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Du M, Liu M, Liu J. Global, regional, and national disease burden and attributable risk factors of HIV/AIDS in older adults aged 70 years and above: a trend analysis based on the Global Burden of Disease study 2019. Epidemiol Infect 2023; 152:e2. [PMID: 38097398 PMCID: PMC10789987 DOI: 10.1017/s0950268823001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
We aimed to assess the burden and trend of the HIV/AIDS epidemic among older adults over the past three decades at different geographical levels, based on the data collected from the Global Burden of Diseases (GBD) study 2019. This assessment identified the average annual percentage changes (AAPCs) using Joinpoint regression analysis. Globally, the incidence of HIV/AIDS has decreased (AAPC = -3.107); however, the overall prevalence has consistently increased (AAPC = 5.557). Additionally, both mortality (AAPC = 2.166) and disability-adjusted life years (DALYs; AAPC = 2.429) have increased. The highest increasing trends in female HIV/AIDS incidence and prevalence were observed in the Central Asia region. However, for males, these trends were observed in the Oceania region and the high-income Asia Pacific region, respectively. In recent decades, females aged 70-74 years had the highest incidence and prevalence, while males aged 70-74 years had highest mortality and DALYs in low social development index (SDI) regions. Unsafe sex resulted in 15 381.16 deaths, accounting for 90.73% of all HIV/AIDS deaths, and 331 140.56 DALYs, accounting for 91.12% of all HIV/AIDS DALYs. The HIV/AIDS disease burden differs by region, age, and sex among older adults. Sexual health education and targeted screening for older adults are recommended.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Maclin BJ, Wang Y, Rodriguez-Diaz C, Donastorg Y, Perez M, Gomez H, Barrington C, Kerrigan D. Comparing typologies of violence exposure and associations with syndemic health outcomes among cisgender and transgender female sex workers living with HIV in the Dominican Republic. PLoS One 2023; 18:e0291314. [PMID: 37695770 PMCID: PMC10495030 DOI: 10.1371/journal.pone.0291314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
Violence against women research largely excludes transgender women's experiences and violence from perpetrators other than intimate partners. This study compares patterns of violence exposure among cisgender and transgender female sex workers (FSWs) and the associations with syndemic health outcomes. We used cross-sectional surveys from samples of cisgender and transgender FSWs living with HIV in the Dominican Republic (N = 211 and 100, respectively). We used latent class analysis to identify patterns of emotional, physical, and sexual violence and harassment by partners, clients, and police. We assessed sociodemographic and occupational predictors in relation to class membership, and class membership in relation to health (HIV continuum of care outcomes, mental health, substance use), using logistic regression. Two classes were identified in cisgender sample: Low Reported Violence Exposure (Class 1) and Sex Work-related Police Harassment (Class 2). Class 2 participants had greater odds of scoring abnormal or borderline abnormal anxiety on the Hospital Anxiety and Depression Scale (HADS-A) (adjusted OR = 3.97, p<0.01), moderate-to-severe depression per the Patient Health Questionnaire-9 (PHQ-9) (aOR = 5.74, p<0.01), and any illicit drug use in the past six months (aOR = 3.06, p<0.05), compared to Class 1. The transgender sample produced three classes: Low Reported Violence Exposure (Class 1); Sex Work-related Police Harassment (Class 2); and Sex Work-related Violence and Harassment (Class 3). Class 3 participants had greater odds of having anxiety (aOR = 6.65, p<0.01) and depression (aOR = 4.45, p<0.05), while Class 2 participants had greater odds of perfect ART adherence during the previous four days (aOR = 2.78, p<0.05), compared to Class 1. The more diverse and extreme violence patterns uncovered for the transgender sample show this group's heightened risk, while similar patterns across groups regarding police abuse highlight a need for police-focused violence prevention interventions. Each sample's highest violence class was associated with poor mental health, underscoring the need for mental health interventions for all FSWs.
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Affiliation(s)
- Beth J. Maclin
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Carlos Rodriguez-Diaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
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Mukherjee TI, Terlikbayeva A, McCrimmon T, Primbetova S, Mergenova G, Benjamin S, Witte S, El-Bassel N. Association of gender-based violence with sexual and drug-related HIV risk among female sex workers who use drugs in Kazakhstan. Int J STD AIDS 2023; 34:666-676. [PMID: 37083464 PMCID: PMC11067510 DOI: 10.1177/09564624231170902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Little is known about the prevalence of intimate partner violence (IPV) or client violence, and associated HIV risk among women who engage in sex work (WESW) and use drugs in Kazakhstan, despite a growing HIV epidemic. METHODS Women who reported engaging in sex work and using illicit drugs were recruited from Almaty and Temirtau, Kazakhstan between 2015 and 2017. A cross-sectional analysis was conducted to determine prevalence and correlates of physical and sexual violence perpetrated by intimate partners and clients. Associations between each type of violence with sexual and drug-related HIV risk behaviors were assessed with negative-binomial and logistic regression models, respectively. RESULTS Of the 400 women, 45% and 28% reported recent IPV and client violence, respectively. IPV and client violence was associated with a greater number of sex work clients [IPV: adjusted incidence rate ratio (aIRR)physical: 1.86, 1.28-2.71; aIRRsexual: 2.28, 1.56-3.35]; [client violence: aIRRphysical: 2.20, 1.44-3.42; aIRRsexual: 2.54, 1.72-3.83], and client violence was associated with greater frequency of condomless sex with clients [aIRRphysical: 2.33, 1.41-4.03; aIRRsexual: 2.16, 1.35-3.56]. Violence was not associated with injection drug use, despite exchanging sex for drugs being associated with higher odds of violence. CONCLUSION HIV prevention programs for WESW in Kazakhstan should consider multi-sectoral approaches that address economic hardship and relationship-based components, in addition to violence reduction.
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Affiliation(s)
- Trena I Mukherjee
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | | | - Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | - Susan Witte
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
- Columbia University School of Social Work, New York, NY, USA
| | - Nabila El-Bassel
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
- Columbia University School of Social Work, New York, NY, USA
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Harris MT, Goldenberg S, Cui Z, Fairbairn N, Milloy MJS, Hayashi K, Samet JH, Walley AY, Nolan S. Association of sex work and social-structural factors with non-fatal overdose among women who use drugs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103950. [PMID: 36640591 PMCID: PMC9974922 DOI: 10.1016/j.drugpo.2022.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/24/2022] [Accepted: 12/24/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Women who use drugs (WWUD) and engage in sex work experience disproportionate sex- and drug-related harms, such as HIV, however comparatively little is known about their overdose risk. Therefore, we examined the association between sex work and overdose and secondarily explored the association of social-structural factors, such as policing and gendered violence, with overdose. METHODS Data were derived from two community cohort studies based in Vancouver, Canada between 2005 to 2018. We used logistic regression with GEE to examine the associations between a) sex work and nonfatal overdose and b) social-structural and individual variables with overdose among WWUD who engaged in sex work during the study. Sex work, overdose, and other variables were time-updated, captured every six months. RESULTS Among 857 WWUD included, 56% engaged in sex work during the study. Forty-three percent of WWUD engaged in sex work had at least one overdose compared to 26% of WWUD who did not. Sex work was not significantly associated with an increased odds of overdose (AOR = 1.14, 95% CI: 0.93-1.40). In the exploratory analysis amongst 476 WWUD engaged in sex work, social-structural variables associated with overdose in the multivariable model included exposure to: punitive policing (OR = 1.97, 95% CI: 1.30-2.96) and physical or sexual violence (OR = 2.55, 95% CI: 1.88-3.46). CONCLUSIONS WWUD engaged in sex work had an increased overdose burden that may be driven by social-structural factors rather than sex work itself. Interventions that address policing and gendered violence represent potential targets for effective overdose prevention.
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Affiliation(s)
- Miriam Th Harris
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA.
| | - Shira Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA; Centre for Gender and Sexual Health Equity, St Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada
| | - Zishan Cui
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J S Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Jeffrey H Samet
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
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