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Nabayinda J, Namirembe R, Kizito S, Nsubuga E, Nabunya P, Bahar OS, Magorokosho N, Kiyingi J, Nattabi J, Tozan Y, Mayo-Wilson LJ, Mwebembezi A, Witte SS, Ssewamala FM. Correlates of Intimate Partner Violence Among Young Women Engaged in Sex Work in Southern Uganda. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:10749-10770. [PMID: 37212371 PMCID: PMC10524718 DOI: 10.1177/08862605231175908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Intimate partner violence (IPV) is a significant global public health problem that results in high social and economic costs to individuals and communities. Compared to women in the general population, women engaged in sex work (WESW) are more likely to experience physical, emotional, and sexual IPV. This study examines the correlates of IPV among young WESW with their intimate partners in Southern Uganda. We used baseline data from the Kyaterekera project, a 5 year NIH-funded longitudinal study aimed at reducing HIV risks among 542 WESW in Southern Uganda. To examine the factors associated with IPV, we fitted three separate multi-level Poisson regression models for physical, emotional, and sexual IPV, respectively. Average age was 31.4 years, and 54% of the women reported being victims of at least one form of IPV from their intimate partners. Model one assessed correlates of sexual IPV. Being married women (β = .71, 95% CI [0.24, 1.17]), divorced/separated/widowed (β = .52, [0.02, 1.02]), depressed (β = .04, [0.02, 0.05]), and having any sexually transmitted infections (STIs) (β = .58, [0.14, 1.01]) were associated with sexual IPV. Model two assessed correlates of physical IPV. Experience of childhood sexual abuse (β = .12, [0.04, 0.19]) was associated with an increase in physical IPV, and increasing age reduced its occurrence (β = -.02, [-0.04, -0.001]). Finally, model three assessed emotional IPV. Women with higher education (β = .49, [0.14, 0.85]) and symptoms of depression (β = .02, [0.001, 0.04]) had higher risks for emotional IPV. For WESW, IPV presents an additional potential pathway for HIV and STIs acquisition and transmission through a lack of negotiating power for safe sex. Efforts to reduce violence against WESW should be prioritized as a strategy for enhancing the well-being of WESW.
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Affiliation(s)
| | - Rashida Namirembe
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Samuel Kizito
- Washington University in St. Louis Brown School, MO, USA
| | - Edward Nsubuga
- Washington University in St. Louis Brown School, MO, USA
| | | | | | | | - Joshua Kiyingi
- Washington University in St. Louis Brown School, MO, USA
| | | | | | | | | | - Susan S. Witte
- Columbia University School of Social Work, New York, NY, USA
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Ssewamala FM, Sauceda JA, Brathwaite R, Neilands TB, Nabunya P, Brown D, Sensoy Bahar O, Namuwonge F, Nakasujja N, Mugarura A, Mwebembezi A, Nartey P, Mukasa B, Gwadz M. Suubi + Adherence4Youth: a study protocol to optimize the Suubi Intervention for Adherence to HIV treatment for youth living with HIV in Uganda. BMC Public Health 2023; 23:717. [PMID: 37081534 PMCID: PMC10116736 DOI: 10.1186/s12889-023-15564-4] [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: 02/01/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Suubi is an evidenced based multi-component intervention that targets psychosocial and economic hardships to improve ART adherence, viral suppression, mental health, family financial stability, and family cohesion for adolescents living with HIV (ALHIV) in Uganda. Suubi was originally tested as a combined package of four components: 1) Financial Literacy Training; 2) incentivized matched Youth Savings Accounts with income-generating activities; 3) a manualized and visual-based intervention for ART adherence and stigma reduction; and 4) engagement with HIV treatment-experienced role models. However, it is unknown if each component in Suubi had a positive effect, how the components interacted, or if fewer components could have produced equivalent effects. Hence, the overall goal of this new study is to identify the most impactful and sustainable economic and psychosocial components across 48 health clinics in Uganda. METHODS A total of 576 ALHIV (aged 11-17 years at enrollment) will be recruited from 48 clinics and each clinic will be randomized to one of 16 study conditions. Each condition represents every possible combination of the 4 components noted above. Assessments will be conducted at baseline, 12, 24, 36 and 48- months post-intervention initiation. Using the multi-phase optimization strategy (MOST), we will identify the optimal combination of components and associated costs for viral suppression, as well as test key mediators and moderators of the component-viral suppression relationship. DISCUSSION The study is a shift in the paradigm of research to use new thinking to build/un-pack highly efficacious interventions that lead to new scientific knowledge in terms of understanding what drives an intervention's success and how to iterate on them in ways that are more efficient, affordable and scalable. The study advances intervention science for HIV care outcomes globally. TRIAL REGISTRATION This project was registered at clinicaltrials.gov (NCT05600621) on October, 31, 2022. https://clinicaltrials.gov/ct2/show/NCT05600621.
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Affiliation(s)
- Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - John A Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Derek Brown
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Allan Mugarura
- International Center for Child Health and Development, Masaka, Uganda
| | | | - Portia Nartey
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | | | - Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), New York University Silver School of Social Work, New York, NY, USA
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, New York, NY, USA
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Nabayinda J, Kizito S, Witte S, Nabunnya P, Kiyingi J, Namuwonge F, Nsubuga E, Bahar OS, Mayo-Wilson LJ, Yang LS, Nattabi J, Magorokosho N, Ssewamala FM. Factors Associated with Consistent Condom Use Among Women Engaged in Sex Work: Lessons From the Kyaterekera Study in Southwestern Uganda. AIDS Behav 2023; 27:969-977. [PMID: 36112259 PMCID: PMC9974574 DOI: 10.1007/s10461-022-03833-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
We examined the factors associated with consistent condom use among women engaged in sex work in the Southern parts of Uganda. We used baseline data from a longitudinal study involving WESW from 19 hotspots in Southern Uganda. We conducted hierarchical models to determine the individual, economic, behavioral, and health-related factors associated with consistent condom use. We found that, alcohol use (b=-0.48, 95% CI=-0.77, -0.19), accepting money for condomless sex (b=-0.33, 95% CI=-0.38, -0.28), multiple customers (b=-0.01, 95% CI=-0.01, -0.005), being married (b = 0.50, 95% CI = 0.01, 0.99), owning more assets (b = 0.08, 95% CI = 0.05, 0.13), having another income earner in the household (b = 0.55, 95% CI = 0.27, 0.83), condom use self-efficacy (b = 0.11, 95% CI = 0.03, 0.19), condom use communication (b = 0.06, 95% CI = 0.001, 0.12), and being knowledgeable about HIV/STIs transmission (b = 0.08, 95% CI = 0.01, 0.15) were associated with consistent condom use. Additionally, 29% of the women were consistent condom users. Hence, there is need to implement interventions that promote consistent condom use among WESW.
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Affiliation(s)
- Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Susan Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Proscovia Nabunnya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB7400, 27599, Chapel Hill, NC, USA
| | - Lyla Sunyoung Yang
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
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Cénat JM, Kogan CS, Kebedom P, Ukwu G, Moshirian Farahi SMM, Darius WP, Mulopo Bakombo S, Dalexis RD, Ndengeyingoma A, Noorishad PG, Labelle PR. Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review. Addict Behav 2023; 138:107567. [PMID: 36521424 DOI: 10.1016/j.addbeh.2022.107567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Psychostimulants (e.g., cocaine, amphetamine) are among the most widely used drugs globally with detrimental short and long-term physical, psychological and social consequences. There is limited data on psychostimulant use for various racial and ethnic groups, including Black people, and the challenges they face living as minorities overcoming historical challenges including increased incarceration associated with drug possession. METHODS Peer-reviewed articles were identified in five databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, MEDLINE). Eligible studies were published in French or English, provided empiral data on psychostimulant use in Black individuals living in a minority context. The PRISMA guideline was used for structuring the review. Random-effects meta-analyses were generated to estimate the pooled prevalence of lifetime and periodic psychostimulant use among Black individuals using STATA 16. RESULTS Sixty-three studies published from 1991 to 2022 with a sample size of 139,683 Black individuals were included in the current meta-analysis. Results indicate a pooled prevalence estimate of 11.4% for any form of psychostimulant use among Black individuals. The pooled prevalence estimates were 12.4% (95% CI, 8.4% - 16.4%) for cocaine, 8.3% (95% CI, 0% - 19.1%) for amphetamines, and 11.4% (95% CI, 4.6% - 18.1%) for other stimulants. Prediction intervals for all psychostimulant types were highly heterogenous ranging from 0% to as high as 51.2% for amphetamine suggesting prevalence of use in some studies of Black people could be found to be as low as zero. Subgroup analyses were conducted to examine differences between age groups, gender, reference period, and type of assessment. CONCLUSIONS High prevalence rates of psychostimulant use among Black people argues for greater access to evidence-based treatments. However, current psychosocial interventions are suboptimal, warranting further study. Consideration needs to be given to the challenges of the large range of prediction intervals, living in urban areas, racial discrimination experiences, race-based stress, and sociodemographic characteristics, including poverty, education level, age, gender.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Philmona Kebedom
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gloria Ukwu
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Assumpta Ndengeyingoma
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Nursing, Université du Québec en Outaouais, Quebec, Canada
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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] [MESH Headings] [Grants] [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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McMahon JM, Simmons J, Braksmajer A, LeBlanc N. HIV-serodifferent couples' perspectives and practices regarding HIV prevention strategies: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000620. [PMID: 36962775 PMCID: PMC10022221 DOI: 10.1371/journal.pgph.0000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
A substantial proportion of heterosexually acquired HIV infections in the U.S. occur between partners in primary relationships characterized by mixed HIV status. The U.S. Centers for Disease Control and Prevention have issued guidelines prioritizing HIV-serodifferent couples for primary HIV prevention, including treatment-as-prevention and pre-exposure prophylaxis (PrEP). Yet, very little research has been conducted to understand the perspectives and practices of HIV-serodifferent couples regarding HIV prevention strategies in the U.S. To help fill this gap, we conducted a mixed methods study with 27 mostly Black/African American and Latinx HIV-serodifferent heterosexual couples residing in New York City to explore their knowledge, attitudes, practices, and perspectives regarding combination HIV prevention, including condoms, PrEP and viral control. All couples expressed the desire to maintain viral suppression in the HIV-positive partner, which was not always achieved. There was considerable heterogeneity in the use of HIV prevention methods by couples; and several patterns emerged that were largely driven by gender and relationship dynamics. Female partners, in particular, expressed high levels of anxiety around transmission of HIV and thus desired multiple methods of protection. Healthcare providers should consider couples' psychosocial well-being, relationship quality, and other motivational factors when helping to tailor HIV preventative care for mixed-status couples.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Janie Simmons
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Amy Braksmajer
- Department of Sociology, State University of New York at Geneseo, Geneseo, New York, United States of America
| | - Natalie LeBlanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
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Ssewamala FM, Sensoy Bahar O, Nabunya P, Thames AD, Neilands TB, Damulira C, Mukasa B, Brathwaite R, Mellins C, Santelli J, Brown D, Guo S, Namatovu P, Kiyingi J, Namuwonge F, McKay MM. Suubi+Adherence-Round 2: A study protocol to examine the longitudinal HIV treatment adherence among youth living with HIV transitioning into young adulthood in Southern Uganda. BMC Public Health 2021; 21:179. [PMID: 33478469 PMCID: PMC7818782 DOI: 10.1186/s12889-021-10202-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Youth living with HIV (YLHIV) in Sub-Saharan African (SSA) are less likely to adhere to antiretroviral therapy (ART) and other health-related regimens. As a consequence, YLHIV are not only at risk for health problems and mental health comorbidities, but are also at risk for cognitive deficits, including in areas of memory and executive functioning. The Suubi+Adherence study followed 702 adolescents (10-16 years of age) receiving bolstered standard of care and a family economic empowerment intervention comprising an incentivized youth financial savings account (YSA) augmented with financial literacy training (FLT) and peer mentorship. The study findings pointed to superior short-term viral suppression and positive adolescent health and mental health functioning among participants receiving the intervention. The original group of adolescents who received Suubi+Adherence are now transitioning into young adulthood. This paper presents a protocol for the follow-up phase titled Suubi+Adherence Round 2. METHODS The original cohort in Suubi+Adherence will be tracked for an additional five years (2020-2025). Specifically, the long term follow-up will allow to: 1) ascertain the extent to which the short term outcomes identified in the first 6 years of the intervention are maintained as the same group transitions through young adulthood; and 2) address new scientific questions regarding ART adherence; HIV care engagement; protective health behaviors; and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. Additionally, the team examines the potential mechanisms through which the observed long-term outcomes happen. Moreover, the Suubi+Adherence-Round 2 adds a qualitative component and extends the cost effectiveness component. DISCUSSION Guided by asset and human development theories, Suubi+Adherence-R2 will build on the recently concluded Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA as they transition into young adulthood. The study will address new scientific questions regarding long-term ART adherence, HIV care engagement, protective health behaviors, and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. The findings may inform efforts to improve HIV care among Uganda's YLHIV, with potential replicability in other low-resource countries. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT01790373.
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Affiliation(s)
- Fred M Ssewamala
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA.
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - April D Thames
- Department of Psychology, University of Southern California, 3620 S. McClintock Avenue Rm 520, Los Angeles, CA, 90089, USA
| | - Torsten B Neilands
- School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Christopher Damulira
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Barbara Mukasa
- Mildmay Uganda, 12 Km Entebbe Road, Naziba Hill, Lweza, Kampala, Uganda
| | - Rachel Brathwaite
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Claude Mellins
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - John Santelli
- Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA
| | - Derek Brown
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Shenyang Guo
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Phionah Namatovu
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | - Mary M McKay
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
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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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Ssewamala FM, Sensoy Bahar O, Tozan Y, Nabunya P, Mayo-Wilson LJ, Kiyingi J, Kagaayi J, Bellamy S, McKay MM, Witte SS. A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial. BMC Womens Health 2019; 19:111. [PMID: 31419968 PMCID: PMC6697981 DOI: 10.1186/s12905-019-0807-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda. METHODS This three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences. DISCUSSION When WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention's efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT03583541 .
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Affiliation(s)
- Fred M Ssewamala
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Yesim Tozan
- College of Global Public Health, New York University, New York City, NY, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | | | - Joshua Kiyingi
- International Center for Child Health and Development, Masaka, Uganda
| | | | | | - Mary M McKay
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Susan S Witte
- Columbia University School of Social Work, New York City, NY, USA
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10
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Kamel-Khodabandeh A, Mirzaee M, Jahani Y, Sharifi H. Sex under Influence of Drugs: A Nationwide Survey among Iranian Female Sex Workers. ADDICTION & HEALTH 2019; 10:205-215. [PMID: 31263519 PMCID: PMC6593167 DOI: 10.22122/ahj.v10i4.566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Due to the high level of sexual relationships, prostitute women are faced with many dangers, including acquired immune deficiency syndrome (AIDS), sexually transmitted infections (STIs), fertility problems, drug use, etc. In this regard, addict prostitute women are exposed to more risks because drug use is considered as an outstanding factor in those associated with transmission of AIDS and being in an insecure sexual relationship. The purpose of this study was to find out the variables influential on the level of drug use, before or during sexual relationship. Methods In 2010, 625 prostitute women were selected by multistage sampling from 21 centers out of 12 provinces. Then, we used a standard questionnaire for gathering data by a face-to-face interview. The multilevel ordinal logistic regression in survey model was used to find out the relationship between variables and the level of drug use before or during sexual relationship. Findings The number of monetary customers at the last working day [adjusted odds ratio (AOR): 1.87, 95% confidence interval (CI): 1.50-2.32] and having sexual relationship during the past month with monetary customers (AOR: 4.77, 95% CI: 2.61-8.70) were significantly related to the level of drug use before or during sexual relationship in the past month. Conclusion Since the level of drug use before or during sexual relationship was higher in women who had more daily sexual relationships, these women are exposed to the consequences of drug use; thus, identifying the status of this group of women is important to plan for future injuries.
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Affiliation(s)
- Atiyeh Kamel-Khodabandeh
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghaddameh Mirzaee
- Associate Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Associate Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- Associate Professor, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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11
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Harper GW, Muthigani A, Neubauer LC, Simiyu D, Murphy AG, Ruto J, Suleta K, Muthiani P. The Development and Evaluation of a National School-based HIV Prevention Intervention for Primary School Children in Kenya. JOURNAL OF HIV AND AIDS 2019; 4. [PMID: 30733998 DOI: 10.16966/2380-5536.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary schools in Kenya provide a promising venue for widespread delivery of HIV prevention interventions. This article describes the development and evaluation of Making Life's Responsible Choices (MLRC), a school-based HIV prevention intervention for primary school children developed through a collaborative global partnership involving multiple community stakeholders. Intervention development was informed by extensive reviews of youth-focused evidence-based HIV prevention interventions, and was rooted in both the Theory of Planned Behavior and Social Cognitive Theory. MLRC includes six modules: 1) self-awareness, 2) human sexuality, 3) healthy relationships, 4) drug/alcohol abuse, 5) HIV/AIDS and other sexually transmitted infections, and 6) behavior change. Class 5 pupils (N=1846; 52.1% girls, 47.9% boys; mean age = 12) attending 46 different Catholic-sponsored public and private primary schools throughout Kenya participated in the evaluation of the intervention program which was delivered in the classroom and occurred over the course of 40 weeks (one academic term). Changes in knowledge and behavioral intentions were assessed using a one-group pre-test post-test experimental design. Pupils completed module-specific assessment measures, and paired samples t-tests were used to compare changes in knowledge and behavioral intentions at the classroom level. Gender-specific analyses were also conducted. All six modules displayed statistically significant positive changes in the mean percentage of knowledge items answered correctly for the full sample, with marginal gender differences revealed. Statistically significant health-promoting changes were seen in 11 of the 18 behavioral intention items (3 per module), with gender differences also revealed. Findings suggest that implementing interventions such as MLRC has the potential to thwart the spread of HIV among youth in Kenya, and equip youth with health-promoting skills. In addition, school-based programs have the potential to become institutionalized in school settings in order to maintain their long-term sustainability.
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Affiliation(s)
| | - Augusta Muthigani
- Commission for Education and Religious Education at the Kenya Conference of Catholic Bishops
| | | | - David Simiyu
- Commission for Education and Religious Education at the Kenya Conference of Catholic Bishops
| | | | - Julius Ruto
- Commission for Education and Religious Education at the Kenya Conference of Catholic Bishops
| | | | - Paul Muthiani
- Commission for Education and Religious Education at the Kenya Conference of Catholic Bishops
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12
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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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Ssewamala FM, Bermudez LG, Neilands TB, Mellins CA, McKay MM, Garfinkel I, Sensoy Bahar O, Nakigozi G, Mukasa M, Stark L, Damulira C, Nattabi J, Kivumbi A. Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda. BMC Public Health 2018; 18:693. [PMID: 29871619 PMCID: PMC5989412 DOI: 10.1186/s12889-018-5604-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Asset-based economic empowerment interventions, which take an integrated approach to building human, social, and economic capital, have shown promise in their ability to reduce HIV risk for young people, including adolescent girls, in sub-Saharan Africa. Similarly, community and family strengthening interventions have proven beneficial in addressing mental health and behavioral challenges of adolescents transitioning to adulthood. Yet, few programs aimed at addressing sexual risk have applied combination interventions to address economic stability and mental health within the traditional framework of health education and HIV counseling/testing. This paper describes a study protocol for a 5-year, NIMH-funded, cluster randomized-controlled trial to evaluate a combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. The intervention, titled Suubi4Her, combines savings-led economic empowerment through youth development accounts (YDA) with an innovative family strengthening component delivered via Multiple Family Groups (MFG). METHODS Suubi4Her will be evaluated via a three-arm cluster randomized-controlled trial design (YDA only, YDA + MFG, Usual Care) in 42 secondary schools in the Central region of Uganda, targeting a total of 1260 girls (ages 15-17 at enrollment). Assessments will occur at baseline, 12, 24, and 36 months. This study addresses two primary outcomes: 1) change in HIV risk behavior and 2) change in mental health functioning. Secondary exploratory outcomes include HIV and STI incidence, pregnancy, educational attainment, financial savings behavior, gender attitudes, and self-esteem. For potential scale-up, cost effectiveness analysis will be employed to compare the relative costs and outcomes associated with each study arm. CONCLUSIONS Suubi4Her will be one of the first prospective studies to examine the impact and cost of a combination intervention integrating economic and social components to reduce known HIV risk factors and improve mental health functioning among adolescent girls, while concurrently exploring mental health as a mediator in HIV risk reduction. The findings will illuminate the pathways that connect economic needs, mental health, family support, and HIV risk. If successful, the results will promote holistic HIV prevention strategies to reduce risk among adolescent girls in Uganda and potentially the broader sub-Saharan Africa region. TRIAL REGISTRATION Clinical Trials NCT03307226 (Registered: 10/11/17).
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Affiliation(s)
- Fred M. Ssewamala
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Laura Gauer Bermudez
- Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027 USA
| | - Torsten B. Neilands
- School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
| | - Claude A. Mellins
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY 10032 USA
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Irv Garfinkel
- Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027 USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Gertrude Nakigozi
- Rakai Health Sciences Program, Old Bukoba Road, 279 Kalisizo, Uganda
| | - Miriam Mukasa
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | - Lindsay Stark
- Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY 10032 USA
| | - Christopher Damulira
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | - Jennifer Nattabi
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
| | - Apollo Kivumbi
- International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda
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14
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Microfinance for women at high risk for HIV in Kazakhstan: study protocol for a cluster-randomized controlled trial. Trials 2018; 19:187. [PMID: 29558982 PMCID: PMC5859522 DOI: 10.1186/s13063-018-2566-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Among women at high risk for HIV and other sexually transmitted diseases (STIs), gender and economic issues limit the impact of behavioral prevention strategies. Women in Kazakhstan with dual risks of sex trading and drug use face elevated risk for HIV and STIs and may benefit from an economic empowerment intervention which combines HIV-risk reduction (HIVRR) education with financial skills-building and asset-building to promote reduced reliance on sex trading for income. METHODS/DESIGN The study employs a two-arm, cluster-randomized controlled trial (c-RCT) design. We will use cluster randomization to assign 350 women in approximately 50 cohorts to a traditional four-session HIV-risk-reduction intervention combined with a six-session financial literacy intervention, enrollment in a 24-session vocational training program and receipt of matched savings (HIVRR+MF); or to the four-session HIV-risk-reduction intervention alone (HIVRR). Repeated behavioral and biological assessments will be conducted at baseline, then at 6, 9, and 15 months post randomization/session 1. DISCUSSION This study responds to an identified need in the academic literature for rigorous testing of structural interventions, including combination microfinance and HIV-prevention interventions. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02406482 . Registered on 30 March 2015.
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15
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Latimer J, Fleckman J, Wallace M, Rountree M, Theall K. The Influence of Violence Victimization on Sexual Health Behaviors and Outcomes. AIDS Patient Care STDS 2017; 31:237-244. [PMID: 28429958 PMCID: PMC5446596 DOI: 10.1089/apc.2016.0265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This study examines the implications of a history of personal violence on health and health behaviors. A secondary analysis of cross-sectional data involving adults (n = 214) from a semirural area in southern Louisiana between October 2008 and December 2010 was conducted to ascertain the association between a personal history of violence victimization and indicators of sexual health behaviors and outcomes: communication with sexual partners about HIV status, consistent condom use, and sexually transmitted infection (STI). While violence victimization is widely accepted as a risk factor for high-risk sex behavior, the mechanisms underlying violence victimization's influence on sexual health outcomes remain unclear. Bivariate analyses demonstrated a significant positive association between experience of physical abuse and lifetime history of STI. Surprisingly, respondents reporting lifetime physical violence were more than two times more likely to ask sexual partners about HIV status [odds ratio (OR) for physical attack = 2.23, 95% confidence intervals (CI) = 1.00-4.97; OR for physical injury = 4.60, 95% CI = 1.79-11.85]. Consistent condom use was not significantly associated with violence exposure in adjusted models. There was no evidence that communication with sexual partners mediated the relationship between experiences of violence and condom use. The link between personal history of violence and condom use may be mediated through alternative pathways beyond communication.
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Affiliation(s)
- Jennifer Latimer
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Julia Fleckman
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | | | - Katherine Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
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16
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Ahuama-Jonas C, Burlew AK, Campbell ANC, Tross S. Strength in the midst of pain: Abuse as a predictor of sexual relationship power among substance-abusing Black women. J Ethn Subst Abuse 2017; 16:432-444. [PMID: 28368690 DOI: 10.1080/15332640.2017.1300552] [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
The aim of this research was to explore the association of abuse experiences (child sexual abuse and adult physical/sexual violence) to sexual relationship power among Black substance-abusing women. The study was a secondary analysis of baseline data collected from 124 Black women in 12 drug treatment programs across the United States who initially participated in an HIV risk reduction trial conducted within the National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse (NIDA). The findings revealed that adult sexual abuse, but not childhood sexual or adult physical abuse, was associated with lower relationship control and decision-making dominance as measured by the Sexual Relationship Power Scale. The findings suggest that designing and implementing sexual risk reduction interventions that address adult sexual violence may enhance the relationship power of Black substance-abusing women and in turn may promote safer sex practices.
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Affiliation(s)
| | | | - Aimee N C Campbell
- b New York State Psychiatric Institute , Columbia University Medical Center , New York , New York
| | - Susan Tross
- c HIV Center for Clinical and Behavioral Studies , Columbia University College of Physicians and Surgeons , New York , New York
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17
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Walch SE, Rudolph SM. Negative Affect and Risk for Human Immunodeficiency Virus: One Size May Not Fit All. Am J Health Promot 2016; 20:324-33. [PMID: 16706003 DOI: 10.4278/0890-1171-20.5.324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Research examining the relationship between human immunodeficiency virus (HIV)-related risk behavior and negative affective states has netted mixed findings. The present study examined the potential moderating role of gender and sexual orientation on negative affect and HIV-related risk behavior. Design. Measures of depression, anxiety, and HIV-related risk behavior were collected from participants at the time of pretest counseling. Analysis of variance was used to examine HIV-related risk behavior as a function of negative affect levels and gender and behavioral sexual orientation. Setting. The study was conducted through a community-based, anonymous HIV counseling and testing site. Subjects. Participants included 185 consecutively recruited men and women presenting for HIV testing. Measures. Participants completed a structured interview regarding HIV-related risk behavior, the Center for Epidemiological Studies Depressed Mood Scale, and the Beck Anxiety Inventory. Results. Greater HIV-related risk behavior was associated with high levels of anxiety and moderate or high levels of depression for bisexual women. Greater HIV-related risk behavior was also associated with low levels of anxiety and mild to moderate levels of depression for bisexual men. Conclusions. The relationship between negative affective states and HIV-related risk behavior may vary as a function of gender and behavioral sexual orientation. Better understanding of the relationship between negative affect and risk behavior may be achieved through consideration of these sources of variation.
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Affiliation(s)
- Susan E Walch
- Department of Psychology, The University of West Florida, Pensacola, Florida 32514, USA.
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18
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Jipguep MC, Sanders-Phillips K, Cotton L. Another Look at HIV in African American Women: The Impact of Psychosocial and Contextual Factors. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798404266048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study tested a conceptual model that integrates structural and psychological determinants of HIV prevention for African American women. The sample consisted of African American mothers (N = 129) of children in Head Start programs. Higher levels of perceived stress were associated with higher levels of HIV risk; higher levels of perceived racism were related to higher HIV prevention behavior. A combined psychological functioning score, representing levels of depression and anger, significantly moderated the relationships of perceived stress and racism to prevention behavior. This study confirms the importance of interactions between sociostructural factors and psychological factors as predictors of health behavioral outcomes and reinforces the need to examine the impact of structural factors on psychological functioning, perceived HIV risk, and HIV prevention behavior in African American women.
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19
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Apostolopoulos Y, Sönmez S, Hege A, Lemke M. Work Strain, Social Isolation and Mental Health of Long-Haul Truckers. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/0164212x.2015.1093995] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Kaplan KC, Hormes JM, Wallace M, Rountree M, Theall KP. Racial Discrimination and HIV-related Risk Behaviors in Southeast Louisiana. Am J Health Behav 2016; 40:132-43. [PMID: 26685822 PMCID: PMC5030196 DOI: 10.5993/ajhb.40.1.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES We examined the relationship between cumulative experiences of racial discrimination and HIV-related risk taking, and whether these relationships are mediated through alcohol use among African Americans in semi-rural southeast Louisiana. METHODS Participants (N = 214) reported on experiences of discrimination, HIV sexual risk-taking, history of sexually transmitted infection (STI), and health behaviors including alcohol use in the previous 90 days. Experiences of discrimination (scaled both by frequency of occurrence and situational counts) as a predictor of a sexual risk composite score as well as a history of STI was assessed using multivariate linear and logistic regression, respectively, including tests for mediation by alcohol use. RESULTS Discrimination was common in this cohort, with respondents confirming their experience on average 7 of the 9 potential situations and on more than 34 separate occasions. After adjustment, discrimination was significantly associated with increasing sexual risk-taking and lifetime history of STI when measured either by frequency of occurrence or number of situations, although there was no evidence that these relationships were mediated through alcohol use. CONCLUSIONS Cumulative experiences of discrimination may play a significant role in sexual risk behavior and consequently increase vulnerability to HIV and other STIs.
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Affiliation(s)
- Kathryn C Kaplan
- Allan Rosenfield Global Health at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia M Hormes
- University of Albany, State University of New York, Albany, NY, USA
| | - Maeve Wallace
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Katherine P Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Comprehensive Alcohol Research Center, Louisiana State University, Health Sciences Center, USA.
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Campos S, Benoit E, Dunlap E. Black Women with Multiple Sex Partners: The Role of Sexual Agency. JOURNAL OF BLACK SEXUALITY AND RELATIONSHIPS 2016; 3:53-74. [PMID: 28730162 PMCID: PMC5512887 DOI: 10.1353/bsr.2016.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motivations of low-income substance using heterosexual Black women in New York City for having multiple sexual partners are explored in this paper. Analysis of in-depth interviews with 50 study participants demonstrates that their relationships consisted of those who had: (1) a main sex partner and a secondary sex partner; or (2) two or more "casual" partners. Individual-level motivations for extra relational sex fell into four dominant themes: sexual pleasure, partner infidelity, sex exchange and past main partners. Using a Black feminist framework, we describe how participants displayed considerable autonomy by actively forming and withdrawing from sexual relationships with men. However, women described low rates of condom use with main partners and inconsistent use of condoms with more casual sexual partners. This contradiction becomes an important area for sexual health interventions. Women who had sexual relations with only one current mate in the past two years were recruited as a monogamous comparison group.
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Affiliation(s)
| | - Ellen Benoit
- National Development and Research Institutes, Inc
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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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Minnis AM, Doherty IA, Kline TL, Zule WA, Myers B, Carney T, Wechsberg WM. Relationship power, communication, and violence among couples: results of a cluster-randomized HIV prevention study in a South African township. Int J Womens Health 2015; 7:517-25. [PMID: 25999767 PMCID: PMC4435250 DOI: 10.2147/ijwh.s77398] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Inequitable gender-based power in relationships and intimate partner violence contribute to persistently high rates of HIV infection among South African women. We examined the effects of two group-based HIV prevention interventions that engaged men and their female partners together in a couples intervention (Couples Health CoOp [CHC]) and a gender-separate intervention (Men’s Health CoOp/Women’s Health CoOp [MHC/WHC]) on women’s reports of power, communication, and conflict in relationships. Methods The cluster-randomized field experiment included heterosexual couples from a high-density South African township in which neighborhoods were randomized to one of the intervention arms or a control arm that received the WHC only. Participants completed in-person study visits at baseline and 6-month follow-up. We examined group differences using one-way analysis of variance and multivariable regression models. Results Of the 290 couples enrolled, 255 women remained in the same partnership over 6 months. Following the intervention, women in the CHC arm compared with those in the WHC arm were more likely to report an increase in relationship control (β=0.92, 95% confidence interval [CI]: 0.02, 1.83, P=0.045) and gender norms supporting female autonomy in relationships (β=0.99, 95% CI: 0.07, 1.91, P=0.035). Women in the MHC/WHC arm were more likely to report increases in relationship equity, relative to those in the CHC arm, and had a higher odds of reporting no victimization during the previous 3 months (MHC/WHC vs WHC: odds ratio =3.05, 95% CI: 1.55, 6.0, P=0.001; CHC vs MHC/WHC: odds ratio =0.38, 95% CI: 0.20, 0.74, P=0.004). Conclusion Male partner engagement in either the gender-separate or couples-based interventions led to modest improvements in gender power, adoption of more egalitarian gender norms, and reductions in relationship conflict for females. The aspects of relationship power that improved, however, varied between the couples and gender-separate conditions, highlighting the need for further attention to development of both gender-separate and couples interventions.
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Affiliation(s)
- Alexandra M Minnis
- RTI International, Research Triangle Park, NC, USA ; School of Public Health, University of California, Berkeley, CA, USA
| | - Irene A Doherty
- RTI International, Research Triangle Park, NC, USA ; University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa ; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, NC, USA ; University of North Carolina, Chapel Hill, NC, USA ; North Carolina State University, Raleigh, NC, USA ; Duke University School of Medicine, Durham, NC, 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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Woolf-King SE, Maisto SA. The effects of alcohol, relationship power, and partner type on perceived difficulty implementing condom use among African American adults: an experimental study. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:571-81. [PMID: 25277692 PMCID: PMC4359030 DOI: 10.1007/s10508-014-0362-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/09/2014] [Accepted: 06/14/2014] [Indexed: 06/03/2023]
Abstract
African American adults are disproportionately affected by HIV in the United States, underscoring the need for additional research on barriers to condom use. Guided by the theory of gender and power, this experimental study used a series of vignettes to test causal hypotheses regarding the influence of event-level alcohol use (present and absent), partner type (serious and casual), and relationship power (low and equal) on perceived difficulty implementing condom use. A total of 299 (151 women and 148 men) heterosexual African American adults indicated how "difficult" it would be to use a condom after reading 8 hypothetical sexual encounters, presented in a random order. A 2 × 2 × 2 × 2 repeated measures analysis of covariance with one between subjects factor (gender) and one covariate (condom use self-efficacy) was used to estimate the effects of these variables on an index of perceived difficulty. The women in the study reported significantly higher ratings of difficulty implementing condom use in vignettes characterized by low relationship power (p < .001) and presence of alcohol use (p < .001); the manipulated independent variables did not produce any main effects for men. Both men and women's ratings of perceived difficulty decreased as condom use self-efficacy increased (p < .001). This is the first study to use an experimental methodology to test hypotheses about barriers to condom use among a community-based sample of African American adults. These data can be used to enhance existing HIV prevention interventions.
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Affiliation(s)
- Sarah E Woolf-King
- Center for AIDS Prevention Studies, Department of Medicine, University of California, 50 Beale Street, Suite 1300, San Francisco, CA, 94105, USA,
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Culturally sensitive risk behavior prevention programs for African American adolescents: a systematic analysis. Clin Child Fam Psychol Rev 2014; 16:187-212. [PMID: 23660972 DOI: 10.1007/s10567-013-0133-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The current review conducted a systematic assessment of culturally sensitive risk prevention programs for African American adolescents. Prevention programs meeting the inclusion and exclusion criteria were evaluated across several domains: (1) theoretical orientation and foundation; (2) methodological rigor; (3) level of cultural integration; (4) program target or domain (e.g., schools, communities, families); (5) outcome change level assessed (e.g., addressing change in beliefs/values or behaviors); and (6) program effects on risk behaviors. Thirteen studies (N = 13) with adolescent participants ranging from 10 to 18 years were identified and evaluated. Analyses suggested that more effective culturally sensitive risk prevention programs included the following: (1) a clearly articulated theoretical orientation, which utilized both universal (e.g., behavioral theories) and culturally specific (e.g., Africultural theories) frameworks; (2) a rigorous methodological design (e.g., inclusion of control group, utilization of program manuals, valid and reliable study measures); (3) an integration of culture at multiple levels (e.g., accessibility, delivery, and content) of programming; (4) consideration of the influence of multiple contexts and domains (e.g., family, community, school); (5) multiple behavior change outcomes (e.g., behaviors, relationships, values); and (6) sustained program effects over time. Recommendations for increasing the effectiveness and efficacy of culturally sensitive prevention programs are discussed.
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The relationship between substance use and sexual health among African-American female adolescents with a history of seeking mental health services. Womens Health Issues 2014; 23:e365-71. [PMID: 24183411 DOI: 10.1016/j.whi.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/28/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services. METHODS Participants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14-22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs. FINDINGS Substance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior. CONCLUSIONS Results suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.
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Gilmore AK, Schacht RL, George WH, Davis KC, Norris J, Heiman JR. Verbal Sexual Coercion Experiences, Sexual Risk, and Substance Use in Women. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2014; 23:725-739. [PMID: 26941549 PMCID: PMC4773047 DOI: 10.1080/10926771.2014.933462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Research has linked sexual assault, substance use, and sexually transmitted infection (STI) risk in women. Sexual assault by means of verbal sexual coercion (VSC) is more common than sexual assault by means of physical tactics, but VSC is rarely assessed independently. In addition, past work has established global connections among substance use, sexual assault history, and STI risk; however, assessing substance use during sexual behavior is less common. This study examined the relations among VSC, STI risk behavior, and substance use and attitudes. We hypothesized that women with larger numbers of VSC experiences would report more frequent sexual risk behaviors and substance use and attitudes. Participants with larger numbers of VSC experiences reported larger numbers of anal sex partners, more frequent penile-vaginal sex and sexual activity after substance use, and stronger sex-related alcohol expectancies. These findings suggest that VSC is associated with higher levels of STI risk in women.
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Affiliation(s)
- Amanda K Gilmore
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Rebecca L Schacht
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - William H George
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Kelly Cue Davis
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Jeanette Norris
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Julia R Heiman
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
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Herrick A, Kuhns L, Kinsky S, Johnson A, Garofalo R. Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women. J Am Psychiatr Nurses Assoc 2013; 19:345-55. [PMID: 24217447 DOI: 10.1177/1078390313511328] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Young sexual minority women are at risk for negative sexual health outcomes, including sexually transmitted infections and unintended pregnancies, yet little is known about these risks. We examined factors that may influence sexual risk from a psychosocial and contextual perspective. Analyses were conducted to examine within group relationships between sexual behaviors, negative outcomes, and related factors in a sample of young sexual minority women. Participants (N = 131) were young (mean = 19.8) and diverse in terms of race/ethnicity (57% non-White). Sex under the influence, having multiple partners, and having unprotected sex were common behaviors, and pregnancy (20%) and sexually transmitted infection (12%) were common outcomes. Risk behaviors were associated with age, alcohol abuse, and older partners. Results support the need for further research to understand how these factors contribute to risk in order to target risk reduction programs for this population.
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Affiliation(s)
- Amy Herrick
- Amy Herrick, PhD, University of Pittsburgh, Pittsburgh, PA, USA
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Stevens-Watkins D, Knighton JS, Mitchell N, Oser CB, Leukefeld C. Perception of Eligible Black Men as a Context for HIV Risk Behavior Among Black Women. JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 41:776-782. [PMID: 24052684 PMCID: PMC3774051 DOI: 10.1002/jcop.21571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
African American women are leading in number of newly diagnosed HIV cases, which is a cause for alarm and has a deleterious impact on families and communities. Research suggests the gender-ratio imbalance as a contextual factor leading to increases in high risk sexual behavior and subsequent increases in the rates of HIV infection among African American women. The current study examines correlates of consistent condom use among 213 single, heterosexual, African American women in the community, on probation, and incarcerated who believe it is difficult to find an eligible Black man. Results of this study reveal that drug using women and incarcerated women were less likely to use condoms consistently. In addition, after controlling for drug use and criminal justice status, age emerged as significant. Specifically, older African American women were less likely to use condoms consistently. Community level implications and targeted prevention efforts are discussed.
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Rajapure V, Tirwa R, Poudyal H, Thakur N. Prevalence and Risk Factors Associated with Sexually Transmitted Diseases (STDs) in Sikkim. J Community Health 2012; 38:156-62. [DOI: 10.1007/s10900-012-9596-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pingel ES, Bauermeister JA, Elkington KS, Fergus S, Caldwell CH, Zimmerman MA. Condom Use Trajectories in Adolescence and the Transition to Adulthood: The Role of Mother and Father Support. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2012; 22:350-366. [PMID: 22639524 PMCID: PMC3358796 DOI: 10.1111/j.1532-7795.2011.00775.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Few studies have investigated how mother and father support differ on predicting youths' sexual risk behavior. We therefore examined the influence of parental support on condom use trajectories and its correlates in a predominantly African American sample [(N=627; 53% female; M = 14.86 years (SD=. 64)] from adolescence to young adulthood. We used hierarchical growth curve modeling to examine the relationship between condom use, substance use, psychological distress and parental support prospectively. We found that consistent condom use decreased over time and was associated negatively with psychological distress and substance use. Furthermore, both maternal and paternal support were associated with more condom use over time. We discuss the implications of our findings for HIV prevention programs.
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Affiliation(s)
- Emily S. Pingel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - José A. Bauermeister
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine S. Elkington
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Stevenson Fergus
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Cleopatra H. Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Longmire-Avital B, Holder CA, Golub SA, Parsons JT. Risk factors for drinking among HIV-positive African American adults: the depression-gender interaction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:260-6. [PMID: 22324798 DOI: 10.3109/00952990.2011.653425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alcohol misuse disproportionately affects people living with HIV. People who struggle with alcohol are also likely to be concurrently struggling with depression. Although there is evidence linking depression to HIV, depression to alcohol, and alcohol to HIV, there is limited research that simultaneously examines the interlocking associations between all three factors. OBJECTIVE To investigate the interaction between depression symptomatology and gender on alcohol misuse, while controlling for motivation to reduce drinking, among HIV-positive African Americans. This population was examined because of their increased for developing alcohol dependence. METHODS Data analysis was conducted on baseline survey data of HIV-positive African American adults (N = 88) who drink and were enrolled in the Project PLUS (Positive Living through Understanding and Support) intervention to examine the correlates (i.e., gender, motivation, depression) of drinking in the past 30 days. RESULTS Hierarchical linear regression analysis showed a significant interaction between gender and depression to predict total drinks reported (R(2) = .56, p < .001). While depression was the sole predictor of drinking for men and suppressed the role of motivation, the reverse was true for women; depression was not a significant predictor after controlling for motivation to reduce drinking. CONCLUSION African American men and women living with HIV have different risk factors for recent drinking. SCIENTIFIC SIGNIFICANCE Understanding the link between depression, gender, and motivation to reduce drinking for HIV-positive adults with alcohol problems is crucial for the development of gender and culturally relevant treatments.
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Ober AJ, Iguchi MY, Weiss RE, Gorbach PM, Heimer R, Ouellet LJ, Shoptaw S, Anglin MD, Zule WA. The relative role of perceived partner risks in promoting condom use in a three-city sample of high-risk, low-income women. AIDS Behav 2011; 15:1347-58. [PMID: 20976538 PMCID: PMC3180610 DOI: 10.1007/s10461-010-9840-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
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Affiliation(s)
- Allison J Ober
- Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, 90025, USA.
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Sexually Transmitted Infections and Hepatitis in Men With a History of Incarceration. Sex Transm Dis 2011; 38:634-9. [DOI: 10.1097/olq.0b013e31820bc86c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Longitudinal examination of alcohol use: a predictor of risky sexual behavior and Trichomonas vaginalis among African-American female adolescents. Sex Transm Dis 2011; 38:96-101. [PMID: 20739910 DOI: 10.1097/olq.0b013e3181f07abe] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol use has been linked to risky sexual practices among adolescents. However, limited research on alcohol use and risky sexual behavior has been conducted on African-American female adolescents. This study examined high quantity of alcohol as a longitudinal predictor of risky sexual behavior and sexually transmitted diseases (STDs) among African-American female adolescents, a high-risk population for STDs. METHODS Three hundred ninety-three adolescent females, 15 to 21 years, were assessed on sociodemographics, alcohol use, and risky sexual behaviors. Participants also provided 2 swab specimens that were assayed for STDs. High quantity of alcohol use was defined as ≥ 3 drinks in 1 sitting. RESULTS Binary generalized estimating equation models were conducted assessing the impact of alcohol use at baseline on risky sexual behavior and STDs over a 12-month period. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high quantity of alcohol use predicted positive TV test results, inconsistent condom use, high sexual sensation seeking, multiple sexual partners, sex while high on alcohol or drugs, and having anal sex over a 12-month follow-up period. CONCLUSIONS These findings suggest that HIV/STD-related behavioral interventions for African-American adolescents should discuss the link between alcohol and HIV/STD-risk behavior. A deeper understanding is paramount to the development of efficacious prevention programs at individual and community levels.
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Seth P, Wingood GM, DiClemente RJ, Robinson LS. Alcohol use as a marker for risky sexual behaviors and biologically confirmed sexually transmitted infections among young adult African-American women. Womens Health Issues 2011; 21:130-5. [PMID: 21276736 PMCID: PMC4232951 DOI: 10.1016/j.whi.2010.10.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/01/2010] [Accepted: 10/27/2010] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Previous research has primarily focused on the relationship between illicit drug use and HIV/sexually transmitted infection (STI) risk behavior among African-American women. Very few studies have solely reviewed the role of alcohol use on risky sexual behavior. The present study examined the relationship between alcohol use at non-abuse levels and risky sexual behaviors and STIs among young adult African-American women. METHODS Eight hundred forty-eight African American women, ages 18 to 29, participated at baseline, with 669 and 673 women at 6 and 12 months follow-up, respectively. Participants completed an Audio Computer Assisted Survey Interview assessing sociodemographics, alcohol use, and risky sexual behaviors. Subsequently, participants provided two vaginal swab specimens for STIs. RESULTS Multivariate logistic regression analyses were conducted for cross-sectional analyses, with illicit drug use as a covariate. Women who consumed alcohol were more likely to have multiple partners and risky partners. Binary generalized estimating equation models assessed the impact of alcohol use at baseline on risky sexual behavior and STIs over a 12-month period. Illicit drug use, intervention group, and baseline outcome measures were entered as covariates. Alcohol consumption predicted positive results for chlamydia, positive results for any STI, and never using a condom with a casual partner over a 12-month follow-up period. DISCUSSION Frequency of alcohol use at non-abuse levels was correlated with and predicted risky sexual behaviors and STIs. Prevention programs for African-American women should incorporate education regarding the link between alcohol and HIV/STI risk behaviors and the potential negative health consequences.
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Affiliation(s)
- Puja Seth
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
- Emory Center for AIDS Research, Social and Behavioral Sciences Core
| | - Gina M. Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
- Emory Center for AIDS Research, Social and Behavioral Sciences Core
- 1518 Clifton Road NE, Room 556, Atlanta, GA 30322; Telephone: (404) 727-0241; Fax: (404) 727-1369
| | - Ralph J. DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
- Emory Center for AIDS Research, Social and Behavioral Sciences Core
- 1518 Clifton Road NE, Room 554, Atlanta, GA 30322; Telephone: (404) 727-0237; Fax: (404) 727-1369
| | - LaShun S. Robinson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
- 1520 Clifton Road NE, Room 274, Atlanta, GA 30322; Telephone: (404) 712-9189; Fax: (404) 712-9738
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38
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Ao TTH, Sam N, Kiwelu I, Mahal A, Subramanian SV, Wyshak G, Kapiga S. Risk factors of alcohol problem drinking among female bar/hotel workers in Moshi, Tanzania: a multi-level analysis. AIDS Behav 2011; 15:330-9. [PMID: 21082340 DOI: 10.1007/s10461-010-9849-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is limited information on alcohol problem drinking, which has been associated with sexually transmitted infections (STIs), including HIV, among female bar/hotel workers in Africa. This paper aimed to identify the individual- and facility-level determinants of alcohol problem drinking in this setting. Problem drinking was defined based on the CAGE alcohol screening scale. Multi-level logistic regression was used to identify individual- and facility-level factors associated with problem drinking. About 37.3% of women (N = 1629) were classified as having probable or definite problem drinking. In multi-level analysis, main characteristics associated with problem drinking included: having 3-4 partners in the past 5 years compared to having 1-2, used a condom in the last sex comparing to non-use, history of transactional sex, having more pregnancies, and facilities whose employees do not live on the premises. Interventions which combine alcohol and sexual risk reduction counseling are urgently needed in this population.
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Affiliation(s)
- Trong Thanh-Hoang Ao
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Epperson MW, Khan MR, El-Bassel N, Wu E, Gilbert L. A longitudinal study of incarceration and HIV risk among methadone maintained men and their primary female partners. AIDS Behav 2011; 15:347-55. [PMID: 20063053 DOI: 10.1007/s10461-009-9660-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examines the longitudinal relationship between personal and sexual partner incarceration and subsequent HIV risk behaviors among drug-involved men and their primary female sexual partners. A random sample of 356 men in methadone treatment in New York City were interviewed at baseline, 6 and 12 months; these men also reported information on their primary female sexual partners. Female partner recent incarceration was associated with subsequent increase in multiple partnerships for the male participants (AOR: 3.31; 95% C.I.: 1.26-8.72, P < .05). Female partner incarceration was also associated with reduced likelihood of subsequent unprotected sex between primary partners (AOR: .13; 95% C.I.: .05-.40, P < .01); this finding is somewhat unique and warrants further investigation. Findings support the notion of mutual influence in the case of female partner incarceration, which is associated with both female partner and male partner risk behaviors. HIV prevention implications are discussed, including the need for couple-based HIV prevention interventions targeting couples affected by incarceration.
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40
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Hendershot CS, Magnan RE, Bryan AD. Associations of marijuana use and sex-related marijuana expectancies with HIV/STD risk behavior in high-risk adolescents. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 24:404-14. [PMID: 20853925 DOI: 10.1037/a0019844] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple studies suggest an association of marijuana use with increased rates of sexual risk behavior and sexually transmitted diseases (STDs). Most studies have focused on global associations of marijuana use with sexual risk outcomes and few have examined relevant cognitive variables. Adolescents in the juvenile justice system are at elevated risk for HIV/STDs and preliminary evidence suggests that marijuana is a potentially important cofactor for sexual risk behavior in this population. This study evaluated global, situational and event-level associations of marijuana use and sex-related marijuana expectancies with sexual risk outcomes in a large, racially diverse sample of adjudicated youth (n = 656, 66% male, mean age = 16.7 years). Cross-sectional and prospective analyses identified associations of marijuana use and dependence symptoms with sexual risk outcomes, including lower frequency of condom use and higher STD incidence. Stronger sex-related marijuana expectancies predicted greater intentions for and frequency of marijuana use in sexual situations. In event-level analyses that controlled for alcohol, marijuana use predicted a significantly decreased likelihood of condom use; this association was moderated by sex-related marijuana expectancies. Mediation analyses suggested that behavioral intentions partly accounted for the prospective association of expectancies with marijuana use before sex. These results provide further evidence that marijuana use is a potentially important cofactor for HIV/STD transmission in high-risk adolescents and suggest that cognitive factors could be important for characterizing this association.
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Affiliation(s)
- Christian S Hendershot
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA.
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41
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Champion J. Context of sexual risk behaviour among abused ethnic minority adolescent women. Int Nurs Rev 2011; 58:61-7. [DOI: 10.1111/j.1466-7657.2010.00857.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Hagan H, Perlman DC, Des Jarlais DC. Sexual risk and HIV infection among drug users in New York City: a pilot study. Subst Use Misuse 2011; 46:201-7. [PMID: 21303240 PMCID: PMC4458329 DOI: 10.3109/10826084.2011.521470] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Measures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.
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Affiliation(s)
- Holly Hagan
- College of Nursing, New York University, New York, New York 10003, USA.
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43
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Abstract
This study examines the relationship between age and HIV sexual risk behaviors among a random sample of 372 women in methadone treatment in New York City. Logistic regression results indicate that women of all ages are at risk for HIV through inconsistent condom use. Exposure to intimate partner violence (IPV), alcohol use, and HIV-negative status are associated with inconsistent condom use during vaginal sex. Age (35-44), having a main sexual partner with an HIV risk factor, IPV, and alcohol use are associated with using crack or cocaine during sex. Similarly, age (35-44), having a main sexual partner with an HIV risk factor, IPV, and drug use are associated with consuming four or more drinks prior to sex. The findings highlight the importance of age-appropriate HIV prevention and intervention strategies, as well as the need to address intimate partner violence, mental health, polysubstance use, and relational factors associated with HIV sexual risk behaviors among women in methadone treatment.
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Affiliation(s)
- Malitta Engstrom
- School of Social Service Administration, The University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA.
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44
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Factors affecting the willingness of counselors to integrate preconception care into sexually transmitted disease clinics. Womens Health Issues 2010; 20:329-34. [PMID: 20800769 DOI: 10.1016/j.whi.2010.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/17/2010] [Accepted: 05/27/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND The high rate of unintended pregnancy is an immediate barrier to providing preconception care (PCC). Failure to deliver additional PCC messages at sexually transmitted disease (STD) clinics might represent a major missed opportunity to target women at increased risk for unintended pregnancy for behaviors that also put them at risk for adverse pregnancy outcomes. METHODS Using a survey questionnaire, we assessed perceptions of PCC and factors influencing the willingness of STD counselors to integrate PCC as an intervention service provided by the STD clinics of 140 STD counselors. We used a cross-sectional design and selected survey participants with a minimum of 2 years' experience in providing HIV pretest and posttest counseling and syphilis interviewing using a nonprobability, purposive sample. RESULTS The level of occupational responsibility and the amount of time available seemed to affect counselor perceptions of the importance of PCC and whether it should be integrated as an intervention service provided by STD clinics. Findings suggested that, although most STD counselors reported that PCC was an important issue, there was significant variation in the perception of whether PCC should be delivered at STD clinics. CONCLUSION STD counselors perceived PCC to be an important intervention service that can be delivered at STD clinics. Additional study is needed to identify factors that might affect full integration into the STD clinic setting.
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45
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Kogan SM, Brody GH, Chen YF, Grange CM, Slater LM, DiClemente RJ. Risk and protective factors for unprotected intercourse among rural African American young adults. Public Health Rep 2010; 125:709-17. [PMID: 20873287 DOI: 10.1177/003335491012500513] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Despite increasing risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), few data are available concerning the factors associated with risky sexual behavior among African American young adults who do not attend college. Additionally, the possibility that different risk mechanisms affect men and women remains understudied. This article reports on the risk and protective factors associated with unprotected intercourse and gender differences in these factors' influence among this group. Predictors were derived from ecological and self-regulatory theories of risk behavior. METHODS African Americans aged 18-21 years were recruited via respondent-driven sampling (RDS) from seven contiguous rural counties. Risk and protective factors for unprotected intercourse were analyzed for 214 of 292 participants who reported sexual intercourse during the past three months. RESULTS Among sexually active participants, 62.6% used condoms inconsistently. The influence of leaving the parental home, perceived discrimination, risk-taking peers, family relationships, risk-taking propensity, and binge drinking on unprotected intercourse were moderated by gender. Positive attitudes toward condom use were associated with less unprotected intercourse controlling for the influence of risk variables for both men and women. CONCLUSIONS Men and women have unique STI prevention needs. Additional research addressing these needs is necessary, particularly for rural African American men.
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46
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Senn TE, Carey MP, Vanable PA. The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic. J Natl Med Assoc 2010; 102:614-20. [PMID: 20690325 DOI: 10.1016/s0027-9684(15)30639-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES High rates of psychosocial and health problems have been identified among patients attending sexually transmitted disease (STD) clinics, who are disproportionately urban, have low income, and are racial/ethnic minorities. This study sought to determine whether these problems co-occurred and whether they indicated the presence of a syndemic. METHODS Patients (N = 1557, 46% female, 64% African American) attending an urban STD clinic completed a computerized survey assessing childhood sexual abuse (CSA), depressive symptoms, binge drinking, marijuana use, intimate partner violence (IPV), and sexual risk behavior. Medical records were reviewed to determine incident STD diagnosis. RESULTS The psychosocial and health problems were interrelated. Endorsing more psychosocial problems was associated with a greater likelihood of having multiple sexual partners and STD diagnosis. Interactions between CSA and marijuana use and between CSA and IPV predicted STD diagnosis. CONCLUSIONS Numerous psychosocial and health problems co-occur among urban STD clinic patients. There was some evidence of a syngergistic relationship (i.e., a syndemic) between these conditions, resulting in worsened sexual health outcomes. Health care needs to be multidisciplinary to address the multiple psychosocial and health problems faced by STD clinic patients. Research needs to identify factors that may underlie these comorbid conditions.
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Affiliation(s)
- Theresa E Senn
- Center for Health and Behavior, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244, USA.
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47
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Kopetz CE, Reynolds EK, Hart CL, Kruglanski AW, Lejuez C. Social context and perceived effects of drugs on sexual behavior among individuals who use both heroin and cocaine. Exp Clin Psychopharmacol 2010; 18:214-20. [PMID: 20545385 PMCID: PMC3198869 DOI: 10.1037/a0019635] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers have identified the association between the use of cocaine and sexual behavior as an important risk factor for HIV infection and have attempted to elucidate the nature of this association. Several lines of research have suggested that facilitation of sexual behavior during intoxication with cocaine may be because of the direct pharmacological effects of the drug (e.g., increase in sexual desire), whereas others have pointed to the importance of factors related to the context of drug use (e.g., opportunities for sexual behavior, expectations about the effects of the drug, social norms). The present study explored the perceived effects of cocaine and heroin on sexual behavior, as well as the social context of drug use as a function of drug type (cocaine vs. heroin), among 46 inner-city drug users who reported a history of regular use of both crack cocaine and heroin. Results indicated that compared to heroin, cocaine had deleterious effects on participants' perceived sexual desire and performance. Despite such deleterious effects on sexual behavior, cocaine was more frequently used with an intimate partner than heroin. Furthermore, participants did not differ in the extent to which they used the two drugs in other social contexts (e.g., with friends, family, or neighbors). These preliminary results suggest that the relationship between cocaine and sexual behavior, especially among long-term cocaine users, may be facilitated by opportunities for sex that exist in the context of cocaine use, rather than by the pharmacological effects of the drug.
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Affiliation(s)
- Catalina E. Kopetz
- Department of Psychology, University of Maryland, College Park,Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park,“Babes-Bolyai” University, Cluj-Napoca
| | - Elizabeth K. Reynolds
- Department of Psychology, University of Maryland, College Park,Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park
| | - Carl L. Hart
- Columbia University, Department of Psychology and College of Physicians and Surgeons, New York State Psychiatric Institute
| | | | - C.W. Lejuez
- Department of Psychology, University of Maryland, College Park,Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park
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48
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Abstract
HIV is an increasingly critical and costly health problem for American women. Substance use plays a major role in human immunodeficiency virus (HIV) infection in women. There are several plausible explanations for the association between substance use and HIV risk behavior. Pregnant substance abusers are a population deserving special attention given the prevalence of risk behavior in this population and the added risk of perinatal transmission of HIV. Current guidelines for the screening and treatment of HIV among pregnant women and their infants are delineated. Substance abuse treatment has a limited impact on HIV risk behavior in female substance abusers. Similarly, traditional knowledge-based and skill-based HIV risk reduction interventions have modest efficacy in this population. Hence, there is a need to develop new interventions that directly target sex-related and drug-related HIV risk behavior among female substance abusers. Recent work suggests that the incorporation of motivational interviewing components into traditional HIV risk reduction interventions may be a promising new direction for the field.
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Affiliation(s)
- Susan E Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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49
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Panchanadeswaran S, Frye V, Nandi V, Galea S, Vlahov D, Ompad D. Intimate partner violence and consistent condom use among drug-using heterosexual women in New York City. Women Health 2010; 50:107-24. [PMID: 20437300 PMCID: PMC2882151 DOI: 10.1080/03630241003705151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study examined the associations of relationship factors, partner violence, relationship power, and condom-use related factors with condom use with a main male partner among drug-using women. Over two visits, 244 heterosexual drug-using women completed a cross-sectional survey. Multivariate logistic regression models indicated that women who expected positive outcomes and perceived lower condom-use barriers were more likely to report condom use with their intimate partners. The findings suggest that future interventions aiming at reducing HIV risk among drug-using women should focus on women's subjective appraisals of risks based on key relationship factors in addition to the occurrence of partner violence.
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Affiliation(s)
- Subadra Panchanadeswaran
- Assistant Professor, Adelphi University School of Social Work, 1 South Avenue, Garden City, NY 11530, , Telephone: 516-877-4310, Fax: 516-877-4392
| | - Victoria Frye
- Adjunct Research Investigator, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019,
| | - Vijay Nandi
- Sr. Research Analyst, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019, , Telephone: 212-419-3535
| | - Sandro Galea
- Director, Center for Global Health, Professor of Epidemiology, School of Public Health Professor of Emergency Medicine, Medical School Research Professor, Institute for Social Research University of Michigan, Ann Arbor, MI, 48109, , Telephone: 734.647.9741
| | - David Vlahov
- Senior Vice President for Research and Director, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019, , Telephone: 212-822-7283
| | - Danielle Ompad
- Associate Director Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019, , Telephone: 212-822-7283
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50
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Castor D, Pilowsky DJ, Hadden B, Fuller C, Ompad DC, de Leon CL, Neils G, Hoepner L, Andrews HF, Latkin C, Hoover DR. Sexual risk reduction among non-injection drug users: report of a randomized controlled trial. AIDS Care 2009; 22:62-70. [DOI: 10.1080/09540120903012510] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Delivette Castor
- a The Aaron Diamond AIDS Research Center , Rockefeller University , New York , NY , USA
| | - Daniel J. Pilowsky
- b Department of Psychiatry, Columbia College of Physicians and Surgeons , Columbia University , New York , NY , USA
- c Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
- d HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute , New York , NY , USA
| | - Bernadette Hadden
- e Hunter College School of Social Work , City University of New York , New York , NY , USA
| | - Crystal Fuller
- c Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
- f Center for Urban Epidemiological Studies , New York Academy of Medicine , New York , NY , USA
| | - Danielle C. Ompad
- f Center for Urban Epidemiological Studies , New York Academy of Medicine , New York , NY , USA
| | - Cora L. de Leon
- g Department of Environmental Health Sciences, Mailman School of Public Health , Columbia University , New York , NY , USA
- h Data Coordinating Center , Columbia University , New York , NY , USA
| | - Greg Neils
- d HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute , New York , NY , USA
- h Data Coordinating Center , Columbia University , New York , NY , USA
| | - Lori Hoepner
- g Department of Environmental Health Sciences, Mailman School of Public Health , Columbia University , New York , NY , USA
- h Data Coordinating Center , Columbia University , New York , NY , USA
| | - Howard F. Andrews
- d HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute , New York , NY , USA
- h Data Coordinating Center , Columbia University , New York , NY , USA
- i Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Carl Latkin
- j Department of Health, Behavior, and Society , Johns Hopkins School of Public Health , Baltimore , MD , USA
| | - Donald R. Hoover
- k Center for HSR on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research , The State University of New Jersey Rutgers State University , New Brunswick , NJ , USA
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