1
|
Skalski-Bednarz SB, Toussaint LL, Surzykiewicz J. Beyond HIV Shame: Effects of Self-Forgiveness in Improving Mental Health in HIV-Positive Individuals in Poland. JOURNAL OF RELIGION AND HEALTH 2024; 63:4232-4254. [PMID: 39096441 DOI: 10.1007/s10943-024-02084-7] [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] [Accepted: 07/05/2024] [Indexed: 08/05/2024]
Abstract
Guided by the bio-psycho-socio-spiritual approach, this randomized controlled trial assessed the efficacy of a self-forgiveness intervention among 60 HIV-positive individuals in Poland. Participants underwent a 90-min "Restore: The Journey Toward Self-Forgiveness" session, in contrast to a wait-list control group. The intervention significantly enhanced self-forgiveness, spirituality, mental well-being, and heart rate variability in response to a cognitive stressor (i.e., a mental arithmetic challenge). Significant effects were observed in both between-group and within-subject comparisons. These results support the incorporation of self-forgiveness into psychological rehabilitation programs for HIV to improve quality of life and health outcomes.
Collapse
Affiliation(s)
- Sebastian Binyamin Skalski-Bednarz
- Institute of Psychology, Humanitas University, Kilinskiego 43, 41-200, Sosnowiec, Poland.
- Faculty of Philosophy and Education, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Germany.
| | | | - Janusz Surzykiewicz
- Faculty of Philosophy and Education, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Germany
- Faculty of Education, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| |
Collapse
|
2
|
Ondeng'e K, Guo X, Mbeda C, Schnabel D, Panchia R, Dominguez K, Dadabhai S, Hamilton EL, Sandfort TGM. Bisexuality among Men who have Sex with Men in Sub-Saharan Africa: Findings from the HPTN 075 Study. AIDS Behav 2024:10.1007/s10461-024-04556-z. [PMID: 39607599 DOI: 10.1007/s10461-024-04556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2024] [Indexed: 11/29/2024]
Abstract
Studies among men who have sex with men (MSM) in sub-Saharan Africa (SSA) focus mainly on HIV epidemiology, revealing little about the diversity within this population. We utilized data from the HIV Prevention Trials Network (HPTN) 075 study, to explore demographic and psychosexual characteristics of MSM in SSA who also have sex with women. Persons included in the analyses were aged 18-44 years and assigned male sex at birth and identified as male, reported anal sex with a man in the past 3 months, and had enrolled at one of four study sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town and Soweto, South Africa). Nearly a quarter of the participants had recently engaged in sex with both men and women (MSMW). These men differed in terms of demographic and psychosexual characteristics, and sexual behavior from men who only had had sex with men (MSME). Compared to the latter, MSMW were more likely to prefer the insertive sexual role, reported more sexual partners in the past three months, and had more instances of condomless insertive anal intercourse with a man. These findings suggest that men who have sex with both men and women have specific characteristics and need tailored interventions that take their specific needs into account.
Collapse
Affiliation(s)
- Ken Ondeng'e
- Kenya Medical Research Institute, Center for Global Health, Kisumu, Kenya.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Calvin Mbeda
- Kenya Medical Research Institute, Center for Global Health, Kisumu, Kenya
| | - David Schnabel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sufia Dadabhai
- Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi
| | - Erica L Hamilton
- Network and Collaborative Research Division, Durham, NC, FHI 360, USA
| | - Theo G M Sandfort
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
3
|
Harper GW, Hong C, Jauregui JC, Odhiambo EO, Jadwin-Cakmak L, Olango K, Rivet Amico K, Tucker HM, Lyons M, Odero W, Graham SM. Proximal and distal minority stressors and mental health among young gay and bisexual men and other men who have sex with men (GBMSM) in Kisumu, Kenya. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 39497273 DOI: 10.1002/ajcp.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 10/09/2024] [Accepted: 10/16/2024] [Indexed: 11/21/2024]
Abstract
Young gay and bisexual men and other men who have sex with men (GBMSM) in Kenya experience pervasive intersectional stigma and discrimination, contributing to elevated levels of negative mental health symptoms. Grounded in the Minority Stress Model, this paper explores associations of proximal and distal minority stressors with three types of negative mental health outcomes among young HIV-negative GBMSM (n = 63) between the ages of 19-34 who participated in a pilot trial of a sexual health intervention. Using the PHQ-9, GAD-7, and PC-PTSD-5 screening measures, levels of clinically significant symptoms were reported as follows: 15.8% depressive symptoms, 12.7% anxiety symptoms, 31.7% posttraumatic stress symptoms. Results from stepwise linear regression analyses suggest that GBMSM-related stigma (distal stressor) was the strongest correlate for all three mental health outcomes, and concealment motivation (proximal stressor) was an additional significant correlate only in the depressive symptoms model. These findings should be viewed with caution and seen as initial observations given the small sample which limits our interpretations of the findings. Structural-level interventions are needed to decrease GBMSM's exposure to intersectional stigma and discrimination, such as decriminalization of same-sex sexual activity, as well as individual and group-level interventions that assist GBMSM with improving their adaptive coping strategies.
Collapse
Affiliation(s)
- Gary W Harper
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Chenglin Hong
- School of Social Work, University of Connecticut, Hartford, Connecticut, USA
| | - Juan C Jauregui
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | | | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kennedy Olango
- Men Against AIDS Youth Group (MAAYGO), Kisumu, Kisumu County, Kenya
| | - K Rivet Amico
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Heather M Tucker
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Myla Lyons
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wilson Odero
- Department of Family Medicine and Community Health, Maseno University School of Medicine, Kisumu, Kisumu County, Kenya
| | - Susan M Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
Logie CH, Kinitz DJ, Gittings L, Lalor P, MacKenzie F, Newman PA, Baral SD, Mbuagbaw L, Shuper P, Levermore K. Intersecting Stigma and the HIV Care Cascade: Qualitative Insights from Sex Workers, Men who have Sex with Men, and Transgender Women Living with HIV in Jamaica. AIDS Behav 2024; 28:3768-3786. [PMID: 39098884 DOI: 10.1007/s10461-024-04460-6] [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] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
In Jamaica, stigma experiences of sex workers (SW), gay men and other men who have sex with men (MSM), and transgender women living with HIV remain understudied. To address this gap, we explored experiences of stigma and linkages with the HIV care cascade among key populations living with HIV in Jamaica, including cisgender women SW, MSM, and transgender women. This qualitative study involved n = 9 focus groups (FG), n = 1 FG per population living with HIV (SW, MSM, transgender women) in each of three sites (Kingston, St. Ann, Montego Bay). We also conducted key informant (KI) interviews. We applied thematic analysis informed by the Health Stigma and Discrimination (HSD) Framework. FG participants (n = 67) included SW (n = 18), MSM (n = 28), and trans women (n = 21); we interviewed n = 10 KI (n = 5 cisgender women, n = 5 cisgender men). Participant discussions revealed that stigma drivers included low HIV treatment literacy, notably misinformation about antiretroviral therapy (ART) benefits and HIV acquisition risks, and a lack of legal protection from discrimination. Stigma targets health (HIV) and intersecting social identities (sex work, LGBTQ identities, gender non-conformity, low socio-economic status). Stigma manifestations included enacted stigma in communities and families, and internalized stigma-including lateral violence. HIV care cascade impacts included reduced and/or delayed HIV care engagement and ART adherence challenges/disruptions. Participants discussed strategies to live positively with HIV, including ART adherence as stigma resistance; social support and solidarity; and accessing affirming institutional support. In addition to addressing intersecting stigma, future research and programing should bolster multi-level stigma-resistance strategies to live positively with HIV.
Collapse
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Richmond Hill, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | - David J Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lesley Gittings
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Patrick Lalor
- Jamaica AIDS Support for Life (JASL), Kingston, Jamaica
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Paul Shuper
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | | |
Collapse
|
5
|
Rucinski K, Knight J, Willis K, Wang L, Rao A, Roach MA, Phaswana-Mafuya R, Bao L, Thiam S, Arimi P, Mishra S, Baral S. Challenges and Opportunities in Big Data Science to Address Health Inequities and Focus the HIV Response. Curr HIV/AIDS Rep 2024; 21:208-219. [PMID: 38916675 PMCID: PMC11283392 DOI: 10.1007/s11904-024-00702-3] [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] [Accepted: 05/31/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW Big Data Science can be used to pragmatically guide the allocation of resources within the context of national HIV programs and inform priorities for intervention. In this review, we discuss the importance of grounding Big Data Science in the principles of equity and social justice to optimize the efficiency and effectiveness of the global HIV response. RECENT FINDINGS Social, ethical, and legal considerations of Big Data Science have been identified in the context of HIV research. However, efforts to mitigate these challenges have been limited. Consequences include disciplinary silos within the field of HIV, a lack of meaningful engagement and ownership with and by communities, and potential misinterpretation or misappropriation of analyses that could further exacerbate health inequities. Big Data Science can support the HIV response by helping to identify gaps in previously undiscovered or understudied pathways to HIV acquisition and onward transmission, including the consequences for health outcomes and associated comorbidities. However, in the absence of a guiding framework for equity, alongside meaningful collaboration with communities through balanced partnerships, a reliance on big data could continue to reinforce inequities within and across marginalized populations.
Collapse
Affiliation(s)
- Katherine Rucinski
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kalai Willis
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary Anne Roach
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Refilwe Phaswana-Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research (PACER) Extramural Unit, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Le Bao
- Department of Statistics, Pennsylvania State University, University Park, PA, USA
| | - Safiatou Thiam
- Conseil National de Lutte Contre Le Sida, Dakar, Senegal
| | - Peter Arimi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation & Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
6
|
Grinsztejn B, Mussini C, Cortes C, Tan DHS, Phanuphak N. Beating the odds: medicines alone will not stop HIV. J Int AIDS Soc 2024; 27:e26321. [PMID: 38923714 PMCID: PMC11197959 DOI: 10.1002/jia2.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FIOCRUZRio de JaneiroBrazil
| | | | - Claudia Cortes
- HIV/AIDS WorkgroupFaculty of MedicineUniversity of ChileSantiagoChile
- Department of Internal MedicineFaculty of MedicineUniversity of ChileSantiagoChile
- Hospital Clínico San Borja Arriarán & Fundación ArriaránSantiagoChile
- Millenium Institute on Immunology and ImmunotherapySantiagoChile
| | - Darrell H. S. Tan
- Division of Infectious DiseasesSt. Michael's HospitalTorontoOntarioCanada
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationDalla Lana School of Public HealthTorontoOntarioCanada
| | | |
Collapse
|
7
|
Carrico AW, Ewart LD, Davidovich U, Maher L, Jonas KJ, Horvath KJ, Hirshfield S, Guadamuz TE, Carney T, Grov C. Responding to the global epidemic of amphetamine-type stimulant use compromising biomedical HIV prevention among men who have sex with men. Lancet HIV 2024; 11:e350-e352. [PMID: 38816140 DOI: 10.1016/s2352-3018(24)00086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/25/2024] [Accepted: 03/20/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Adam W Carrico
- Florida International University Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA.
| | - Leah Davis Ewart
- Florida International University Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Social Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Lisa Maher
- Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Thomas E Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Tara Carney
- Mental Health, Alcohol, Substance Use and Tobacco Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Christian Grov
- City University of New York Graduate School of Public Health, New York, NY, USA
| |
Collapse
|
8
|
Vasireddy V, Brown NE, Shah N, Crowell TA. Sustaining HIV service delivery to key population clients using client-centered models during the debate and enactment of the Anti-Homosexuality Act in Uganda. J Int AIDS Soc 2024; 27:e26253. [PMID: 38712676 DOI: 10.1002/jia2.26253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Vamsi Vasireddy
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- U.S. Mission to Uganda, Kampala, Uganda
| | - Natalie E Brown
- U.S. Mission to Uganda, Kampala, Uganda
- U.S. Department of State and Smithsonian Institution, Washington, DC, USA
| | - Neha Shah
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| |
Collapse
|
9
|
Mujugira A, Muwonge T, Aliganyira B, Okoboi S. Uganda's Anti-Homosexuality Act undermines public health. J Int AIDS Soc 2024; 27:e26259. [PMID: 38712671 DOI: 10.1002/jia2.26259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Andrew Mujugira
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Timothy Muwonge
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Stephen Okoboi
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
| |
Collapse
|
10
|
Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
11
|
Loeb T, Willis K, Velishavo F, Lee D, Rao A, Baral S, Rucinski K. Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study. JMIR Public Health Surveill 2024; 10:e48963. [PMID: 38573760 PMCID: PMC11027056 DOI: 10.2196/48963] [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: 05/12/2023] [Revised: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. OBJECTIVE To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations' HIV service providers. METHODS We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. RESULTS Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5% to 3.6% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7% to 1.5% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9% to 2.8%, and the proportion of MSM decreased from 1.5% to 0.75%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6% to 4.0% in regions with high prevalence and decreased the proportion from 1.4% to 1.2% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1% to 3.4%) and decreased the proportion of MSM in all regions. CONCLUSIONS Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response.
Collapse
Affiliation(s)
- Talia Loeb
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kalai Willis
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Daniel Lee
- United States Agency for International Development Dominican Republic, Santo Domingo, Dominican Republic
| | - Amrita Rao
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Stefan Baral
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Rucinski
- Data for Implementation (Data.FI), Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
12
|
Dai Z, Wu Y, Liu X, Fu J, Si M, Chen X, Wang H, Xiao W, Huang Y, Yu F, Mi G, Su X. Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model. Brain Behav 2024; 14:e3472. [PMID: 38549560 PMCID: PMC10979188 DOI: 10.1002/brb3.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis. METHODS A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma. RESULTS Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma. CONCLUSION The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.
Collapse
Affiliation(s)
- Zhenwei Dai
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yijin Wu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xin Liu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jiaqi Fu
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Mingyu Si
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xu Chen
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Hao Wang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Weijun Xiao
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yiman Huang
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Fei Yu
- Danlan Public WelfareBeijingChina
| | | | - Xiaoyou Su
- School of Population Medicine and Public HealthChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| |
Collapse
|
13
|
Parmley LE, Miller SS, Chingombe I, Mapingure M, Mugurungi O, Rogers JH, Musuka G, Samba C, Hakim AJ, Harris TG. Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe. J Int AIDS Soc 2024; 27:e26231. [PMID: 38627887 PMCID: PMC11021625 DOI: 10.1002/jia2.26231] [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: 06/18/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation. METHODS A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation. RESULTS Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20-26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05). CONCLUSIONS Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.
Collapse
Affiliation(s)
| | | | | | | | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child CareHarareZimbabwe
| | - John H. Rogers
- Division of Global HIV & TBU.S. Centers for Disease ControlHarareZimbabwe
| | | | | | - Avi J. Hakim
- Division of Global HIV & TBU.S. Centers for Disease ControlAtlantaGeorgiaUSA
| | - Tiffany G. Harris
- ICAP at Columbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| |
Collapse
|
14
|
Dyer O. Surge in anti-gay laws in Africa imperil progress on HIV/AIDS, experts say. BMJ 2024; 384:q599. [PMID: 38458621 DOI: 10.1136/bmj.q599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
|
15
|
Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
Collapse
Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
16
|
Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health 2024; 9:e109-e127. [PMID: 38307678 DOI: 10.1016/s2468-2667(23)00312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024]
Abstract
Health disparities related to sexual orientation and gender identity exist across multiple outcomes. Scholarship has begun to evaluate whether structural stigma-ie, societal-level conditions, cultural norms, and institutional policies that constrain opportunities, resources, and wellbeing-contributes to health burdens among LGBTQ+ individuals. We conducted a comprehensive review of quantitative studies examining this hypothesis. We found 98 articles that linked objective (ie, non-self-reported) measures of structural stigma to mental (n=57), behavioural (ie, substance use; n=27; HIV/AIDS or sexually transmitted infection; n=20), and physical (n=20) health outcomes. There was generally consistent evidence that structural stigma increases risk of poor health among LGBTQ+ individuals. Several methodological strengths were identified, including the use of multiple measures (eg, laws or policies [59%, 58 of 98]), designs (eg, quasi-experiments [21%, 21 of 98]), and samples (eg, probability-based [56%, 55 of 98]). However, important gaps exist. Just over half of studies included area-level covariates or non-LGBTQ+ comparison groups, which are necessary to address alternative explanations for the observed associations. Additionally, while studies (n=90) have begun to identify candidate mechanisms, only nine (10%) formally tested mediation. We offer suggestions for future research to advance this literature, which has implications not only for the identification of structural determinants of LGBTQ+ health but also for the development of public health interventions that reduce LGBTQ+ health disparities.
Collapse
Affiliation(s)
| | - Micah R Lattanner
- Department of Public Health, Santa Clara University, Santa Clara, CA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard University, Boston, MA, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
17
|
Neel AH, Rodríguez DC, Sikazwe I, Pillay Y, Barron P, Pereira SK, Makakole-Nene S, Bennett SC. HIV programme sustainability in Southern and Eastern Africa and the changing role of external assistance for health. Health Policy Plan 2024; 39:i107-i117. [PMID: 38253440 PMCID: PMC10803196 DOI: 10.1093/heapol/czad091] [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] [Revised: 09/13/2023] [Indexed: 01/24/2024] Open
Abstract
High human immunodeficiency virus (HIV)-prevalence countries in Southern and Eastern Africa continue to receive substantial external assistance (EA) for HIV programming, yet countries are at risk of transitioning out of HIV aid without achieving epidemic control. We sought to address two questions: (1) to what extent has HIV EA in the region been programmed and delivered in a way that supports long-term sustainability and (2) how should development agencies change operational approaches to support long-term, sustainable HIV control? We conducted 20 semi-structured key informant interviews with global and country-level respondents coupled with an analysis of Global Fund budget data for Malawi, Uganda, and Zambia (from 2017 until the present). We assessed EA practice along six dimensions of sustainability, namely financial, epidemiological, programmatic, rights-based, structural and political sustainability. Our respondents described HIV systems' vulnerability to donor departure, as well as how development partner priorities and practices have created challenges to promoting long-term HIV control. The challenges exacerbated by EA patterns include an emphasis on treatment over prevention, limiting effects on new infection rates; resistance to service integration driven in part by 'winners' under current EA patterns and challenges in ensuring coverage for marginalized populations; persistent structural barriers to effectively serving key populations and limited capacity among organizations best positioned to respond to community needs; and the need for advocacy given the erosion of political commitment by the long-term and substantive nature of HIV EA. Our recommendations include developing a robust investment case for primary prevention, providing operational support for integration processes, investing in local organizations and addressing issues of political will. While strategies must be locally crafted, our paper provides initial suggestions for how EA partners could change operational approaches to support long-term HIV control and the achievement of universal health coverage.
Collapse
Affiliation(s)
- Abigail H Neel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), 34620 Lukasu Road, Mass Media, Lusaka 10101, Zambia
| | - Yogan Pillay
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Shreya K Pereira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | | | - Sara C Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| |
Collapse
|
18
|
Abu-Ba’are GR, Aidoo-Frimpong G, Stockton M, Zigah EY, Amuah S, Amu-Adu P, Amoh-Otoo RP, Nyblade L, Torpey K, Nelson LE. "I told myself, be bold and go and test": Motivators and barriers to HIV testing among gay, bisexual, and other cis-gender men who have sex with men in Ghana ‒ West Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002231. [PMID: 38206889 PMCID: PMC10783711 DOI: 10.1371/journal.pgph.0002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024]
Abstract
Despite a disproportionately high burden of HIV, GBMSM in Ghana and sub-Saharan Africa often delay testing until the point of illness. However, limited studies examine factors that affect their participation in testing. We used qualitative in-depth interviews (IDIs) and focus group discussions (FGDs) to collect insights into experiences, motivators, and barriers to HIV testing among GBMSM. Two community-based organizations used snowball and convenience sampling to recruit 10 GBMSM for IDIs and 8 to 12 for FGDs. We transcribed, coded, identified, and analyzed the relationship and commonalities between the participants' responses. Under experiences with testing, 1) fear of HIV infection created a stressful HIV testing experience, and 2) a friendly and supportive healthcare environment facilitated a positive experience in healthcare facilities. Motivators or facilitators of testing include 1) the perception or belief that HIV testing is an HIV prevention strategy; 2) encouragement from friends and peers; 3) understanding risk associated with certain sexual behaviors; 4) education or information on HIV; 5) access to free testing and incentives; 6) early symptoms and provider recommendation. Barriers to HIV testing include 1) negative community perceptions of HIV; 2) individual-level low-risk perception or indifference about HIV infection; 3) health system issues; 5) Perceived stigma at healthcare facilities. The findings point to the need to address critical issues around stigma, education, peer support, and healthcare resources through interventions and research to improve HIV testing among GBMSM in the country.
Collapse
Affiliation(s)
- Gamji Rabiu Abu-Ba’are
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
- Behavioral, Sexual and Global Health Lab, West Africa Site, Jama’a Action, West Legon, Accra, Ghana
| | - Gloria Aidoo-Frimpong
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Melissa Stockton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual and Global Health Lab, West Africa Site, Jama’a Action, West Legon, Accra, Ghana
- Priorities on Rights and Sexual Health, Accra, Ghana
| | - Samuel Amuah
- Youth Alliance for Health and Human Rights, Kumasi, Ghana
| | | | | | - Laura Nyblade
- RTI International, Washington, District of Columbia, United States of America
| | - Kwasi Torpey
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - LaRon E. Nelson
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
| |
Collapse
|
19
|
Smith-Sreen J, Bosire R, Farquhar C, Katz DA, Kimani J, Masyuko S, Mello MJ, Aluisio AR. Leveraging emergency care to reach key populations for 'the last mile' in HIV programming: a waiting opportunity. AIDS 2023; 37:2421-2424. [PMID: 37965739 PMCID: PMC10655840 DOI: 10.1097/qad.0000000000003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Joshua Smith-Sreen
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Carey Farquhar
- Department of Global Health
- Department of Epidemiology
- Medicine, University of Washington, Seattle, Washington, USA
| | | | - Joshua Kimani
- University of Nairobi College of Health Sciences, Institute of Tropical and Infectious Diseases, Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
20
|
Decriminalisation and the end of AIDS: keep the promise, follow the science, and fulfill human rights. Sex Reprod Health Matters 2023; 31:2194188. [PMID: 37351922 PMCID: PMC10291907 DOI: 10.1080/26410397.2023.2194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
|
21
|
Baral S, Millett G, Syarif O, Turpin N, Schwartz S. There is no path to ending AIDS by 2030 without improving human rights. J Int AIDS Soc 2023; 26:e26197. [PMID: 38063252 PMCID: PMC10704397 DOI: 10.1002/jia2.26197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Stefan Baral
- Center for Public Health and Human RightsDepartment of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMarylandUSA
| | - Gregorio Millett
- Public Policy OfficeThe Foundation for AIDS Research (amfAR)WashingtonDistrict of ColumbiaUSA
| | - Omar Syarif
- Global Network of People Living with HIV (GNP+)AmsterdamNetherlands
| | | | - Sheree Schwartz
- Center for Public Health and Human RightsDepartment of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMarylandUSA
| |
Collapse
|
22
|
Iroezindu MO, Crowell TA, Ogoina D, Yinka-Ogunleye A. Human Mpox in People Living with HIV: Epidemiologic and Clinical Perspectives from Nigeria. AIDS Res Hum Retroviruses 2023; 39:593-600. [PMID: 37646422 DOI: 10.1089/aid.2023.0034] [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] [Indexed: 09/01/2023] Open
Abstract
Sub-Saharan Africa (SSA) is disproportionately affected by mpox and HIV. We described epidemiologic trends and clinical experiences in the management of mpox in people living with HIV (PLWH) in Nigeria and further examined how the rapidly accumulating body of knowledge from the 2022 global mpox outbreak might be explored to improve mpox care in PLWH in SSA. During the 2017/2018 Nigerian mpox outbreak, we reported that 9/40 (22.5%) hospitalized mpox patients with known HIV status were PLWH. In the 2022 global mpox outbreak, 52% of confirmed mpox cases with known HIV status were PLWH, predominantly sexual and gender minority groups. However, substantial missing data on HIV status of confirmed mpox cases highlights a critical gap in HIV testing as a component of mpox management. Before 2022, sexual activity was not commonly linked to mpox transmission, but this was identified as a major driver of transmission during the 2022 mpox outbreak. Notable sexual history observed in Nigerian mpox patients in 2017/2018 suggests that the contribution of sexual activity in human-to-human mpox transmission might have been underappreciated for years. Our cohort of PLWH with mpox, predominantly individuals with advanced or uncontrolled HIV, were significantly more likely to experience severe mpox manifestations and prolonged disease compared with those without HIV. This contrasts with the generally less remarkable differences in mpox presentation between people with and without HIV in Western countries, an observation that can be at least partially explained by more stable HIV disease. The unavailability of mpox antiviral drugs and vaccines in SSA highlights global inequity in mpox response, which requires an urgent attention. As mpox countermeasures become available in SSA, lessons learned from their use in Western countries could provide important guidance for care providers in SSA. Public health measures to mitigate stigmatization in PLWH with mpox is also critical.
Collapse
Affiliation(s)
- Michael O Iroezindu
- Clinical Research Center, HJF Medical Research International, Abuja, Nigeria
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Dimie Ogoina
- Infectious Disease Unit, Niger Delta University Teaching Hospital, Okolobiri, Nigeria
| | | |
Collapse
|
23
|
Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany-Moretlwe S, Taiwo B, Masters MC, Lazarus JV. HIV infection. Nat Rev Dis Primers 2023; 9:42. [PMID: 37591865 DOI: 10.1038/s41572-023-00452-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
Collapse
Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
24
|
Hinman K, Sun N, Amon JJ. Ensuring access to justice: the need for community paralegals to end AIDS by 2030. J Int AIDS Soc 2023; 26:e26146. [PMID: 37535441 PMCID: PMC10399720 DOI: 10.1002/jia2.26146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION The HIV response has long recognized that certain "key populations" such as individuals in detention, adolescent girls and young women, sex workers, people who use drugs, LGBTQ individuals, migrants and others face higher barriers to access to, uptake of, and retention in HIV prevention and treatment services. One approach to addressing these barriers is the training of community paralegals to advocate for the rights of individuals and to address discrimination in health settings. DISCUSSION Community paralegal programmes have been able to successfully address rights violations that impact access to health services and underlying determinants of health across a range of countries and populations, focusing upon issues such as discrimination and the denial of health services; unlawful detention of outreach workers, sex workers, persons who use drugs and men who have sex with men; and harmful traditional practices and gender-based violence. In addition to resolving specific cases, evaluations of paralegal programmes have found that these programmes increased legal literacy among key populations at risk of HIV and increased understanding of human rights among healthcare providers, resulting in improved access to HIV services. Some evaluations have noted challenges related to the sustainability of paralegal programmes similar to those raised with community health worker programmes more broadly. CONCLUSIONS To achieve global HIV goals, funding for legal literacy and paralegal programmes should be increased and interventions should be rigorously evaluated. Efforts should target discrimination in access to HIV prevention and treatment and criminalization of key populations, two key barriers to ensuring access to HIV prevention and treatment services.
Collapse
Affiliation(s)
- Kati Hinman
- Office of Global HealthDornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Nina Sun
- Office of Global HealthDornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Joseph J. Amon
- Office of Global HealthDornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
25
|
Nkengasong J, Ratevosian J. Legal and policy barriers for an effective HIV/AIDS response. Lancet 2023; 401:1405-1407. [PMID: 37030314 DOI: 10.1016/s0140-6736(23)00729-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/10/2023]
|