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Social Support Associated with Condom Use Behavior Among Female Sex Workers in Iran. Int J Behav Med 2022; 29:321-333. [PMID: 34476736 PMCID: PMC8412856 DOI: 10.1007/s12529-021-10017-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the widespread knowledge about social support and health, there is little information about the association between social support and HIV risk behaviors such as condom use among female sex workers (FSWs) in Iran. This study aimed to determine the association between social support and frequency of condom use among FSWs in Tehran, Iran. METHODS Using mixed sampling methods, we recruited 170 FSWs in Tehran in 2017. We measured self-reported social support by face-to-face interviews using a standardized questionnaire. Linear regression was used to assess the association between socio-demographic characteristics (age, education level, marital status, and place of living), transactional sex characteristics (age at first transactional sex and frequency of transactional sex in the last month), HIV knowledge, social support network characteristics (social network size, duration of tie, intimacy, social support), and condom use behavior. RESULTS Of the total of 1193 persons in FSW's social networks, 615 (51%) were sexual partners, 529 (44%) were peer sex workers, and 36 (5%) were family members. The participants perceived moderate social support from sexual partners, low from peer sex workers, and very low from family members. Adjusted for individual and other network characteristics, peer sex worker social support (b = 0.28, 95%CI 0.06, 0.50), and family support (b = 1.12, 95%CI 0.028, 2.23) were significantly associated with condom use. CONCLUSION Family and peer sex worker social support are associated with condom use, but less strongly than HIV knowledge or place of living. However, very few FSWs are socially connected with families. Interventions to promote condom use among this vulnerable population should also consider social and familial support.
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Jorjoran Shushtari Z, Salimi Y, Hosseini SA, Sajjadi H, Snijders TAB. Determinants of safe sexual behavior of female sex workers in Tehran: the woman, her network, and the sexual partner. BMC Public Health 2021; 21:2219. [PMID: 34872543 PMCID: PMC8647307 DOI: 10.1186/s12889-021-12266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the steady growth of sexual transmission of HIV, there is little evidence about safe sexual behavior of FSWs, and social network effects on this behavior, in Iran. Our aim in this study was to determine the effect of social network characteristics on condom use among FSWs, considering individual characteristics of the FSWs and of their sexual partners, characteristics of their relationship, and the FSW's personal network. METHODS A cross-sectional ego-centric network survey of 170 FSWs was carried out in Tehran between January and June 2017. A multilevel ordered logistic regression analysis was conducted to examine the effects of individual and relational characteristics simultaneously. RESULTS Condom use in sexual relationships of the FSWs on average was rather low. Important determinants of safe sexual behavior were found both at the level of the individual FSW and at the level of the sexual partner. The main determinants at the level of the individual FSW were FSWs' age and HIV knowledge. At the level of the sexual partner, age and education of sexual partners, as well as intimacy, duration of tie, frequency of contacts with a given partner, frequency of contact, perceived social support, and perceived safe sex norms were significantly associated with condom use. CONCLUSIONS The findings highlighted that considering only the individual characteristics of female sex workers is not sufficient for effectively promoting condom use. Factors at the network and dyadic level should also be considered, especially the role of sexual partners. Network-based interventions may be useful which modify social relationships to create a social environment that can facilitate changes in sexual behavior.
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Affiliation(s)
- Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Ali Hosseini
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran.
| | - Homeira Sajjadi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran
| | - Tom A B Snijders
- Department of Sociology, University of Groningen, 9712 TG, Groningen, Netherlands
- Nuffield College, University of Oxford, Oxford, OX1 1NF, UK
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Friedler A. Sociocultural, behavioural and political factors shaping the COVID-19 pandemic: the need for a biocultural approach to understanding pandemics and (re)emerging pathogens. Glob Public Health 2020; 16:17-35. [PMID: 33019889 DOI: 10.1080/17441692.2020.1828982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although there has been increasing focus in recent years on interdisciplinary approaches to health and disease, and in particular the dimension of social inequalities in epidemics, infectious diseases have been much less focused on. This is especially true in the area of cultural dynamics and their effects on pathogen behaviours, although there is evidence to suggest that this relationship is central to shaping our interactions with infectious disease agents on a variety of levels. This paper makes a case for a biocultural approach to pandemics such as COVID-19. It then uses this biocultural framework to examine the anthropogenic dynamics that influenced and continue to shape the COVID-19 pandemic, both during its initial phase and during critical intersections of the pandemic. Through this understanding of biocultural interactions between people, animals and pathogens, a broader societal and political dimension is drawn as a function of population level and international cultures, to reflect on the culturally mediated differential burden of the pandemic. Ultimately, it is argued that a biocultural perspective on infectious disease pandemics will allow for critical reflection on how culture shapes our behaviours at all levels, and how the effects of these behaviours are ultimately foundational to pathogen ecology and evolution.
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Affiliation(s)
- Anna Friedler
- Département des sciences humaines et sociales, École des Hautes Études en Santé Publique - Campus de Paris, Saint-Denis, France.,l'Unité des Virus Emergents, Aix-Marseille Université, Marseille, France
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Jorjoran Shushtari Z, Hosseini SA, Sajjadi H, Salimi Y, Shahesmaeili A, Snijders TA. HIV risk perception and sexual behaviors among female sex workers in Tehran, Iran. Med J Islam Repub Iran 2019; 33:101. [PMID: 31934561 PMCID: PMC6946931 DOI: 10.34171/mjiri.33.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background: An adequate perception of the degree to which one is at risk of having or contracting HIV is necessary for behavioural change and the adoption of safe behaviours. There are limited data regarding HIV risk perceptions among female sex workers in Iran. This study aimed to determine the HIV risk perception status and its association with sexual behaviours among female sex workers in Tehran. Methods: A cross sectional study was conducted among 170 female sex workers in Tehran. Participants were recruited using a combination of snowball, purposeful, and convenience sampling methods. Multiple logistic regression was used to identify adjusted associations between background factors, sexual behaviours, and HIV risk perception. The analysis was conducted by the "logistf" package in the R statistical system. P-value less than .05 was considered as statistically significant. Results: Among the participants, 122 (77%) reported high HIV risk perception. Most female sex workers with high HIV risk perception reported that they did not consistently use condoms (n=120, 98%. Female sex workers with a higher frequency of sex work (AOR=1.18, 95% CI: 1.08, 1.31), inconsistent condom use (AOR=0.15, 95% CI: 0.02, 0.66), a history of HIV testing (AOR=5.1, 95% CI: 1.2, 26.0), and low HIV knowledge (AOR=0.97, 95% CI=0.95, 0.996) were more likely to report high HIV risk perception. Conclusion: Most female sex workers with risky sexual behaviours had a high HIV risk perception. Effective educational programs are suggested to enable female sex workers to correctly assess their own HIV risk and change risk behaviors based on self-assessment of actual risk.
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Affiliation(s)
- Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Armita Shahesmaeili
- 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
| | - Tom A.B. Snijders
- Department of Sociology, University of Groningen, 9712 TG Groningen, Netherlands
- Nuffield College, University of Oxford, OX1 1NF Oxford, United Kingdom
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Reynolds GL, Fisher DG. A latent class analysis of alcohol and drug use immediately before or during sex among women. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:179-188. [PMID: 30359095 DOI: 10.1080/00952990.2018.1528266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Alcohol and drug use by women is related to high-risk sexual practices and protective behaviors. OBJECTIVES To determine sexual risk and protective behaviors using information about women's drug use immediately before or during sex. METHODS Latent class analysis using PROC LCA in SAS software was used to determine classes of women using both past 30-day drug use and before or during sex. Participants were recruited from a community-based research site located in a low socio-economic area of Los Angeles County and completed the Risk Behavior Assessment, which elicits information on drug and sex risk behaviors. RESULTS The Risk Behavior Assessment and HIV and sexually transmitted infections testing was obtained on 812 women. Five distinct groups were identified by PROC LCA: An Abstinent group comprised of 26% of participants; an Alcohol and Marijuana group (16%); an Amphetamine group (11%); a No Sex-with-Alcohol group (37%); and a Poly Drug group (11%). Multinomial logistic regression revealed that sexual behaviors and condom use were different across the five groups: The Alcohol and Marijuana group had a higher odds of vaginal intercourse, while the No Sex-with-Alcohol group was most likely to use condoms for vaginal intercourse. The Poly Drug group had the highest risk for anal intercourse while the Amphetamine and Poly Drug groups had high proportions of women with injection-drug using and men-who-have-sex-with-men sexual partners. CONCLUSION Identifying women based on drug use immediately before or during sex can help providers understand prevention and risk-reduction practices and interventions for drug-using women.
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Affiliation(s)
- Grace L Reynolds
- a Department of Health Care Administration , California State University , Long Beach , CA , USA.,b Center for Behavioral Research and Services , California State University , Long Beach , CA , USA
| | - Dennis G Fisher
- b Center for Behavioral Research and Services , California State University , Long Beach , CA , USA.,c Psychology Department , California State University , Long Beach , CA , USA
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Shushtari ZJ, Hosseini SA, Sajjadi H, Salimi Y, Latkin C, Snijders TAB. Social network and HIV risk behaviors in female sex workers: a systematic review. BMC Public Health 2018; 18:1020. [PMID: 30115056 PMCID: PMC6097207 DOI: 10.1186/s12889-018-5944-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Social network characteristics have an important role in understanding HIV transmission among female sex workers. The purpose of this systematic review was to summarize and critically appraise the existing studies on the social network characteristics and HIV risk behaviors among female sex workers. Method A systematic review was performed using predefined eligibility criteria through searching electronic databases. Two independent reviewers assessed the methodological quality of studies. Results Nineteen papers met the eligible review criteria. The synthesized evidence suggests that characteristics of social networks, especially functional characteristics such as social support and social capital, are important constructs for understanding the HIV risk behaviors. Conclusions The findings of the present review enhance our understanding of the role of social network characteristics in HIV risk behaviors among female sex workers. However, the findings also highlighted a dearth of knowledge about the association of structural characteristics of social networks with HIV risk behaviors among female sex workers.
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Affiliation(s)
- Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran
| | - Seyed Ali Hosseini
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, P.O Box: 1985713834, Tehran, Iran.
| | - Homeira Sajjadi
- Social welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Yahya Salimi
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Carl Latkin
- Department of Health, Behavior and Society, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tom A B Snijders
- Department of Sociology, University of Groningen, 9712, TG Groningen, Netherlands.,Nuffield College, University of Oxford, Oxford, OX1 1NF, UK
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Ghosh D, Krishnan A, Gibson B, Brown SE, Latkin CA, Altice FL. Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review. AIDS Behav 2017; 21:1183-1207. [PMID: 27125244 DOI: 10.1007/s10461-016-1413-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.
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Affiliation(s)
- Debarchana Ghosh
- Department of Geography and Institute for Collaboration on Health Intervention and Prevention, University of Connecticut, 215 Glenbrook Road, AUST 421, U-4148, Storrs, CT, 06269, USA.
| | - Archana Krishnan
- Department of Communication, University at Albany, SUNY, Albany, NY, USA
| | - Britton Gibson
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Shan-Estelle Brown
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Epidemiology, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frederick L Altice
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Trenz RC, Scherer M, Whitehead NE, Latimer WW. Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users. Subst Use Misuse 2016; 51:1716-23. [PMID: 27487197 PMCID: PMC5024347 DOI: 10.1080/10826084.2016.1197260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. OBJECTIVES To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. METHODS Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. RESULTS Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. CONCLUSIONS The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.
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Affiliation(s)
- Rebecca C Trenz
- a School of Social and Behavioral Sciences, Mercy College , Dobbs Ferry , New York , USA
| | - Michael Scherer
- b Pacific Institute for Research and Evaluation , Calverton , Maryland , USA
| | - Nicole Ennis Whitehead
- c Department of Clinical and Health Psychology, University of Florida , Gainesville , Florida , USA
| | - William W Latimer
- d Department of Health Sciences, Lehman College , West Bronx , New York , USA
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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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Kingori C, Reece M, Obeng S, Murray M, Shacham E, Dodge B, Akach E, Ngatia P, Ojakaa D. Impact of internalized stigma on HIV prevention behaviors among HIV-infected individuals seeking HIV care in Kenya. AIDS Patient Care STDS 2012; 26:761-8. [PMID: 23113743 DOI: 10.1089/apc.2012.0258] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. HIV-positive individuals are likely to internalize stigma, may suffer from psychosocial issues, or engage in maladaptive behaviors to cope with the diagnosis. Internalized stigma stems from fear of stigmatization also known as felt stigma. The current study examined the impact of HIV felt stigma on overall health and success of HIV prevention behaviors among 370 participants living with HIV and receiving care at an urban HIV clinic in Kenya. An 18-item instrument was cross culturally adapted to measure felt stigma. Descriptive and logistic regression analyses examined the data. Findings indicate that 25.9% (n=96) of participants who reported experiencing high levels of felt stigma related to other people's attitudes toward their condition, ostracizing, and a disruption of their personal life, were likely to not adhere to prescribed HIV medication and not disclose their HIV serostatus to one other person. Those who also experienced felt stigma related to a disruption of their personal lives while mediated by depression were likely to report poor overall health. Findings support having HIV clinics and interventions develop relevant HIV prevention strategies that focus on the emerging dimensions of felt stigma which can significantly impact disclosure of serostatus, medication adherence, and overall health.
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Affiliation(s)
- Caroline Kingori
- Department of Social and Public Health, Ohio University, Athens Ohio
| | - Michael Reece
- Center for Sexual Health Promotion, School of Health and Physical Education, Indiana University, Bloomington, Indiana
| | - Samuel Obeng
- African Studies Program, School of Health and Physical Education, Indiana University, Bloomington, Indiana
| | - Maresa Murray
- Department of Applied Health Science, School of Health and Physical Education, Indiana University, Bloomington, Indiana
| | - Enbal Shacham
- Department of Behavioral Sciences and Health Education, School of Public Health, Saint Louis University, St. Louis, Missouri
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Health and Physical Education, Indiana University, Bloomington, Indiana
| | - Emannuel Akach
- African Medical Research Foundation (AMREF), Nairobi, Kenya
| | - Peter Ngatia
- African Medical Research Foundation (AMREF), Nairobi, Kenya
| | - David Ojakaa
- African Medical Research Foundation (AMREF), Nairobi, Kenya
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Harrell PT, Mancha BE, Petras H, Trenz RC, Latimer WW. Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors. Drug Alcohol Depend 2012; 122:220-7. [PMID: 22030276 PMCID: PMC3309123 DOI: 10.1016/j.drugalcdep.2011.10.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 09/30/2011] [Accepted: 10/02/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections. METHODS Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV. RESULTS Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR=6.97, 95% CI=4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR=2.66, 95% CI=1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR=2.50, 95% CI=1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR=0.10, 95% CI=0.06-0.18), but no significant differences were found for HIV. CONCLUSIONS Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.
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Affiliation(s)
- P T Harrell
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD 21205, United States.
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Gwizdala RA, Miller M, Bhat M, Vavagiakis P, Henry C, Neaigus A, Shi Q, Lowy FD. Staphylococcus aureus colonization and infection among drug users: identification of hidden networks. Am J Public Health 2011; 101:1268-76. [PMID: 21653250 DOI: 10.2105/ajph.2010.300028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We combined social-network analysis and molecular epidemiology to investigate Staphylococcus aureus among drug users. METHODS From 2003 through 2005, we recruited adult drug users in Brooklyn, New York. Of 501 individuals recruited, 485 participated. Participants were screened for HIV infection and S. aureus carriage, and they answered a questionnaire assessing risk factors for S. aureus. Participants were asked to nominate up to 10 members of their social networks, and they were invited to recruit nominees to participate. RESULTS We identified 89 sociocentric risk networks, 1 of which contained 327 (67%) members. One third of participants were either colonized (20%) or infected (19%) with S. aureus. Overall strain similarity was unusually high, suggesting spread within and across networks. In multivariate analysis, 7 health-related and drug-use variables remained independently associated with infection. Moreover, 27% of nominees were not drug users. CONCLUSIONS We found a large, linked, hidden network among participants, with no discernible clustering of closely related strains. Our results suggest that once a pathogen is introduced into a sociocentric network of active drug users, an identifiable community S. aureus reservoir is likely created, with significant linkages to the general population.
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Affiliation(s)
- Robert A Gwizdala
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Miller M, Liao Y, Wagner M, Korves C. HIV, the clustering of sexually transmitted infections, and sex risk among African American women who use drugs. Sex Transm Dis 2008; 35:696-702. [PMID: 18418289 DOI: 10.1097/olq.0b013e31816b1fb8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED African American women have high rates of most sexually transmitted infections (STIs), including HIV. STIs have been associated with increased HIV transmission risk. METHODS Two hundred twenty-eight black women who used drugs completed a structured questionnaire in a central Brooklyn, NY-based research center between March 2003 and August 2005. Women were screened for HIV, herpes simplex virus-2, syphilis, gonorrhea, chlamydia, and trichomoniasis. This analysis determined if STIs cluster within individuals and if clustering and sex practices or partnerships differ by HIV status. RESULTS Thirty-eight (17%) women tested HIV seropositive and STI prevalence was herpes simplex virus-2 (79%), trichomoniasis (37%), chlamydia (11%), and gonorrhea (2%). Few women knew themselves to be infected with STIs other than HIV. Excluding HIV, the mean number of STIs per woman was 1.3 (SD 0.7). HIV-infected women were significantly more likely than uninfected women to have multiple positive screens (1.6 vs. 1.2, P = 0.002). Women reported having both lower and higher risk sex partners. HIV-infected women were 2 times more likely than uninfected woman to report current sex work (P = 0.05), the only difference in sex risk. In a linear regression model, crack cocaine use was uniquely associated with multiple positive STI screens, excluding HIV (P = 0.002). CONCLUSIONS Several STIs, including HIV, seem to be endemic among black women who use drugs in this community. In addition to the known geographical clustering of HIV and STIs, STIs were also found to cluster at the individual level. Multiply STI infected individuals may unknowingly, but efficiently, contribute to high STI and HIV rates.
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Affiliation(s)
- Maureen Miller
- Department of Epidemiology and Biostatistics, School of Public Health, New York Medical College, Valhalla, NY 10595, USA.
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