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Boothe MAS, Semá Baltazar C, Sathane I, Raymond HF, Fazito E, Temmerman M, Luchters S. Young key populations left behind: The necessity for a targeted response in Mozambique. PLoS One 2021; 16:e0261943. [PMID: 34972172 PMCID: PMC8719759 DOI: 10.1371/journal.pone.0261943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The first exposure to high-risk sexual and drug use behaviors often occurs during the period of youth (15-24 years old). These behaviors increase the risk of HIV infection, especially among young key populations (KP)-men how have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID). We describe the characteristics of young KP participants in the first Biobehavioral Surveillance (BBS) surveys conducted in Mozambique and examine their risk behaviors compared to adult KP. METHODS Respondent-driven sampling (RDS) methodology was used to recruit KP in three major urban areas in Mozambique. RDS-weighted pooled estimates were calculated to estimate the proportion of young KP residing in each survey city. Unweighted pooled estimates of risk behaviors were calculated for each key population group and chi-square analysis assessed differences in proportions between youth (aged less than 24 years old) and older adult KP for each population group. RESULTS The majority of MSM and FSW participants were young 80.7% (95% CI: 71.5-89.9%) and 71.9% (95% CI: 71.9-79.5%), respectively, although not among PWID (18.2%, 95% CI: 13.2-23.2%). Young KP were single or never married, had a secondary education level or higher, and low employment rates. They reported lower perception of HIV risk (MSM: 72.3% vs 56.7%, p<0.001, FSW: 45.3% vs 24.4%, p<0.001), lower HIV testing uptake (MSM: 67.5% vs 72.3%, p<0.001; FSW: 63.2% vs 80.6%; p<0.001, PWID: 53.3% vs 31.2%; p = 0.001), greater underage sexual debut (MSM: 9.6% vs 4.8%, p<0.001; FSW: 35.2% vs 22.9%, p<0.001), and greater underage initiation of injection drug use (PWID: 31.9% vs 7.0%, p<0.001). Young KP also had lower HIV prevalence compared to older KP: MSM: 3.3% vs 27.0%, p<0.001; FSW: 17.2% vs 53.7%, p<0.001; and PWID: 6.0% vs 55.0%, p<0.001. There was no significant difference in condom use across the populations. CONCLUSION There is an immediate need for a targeted HIV response for young KP in Mozambique so that they are not left behind. Youth must be engaged in the design and implementation of interventions to ensure that low risk behaviors are sustained as they get older to prevent HIV infection.
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Affiliation(s)
- Makini A. S. Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Cynthia Semá Baltazar
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- National Institute of Health, Maputo, Mozambique
| | - Isabel Sathane
- National STI-HIV/AIDS Control Program, National Directorate of Public Health, Mozambique
| | - Henry F. Raymond
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Erika Fazito
- ICAP, Columbia University, Pretoria, South Africa
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Tuot S, Teo AKJ, Chhoun P, Mun P, Prem K, Yi S. Risk factors of HIV infection among female entertainment workers in Cambodia: Findings of a national survey. PLoS One 2020; 15:e0244357. [PMID: 33347494 PMCID: PMC7751854 DOI: 10.1371/journal.pone.0244357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cambodia has been well recognized for its success in the fight against the HIV epidemic. However, challenges remain in eliminating HIV infections in key populations, including women working in entertainment establishments, such as massage parlors, karaoke bars, or beer gardens. This study explored the prevalence of HIV and identified factors associated with HIV infection among female entertainment workers (FEWs) in Cambodia. Methods This national biological and behavioral survey was conducted in 2016 in Phnom Penh and 17 provinces. We used a two-stage cluster sampling method to recruit FEWs for HIV testing performed on-site and face-to-face interviews using a structured questionnaire. We investigated factors associated with HIV infection using multiple logistic regression. Results This study included 3149 FEWs with a mean age of 26.2 years (SD 5.7). The adjusted prevalence of HIV was 3.2% (95% CI 1.76–5.75). In the multiple logistic regression model, the odds of HIV infection were significantly higher among FEWs in the age group of 31 to 35 (AOR 2.72, 95% CI 1.36–8.25) and 36 or older (AOR 3.62, 95% CI 1.89–10.55); FEWs who were not married but living with a sexual partner (AOR 3.00, 95% CI 1.16–7.79); FEWs who had at least ten years of formal education (AOR 0.32, 95% CI 0.17–0.83); FEWs who reported having abnormal vaginal discharge (AOR 3.51, 95% CI 1.12–9.01), genital ulcers or sores (AOR 2.06, 95% CI 1.09–3.17), and genital warts (AOR 2.89, 95% CI 1.44–6.33) in the past three months; and FEWs who reported using illicit drugs (AOR 3.28, 95% CI 1.20–4.27) than their respective reference group. The odds of HIV infection were significantly lower among FEWs working in karaoke bars (AOR 0.26, 95% CI 0.14–0.50) and beer gardens (AOR 0.17, 95% CI 0.09–0.54) than among freelance FEWs. Conclusions The prevalence of HIV among FEWs in Cambodia remains much higher than that in the general population. These findings indicate that differentiated strategies to address HIV and other sexually transmitted infections should be geared towards FEWs working as freelancers or in veiled entertainment venues such as massage parlors and freelance sex workers. Prevention efforts among venue-based FEWs should be sustained.
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Affiliation(s)
- Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, California, United States of America
- * E-mail:
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Kuteesa MO, Seeley J, Cook S, Webb EL. Multi-level experiences and determinants of alcohol misuse and illicit drug use among occupational groups at high-risk of HIV in sub-Saharan Africa: A thematic synthesis of qualitative findings. Glob Public Health 2019; 15:715-733. [PMID: 31640453 PMCID: PMC7175470 DOI: 10.1080/17441692.2019.1679216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk (n = 4) or sex workers (n = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings.
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Affiliation(s)
- Monica O Kuteesa
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of HIV interventions and Epidemiology, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Comins CA, Schwartz SR, Phetlhu DR, Guddera V, Young K, Farley JE, West N, Parmley L, Geng E, Beyrer C, Dowdy D, Mishra S, Hausler H, Baral S. Siyaphambili protocol: An evaluation of randomized, nurse-led adaptive HIV treatment interventions for cisgender female sex workers living with HIV in Durban, South Africa. Res Nurs Health 2019; 42:107-118. [PMID: 30644999 DOI: 10.1002/nur.21928] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/25/2018] [Indexed: 01/05/2023]
Abstract
In South Africa, 60% of female sex workers are estimated to be living with human immunodeficiency virus (HIV). Many of these women face structural and individual-level barriers to initiating, accessing, and adhering to antiretroviral therapy (ART). While data are limited, it is estimated that less than 40% of sex workers living with HIV achieve viral suppression, leading to suboptimal clinical outcomes and sustained risks of onward sexual and vertical HIV transmission. Siyaphambili, a NINR/NIH-funded study, focuses on studying optimal implementation strategies for meeting HIV treatment needs among cisgender female sex workers living with HIV who are not virally suppressed. Here, we present the study protocol of this sequential multiple assignment randomized trial. In total, 800 viremic female sex workers will be enrolled into an 18-month adaptive implementation study to 1) compare the effectiveness and durability of a nurse-led decentralized ART treatment program versus an individualized case management approach, in isolation or in combination to achieve viral suppression and 2) estimate incremental cost-effectiveness of interventions and combinations of interventions. The primary outcome is a combined intention-to-treat outcome of retention in ART care and viral suppression at 18 months with secondary implementation outcomes. Siyaphambili aims to inform the implementation of and scale-up of HIV treatment services for female sex workers by determining the minimal package of services needed to achieve viral suppression and by characterizing individuals in need of more intensive HIV treatment approaches.
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Affiliation(s)
- Carly A Comins
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | | | - Jason E Farley
- Johns Hopkins University, School of Nursing, The REACH Initiative, Baltimore, Maryland
| | - Nora West
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Lauren Parmley
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Elvin Geng
- University of California, San Francisco, California
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harry Hausler
- Johns Hopkins University, School of Nursing, The REACH Initiative, Baltimore, Maryland
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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Syvertsen JL, Agot K, Ohaga S, Bazzi AR. You can't do this job when you are sober: Heroin use among female sex workers and the need for comprehensive drug treatment programming in Kenya. Drug Alcohol Depend 2019; 194:495-499. [PMID: 30529906 PMCID: PMC6334295 DOI: 10.1016/j.drugalcdep.2018.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 01/01/2023]
Abstract
AIMS Globally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services. METHODS In a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use. RESULTS Among 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks. CONCLUSIONS Drawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA; Department of Anthropology, University of California, Riverside, 1320B Watkins Hall, Riverside, CA 92521, USA.
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
| | - Angela Robertson Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118, USA.
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Abstract
Purpose of review Opioid use disorder (OUD) is a global phenomenon and is on the rise in Africa, denoting a shift from historical patterns of drug transport to internal consumption. In contrast, opioids for clinical pain management in Africa remain among the least available globally. This region also has the highest HIV and HCV disease burden, and the greatest shortages of health workers and addiction treatment. We undertook a systematic review of the literature to describe opioid use in Africa and how it is being addressed. Recent findings A total of 84 articles from 2000 to 2018 were identified. Descriptions of country-specific populations and patterns of opioid misuse were common. A smaller number of articles described interventions to address OUD. Summary OUD occurs in sub-Saharan Africa, with attendant clinical and social costs. Evidence-based policies and health system resources are needed to promote OUD prevention and management, and infectious disease transmission reduction.
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Makhakhe NF, Lane T, McIntyre J, Struthers H. Sexual transactions between long distance truck drivers and female sex workers in South Africa. Glob Health Action 2018; 10:1346164. [PMID: 28764585 PMCID: PMC5645692 DOI: 10.1080/16549716.2017.1346164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Female sex workers (FSWs) and long distance truck drivers (LDTDs) are considered key populations at high risk for HIV transmission due to high prevalence. The intersection of these mobile populations presents unique challenges in the fight against HIV and the movement towards reducing new infections. Objective: The purpose of this study was to explore the nature of sex trade along a particular transport route. Sexual transactions and the vulnerabilities that exist between these two groups with regards to HIV/AIDS are described, with the purpose of furthering the agenda for targeted interventions. Methods: Qualitative in-depth interviews were conducted with 14 participants, seven FSWs and seven LDTDs. We recruited FSWs through snowballing, and LDTDs through intercepts at truck stops. Semi-structured interview guides were used for data collection, and thematic analysis was conducted. Results: The sex trade in this study is characterized by competition, fuelled by money-driven and age-disparate rivalry. Despite widespread HIV knowledge, FSWs contend with persistent challenges regarding condom use negotiation, induced by more money in the exchange for unsafe sex. Despite the placement of wellness centres in truck stops along the highway, LDTDs face stigma related challenges with regards to testing for HIV and personal acknowledgement of their involvement in the sex trade. Conclusion: The nature of the sex trade along the highway continues to be risky despite the availability of HIV testing and antiretroviral treatment (ART). The sex trade is perceived to be increasing along trucking routes, in spite of measures instituted to limit access to FSWs. FSWs struggle to cope with the pressure of unprotected sex because of the need to generate more income, as well as avoid incidents of violence and threats. Interventions along transport routes need to be inclusive of FSWs who could play a vital role in stigma reduction amongst LDTDs through peer education.
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Affiliation(s)
- Nosipho Faith Makhakhe
- a Department of Psychology, School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Tim Lane
- b Department of Medicine , Center for AIDS Prevention Studies , San Francisco , CA , USA
| | - James McIntyre
- c Anova Health Institute , Johannesburg , South Africa.,d School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Helen Struthers
- c Anova Health Institute , Johannesburg , South Africa.,e Division of Infectious Diseases & HIV Medicine, Department of Medicine , University of Cape Town , Cape Town , South Africa
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Dietrich JJ, Lazarus E, Andrasik M, Hornschuh S, Otwombe K, Morgan C, Isaacs AJ, Huang Y, Laher F, Kublin JG, Gray GE. Mobile Phone Questionnaires for Sexual Risk Data Collection Among Young Women in Soweto, South Africa. AIDS Behav 2018; 22:2312-2321. [PMID: 29594618 DOI: 10.1007/s10461-018-2080-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recall and social desirability bias undermine self-report of paper-and-pencil questionnaires. Mobile phone questionnaires may overcome these challenges. We assessed and compared sexual risk behavior reporting via in-clinic paper-and-pencil and mobile phone questionnaires. HVTN 915 was a prospective cohort study of 50 adult women in Soweto, who completed daily mobile phone, and eight interviewer-administered in-clinic questionnaires over 12 weeks to assess sexual risk. Daily mobile phone response rates were 82% (n = 3486/4500); 45% (n = 1565/3486) reported vaginal sex (median sex acts 2 (IQR: 1-3)) within 24 h and 40% (n = 618/1565) consistent condom. Vaginal sex reporting was significantly higher via mobile phone across all visits (p < 0.0001). There was no significant difference in condom use reporting by mobile phone and in-clinic paper-based questionnaires across all visits (p = 0.5134). The results show high adherence and reporting of sex on the mobile phone questionnaire. We demonstrate feasibility in collecting mobile phone sexual risk data.
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Affiliation(s)
- Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO BOX 114, Diepkloof, Soweto, Johannesburg, 1864, South Africa.
| | - Erica Lazarus
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO BOX 114, Diepkloof, Soweto, Johannesburg, 1864, South Africa
| | - Michele Andrasik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO BOX 114, Diepkloof, Soweto, Johannesburg, 1864, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO BOX 114, Diepkloof, Soweto, Johannesburg, 1864, South Africa
| | - Cecilia Morgan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Abby J Isaacs
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO BOX 114, Diepkloof, Soweto, Johannesburg, 1864, South Africa
| | - James G Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, PO BOX 114, Diepkloof, Soweto, Johannesburg, 1864, South Africa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- South African Medical Research Council, Cape Town, South Africa
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Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health 2018; 18:193. [PMID: 29378631 PMCID: PMC5789578 DOI: 10.1186/s12889-018-5100-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya. Methods A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital’s voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices. Results Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users. Conclusion Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.
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Affiliation(s)
- Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya.
| | - Charles Matoka
- Department of Applied Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya
| | - James Ouma
- Department of Environmental Health, University of Kabianga, P. O. Box 2030-20200, Kericho, Kenya
| | | | - Michael F Otieno
- Department of Medical Laboratory Sciences, Kenyatta University, P. O. Box 43844-00100, Nairobi, Kenya
| | - Tom Were
- Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, P.O. Box 190-50100, Kakamega, Kenya.
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Scheibe A, Shelly S, Lambert A, Schneider A, Basson R, Medeiros N, Padayachee K, Savva H, Hausler H. Using a programmatic mapping approach to plan for HIV prevention and harm reduction interventions for people who inject drugs in three South African cities. Harm Reduct J 2017; 14:35. [PMID: 28592246 PMCID: PMC5463380 DOI: 10.1186/s12954-017-0164-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stigma, criminalisation and a lack of data on drug use contribute to the "invisibility" of people who inject drugs (PWID) and make HIV prevention and treatment service delivery challenging. We aimed to confirm locations where PWID congregate in Cape Town, eThekwini and Tshwane (South Africa) and to estimate PWID population sizes within selected electoral wards in these areas to inform South Africa's first multi-site HIV prevention project for PWID. METHODS Field workers (including PWID peers) interviewed community informants to identify suspected injecting locations in selected electoral wards in each city and then visited these locations and interviewed PWID. Interviews were used to gather information about the accessibility of sterile injecting equipment, location coordinates and movement patterns. We used the Delphi method to obtain final population size estimates for the mapped wards based on estimates from wisdom of the crowd methods, the literature and programmatic data. RESULTS Between January and April 2015, we mapped 45 wards. Tshwane teams interviewed 39 PWID in 12 wards, resulting in an estimated number of accessible PWID ranging from 568 to 1431. In eThekwini, teams interviewed 40 PWID in 15 wards with an estimated number of accessible PWID ranging from 184 to 350. The Cape Town team interviewed 61 PWID in 18 wards with an estimated number of accessible PWID ranging between 398 and 503. Sterile needles were only available at one location. Almost all needles were bought from pharmacies. Between 80 and 86% of PWID frequented more than one location per day. PWID who reported movement visited a median of three locations a day. CONCLUSIONS Programmatic mapping led by PWID peers can be used effectively to identify and reach PWID and build relationships where access to HIV prevention commodities for PWID is limited. PWID reported limited access to sterile injecting equipment, highlighting an important HIV prevention need. Programmatic mapping data show that outreach programmes should be flexible and account for the mobile nature of PWID populations. The PWID population size estimates can be used to develop service delivery targets and as baseline measures.
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Affiliation(s)
- Andrew Scheibe
- TB/HIV Care Association, Cape Town, South Africa
- Desmond Tutu HIV Centre, Cape Town, South Africa
| | - Shaun Shelly
- TB/HIV Care Association, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | - Helen Savva
- United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Harry Hausler
- TB/HIV Care Association, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Ghosh D, Krishnan A, Gibson B, Brown SE, Latkin CA, Altice FL. Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review. AIDS Behav 2017; 21:1183-1207. [PMID: 27125244 DOI: 10.1007/s10461-016-1413-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.
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Affiliation(s)
- Debarchana Ghosh
- Department of Geography and Institute for Collaboration on Health Intervention and Prevention, University of Connecticut, 215 Glenbrook Road, AUST 421, U-4148, Storrs, CT, 06269, USA.
| | - Archana Krishnan
- Department of Communication, University at Albany, SUNY, Albany, NY, USA
| | - Britton Gibson
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Shan-Estelle Brown
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Epidemiology, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frederick L Altice
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Stahlman S, Beyrer C, Sullivan PS, Mayer KH, Baral SD. Engagement of Gay Men and Other Men Who Have Sex with Men (MSM) in the Response to HIV: A Critical Step in Achieving an AIDS-Free Generation. AIDS Behav 2016; 20:330-340. [PMID: 27048235 DOI: 10.1007/s10461-016-1388-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men who have sex with men (MSM) continue to be at elevated risk for HIV acquisition and transmission secondary to biological and behavioral characteristics, social and sexual network characteristics, community environmental factors, and structural factors. HIV incidence rates remain high among MSM in both low- and high-income settings, and in both concentrated and more generalized HIV epidemic settings. While data quality tends to be poorer, the best estimates collectively suggest that MSM have up to 20 times the odds of living with HIV as compared to other reproductive aged adults across low- and middle-income countries. Recent prevention strategies to lower biological HIV transmission and acquisition risks, including the early use of antiretrovirals to decrease infectiousness for those living with HIV, and pre-exposure prophylaxis for those at significant risk of HIV acquisition, have demonstrated the potential to change the trajectory of the HIV epidemics among MSM. However, the coverage and effectiveness of these approaches is limited by structural factors including the punitive legal frameworks and institutional discrimination that contribute to limited uptake, challenges to adherence, and suboptimal health-seeking behaviors among MSM. More intensive efforts will be required to reach MSM who do not currently have access to relevant and effective prevention and treatment services or elect not to access these services given enacted and/or perceived stigma. Respect for human rights, including efforts to aggressively confront and combat the forms of stigma that are preventing us from achieving an AIDS-Free generation, are needed for all people including gay men and other MSM.
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Affiliation(s)
- Shauna Stahlman
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kenneth H Mayer
- Fenway Health, The Fenway Institute, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stefan D Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wu ZH, Tennen H, Hosain M, Coman E, Cullum J, Berenson AB. Stress mediates the relationship between past drug addiction and current risky sexual behavior among low income women. Stress Health 2016; 32:138-44. [PMID: 24985341 PMCID: PMC4282630 DOI: 10.1002/smi.2587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 04/03/2014] [Accepted: 04/22/2014] [Indexed: 11/05/2022]
Abstract
This study examined the role of stress as a mediator of the relationship between prior drug addiction and current high-risk sexual behaviour. Eight hundred twenty women aged 18 to 30 years, who received care at community-based family planning clinics, were interviewed using the Composite International Diagnostic Interview and the Sexual Risk Behavior Assessment Schedule. They also completed the brief version of the Self-Control Scale as a measure of problem-solving strategies and measures of recent stressful events, daily hassles and ongoing chronic stress. Regardless of addiction history, stress exposure during the previous 12 months was associated with risky sexual behaviour during the previous 12 months. Structural equation modelling revealed that 12-month stress levels mediated the relationship between past drug addiction and 12-month high-risk sexual behaviours, as well as the negative relationship between problem-solving strategies and high-risk sexual behaviours. Problem-solving strategies did not moderate the relationship between drug addiction and high-risk sexual behaviours. These findings suggest that stress management training may help reduce risky behaviour among young, low-income women.
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Affiliation(s)
- Z. Helen Wu
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Howard Tennen
- Department of Community Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Monawar Hosain
- Health Statistics and Data Management Unit, Dept. of Health and Human Service Concord, NH 03301
| | - Emil Coman
- TRIPP Center, University of Connecticut Health Center, Farmington, CT -06030, USA
| | - Jerry Cullum
- Frost Research Center, Hope College, Holland, MI, USA
| | - Abbey B. Berenson
- Department of Obstetrics and Gynecology and Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch, Galveston
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Carney T, Petersen Williams PM, Plüddemann A, Parry CDH. Sexual HIV risk among substance-using female commercial sex workers in Durban, South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016. [PMID: 26223332 DOI: 10.2989/16085906.2015.1040811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined data collected from a sample of female sex workers (FSWs) during the first two years of a brief risk-reduction intervention for vulnerable populations that focused on substance use and HIV risk-related behaviours (2007-2009) as part of a rapid assessment and response evaluation study. In 2007, in collaboration with a local non-governmental organisation (NGO), an initiative was begun to roll out targeted harm reduction strategies for drug-using street based FSWs in Durban, South Africa. Data were collected on demographic characteristics, substance use and HIV risk behaviours to tailor these harm reduction strategies with participants. Over the first two years of the intervention, data were collected from 646 FSWs: 428 who reported being at low risk for HIV and 218 who reported being at high risk for HIV (defined as engaging in unprotected sex with sexual partners in the past 90 days). FSWs who had previously been diagnosed with HIV or a sexually transmitted disease (STD) were significantly less likely to report engaging in unprotected sex. Those who used over-the-counter or prescription (OTC/PRE) drugs reported engaging in unprotected sex significantly more often than FSWs who did not use these substances, while those who used heroin were less likely to report unprotected sex. The findings are encouraging in that those who are aware of their HIV status are less likely to engage in risky sexual behaviour, and therefore HIV testing and counselling is recommended. It indicates the need to identify strategies to encourage the likelihood of all FSWs, particularly those who are HIV-positive, to use condoms. It also encourages further research to investigate specific substances as possible predictors of high risk behaviours in high-risk populations of sex workers.
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Affiliation(s)
- Tara Carney
- a Alcohol and Drug Abuse Research Unit , Medical Research Council , Tygerberg , South Africa
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15
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Draus P, Roddy J, Asabigi K. Streets, strolls and spots: sex work, drug use and social space in Detroit. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:453-60. [PMID: 25736572 DOI: 10.1016/j.drugpo.2015.01.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/01/2015] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND In this paper, we explore social spaces related to street sex work and illicit drug use in Detroit. We consider these spaces as assemblages (Duff, 2011, 2013; Latour, 2005) that reflect the larger moral geography (Hubbard, 2012) of the city and fulfill specific functions in the daily lives of drug using sex workers. METHODS We draw on thirty-one in-depth qualitative interviews with former street sex workers who were recruited through a court-based treatment and recovery program, as well as ethnographic field notes from drug treatment and law enforcement settings. RESULTS Our interview findings reveal highly organized and routine activities that exist in a relatively stable, symbiotic relationship with law enforcement practices, employment and commuter patterns, and built environments. While the daily life of street sex work involves a good deal of individual agency in terms of moving between spaces and negotiating terms of exchange, daily trajectories were also circumscribed by economics, illicit substance use, and the objective risks of the street and the police. CONCLUSION We consider the implications of these results for future policy directed at harm reduction in the street setting.
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Affiliation(s)
- Paul Draus
- Department of Behavioral Sciences, The University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48214, United States.
| | - Juliette Roddy
- Department of Social Sciences, The University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48214, United States.
| | - Kanzoni Asabigi
- The City of Detroit, Department of Health and Wellness Promotion, United States.
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The epidemiology of HIV among men who have sex with men in countries with generalized HIV epidemics. Curr Opin HIV AIDS 2014; 9:156-67. [PMID: 24445371 DOI: 10.1097/coh.0000000000000037] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Key populations at high risk for HIV acquisition and transmission, such as MSM, have long been identified as essential subpopulations for epidemiological surveillance of the HIV epidemic. However, surveillance systems in the context of generalized and widespread HIV epidemics have traditionally excluded these men. RECENT FINDINGS Emerging and consistent data highlight the disproportionate burden of HIV among MSM that exists when compared with other men of reproductive age across countries with generalized epidemics. Correlates of prevalent HIV infection include individual-level determinants of HIV acquisition and transmission similar to that found in concentrated HIV epidemics and community-level structural factors, such as stigma, being blackmailed, and history of homophobic abuse. HIV incidence was only available from two countries (Kenya, Thailand) with generalized HIV epidemics, but in both settings was an order of magnitude higher than that of other populations. SUMMARY The data presented here suggest that the dynamics of HIV infection among men are more similar across the world than they are different. Many HIV epidemics among average-risk reproductive age adults are slowing across both generalized and concentrated settings. It is in this context that high HIV incidence is observed among MSM, especially young MSM. This trend suggests a change in the trajectory of these HIV epidemics, a change that we may miss if we continue to understudy these populations based on unproved and dated assumptions.
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A public health perspective on HIV/AIDS in Africa: Victories and unmet challenges. PATHOPHYSIOLOGY 2014; 21:237-56. [DOI: 10.1016/j.pathophys.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 01/05/2023] Open
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Reid-Hresko J. Our bodies are our own: resistance to ABC-based HIV-prevention programmes in northern Tanzanian conservation organisations. CULTURE, HEALTH & SEXUALITY 2014; 16:765-779. [PMID: 24816078 DOI: 10.1080/13691058.2014.911959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
ABC-based HIV-prevention programmes have been widely employed in northern Tanzanian wildlife conservation settings in an attempt to (re)shape the sexual behaviours of conservation actors. Utilising findings from 66 semi-structured interviews conducted in 2009-2010, this paper examines ABC prevention as a form of Foucauldian governmentality--circulating technologies of power that mobilise disciplinary technologies and attempt to transform such efforts into technologies of the self--and explores how individuals understand and respond to attempts to govern their behaviour. ABC regimes attempt to rework subjectivity, positioning HIV-related behaviours within a risk-based neoliberal rationality. However, efforts to use ABC as a technology to govern populations and individual bodies are largely incommensurate with existing Tanzanian sociocultural formations, including economic and gendered inequalities, and local understandings of sexuality. The language research participants used to talk about ABC and the justifications they offered for non-compliance illuminate this discrepancy. Data reveal that the recipients of ABC campaigns are active producers of understandings that work for them in their lives, but may not produce the behavioural shifts envisioned by programme goals. These findings corroborate previous research, which questions the continued plausibility of ABC as a stand-alone HIV- prevention framework.
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Affiliation(s)
- John Reid-Hresko
- a Division of Social Science, Quest University Canada , British Columbia , Canada
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Langa J, Sousa C, Sidat M, Kroeger K, McLellan-Lemal E, Belani H, Patel S, Shodell D, Shodell M, Benech I, Needle R. HIV risk perception and behavior among sex workers in three major urban centers of Mozambique. PLoS One 2014; 9:e94838. [PMID: 24736653 PMCID: PMC3988096 DOI: 10.1371/journal.pone.0094838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/19/2014] [Indexed: 11/19/2022] Open
Abstract
HIV risk perceptions and behaviors of 236 commercial sex workers from three major Mozambican urban centers were studied using the International Rapid Assessment, Response and Evaluation (I-RARE) methodology. All were offered HIV testing and, in Maputo, syphilis testing was offered as well. Sixty-three of the 236 opted for HIV testing, with 30 (48%) testing positive for HIV. In Maputo, all 30 receiving HIV tests also had syphilis testing, with 6 (20%) found to be positive. Results include interview excerpts and qualitative results using I-RARE methodology and AnSWR-assisted analyses of the interviews and focus group sessions.
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Affiliation(s)
- Judite Langa
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - César Sousa
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Karen Kroeger
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Hrishikesh Belani
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shama Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel Shodell
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Michael Shodell
- Long Island University, New York, New York, United States of America
- * E-mail:
| | - Irene Benech
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard Needle
- Office of the Global Aids Coordinator, Washington, District of Columbia, United States of America
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20
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Trenz RC, Scherer M, Duncan A, Harrell PT, Moleko AG, Latimer WW. Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users. Drug Alcohol Depend 2013; 132:441-8. [PMID: 23562370 PMCID: PMC4191842 DOI: 10.1016/j.drugalcdep.2013.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND HIV transmission risk among non-injection drug users is high due to the co-occurrence of drug use and sexual risk behaviors. The purpose of the current study was to identify patterns of drug use among polysubstance users within a high HIV prevalence population. METHODS The study sample included 409 substance users from the Pretoria region of South Africa. Substances used by 20% or more the sample included: cigarettes, alcohol, marijuana and heroin in combination, marijuana and cigarettes in combination, and crack cocaine. Latent class analysis was used to identify patterns of polysubstance use based on types of drugs used. Multivariate logistic regression analyses compared classes on demographics, sexual risk behavior, and disease status. RESULTS Four classes of substance use were found: MJ+Cig (40.8%), MJ+Her (30.8%), Crack (24.7%), and Low Use (3.7%). The MJ+Cig class was 6.7 times more likely to use alcohol and 3 times more likely to use drugs before/during sex with steady partners than the Crack class. The MJ+Cig class was 16 times more likely to use alcohol before/during sex with steady partners than the MJ+Her class. The Crack class was 6.1 times more likely to engage in transactional sex and less likely to use drugs before/during steady sex than the MJ+Her class. CONCLUSIONS Findings illustrate patterns of drug use among a polysubstance using population that differ in sexual risk behavior. Intervention strategies should address substance use, particularly smoking as a route of administration (ROA), and sexual risk behaviors that best fit this high-risk population.
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Affiliation(s)
- Rebecca C Trenz
- Mercy College, School of Social and Behavioral Sciences, Mahoney Hall, 555 Broadway, Dobbs Ferry, NY 10522, United States.
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Prüss-Ustün A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV due to female sex work: regional and global estimates. PLoS One 2013; 8:e63476. [PMID: 23717432 PMCID: PMC3662690 DOI: 10.1371/journal.pone.0063476] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/03/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are at high risk of HIV infection. Our objective was to determine the proportion of HIV prevalence in the general female adult population that is attributable to the occupational exposure of female sex work, due to unprotected sexual intercourse. METHODS Population attributable fractions of HIV prevalence due to female sex work were estimated for 2011. A systematic search was conducted to retrieve required input data from available sources. Data gaps of HIV prevalence in FSWs for 2011 were filled using multilevel modeling and multivariate linear regression. The fraction of HIV attributable to female sex work was estimated as the excess HIV burden in FSWs deducting the HIV burden in FSWs due to injecting drug use. RESULTS An estimated fifteen percent of HIV in the general female adult population is attributable to (unsafe) female sex work. The region with the highest attributable fraction is Sub Saharan Africa, but the burden is also substantial for the Caribbean, Latin America and South and Southeast Asia. We estimate 106,000 deaths from HIV are a result of female sex work globally, 98,000 of which occur in Sub-Saharan Africa. If HIV prevalence in other population groups originating from sexual contact with FSWs had been considered, the overall attributable burden would probably be much larger. DISCUSSION Female sex work is an important contributor to HIV transmission and the global HIV burden. Effective HIV prevention measures exist and have been successfully targeted at key populations in many settings. These must be scaled up. CONCLUSION FSWs suffer from high HIV burden and are a crucial core population for HIV transmission. Surveillance, prevention and treatment of HIV in FSWs should benefit both this often neglected vulnerable group and the general population.
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Affiliation(s)
- Annette Prüss-Ustün
- Department of Public Health and Environment, World Health Organization, Geneva, Switzerland.
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Wechsberg WM, Golin C, El-Bassel N, Hopkins J, Zule W. Current interventions to reduce sexual risk behaviors and crack cocaine use among HIV-infected individuals. Curr HIV/AIDS Rep 2013; 9:385-93. [PMID: 22872433 DOI: 10.1007/s11904-012-0131-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The dual global epidemics of crack cocaine use and HIV have resulted in a large number of people living with HIV who use crack cocaine, many of whom continue to engage in unprotected sex. Crack use also increases the rate of HIV progression. Consequently, there is an urgent need for effective interventions to decrease crack use and unprotected sex and to improve antiretroviral therapy (ART) adherence in this population. This article reviews the recent published literature on interventions for reducing crack use and unprotected sex among people living with HIV. Only a few intervention outcome studies targeting exclusively HIV positive crack cocaine users were identified, whereas other studies used a mixed sample. Some interventions focused on reducing crack use and several focused on reducing sex-risk behaviors. Consequently, there is a critical need for efficacious interventions that address crack use, risky sex and ART adherence among people living with HIV.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse, Treatment, Evaluations and Interventions Program, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA.
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Rhodes SD, Tanner A, Duck S, Aronson RE, Alonzo J, Garcia M, Wilkin AM, Cashman R, Vissman AT, Miller C, Kroeger K, Naughton MJ. Female sex work within the rural immigrant Latino community in the southeast United States: an exploratory qualitative community-based participatory research study. Prog Community Health Partnersh 2013; 6:417-27. [PMID: 23221286 DOI: 10.1353/cpr.2012.0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about the structure and context of, and the risks encountered in, sex work in the United States. OBJECTIVE This community-based participatory research (CBPR) study explored female sex work and the feasibility of conducting a larger study of sex work within the immigrant Latino community in North Carolina. METHODS Twelve abbreviated life story interviews were conducted with Latina women who sold sex, other women who sold sex to Latino men, and Latino men who hired sex workers. Content analysis was used to analyze narrative data. RESULTS Themes emerged to describe the structure of sex work, motivations to sell and hire sex, and the sexual health-related needs of sex workers. Lessons learned included the ease of recruiting sex workers and clients, the need to develop relationships with controllers and bar owners/managers, and the high compensation costs to reimburse sex workers for participation. CONCLUSIONS Study findings suggest that it is possible to identify and recruit sex workers and clients and collect formative data within this highly vulnerable and neglected community; the prevention of HIV and STDs is a priority among sex workers, and the need for a larger study to include non-Latino men who report using Latina sex workers, other community insiders (e.g., bartenders), and service providers for Latina sex workers.
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Mbwambo J, McCurdy SA, Myers B, Lambdin B, Kilonzo GP, Kaduri P. Drug trafficking, use, and HIV risk: The need for comprehensive interventions. SAHARA J 2012; 9:154-9. [DOI: 10.1080/17290376.2012.743832] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Domanico A, Malta M. Implementation of harm reduction toward crack users in Brazil: barriers and achievements. Subst Use Misuse 2012; 47:535-46. [PMID: 22428821 DOI: 10.3109/10826084.2012.644170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
From 2002 to 2005, we evaluated five Brazilian harm reduction programs ran by active drug users who distributed pipes, condoms, educational material, and provided referral to crack users. System-wide barriers identified: funds discontinuation and legislation barriers toward fieldwork. Major achievements: increased access to health, social, and psychological support. Crack-cocaine users experience a plethora of health/social problems, attenuated by low-threshold and user-friendly interventions, particularly those developed by other drug users. However, a stronger political commitment is needed to face a fast growing crack-cocaine epidemic in Brazil, aiming to ensure availability/continuity of funds, implementation of large-scale interventions, outreach workers training, and proper evaluation.
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Katsulis Y, Durfee A. Prevalence and correlates of sexual risk among male and female sex workers in Tijuana, Mexico. Glob Public Health 2012; 7:367-83. [PMID: 22304493 DOI: 10.1080/17441692.2012.656672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We investigated prevalence and correlates of sexual risk behaviours among male and female sex workers in Tijuana, Mexico, the busiest border crossing area on the US - Mexico border, analysing survey data from a purposive, cross-sectional sample of male and female sex workers who worked in a range of indoor and outdoor settings. Logistic regression was used to determine factors that were associated with sexual risk-taking, defined as failing to use a condom with last client. In bivariate regression models, gender, work setting (e.g., indoor vs. outdoor), poverty, engaging in survival sex, marital status and perceived drug addiction were correlated with sexual risk. When controlling for work location, housing insecurity, poverty, survival sex, marital status and perceived drug addiction, male sex workers were still 10 times more likely than female sex workers (FSW) to engage in sex without a condom during their last encounter with a client. And, although FSW were significantly more likely than males to have used a condom with a client, they were significantly less likely than males to have used a condom with their regular partner. Future research should further examine how gender shapes sexual risk activities in both commercial and non-commercial relationships.
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Maticka-Tyndale E. Condoms in sub-Saharan Africa. Sex Health 2012; 9:59-72. [DOI: 10.1071/sh11033] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 11/16/2011] [Indexed: 11/23/2022]
Abstract
Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.
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Couture MC, Evans JL, Sothy NS, Stein ES, Sichan K, Maher L, Page K. Correlates of amphetamine-type stimulant use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia. Drug Alcohol Depend 2012; 120:119-26. [PMID: 21820251 PMCID: PMC3226861 DOI: 10.1016/j.drugalcdep.2011.07.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/25/2011] [Accepted: 07/09/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Amphetamine-type stimulant (ATS) use has increased in Cambodia and emerged as a significant problem among female sex workers (FSWs), potentially contributing to increased risk of HIV. We examined the prevalence of ATS use and its effect on sexual risk behaviors, and sexually transmitted infections (STI) among FSWs in Phnom Penh, Cambodia. METHODS A one-year prospective study among young women engaged in sex work in brothels, entertainment establishments and on a freelance basis. Socio-demographics, sexual risks, and recent ATS use were assessed by self-report. Blood and urine samples were collected to detect HIV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Bivariate and multivariate longitudinal analyses were conducted to assess the effects of ATS use on number of sex partners, inconsistent condom use with paying partners and incident STI. RESULTS ATS use was higher among women working freelance (35.6%) and in brothels (34.8%) compared to women working in entertainment establishments (17.7%) or in multiple venues (14.8%). ATS users reported more sex partners and days drunk in the previous month. In multivariate longitudinal analysis, ATS use was associated with having a higher number of sex partners (adjusted relative ratio 1.49; 95% CI: 1.00-2.21) and incident STI (adjusted odds ratio 5.41; 95% CI: 1.15-25.48), but not inconsistent condom use with paying partner. CONCLUSION ATS users had more sex partners, high level of alcohol use, and were at increased risk of STI. Our findings underscore ATS use as an important emerging risk exposure that should be integrated into HIV prevention interventions targeting this population.
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Affiliation(s)
- Marie-Claude Couture
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA
| | | | - Neth San Sothy
- National Center for HIV/AIDS, Dermatology and STD. #245H, Sreet 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia
| | - Ellen S. Stein
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA
| | - Keo Sichan
- Cambodian Women’s development Agengy, #19, Street 242, Sangkat Boeng Prolit, Khan 7 Makara, Phnom Penh, Cambodia
| | - Lisa Maher
- University of New South Wales, National Centre in HIV Epidemiology and Clinical Research, CFI Building, Corner Boundary and West Streets, Darlinghurst NSW 2010, Australia
| | - Kimberly Page
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA,Corresponding author: K. Page, University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA., , Phone: 415-597-4954., Fax: 415-597-8299
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Browne FA, Wechsberg WM, Bowling JM, Luseno WK. Correlates of male condom use skills among high-risk women in South Africa. JOURNAL OF SEX RESEARCH 2011; 49:255-263. [PMID: 21660835 PMCID: PMC5633854 DOI: 10.1080/00224499.2011.578219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This exploratory study examined the performance of 295 South African women--who recently traded sex for goods or had unprotected sex--on a male condom use mastery index. Bivariate and multivariate logistic regression analyses were conducted to determine whether age, marital status, highest education obtained, male condom use at first penetrative sex, receiving prior demonstration of male condom use, recent sexually transmitted infection symptoms, and recently trading sex were significantly associated with index scores. Adjusted odds ratios indicated that age and sexually transmitted infection symptoms were negatively associated with condom skills; women who were older and had a higher number of recent sexually transmitted infection symptoms were more likely to have lower scores. Furthermore, participants executed, on average, approximately one third of condom use steps correctly. These findings suggest a need for increased behavioral skills training for women engaging in sexual risk behaviors because many lack the skills required to use a male condom properly.
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Affiliation(s)
- Felicia A Browne
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC 27709, USA.
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Wechsberg WM, Zule WA, Luseno WK, Kline TL, Browne FA, Novak SP, Ellerson RM. Effectiveness of an Adapted Evidence-Based Woman-Focused Intervention for Sex Workers and Non-Sex Workers: The Women's Health CoOp in South Africa. JOURNAL OF DRUG ISSUES 2011. [DOI: 10.1177/002204261104100205] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
South Africa's concurrent epidemics of HIV, substance use, and gender-based violence point to the urgent need for interventions that address the intersectional nature of these issues. A community-based randomized trial assessed the efficacy of an adapted evidence-based Woman-Focused HIV intervention addressing all three issues with sex workers and non-sex workers. At 6-month follow-up, non-sex workers in the Woman-Focused intervention reported significantly lower mean numbers of days drinking alcohol in the previous 30 days, were significantly less likely to meet DSM-IV criteria for alcohol dependence, were more likely to report using a condom at last sex with a main partner, and were less likely to report sexual abuse by a main partner in the previous 90 days. Sex workers in the Woman-Focused intervention were significantly less likely to report physical abuse by a main partner. The findings suggest that gender-focused interventions can be effective for vulnerable women and should be offered more broadly.
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Zhang H, Liao M, Nie X, Pan R, Wang C, Ruan S, Zhang C, Tao X, Kang D, Jiang B. Predictors of consistent condom use based on the Information-Motivation-Behavioral Skills (IMB) model among female sex workers in Jinan, China. BMC Public Health 2011; 11:113. [PMID: 21329512 PMCID: PMC3056744 DOI: 10.1186/1471-2458-11-113] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 02/17/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Female commercial sex workers (FSWs) are at high risk of human immunodeficiency virus (HIV) transmission in China. This study was designed to examine the predictors of condom use with clients during vaginal intercourse among FSWs based on the Information-Motivation-Behavioral Skills (IMB) model and to describe the relationships between IMB model constructs. METHODS A cross-sectional study was conducted in Jinan of Shandong Province, from May to October, 2009. Participants (N = 432) were recruited using Respondent-Driven Sampling (RDS). A self-administered questionnaire was used to collect data. Structural equation modeling was used to assess the IMB model. RESULTS A total of 427 (98.8%) participants completed their questionnaires. Condom use was significantly predicted by social referents support, experiences with and attitudes toward condoms, self-efficacy, and health behaviors and condom use skills. Significant indirect predictors of condom use mediated through behavioral skills included HIV knowledge, social referents support, and substance use. CONCLUSIONS These results suggest that the IMB model could be used to predict condom use among Chinese FSWs. Further research is warranted to develop preventive interventions on the basis of the IMB model to promote condom use among FSWs in China.
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Affiliation(s)
- Hua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province 250012, China
| | - Meizhen Liao
- Institute for AIDS/STD Control and Prevention, Shandong Province CDC, Jinan, Shandong Province 250014, China
| | - Xijuan Nie
- Institute for AIDS/STD Control and Prevention, Licheng District CDC, Jinan, Shandong Province 250100, China
| | - Rongjian Pan
- Institute for AIDS/STD Control and Prevention, Licheng District CDC, Jinan, Shandong Province 250100, China
| | - Chuangxin Wang
- Institute for AIDS/STD Control and Prevention, Licheng District CDC, Jinan, Shandong Province 250100, China
| | - Shiman Ruan
- Institute for AIDS/STD Control and Prevention, Jinan City CDC, Jinan, Shandong Province 250000, China
| | - Changqing Zhang
- Institute for AIDS/STD Control and Prevention, Jinan City CDC, Jinan, Shandong Province 250000, China
| | - Xiaorun Tao
- Institute for AIDS/STD Control and Prevention, Shandong Province CDC, Jinan, Shandong Province 250014, China
| | - Dianmin Kang
- Institute for AIDS/STD Control and Prevention, Shandong Province CDC, Jinan, Shandong Province 250014, China
| | - Baofa Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province 250012, China
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Cicero TJ, Ellis MS, Paradis A, Ortbal Z. Role of key informants and direct patient interviews in epidemiological studies of substance abuse. Pharmacoepidemiol Drug Saf 2010; 20:308-12. [PMID: 21351313 DOI: 10.1002/pds.2075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/27/2010] [Accepted: 10/07/2010] [Indexed: 11/10/2022]
Abstract
PURPOSE The present study was undertaken to assess the degree to which key informants' perceptions of relative abuse liability of opioids in their communities correspond to actual drug use in their patients. METHODS Key informants (n = 49) and their patients (n = 738) were asked to complete anonymous, independent paper surveys about perceived or actual abuse of nine targeted opioid drugs: buprenorphine, fentanyl, heroin, hydrocodone, hydromorphone, methadone, morphine, oxycodone and tramadol. RESULTS There was a strong correspondence (R = 0.98) between KI rankings of relative abuse of opioids in their patient population and the actual rank order calculated from their patients' selection of a primary euphorigenic opioid. The patient surveys not only validated the KI's conclusions, but also provided a great deal of important information about the nature of the abuse patterns. Notably, significant co-morbidity was found in the patient population: 55% had a history of psychiatric problems; chronic pain of moderate intensity was common; 67% were nicotine dependent; and 43% were diagnosed alcoholics. DISCUSSION Our results demonstrate that KI's perceived rank order of drugs of choice correlated almost perfectly with their patients' choice of a primary drug. These data suggest that key informants, as they have for decades in epidemiological research, provide a reliable, high-level view of substance abuse in their catchment area. As such, KIs provide valid and reliable information on scope and patterns of abuse, but if more detail is required about the characteristics of abuse, such as that required for FDA-mandated Risk Evaluation and Mitigation Strategies, then direct interviews with the abusers themselves seem more appropriate.
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Affiliation(s)
- Theodore J Cicero
- Washington University in St. Louis, Department of Psychiatry, St. Louis, MO, USA.
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Hedden SL, Hulbert A, Cavanaugh CE, Parry CD, Moleko AG, Latimer WW. Alcohol, Drug and Sexual Risk Behavior Correlates of Recent Transactional Sex Among Female Black South African Drug Users. JOURNAL OF SUBSTANCE USE 2010; 16:57-67. [PMID: 21603063 DOI: 10.3109/14659891003721141] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transactional sex among black South African women has become a mode of economic survival putting them at higher risk for HIV and other infectious disease. In order to inform HIV interventions, drug and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black, South African women in Pretoria were examined using log binomial regression. Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use (Adjusted Prevalence Ratio (APR)=1.3, 95% CI=1.1, 1.5) and knew of anyone who died of AIDS (APR =1.5, 95% CI 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR =0.6, 95% CI= 0.4, 0.8), condom use in their first sexual encounter (APR =0.7, 95% CI=0.6, 1.0) or reported a recent steady sexual partnership (APR =0.8, 95% CI=0.7, 0.9). Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.
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Affiliation(s)
- Sarra L Hedden
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 2213 McElderry St., Baltimore, MD, 21205, USA
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Prevalence of psychological problems and relationships with condom use and HIV prevention behaviors among Chinese female sex workers in Hong Kong. AIDS Care 2010; 22:659-68. [PMID: 20467945 DOI: 10.1080/09540120903431314] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study investigated the prevalence of psychological problems and their relationships with relevant HIV prevention behaviors among female sex workers (FSWs). An anonymous cross-sectional survey was conducted. With a mapping exercise, 293 Chinese FSWs were recruited from a red-light district in Hong Kong. Results showed high prevalence of psychological problems among FSWs: substance use (40.4%), probable depression (53.9%), self-harm tendencies (34-38%), poor self-esteem (48-52%), and pessimistic future outlook (46-47%). Inconsistent condom use was common (51% with clients, 23% with one-night-stand sex partner, and 73% with boyfriends). Over 70% had not used HIV-related prevention services in the last 6 months. Multivariate analyses indicated that psychological problems were significantly associated with inconsistent condom use and non-use of prevention services. The poor psychological well-beings of FSWs have important public health implications. Relevant professional services should be provided and integrated with HIV prevention efforts.
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Floyd LJ, Hedden S, Lawson A, Salama C, Moleko AG, Latimer W. The association between poly-substance use, coping, and sex trade among black South African substance users. Subst Use Misuse 2010; 45:1971-87. [PMID: 20438343 PMCID: PMC6414046 DOI: 10.3109/10826081003767635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The current study examined the relationship between poly-substance use and sex trade among 343 black South African substance users recruited from the Pretoria region between 2002 and 2006 (57% males; mean age 24 years). The assessment comprised a HIV-risk behavior interview, urinalysis to confirm self-report of drug use, and an HIV test. Logistic regression analyses indicated poly-substance use was positively associated with sex trade among persons using drugs to cope with stress. Results indicate the importance of considering coping strategies as modifiable psychosocial factor related to sexual risk-taking behaviors and substance use. The study's implications and limitations are discussed.
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Affiliation(s)
- Leah J Floyd
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Opportunities for enhancing and integrating HIV and drug services for drug using vulnerable populations in South Africa. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:289-95. [DOI: 10.1016/j.drugpo.2009.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the recent literature examining the intersection between alcohol and other drug use and HIV risk behaviors for South African men and women, and the implications for the development of interventions and future research. RECENT FINDINGS The current literature indicates that substance use in sexual contexts (i.e. before or during sex) as well as outside of the sexual context is associated with HIV risk behaviors, such as having unprotected sex and multiple sex partners. Additionally, environments where substances are used, such as drinking establishments, may be associated with HIV risk behaviors. Moreover, sexual violence is also associated with substance use. Brief HIV prevention interventions to address substance use have demonstrated promising findings - such as consistent condom use, less impaired sex, and less unprotected vaginal and anal intercourse - when compared with other interventions. SUMMARY Recent research findings support the previous literature concerning the link between substance use and HIV risk behaviors in South Africa and suggest the need for interventions focused on sexual risk behaviors in the context of substance use and the environments in which they are used.
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Kerr T, Kiatying-Angsulee N, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Lai C, Wood E. High rates of midazolam injection among drug users in Bangkok, Thailand. Harm Reduct J 2010; 7:7. [PMID: 20338062 PMCID: PMC2855558 DOI: 10.1186/1477-7517-7-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 03/26/2010] [Indexed: 11/17/2022] Open
Abstract
Background Reports from Thailand suggest that a growing number of people who inject drugs (IDU) are now injecting midazolam, a legal benzodiazepine with potent amnestic and ventilatory depressant effects. We therefore sought to examine midazolam injection among a community-recruited sample of Thai IDU. Methods We examined the prevalence and correlates of midazolam injection among 252 IDU participating in the Mitsampan Community Research Project, Bangkok, using multivariate logistic regression. We also examined the use of midazolam in combination with other drugs. Results 252 IDU participated in this study, including 66 (26.2%) women. In total, 170 (67.5%) participants reported ever having injected midazolam, and 144 (57.1%) reported daily midazolam injection in the past six months. In multivariate analyses, a history of midazolam injection was independently associated with using drugs in combination (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI]: 2.96-11.60), younger age (AOR = 0.43; 95%CI: 0.22-0.83), having a history of methadone treatment (AOR = 3.12, 95%CI: 1.55-6.90), and binge drug use (AOR = 2.25, 95%CI: 1.09-4.63). The drugs most commonly used in combination with midazolam were heroin (72.3%) and yaba (methamphetamine) (30.5%). Conclusion We observed a high rate of midazolam injection among Thai IDU. Midazolam injection was strongly associated with polysubstance use and binge drug use, and was most commonly used in combination with both opiates and methamphetamines. Our findings suggest that midazolam injection has become increasingly common within Thailand. Evidence-based approaches for reducing harms associated with midazolam injection are needed.
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Affiliation(s)
- Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.
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