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Osakwe CE, van der Drift I, Opper CA, Zule WA, Browne FA, Wechsberg WM. Condom Use at Last Sex and Sexual Negotiation Among Young African American Women in North Carolina: Context or Personal Agency. J Racial Ethn Health Disparities 2024; 11:2256-2264. [PMID: 37495904 PMCID: PMC10811276 DOI: 10.1007/s40615-023-01693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 07/28/2023]
Abstract
African American women are 10.8 times more likely to be diagnosed with HIV compared with White women. This descriptive study fills a gap by examining associations among social and contextual factors and sexual communication, condom use, and safer sex negotiation among African American women. Study participants between 18 and 25 years of age and who reported recent substance use were recruited from three North Carolina counties. A risk behavior survey was administered via audio computer-assisted self-interview, and logistic regression analyses were conducted to assess associations between social and contextual variables and condom use at last sex with a main partner. Education (AOR: 2.078; 95% CI: 1.214, 3.556), sexual communication with a main partner (AOR: 1.079; 95% CI: 1.050, 1.109), and condom use relationship scale (AOR: 1.059; 95% CI: 1.023, 1.098) were positively associated with condom use at last sex, whereas living with a main partner (AOR: 0.447; 95% CI: 0.210, 0.950) and the alcohol and drug problem scale (AOR: 0.971; 95% CI: 0.944, 0.998) were negatively associated with condom use (p < 0.05). The study findings show that among young African American women at risk for HIV, contextual and personal factors may influence condom use. A socio-ecological approach combining personal empowerment, interpersonal, structural, and biobehavioral strategies is necessary in implementing holistic gender-focused HIV prevention programs.
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Affiliation(s)
| | - Isa van der Drift
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, PO Box 12194, NC, 27709-2194, Durham, USA
| | - Claudia A Opper
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, PO Box 12194, NC, 27709-2194, Durham, USA
| | - William A Zule
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, PO Box 12194, NC, 27709-2194, Durham, USA
| | - Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, PO Box 12194, NC, 27709-2194, Durham, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, PO Box 12194, NC, 27709-2194, Durham, USA.
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Department of Psychology, North Carolina State University, Raleigh, NC, USA.
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
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Nydegger LA, Kidane H, Benitez S, Yuan M, Claborn KR. A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:771-783. [PMID: 37796358 PMCID: PMC10844362 DOI: 10.1007/s10508-023-02712-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.
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Affiliation(s)
- Liesl A Nydegger
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Hampton House, 624 N. Broadway Street, Baltimore, MD, 21205, USA.
| | - Heran Kidane
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Sabrina Benitez
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - Mandy Yuan
- School of Human Ecology, University of Texas at Austin, Austin, TX, USA
| | - Kasey R Claborn
- School of Social Work, University of Texas at Austin, Austin, USA
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Pahl K, Williams SZ, Capasso A, Lewis CF, Lekas HM. A longitudinal pathway from ethnic-racial discrimination to sexual risk behaviors among Black women and Latinas: Ethnic-racial identity exploration as a protective factor. Soc Sci Med 2023; 316:115061. [PMID: 35637046 DOI: 10.1016/j.socscimed.2022.115061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Black women and Latinas in their thirties continue to be at risk for HIV transmission via heterosexual intercourse. METHODS Informed by the Theory of Gender and Power, this study investigated a longitudinal path model linking experiences of ethnic-racial discrimination in late adolescence to sexual risk behaviors in adulthood among 492 Black women and Latinas. We also tested whether ethnic-racial identity exploration served as a resilience asset protecting women against the psychological impact of ethnic-racial discrimination. Survey data from female participants in the Harlem Longitudinal Development Study, which has followed a cohort of New York City Black and Latinx youth since 1990, were analyzed. Data for this analysis were collected at four time points when participants were on average 19, 24, 29, and 32 years of age. Structural equation modeling was used to examine a hypothesized pathway from earlier ethnic-racial discrimination to later sexual risk behaviors and the protective role of ethnic-racial identity exploration. RESULTS Results confirmed that ethnic-racial discrimination in late adolescence was linked with sexual risk behaviors in the early thirties via increased levels of affective distress in emerging adulthood, experiences of victimization in young adulthood, and substance use in the early thirties among women low in ethnic-racial identity exploration. We also found that ethnic-racial identity served as a resilience asset, as the association between discrimination in late adolescence and affective distress in emerging adulthood was not significant among women with higher levels of ethnic-racial identity exploration. CONCLUSIONS The results provide important preliminary evidence that ethnic-racial identity exploration may serve as a resilience asset among Black women and Latinas confronting racial discrimination. Further, we suggest that ethnic-racial identity exploration may constitute an important facet of critical consciousness.
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Affiliation(s)
- Kerstin Pahl
- Department of Psychiatry, New York University Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA; Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Sharifa Z Williams
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA
| | - Ariadna Capasso
- NYU School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Crystal Fuller Lewis
- Department of Psychiatry, New York University Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA; Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA
| | - Helen Maria Lekas
- Department of Psychiatry, New York University Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA; Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA
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Cook AM, Maurer JM, Reynolds BL, Harenski CL, Kiehl KA. PSYCHOPATHY AND RISKY SEXUAL BEHAVIOR IN INCARCERATED WOMEN. CRIMINAL JUSTICE AND BEHAVIOR 2022; 49:1456-1473. [PMID: 37920552 PMCID: PMC10621873 DOI: 10.1177/00938548221105057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
To date, very few studies have explored the association between psychopathic traits and risky sexual behavior (RSB) among women. Here, we investigated this relationship in a sample of 137 incarcerated women. Psychopathic traits were assessed via the Hare Psychopathy Checklist-Revised (PCL-R) and lifetime RSB measures, including number of lifetime sexual partners, frequency of engaging in sexual intercourse while intoxicated, and frequency of forgoing protection (e.g., condom usage) during sexual intercourse, were assessed through self-report. PCL-R Facet 3 scores (assessing lifestyle psychopathic traits) were associated with an increased frequency of engaging in sexual intercourse while intoxicated. In addition, women scoring high on the PCL-R were more likely to engage in sexual intercourse while intoxicated compared with a previously collected sample of men scoring high on the PCL-R. The results obtained in the current study help improve our understanding of the association between psychopathic traits and RSB among women.
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Affiliation(s)
| | | | | | | | - Kent A Kiehl
- The Mind Research Network, The University of New Mexico
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Wyrick DL, Tanner AE, Milroy JJ, Guastaferro K, Bhandari S, Kugler KC, Thorpe S, Ware S, Miller AM, Collins LM. itMatters: Optimization of an online intervention to prevent sexually transmitted infections in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1212-1222. [PMID: 32692637 PMCID: PMC7909750 DOI: 10.1080/07448481.2020.1790571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
ObjectiveTo describe an iterative approach to developing an online intervention targeting the intersection of alcohol use and sexual behaviors among first year college students. Methods and Participants: Using the multiphase optimization strategy (MOST), we conducted two iterative optimization trials to: (1) identify candidate intervention components (i.e., descriptive norms, injunctive norms, outcome expectancies, perceived benefits of protective behavioral strategies, and self-efficacy to use strategies); (2) revise components; and (3) identify the optimized intervention. Participants were first year college students at six geographically diverse universities (optimization trial 1 N = 5,880; optimization trial 2 N = 3,551) Results: For both optimization trials, the results indicated that only descriptive and injunctive norms produced a significant effect (p<.05). Conclusions: The iterative process of MOST allowed us to develop an optimized intervention which is an essential tool to maximize intervention effectiveness and efficiency to improve uptake, sustainability, and public health impact.
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Affiliation(s)
- David L. Wyrick
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Amanda E. Tanner
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Jeffrey J. Milroy
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Kate Guastaferro
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
| | - Sandesh Bhandari
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
| | - Kari C. Kugler
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, Pennsylvania
| | - Shemeka Thorpe
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Samuella Ware
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Alicia M. Miller
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Linda M. Collins
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
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Aaron KJ, Brill I, Causey-Pruitt Z, Murphy K, Augenbraun M, Kassaye S, Milam JE, Seidman D, French AL, Gange SJ, Adimora AA, Sheth AN, Fischl MA, Van Der Pol B, Marrazzo J, Kempf MC, Dionne-Odom J. Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015). Sex Transm Infect 2022; 98:4-10. [PMID: 33408096 PMCID: PMC9099234 DOI: 10.1136/sextrans-2020-054674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Syphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women's Interagency HIV Study (WIHS) to inform targeted interventions. METHODS The retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994-2002) and recent (2011-2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis. RESULTS The study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p<0.01). In adjusted models for the early cohort, factors associated with syphilis included age, black race, low income, hepatitis C seropositivity, drug use, HIV infection and >100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30-39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40-49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection. CONCLUSIONS Syphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use.
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Affiliation(s)
- Kristal J Aaron
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ilene Brill
- Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA
| | - Zenoria Causey-Pruitt
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kerry Murphy
- Department of Medicine/Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Augenbraun
- Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Seble Kassaye
- Department of Medicine/Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Joel E Milam
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, and Bixby Center for Global Reproductive Health, San Francisco, California, USA
| | - Audrey L French
- Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, Illinois, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anandi N Sheth
- Department of Medicine/Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Department of Medicine/Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Barbara Van Der Pol
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeanne Marrazzo
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mirjam-Colette Kempf
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA,Department of Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodie Dionne-Odom
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Madkour AS, Clum G, Green J, Latimer J, Schmidt N, Johnson C, Kissinger P. Patterns and correlates of substance use among young adult African American women. J Ethn Subst Abuse 2022; 21:197-215. [PMID: 32052710 DOI: 10.1080/15332640.2020.1725708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patterns and correlates of substance use among urban African American young women (ages 18-19, n = 459) were examined. Four patterns were identified: no/infrequent alcohol and marijuana use (64.9%); recent alcohol only use (18.2%); recent marijuana only use (7.9%); and recent alcohol and marijuana use (9.0%). Having a recent male sexual partner and a history of sexual coercion were associated with increased odds of marijuana-only and dual use. Greater family support and childhood sexual abuse were associated with increased odds of alcohol-only use. Results suggest that sexual relationships and history of abuse/coercion are important factors in young African American women's substance use.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gretchen Clum
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jakevia Green
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jen Latimer
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Carolyn Johnson
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Patricia Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Gibson B, Hoff E, Haas A, Adams ZM, Price CR, Goddard-Eckrich D, Sheth SS, Dasgupta A, Meyer JP. Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065211070543. [PMID: 35023410 PMCID: PMC8771433 DOI: 10.1177/17455065211070543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health. METHODS We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes. RESULTS Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09-4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13-0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors. CONCLUSIONS This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women's expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.
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Affiliation(s)
- Britton Gibson
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT, USA
| | - Emily Hoff
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Alissa Haas
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Anindita Dasgupta
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
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Bolarinwa OA, Boikhutso T. Mapping evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa: A scoping review. Afr J Prim Health Care Fam Med 2021; 13:e1-e10. [PMID: 34797120 PMCID: PMC8661283 DOI: 10.4102/phcfm.v13i1.3091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Globally, most young women have an unmet need for sexual and reproductive health (SRH), which remains a public health concern. Identifying the predictors can help reduce this challenge. Aim This scoping review maps evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa. Method Askey and O’Malley’s framework guided this review. We searched five databases from January 2000 to December 2020 using relevant keywords, Boolean terms and medical subject heading terms. All relevant extracted data were organised into the study themes, and summary of all the findings were reported in a narrative format. Results Nine studies met the inclusion criteria out of 1219 studies identified. Four out of the nine studies were national-based studies, while the remaining five studies were conducted in Western Cape (two), Eastern Cape (two) and KwaZulu-Natal (one). Out of the nine studies included, three reported predictors of unintended pregnancy, while six reported predictors of sexually transmitted infections and HIV among young women in South Africa. The most prevailing predictors of adverse sexual and reproductive health outcomes were gender-based violence and alcohol use, while other predictors were lower socio-economic status, place of residence, multiple sexual partnerships, low education and being between the ages of 20–24 years. Conclusion We conclude that gender-based violence and alcohol abuse are the most prevailing predictors of adverse sexual and reproductive health outcomes among young women in South Africa.
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Affiliation(s)
- Obasanjo A Bolarinwa
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Nydegger LA, Dickson-Gomez J, Ko TK. Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration. CULTURE, HEALTH & SEXUALITY 2021; 23:659-673. [PMID: 32212993 PMCID: PMC7529643 DOI: 10.1080/13691058.2020.1720297] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/20/2020] [Indexed: 05/03/2023]
Abstract
In the USA, Black women are at disproportionately higher risk for HIV compared to women of other races/ethnicities, which can be explained by the Substance Abuse, Violence and AIDS (SAVA) syndemic. Disparities in HIV, substance use and violence are driven by multiple influences, including structural factors (e.g. housing and poverty), which exacerbate social- and individual-level factors leading to more sex partners, engaging in unprotected sex, having sex for money, experiencing forced sex from an intimate partner or increased substance use, all of which increase HIV risk. Pre-exposure prophylaxis (PrEP), a pill that can prevent HIV, is a discreet and underutilised method that Black women experiencing syndemics can use to decrease their risk. This study explored Black women's interest in, and barriers to adopting PrEP over 6 months. Thirty Black women (age M = 32.2) who experienced multiple substance use, violence and HIV-related syndemic factors were interviewed four times over a 6-month period. Results demonstrated that experiencing intimate partner violence, substance use, community violence and other structural factors (poor access to social services, transport and childcare) all acted as barriers to PrEP adoption. Future research should consider multi-level interventions that include methods such as media campaigns, providing PrEP or referrals where women who experience syndemic and structural factors seek help, and implement a PrEP adherence programmes and interventions in support group settings.
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Affiliation(s)
- Liesl A. Nydegger
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Julia Dickson-Gomez
- Department of Epidemiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thant Ko Ko
- Institute for Health Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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11
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Tanner AE, Guastaferro KM, Rulison KL, Wyrick DL, Milroy JJ, Bhandari S, Thorpe S, Ware S, Miller AM, Collins LM. A Hybrid Evaluation-Optimization Trial to Evaluate an Intervention Targeting the Intersection of Alcohol and Sex in College Students and Simultaneously Test an Additional Component Aimed at Preventing Sexual Violence. Ann Behav Med 2021; 55:1184-1187. [PMID: 33704366 DOI: 10.1093/abm/kaab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Using the multiphase optimization strategy (MOST), we previously developed and optimized an online behavioral intervention, itMatters, aimed at reducing the risk of sexually transmitted infections (STI) among first-year college students by targeting the intersection of alcohol use and sexual behaviors. PURPOSE We had two goals: (a) to evaluate the optimized itMatters intervention and (b) to determine whether the candidate sexual violence prevention (SVP) component (included at the request of participating universities) had a detectable effect and therefore should be added to create a new version of itMatters. We also describe the hybrid evaluation-optimization trial we conducted to accomplish these two goals in a single experiment. METHODS First year college students (N = 3,098) at four universities in the USA were individually randomized in a hybrid evaluation-optimization 2 × 2 factorial trial. Data were analyzed using regression models, with pre-test outcome variables included as covariates in the models. Analyses were conducted separately with (a) immediate post-test scores and (b) 60-day follow-up scores as outcome variables. RESULTS Experimental results indicated a significant effect of itMatters on targeted proximal outcomes (norms) and on one distal behavioral outcome (binge drinking). There were no significant effects on other behavioral outcomes, including the intersection of alcohol and sexual behaviors. In addition, there were mixed results (positive short-term effect; no effect at 60-day follow-up) of the SVP component on targeted proximal outcomes (students' self-efficacy to reduce/prevent sexual violence and perceived effectiveness of protective behavioral strategies). CONCLUSIONS The hybrid evaluation-optimization trial enabled us to evaluate the individual and combined effectiveness of the optimized itMatters intervention and the SVP component in a single experiment, conserving resources and providing greatly improved efficiency. TRIAL REGISTRATION NCT04095065.
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Kate M Guastaferro
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kelly L Rulison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - David L Wyrick
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Jeffrey J Milroy
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Sandesh Bhandari
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Shemeka Thorpe
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Alicia M Miller
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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12
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Dias JA, Luciano TV, Santos MCLFS, Musso C, Zandonade E, Spano LC, Miranda AE. [Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors]. CAD SAUDE PUBLICA 2021; 37:e00174919. [PMID: 33624738 DOI: 10.1590/0102-311x00174919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 06/29/2020] [Indexed: 11/22/2022] Open
Abstract
The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.
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Affiliation(s)
| | | | | | - Carlos Musso
- Universidade Federal do Espírito Santo, Vitória, Brasil
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Meyer J, Price C, Tracey D, Sharpless L, Song Y, Madden L, Elwyn G, Altice F. Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders. Patient Prefer Adherence 2021; 15:1913-1927. [PMID: 34511887 PMCID: PMC8420782 DOI: 10.2147/ppa.s315543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs. METHODS We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months. RESULTS A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05-16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19-7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05). CONCLUSION Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.
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Affiliation(s)
- Jaimie Meyer
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- Correspondence: Jaimie Meyer Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USATel +203 737 6233Fax +203 737 4051 Email
| | - Carolina Price
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | | | - Yue Song
- Yale School of Public Health, New Haven, CT, USA
- Oregon Health Sciences University, Portland, OR, USA
| | - Lynn Madden
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- Scientific Institute for Quality of Healthcare, University Nijmegen Medical Centre, Nijmegen, Netherlands
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Frederick Altice
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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14
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Doherty IA, Browne FA, Wechsberg WM. Think Inside the Box: the Heterogeneity of "in Risk" Among "at Risk" Female African American Adolescents in North Carolina. J Racial Ethn Health Disparities 2020; 7:1150-1159. [PMID: 32297304 PMCID: PMC10961606 DOI: 10.1007/s40615-020-00739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION An abundance of research investigates the health of often referred to as "at risk" or "high risk" youth from underserved communities and usually racial/ethnic minorities. These ubiquitous terms relate to poverty, violence, and unsafe behaviors (e.g., sex without condoms, alcohol, and drug use). METHODS This analysis distinguished the heterogeneity of risks among African American female adolescents recruited for an intervention study from underserved communities in North Carolina. Eligibility included: ages 16-19, considered or dropped out of school, never completed high school, and during the past 3 months had sex with a male partner and used drugs or alcohol. A variable was created to represent the continuum of risk comprised of history of homelessness, or trading sex, or current heavy alcohol and marijuana use. Participants fell into 0, 1, or 2-3 categories. Ordinal logistic regression estimated the odds of adverse poor outcomes by category. Linear regression estimated reduction in material and emotional support by category. RESULTS Of the 237 participants, 59.5%, 27.8%, and 12.7% were in 0, 1, or 2-3 categories, respectively. Relative to adolescents in 0 categories, participants in other categories were more likely to report food insecurity (OR = 3.27, 95%CI [1.8, 5.94]); past arrest (OR = 3.56 [2.08, 6.09]); run away (OR = 3.30 [1.79, 6.10]); multiple sex partners (2.97 [1.61, 5.48]); and vaginal/anal sexual abuse (OR = 3.21[1.73, 5.96]). Material and emotional support was significantly lower for participants in 2-3 risk categories. CONCLUSIONS Vague use of "at risk" fails to recognize the heterogeneity of experiences and needs of underserved African American youth.
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Affiliation(s)
- Irene A Doherty
- RTI International, Research Triangle Park, Durham, NC, USA.
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC, USA.
| | - F A Browne
- RTI International, Research Triangle Park, Durham, NC, USA
| | - W M Wechsberg
- RTI International, Research Triangle Park, Durham, NC, USA
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15
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Hood KB, Pollack LM, Jackson DD, Boyer CB. Associations Among Behavioral Risk, Sociodemographic Identifiers, and Sexually Transmitted Infections in Male and Female Army Enlisted Personnel. Mil Med 2020; 186:e75-e84. [PMID: 32909601 DOI: 10.1093/milmed/usaa247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 07/30/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Rates of sexually transmitted infections (STIs) are higher among U.S. military personnel than their civilian counterparts. Yet there is a paucity of military-specific research that has utilized theoretical frameworks to describe the relative influence of the multiple and interrelated risk factors associated with STIs in this population of young, healthy men and women. The aim of this study was to examine the relative influence of Information, Motivation, and Behavioral Skills Model (IMB) factors known to be associated with condom use and STI diagnosis, as well as examine gender differences among a cohort of young, active duty enlistees who are in the very early stages of their military careers. MATERIALS AND METHODS Data were collected in 2011 to 2013 through self-administered questionnaires and laboratory-confirmed tests of STIs. Logistic regression analyses were used to assess IMB constructs, behavioral risk variables, and sociodemographic factors associated with STI diagnosis and condom use separately among female and male military personnel. RESULTS STIs among males were significantly associated with nonwhite race, lower STI behavioral intentions and STI behavioral skills, and engaging in sex after drinking alcohol. Further, males who reported more positive attitudes toward using condoms, higher confidence in preventing drinking, higher alcohol prevention norms among peers, a lower frequency of drinking alcohol before engaging in sexual intercourse, more sexual partners, and higher STI behavioral intentions were significantly more likely to report using condoms consistently during sexual encounters. Among female participants, a history of STIs was significantly associated with higher numbers of reported sexual partners and greater alcohol prevention efficacy while lifetime consistent condom use was significantly associated only with stronger intentions to avoid behaviors that might result in STI acquisition. CONCLUSION Our findings support the need for development of STI prevention strategies that include education and skills-building approaches to reduce alcohol misuse among enlisted military personnel, and especially male personnel. Such programs should include factors that uniquely influence the experiences of males and females in the military context.
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Affiliation(s)
- Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Lance M Pollack
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | | | - Cherrie B Boyer
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, CA 94118, USA
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16
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Banks DE, Hensel DJ, Zapolski TCB. Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1939-1964. [PMID: 32157486 PMCID: PMC7321914 DOI: 10.1007/s10508-019-01609-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 05/21/2023]
Abstract
Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.
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Affiliation(s)
- Devin E Banks
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA
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17
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Carey MP, Rich C, Norris AL, Krieger N, Gavarkovs AG, Kaplan C, Guthrie KM, Carey KB. A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1231-1250. [PMID: 32189096 PMCID: PMC7150639 DOI: 10.1007/s10508-020-01635-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.
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Affiliation(s)
- Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA.
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Alyssa L Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Naomi Krieger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Adam G Gavarkovs
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | - Clair Kaplan
- Department of Clinical Research, Planned Parenthood of Southern New England, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | - Kate B Carey
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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18
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Ngoc Do H, Ngoc Nguyen D, Quynh Thi Nguyen H, Tuan Nguyen A, Duy Nguyen H, Phuong Bui T, Bich Thi Vu T, Thanh Le K, Tuan Nguyen D, Tat Nguyen C, Gia Vu L, Thu Vu G, Xuan Tran B, A. Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1903. [PMID: 32183402 PMCID: PMC7143552 DOI: 10.3390/ijerph17061903] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022]
Abstract
Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.
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Affiliation(s)
- Ha Ngoc Do
- Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam;
| | - Diep Ngoc Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
| | - Hoa Quynh Thi Nguyen
- Department of Research on Youth Culture and Lifestyle, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.Q.T.N.); (A.T.N.)
| | - Anh Tuan Nguyen
- Department of Research on Youth Culture and Lifestyle, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.Q.T.N.); (A.T.N.)
| | - Hiep Duy Nguyen
- Department of Research on Children’s issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.D.N.); (T.P.B.)
| | - Thanh Phuong Bui
- Department of Research on Children’s issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.D.N.); (T.P.B.)
| | - Thao Bich Thi Vu
- Department of Research on Youth’s Organisations and Youth Campaign, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (T.B.T.V.); (K.T.L.)
| | - Khiet Thanh Le
- Department of Research on Youth’s Organisations and Youth Campaign, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (T.B.T.V.); (K.T.L.)
| | - Dung Tuan Nguyen
- Department of Research on Youth and Legal issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam;
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Linh Gia Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.G.V.); (G.T.V.)
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.G.V.); (G.T.V.)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
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Tang AM, Hamunime N, Adams RA, Kanyinga G, Fischer-Walker C, Agolory S, Prybylski D, Mutenda N, Sughrue S, Walker DD, Rennie T, Zahralban-Steele M, Kerrigan A, Hong SY. Introduction of an Alcohol-Related Electronic Screening and Brief Intervention (eSBI) Program to Reduce Hazardous Alcohol Consumption in Namibia's Antiretroviral Treatment (ART) Program. AIDS Behav 2019; 23:3078-3092. [PMID: 31444711 PMCID: PMC6801208 DOI: 10.1007/s10461-019-02648-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Alcohol is the most widely abused substance in Namibia and is associated with poor adherence and retention in care among people on antiretroviral therapy (ART). Electronic screening and brief interventions (eSBI) are effective in reducing alcohol consumption in various contexts. We used a mixed methods approach to develop, implement, and evaluate the introduction of an eSBI in two ART clinics in Namibia. Of the 787 participants, 45% reported some alcohol use in the past 12 months and 25% reported hazardous drinking levels. Hazardous drinkers were more likely to be male, separated/widowed/divorced, have a monthly household income > $1000 NAD, and report less than excellent ART adherence. Based on qualitative feedback from participants and providers, ART patients using the eSBI for the first time found it to be a positive and beneficial experience. However, we identified several programmatic considerations that could improve the experience and yield in future implementation studies.
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Affiliation(s)
- A M Tang
- School of Medicine, Tufts University, Boston, MA, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, MV248, Boston, MA, 02111, USA.
| | - N Hamunime
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - R A Adams
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - G Kanyinga
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | | | - S Agolory
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - D Prybylski
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - N Mutenda
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - S Sughrue
- School of Medicine, Tufts University, Boston, MA, USA
| | - D D Walker
- School of Social Work, University of Washington, Seattle, WA, USA
| | - T Rennie
- School of Pharmacy, University of Namibia, Windhoek, Namibia
| | | | - A Kerrigan
- School of Medicine, Tufts University, Boston, MA, USA
| | - S Y Hong
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
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Ajayi AI, Olamijuwon EO. What predicts self-efficacy? Understanding the role of sociodemographic, behavioural and parental factors on condom use self-efficacy among university students in Nigeria. PLoS One 2019; 14:e0221804. [PMID: 31461479 PMCID: PMC6713390 DOI: 10.1371/journal.pone.0221804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/16/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Risky sexual behaviours are not uncommon among young adults particularly those in the higher levels of education. It is known that higher self-efficacy could contribute to better sexual and reproductive health outcomes including the use of condoms. However, there is limited research on the role of socio-demographic, behavioural and parental factors as predictors of condom-use self-efficacy. As a result, this exploratory study was designed to assess the predictors of self-efficacy for condom use among university students in Nigeria. METHODS A cross-sectional survey was conducted with 755 university students in Nigeria from February to April 2018. Self-efficacy for condom use was assessed by combining responses to 11-items measures of condom self-efficacy drawn from the work of Barkley and colleagues. We fitted a structural equation model to identify the pathways through which socio-demographic, behavioural and parental factors predict two constructs of condom-use self-efficacy (self-efficacy for condom purchase and use and partner communication self-efficacy) in the sample. RESULTS Demographic factors such as age (β = -0.29, p<0.05) and sex (β = 0.42, p<0.05), as well as ratings on religious importance (β = -0.08, p<0.05) were directly associated with self-efficacy for condom purchase and use. These factors showed significantly mediated effects through sexual experience which also had a direct positive relationship (β = 0.73, p<0.05) with self-efficacy for condom purchase and use. The receipt of parental support, on the other hand, was directly associated with higher partner communication efficacy for condom use (β = 0.07, p<0.05). We found no evidence that the level of partner communication efficacy was directly associated with any of the behavioural, demographic or parental factors. CONCLUSION The findings of this study affirm that sex, or age or having higher ratings on religious importance alone does not increases self-efficacy but also exposure to sexual activity through which these factors affect self-efficacy for condom purchase and use. These findings also highlight the need to address and strengthen condom use self-efficacy among young adults, particularly the sexually inexperienced, highly religious and young adults with limited support from their parent.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health Unit, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
| | - Emmanuel Olawale Olamijuwon
- Department of Statistics and Demography, Faculty of Social Science, University of Eswatini (formerly Swaziland), Kwaluseni, Eswatini
- Demography and Population Studies Programme, Schools of Public Health and Social Science, University of the Witwatersrand, Johannesburg, South Africa
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21
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Abstract
BACKGROUND Prescription opioid misuse (POM) is a significant problem among U.S. adults, including Blacks, as indicated by past research. Despite potential gender differences in POM among Black adults, previous research has yet to examine this possibility. OBJECTIVES This study identified the prevalence and unique correlates of POM among both Black men and Black women. Results were compared to those of Whites. METHODS We used data from 2015-2016 National Survey on Drug Use and Health (N = 60,133). Weighted logistic regression models stratified by race and gender were estimated. One model was stratified by gender only, with race serving as the primary predictor. RESULTS Findings revealed 3.4% of Black women, 4.9% of Black men, 4.1% of White women, and 5.4% of White men reported past-year POM; although, no significant differences were found. Among Black women only, lower socioeconomic status increased odds of POM. Higher educational attainment, residence in rural areas and older age lowered odds of POM. Encounters with drug dealers, illicit drug, marijuana, and tobacco use, other prescription drug misuse, and poor health were associated with increased odds of POM among Black men. In the gender stratified models, White men were more likely to report POM than Black men. However, White women were not more likely to report POM compared to Black women. CONCLUSIONS Clear gender differences exist in the prevalence and correlates of POM among Black adults. Prevention and intervention strategies must be cognizant of these differences when developing programs to decrease POM.
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Affiliation(s)
- Harvey L Nicholson
- a Department of Sociology , University of Central Florida , Orlando , Florida , USA
| | - Jolene Vincent
- b Department of Sociology , College of William and Mary , Williamsburg , Virginia , USA
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22
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Martins DC, Pesce GB, Silva GMD, Fernandes CAM. Sexual behavior and sexually transmitted diseases among the female partners of inmates. Rev Lat Am Enfermagem 2018; 26:e3043. [PMID: 30328971 PMCID: PMC6190487 DOI: 10.1590/1518-8345.2568.3043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze the sexual behavior of the female partners of inmates and estimate
the prevalence of sexually transmitted diseases. Method: cross-sectional, quantitative study involving 349 female partners of inmates.
The Estudo de Comportamento Sexual [Sexual Behavior Study],
an instrument validated in Brazil, was used to collect the data. The
Statistical Package for the Social Sciences, version 20 was used in the
statistical analysis. Results: 41.2% of the female partners of inmates reported a prior history of sexually
transmitted disease. Association was found between having more than one
partner in the last 12 months (<0.006), sexual violence (<0.001),
having sex for money (<0.001), under the influence of alcohol
(<0.001), and under the influence of drugs (<0.005). The variables
associated with sexually transmitted infections in the logistic regression
were: having more than one partner in the last 12 months, sexual violence,
sex for money, and under the effect of alcohol or drugs. Conclusion: The number of partners, sexual violence, sex for money, and under the
influence of alcohol or drugs are sexual risk behaviors that increase the
prevalence of sexually transmitted infections among the female partners of
inmates.
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Affiliation(s)
- Debora Cristina Martins
- Universidade Estadual de Maringá, Programa de Pós-graduação em Enfermagem, Maringá, PR, Brazil.,Centro Universitário de Maringá, Centro de Ciências da Saúde, Maringá, PR, Brazil.,Prefeitura Municipal de Apucarana, Autarquia Municipal de Saúde, Apucarana, PR, Brazil
| | - Giovanna Brichi Pesce
- Universidade Estadual de Maringá, Programa de Pós-graduação em Enfermagem, Maringá, PR, Brazil
| | - Giordana Maronezzi da Silva
- Universidade Estadual de Maringá, Programa de Pós-graduação em Enfermagem, Maringá, PR, Brazil.,Prefeitura Municipal de Apucarana, Autarquia Municipal de Saúde, Apucarana, PR, Brazil
| | - Carlos Alexandre Molena Fernandes
- Universidade Estadual de Maringá, Programa de Pós-graduação em Enfermagem, Maringá, PR, Brazil.,Universidade Estadual do Paraná, Faculdade Estadual de Educação Ciências e Letras de Paranavaí, Paranavaí, PR, Brazil
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23
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Browne FA, Wechsberg WM, Kizakevich PN, Zule WA, Bonner CP, Madison AN, Howard BN, Turner LB. mHealth versus face-to-face: study protocol for a randomized trial to test a gender-focused intervention for young African American women at risk for HIV in North Carolina. BMC Public Health 2018; 18:982. [PMID: 30081868 PMCID: PMC6080398 DOI: 10.1186/s12889-018-5796-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 01/06/2023] Open
Abstract
Background Disparities in the prevalence of HIV persist in the southern United States, and young African American women have a disproportionate burden of HIV as compared with young women of other racial/ethnic backgrounds. As a result, engaging young African American women in the HIV care continuum through HIV testing is imperative. This study is designed to reach this key population at risk for HIV. The study seeks to test the efficacy of two formats of a gender-focused, evidence-based, HIV-risk reduction intervention—the Young Women’s CoOp (YWC)—relative to HIV counseling and testing (HCT) among young African American women between the ages of 18 and 25 who use substances and have not recently been tested for HIV. Methods Using a seek-and-test framework, this three-arm cross-over randomized trial is being conducted in three county health departments in North Carolina. Each county is assigned to one of three study arms in each cycle: in-person (face-to-face) YWC, mobile Health (mHealth) YWC, or HCT. At study enrollment, participants complete a risk behavior survey via audio computer-assisted self-interview, and drug, alcohol, and pregnancy screening tests, and are then referred to HIV, gonorrhea, and chlamydia testing through their respective health departments. Participants in either of the YWC arms are asked to return approximately 1 week later to either begin the first of two in-person individual intervention sessions or to pick up the mHealth intervention preloaded on a tablet after a brief introduction to using the app. Participants in all arms are asked to return for a 6-month follow-up and 12-month follow-up, and repeat the survey and biological testing from baseline. Discussion The findings from this study will demonstrate which delivery format (mHealth or face-to-face) is efficacious in reducing substance use and sexual risk behaviors. If found to be efficacious, the intervention has potential for wider dissemination and reach. Trial registration ClinicalTrials.gov: NCT02965014. Registered November 16, 2016.
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Affiliation(s)
- Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA.
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA.,Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA
| | - Paul N Kizakevich
- Research Computing Division, RTI International, Research Triangle Park, NC, USA
| | - William A Zule
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Courtney P Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Ashton N Madison
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Brittni N Howard
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Leslie B Turner
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
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24
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Boyer CB, Santiago Rivera OJ, Chiaramonte DM, Ellen JM. Examination of Behavioral, Social, and Environmental Contextual Influences on Sexually Transmitted Infections in At Risk, Urban, Adolescents, and Young Adults. Sex Transm Dis 2018; 45:542-548. [PMID: 29466279 PMCID: PMC6043398 DOI: 10.1097/olq.0000000000000797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the large body of extant literature on sexually transmitted infections (STIs) in adolescents and young adults (AYAs), more research on social and environmental contextual factors is needed. Also, further examination of STI indicators by gender remains a critical area of research focus. METHODS Anonymous survey data were collected using audio computer-assisted self-interviews in community venues in urban, low-income, STI prevalent, US neighborhoods to reach AYAs, aged 12 to 24 years. Conventional descriptive statistics, bivariate analysis, and multiple logistical regression models were used to assess indicators of a self-reported lifetime prevalence of STIs. RESULTS Participants (N = 1540) were on average 20.6 years; 57.2% were women, the majority were racial and ethnic minorities (92%), and almost half (49.2%) identified as sexual minorities. Nearly one third (32.%) had 1 or more STIs. As expected, gender differences were identified. For AYA men, being African American/Black, moving residences more than 4 times since kindergarten, and having a history of human immunodeficiency virus testing were each positively associated with STIs. Also, those who strongly disagreed that many young people in their community exchanged sex for money had a significantly lower likelihood of having an STI. For AYA women, exchanging sex for drugs or money, lacking money, which prevented activities, and using marijuana were each associated with STIs. CONCLUSIONS This research extends our understanding of social and environmental contextual influences on AYAs' risk for STIs. It highlights differences in risk exposures that are distinctly different for AYA women and men, suggesting the need for tailored interventions to address their unique economic needs and social challenges.
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Affiliation(s)
| | | | | | - Jonathan M Ellen
- President and Vice Dean, All Children's Hospital Johns Hopkins Medicine, St Petersburg, FL
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25
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Przybyla SM, Krawiec G, Godleski SA, Crane CA. Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1351-1366. [PMID: 28975477 PMCID: PMC7864120 DOI: 10.1007/s10508-017-1050-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 05/24/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46-1.85); OR 1.65 (95% CI 1.14-2.39); OR 2.88 (95% CI 2.01-4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.
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Affiliation(s)
- Sarahmona M Przybyla
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA.
| | - Gabriela Krawiec
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA
| | | | - Cory A Crane
- Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, USA
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26
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Wagenaar C, Florence M, Adams S, Savahl S. Factors influencing the relationship between alcohol consumption and risky sexual behaviour among young people: A systematic review. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1483049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Cassandra Wagenaar
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - Maria Florence
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - Sabirah Adams
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - Shazly Savahl
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
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27
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Gamarel KE, Nichols S, Kahler CW, Westfall AO, Lally MA, Wilson CM. A cross-sectional study examining associations between substance use frequency, problematic use and STIs among youth living with HIV. Sex Transm Infect 2018; 94:304-308. [PMID: 29180537 PMCID: PMC6002747 DOI: 10.1136/sextrans-2017-053334] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/04/2017] [Accepted: 11/04/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study sought to examine the prevalence of STIs and whether substance use frequency and/or problematic use-specifically alcohol, marijuana and other drugs-was associated with having an STI diagnosis among youth living with HIV (YLWH) METHODS: A sample of 823 YLWH were recruited at 14 adolescent HIV clinics through the Adolescent Medicine Trials Network for HIV Interventions. Study staff abstracted STI data from medical records for up to 26 weeks prior to participants' completing a cross-sectional survey including the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), which measures substance use frequency and consequences. RESULTS Almost one-third of youth had been diagnosed with an STI (30.5%) at the time of their baseline assessment. In multivariable analyses, those who engaged in weekly or greater marijuana use (adjusted OR (AOR)=10.66, 95% CI: 4.39 to 25.87, P<0.001) had an increased odds of being diagnosed with an STI. Additionally, youth who met alcohol use criteria for moderate (AOR=5.23, 95% CI: 2.50 to 10.93, P<0.001) and high risk (AOR=6.53, 95% CI: 1.20 to 35.68, P<0.05) alcohol use had an increased odds of being diagnosed with an STI compared with low-risk alcohol users. CONCLUSIONS Study findings underscore the need to investigate the role of greater frequency of marijuana use and problematic alcohol use in STI incidence among YLWH. Given the associations between both substance use frequency and problematic use in STI diagnoses among YLWH seen in HIV care settings, clinicians should use validated substance use screening tools which capture both frequencies and consequences in order to identify YLWH who may need further evaluation and treatment.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Sharon Nichols
- Department of Medicine, University of California, San Diego, CA USA
| | - Christopher W. Kahler
- Center for Alcohol & Addiction Studies and Department of Behavioral and Social Science, Brown University School of Public Health, Providence, RI USA
| | | | - Michelle A. Lally
- Lifespan Hospital System, Providence, RI USA
- Alpert Medical School, Brown University, Providence, RI USA
| | - Craig M. Wilson
- Department of Epidemiology, University of Alabama at Birmingham, USA
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28
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Adeniyi OV, Ajayi AI, Moyaki MG, Goon DT, Avramovic G, Lambert J. High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa. BMC Health Serv Res 2018; 18:140. [PMID: 29482587 PMCID: PMC5828463 DOI: 10.1186/s12913-018-2942-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). METHODS Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. RESULTS The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. CONCLUSION Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were exposed to integrated services. The study confirms that integration of HIV care and family planning services is an important strategy to reduce unplanned pregnancy among women living with HIV. The study's findings have significant implications for the elimination of mother-to-child transmission of HIV in South Africa. Innovative interventions are needed to further consolidate and maximise the benefit of the integration of family planning services with HIV care.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Cecilia Makiwane Hospital/East London Hospital Complex, East London, South Africa
| | - Anthony Idowu Ajayi
- Department of Sociology, University of Fort Hare, 50, Church Street, East London, South Africa
| | | | - Daniel Ter Goon
- Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Gordana Avramovic
- University College Dublin/Mater Misericordiae University Hospital, Catherine McAuley Education & Research Centre, Dublin, Ireland
| | - John Lambert
- University College Dublin/Mater Misericordiae University Hospital, Catherine McAuley Education & Research Centre, Dublin, Ireland
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29
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Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients. Ann Behav Med 2018; 51:39-56. [PMID: 27550626 DOI: 10.1007/s12160-016-9826-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior. PURPOSE We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients. METHODS Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern USA (N = 3761, 59 % male, 72 % Black) completed measures at 3-month intervals over 9-12 months. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in the number of partners and unprotected sex. RESULTS Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs = 0.17-0.40, ps < 0.001) and changes in (rs = 0.21-0.80, ps < 0.05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = 0.25-0.43, ps < 0.001) and changes in (rs = 0.24-0.57, ps < 0.01) alcohol use and unprotected sex in one study recruiting hazardous drinkers. CONCLUSIONS Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use.
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30
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Palamar JJ, Griffin-Tomas M, Acosta P, Ompad DC, Cleland CM. A comparison of self-reported sexual effects of alcohol, marijuana, and ecstasy in a sample of young adult nightlife attendees. PSYCHOLOGY & SEXUALITY 2018; 9:54-68. [PMID: 29430277 DOI: 10.1080/19419899.2018.1425220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol, marijuana, and ecstasy (3,4-methylenedioxymethamphetamine [MDMA], 'Molly') are among the most prevalent substances used by young adults; however, few studies have focused on the specific sexual effects associated with use. Examining subjective sexual effects (e.g. increased libido) associated with use can inform prevention efforts. Data were analysed from 679 nightclub and dance festival attendees in New York City (ages 18-25) to examine and compare self-reported sexual effects associated with use of alcohol, marijuana, and ecstasy. Results suggest that compared to marijuana, alcohol and ecstasy were more strongly associated with heightened perceived sexual effects (i.e. perceived sexual attractiveness of self and others, sexual desire, length of intercourse, and sexual outgoingness). Increased body and sex organ sensitivity and increased sexual intensity were most commonly associated with ecstasy use. Sexual dysfunction was most common while using alcohol or ecstasy, especially among males, and females were more likely to report sexual dysfunction after using marijuana. Post-sex regret was most common with alcohol use. Alcohol, marijuana, and ecstasy each have different sexual effects; therefore, each is associated with different risks and benefits for users. Findings can inform prevention and harm reduction as young adults are prone to use these substances.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center, New York, NY, USA.,Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Marybec Griffin-Tomas
- Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA.,College of Global Public Health, New York University, New York, NY, USA
| | - Patricia Acosta
- Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Danielle C Ompad
- Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, New York, NY, USA.,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA.,College of Global Public Health, New York University, New York, NY, USA
| | - Charles M Cleland
- Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, New York, NY, USA.,Rory Meyers College of Nursing, New York University, New York, NY, USA
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31
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McCoy HV, Shehadeh N, Rubens M. Alcohol Use and Sexual Risk Behaviors in a Migrant Worker Community. J Immigr Minor Health 2017; 18:561-567. [PMID: 26123756 DOI: 10.1007/s10903-015-0240-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are not many studies exploring the association between alcohol use and risky sexual behaviors among migrant workers. This study analyzed how changes in alcohol use was associated with changes in risky sexual behavior and psychosocial variables. Data for this study was drawn from an HIV risk reduction project. Repeated measures ANOVA and Linear mixed model statistical method was conducted to find changes and association between alcohol use, sexual risk and psychosocial variables over time. The sample (n = 203) was composed of African Americans (33.0 %) and Hispanics (77.0 %) men. Both groups, over time, showed reduction in sexual risk in accordance with reduction in alcohol use. Changes in alcohol use and psychosocial variables showed significant association with sexual risk changes over time. Psychological strategies like building social support should be considered for HIV risk reduction intervention directed towards high alcohol consuming migrant workers.
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Affiliation(s)
- H Virginia McCoy
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II 559, Miami, FL, 33199, USA
| | - Nancy Shehadeh
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II 559, Miami, FL, 33199, USA
| | - Muni Rubens
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC II 559, Miami, FL, 33199, USA.
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32
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Zebrak KA, Green KM. The role of young adult social bonds, substance problems, and sexual risk in pathways between adolescent substance use and midlife risky sexual behavior among urban African Americans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:828-838. [PMID: 28933870 DOI: 10.1037/adb0000313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections relative to other racial groups. Although substance use has been linked to risky sexual behavior, the understanding of how these associations develop over the life course remains limited, particularly the role of social bonds. This study uses structural equation modeling to examine pathways from adolescent substance use to young adult sexual risk, substance problems, and social bonds and then to midlife risky sexual behavior among African American men and women, controlling for childhood confounders. Data come from 4 assessments, 1 per developmental period, of a community-based urban African American cohort (N = 1,242) followed prospectively from ages 6 to 42 years. We found that greater adolescent substance use predicts greater young adult substance problems and increased risky sexual behavior, both of which in turn predict greater midlife sexual risk. Although greater adolescent substance use predicts fewer young adult social bonds for both genders, less young adult social bonding is unexpectedly associated with decreased midlife risky sexual behavior among women and not related for men. Substance use interventions among urban African American adolescents may have both immediate and long-term effects on decreasing sexual risk behaviors. Given the association between young adult social bonding and midlife risky sex among females, number of social bonds should not be used as a criterion for determining whom to screen for sexual risk among African American women. Future studies should explore other aspects of social bonding in linking substance use and risky sexual behavior over time. (PsycINFO Database Record
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Affiliation(s)
- Katarzyna A Zebrak
- Department of Behavioral and Community Health, University of Maryland School of Public Health
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health
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33
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Morrison-Beedy D, Grove L, Ji M, Baker E. Understanding the "Why" for High-Risk Behavior: Adolescent Girls' Motivations for Sex. J Assoc Nurses AIDS Care 2017; 28:877-887. [PMID: 28784584 DOI: 10.1016/j.jana.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/20/2017] [Indexed: 11/16/2022]
Abstract
Identifying why girls participate in safe and risky sexual behaviors is key to developing successful intervention strategies. This study identified motivations for sex in 738 girls enrolled in the Health Improvement Project for Teens (HIPTeens) randomized controlled trial and analyzed differences in sex motives among at-risk subgroups. Sexually active girls, ages 15-19 years, were recruited from urban community-based settings. Baseline data were collected via audio computer-assisted self-interview surveys including a modified Sex Motives Scale based on six domains (intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval), assessing drivers of both protective and risk-promoting motivations. Statistically significant motive differences across domains were identified among subgroups with different risk profiles, including mental health issues (depression, drug and alcohol use) as well as demographic group characteristics (race, age, and parental status). Understanding why girls have sex provides an opportunity to address motivation-focused strategies that may augment intervention efficacy.
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Oliveira Serra MAA, Araújo E Silva R, Beserra EP, Melo TN, Sousa LV, Araújo MFM. Use of alcohol and drugs in the view of people living with HIV/AIDS: a qualitative study. Public Health 2017; 149:99-105. [PMID: 28582690 DOI: 10.1016/j.puhe.2017.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/25/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the meaning of the experiences of patients infected by HIV using antiretroviral therapy, regarding the use of alcohol and drugs. STUDY DESIGN A qualitative phenomenological study. METHOD A total of 25 patients receiving antiretroviral treatment participated in the investigation, of which 14 were male and 11 were females, who expressed their feelings and perceptions through participation in focus groups and the interpretation of costumes. The empirical material was transcribed in full and later organized and analyzed using the phenomenological method. RESULTS Based on this amusing experience we realized that participants were unaware of the effects of the use of alcohol and drugs in the AIDS progression. Since they have kept with their smoking and alcoholism habits to be accepted in a social group and consequently prevent prejudice. We believe that our health education strategy was adequate to improve antiretroviral therapy, since it helped in subject comprehension and patients self-care body expression. CONCLUSION This phenomenological study made it possible to understand the experience of patients living with HIV regarding the use of alcohol and drugs, and contributes to the planning and implementation of intervention programs based on a participative model of care, with a view to prioritizing the holistic aspects involved in the treatment of people living with HIV/AIDS.
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Affiliation(s)
| | | | - E P Beserra
- Federal University of Ceará, Fortaleza, Brazil
| | - T N Melo
- Federal University of Maranhão, Imperatriz, Brazil
| | - L V Sousa
- Federal University of Maranhão, Imperatriz, Brazil
| | - M F M Araújo
- University for International Integration Lusophony Afro Brazilian, Brazil
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Trenz RC, Scherer M, Whitehead NE, Latimer WW. Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users. Subst Use Misuse 2016; 51:1716-23. [PMID: 27487197 PMCID: PMC5024347 DOI: 10.1080/10826084.2016.1197260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. OBJECTIVES To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. METHODS Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. RESULTS Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. CONCLUSIONS The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.
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Affiliation(s)
- Rebecca C Trenz
- a School of Social and Behavioral Sciences, Mercy College , Dobbs Ferry , New York , USA
| | - Michael Scherer
- b Pacific Institute for Research and Evaluation , Calverton , Maryland , USA
| | - Nicole Ennis Whitehead
- c Department of Clinical and Health Psychology, University of Florida , Gainesville , Florida , USA
| | - William W Latimer
- d Department of Health Sciences, Lehman College , West Bronx , New York , USA
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Sacamano PL, Farley JE. Behavioral and Other Characteristics Associated with HIV Viral Load in an Outpatient Clinic. PLoS One 2016; 11:e0166016. [PMID: 27806109 PMCID: PMC5091742 DOI: 10.1371/journal.pone.0166016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
Persons living with HIV (PLWH) who are engaged in care, yet not virally suppressed, represent a risk for transmission and opportunity for risk reduction interventions. This study describes characteristics of an outpatient clinic cohort of PLWH by laboratory confirmed viral suppression status and examines associations with demographics and sexual and drug use behaviors gathered through questionnaire. From a sample of 500 clinic patients, 438 were prescribed antiretroviral treatment (ART) and 62 were not. Among the 438 on ART, 72 (16.4%) were not virally suppressed at the most recent lab draw. Compared to individuals with a suppressed viral load, those that were unsuppressed were more likely to: be black (79.2% vs. 64.2%; p = 0.014); earn below $25,000/year (88.9% vs. 65.0%; p < 0.001); be of a younger age (47.8 vs. 50.0 mean years; p = 0.009); be on opiate substitution (14.1% vs. 6.3%; p = 0.023); and acknowledge poly-substance (38.9% vs. 24.4%; p = 0.012) and excessive alcohol use (13.9% vs. 6.0%; p = 0.019). Conversely, a smaller proportion of those with an unsuppressed viral load had multiple sex partners in the previous 30 days (39.8% vs. 58.5%; p = 0.003). In multivariable regression of those on ART, the prevalence of an unsuppressed viral load was 3% lower with each increasing year of age (aPR: 0.97; 95% CI: 0.95, 0.99) and 47% lower with income over $25,000/year (aPR: 0.33; 95% CI: 0.16, 0.70). In a separate analysis of all 500 subjects, ART was less frequently prescribed to blacks compared to whites, heterosexuals, those with lower education and income, and persons with active substance use. Findings confirm that a large proportion of PLWH and engaged in care were not virally suppressed and continued behaviors that risk transmission, indicating the need for screening, prevention counseling and access to ancillary services to lower the incidence of HIV infections.
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Affiliation(s)
- Paul L. Sacamano
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Jason E. Farley
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
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Klein H, Sterk CE, Elifson KW. Knowledge about HIV in a Community Sample of Urban African Americans in the South. ACTA ACUST UNITED AC 2016; 7. [PMID: 27891291 PMCID: PMC5123594 DOI: 10.4172/2155-6113.1000622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Race and HIV are intertwined in complex ways. African Americans, particularly those residing in the southern United States, are at great risk for contracting and subsequently transmitting HIV. Research on the extent to which members of this population understand the risks associated with engaging in specific behaviors is limited. This paper examines HIV knowledge among at-risk adult African American men and women and the factors associated with levels of HIV knowledge. METHODS Based on a conceptual model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2011. Questionnaire-based interviews were conducted with 1,864 respondents from 80 strategically-chosen census block groups in Atlanta, Georgia. An innovative approach to assessing amount of HIV knowledge was implemented, to derive better estimates of the extent of knowledge. RESULTS Overall, HIV knowledge was low (average=43.5% correct answers). Seven factors were identified as contributing uniquely to having higher levels of knowledge about HIV transmission: (1) younger age, (2) being educated beyond the high school level, (3) being gay, lesbian or bisexual, (4) experiencing sexual abuse during childhood and/or adolescence, (5) drinking alcohol less frequently, (6) knowing a larger number of HIV-infected persons and (7) knowing anyone currently living with "full blown" AIDS. CONCLUSION HIV educational and intervention programs targeting at-risk African American adults need to develop effective ways of bolstering a solid understanding of how HIV is/not transmitted. In particular, efforts need to be targeted toward older adults, those with lower levels of educational attainment and persons who are not acquainted with anyone who is HIV-infected.
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Affiliation(s)
- H Klein
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University Atlanta, Georgia
| | - C E Sterk
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University Atlanta, Georgia
| | - K W Elifson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University Atlanta, Georgia
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Ann Lyons H. Heterosexual Casual Sex and STI Diagnosis: A Latent Class Analysis. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2016; 29:32-47. [PMID: 29276549 PMCID: PMC5737755 DOI: 10.1080/19317611.2016.1210711] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Casual sex is common during the emerging adult life course stage, but little research has taken a person-centered approach to investigate if casual sexual behavior influences STI rates. Using a nationally representative sample and latent class analysis, results showed three distinctive latent classes. Abstainers were the least likely to have an STI, followed by the casual sex experienced, and then the casual sex risk-takers. Once other covariates were included in the model, there was no significant difference between the abstainers and casual sex experienced classes. These results highlight the need for future research to include diverse samples of emerging adults.
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Affiliation(s)
- Heidi Ann Lyons
- Department of Sociology, Anthropology, Social Work, and Criminal Justice, Oakland University, Rochester, MI
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Stock ML, Peterson LM, Molloy BK, Lambert SF. Past racial discrimination exacerbates the effects of racial exclusion on negative affect, perceived control, and alcohol-risk cognitions among Black young adults. J Behav Med 2016; 40:377-391. [PMID: 27646550 DOI: 10.1007/s10865-016-9793-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/01/2016] [Indexed: 01/08/2023]
Abstract
Racial discrimination is associated with alcohol use and risky sex cognitions and behaviors, which are risk factors for negative health outcomes, including human immunodeficiency virus infection. The current study investigated the causal impact of racial discrimination on alcohol and sexual-risk cognitions while exploring potential mediators that might help explain this relation: negative affect, perceived control, and meaningful existence. We also examined if past discrimination impacts the strength of (moderates) these effects. Participants were 287 Black/African American young adults aged 18-25. They were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted greater: perceived racial discrimination, negative affect, alcohol use willingness, and reduced perceived control and meaningful existence. Furthermore, excluded participants who experienced more past racial discrimination reported the lowest perceived control, and greatest negative affect and alcohol-risk cognitions. The findings suggest that past racial discrimination exacerbates the harmful health effects of immediate experiences of discrimination.
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Affiliation(s)
- Michelle L Stock
- Department of Psychology, The George Washington University, 2125 G St. N.W., Washington, DC, USA.
| | | | - Brianne K Molloy
- Department of Psychology, The George Washington University, 2125 G St. N.W., Washington, DC, USA
| | - Sharon F Lambert
- Department of Psychology, The George Washington University, 2125 G St. N.W., Washington, DC, USA
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Seth P, Figueroa A, Wang G. Centers for Disease Control and Prevention-Funded Human Immunodeficiency Virus Testing, Positivity, and Service Delivery among Newly Diagnosed Women in 61 Health Department Jurisdictions, United States, 2014. Womens Health Issues 2016; 26:496-503. [PMID: 27424776 DOI: 10.1016/j.whi.2016.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND More than 1.2 million persons are living with human immunodeficiency virus (HIV) in the United States; at the end of 2011, 23% of them were women. Minority women are disproportionately affected by HIV, and new infections are higher among older women. HIV testing and service delivery among women funded by the U.S. Centers for Disease Control and Prevention (CDC) is examined. METHODS Data were submitted by 61 health department jurisdictions. HIV testing, HIV-positive tests, new HIV diagnoses among women, and linkage and referral services among newly diagnosed women are described. Differences across demographic characteristics for HIV diagnoses, linkage, and referral services were assessed. Diagnoses were identified as new when women who tested HIV positive were not found to be reported previously in the jurisdiction's HIV surveillance system; when jurisdictions could not verify prior test results in their surveillance systems, new diagnoses were identified by self-report. RESULTS Of CDC-funded testing events in 2014, 1,484,902 (48.7%) were among women, and they accounted for 19.5% of all HIV-positive testing events. Among women tested, 0.4% were HIV positive, and 0.1% had new HIV diagnoses. Women aged 40 and older and Black women were more likely to test HIV positive (0.7% and 0.5%, respectively). Among newly diagnosed women, 62.8% were linked within any timeframe, 57.1% were linked within 90 days, 74.1% were referred to partner services, 57.5% were interviewed for partner services, and 55.5% were referred to HIV risk reduction services. CONCLUSIONS Among all women receiving CDC-funded HIV testing, Black women and older women were more likely to have HIV-positive tests and new diagnoses. Although women overall may not be at the highest risk for HIV, Black women in this sample are disproportionately affected. Additionally, linkage, referral, and interview services for women need improvement. Targeted testing approaches may ensure effective test-and-treat strategies for women.
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Affiliation(s)
- Puja Seth
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Argelia Figueroa
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Guoshen Wang
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Nankinga O, Misinde C, Kwagala B. Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda. BMC Public Health 2016; 16:440. [PMID: 27229928 PMCID: PMC4881206 DOI: 10.1186/s12889-016-3103-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 05/13/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a major reproductive and public health concern, especially in the era of HIV/AIDS. This study examined the relationship between sexual empowerment and STI status of women in union (married or cohabiting) in Uganda, controlling for sexual behaviour, partner factors, and women's background characteristics. METHODS The study, based on data from the 2011 Uganda Demographic and Health Survey (UDHS), analysed 1307 weighted cases of women age 15-49 in union and selected for the domestic violence module. Chi-squared tests and multivariate logistic regressions were used to examine the predicators of STI status. The main explanatory variables included sexual empowerment, involvement in decision making on own health, experience of any sexual violence, condom use during last sex with most recent partner, number of lifetime partners and partner control behaviours. Sexual empowerment was measured with three indicators: a woman's reported ability to refuse sex, ability to ask her partner to use a condom, and opinion regarding whether a woman is justified to refuse sex with her husband if he is unfaithful. RESULTS Results show that 28 % of women in union reported STIs in the last 12 months. Sexual violence and number of lifetime partners were the strongest predictors of reporting STIs. Women's sexual empowerment was a significant predictor of their STI status, but, surprisingly, the odds of reporting STIs were greater among women who were sexually empowered. Reporting of STIs was negatively associated with a woman's participation in decision-making with respect to her own health, and was positively associated with experience of sexual violence, partner's controlling behaviour, and having more than one life partner. CONCLUSIONS Our findings suggest that, with respect to STIs, sexual empowerment as measured in the study does not protect women who have sexually violent and controlling partners. Interventions promoting sexual health must effectively address negative masculine attitudes and roles that perpetuate unhealthy sexual behaviours and gender relations within marriage. It is also important to promote marital fidelity and better communication within union and to encourage women to take charge of their health jointly with their partners.
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Affiliation(s)
- Olivia Nankinga
- Department of Population Studies, School of Statistics and Planning, College of Business and Management, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Cyprian Misinde
- Department of Population Studies, School of Statistics and Planning, College of Business and Management, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management, Makerere University, P.O Box 7062, Kampala, Uganda.
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Wells BE, Rendina HJ, Kelly BC, Golub SA, Parsons JT. Demographic Predictors of Event-Level Associations between Alcohol Consumption and Sexual Behavior. J Urban Health 2016; 93:155-69. [PMID: 26678072 PMCID: PMC4794469 DOI: 10.1007/s11524-015-0015-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Alcohol consumption is associated with sexual behavior and outcomes, though research indicates a variety of moderating factors, including demographic characteristics. To better target interventions aimed at alcohol-related sexual risk behavior, our analyses simultaneously examine demographic predictors of both day- and event-level associations between alcohol consumption and sexual behavior in a sample of young adults (N = 301) who are sexually active and consume alcohol. Young adults (aged 18-29) recruited using time-space sampling and incentivized snowball sampling completed a survey and a timeline follow-back calendar reporting alcohol consumption and sexual behavior in the past 30 days. On a given day, a greater number of drinks consumed was associated with higher likelihood of sex occurring, particularly for women and single participants. During a given sexual event, number of drinks consumed was not associated with condom use, nor did any demographic predictors predict that association. Findings highlight associations between alcohol and sexual behavior, though not between alcohol and sexual risk behavior, highlighting the need for additional research exploring the complex role of alcohol in sexual risk behavior and the need to develop prevention efforts to minimize the role of alcohol in the initiation of sexual encounters.
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Affiliation(s)
- Brooke E Wells
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA
- Center for Human Sexuality Studies, Widener University, One University Place, Chester, PA, 19013, USA
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA
| | - Brian C Kelly
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA
- Department of Sociology, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY, 10065, USA
- Doctoral Program in Basic and Applied Social Psychology, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W. 36th St., 9th Fl., New York, NY, 10018, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA.
- Doctoral Program in Public Health, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10034, USA.
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Alcohol Use Predicts Number of Sexual Partners for Female but not Male STI Clinic Patients. AIDS Behav 2016; 20 Suppl 1:S52-9. [PMID: 26310596 DOI: 10.1007/s10461-015-1177-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study tested the hypothesis that greater alcohol involvement will predict number of sexual partners to a greater extent for women than for men, and that the hypothesized sex-specific, alcohol-sexual partner associations will hold when controlling for alternative sex-linked explanations (i.e., depression and drug use). We recruited 508 patients (46 % female, 67 % African American) from a public sexually transmitted infections (STI) clinic. Participants reported number of sexual partners, drinks per week, maximum drinks per day, frequency of heavy drinking; they also completed the AUDIT-C and a measure of alcohol problems. As expected, men reported more drinking and sexual partners. Also as expected, the association between alcohol use and number of partners was significant for women but not for men, and these associations were not explained by drug use or depression. A comprehensive prevention strategy for women attending STI clinics might include alcohol use reduction.
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Swartzendruber A, Sales JM, Brown JL, DiClemente RJ, Rose ES. Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:63-72. [PMID: 25929200 DOI: 10.1007/s10508-015-0518-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/19/2014] [Accepted: 10/19/2014] [Indexed: 06/04/2023]
Abstract
African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14-20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.
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Affiliation(s)
- Andrea Swartzendruber
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
- Centers for AIDS Research, Emory University, Atlanta, GA, USA.
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
- Centers for AIDS Research, Emory University, Atlanta, GA, USA
| | - Jennifer L Brown
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
- Centers for AIDS Research, Emory University, Atlanta, GA, USA
| | - Ralph J DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
- Centers for AIDS Research, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Epidemiology, and Immunology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Eve S Rose
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
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Advancing Behavioral HIV Prevention: Adapting an Evidence-Based Intervention for People Living with HIV and Alcohol Use Disorders. AIDS Res Treat 2015; 2015:879052. [PMID: 26697216 PMCID: PMC4678056 DOI: 10.1155/2015/879052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/19/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022] Open
Abstract
Alcohol use disorders (AUDs) are highly prevalent among people living with HIV/AIDS (PLWHA) and are associated with increased HIV risk behaviors, suboptimal treatment adherence, and greater risk for disease progression. We used the ADAPT-ITT strategy to adapt an evidence-based intervention (EBI), the Holistic Health Recovery Program (HHRP+), that focuses on secondary HIV prevention and antiretroviral therapy (ART) adherence and apply it to PLWHA with problematic drinking. Focus groups (FGs) were conducted with PLWHA who consume alcohol and with treatment providers at the largest HIV primary care clinic in New Orleans, LA. Overall themes that emerged from the FGs included the following: (1) negative mood states contribute to heavy alcohol consumption in PLWHA; (2) high levels of psychosocial stress, paired with few adaptive coping strategies, perpetuate the use of harmful alcohol consumption in PLWHA; (3) local cultural norms are related to the permissiveness and pervasiveness of drinking and contribute to heavy alcohol use; (4) healthcare providers unanimously stated that outpatient options for AUD intervention are scarce, (5) misperceptions about the relationships between alcohol and HIV are common; (6) PLWHA are interested in learning about alcohol's impact on ART and HIV disease progression. These data were used to design the adapted EBI.
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Billings DW, Leaf SL, Spencer J, Crenshaw T, Brockington S, Dalal RS. A Randomized Trial to Evaluate the Efficacy of a Web-Based HIV Behavioral Intervention for High-Risk African American Women. AIDS Behav 2015; 19:1263-74. [PMID: 25616838 DOI: 10.1007/s10461-015-0999-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to develop and test a cost-effective, scalable HIV behavioral intervention for African American women. Eighty-three African American women were recruited from a community health center and randomly assigned to either the web-based Safe Sistah program or to a delayed HIV education control condition. The primary outcome was self-reported condom use. Secondary measures assessed other aspects of the gender-focused training included in Safe Sistah. Participants completed self-report assessments prior to randomization, 1- and 4-months after their program experience. Across the entire study period, women in the experimental condition significantly increased their condom use relative to controls (F = 5.126, p = 0.027). Significant effects were also found for sexual communication, sex refusal, condom use after alcohol consumption, and HIV prevention knowledge. These findings indicate that this web-based program could be an important component in reducing the HIV disparities among African American women.
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Affiliation(s)
- Douglas W Billings
- ISA Associates, Inc., 201 North Union Street, Suite 330, Alexandria, VA, 22314, USA,
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Livingston JA, Testa M, Windle M, Bay-Cheng LY. Sexual risk at first coitus: Does alcohol make a difference? J Adolesc 2015; 43:148-58. [PMID: 26121927 DOI: 10.1016/j.adolescence.2015.05.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 04/02/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
This study examines whether use of alcohol at first coitus is associated with increased sexual risk for young women. First coitus is the focus of the investigation because it is a memorable, formative experience that has implications for subsequent sexual health. A community sample of young women ages 18-19 years (N = 227) completed retrospective interviews. Characteristics and perceptions of the first coital event were examined using chi squares and one-way multivariate analysis of variance (MANOVA) to determine if there were differences based on alcohol-involvement. Alcohol-involved first coitus events occurred in social settings with risky partners, were rated less positively, and were non-consensual relative to those that did not involve alcohol. Alcohol use was not related to condom use. Alcohol-involvement was associated with subsequent pairing of alcohol with sex and incapacitated rape. Adolescent alcohol use occurs in contexts that increases young women's sexual risk through exposure to risky partners.
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Affiliation(s)
- Jennifer A Livingston
- Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, United States.
| | - Maria Testa
- Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, United States
| | - Michael Windle
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - Laina Y Bay-Cheng
- School of Social Work, University at Buffalo, 685 Baldy Hall, Buffalo, NY 14260, United States
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Cooper HLF, Linton S, Haley DF, Kelley ME, Dauria EF, Karnes CC, Ross Z, Hunter-Jones J, Renneker KK, Del Rio C, Adimora A, Wingood G, Rothenberg R, Bonney LE. Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing. AIDS Behav 2015; 19:1016-30. [PMID: 25150728 DOI: 10.1007/s10461-014-0883-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.
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Affiliation(s)
- Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road, NE Room 526, Atlanta, GA, 30322, USA,
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Jackson JM, Seth P, DiClemente RJ, Lin A. Association of Depressive Symptoms and Substance Use With Risky Sexual Behavior and Sexually Transmitted Infections Among African American Female Adolescents Seeking Sexual Health Care. Am J Public Health 2015; 105:2137-42. [PMID: 25905854 DOI: 10.2105/ajph.2014.302493] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined how depression and substance use interacted to predict risky sexual behavior and sexually transmitted infections (STIs) among African American female adolescents. METHODS We measured depressive symptoms, substance use, sexual behavior, and STIs in 701 African American female adolescents, aged 14 to 20 years, at baseline and at 6-month intervals for 36 months in Atlanta, Georgia (2005-2007). We used generalized estimating equation models to examine effects over the 36-month follow-up period. RESULTS At baseline, more than 40% of adolescents reported significant depressive symptoms; 64% also reported substance use in the 90 days before assessment. Depression was associated with recently incarcerated partner involvement, sexual sensation seeking, unprotected sex, and prevalent STIs (all P < .001). In addition, adolescents with depressive symptoms who reported any substance use (i.e., marijuana, alcohol, Ecstasy) were more likely to report incarcerated partner involvement, sexual sensation seeking, unprotected sex, and have an incident STI over the 36-month follow-up (all P < .05). CONCLUSIONS African American female adolescents who reported depressive symptoms and substance use were more likely to engage in risky behavior and acquire incident STIs. This population might benefit from future prevention efforts targeting the intersection of depression and substance use.
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Affiliation(s)
- Jerrold M Jackson
- Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Puja Seth
- Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Ralph J DiClemente
- Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Anne Lin
- Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Kakaire O, Byamugisha JK, Tumwesigye NM, Gamzell-Danielsson K. Prevalence and factors associated with sexually transmitted infections among HIV positive women opting for intrauterine contraception. PLoS One 2015; 10:e0122400. [PMID: 25859659 PMCID: PMC4393084 DOI: 10.1371/journal.pone.0122400] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Women living with HIV/AIDS (WLHA) are a high risk group for sexually transmitted infections (STIs). However, the majority of women with STIs are asymptomatic. Data on prevalence of STIs among WLHA in Uganda are limited. The objective of the study was to determine prevalence and factors associated with STIs among WLHA opting for intrauterine contraceptive device (IUD). Methods Three hundred fifty one WLHA deemed free of STIs using a syndromic logarithm were enrolled into the study. Endo-cervical swabs were taken before IUD insertion and PCR test for Nisseria gonorrhea (NG), Trichomonas vaginalis (TV) and Chlamydia trachomatis (CT) infections conducted. Results Participants’ mean age was 29.4 ± 6.2 years, 83% were under 35years, 50% had secondary education and 73% were married. The majority (69%) had disclosed their HIV sero status to their spouses, 82% used Cotrimoxazole prophylaxis, 70% were on antiretroviral therapy, 90% had CD4 count greater than 350, about 60% reported condoms use and 70% were of parity 2-4. Over 50% of the participants’ spouses were older than 35 years and 72% had attained secondary education. STIs prevalence was 11.1%, (95% CI 7.8-14.4) and individual prevalence for TV, NG, and CT was 5.9%, 5.4% and 0.9% respectively. Factors independently associated with STI were having primary or less education (OR= 2.3, 95% CI: 1.09 - 4.85) having a spouse of primary or less education (OR= 3.3, 95% CI: 1.6 - 6.78) and muslim faith (OR= 0.2, 95% CI: 0.04 - 0.78). Conclusion STI prevalence was 11.1%. TV and NG were the commonest STIs in this population. Having primary or less education for both participant and spouse was associated with increased risk while being of muslim faith was associated with reduced risk of STI.
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Affiliation(s)
- Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala, Uganda
- * E-mail:
| | - Josaphat Kayogoza Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- School of Public Health, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala Uganda
| | - Kristina Gamzell-Danielsson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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