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Zhong X, Chen S, Xiao H, Xiao X, Yu S, Shen Y, Chen C, Wang H. Perceived HIV risk and factors associated with condom use among women aged 40 and older: A cross-sectional survey. Int J Nurs Sci 2023; 10:533-539. [PMID: 38020828 PMCID: PMC10667289 DOI: 10.1016/j.ijnss.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives A noticeable increase in HIV-positive cases among women, particularly those of middle and old age, has been observed worldwide. This study aimed to describe women's perceived HIV risk, HIV/Acquired Immunodeficiency Syndrome (AIDS) knowledge, attitude, and sexual behaviors to determine factors associated with condom use among these women in Hunan, China. Methods A cross-sectional study was conducted from July 2019 to August 2020 among 958 women aged 40 and older in four regions of Hunan, China. We collected data on sociodemographic characteristics, perceived HIV risk, HIV/AIDS knowledge and attitude, condom use, and sexual behaviors. Univariate and multivariate logistic regression were performed to identify factors related to condom use. Results Out of 958 participants, 60.6% perceived no risk of HIV infection, and 46.8% reported they had never used a condom during their past sexual life. Those who were older, had lower monthly household income for family, had not received HIV education in the past year, were unwilling to use condoms, could not determine condom use during sexual activity, and had more negative attitudes towards HIV/AIDS and HIV-positive people were less likely to use condoms in their past sexual behaviors. Conclusions In Hunan Province, most women aged 40 and older perceived themselves as having a low or no risk of HIV infection; their rate of condom use was low, and six factors were associated with condom use. It is imperative to strengthen HIV prevention and control programs among women aged 40 and above, particularly focusing on those who may use condoms infrequently or not at all.
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Affiliation(s)
- Xueyuan Zhong
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Shuying Chen
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Hong Xiao
- Fred Hutch Cancer Research Center Seattle, WA, USA
- School of Public Health of Zhejiang University, Hangzhou, China
| | - Xueling Xiao
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Simin Yu
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Yan Shen
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Chen Chen
- Department of Vascular Surgery, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Honghong Wang
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
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Tieosapjaroen W, Ong JJ, Fairley CK, Saleem K, Phillips TR, Tran J, Bradshaw CS, Chen MY, Chow EPF. Trends and associated factors in HIV testing among heterosexual men and women in Melbourne, Australia, 2011-2020. Sex Health 2023; 20:411-423. [PMID: 37468130 DOI: 10.1071/sh22195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Despite the increase in the proportion of HIV notifications attributed to heterosexuals in Australia, little is known about their HIV testing behaviours. We investigated the trends and factors associated with HIV testing behaviours among heterosexuals. METHODS We analysed the trend and proportion of heterosexuals attending the centre for the first time between 2011 and 2020, who had ever tested and tested for HIV in the past 12months and the median number of months since their last HIV test. We identified factors associated with HIV testing behaviours using univariable and multivariable logistic regressions. RESULTS Of the 78652 heterosexuals included, 53.1% were men and 46.9% were women. Overall, the proportion of heterosexuals who had ever tested for HIV was 40.8%, with a declining testing trend from 40.2% in 2011 to 36.5% in 2020 (P trend <0.001). Overall, the proportion of heterosexuals tested for HIV in the past 12months was 15.7%, with no significant change from 15.3% in 2011 to 14.7% in 2020 (P trend =0.489). The median number of months since the last HIV test decreased from 18.0 (IQR 6.9-37.3) in 2011 to 15.0 (IQR 6.4-32.5) in 2020 (P trend <0.001). Individuals who had condomless sex with casual partners (aOR 0.92, 95% CI 0.88-0.96) and who were diagnosed with a sexually transmitted infection (aOR 0.88, 95% CI 0.84-0.93) were less likely to have ever tested for HIV. CONCLUSIONS HIV testing was low among heterosexuals, and individuals who engaged in condomless sex and had another sexually transmitted infection were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are needed.
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Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; and Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Kanwal Saleem
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
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Cianelli R, Villegas N, Oliveira GD, Sailsman S, Montano NP, Martinez AS, Toledo C, Sandalaula M, Sanchez H. Exploring the Psychosocial Impact of Living With HIV on Minority Older Women. J Am Psychiatr Nurses Assoc 2022; 28:216-224. [PMID: 32469282 DOI: 10.1177/1078390320927462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Among older adults, minority older women will account for 60% of the new HIV diagnoses. The psychosocial impact of living with HIV among this vulnerable population narrated by their own voices has been understudied. AIMS: The purpose of this study was to explore the psychosocial impact of living with HIV on minority older women. METHODS: In-depth interviews were conducted with 28 minority older women living with HIV at an Ambulatory Care Center HIV Clinic in South Florida. All interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to identify and define the major themes that emerged from the interviews. Questions included those concerning description of life after the HIV diagnosis, most challenging aspects of life after the diagnosis, and daily activities since the diagnosis. RESULTS: The analysis of the interview data led to five main themes: (I) Social Impact of HIV, (II) Threats to Health and Well-Being, (III) HIV as a Death Sentence, (IV) Spirituality, and (V) HIV Treatment Adherence. In their narratives, women described a myriad of psychosocial issues such as depressed mood, isolation, economic challenges, stigma, anhedonia of interest, fear of death, among others. CONCLUSIONS: There is a compelling empirical need for rapid implementation of a culturally tailored, holistic, low-cost, multistrategy intervention to early screen and reduce the psychosocial impact of HIV among minority older women.
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Affiliation(s)
- Rosina Cianelli
- Rosina Cianelli, PhD, MPH, RN, IBCLC, FAAN, University of Miami, Coral Gables, FL, USA
| | - Natalia Villegas
- Natalia Villegas, PhD, MSN, RN, IBCLC, University of Miami, Coral Gables, FL, USA
| | - Giovanna De Oliveira
- Giovanna De Oliveira, PhD, MSN, RN, ANP-C, PMHNP-BC, University of Miami, Coral Gables, FL, USA
| | - Sonique Sailsman
- Sonique Sailsman, PhD, RN, Barry University, Miami Shores, FL, USA
| | - Nilda Peragallo Montano
- Nilda Peragallo Montano, DrPH, RN, FAAN, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angel Solorzano Martinez
- Angel Solorzano Martinez DNP, MSN, MBA, RN, CNS, PMHNP-BC, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Christine Toledo
- Christine Toledo, PhD, MSN, RN, University of Miami, Coral Gables, FL, USA
| | - Muheriwha Sandalaula
- Muheriwha Sandalaula, PhDc, MScMid, RN, University of Miami, Coral Gables, FL, USA
| | - Heather Sanchez
- Heather Sanchez, RN, University of Miami, Coral Gables, FL, USA
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Lee CY, Lin YP, Wang SF, Lu PL. Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019. Infect Dis Ther 2022; 11:1033-1056. [PMID: 35301666 PMCID: PMC9124249 DOI: 10.1007/s40121-022-00619-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Late initiation (LI) of combination antiretroviral therapy (cART)-defined as having a CD4+ count of < 200 cells/μL or an AIDS-defining disease at cART initiation-has detrimental outcomes but remains prevalent worldwide, with LI trends and etiologies following the implementation of various HIV policies remaining underinvestigated. We assessed key concerns, characterized the determinants of various statuses at cART initiation, and evaluated the effects of those statuses on all-cause mortality after cART initiation. METHODS This multicenter retrospective cohort study enrolled 1198 patients with newly diagnosed HIV infection during 2009-2019 who were grouped by status at cART initiation: those without LI (non-LI group, 56.01%); those with LI but without late presentation (LP) of HIV (LP: a CD4 + count of < 200 cells/μL at HIV presentation or AIDS events ≤ 3 months of HIV diagnosis) [LILP(-) group, 4.51%]; and those with LI and with LP of HIV [LILP(+) group, 39.48%]. Joinpoint regression was used to identify changes in LI proportion. RESULTS The median CD4+ count at cART initiation increased significantly between 2009 (98 cells/μL) and 2015 (325 cells/μL) and stabilized thereafter (P for trend < 0.001). For LI, we identified one joinpoint in 2015: a substantial decrease from 77.14% in 2009 to 34.45% in 2015, followed by a nonsignificant increase to 39.1% in 2019. Overall, LILP(+) explained 89.8% of LI, without significant changes (92.59% in 2009 to 94.23% in 2019). In addition to HIV diagnosis during 2009-2012, multinomial logistic regression identified an age over 30 years and acute HIV infection as risk factors for LILP(+) and LILP(-), respectively. LILP(-) and LILP(+) were associated with a higher all-cause mortality risk. CONCLUSION Given the rise in LI from 2015 in the era of treat-all and rapid cART initiation, strategic interventions to increase earlier cART initiation must be intensified in Taiwan, especially among populations with delayed access to HIV testing services.
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Affiliation(s)
- Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Department of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- College of Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
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Lee CY, Wu PH, Lu PL, Liang FW. Different Trends of Distinct Time Points of AIDS Events Following HIV Diagnosis in Various At-risk Populations: A Retrospective Nationwide Cohort Study in Taiwan. Infect Dis Ther 2021; 10:1715-1732. [PMID: 34245451 PMCID: PMC8322356 DOI: 10.1007/s40121-021-00494-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Acquired immune deficiency syndrome (AIDS) events at distinct time points after human immunodeficiency virus (HIV) diagnosis require various AIDS prevention strategies. However, no nationwide epidemiological surveillance studies have been conducted to explore the trends of distinct AIDS event time points in various at-risk populations. The aim of this study was to explore the issues and characterize the determinants of AIDS status after HIV diagnosis. Methods This nationwide cohort study enrolled HIV-positive Taiwanese during 1984–2016. AIDS events were classified into three time points (≤ 3, 4–12, > 12 months) by their occurrence time after HIV diagnosis. The periods of HIV/AIDS diagnosis were divided into six categories according to the calendar year of HIV/AIDS diagnosis: 1984–1991, 1992–1996, 1997–2001, 2002–2006, 2007–2011, and 2012–2016. HIV-positive Taiwanese during 1984–2011 were then selected to determine the factors associated with four AIDS statuses within 5 years after HIV diagnosis (no AIDS, AIDS ≤ 3 months, within 4–12 months, > 12 months) using multinomial logistic regression. Results Of 33,142 cases, we identified 15,254 (46%) AIDS events. The overall AIDS incidence (events/100 person-years) peaked during 1992–1996 (20.61), then declined, and finally stabilized from 2002 (8.96–9.82). The evolution of the proportion of distinct time points of AIDS events following HIV diagnosis changed significantly in heterosexuals and intravenous drug users (IDUs) during 1984–2016 (decline at ≤ 3 months in IDUs, decline at 4–12 months in IDUs, and increase at > 12 months in heterosexuals and IDUs) but not among men who have sex with men (MSM). Time points at ≤ 3 months remained at > 50% among MSM and at > 55% among heterosexuals. In multinomial logistic regression, IDUs (vs. men who have sex with men; MSM) had a lower risk of all AIDS statuses; heterosexuals (vs. MSM) had a higher risk of AIDS events ≤ 3 months after HIV diagnosis. Conclusion The magnitude of AIDS in Taiwan has been stable since 2002. Enhancing early diagnosis among people with sexual contact and optimizing the HIV care continuum among heterosexuals and IDUs should be priorities for further AIDS prevention strategies.
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Affiliation(s)
- Chun-Yuan Lee
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd., Xiaogang Dist., Kaohsiung City, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Hua Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
| | - Po-Liang Lu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
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Rapidly Spreading Human Immunodeficiency Virus Epidemic Among Older Males and Associated Factors: A Large-scale Prospective Cohort Study in Rural Southwest China. Sex Transm Dis 2020; 46:234-239. [PMID: 30870324 PMCID: PMC6426354 DOI: 10.1097/olq.0000000000000957] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Supplemental digital content is available in the text. Human immunodeficiency virus incidence was associated with males, older age, less than secondary schooling and not currently being married. Background Increasing risk of human immunodeficiency virus (HIV) heterosexual transmission can raise the potential for a more diffuse and generalized epidemic. In response to the paucity of data on HIV incidence among heterosexuals in China, we conducted a large-scale, population-based cohort study located in rural southwest China. Methods Baseline enrollment for the study was conducted from 2013 to 2014 and follow-up at 12 months was from 2014 to 2015 among adults 20 years or older in 3 rural counties of Southwest China. Study participants were informed of the study by brochures and leaflets distributed in outreach activities. Interviews and blood collection were conducted in private rooms. Blood samples were tested for HIV infection. Results The HIV prevalence of the sample was 0.29% (95% confidence interval [CI], 0.27–0.30) (2063 of 722,795) among the total adult population of 1,090,296 potential participants 20 years or older at baseline. Of the 720,732 individuals who tested HIV-negative at baseline, 493,990 (69%) completed the follow-up. Overall HIV incidence was 2.73 (95% CI, 2.38–3.08) per 10,000 person-years (PY) (235 of 860,627 PY). Human immunodeficiency virus incidence was associated with males, older age, less than secondary schooling and not currently being married. Human immunodeficiency virus incidence was 71.28 (95% CI, 35.21–107.35) per 10,000 PY among males aged 50 to 69 years who had less than secondary schooling and were divorced or widowed. Heterosexual sex was the dominant transmission mode for HIV seroconversions (99.0%). Conclusions Older heterosexual males were at disproportionate risk of HIV infection. Health authorities in China need to develop and implement innovative interventions suitable for the broader population of older heterosexuals.
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Kuofie AA, Bauer A, Berkley-Patton J, Bowe-Thompson C. HIV Knowledge and Risk Behaviors Among Older Church-Affiliated Blacks. Gerontol Geriatr Med 2019; 5:2333721419855668. [PMID: 31276020 PMCID: PMC6598319 DOI: 10.1177/2333721419855668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 11/15/2022] Open
Abstract
There is an emerging population of older adults living with HIV, and among them, Black older adults experience the greatest burden of the disease. This is a growing public health concern, as older adults are disproportionately diagnosed at a later stage of the disease, while reporting similar risk factors as younger adults. It has also been shown that the Black Church is well positioned to offer health screenings. Thus, this study aimed to assess HIV knowledge, beliefs, and risk behaviors of older church-affiliated Black adults. Data were collected from a sample of Black adults (N = 543) from four predominately Black churches in Kansas City, MO. Participants were surveyed on measures assessing demographic characteristics, HIV knowledge and attitudes, and HIV testing and risk behaviors. Results indicated that compared to younger Black adults, Black older adults were less knowledgeable about the transmission of HIV and were less willing to be tested for HIV in church settings. However, there was no significant difference on the perceived seriousness of HIV in the community. Results further showed that Black older adults were less likely to use condoms/barriers during the past 6 months and over their lifetime. We discuss the implications of results for HIV intervention programs.
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Affiliation(s)
- Araba A. Kuofie
- University of Kansas, Lawrence, USA
- Araba A. Kuofie, Department of Psychology, University of Kansas, 1415 Jayhawk Blvd., 327 Fraser Hall, Lawrence, KS 66045, USA.
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Lee CY, Jen IA, Lan YC, Yen YF, Chuang PH, Chen M, Lee Y, Chen YMA. AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan. BMC Public Health 2018; 18:589. [PMID: 29720151 PMCID: PMC5932870 DOI: 10.1186/s12889-018-5500-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Taiwan has implemented several important interventions for various HIV-at-risk populations to combat the HIV epidemic, little is known regarding AIDS incidence at presentation and during follow-up among the various HIV-at-risk populations in Taiwan. A better understanding of AIDS incidence trends would help improve patient care and optimize public health strategies aimed at further decreasing HIV-related morbidity and mortality. METHODS Data from Taiwan Centers for Disease Control-operated Notifiable Diseases Surveillance System and Taiwan National Health Insurance Research Database (1998-2012) was divided into five cohort periods (consecutive 3-year groups). Logistic regression was employed to identify factors associated with AIDS incidence at presentation. Time-dependent Cox regression was used to identify factors associated with AIDS incidence during the follow-up period. RESULTS Of 22,665 patients [mean age: 32 years; male (93.03%)], 6210 (27.4%) had AIDS incidence over 2 (1.16) [median (interquartile range)] years of follow-up. AIDS developed in ≤3 months of HIV diagnosis in 73.6% AIDS patients. AIDS incidence trends at presentation and during follow-up differed according to HIV transmission routes over the five periods: AIDS at presentation increased in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.648 for bisexuals) but decreased to a nadir in period 3 and then increased slightly in period 5 (P < 0.001) in people who injected drugs (PWIDs). AIDS incidence during the follow-up period increased from period 1 to a peak in period 3 or 4, before declining slightly in period 5, in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.549 for bisexuals). However, it increased throughout the five periods in PWIDs (P < 0.001). Older age, sexual contact group versus PWIDs, high versus low income level, cohort periods, and HIV diagnosis regions helped predict AIDS at presentation and during follow-up. CONCLUSIONS Disparities in AIDS incidence trends in various HIV-at-risk populations reflect different sociodemographic variables of HIV exposure and the adopted HIV prevention strategies. This study suggests the urgent need for tailored strategies aimed at specific populations at presentation and during follow-up.
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Affiliation(s)
- Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
| | - I-An Jen
- Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ching Lan
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Yung-Feng Yen
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
| | - Pei-Hung Chuang
- Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Yun Lee
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
| | - Yi-Ming A. Chen
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Microbiology and Institute of Medical Research, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Konkle-Parker D, Fouquier K, Portz K, Wheeless L, Arnold T, Harris C, Turan J. Women's decision-making about self-protection during sexual activity in the deep south of the USA: a grounded theory study. CULTURE, HEALTH & SEXUALITY 2018; 20:84-98. [PMID: 28621176 PMCID: PMC5718927 DOI: 10.1080/13691058.2017.1331468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Many women continue to become infected with HIV, particularly in the Southeastern USA, despite widespread knowledge about methods to prevent its sexual transmission. This grounded theory investigation examined the decision-making process women use to guide their use or non-use of self-protective measures when engaging in sexual activity. Participants included women in the Mississippi cohort of the Women's Interagency HIV Study who were infected with or at high risk for HIV. Theoretical sampling was used to recruit a sample of 20 primarily African American women aged between 26 and 56 years, living in rural and urban areas. Data were analysed using constant comparative method to generate a theory of the process that guided women's self-protective decisions. Three key themes were identified: (1) sexual silence, an overall context of silence around sexuality in their communities and relationships; (2) the importance of relationships with male partners, including concepts of 'love and trust', 'filling the void' and 'don't rock the boat'; and (3) perceptions of risk, including 'it never crossed my mind', 'it couldn't happen to me' and 'assumptions about HIV'. These themes impacted on women's understandings of HIV-related risk, making it difficult to put self-protection above other interests and diminishing their motivation to protect themselves.
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Affiliation(s)
- Deborah Konkle-Parker
- Department of Medicine/Infectious Diseases, University of MS Medical Center, Jackson, MS, USA
| | | | - Kaitlin Portz
- Department of Pshychology, Jackson State University, Jackson, MS, USA
| | - Linnie Wheeless
- Department of Pshychology, Jackson State University, Jackson, MS, USA
| | - Trisha Arnold
- Department of Pshychology, Jackson State University, Jackson, MS, USA
| | - Courtney Harris
- Department of Pshychology, Jackson State University, Jackson, MS, USA
| | - Janet Turan
- Department of Health Care Organization and Policy, University of Alabama, Birmingham, AL, USA
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Syme ML, Cohn TJ, Barnack-Tavlaris J. A Comparison of Actual and Perceived Sexual Risk Among Older Adults. JOURNAL OF SEX RESEARCH 2017; 54:149-160. [PMID: 26813853 PMCID: PMC5573595 DOI: 10.1080/00224499.2015.1124379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual risk among older adults (OAs) is prevalent, though little is known about the accuracy of sexual risk perceptions. Thus, the aim was to determine the accuracy of sexual risk perceptions among OAs by examining concordance between self-reported sexual risk behaviors and perceived risk. Data on OAs aged 50 to 92 were collected via Amazon.com's Mechanical Turk. Frequency of sexual risk behaviors (past six months) were reported along with perceived risk, namely, sexually transmitted infection (STI) susceptibility. Accuracy categories (accurate, underestimated, overestimated) were established based on dis/concordance between risk levels (low, moderate, high) and perceived risk (not susceptible, somewhat susceptible, very susceptible). Approximately half of the sample reported engaging in vaginal (49%) and/or oral sex (43%) without a condom in the past six months. However, approximately two-thirds of the sample indicated they were "not susceptible" to STIs. No relationship was found between risk behaviors and risk perceptions, and approximately half (48.1%) of OAs in the sample underestimated their risk. Accuracy was found to decrease as sexual risk level increased, with 93.1% of high-risk OAs underestimating their risk. Several sexual risk behaviors are prevalent among OAs, particularly men. However, perception of risk is often inaccurate and warrants attention.
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11
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Hughes AK, Alford KR. HIV Transmission: Myths about Casual Contact and Fear about Medical Procedures Persist Among Older Adults. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:49-52. [PMID: 27429205 DOI: 10.1080/19371918.2016.1188743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
HIV infection among older adults is increasing. Previous research suggests that many older adults do not see themselves as at risk for HIV and that many subscribe to myths related to HIV transmission. In this focus group study (N = 48) we solicited the beliefs that older adults held about HIV. The older adults in this study were knowledgeable about how HIV is typically transmitted. However, we also identified that they subscribed to misconceptions regarding casual contact transmission and were fearful of transmission from the medical system. Educational efforts aimed at older adults must be tailored to address these persistent misconceptions.
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Affiliation(s)
- Anne K Hughes
- a School of Social Work, Michigan State University , East Lansing , Michigan , USA
| | - Kristen R Alford
- b Department of Sociology and Social Work , Calvin College , Grand Rapids , Michigan , USA
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12
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Gedin TC, Resnick B. Increasing risk awareness and facilitating safe sexual activity among older adults in senior housing. J Community Health Nurs 2016; 31:187-97. [PMID: 25356989 DOI: 10.1080/07370016.2014.958390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The prevalence of HIV in older adults is rising. This increase can be attributed to inconsistent condom use, low perceived disease susceptibility, and a sexual health knowledge gap found in older adults. Yet, little to no health promotion for older adults focuses on sex education. This study sought to determine the feasibility of a group-based educational program in senior housing settings and consider the utility of a self-efficacy based group education program on knowledge of disease risk and preventive techniques among older adults living in senior housing.
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Affiliation(s)
- Tonii C Gedin
- a University of Maryland , School of Nursing , Baltimore , Maryland
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13
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Gwadz M, Cleland CM, Kutnick A, Leonard NR, Ritchie AS, Lynch L, Banfield A, McCright-Gill T, Del Olmo M, Martinez B. Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection in New York City. Front Public Health 2016; 4:76. [PMID: 27200330 PMCID: PMC4846660 DOI: 10.3389/fpubh.2016.00076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/08/2016] [Indexed: 12/28/2022] Open
Abstract
Background The Centers for Disease Control and Prevention recommends persons at high risk for HIV infection in the United States receive annual HIV testing to foster early HIV diagnosis and timely linkage to health care. Heterosexuals make up a significant proportion of incident HIV infections (>25%) but test for HIV less frequently than those in other risk categories. Yet factors that promote or impede annual HIV testing among heterosexuals are poorly understood. The present study examines individual/attitudinal-, social-, and structural-level factors associated with past-year HIV testing among heterosexuals at high risk for HIV. Methods Participants were African-American/Black and Hispanic heterosexual adults (N = 2307) residing in an urban area with both high poverty and HIV prevalence rates. Participants were recruited by respondent-driven sampling in 2012–2015 and completed a computerized structured assessment battery covering background factors, multi-level putative facilitators of HIV testing, and HIV testing history. Separate logistic regression analysis for males and females identified factors associated with past-year HIV testing. Results Participants were mostly male (58%), African-American/Black (75%), and 39 years old on average (SD = 12.06 years). Lifetime homelessness (54%) and incarceration (62%) were common. Half reported past-year HIV testing (50%) and 37% engaged in regular, annual HIV testing. Facilitators of HIV testing common to both genders included sexually transmitted infection (STI) testing or STI diagnosis, peer norms supporting HIV testing, and HIV testing access. Among women, access to general medical care and extreme poverty further predicted HIV testing, while recent drug use reduced the odds of past-year HIV testing. Among men, past-year HIV testing was also associated with lifetime incarceration and substance use treatment. Conclusion The present study identified gaps in rates of HIV testing among heterosexuals at high risk for HIV, and both common and gender-specific facilitators of HIV testing. Findings suggest a number of avenues for increasing HIV testing rates, including increasing the number and types of settings offering high-quality HIV testing; promoting STI as well as HIV testing; better integrating STI and HIV testing systems; implementing peer-driven social/behavioral intervention approaches to harness the positive influence of social networks and reduce unfavorable shared peer norms; and specialized approaches for women who use drugs.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Laura Lynch
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Angela Banfield
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Talaya McCright-Gill
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Montserrat Del Olmo
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
| | - Belkis Martinez
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing , New York, NY , USA
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14
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Evangeli M, Baker LLE, Pady K, Jones B, Wroe AL. What leads some people to think they are HIV-positive before knowing their diagnosis? A systematic review of psychological and behavioural correlates of HIV-risk perception. AIDS Care 2016; 28:943-53. [PMID: 26852667 DOI: 10.1080/09540121.2016.1139040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Current HIV-risk perception refers to the extent to which individuals think they might be HIV-positive. This belief, distinct from the perceived risk about being infected with HIV in the future, is likely to have a range of important consequences. These consequences may include both psychological effects (e.g., impacts on well-being) and behavioural effects (e.g., HIV testing uptake). Given these possible outcomes, and the suggested importance of risk perception in health behaviour models, understanding the behavioural and psychological antecedents of current HIV-risk perception is crucial. This systematic review investigates the relationship between behavioural and psychological factors and current HIV-risk perception (in individuals who are unaware of their actual HIV status). Eight studies were eligible for inclusion in the review (five quantitative and three qualitative studies). Drug risk behaviour and sexual risk behaviour (both self and partner) were often associated with current HIV-risk perception, although other studies failed to show a relationship between one's own sexual risk behaviour and risk perception. Psychological factors were only rarely assessed in relation to current HIV-risk perception. Where these variables were included, there was evidence that experiencing symptoms perceived to be consistent with HIV and prompts to test were associated with increased current HIV-risk perception. These findings are consistent with the Common-Sense Model (CSM) of illness representation and self-regulation. Methodological quality criteria were rarely met for the included studies. In addition, it was often difficult to ascertain whether potentially includable studies were eligible due to imprecise definitions of HIV-risk perception. Research and practice implications are discussed, with particular emphasis on the role of risk appraisals as a potential mediator of the relationship between HIV-risk behaviour, symptoms and current HIV-risk perception.
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Affiliation(s)
- Michael Evangeli
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Laura L E Baker
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Kirsten Pady
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Bethanie Jones
- a Department of Psychology , Royal Holloway University of London , Egham , UK
| | - Abigail L Wroe
- a Department of Psychology , Royal Holloway University of London , Egham , UK
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15
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Gwadz M, Cleland CM, Leonard NR, Kutnick A, Ritchie AS, Banfield A, Hagan H, Perlman DC, McCright-Gill T, Sherpa D, Martinez BY. Hybrid STTR intervention for heterosexuals using anonymous HIV testing and confidential linkage to care: a single arm exploratory trial using respondent-driven sampling. BMC Public Health 2015; 15:1133. [PMID: 26572865 PMCID: PMC4647497 DOI: 10.1186/s12889-015-2451-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An estimated 14 % of the 1.2 million individuals living with HIV in the U.S. are unaware of their status. Yet this modest proportion of individuals with undiagnosed HIV is linked to 44-66 % of all new infections. Thus innovative intervention approaches are needed to seek out and test those with undiagnosed HIV, and link them to HIV treatment with high retention, an approach referred to as "Seek, Test, Treat, and Retain" (STTR). The present protocol describes a creative "hybrid" STTR approach that uses anonymous HIV testing followed by confidential care linkage, focused on heterosexuals at high risk (HHR) for HIV, who do not test as frequently as, and are diagnosed later, than other risk groups. METHODS/DESIGN This is a single-arm exploratory intervention efficacy trial. The study has two phases: one to seek out and test HHR, and another to link those found infected to HIV treatment in a timely fashion, with high retention. We will recruit African American/Black and Latino adult HHR who reside in urban locations with high poverty and HIV prevalence. Participants will be recruited with respondent-driven sampling, a peer recruitment method. The "Seek and Test" phase is comprised of a brief, convenient, single-session, anonymous HIV counseling and testing session. The "Treat and Retain" component will engage those newly diagnosed with HIV into a confidential research phase and use a set of procedures called care navigation to link them to HIV primary care. Participants will be followed for 6 months with objective assessment of outcomes (using medical records and biomarkers). DISCUSSION Undiagnosed HIV infection is a major public health problem. While anonymous HIV testing is an important part of the HIV testing portfolio, it does not typically include linkage to care. The present study has potential to produce an innovative, brief, cost-effective, and replicable STTR intervention, and thereby reduce racial/ethnic disparities in HIV/AIDS. TRIAL REGISTRATION ClinicalTrials.gov, NCT02421159 , Registered April 15, 2015.
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Affiliation(s)
- Marya Gwadz
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Noelle R Leonard
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Angela Banfield
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Holly Hagan
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
- Mount Sinai Beth Israel Medical Center, 120 East 16th Street, New York, NY, USA.
| | - David C Perlman
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
- Mount Sinai Beth Israel Medical Center, 120 East 16th Street, New York, NY, USA.
| | - Talaya McCright-Gill
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Dawa Sherpa
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
| | - Belkis Y Martinez
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 6th floor, New York, 10010, NY, USA.
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16
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Gwadz M, Cleland CM, Hagan H, Jenness S, Kutnick A, Leonard NR, Applegate E, Ritchie AS, Banfield A, Belkin M, Cross B, Del Olmo M, Ha K, Martinez BY, McCright-Gill T, Swain QL, Perlman DC, Kurth AE. Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention: a "seek, test, treat, and retain" study. BMC Public Health 2015; 15:481. [PMID: 25958200 PMCID: PMC4434577 DOI: 10.1186/s12889-015-1816-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/01/2015] [Indexed: 11/10/2022] Open
Abstract
Background Over 50,000 individuals become infected with HIV annually in the U.S., and over a quarter of HIV infected individuals are heterosexuals. Undiagnosed HIV infection, as well as a lack of retention in care among those diagnosed, are both primary factors contributing to ongoing HIV incidence. Further, there are racial/ethnic disparities in undiagnosed HIV and engagement in care, with African Americans/Blacks and Latinos remaining undiagnosed longer and less engaged in care than Whites, signaling the need for culturally targeted intervention approaches to seek and test those with undiagnosed HIV infection, and link them to care with high retention. Methods/Design The study has two components: one to seek out and test heterosexuals at high risk for HIV infection, and another to link those found infected to HIV care with high retention. We will recruit sexually active African American/Black and Latino adults who have opposite sex partners, negative or unknown HIV status, and reside in locations with high poverty and HIV prevalence. The “Seek and Test” component will compare the efficacy and cost effectiveness of two strategies to uncover undiagnosed HIV infection: venue-based sampling and respondent-driven sampling (RDS). Among those recruited by RDS and found to have HIV infection, a “Treat and Retain” component will assess the efficacy of a peer-driven intervention compared to a control arm with respect to time to an HIV care appointment and health indicators using a cluster randomized controlled trial design to minimize contamination. RDS initial seeds will be randomly assigned to the intervention or control arm at a 1:1 ratio and all recruits will be assigned to the same arm as the recruiter. Participants will be followed for 12 months with outcomes assessed using medical records and biomarkers, such as HIV viral load. Discussion Heterosexuals do not test for HIV as frequently as and are diagnosed later than other risk groups. The study has the potential to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the majority of heterosexuals at high risk are African American/Black or Latino, the study has great potential to reduce racial/ethnic disparities in HIV/AIDS. Trial registration ClinicalTrials.gov, NCT01607541, Registered May 23, 2012.
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Affiliation(s)
- Marya Gwadz
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Charles M Cleland
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Holly Hagan
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Samuel Jenness
- Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA.
| | - Alexandra Kutnick
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Noelle R Leonard
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Elizabeth Applegate
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Amanda S Ritchie
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Angela Banfield
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Mindy Belkin
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Bridget Cross
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Montserrat Del Olmo
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Katharine Ha
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Belkis Y Martinez
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Talaya McCright-Gill
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - Quentin L Swain
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
| | - David C Perlman
- Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical Dependency Institute, 120 Water Street, Floor 24, New York, NY, 10038, USA.
| | - Ann E Kurth
- NYU College of Nursing, Center for Drug Use and HIV Research (CDUHR), 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
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Nevedal A, Sankar A. The Significance of Sexuality and Intimacy in the Lives of Older African Americans With HIV/AIDS. THE GERONTOLOGIST 2015; 56:762-71. [PMID: 26035889 DOI: 10.1093/geront/gnu160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/26/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Aging and HIV/AIDS research focuses primarily on standardized clinical, social, and behavioral measures, leaving unanswered questions about how this chronic and stigmatizing condition affects life course expectations and the meaning of aging with the disease. Utilizing Gaylene Becker's (1997) life course disruption theory, we explored older African Americans' experiences of living with HIV/AIDS. DESIGN AND METHODS A purposive sample (N = 43) of seropositive African Americans aged 50 and older was selected from a parent study. Thirteen participants completed one semi-structured in-depth interview on life course expectations and experiences of living with HIV/AIDS. Interview transcripts were analyzed using standard qualitative coding and thematic analysis. RESULTS Responding to broad, open-ended questions about the impact of HIV on life course expectations, participants emphasized how HIV limited their ability to experience sexuality and intimacy. Two major themes emerged, damaged sexuality and constrained intimacy. IMPLICATIONS Older African Americans' discussions of living with HIV focused on the importance of and the challenges to sexuality and intimacy. Researchers and clinicians should be attentive to significant and ongoing HIV-related challenges to sexuality and intimacy facing older African Americans living with HIV/AIDS.
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Affiliation(s)
- Andrea Nevedal
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.
| | - Andrea Sankar
- Department of Anthropology, Wayne State University, Detroit, Michigan
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18
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Ludwig-Barron N, Wagner KD, Syvertsen JL, Ewald IJ, Patterson TL, Semple SJ, Stockman JK. "When you get old like this … you don't run those risks anymore": influence of age on sexual risk behaviors and condom use attitudes among methamphetamine-using heterosexual women with a history of partner violence. Womens Health Issues 2014; 24:620-8. [PMID: 25128035 PMCID: PMC4254316 DOI: 10.1016/j.whi.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/25/2014] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Drug use and partner violence affect older women, yet few studies highlight age-specific HIV risks and prevention strategies. This study compares sexual risk behaviors, condom use attitudes, and HIV knowledge between midlife/older women (ages 45+) and younger women (ages 18-44) reporting methamphetamine use and partner violence in San Diego, California. METHODS Our mixed methods study used themes from a qualitative substudy (n = 18) to inform logistic regression analysis of baseline data from an HIV behavioral intervention trial (n = 154). FINDINGS Age-related qualitative themes included physiologic determinants, HIV knowledge, and "dodging the bullet," referring to a lifetime of uncertainty surrounding HIV serostatus after engaging in unsafe drug and sex practices. Midlife/older age was associated with never being married (24.2% vs. 51.2; p = .03), having less than a high school education/GED (12.1% vs. 34.7%; p = .04), lower condom use self-efficacy (2.87 vs. 3.19; p = .03), lower positive outcome expectancies (1.9 vs. 2.1; p = .04), and lower HIV knowledge (85.3% vs. 89.7%; p = .04); however, sexual risk behaviors were not associated with age group. In the multivariate analysis, midlife/older age remained independently associated with lower condom use self-efficacy (adjusted odds ratio, 0.49; 95% CI, 0.27-0.87) and lower HIV knowledge (adjusted odds ratio, 0.96; 95% CI, 0.93-0.99). CONCLUSIONS Midlife/older methamphetamine-using women with experiences of partner violence present similar sexual risk profiles, but possess different HIV-related knowledge and attitudes toward prevention methods compared with their younger counterparts. Clinicians and public health practitioners can have a positive impact on this overlooked population by assessing HIV risks during routine screenings, encouraging HIV testing, and providing age-appropriate HIV prevention education.
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Affiliation(s)
- Natasha Ludwig-Barron
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | | | - Ivy J Ewald
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.
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19
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Unprotected Sex with Injecting Drug Users among Iranian Female Sex Workers: Unhide HIV Risk Study. AIDS Res Treat 2012; 2012:651070. [PMID: 22506107 PMCID: PMC3313628 DOI: 10.1155/2012/651070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/18/2011] [Accepted: 01/09/2012] [Indexed: 01/07/2023] Open
Abstract
Purpose. To assess the prevalence and associated factors of unprotected sex with injecting drug users (IDUs) among a sample of female sex workers (FSWs) in Iran. Methods. This cross-sectional study included 144 FSWs who were interviewed as a part of Unhide HIV Risk Study, a national behavioral survey focusing on various high-risk populations, including IDUs, FSWs, and Men who have Sex with Men (MSMs) in 2009. The survey was conducted in eight provinces in Iran using respondent-driven sampling. Participants' sociodemographic status, HIV knowledge, and HIV attitude were analyzed via logistic regression to determine the predictors of unprotected sex with IDU(s) during the past month. Results. Nineteen percent of FSWs reported at least one occasion of unprotected sex with IDU(s) in the month preceding the study. Higher educational level (OR = −0.653, 95%CI = −1.192 to −0.115), perceived HIV risk (OR = −1.047, 95%CI = −2.076 to −0.019), and perceived family intimacy during childhood (OR = −1.104, 95%CI = −1.957 to −0.251) were all independently associated with lower odds of having unprotected sex with IDU(s) in the month preceding the study. Age, marital status, living condition, HIV knowledge, and perceived behavioral control did not affect the odds of FSWs having sex with IDUs. Conclusion. Perceived HIV risk, which is a modifiable factor, seems to be a promising target for harm reduction interventions amongst Iranian female sex workers. Data presented here may aid in reducing or eliminating the role of sex workers as a bridge for HIV transmission from IDUs to the general population in Iran.
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Nokes KM, Nicholas PK, Rivero M, Rosa ME, Kirksey K, Moezzi S, Corless IB, Maryland M, Willard S, Robinson L, Hamilton MJ, Sefcik E, Wantland D, Holzemer WL, Portillo C. Sexual Function in Younger and Older HIV+adults in the United States and Puerto Rico. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-011-9120-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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