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Kablawi D, Milic J, Thomas T, Fotsing Tadjo T, Cinque F, Elgretli W, Gioè C, Lebouché B, Tsochatzis E, Finkel J, Bhagani S, Cascio A, Guaraldi G, Mazzola G, Saeed S, Sebastiani G. Metabolic dysfunction-associated steatohepatitis exhibits sex differences in people with HIV. HIV Med 2024. [PMID: 39091015 DOI: 10.1111/hiv.13697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES People with HIV are at increased risk for metabolic dysfunction-associated steatohepatitis (MASH). Although sex differences are documented in the general population, their role in the context of HIV is less understood. METHODS This was a multicentre cohort study including people with HIV without viral hepatitis coinfection. A FibroScan-AST (FAST) score >0.35 was used to diagnose MASH with significant liver fibrosis (stage F2-F4). We investigated sex-based differences in MASH trends as a function of age using a segmented linear mixed-effects model. Random effects accounted for clustering by the four sites. Adjusted models included ethnicity, diabetes, hypertension, and detectable HIV viral load. RESULTS We included 1472 people with HIV (25% women). At baseline, the prevalence of MASH with fibrosis by FAST score was lower in women than in men (4.8% vs. 9.2%, p = 0.008). Based on the adjusted model, male sex (+0.034; p = 0.04), age per year (+0.003; p = 0.05), detectable HIV viral load (+0.034; p = 0.02), and hypertension (+0.03; p = 0.01) were positively associated with MASH with fibrosis. Although men exhibited generally higher FAST scores, FAST scores increased in women during the critical biological age of presumed perimenopause to menopause (between 40 and 50 years), reaching levels similar to those in men by the age of 55 years. CONCLUSION Despite women with HIV having a lower prevalence of MASH with fibrosis than men, they exhibit an acceleration in FAST score increase around the perimenopausal age. Future studies should target adequate consideration of sex differences in clinical investigation of metabolic dysfunction-associated steatotic liver disease to fill current gaps and implement precision medicine for people with HIV.
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Affiliation(s)
- Dana Kablawi
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Tyler Thomas
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Thierry Fotsing Tadjo
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Felice Cinque
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Claudia Gioè
- Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", Palermo, Italy
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University Health Centre, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Palermo, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Mazzola
- Department of Infectious Diseases, Sant'Elia Hospital, Caltanissetta, Italy
| | - Sahar Saeed
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Giada Sebastiani
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
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Long C, Cinque F, Kablawi D, Kim DHD, Tadjo TF, Elgretli W, Ballesteros LR, Lupu A, Nudo M, Lebouché B, Kronfli N, Cox J, Costiniuk CT, De Pokomandy A, Routy JP, Klein MB, Lamonde F, Agnihotram RV, Saeed S, Sebastiani G. Material deprivation is associated with liver stiffness and liver-related outcomes in people with HIV. Liver Int 2024. [PMID: 39011563 DOI: 10.1111/liv.16022] [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] [Received: 05/14/2024] [Revised: 06/08/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Socioeconomic status (SES) is a driver of health disparities and chronic diseases. People with HIV (PWH) are at risk for chronic liver diseases. We evaluated the association between low SES and hepatic outcomes in PWH. METHODS We included PWH from a prospective cohort. SES was assessed by the Pampalon material and social deprivation index to classify the cohort into quintiles of deprivation. Multivariable linear regression was used to investigate associations of material and social deprivation with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) as markers of hepatic fibrosis and steatosis, respectively. Incidence of outcomes was evaluated through survival analysis. RESULTS Among the 804 PWH included, 45% and 72% were living in areas of the highest material and social deprivation, respectively. Materially deprived PWH were more frequently female and of non-white ethnicity and had higher prevalence of metabolic comorbidities. After adjustments, material deprivation correlated with increased LSM (β = 1.86, 95% CI 0.53-3.17) but not with CAP (β = 6.47, 95% CI -5.55-18.49). Patients were observed for a median follow-up of 3.8 years. Incidence of liver-related events was higher in most materially deprived compared to most privileged PWH (hazard ratio 3.03, 95% CI 1.03-8.92), while there was no difference in extrahepatic outcomes or all-cause mortality. Social deprivation showed no association with either LSM or clinical outcomes. CONCLUSIONS Living in materially deprived neighbourhoods as a proxy for lower SES, is associated with LSM and liver-related events in PWH. Future strategies should explore mechanisms underlying these relationships and whether enhanced material security improves hepatic outcomes.
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Affiliation(s)
- Clara Long
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Felice Cinque
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dana Kablawi
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dong Hyun Danny Kim
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Fotsing Tadjo
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Luz Ramos Ballesteros
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Amanda Lupu
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Nudo
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Cecilia T Costiniuk
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Alexandra De Pokomandy
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marina B Klein
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Frederic Lamonde
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ramanakumar V Agnihotram
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Giada Sebastiani
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Xiong P, Chen Y, Shi Y, Liu M, Yang W, Liang B, Liu Y. Global burden of diseases attributable to intimate partner violence: findings from the Global Burden of Disease Study 2019. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02637-x. [PMID: 38520514 DOI: 10.1007/s00127-024-02637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Our study aims to evaluate the global burden of disease attributable to IPV from 1990 to 2019 at global, regional, national, and socio-demographic index (SDI) levels. Our research question is: What is the global burden of disease attributable to intimate partner violence (IPV) from 1990 to 2019, and how does it vary at global, regional, national, and socio-demographic index (SDI) levels? METHODS Data parameters for the number of deaths, disability-adjusted life years (DALYs), and age-standardized rate were obtained from the Global Burden of Disease Study 2019. We calculated the percentage change and population attributable fraction with 95% uncertainty intervals. RESULTS IPV directly accounted for 0.14% [95% UI 0.09%, 0.21%] and 0.32% [95% UI 0.17%, 0.49%] of global all-cause deaths and DALYs in 2019, respectively. The age-standardized deaths and DALYs rates of IPV increased by 12.83% and 4.00% respectively from 1990 to 2019. Women aged 35-39 and 30-34 had the highest deaths and DALYs rate respectively. The highest age-standardized rates of IPV-related deaths and DALYs were observed in Southern Sub-Saharan. Both of deaths and DALYs were high in low-socio-demographic Index (SDI) quintile in 2019. CONCLUSIONS A higher level of deaths and DALYs attributable to IPV were reported in younger women, in the early 2000s, in Southern Sub-Saharan regions and in low SDI regions. Our study provides policymakers with up-to-date and comprehensive information.
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Affiliation(s)
- Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 West Huangpu Road, Guangzhou, 510632, People's Republic of China.
| | - Yuhan Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 West Huangpu Road, Guangzhou, 510632, People's Republic of China
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Yuchen Shi
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 West Huangpu Road, Guangzhou, 510632, People's Republic of China
- Capital University of Economics and Business, Beijing, People's Republic of China
| | - Min Liu
- Zhuhai Center for Maternal and Child Health Care, Zhuhai, People's Republic of China
| | - Weixin Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 West Huangpu Road, Guangzhou, 510632, People's Republic of China
- Department of Dermato-Venereology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Baolin Liang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 West Huangpu Road, Guangzhou, 510632, People's Republic of China
| | - Yaozhong Liu
- Guangzhou Huashang College, Guangzhou, People's Republic of China
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Nguyen LT, Minh Giang L, Nguyen DB, Nguyen TT, Lin C. Unraveling reproductive and maternal health challenges of women living with HIV/AIDS in Vietnam: a qualitative study. Reprod Health 2024; 21:34. [PMID: 38468301 DOI: 10.1186/s12978-024-01768-3] [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: 11/27/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) remains a significant public health concern worldwide. Women living with HIV/AIDS (WLHA) have the additional and unique need to seek sexual and reproductive health services. WLHA's maternal health journeys can be shaped by the cultural norms and resources that exist in their society. This study sought to understand if and how WLHA's family planning, pregnancy, and motherhood experiences could be influenced by the patriarchal culture, gender roles, and HIV stigma in Vietnam, specifically. METHODS Between December 2021 and March 2022, 30 WLHA with diverse socioeconomic backgrounds and childbirth experiences were interviewed in Hanoi, Vietnam. These semi-structured interviews covered topics including HIV stigma, gender norms, pregnancy experiences, and child-rearing challenges. Interviews were audio recorded, transcribed, and analysed using ATLAS.ti. RESULTS Qualitative analyses of participant quotes revealed how limited information on one's health prospects and reproductive options posed a significant challenge to family planning. Societal and familial expectations as well as economic circumstances also influenced reproductive decision-making. WLHA often encountered substandard healthcare during pregnancy, labor, and delivery. Stigma and lack of provider attentiveness resulted in cases where women were denied pain relief and other medical services. Communication breakdowns resulted in failure to administer antiretroviral therapy for newborns. Motherhood for WLHA was shadowed by concerns for not only their own health, but also the wellbeing of their children, as HIV stigma affected their children at school and in society as well. Many WLHA highlighted the constructive or destructive role that family members could play in their childbirth decision-making and care-giving experiences. CONCLUSIONS Overall, this study underscores the complex ways that cultural expectations, family support, and stigma in healthcare impact WLHA. Efforts to educate and engage families and healthcare providers are warranted to better understand and address the needs of WLHA, ultimately improving their reproductive and maternal health.
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Affiliation(s)
- Lynn T Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, 855 Tiverton Dr, Los Angeles, CA, USA
| | - Le Minh Giang
- Center for Training and Research On Substance Use and HIV, Hanoi Medical University, Room 211B, Building E3, No.1, Ton That Tung Street, Hanoi, Vietnam
| | - Diep B Nguyen
- Center for Training and Research On Substance Use and HIV, Hanoi Medical University, Room 211B, Building E3, No.1, Ton That Tung Street, Hanoi, Vietnam
| | - Trang T Nguyen
- Center for Training and Research On Substance Use and HIV, Hanoi Medical University, Room 211B, Building E3, No.1, Ton That Tung Street, Hanoi, Vietnam
| | - Chunqing Lin
- David Geffen School of Medicine, University of California, Los Angeles, 855 Tiverton Dr, Los Angeles, CA, USA.
- , 760 Westwood Plaza, 17-369E, Los Angeles, CA, 90024, USA.
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Katugume P, Namukowa JB, Nankunda O, Muhwezi TJ, Namaseruka R, Wakida EK, Obua C, Kakongi N. Coping strategies, challenges and potential interventions among adult patients with HIV and mental illness comorbidity in southwestern Uganda. Glob Public Health 2024; 19:2372802. [PMID: 38989538 DOI: 10.1080/17441692.2024.2372802] [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: 10/26/2023] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
HIV and mental illness comorbidity presents significant healthcare challenges, especially in low- and middle-income countries where healthcare systems often address individual conditions rather than comorbidities. This results in poor coping, increased vulnerability and diminished health-related quality of life. This study investigated coping strategies, challenges and potential interventions for individuals with HIV-mental illness comorbidity in Southwestern Uganda. The study included purposively selected people with HIV and mental illnesses seeking care in health facilities across Southwestern Uganda. Data from in-depth, semi-structured interviews were transcribed verbatim and entered into ATLAS.ti-7 for analysis. Thematic analysis was employed, generating codes from the transcripts to develop themes. The data revealed three categories: coping strategies, challenges and potential interventions. Three key coping strategies emerged: conscious avoidance of emotional stressors, maintaining emotional stability through social interactions and reliance on prayer. Challenges included social isolation, financial crises, vulnerability to abuse and medication management issues. Respondents recommended scaling up mass educational programmes to increase awareness of causes, preventive measures and association between the two comorbidities, together with implementing financial aid initiatives as viable interventions. These findings highlight the importance of addressing comorbidities together for improved emotional stability and underscore the value of the proposed potential interventions for healthcare systems and policymakers.
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Affiliation(s)
- Prosper Katugume
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Bosco Namukowa
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Oliver Nankunda
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Trevor James Muhwezi
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Namaseruka
- Department of Pharmaceutical Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K Wakida
- Office of Research Administration, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Celestino Obua
- Department of Pharmacology and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nathan Kakongi
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Ayorinde A, Ghosh I, Ali I, Zahair I, Olarewaju O, Singh M, Meehan E, Anjorin SS, Rotheram S, Barr B, McCarthy N, Oyebode O. Health inequalities in infectious diseases: a systematic overview of reviews. BMJ Open 2023; 13:e067429. [PMID: 37015800 PMCID: PMC10083762 DOI: 10.1136/bmjopen-2022-067429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES The aim of this systematic overview of reviews was to synthesise available evidence on inequalities in infectious disease based on three dimensions of inequalities; inclusion health groups, protected characteristics and socioeconomic inequalities. METHODS We searched MEDLINE, Embase, Web of Science and OpenGrey databases in November 2021. We included reviews published from the year 2000 which examined inequalities in the incidence, prevalence or consequences of infectious diseases based on the dimensions of interest. Our search focused on tuberculosis, HIV, sexually transmitted infections, hepatitis C, vaccination and antimicrobial resistance. However, we also included eligible reviews of any other infectious diseases. We appraised the quality of reviews using the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) checklist. We conducted a narrative data synthesis. RESULTS We included 108 reviews in our synthesis covering all the dimensions of inequalities for most of the infectious disease topics of interest, however the quality and volume of review evidence and consistency of their findings varied. The existing literature reviews provide strong evidence that people in inclusion health groups and lower socioeconomic status are consistently at higher risk of infectious diseases, antimicrobial resistance and incomplete/delayed vaccination. In the protected characteristics dimension, ethnicity, and sexual orientation are important factors contributing to inequalities across the various infectious disease topics included in this overview of reviews. CONCLUSION We identified many reviews that provide evidence of various types of health inequalities in different infectious diseases, vaccination, and antimicrobial resistance. We also highlight areas where reviews may be lacking. The commonalities in the associations and their directions suggest it might be worth targeting interventions for some high risk-groups that may have benefits across multiple infectious disease outcomes rather than operating purely in infectious disease siloes.
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Affiliation(s)
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ifra Ali
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Iram Zahair
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Olajumoke Olarewaju
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Megha Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Meehan
- School of Public Health and Prevention Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Suzanne Rotheram
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Noel McCarthy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
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Suantari D. Misconceptions and stigma against people living with HIV/AIDS: a cross-sectional study from 2017 Indonesia Demographic and Health Survey. Epidemiol Health 2021; 43:e2021094. [PMID: 34749487 PMCID: PMC8920734 DOI: 10.4178/epih.e2021094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Data are not available in Indonesia to measure the main indicators of zero new infections, zero acquired immune deficiency syndrome (AIDS)-related deaths and zero discrimination. This study aimed to determine factors related to misconceptions about human immunodeficiency virus (HIV) transmission and the stigma against people living with HIV/AIDS (PLWHA) in Indonesia METHODS This cross-sectional study used secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS). The sample was women and men aged 17–45 years and married (n=3,023). RESULTS Education and wealth index quintile were significantly related to misconceptions about HIV transmission. Respondents with low levels of education were more likely to have misconceptions about HIV transmission. Respondents who were in the poorest, poorer, middle, and richer quintiles of the wealth index were more likely to have misconceptions about HIV transmission than those in the richest quintile. Educational level, employment status, and wealth index quintile were predictors of stigma against PLWHA. CONCLUSIONS There are still many Indonesian people with misconceptions about HIV transmission and stigma against PLWHA. Future studies should focus on educational programs or interventions aimed at increasing public knowledge and awareness, promoting compassion towards PLWHA, and emphasizing respect for the rights of PLWHA. These interventions are particularly important for populations who are uneducated and living in poverty.
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Huertas-Zurriaga A, Palmieri PA, Edwards JE, Cesario SK, Alonso-Fernandez S, Pardell-Dominguez L, Dominguez-Cancino KA, Leyva-Moral JM. Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis. Reprod Health 2021; 18:148. [PMID: 34246286 PMCID: PMC8272303 DOI: 10.1186/s12978-021-01197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/24/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. METHODS A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. RESULTS Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. CONCLUSION WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Hospital Universitari Germans Trias I Pujol, Badalona, 08916 Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Patrick A. Palmieri
- South American Center for Qualitative Research, Universidad Norbert Wiener, Av. Arequipa 444, Torre 2, Piso 4, Lima, 15046 Perú
- College of Graduate Health Studies, A. T. Still University, 800 W. Jefferson Street, Kirksville, MO 63501 USA
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
| | - Joan E. Edwards
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - Sandra K. Cesario
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - Sergio Alonso-Fernandez
- Recerca i Innovació en Cures Infermeres, Hospital Universitari Germans Trias I Pujol, Badalona, 08916 Barcelona, Spain
| | - Lidia Pardell-Dominguez
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Department D’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Karen A. Dominguez-Cancino
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Escuela de Enfermería, Universidad Científica del Sur, Carr. Panamericana Sur 19, Villa EL Salvador, Lima, 15067 Perú
- Escuela de Salud Pública, Universidad de Chile, Independencia 939, Independencia, 8380453 Santiago de Chile, Chile
| | - Juan M. Leyva-Moral
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Department D’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Murewanhema G. Adolescent girls, a forgotten population in resource-limited settings in the COVID-19 pandemic: implications for sexual and reproductive health outcomes. Pan Afr Med J 2020; 37:41. [PMID: 33552369 DOI: 10.11604/pamj.supp.2020.37.41.26970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/11/2022] Open
Abstract
Adolescent sexual and reproductive health is an essential aspect that may be forgotten in the COVID-19 pandemic. Valuable insights gained from previous humanitarian crises indicate undesirable short and long-term adolescent maternal consequences in low resource settings. Young girls are at a higher risk of dropping out of school and being forced into early child marriages and high-risk jobs that predispose them to sexual exploitation and sexual and gender-based violence. Economic recessions, supply chain disruptions and reallocation of resources may limit access and utilisation of services and commodities. The COVID-19 pandemic thus indirectly exposes adolescent girls to multiplied risks of unintended pregnancies, sexually transmitted infections including HIV and Human Papilloma Virus. Sexual and gender-based violence, including female genital mutilation cases may increase as intervention programmes to avert these are disrupted, and the resultant psychosocial and socioeconomic consequences may be devastating. Thus, a pro-active approach is required to come up with frameworks to ensure the minimum initial service package for reproductive health. A multi-sectoral collaborative intersection of relevant stakeholders in adolescent sexual and reproductive health is therefore urgently desired.
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Affiliation(s)
- Grant Murewanhema
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, PO Box A178, Avondale, Harare, Zimbabwe
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11
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Murewanhema G. Adolescent girls, a forgotten population in resource-limited settings in the COVID-19 pandemic: implications for sexual and reproductive health outcomes. Pan Afr Med J 2020. [PMID: 33552369 PMCID: PMC7846263 DOI: 10.11604/pamj.supp.2020.37.1.26970] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Adolescent sexual and reproductive health is an essential aspect that may be forgotten in the COVID-19 pandemic. Valuable insights gained from previous humanitarian crises indicate undesirable short and long-term adolescent maternal consequences in low resource settings. Young girls are at a higher risk of dropping out of school and being forced into early child marriages and high-risk jobs that predispose them to sexual exploitation and sexual and gender-based violence. Economic recessions, supply chain disruptions and reallocation of resources may limit access and utilisation of services and commodities. The COVID-19 pandemic thus indirectly exposes adolescent girls to multiplied risks of unintended pregnancies, sexually transmitted infections including HIV and Human Papilloma Virus. Sexual and gender-based violence, including female genital mutilation cases may increase as intervention programmes to avert these are disrupted, and the resultant psychosocial and socioeconomic consequences may be devastating. Thus, a pro-active approach is required to come up with frameworks to ensure the minimum initial service package for reproductive health. A multi-sectoral collaborative intersection of relevant stakeholders in adolescent sexual and reproductive health is therefore urgently desired.
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Affiliation(s)
- Grant Murewanhema
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, PO Box A178, Avondale, Harare, Zimbabwe
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12
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Ahmed M, Seid A. Does Women's Autonomy Matter on Attitude Towards Condom Use in Reducing Risk for HIV Infection Among Married Women in Ethiopia? HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:489-496. [PMID: 33061660 PMCID: PMC7533246 DOI: 10.2147/hiv.s279609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 11/23/2022]
Abstract
Background Condom utilization remains as the forefront guard to reduce the HIV/AIDS pandemic. However, evidence showed that the dynamics of gendered power, beliefs, and attitudes about condoms and sexuality retards condom use for a large proportion of Africa's people. Therefore, this study aimed to assess the association between women's autonomy in health decision making and attitude to condom use in reducing risk for HIV in Ethiopia using a nationally representative, population-based household survey data. Methods A cross-sectional study was carried out using 2016 nationally representative, population-based Ethiopia Demographic and Health Survey. SPSS version 21 was used to analyze the data. Multivariate logistic regression analysis was performed to assess the association between women's autonomy in health decision making and attitude to condom use by controlling confounders. To declare statistically significant associations, adjusted odds ratios (AOR) with 95% confidence interval (CI) were used. Results The present study enrolled 6787 weighted samples of married women. The study showed that the odds of attitude toward condom use were 1.39 times (AOR: 1.39; 95% CI: 1.04-1.85) higher among women who decide for their health care compared to its counterparts. Also, the odds of attitude toward condom use were positively associated among women who conquered higher education (AOR: 1.97; 95% CI: 1.17-3.33), who had the richest wealth index quintile (AOR: 1.45; 95% CI: 1.01-2.07), and who had ever been tested for HIV (AOR: 1.31; 95% CI: 1.09-1.57). However, the odds of attitudes toward condom use were negatively associated among Muslims (AOR: 0.58; 95% CI: 0.46-0.74) and Protestant religion (AOR: 0.69; 95% CI: 0.54-0.88) followers. Conclusion The study culminates that women's autonomy in health decision making improves attitudes toward condom use during sex for HIV prevention in Ethiopia. Besides, women's higher education gets better wealth index, and HIV testing perks up the attitudes toward condom use; but religious affiliation deters it. Therefore, efforts need to be done in promoting women's autonomy along with empowering women in education, economic as well as HIV detection. Furthermore, designing interventions that address primary prevention strategies like using condoms consistently along with addressing religious affiliation can have a significant effect on curtailing HIV/AIDS scourge.
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Affiliation(s)
- Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abdu Seid
- Department of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
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Islam R, Ahmad R, Ghailan K, Hoque KE. An Islamic Microfinance Approach to Scaling up the Economic Life of Vulnerable People with HIV/AIDS in the Muslim Society. JOURNAL OF RELIGION AND HEALTH 2020; 59:1327-1343. [PMID: 31134517 DOI: 10.1007/s10943-019-00832-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
People with HIV/AIDS (PLWHA) commonly pose problems to their family as well as to society because of their vulnerable health and economic conditions. Contrarily, PLWHA encounter social discrimination and adverse realities while finding it difficult to continue in their jobs. These complex phenomena interact to push them into a low economic status. A microfinance program can hopefully assist poor patients to cope with the negative economic consequences of this disease. But the conventional market-oriented microfinance institutions show reluctance to serve this group of people due to the possibilities of having credit risk. In this paper, we propose an alternative microfinancing technique that can provide a better economic life of the PLWHA while absorbing the credit risks. A comprehensive model is designed using specific Islamic financial instruments in conjugation with household economic portfolio theory. Critical realism method was adopted to construct this model. We concluded that the application of Islamic microfinance can enhance income of HIV patients while reducing the productivity-loss. This model can be useful to the microfinance practitioners and policymakers for addressing a different market segment, diversifying products, and formulating policy.
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Affiliation(s)
- Reazul Islam
- Asia-Europe Institute, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rubi Ahmad
- Faculty of Business and Accountancy, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Khalid Ghailan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Kazi Enamul Hoque
- Faculty of Education, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Derose KP, Palar K, Farías H, Adams J, Martínez H. Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research. Food Nutr Bull 2018; 39:549-563. [PMID: 30453759 DOI: 10.1177/0379572118809302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC). OBJECTIVE To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy. METHODS Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects. RESULTS Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists. CONCLUSION High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.
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Affiliation(s)
| | - Kartika Palar
- 2 Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Hugo Farías
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Jayne Adams
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- 1 RAND Corporation, Santa Monica, CA, USA.,4 Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,5 Nutrition International, Ottawa, Canada
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15
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Igulot P, Magadi MA. Socioeconomic Status and Vulnerability to HIV Infection in Uganda: Evidence from Multilevel Modelling of AIDS Indicator Survey Data. AIDS Res Treat 2018; 2018:7812146. [PMID: 29983999 PMCID: PMC6011175 DOI: 10.1155/2018/7812146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/23/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is controversy on the association between socioeconomic status (SES) and HIV infection. Some evidence claims higher SES is negatively associated with HIV infection while others report the reverse. OBJECTIVES To examine the association between SES and HIV infection in Uganda and to examine whether the SES-HIV relationship varies by gender, rural-urban place of residence, and time (2004-2005 and 2011) in Uganda. METHODS Multilevel analysis was applied to 39,766 individual cases obtained in 887 clusters of Uganda HIV/AIDS Indicators Survey conducted in 2004-2005 and 2011. RESULTS Household wealth is associated with increased vulnerability in the general population and in rural areas. Compared with no educational attainment, secondary or higher education is associated with reduced vulnerability to the risk of HIV infection by 37% in the general population. However, this effect was stronger in urban than rural areas. Besides individual-level factors, unobserved community factors too play an important role and account for 9% of unexplained variance after individual-level factors are considered. CONCLUSION Household wealth increases vulnerability but education reduces it. The social environment influences vulnerability to HIV infection independent of individual-level factors. HIV/AIDS awareness targeting sexual practices of wealthy individuals and those with primary-level educational attainment together with improving educational attainment and addressing contextual factors influencing vulnerability to HIV infection are necessary strategies to reduce HIV infections in Uganda.
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16
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Hill LM, Abler L, Maman S, Twine R, Kahn K, MacPhail C, Pettifor A. Hope, the Household Environment, and Sexual Risk Behaviors Among Young Women in Rural South Africa (HPTN 068). AIDS Behav 2018; 22:1908-1918. [PMID: 29076034 PMCID: PMC5920793 DOI: 10.1007/s10461-017-1945-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We assessed the psychological trait of hope as an explanatory mediator in the relationship between the home environment and sexual risk behaviors among 2533 young women in rural South Africa. Hope mediated the relationship between average household age and sexual debut (mediated effect = - 0.003, p < 0.05), and between household consumption and sexual debut (mediated effect = - 0.019, p < 0.05). Both higher average household age (β = 0.01; 95% CI 0.00, 0.01) and greater household consumption (β = 0.05; 95% CI 0.02, 0.08) were marginally associated with higher hope. In turn, greater hope was associated with lower odds of sexual debut (aOR = 0.62; 95% CI 0.52, 0.74). These results provide important preliminary evidence of the role of the home environment in shaping protective psychological assets and healthy sexual behaviors. Continued exploration of the relationship between hope and the home environment may help to explain why young women in this context have a disproportionate risk for HIV.
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Affiliation(s)
- Lauren M Hill
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.
| | - Laurie Abler
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Audrey Pettifor
- Department of Epidemiology, UNC Chapel Hill, Chapel Hill, NC, USA
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Magadi MA. Understanding the urban-rural disparity in HIV and poverty nexus: the case of Kenya. J Public Health (Oxf) 2018; 39:e63-e72. [PMID: 27412176 DOI: 10.1093/pubmed/fdw065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 05/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background The relationship between HIV and poverty is complex and recent studies reveal an urban-rural divide that is not well understood. This paper examines the urban-rural disparity in the relationship between poverty and HIV infection in Kenya, with particular reference to possible explanations relating to social cohesion/capital and other moderating factors. Methods Multilevel logistic regression models are applied to nationally-representative samples of 13 094 men and women of reproductive age from recent Kenya Demographic and Health Surveys. Results The results confirm a disproportionate higher risk of HIV infection among the urban poor, despite a general negative association between poverty and HIV infection among rural residents. Estimates of intra-community correlations suggest lower social cohesion in urban than rural communities. This, combined with marked socio-economic inequalities in urban areas is likely to result in the urban poor being particularly vulnerable. The results further reveal interesting cultural variations and trends. In particular, recent declines in HIV prevalence among urban residents in Kenya have been predominantly confined to those of higher socio-economic status. Conclusion With current rapid urbanization patterns and increasing urban poverty, these trends have important implications for the future of the HIV epidemic in Kenya and similar settings across the sub-Saharan Africa region.
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Affiliation(s)
- Monica A Magadi
- Professor of Social Research, School of Social Sciences, University of Hull, Hull HU6 7RX, UK
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18
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Stopka TJ, Brinkley-Rubinstein L, Johnson K, Chan PA, Hutcheson M, Crosby R, Burke D, Mena L, Nunn A. HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South. JMIR Public Health Surveill 2018; 4:e35. [PMID: 29615383 PMCID: PMC5904450 DOI: 10.2196/publichealth.8773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/21/2018] [Accepted: 02/04/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. OBJECTIVE The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. METHODS We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. RESULTS There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92). CONCLUSIONS We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
- Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
| | - Kendra Johnson
- Mississippi State Department of Health, Jackson, MS, United States
| | - Philip A Chan
- School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Brown University, Providence, RI, United States
| | - Marga Hutcheson
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
| | - Richard Crosby
- College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Deirdre Burke
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
| | - Leandro Mena
- John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Amy Nunn
- School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Brown University, Providence, RI, United States
- Rhode Island Public Health Institute, Providence, RI, United States
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Mabaso M, Sokhela Z, Mohlabane N, Chibi B, Zuma K, Simbayi L. Determinants of HIV infection among adolescent girls and young women aged 15-24 years in South Africa: a 2012 population-based national household survey. BMC Public Health 2018; 18:183. [PMID: 29373958 PMCID: PMC5787232 DOI: 10.1186/s12889-018-5051-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 01/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND South Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15-24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa. METHODS A secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence. RESULTS Out of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20-24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women's models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022). CONCLUSION These findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption.
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Affiliation(s)
- Musawenkosi Mabaso
- Epidemiology and Strategic Information Unit, HIV/AIDS, STIs and TB programme, Human Sciences Research Council, PO Box 37429, Overport, Durban, 4067 South Africa
| | - Zinhle Sokhela
- HIV/AIDS, STIs and TB programme, Human Sciences Research Council, Port Elizabeth, South Africa
| | - Neo Mohlabane
- HIV/AIDS, STIs and TB programme, Human Sciences Research Council, Pretoria, South Africa
| | - Buyisile Chibi
- HIV/AIDS, STIs and TB programme, Human Sciences Research Council, Port Elizabeth, South Africa
| | - Khangelani Zuma
- Research Methodology and Data Center, Human Sciences Research Council, Pretoria, South Africa
| | - Leickness Simbayi
- Office of the Deputy CEO for Research, Human Sciences Research Council, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Bunyasi EW, Coetzee DJ. Relationship between socioeconomic status and HIV infection: findings from a survey in the Free State and Western Cape Provinces of South Africa. BMJ Open 2017; 7:e016232. [PMID: 29162570 PMCID: PMC5719303 DOI: 10.1136/bmjopen-2017-016232] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies have shown a mixed association between socioeconomic status (SES) and prevalent HIV infection across and within settings in sub-Saharan Africa. In general, the relationship between years of formal education and HIV infection changed from a positive to a negative association with maturity of the HIV epidemic. Our objective was to determine the association between SES and HIV in women of reproductive age in the Free State (FSP) and Western Cape Provinces (WCP) of South Africa (SA). STUDY DESIGN Cross-sectional. SETTING SA. METHODS We conducted secondary analysis on 1906 women of reproductive age from a 2007 to 2008 survey that evaluated effectiveness of Prevention of Mother-to-Child HIV Transmission Programmes. SES was measured by household wealth quintiles, years of formal education and employment status. Our analysis principally used logistic regression for survey data. RESULTS There was a significant negative trend between prevalent HIV infection and wealth quintile in WCP (P<0.001) and FSP (P=0.025). In adjusted analysis, every additional year of formal education was associated with a 10% (adjusted OR (aOR) 0.90 (95% CI 0.85 to 0.96)) significant reduction in risk of prevalent HIV infection in WCP but no significant association was observed in FSP (aOR 0.99; 95% CI 0.89 to 1.11). There was no significant association between employment and prevalent HIV in each province: (aOR 1.54; 95% CI 0.84 to 2.84) in WCP and (aOR 0.96; 95% CI 0.71 to 1.30) in FSP. CONCLUSION The association between HIV infection and SES differed by province and by measure of SES and underscores the disproportionately higher burden of prevalent HIV infection among poorer and lowly educated women. Our findings suggest the need for re-evaluation of whether current HIV prevention efforts meet needs of the least educated (in WCP) and the poorest women (both WCP and FSP), and point to the need to investigate additional or tailored strategies for these women.
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Affiliation(s)
- Erick Wekesa Bunyasi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - David John Coetzee
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Wechsberg WM, Peasant C, Kline T, Zule WA, Ndirangu J, Browne FA, Gabel C, van der Horst C. HIV Prevention Among Women Who Use Substances And Report Sex Work: Risk Groups Identified Among South African Women. AIDS Behav 2017; 21:155-166. [PMID: 28887751 DOI: 10.1007/s10461-017-1889-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This cross-sectional study presents baseline data from women (n = 641) in a community-based randomized trial in Pretoria, South Africa. Women were eligible if they reported recent alcohol or other drug (AOD) use and condomless sex. Latent class analyses were conducted separately for those who reported sex work and those who did not. Among those who reported sex work, a Risky Sex class (n = 72, 28%) and Low Sexual Risk class (n = 190, 73%) emerged. Those in the Risky Sex class were more likely to report that their last episode of sexual intercourse was with their boyfriend (vs. a client/other partner) compared with the Low Sexual Risk class (p < 0.001). Among participants who did not report sex work, a Drug-Using, Violence-Exposed, and Impaired Sex class (n = 53; 14%) and Risky Sex and Moderate Drinking class (n = 326; 86%) emerged. The findings suggest that interventions for women who engage in sex work should promote safer sexual behavior and empowerment with main partners. Women who use AODs, experience physical or sexual violence, and have impaired sex may be a key population at risk for HIV and should be considered for tailored behavioral interventions in conjunction with South Africa's plan to disseminate HIV prevention methods to vulnerable women. TRIAL REGISTRATION ClinicalTrials.gov registration NCT01497405.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA.
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA.
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Courtney Peasant
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA
| | - Tracy Kline
- Social Statistics Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA
| | - William A Zule
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA
| | - Jacqueline Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, USA
| | - Colby Gabel
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charles van der Horst
- University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Derose KP, Payán DD, Fulcar MA, Terrero S, Acevedo R, Farías H, Palar K. Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study. PLoS One 2017; 12:e0181568. [PMID: 28742870 PMCID: PMC5526502 DOI: 10.1371/journal.pone.0181568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/24/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity. METHODS We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes. RESULTS Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress. CONCLUSIONS Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality.
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Affiliation(s)
- Kathryn P. Derose
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America
| | - Denise D. Payán
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - María Altagracia Fulcar
- United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Sergio Terrero
- United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Hugo Farías
- United Nations World Food Programme - Regional Bureau for Latin American and the Caribbean, Panamá, Rep. de Panama
| | - Kartika Palar
- Division of HIV, ID and Global Medicine, School of Medicine, University of California - San Francisco, San Francisco, California, United States of America
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Audet CM, Blevins M, Cherry CB, González-Calvo L, Green AF, Moon TD. Understanding intra-vaginal and labia minora elongation practices among women heads-of-households in Zambézia Province, Mozambique. CULTURE, HEALTH & SEXUALITY 2017; 19:616-629. [PMID: 27921861 PMCID: PMC5460297 DOI: 10.1080/13691058.2016.1257739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Intra-vaginal drying and tightening and labia minora elongation are commonly practised in some parts of southern Africa. We sought to capture data on these practices among women living in Zambézia province, Mozambique. Information was gathered from 3543 female heads of household on > 500 variables, including vaginal practices, in 2014. Women who planned to use intra-vaginal tightening substances had 1.84 times higher odds of ever receiving an HIV test (p < 0.001) and 1.40 times higher odds of at least one antenatal care visit attended during last pregnancy (p = 0.015). Women who had or planned to undergo labia minora elongation had 2.61 times higher odds of receiving an HIV test in the past (p < 0.001) and 1.60 times higher odds of attending at least one antenatal care visit during their last pregnancy (p < 0.001). There was little evidence for a relationship between self-reported HIV status and anticipated use of intra-vaginal tightening substances (p = 0.21). Current or anticipated participation in labia elongation showed a protective effect on HIV infection (p = 0.028). Given documented associations between intra-vaginal substance use, vaginal infections and HIV acquisition, understanding the prevalence of vaginal practices is an essential component to addressing the epidemic.
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Affiliation(s)
- Carolyn M Audet
- a Department of Health Policy , Vanderbilt University Medical Center , Nashville , USA
| | - Meridith Blevins
- b Department of Biostatistics , Vanderbilt University Medical Center , Nashville , USA
| | | | - Lazaro González-Calvo
- d Friends in Global Health , Impact and Project Evaluation Department , Quelimane , Mozambique
| | - Ann F Green
- c Institute for Global Health , Vanderbilt University Medical Center , Nashville , USA
| | - Troy D Moon
- e Department of Pediatrics , Vanderbilt University , Nashville , USA
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Magadi MA. Multilevel determinants of teenage childbearing in sub-Saharan Africa in the context of HIV/AIDS. Health Place 2017; 46:37-48. [PMID: 28463709 DOI: 10.1016/j.healthplace.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/12/2017] [Accepted: 04/21/2017] [Indexed: 11/29/2022]
Abstract
This paper examined national variations and multilevel determinants of teenage childbearing in sub-Saharan Africa (SSA) in the context of HIV/AIDS using data from recent Demographic and Health Surveys conducted in 29 countries of SSA. Results showed significant community and national variations in teenage childbearing, partly explained by socio-economic and HIV/AIDS context. At community level, lower HIV/AIDS stigma, higher wealth and female education were associated with lower teenage childbearing. However, national socio-economic status had an intricate relationship with teenage childbearing. Higher national GDP per-capita was generally associated with higher teenage childbearing, and this relationship was stronger in lower HIV prevalence countries.
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Affiliation(s)
- Monica A Magadi
- School of Education and Social Sciences, University of Hull, Hull HU6 7RX, UK.
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Beknazarova M, Whiley H, Ross K. Strongyloidiasis: A Disease of Socioeconomic Disadvantage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E517. [PMID: 27213420 PMCID: PMC4881142 DOI: 10.3390/ijerph13050517] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022]
Abstract
Strongyloidiasis is a disease caused by soil transmitted helminths of the Strongyloides genus. Currently, it is predominately described as a neglected tropical disease. However, this description is misleading as it focuses on the geographical location of the disease and not the primary consideration, which is the socioeconomic conditions and poor infrastructure found within endemic regions. This classification may result in misdiagnosis and mistreatment by physicians, but more importantly, it influences how the disease is fundamentally viewed. Strongyloidiasis must be first and foremost considered as a disease of disadvantage, to ensure the correct strategies and control measures are used to prevent infection. Changing how strongyloidiasis is perceived from a geographic and clinical issue to an environmental health issue represents the first step in identifying appropriate long term control measures. This includes emphasis on environmental health controls, such as better infrastructure, sanitation and living conditions. This review explores the global prevalence of strongyloidiasis in relation to its presence in subtropical, tropical and temperate climate zones with mild and cold winters, but also explores the corresponding socioeconomic conditions of these regions. The evidence shows that strongyloidiasis is primarily determined by the socioeconomic status of the communities rather than geographic or climatic conditions. It demonstrates that strongyloidiasis should no longer be referred to as a "tropical" disease but rather a disease of disadvantage. This philosophical shift will promote the development of correct control strategies for preventing this disease of disadvantage.
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Affiliation(s)
- Meruyert Beknazarova
- School of the Environment, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
| | - Harriet Whiley
- School of the Environment, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
| | - Kirstin Ross
- School of the Environment, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
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Ismail SM, Kari F, Kamarulzaman A. The Socioeconomic Implications among People Living with HIV/AIDS in Sudan: Challenges and Coping Strategies. J Int Assoc Provid AIDS Care 2015; 16:446-454. [PMID: 26715489 DOI: 10.1177/2325957415622449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To determine the socioeconomic impacts among HIV-infected persons in Sudan and examine whether there are significant variations in coping strategies between infected men and women, a primary survey was conducted among infected persons (n = 555). Discriminant function was used to analyze the data. We found significant variation in the coping strategies (<.001). HIV/AIDS impacts were more critical for women. Infected people have 3 alternatives in coping with the changes in their income and expenditure, that is, borrow, utilize savings, or sell assets. Policy makers should consider economic information in planning health care to mitigate the impacts and remove the gender gap.
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Affiliation(s)
- Salwa M Ismail
- 1 Federal Ministry of Health, Sudan National AIDS Control Program, Khartoum, Sudan
| | - Fatimah Kari
- 2 Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia
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Bulled NL. Social models of HIV risk among young adults in Lesotho. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 14:239-54. [PMID: 26284999 DOI: 10.2989/16085906.2015.1054295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Extensive research over the past 30 years has revealed that individual and social determinants impact HIV risk. Even so, prevention efforts focus primarily on individual behaviour change, with little recognition of the dynamic interplay of individual and social environment factors that further exacerbate risk engagement. Drawing on long-term research with young adults in Lesotho, I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis, I developed novel scales to measure social control, adoption of modernity, and HIV knowledge. In survey research, I examined the effects of individual characteristics (i.e., socioeconomic status, HIV knowledge, adoption of modernity) and social environment (i.e., social control) on HIV risk behaviours. In addition, I measured the impact of altered environments by taking advantage of an existing situation whereby young adults attending a national college are assigned to either a main campus in a metropolitan setting or a satellite campus in a remote setting, irrespective of the environment in which they were socialised as youth. This arbitrary assignment process generates four distinct groups of young adults with altered or constant environments. Regression models show that lower levels of perceived social control and greater adoption of modernity are associated with HIV risk, controlling for other factors. The impact of social control and modernity varies with environment dynamics.
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Affiliation(s)
- Nicola L Bulled
- a Center for Global Health , University of Virginia , Charlottesville , Virginia , USA
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Rahman M, Nakamura K, Seino K, Kizuki M. Intimate partner violence and symptoms of sexually transmitted infections: are the women from low socio-economic strata in Bangladesh at increased risk. Int J Behav Med 2014; 21:348-57. [PMID: 23515966 DOI: 10.1007/s12529-013-9302-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is little research on whether women who are either poor or illiterate and have experienced intimate partner violence (IPV) have a unique risk of sexually transmitted infections (STIs). Most such research concerns families displaced by wars and conflicts. PURPOSE Therefore, we aimed to further this important area of inquiry by (1) addressing whether an association exists between experiences of physical and/or sexual IPV within the past year and symptoms of STI and (2) exploring the relationship between low socio-economic status and IPV and the relative roles they play as obstacles to reducing women's risk of STI in a nationally representative sample of Bangladesh. METHOD This paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 4,195 currently married women. Exposure was determined from women's experiences of physical and sexual IPV within the past year. Genital sores and genital discharge were used as proxy outcome variables of the symptoms of STI. Descriptive statistics and multivariate logistic regression analysis were used in the study. RESULTS Experience of any physical and/or sexual IPV were associated with genital sores (adjusted odds ratio [AOR] = 1.79; 95 % confidence interval [CI], 1.28-2.51) and genital discharge (AOR 1.90, 95 % CI 1.42-2.53). Severity of physical IPV appeared to have more profound consequences on the outcome measured. Findings also demonstrated that for the risk of STI, women at the nexus of poverty or illiteracy and IPV were not more uniquely disadvantaged. CONCLUSIONS The results suggest that for the risk of STI, the negative effect of having experienced IPV extends across all socio-economic backgrounds and is not limited to women at either at the nexus of poverty or illiteracy and IPV. Findings underscore the calls for protecting women from all forms of physical and sexual violence from their husbands as a part of interventions to reduce the risk of STI.
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Affiliation(s)
- Mosiur Rahman
- International Health Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan,
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Abstract
The link between HIV infection and poverty in sub-Saharan Africa (SSA) is rather complex and findings from previous studies remain inconsistent. While some argue that poverty increases vulnerability, existing empirical evidence largely support the view that wealthier men and women have higher prevalence of HIV. In this paper, we examine the association between HIV infection and urban poverty in SSA, paying particular attention to differences in risk factors of HIV infection between the urban poor and non-poor. The study is based on secondary analysis of data from the Demographic and Health Surveys from 20 countries in SSA, conducted during 2003-2008. We apply multilevel logistic regression models, allowing the urban poverty risk factor to vary across countries to establish the extent to which the observed patterns are generalizable across countries in the SSA region. The results reveal that the urban poor in SSA have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Furthermore, the gender disparity in HIV infection (i.e. the disproportionate higher risk among women) is amplified among the urban poor. The paper confirms that the public health consequence of urban poverty that has been well documented in previous studies with respect to maternal and child health outcomes does apply to the risk of HIV infection. The positive association between household wealth and HIV prevalence observed in previous studies largely reflects the situation in the rural areas where the majority of the SSA populations reside.
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Affiliation(s)
- Monica A Magadi
- Department of Sociology, School of Social Sciences, City University, Northampton Square, London EC1V 0HB, UK.
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Emina JBO, Madise N, Kuepie M, Zulu EM, Ye Y. Identifying HIV most-at-risk groups in Malawi for targeted interventions. A classification tree model. BMJ Open 2013; 3:bmjopen-2012-002459. [PMID: 23793677 PMCID: PMC3657656 DOI: 10.1136/bmjopen-2012-002459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify HIV-socioeconomic predictors as well as the most-at-risk groups of women in Malawi. DESIGN A cross-sectional survey. SETTING Malawi PARTICIPANTS The study used a sample of 6395 women aged 15-49 years from the 2010 Malawi Health and Demographic Surveys. INTERVENTIONS N/A PRIMARY AND SECONDARY OUTCOME MEASURES Individual HIV status: positive or not. RESULTS Findings from the Pearson χ(2) and χ(2) Automatic Interaction Detector analyses revealed that marital status is the most significant predictor of HIV. Women who are no longer in union and living in the highest wealth quintiles households constitute the most-at-risk group, whereas the less-at-risk group includes young women (15-24) never married or in union and living in rural areas. CONCLUSIONS In the light of these findings, this study recommends: (1) that the design and implementation of targeted interventions should consider the magnitude of HIV prevalence and demographic size of most-at-risk groups. Preventive interventions should prioritise couples and never married people aged 25-49 years and living in rural areas because this group accounts for 49% of the study population and 40% of women living with HIV in Malawi; (2) with reference to treatment and care, higher priority must be given to promoting HIV test, monitoring and evaluation of equity in access to treatment among women in union disruption and never married or women in union aged 30-49 years and living in urban areas; (3) community health workers, households-based campaign, reproductive-health services and reproductive-health courses at school could be used as canons to achieve universal prevention strategy, testing, counselling and treatment.
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Affiliation(s)
- Jacques B O Emina
- Department of Population and Development Studies, University of Kinshasa, Kinshasa XI, Democratic Republic of Congo
- AFRILUX, CEPS/INSTEAD 3, Esch-sur-Alzette, Luxembourg
- Research Coordination, INDEPTH Network, Accra, Ghana
| | - Nyovani Madise
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | | | - Eliya M Zulu
- African Institute for Development Policy (AFIDEP), Westlands, Nairobi, Kenya
| | - Yazoume Ye
- ICF International, Calverton, Maryland, USA
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POVERTY, SEXUAL EXPERIENCE AND HIV VULNERABILITY RISKS: EVIDENCE FROM ADDIS ABABA, ETHIOPIA. J Biosoc Sci 2012; 44:677-701. [DOI: 10.1017/s0021932012000193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryThis study explores the relationship between poverty and vulnerability to HIV infection in Ethiopia using primary (quantitative and qualitative) and secondary data from two sub-cities of Addis Ababa. The data show that sexual experience is influenced by diverse factors such as age, gender, economic status and education level. Household economic status and migration explain the nature of sexual experience and level of vulnerability to HIV infection. Poor uneducated women in poor neighbourhoods are more likely to engage in risky sexual encounters despite awareness about the risk of HIV infection as they operate in an environment that provides the ‘path of least resistance’ (Lindegger & Wood, 1995, p. 7). This article argues that poverty provides a situation where early sexual initiation, ‘transactional sex’ and an inability to negotiate for safer sex are associated with low income, lack of education and increased vulnerability to HIV infection. This vulnerability is simultaneously contested and accepted as a commitment to even sacrifice one's life for the sake of one's loved ones. As a modest contribution to the ‘structural violence’ approach, which emphasizes social inequalities based on gender, class, ethnicity and race and inequalities in terms of exposure to risk and access to health care (Massé, 2007), this article challenges the ‘African promiscuity’ discourse, which ‘does not permit policymakers to think beyond sex’ (Stillwaggon, 2006, p. 156), and encourages researchers and policymakers to ask the right questions to understand the complexity of HIV/AIDS and seek solutions to the pandemic.
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The relationship between social roles and self-management behavior in women living with HIV/AIDS. Womens Health Issues 2011; 22:e27-33. [PMID: 21798762 DOI: 10.1016/j.whi.2011.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 05/16/2011] [Accepted: 05/31/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The social roles that women perform can be complicated and may affect their health. While there is some evidence describing traditional social roles of women, there is little evidence exploring the impact of those roles on how a woman manages a chronic condition. The purpose of this paper is to identify and examine the main social roles of 48 HIV infected women, and to explore how these roles relate to their self-management of HIV/AIDS. METHODS Forty-eight HIV infected, adult women were recruited from HIV clinics and AIDS service organizations in Northeast Ohio. All participants participated in one of 12 digitially recorded focus groups. All data were analyzed using qualitative description methodology. RESULTS The participants were predominantly middle-aged (mean = 42 years), African American (69%), and single (58%). Analysis revealed six social roles that these women experience and which affect their self-management. These social roles are: Mother/Grandmother, Believer, Advocate, Stigmatized Patient, Pet Owner, and Employee. These roles had both a positive and negative effect on a woman's self-management of her HIV disease and varied by age and time living with HIV. CONCLUSION Women living with HIV/AIDS struggle to manage the many daily tasks required to live well with this disease. The social context in which this self-management happens is important, and the various social roles that women perform can facilitate or hinder them from completing these tasks. Healthcare and social service providers should learn about these roles in their individual patients, particularly how these roles can be developed to increase HIV/AIDS self-management.
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Magadi M, Desta M. A multilevel analysis of the determinants and cross-national variations of HIV seropositivity in sub-Saharan Africa: evidence from the DHS. Health Place 2011; 17:1067-83. [PMID: 21741295 PMCID: PMC3248638 DOI: 10.1016/j.healthplace.2011.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 06/02/2011] [Accepted: 06/06/2011] [Indexed: 11/17/2022]
Abstract
This paper applies multilevel logistic regression models to Demographic and Health Survey data collected during 2003–2008 from 20 countries of sub-Saharan Africa to examine the determinants and cross-national variations in the risk of HIV seropositivity in the region. The models include individual-level and contextual region/country-level risk factors. Simultaneous confidence intervals of country-level residuals are used to compare the risk of being HIV seropositive across countries. The study reveals interesting general patterns in the risk of HIV seropositivity in sub-Saharan Africa. In particular, the findings highlight the gender disparity in socio-economic risk factors, partly explained by sexual behaviour factors.
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Affiliation(s)
- Monica Magadi
- Department of Sociology, School of Social Sciences, City University London, Northampton Square, London EC1V 0HB, UK.
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