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Brott H, Townley G. Reproductive justice for unhoused women: An integrative review of the literature. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1935-1960. [PMID: 36525556 DOI: 10.1002/jcop.22980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 06/14/2023]
Abstract
This review examines the reproductive health experiences of unhoused women and youth. Guided by the reproductive justice framework, this review examines barriers to accessing contraception, medical abortion, and prenatal care while homeless. Twenty-one articles were identified through keyword searches in Google Scholar, Ebscohost Academic Search Premier, and PsycINFO. In included articles, barriers were identified at the individual, relational, and contextual levels. Findings from this scoping review illustrate the need to examine multiple levels of analysis when seeking to improve access to family planning services for individuals experiencing homelessness. Included literature suggests an overabundance of research documenting barriers to contraceptive care relative to the literature examining abortion and prenatal care experiences and a scarcity of research examining barriers to reproductive justice among unhoused individuals who do not identify as women.
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Affiliation(s)
- Holly Brott
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, Oregon, USA
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2
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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [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: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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3
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Park E, Stockman JK, Thrift B, Nicole A, Smith LR. Structural Barriers to Women's Sustained Engagement in HIV Care in Southern California. AIDS Behav 2020; 24:2966-2974. [PMID: 32323105 PMCID: PMC7790164 DOI: 10.1007/s10461-020-02847-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Since the introduction of antiretroviral therapy, the number of women living with HIV (WLHIV) continues to increase. Despite the decrease in HIV diagnosis among women in California, less than half of WLHIV are retained in HIV care. Structural barriers put women at increased risk for delayed HIV diagnosis, delayed entry into HIV care, and poorer treatment outcomes. The objective of this qualitative analysis is to identify how structural barriers negatively impact women's sustained engagement in HIV care in Southern California. WLHIV accessing local HIV support services participated in a qualitative study by completing a semi-structured interview and brief survey between January and April 2015 (n = 30). Poverty, unemployment, housing instability, and needs for transportation emerged as the dominant structural barriers for women when discussing their challenges with sustained engagement in HIV care. System-level interventions that decrease these noted barriers may help improve HIV care continuum for women living in Southern California.
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Affiliation(s)
- Eunhee Park
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Briana Thrift
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
- Division of Epidemiology, San Diego State University Graduate School of Public Health, San Diego, CA, USA
| | - Ava Nicole
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
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Abstract
Rigorous HIV-related data for the homeless population in Jamaica is limited. A cross-sectional survey using a venue-based sampling approach was conducted in 2015 to derive HIV prevalence and associated risk factors. Three hundred twenty-three homeless persons from the parishes of St. James, St. Ann, Kingston, and St. Andrew (the main urban centers) participated. HIV prevalence was 13.8%, with a difference in gender (males 11.6%, females 26.7%, P = .007). Sex work, multiple partnerships, incarceration, non-injecting drug use, and female rape were common among the participants. Long-term, multilayered, HIV-specific, female-focused interventions are required for the population, along with additional female-centric research.
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Affiliation(s)
- Nicola Skyers
- HIV/STI/Tb Unit, Ministry of Health, Kingston, Jamaica.
| | | | - Willi McFarland
- University of California, San Francisco, San Francisco, CA, USA
| | - Dahlia Cole
- National Council of Drug Abuse, Kingston, Jamaica
| | - Uki Atkinson
- National Council of Drug Abuse, Kingston, Jamaica
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Noska AJ, Roberts MB, Sufrin C, Stein LAR, Beckwith CG, Rich JD, Dauria EF, Clarke JG. History of Sex Exchange in Women with a History of Incarceration. J Health Care Poor Underserved 2018; 27:149-62. [PMID: 27133516 DOI: 10.1353/hpu.2016.0054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sex exchange among incarcerated women is not well-described in the literature. Sex exchange can lead to numerous adverse health outcomes, especially when combined with individual factors (e.g., depression and homelessness) and larger systemic inequalities. The purpose of this study was to explore factors associated with having a history of sex exchange among a sample of incarcerated women. Of 257 women surveyed in this study, 68 women (26.5%) reported a history of sex exchange. In multivariate logistic regression analysis, physical abuse history (p=.05, OR 2.20), history of two or more sexually transmitted infections (p=.01, OR 2.90), injection drug use (p=.04, OR 2.46) and crack-cocaine use (p<.01, OR 3.42) were associated with prior sex exchange. This is one of only two studies to examine factors associated with prior sex exchange among incarcerated women. Our study has important implications for corrections providers to provide more comprehensive care, directly addressing the unique needs of this population.
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Santa Maria D, Hernandez DC, Arlinghaus KR, Gallardo KR, Maness SB, Kendzor DE, Reitzel LR, Businelle MS. Current Age, Age at First Sex, Age at First Homelessness, and HIV Risk Perceptions Predict Sexual Risk Behaviors among Sexually Active Homeless Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E218. [PMID: 29373568 PMCID: PMC5858287 DOI: 10.3390/ijerph15020218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/13/2018] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually active homeless adults from a cross-sectional study of participants (n = 610) recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s), and multiple sexual partners (≥4 sexual partners) in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness.
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Affiliation(s)
- Diane Santa Maria
- Department of Nursing Systems, School of Nursing, University of Texas Health Science Center, Houston, TX 77030, USA.
| | - Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA.
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA.
| | - Katherine R Arlinghaus
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA.
- Department of Health Promotion and Behavioral Sciences School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA.
| | - Kathryn R Gallardo
- Department of Health Promotion and Behavioral Sciences School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA.
| | - Sarah B Maness
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73019, USA.
| | - Darla E Kendzor
- Health Sciences Center, University of Oklahoma, Oklahoma City, OK 73104, USA.
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA.
| | - Michael S Businelle
- Health Sciences Center, University of Oklahoma, Oklahoma City, OK 73104, USA.
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Conner LR, Engstrom M, Junious E, Edwards-Knight K. Woman to Woman (W2W): Adapting an HIV risk reduction intervention for older women. J Women Aging 2017; 30:428-443. [PMID: 28467279 DOI: 10.1080/08952841.2017.1313017] [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: 10/19/2022]
Abstract
Woman to Woman (W2W) is a novel adaptation of the Sisters Informing Sisters about Topics on AIDS (SISTA) HIV prevention program. This article describes the process of adapting and piloting W2W based on recommendations from existing HIV prevention research. Six older women, all of whom had histories of homelessness and the majority of whom identified as African American, enrolled in the study, which piloted the adapted intervention and materials, evaluated the acceptability of the program, and assessed the measures related to the intervention. Participants described satisfaction with the program and had high rates of attendance; observations regarding the measures suggest the need to further develop assessments of HIV knowledge, condom use self-efficacy, and risk behaviors in this context.
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Affiliation(s)
- Laneshia R Conner
- a School of Social Work , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Malitta Engstrom
- b School of Social Policy & Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Eric Junious
- a School of Social Work , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Kevin Edwards-Knight
- a School of Social Work , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
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8
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Wenzel SL, Cederbaum JA, Song A, Hsu HT, Craddock JB, Hantanachaikul W, Tucker JS. Pilot Test of an Adapted, Evidence-Based HIV Sexual Risk Reduction Intervention for Homeless Women. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:112-21. [PMID: 26103921 DOI: 10.1007/s11121-015-0575-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.
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Affiliation(s)
- Suzanne L Wenzel
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Julie A Cederbaum
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Ahyoung Song
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Hsun-Ta Hsu
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Jaih B Craddock
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089, USA
| | - Wichada Hantanachaikul
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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9
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Doblecki-Lewis S, Lester L, Schwartz B, Collins C, Johnson R, Kobetz E. HIV risk and awareness and interest in pre-exposure and post-exposure prophylaxis among sheltered women in Miami. Int J STD AIDS 2015; 27:873-81. [PMID: 26384947 DOI: 10.1177/0956462415601304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022]
Abstract
Pre- and non-occupational post-exposure prophylaxis for the prevention of HIV infection are recommended for adults at substantial risk of HIV. Women experiencing homelessness have increased risk of HIV infection compared with stably-housed women. We conducted a survey of 74 sheltered women at Lotus House Women's Shelter (Lotus House) in Miami to assess risk behaviour as well as knowledge and perception of pre- and non-occupational post-exposure prophylaxis in this population. Of surveyed women, 58.1% engaged in vaginal and/or anal sex while sheltered, and of sexually-active women 55.4% reported inconsistent condom use. 83.8% of women reported no concern regarding HIV acquisition due to their behaviour. Few women surveyed (20.8%) had previously heard of pre- or non-occupational post-exposure prophylaxis. The majority (58.3%) of respondents indicated receptiveness to these prevention methods when introduced. Those indicating that they would consider pre- or non-occupational post-exposure prophylaxis were significantly younger than those indicating that they would not consider these prevention strategies (p = 0.004). Education and referral for pre- and non-occupational post-exposure prophylaxis should be considered for sheltered women at risk of HIV infection. Additional research to optimise implementation of biomedical prevention strategies in this population is needed.
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Affiliation(s)
- Susanne Doblecki-Lewis
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Larissa Lester
- Department of Medical Education, MD/MPH Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bryanna Schwartz
- Department of Medical Education, MD/MPH Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Erin Kobetz
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
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10
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Dauria EF, Oakley L, Jacob Arriola K, Elifson K, Wingood G, Cooper HLF. Collateral consequences: implications of male incarceration rates, imbalanced sex ratios and partner availability for heterosexual Black women. CULTURE, HEALTH & SEXUALITY 2015; 17:1190-206. [PMID: 26056724 PMCID: PMC4578986 DOI: 10.1080/13691058.2015.1045035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
While studies have found correlations between rates of incarceration and sexually transmitted infections (STIs), few studies have explored the mechanisms linking these phenomena. This qualitative study examines how male incarceration rates and sex ratios influence perceived partner availability and sexual partnerships for heterosexual Black women. Semi-structured interviews were conducted with 33 Black women living in two US neighbourhoods, one with a high male incarceration rate and an imbalanced sex ratio (referred to as 'Allentown') and one with a low male incarceration rate and an equitable sex ratio (referred to as 'Blackrock'). Data were analysed using grounded theory. In Allentown, male incarceration reduced the number of available men, and participants largely viewed men available for partnerships as being of an undesirable quality. The number and desirability of men impacted on the nature of partnerships such that they were shorter, focused on sexual activity and may be with higher-risk sexual partners (e.g. transactional sex partners). In Blackrock, marriage rates contributed to the shortage of desirable male partners. By highlighting the role that the quantity and quality of male partners has on shaping sexual partnerships, this study advances current understandings of how incarceration and sex ratios shape HIV- and STI-related risk.
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Affiliation(s)
- Emily F. Dauria
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Lisa Oakley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kimberly Jacob Arriola
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kirk Elifson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Gina Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Hannah L. F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
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Salem BE, Ma-Pham J. Understanding Health Needs and Perspectives of Middle-Aged and Older Women Experiencing Homelessness. Public Health Nurs 2015; 32:634-44. [PMID: 25832775 DOI: 10.1111/phn.12195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Middle-aged and older homeless women have unique health and social service delivery needs; yet, limited research has been conducted in this area. The purpose of this study was to assess perspectives among prefrail and frail, middle-aged and older homeless women. DESIGN AND SAMPLE Focus group methodology was conducted to assess perspectives among these homeless women (N=20) aged 43 to 62. MEASURES Sociodemographic and frailty characteristics were assessed by structured instruments, along with mobility, assistive device use and falls. RESULTS The average age was 53.4; the majority of the sample was African-American (70%). In total, 60% reported living in a shelter for the last 30 days, while 20% were unsheltered. The majority of the sample reported walking independently (80%) and not using an assistive device (65%). Over one third (35%) fell in the last 30 days and 70% fell in the last year. Content analysis revealed several themes that included (1) health care needs and challenges experienced; (2) perspectives on sexual decision making; (3) employment difficulties; (4) existing support systems; and (5) development of future program planning. CONCLUSIONS Future research development and implications are discussed.
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Affiliation(s)
- Benissa E Salem
- School of Nursing, University of California Los Angeles, Los Angeles, California
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12
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Cederbaum JA, Song A, Hsu HT, Tucker JS, Wenzel SL. Adapting an evidence-based intervention for homeless women: engaging the community in shared decision-making. J Health Care Poor Underserved 2014; 25:1552-70. [PMID: 25418227 PMCID: PMC4243536 DOI: 10.1353/hpu.2014.0188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As interest grows in the diffusion of evidence-based interventions (EBIs), there is increasing concern about how to mitigate implementation challenges; this paper concerns adapting an EBI for homeless women. Complementing earlier focus groups with homeless women, homeless service providers (n = 32) were engaged in focus groups to assess capacity, needs, and barriers with implementation of EBIs. Deductive analyses of data led to the selection of four EBIs. Six consensus groups were then undertaken; three each with homeless women (n = 24) and homeless service providers (n = 21). The selected EBI was adapted and pretested with homeless women (n = 9) and service providers (n = 6). The structured consensus group process provided great utility and affirmed the expertise of homeless women and service providers as experts in their domain. Engaging providers in the selection process reduced the structural barriers within agencies as obstacles to diffusion.
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Affiliation(s)
- Julie A. Cederbaum
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
| | - Ahyoung Song
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
| | - Hsun-Ta Hsu
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
| | | | - Suzanne L. Wenzel
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
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13
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Lawani LO, Onyebuchi AK, Iyoke CA. Dual method use for protection of pregnancy and disease prevention among HIV-infected women in South East Nigeria. BMC WOMENS HEALTH 2014; 14:39. [PMID: 24602410 PMCID: PMC3973850 DOI: 10.1186/1472-6874-14-39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND sub-Saharan Africa continue to bear the greatest burden of HIV/AIDS epidemic due to its large population, high fertility rate and unmet contraceptive need, most especially with poor uptake of dual methods (use of condom and another effective family planning method) which protects against STIs/HIV and unplanned pregnancy. The aim of this study was to assess the awareness, pattern and practice of dual methods by HIV infected women, and factors influencing its use in southeast Nigeria. METHODS This was a cross sectional descriptive study of 658 HIV positive women attending the PMTCT/postnatal/family planning clinics in three health facilities in southeast Nigeria. An interviewer administered semi-structured questionnaire was used to abstract needed information. The data were analyzed with Epi-info™ version 7.0 (Centers for Disease Control and Prevention, Atlanta, GA, USA), Odd ratio was determined and the test of statistical significance was with Fisher exact test at 95% CI. RESULTS The mean age of the participants was 29 ± 4.3 years. All the respondents were aware of their HIV status, 62.4% did not know their partners status; 23.1% were sero-concordant, while 14.5% were sero-discordant. Most (67.9%) of the respondents lack awareness on dual methods with only 179/658 (27.2%) practicing it. The commonest (141/179; 78.9%) dual method used was a combination of condom and injectable hormonal contraceptives. Lack of awareness (222/479; 46.3%) and non disclosure (133/479; 27.8%) were the main reasons for non use of dual method in the present study. STI's was higher amongst non users with odd ratio of 1.74 (1.26-2.41), p-value < 0.0004. Unplanned pregnancy was higher in non users with odd ratio of 3.89 (2.52-6.00), p-value < 0.0000 at 95% CI. CONCLUSIONS The awareness and uptake of dual methods amongst HIV infected women in southeast Nigeria is still low and thus associated with a higher risk of STIs and unplanned pregnancy. It is expected that increased awareness, uptake and consistent use will help prevention new infections of HIV/STIs and unplanned pregnancy.
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Affiliation(s)
- Lucky O Lawani
- School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
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14
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Brawner BM, Teitelman AM, Bevilacqua AW, Jemmott LS. Personalized Biobehavioral HIV Prevention for Women and Adolescent Girls. Glob Adv Health Med 2014; 2:100-8. [PMID: 24416702 PMCID: PMC3833571 DOI: 10.7453/gahmj.2013.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. Primary Study Objective: The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. Methods: We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. Results: The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk—reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk—reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Conclusions: Generalized programs and interventions may not have universal, transnational, and crosscultural implications. Personalized biobehavioral strategies are needed to comprehensively address vulnerabilities at biological, social, and structural levels.
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Affiliation(s)
- Bridgette M Brawner
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
| | - Anne M Teitelman
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
| | - Amanda W Bevilacqua
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
| | - Loretta Sweet Jemmott
- Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, United States
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