Ladymeade Reference Unit, Barbados Ministry of Health, St. Michael, Barbados
| | - Nicola Skyers
- HIV Programme, Jamaica Ministry of Health, Kingston, Jamaica
| | - Gabrielle O'Malley
- University of Washington, Seattle, WA, USA
- International Training and Education Center for Health, Seattle, WA, USA
| | - Clive Anderson
- International Training and Education Center for Health, Kingston, Jamaica
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Patterns of sexual and HIV-related stigma among men who have sex with men and women living with HIV in Haiti. Sci Rep 2022; 12:7511. [PMID: 35525876 PMCID: PMC9079062 DOI: 10.1038/s41598-022-11647-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented.
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McCarthy M, Tao J, Lerebours A, Rodriguez C, Flanigan TP, Sanchez MC. Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic. J Int Assoc Provid AIDS Care 2022; 21:23259582221096522. [PMID: 35532067 PMCID: PMC9092578 DOI: 10.1177/23259582221096522] [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] [Indexed: 11/25/2022] Open
Abstract
The Dominican Republic (DR) has the second-highest prevalence of HIV infection in
the Caribbean, but viral suppression and treatment adherence are not well
understood. We conducted a cross-sectional study among people living with
HIV/AIDS(PLWHA) to fill in the knowledge gap. Questionnaire was used to collect
demographic data, antiretroviral therapy (ART) adherence, and barriers and
facilitators to HIV care. Viral load and other clinical information were
extracted through chart reviews. Descriptive analyzes and logistic regression
were conducted to explore factors associated with non-viral suppression and
imperfect ART adherence. Of 193 PLWHA 83.9% were virally suppressed. Those that
were non-virally suppressed were more likely of being male (odds ratio [OR]:
2.55, 95% confidence interval [CI]: 1.17-5.58) and less likely of being
unemployed (OR: 0.28, 95% CI: 0.08-0.96). However, being male (OR: 0.78, 95%
CI:0.40-1.53) and unemployed (OR: 0.28, 95% CI:0. 08-1.21) were less likely to
report imperfect adherence. Tailored interventions are needed to improve
adherence and viral suppression in DR.
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Affiliation(s)
| | - Jun Tao
- 12321Brown University, Providence, RI, USA
| | - Alain Lerebours
- Pontificia Universidad Catolica Madre y Maestra, Santiago, DR
| | - Claudia Rodriguez
- Hospital Regional Universitario Jose Maria Cabral y Baez, Santiago, DR, Dominican Republic
| | - Timothy P Flanigan
- 12321Brown University, Providence, RI, USA.,The Miriam Hospital, Providence, RI, USA
| | - Martha C Sanchez
- 12321Brown University, Providence, RI, USA.,The Miriam Hospital, Providence, RI, USA
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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7
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Llorente-Marrón M, Fontanil-Gómez Y, Díaz-Fernández M, Solís García P. Disasters, Gender, and HIV Infection: The Impact of the 2010 Haiti Earthquake. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7198. [PMID: 34281135 PMCID: PMC8293795 DOI: 10.3390/ijerph18137198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
Although disasters threaten all people who experience them, they do not affect all members of society in the same way. Its effects are not solely restricted to the economic sphere; they also affect the physical and mental health of those who suffer from them, having a particular impact on women and limiting their life chances. The aim of this study was to examine the impact the 2010 Haiti earthquake had on the seropositivity of female survivors. METHOD Using data from the Demographic and Health Survey, this study examines the impact of the 2010 Haiti earthquake on gender relations associated with the probability of being HIV positive through the differences-in-differences strategy. RESULTS A differential of four percentage points is observed in the probability of HIV seropositivity between men and women, favoring men. Additionally, it is observed that the probability of seropositivity intensifies when the cohabitation household is headed by a woman. CONCLUSION Disasters are not indifferent to the gender of the people affected. In the second decade of the 21st century, the conclusions obtained show, once again, the need for incorporating the gender perspective into the management of natural hazards in the field of health. This is the case of the differential exposure to HIV after the earthquake in Haiti.
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Affiliation(s)
- Mar Llorente-Marrón
- Quantitative Economics Department, University of Oviedo, 33006 Oviedo, Spain;
| | | | | | - Patricia Solís García
- Psychology Department, University of Oviedo, 33003 Oviedo, Spain; (Y.F.-G.); (P.S.G.)
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Dunbar W, Pape JW, Coppieters Y. HIV among men who have sex with men in the Caribbean: reaching the left behind. Rev Panam Salud Publica 2021; 45:e12. [PMID: 33708247 PMCID: PMC7939031 DOI: 10.26633/rpsp.2021.12] [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: 03/04/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives. To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030. Methods. A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries. Results. 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic. Conclusions. To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto ‘Leave no one behind’.
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Affiliation(s)
- Willy Dunbar
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Port-au-Prince Haiti Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
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Figueroa JP, Duncan JP, Bailey A, Skyers N. The HIV epidemic in Jamaica: a need to strengthen the National HIV Program. Rev Panam Salud Publica 2020; 44:e157. [PMID: 33245295 PMCID: PMC7679044 DOI: 10.26633/rpsp.2020.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. Methods The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. Results HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. Conclusions Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.
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Affiliation(s)
- J Peter Figueroa
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Jacqueline P Duncan
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Althea Bailey
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Nicola Skyers
- Ministry of Health and Wellness Kingston Jamaica Ministry of Health and Wellness, Kingston, Jamaica
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Logie CH, Wang Y, Marcus N, Lalor P, Williams D, Levermore K. Pathways from Police, Intimate Partner, and Client Violence to Condom Use Outcomes among Sex Workers in Jamaica. Int J Behav Med 2020; 27:378-388. [PMID: 32077049 DOI: 10.1007/s12529-020-09860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Violence reduces sex workers' ability to enforce consistent condom use. Less is known of violence and condom use among gender diverse sex workers in Jamaica, where both sex work and same-sex practices are criminalized. We examined pathways from violence to consistent condom use among sex workers in Jamaica. METHODS We conducted a cross-sectional survey with a peer-driven sample of sex workers (n = 340: n = 124 cisgender men, n = 115 cisgender women, n = 101 transgender women) in Kingston, Ocho Rios, and Montego Bay, Jamaica. We conducted structural equation modeling using weighted least square estimation methods to test the direct effects of police harassment (ever), intimate partner violence (IPV) (ever), and recent (past 6-month) client violence on consistent condom use, and indirect effects via condom use self-efficacy, adjusting for socio-demographic factors. Moderation analysis was conducted to estimate the effect of binge drinking on condom use self-efficacy. We conducted a second SEM taking into consideration measurement invariance to test gender differences. RESULTS Over half of participants reported police harassment, half intimate partner violence, and one-third client violence. Overall, the direct path from police harassment to consistent condom use was significant. Condom use self-efficacy mediated associations between client violence and IPV with consistent condom use. Binge drinking moderated the association between client violence and condom use self-efficacy. There were gender differences in these pathways. CONCLUSIONS Violence has direct and indirect effects on condom use outcomes among sex workers in Jamaica. Multilevel, gender-tailored interventions at policy, police, and community levels can promote sex workers' health and human rights.
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Affiliation(s)
- Carmen H Logie
- Factor-Iwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | - Ying Wang
- Factor-Iwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Canada
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11
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Montgomery MC, Alholm Z, Almonte A, Sykes KJ, Rudolph G, Cusick B, Castello L, Sowemimo-Coker G, Tang I, Haberlack S, Chan PA. A cross-sectional evaluation of HIV testing practices among women in the rural Dominican Republic. BMC WOMENS HEALTH 2020; 20:21. [PMID: 32028952 PMCID: PMC7006117 DOI: 10.1186/s12905-020-0891-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
Background The Dominican Republic (DR) ranks among nations with the highest burden of HIV in the Caribbean. Cultural and gender roles in rural areas of the DR may place women at increased HIV risk. However, little is known about sexual health and HIV testing behaviors among women in the rural DR. Methods We conducted a needs assessment among a systematic sample of adult women in a rural DR community in 2016. Demographic and behavioral attributes related to HIV testing, sexual health, and healthcare utilization were evaluated. Poisson regression analysis was used to identify demographics and behaviors associated with having had a previous HIV test. Significance was defined as a p-value < 0.05. Results Among 105 women evaluated, 77% knew someone with HIV and 73% of women reported that they would be very or extremely likely to take an HIV test if offered. Only 68% reported a previous HIV test, including 47% who were tested over 2 years prior. Barriers to HIV testing included low risk perception (23%), distance or requisite travel (13%), and discomfort being tested (11%). Women who had never been tested for HIV were more likely than those who had been tested to be older (p = 0.03), to have a lower level of education (p = 0.04), and to have never been tested for other sexually transmitted infections (STI; p < 0.01). In the Poisson multiple regression model, the only significant predictor of having had an HIV test was having had an STI test (p = 0.03). Conclusions In the rural DR, numerous barriers contribute to low prevalence of HIV testing among women. Most women report willingness to have an HIV test and many engage in routine health care, indicating that this population may benefit from incorporating HIV testing and other sexual health promotion activities into routine medical care.
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Affiliation(s)
| | - Zachary Alholm
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexi Almonte
- Department of Medicine, Brown University, Providence, RI, USA
| | - Kevin J Sykes
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | | | - Irene Tang
- Department of Medicine, Brown University, Providence, RI, USA
| | - Sarah Haberlack
- Department of Medicine, Brown University, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA.
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12
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Pathways From Sexual Stigma to Inconsistent Condom Use and Condom Breakage and Slippage Among MSM in Jamaica. J Acquir Immune Defic Syndr 2019; 78:513-521. [PMID: 29697593 DOI: 10.1097/qai.0000000000001712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV prevalence among men who have sex with men (MSM) in Jamaica, where same sex practices are criminalized, is among the Caribbean's highest. Sexual stigma, the devaluation, mistreatment, and reduced power afforded to sexual minorities, is a distal driver of HIV vulnerabilities. The mechanisms accounting for associations between sexual stigma and condom use outcomes are underexplored. We examined pathways from sexual stigma to condom use and condom breakage and/or slippage among MSM in Jamaica. METHODS We conducted a cross-sectional survey with a chain-referral sample of MSM (n = 556) in Kingston, Montego Bay, and Ocho Rios. Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of sexual stigma on inconsistent condom use and condom breakage/slippage, and the indirect effects through depression, sexual abuse history, and condom use self-efficacy, adjusting for sociodemographic factors. RESULTS One-fifth of participants (21%; 90/422) who had engaged in anal sex reported inconsistent condom use, and 38% (155/410) reported condom breakage/slippage during the previous 4 weeks. The relationship between sexual stigma and inconsistent condom use was mediated by the combination effect of sexual abuse history, condom use self-efficacy, and depression. The relationship between sexual stigma and condom breakage and slippage was mediated by the combination effect of condom use self-efficacy and sexual abuse history. CONCLUSIONS Sexual stigma is associated with negative condom use outcomes in Jamaican MSM, mediated by psychosocial factors. Multilevel social ecological approaches to the HIV prevention cascade can inform interventions at individual, interpersonal, community, and systemic levels.
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13
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Harris OO. Survival now versus survival later: immediate and delayed HIV risk assessment among young Jamaican men who have transactional sex with men. CULTURE, HEALTH & SEXUALITY 2019; 21:883-897. [PMID: 30444450 DOI: 10.1080/13691058.2018.1524079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 09/06/2018] [Accepted: 09/11/2018] [Indexed: 06/09/2023]
Abstract
This study explored the experiences of young Jamaican men who have sex with men who engaged in transactional sex as a result of homelessness, family neglect or limited financial resources. It further examined the circumstances that affect their immediate or delayed decisions around sexual risk and increased vulnerability for HIV infection. Barriers experienced when accessing condoms, healthcare, HIV testing and other prevention services are also described. Twenty in-depth interviews and one focus group with 10 participants in various parishes in Jamaica were conducted. Findings from this study reveal how stigma and discrimination in the form of pervasive homophobia-influenced participation in the street economy via transactional sex. Socio-structural factors at family and commity level led to diminished social/economic prospects, which extended into adulthood. Sexual decision making was based on immediate needs for protection, food or shelter; concerns about acquiring HIV were considered only after meeting those immediate needs. Future HIV prevention strategies must take seriously the socio-structural factors that influence HIV risk behaviours among young men who have sex with men in Jamaica.
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Affiliation(s)
- Orlando O Harris
- a School of Nursing, University of Rochester , Rochester , NY , USA
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Zalla LC, Herce ME, Edwards JK, Michel J, Weir SS. The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study. J Int AIDS Soc 2019; 22:e25281. [PMID: 31287624 PMCID: PMC6615490 DOI: 10.1002/jia2.25281] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/05/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under-represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. METHODS Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. RESULTS Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co-infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one-third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. CONCLUSIONS This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high-impact interventions may include venue-based, peer navigator-led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.
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Affiliation(s)
- Lauren C Zalla
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael E Herce
- Division of Infectious DiseasesDepartment of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Jessie K Edwards
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Sharon S Weir
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Logie CH, Marcus N, Wang Y, Lacombe-Duncan A, Levermore K, Jones N, Bryan N, Back R, Marshall A. Contextualising sexual health practices among lesbian and bisexual women in Jamaica: a multi-methods study. REPRODUCTIVE HEALTH MATTERS 2018; 26:1517543. [DOI: 10.1080/09688080.2018.1517543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Carmen H. Logie
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Adjunct Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Natania Marcus
- Doctoral Candidate, Applied Psychology and Human Development, University of Toronto, Toronto, Canada
| | - Ying Wang
- Doctoral Candidate, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Ashley Lacombe-Duncan
- Transitional Postdoctoral Research Fellow, School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Kandasi Levermore
- Executive Director, Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Nicolette Jones
- Research Coordinator, Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Nicolette Bryan
- Executive Director, WE-Change, Kingston, Jamaica
- Research Assistant, Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Robin Back
- Research Assistant, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Annecka Marshall
- Lecturer, Institute for Gender and Development Studies, Mona Campus, University of the West Indies, Kingston, Jamaica
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Weir SS, Figueroa JP, Scott M, Byfield L, Jones Cooper C, Hobbs MC. Reaching key populations through key venues: Insights from the Jamaica HIV Prevention Program. PLoS One 2018; 13:e0206962. [PMID: 30475802 PMCID: PMC6261031 DOI: 10.1371/journal.pone.0206962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/23/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION HIV prevention strategies often include outreach to female sex workers at social venues identified as places where people meet new sexual partners. Patrons and staff at these venues may include female sex workers, their clients, as well as others who have high rates of new sexual partnerships. Few studies have compared HIV/STI among venue-based and general populations, across types of venues, or by sub-group of the venue population. Program planners often assume that the prevalence of infection is highest among female sex workers and considerably lower among other people at these venues, but there are few empiric studies assessing the prevalence of infection by sex worker status and type of venue. METHODS In 2011, we used the PLACE method to identify public venues where people meet new sexual partners across Jamaica. The study team visited all venues with reported sex work as well as a 10% random sample of other venues and subsequently interviewed and tested a probability sample of 991 venue patrons and workers for HIV and other STI. RESULTS Community informants identified 1207 venues. All venues where sex work was reported (735 venues) and a random sample of the remainder (134 of 472) were selected for onsite visits. Of these, 585 were found and operational. At a stratified random sample of venues, survey teams interviewed and tested 717 women and 274 men. 394 women reported recent sex work and 211 of these women reported soliciting clients on the street. Women exchanging sex for money were more likely to be infected with HIV (5.4% vs 1.0%; OR = 5.6, 95% CI = 1.8,17.3) or syphilis (11.7% vs. 5.8%, OR = 2.2, 95% CI = 1.7,4,0) than other women, but not significantly more likely to be infected with gonorrhea (8.4% vs 7.8%; OR = 1.1,95% CI = 0.6,1.9), chlamydia (16.2% vs 21.6%;OR = 0.7,95% CI = 0.5,1.0) or trichomoniasis (23.0% vs 17.0%, OR = 1.5,95% CI = 0.9,2.2). Women at venues were more likely to report sex work and multiple partners than women interviewed in a 2008 national population-based household survey commissioned by the Ministry of Health. CONCLUSIONS In Jamaica, although the highest HIV prevalence was among street-based sex workers, the risk of HIV and STI extends to men and women at high risk venues, even those who do not self-identify as sex workers. Findings confirm the appropriateness of outreach to all men and women at these venues.
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Affiliation(s)
- Sharon S. Weir
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - J. Peter Figueroa
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Lovette Byfield
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Marcia C. Hobbs
- Department of Medicine, University of North Carolina, North Carolina, United States of America
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Harris OO, Jarrett S. Beyond Homophobia: How Do Jamaican Men Who Have Sex with Men Build Communities, Affirm Identity, and Mitigate Homophobia? J Assoc Nurses AIDS Care 2018; 29:749-761. [DOI: 10.1016/j.jana.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
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Evans-Gilbert T, Kasimbie K, Reid G, Williams SA. Psychosocial outcomes in a cohort of perinatally HIV-infected adolescents in Western Jamaica. Paediatr Int Child Health 2018; 38:175-180. [PMID: 29400261 DOI: 10.1080/20469047.2018.1428074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psychosocial factors interact with adolescent development and affect the ability of HIV-infected adolescents to cope with and adhere to treatment. AIM To evaluate psychosocial outcomes in perinatally HIV-infected adolescents (PHIVAs) in Western Jamaica after psychosocial intervention. METHODS The Bright Futures Paediatric Symptom Checklist (BF-PSC) was used for psychological screening of PHIVAs in Western Jamaica. Referred patients were evaluated using the Youth version of the Columbia Impairment Scale (CIS). Demographic, laboratory and clinical data obtained between July 2014 and June 2016 were evaluated retrospectively and outcomes were reviewed before and after psychosocial intervention. RESULTS Sixty PHIVAs were enrolled and 36 (60%) had a positive BF-PSC score that necessitated referral. The BF-PSC correctly identified 89% of patients with impaired psychosocial assessment by CIS scores. Referred patients were less likely to adhere to treatment, to be virologically suppressed or to have a CD4+ count of >500 cells/μl, and were more likely to be in the late teenage group or to be of orphan status. After intervention, the prevalence of viral suppression increased and median viral load decreased. A difference in mean CD4+ cell count was detected before but not after intervention in teenage and orphan groups. CONCLUSIONS The BF-PSC identified at-risk PHIVAs with impaired psychosocial functioning. Increased vulnerability was noted in orphans and older teenagers. Psychosocial interventions (including family therapy) reduced psychosocial impairment and improved virological suppression. Mental health intervention should be instituted to facilitate improved clinical outcomes, autonomy of care and transition to adult care.
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Affiliation(s)
- Tracy Evans-Gilbert
- a Department of Paediatrics , Cornwall Regional Hospital , Montego Bay , Jamaica.,b Jamaica Paediatric, Perinatal and Adolescent HIV/AIDS Programme, Ministry of Health , Kingston , Jamaica.,c Department of Child and Adolescent Health , University of the West Indies , Kingston , Jamaica
| | - Kazie Kasimbie
- a Department of Paediatrics , Cornwall Regional Hospital , Montego Bay , Jamaica
| | - Gail Reid
- a Department of Paediatrics , Cornwall Regional Hospital , Montego Bay , Jamaica
| | - Shelly Ann Williams
- b Jamaica Paediatric, Perinatal and Adolescent HIV/AIDS Programme, Ministry of Health , Kingston , Jamaica
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Stonbraker S, Smaldone A, Luft H, Cushman LF, Lerebours Nadal L, Halpern M, Larson E. Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic. Public Health Nurs 2017; 35:166-175. [PMID: 29285785 DOI: 10.1111/phn.12382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the health literacy levels of persons living with human immunodeficiency virus (HIV) (PLWH) at a health clinic in the Dominican Republic (DR) and assess associations between health literacy, HIV-related knowledge, and health information behavior (how patients need, seek, receive, and use information). DESIGN AND SAMPLE Cross-sectional, descriptive. Participants were 107 PLWH attending the Clinic. MEASURES A theoretically based, 64-item survey assessing information behavior and HIV-related knowledge was administered in Spanish through individual interviews. Health literacy was assessed using the Short Assessment of Health Literacy-Spanish and English. RESULTS On average, participants were 40.8 years old and had lived with HIV for 7.7 years. The majority (69.2%) had low health literacy. HIV-related knowledge and information behavior varied by health literacy level and uncertainty regarding a main indicator of disease progression, viral load, was demonstrated regardless of health literacy level. Participants with low health literacy were less likely to answer questions or answer questions correctly and many participants (39.2%) indicated viral transmission can occur through supernatural means. CONCLUSIONS Findings demonstrate unmet information need and that information received may not always be understood. Methods to improve health education are needed to ensure patients receive health information in an understandable way.
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Affiliation(s)
- Samantha Stonbraker
- Columbia University School of Nursing, New York, NY, USA.,Clínica de Familia, La Romana, Dominican Republic
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, NY, USA.,Columbia University College of Dental Medicine, New York, NY, USA
| | - Heidi Luft
- Columbia University School of Nursing, New York, NY, USA
| | - Linda F Cushman
- Department of Population and Family Health, Mailman School of Public Health, New York, NY, USA
| | | | - Mina Halpern
- Clínica de Familia, La Romana, Dominican Republic
| | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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Performance of and preference for oral rapid HIV testing in The Bahamas. J Infect Public Health 2017; 11:126-129. [PMID: 28684223 DOI: 10.1016/j.jiph.2017.06.005] [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] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/09/2017] [Indexed: 11/22/2022] Open
Abstract
Initiatives to increase access to quality rapid HIV diagnostics have had relative success in the Caribbean in recent years, including use of oral rapid HIV testing. However, to date, there has not been any investigation into the performance or acceptability of oral fluids HIV testing in the region. In this cross-sectional study in The Bahamas, 252 persons of unknown serostatus were tested side-by-side with two oral rapid test brands, and the results were compared with the national fingerprick algorithm. In addition, an exit survey was administered to 234 study participants to assess user test preference. The most frequent survey response was to have no test preference (47.8%), but of those who expressed a test preference, most preferred oral (34.4%) versus fingerprick (17.8%) method. Both OraQuick and AWARE were 100% concordant with the gold standard. Therefore, our results show that oral fluids rapid testing is preferred over fingerprick testing by a subset of the potential target population and performs well in a population of undiagnosed persons attending screening clinic in The Bahamas.
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Logie CH, Kenny KS, Lacombe-Duncan A, Levermore K, Jones N, Neil A, Ellis T, Marshall A, Newman PA. Social-ecological factors associated with HIV infection among men who have sex with men in Jamaica. Int J STD AIDS 2017; 29:80-88. [PMID: 28669320 DOI: 10.1177/0956462417717652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Jamaica, where homosexuality is criminalized, scant research has examined associations between sexual stigma and HIV infection. The study objective was to examine correlates of HIV infection among men who have sex with men (MSM) in Jamaica. We conducted a cross-sectional tablet-based survey with MSM in Jamaica using chain referral sampling. We assessed socio-demographic, individual, social, and structural factors associated with HIV infection. A logit-link model, fit using backwards-stepwise regression, was used to estimate a final multivariable model. Among 498 participants (median age: 24, interquartile range: 22-28), 67 (13.5%) were HIV-positive. In the multivariable model, HIV infection was associated with increased odds of socio-demographic (older age, odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.00-1.10]; residing in Kingston versus Ocho Rios [OR: 6.99, 95% CI 2.54-19.26]), individual (poor/fair versus excellent/good self-rated health [OR: 4.55, 95% CI: 1.81-11.42], sexually transmitted infection [STI] history [OR: 3.67, 95% CI: 1.61-8.38]), and structural (enacted sexual stigma [OR: 1.08, 95% CI: 1.01-1.15], having a health care provider [OR: 2.23, 95% CI: 1.06-4.66]) factors. This is among the first studies to demonstrate associations between sexual stigma and HIV infection in Jamaica. Findings underscore the need to integrate STI testing in the HIV care continuum and to address stigma and regional differences among MSM in Jamaica.
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Affiliation(s)
- Carmen H Logie
- 1 Factor-Inwentash Faculty of Social Work, 7938 University of Toronto , Toronto, Canada.,2 Women's College Research Institute, Women's College Hospital, 7938 University of Toronto , Toronto, Canada
| | - Kathleen S Kenny
- 3 Gillings School of Global Public Health, 2331 University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Ashley Lacombe-Duncan
- 1 Factor-Inwentash Faculty of Social Work, 7938 University of Toronto , Toronto, Canada
| | | | | | - Ava Neil
- 4 Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Tyrone Ellis
- 4 Jamaica AIDS Support for Life, Kingston, Jamaica
| | - Annecka Marshall
- 5 Institute for Gender and Development Studies, 62707 University of the West Indies , Mona Campus, Jamaica
| | - Peter A Newman
- 1 Factor-Inwentash Faculty of Social Work, 7938 University of Toronto , Toronto, Canada
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Stonbraker S, Befus M, Lerebours Nadal L, Halpern M, Larson E. Factors Associated with Health Information Seeking, Processing, and Use Among HIV Positive Adults in the Dominican Republic. AIDS Behav 2017; 21:1588-1600. [PMID: 27714522 DOI: 10.1007/s10461-016-1569-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Effective treatment and management of human immunodeficiency virus (HIV) depend on patients' ability to locate, comprehend, and apply health information. This study's purpose was to identify characteristics associated with these skills among HIV positive adults in the Dominican Republic. An information behavior survey was administered to 107 participants then three logistic regressions were conducted to identify characteristics associated with information seeking, processing, and use. Never having cared for someone who was sick was significantly associated with less information seeking, processing, and use. Males were more likely to be active information seekers and those who had attended the clinic for six or fewer years were less likely to actively seek information. Younger individuals had increased odds of higher information processing and those without comorbidities had increased odds of more information use. Results may inform researchers, organizations, and providers about how patients interact with health information in limited resource settings.
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Affiliation(s)
- Samantha Stonbraker
- Columbia University School of Nursing, 617 W. 168th St. Rm 330, New York, NY, 10032, USA.
| | - Montina Befus
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Elaine Larson
- Columbia University School of Nursing, 617 W. 168th St. Rm 330, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Carrasco MA, Arias R, Figueroa ME. The multidimensional nature of HIV stigma: evidence from Mozambique. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 16:11-18. [PMID: 28367746 DOI: 10.2989/16085906.2016.1264983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
HIV stigma continues to be a major challenge to addressing HIV/AIDS in various countries in sub-Saharan Africa, including Mozambique. This paper explores the multidimensional nature of HIV stigma through the thematic analysis of five qualitative studies conducted in high HIV prevalence provinces in Mozambique between 2009 and 2012. These studies included 23 interviews with people living with HIV (PLHIV) (10 women and 13 men); 6 focus groups with 32 peer educators (24 women and 8 men) working for community-based organisations (CBOs) providing services to PLHIV; 17 focus groups with community members (72 men and 70 women); 6 interviews (4 women and 2 men) with people who had family members living with HIV/AIDS; 24 focus groups (12 with men and 12 with women) and 6 interviews with couples. Our findings indicate that HIV stigma is a barrier to HIV testing and counselling, status disclosure, partner notification, and antiretroviral therapy (ART) access and adherence, and that moral stigma seems to be more common than physical stigma. Additionally, the findings highlight that HIV stigma is a dynamic social process that is conceptualised as being tied to personal responsibility. To effectively diminish HIV stigma in Mozambique, future interventions should address moral stigma and re-conceptualise HIV as a chronic disease.
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Affiliation(s)
- Maria A Carrasco
- a Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health . Baltimore , Maryland , USA
| | - Rosario Arias
- a Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health . Baltimore , Maryland , USA
| | - Maria E Figueroa
- b Johns Hopkins Center for Communications Programs , Baltimore , Maryland , USA
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Stonbraker S, Befus M, Nadal LL, Halpern M, Larson E. Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting. Int J STD AIDS 2016; 28:685-692. [PMID: 27495146 DOI: 10.1177/0956462416663990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12-4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15-0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11-20.29 and 6.84 CI: 1.47-37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression.
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Affiliation(s)
| | - Montina Befus
- 2 Department of Epidemiology, Mailman School of Public Health, NY, USA
| | | | - Mina Halpern
- 3 Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Elaine Larson
- 1 Columbia University School of Nursing, NY, USA.,2 Department of Epidemiology, Mailman School of Public Health, NY, USA
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Rodríguez-Díaz CE, Jovet-Toledo GG, Ortiz-Sánchez EJ, Rodríguez-Santiago EI, Vargas-Molina RL. Sexual health and socioeconomic-related factors among HIV-positive men who have sex with men in Puerto Rico. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1949-58. [PMID: 26123066 PMCID: PMC4561021 DOI: 10.1007/s10508-015-0481-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/21/2014] [Accepted: 01/07/2015] [Indexed: 05/04/2023]
Abstract
Most of the research among HIV-positive populations has been approached from behavioral risk models. This is particularly true for those otherwise socially vulnerable groups like men who have sex with men (MSM). As a response to this pattern, we examined data from an ongoing health promotion research being conducted in Puerto Rico (PR). The study is limited to HIV-positive MSM and consists of the participation in a survey interview that includes domains used to assess indicators of socio-economic-related factors (age, educational level, employment, religion, and partnership status) and sexual health (sexual satisfaction, condom use, and sexual health knowledge(SHK)). Participants reported a relatively high level (75 %) of sexual satisfaction and inconsistent condom use (50.9 % reported always using a condom). A deficient (61 %) SHK was also reported. In multivariate analyses, a higher educational level was associated with higher sexual satisfaction (aβ = 3.223; 95 % CI 0.291-6.156) and higher levels of SHK (aβ = 1.328; 95 % CI 0.358-2.297), while unemployment was associated with less condom use (aOR 0.314; 95 % CI 0.122-0.810). Not having a primary sexual partner was associated with less sexual satisfaction (aβ = -3.871; 95 % CI -7.534-0.208) and more condom use (aOR 4.292; 95 % CI 1.310-14.068). Findings support the notion that men of a disadvantaged socioeconomic position may have a poorer sexual health status; with a lower level of education and unemployment leading this disparity. Findings also evidence that partnership status may have a role in the sexual health of HIV-positive MSM. To our knowledge, this is the first comprehensive analysis of sexual health and socioeconomic indicators among Hispanic/Latino HIV-positive MSM in PR and in the Caribbean. Findings provide valuable information to address the sexual health needs of an underserved population.
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Affiliation(s)
- Carlos E Rodríguez-Díaz
- School of Public Health, University of Puerto Rico-Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA,
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Budhwani H, Hearld KR, Barrow G, Peterson SN, Walton-Levermore K. A comparison of younger and older men who have sex with men using data from Jamaica AIDS Support for Life: characteristics associated with HIV status. Int J STD AIDS 2015; 27:769-75. [PMID: 26138898 DOI: 10.1177/0956462415594752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/14/2015] [Indexed: 11/15/2022]
Abstract
Jamaica is home to over 10% of the Caribbean's HIV-positive population. Men who have sex with men (MSM) have a higher prevalence of HIV compared to the general public. Thus, the purpose of this study is to assess characteristics associated with HIV, such as condom use and number of sexual partners, comparing young, those aged 18-24, to older, aged 25 and older, MSM in Jamaica. We hypothesised, and found support for the notion, that younger MSM would have a lower rate of some risky behaviours associated with HIV seropositivity. Service data for 160 self-selected MSM aged 18-62, from Kingston, Jamaica were analysed. The majority identified as homosexual (compared to bisexual), over half of respondents completed a tertiary level of education (e.g. any post-high school training), and 59.1% were employed. Almost all participants reported agreeing to use a condom when requested (93.6%). Prevalence of HIV was 17.8%, much lower than the 32% found in national studies, and is likely an underestimation reflecting patterns of this self-selected sample. Additionally, over one-third reported experiencing sexual abuse. Statistically significant relationships were found between age group and tertiary education, employment status, condom use with a regular partner, and sexual abuse. Younger MSM were more likely to have been sexually abused and were more likely to always wear a condom with their regular partner. A limitation of this study was the extent of missing data, restricting generalisability. However, by acknowledging the heterogeneity of the Jamaican MSM population, and subsequently evaluating behaviours across age groups, nuances emerge which highlight behavioural diversity. Findings may inform public health practitioners in developing targeted interventions.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham, School of Health Professions, Birmingham, AL, USA
| | - Geoffrey Barrow
- University of West Indies, Department of Medicine, Kingston, Jamaica
| | - Suzanne N Peterson
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
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Figueroa JP, Cooper CJ, Edwards JK, Byfield L, Eastman S, Hobbs MM, Weir SS. Understanding the high prevalence of HIV and other sexually transmitted infections among socio-economically vulnerable men who have sex with men in Jamaica. PLoS One 2015; 10:e0117686. [PMID: 25659122 PMCID: PMC4319820 DOI: 10.1371/journal.pone.0117686] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/30/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study estimates HIV prevalence among men who have sex with men (MSM) in Jamaica and explores social determinants of HIV infection among MSM. DESIGN An island-wide cross-sectional survey of MSM recruited by peer referral and outreach was conducted in 2011. A structured questionnaire was administered and HIV/STI tests done. We compared three groups: MSM who accepted cash for sex within the past 3 months (MSM SW), MSM who did not accept cash for sex (MSM non-SW), and MSM with adverse life events (ever raped, jailed, homeless, victim of violence or low literacy). RESULTS HIV prevalence among 449 MSM was 31.4%, MSM SW 41.1%, MSM with adverse life events 38.5%, 17 transgender MSM (52.9%), and MSM non-SW without adverse events 21.0%. HIV prevalence increased with age and number of adverse life events (test for trend P < 0.001), as did STI prevalence (P = 0.03). HIV incidence was 6.7 cases/100 person-years (95% CI: 3.74, 12.19). HIV prevalence was highest among MSM reporting high-risk sex; MSM SW who had been raped (65.0%), had a STI (61.2%) and who self identified as female (55.6%). Significant risk factors for HIV infection common to all 3 subgroups were participation in both receptive and insertive anal intercourse, high-risk sex, and history of a STI. Perception of no or little risk, always using a condom, and being bisexual were protective. CONCLUSION HIV prevalence was high among MSM SW and MSM with adverse life events. Given the characteristics of the sample, HIV prevalence among MSM in Jamaica is probably in the range of 20%. The study illustrates the importance of social vulnerability in driving the HIV epidemic. Programs to empower young MSM, reduce social vulnerability and other structural barriers including stigma and discrimination against MSM are critical to reduce HIV transmission.
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Affiliation(s)
- J. Peter Figueroa
- Department of Community Health and Psychiatry, University of West Indies, Mona, Kingston 7, Jamaica
| | | | - Jessie K. Edwards
- Carolina Population Center and Department of Epidemiology, University of North Carolina, Chapel Hill, United States of America
| | - Lovette Byfield
- Department of Community Health and Psychiatry, University of West Indies, Mona, Kingston 7, Jamaica
| | | | - Marcia M. Hobbs
- Departments of Medicine and Microbiology & Immunology, University of North Carolina, Chapel Hill, United States of America
| | - Sharon S. Weir
- Carolina Population Center and Department of Epidemiology, University of North Carolina, Chapel Hill, United States of America
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Abstract
Global trends in HIV incidence are estimated typically by serial prevalence surveys in selected sentinel populations or less often in representative population samples. Incidence estimates are often modeled because cohorts are costly to maintain and are rarely representative of larger populations. From global trends, we can see reason for cautious optimism. Downward trends in generalized epidemics in Africa, concentrated epidemics in persons who inject drugs (PWID), some female sex worker cohorts, and among older men who have sex with men (MSM) have been noted. However, younger MSM and those from minority populations, as with black MSM in the United States, show continued transmission at high rates. Among the many HIV prevention strategies, current efforts to expand testing, linkage to effective care, and adherence to antiretroviral therapy are known as "treatment as prevention" (TasP). A concept first forged for the prevention of mother to child transmission, TasP generates high hopes that persons treated early will derive considerable clinical benefits and that lower infectiousness will reduce transmission in communities. With the global successes of risk reduction for PWID, we have learned that reducing marginalization of the at-risk population, implementation of nonjudgmental and pragmatic sterile needle and syringe exchange programs, and offering of opiate substitution therapy to help persons eschew needle use altogether can work to reduce the HIV epidemic. Never has the urgency of stigma reduction and guarantees of human rights been more urgent; a public health approach to at-risk populations requires that to avail themselves of prevention services and they must feel welcomed.
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Affiliation(s)
- Sten H Vermund
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA,
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