Social and individual risk determinants of HIV testing practices among noninjection drug users at high risk for HIV/AIDS

Translation and Validation: Chinese Version of the HIV-Related Social Support Scale

Purpose

Social support is increasingly recognized to be important in care of people living with HIV/AIDS (PLWH), we firstly translate and validate the disease-targeted social support instrument in Chinese and to explore the correlation with WHOQOL-HIV.

Patients and Methods

We established content validity for HIV-related social support scale (HSSS) and administered the resultant questionnaire to 310 PLWH. Descriptive statistics were generated for each of the variables of general characteristics; student t-test was used to compare the different groups.

Results

The HSSS demonstrated a high level of internal consistency, both within each subscale and with the total score; all Cronbach’s α values exceeded a priori threshold of ≥0.70. The HSSS cores were positively correlated with WHOQOL-HIV total scores (Pearson correlation: 0.39, P < 0.001). We also found that higher educational level, personal income, CD4 cell count, and shorter duration of antiretroviral therapy are significantly associated with a higher level of social support (P < 0.05).

Conclusion

Social support may improve quality of life for PLWH, Chinese version of HIV-related social support scale can be used in future clinical practice.

"To Me, Everybody Is infected": Understanding Narratives about HIV Risk among HIV-negative Black Men Who Have Sex with Men in the Deep South

For black MSM living in the Deep South, the intersection of sexuality, race, and geography impacts HIV risk substantially. Between July and September 2016, we conducted a qualitative study among HIV-negative black MSM in five southern cities in the US with elevated HIV prevalence. Analysis included assessment of interrater reliability, cluster analysis, and descriptive statistics. We enrolled 99 black MSM (mean age: 33.6; SD = 12.8; range: 17-68 years). Four overarching themes emerged: harboring fear of HIV and the internalization of HIV stigma; scrutinizing potential partners to assess riskiness and HIV status; embracing distance and isolation from those perceived as a threat to HIV status; and exhibiting self-efficacy toward HIV prevention and utilizing risk reduction strategies. Future HIV prevention efforts may benefit by balancing risk and deficit based strategies with those that emphasize resilience, address disenfranchisement via structural interventions, and assess and treat inherent trauma(s).

Emotional and physical reactions to perceived discrimination, language preference, and health-related quality of life among Latinos and Whites

PURPOSE

To investigate whether emotional and physical reactions to perceived discrimination are associated with health-related quality of life (HRQOL) among whites and Latinos (by language preference) in Arizona.

METHODS

A cross-sectional analysis using the Arizona Behavioral Risk Factor Surveillance System (2012-2014) was restricted to non-Hispanic white and Latino (grouped by English- or Spanish-language preference) participants who completed the Reactions to Race optional module (N = 14,623). Four core items from the Centers for Disease Control and Prevention's Healthy Days Measures were included: self-rated health; physically unhealthy, mentally unhealthy; and functionally limited days. Poisson regression models estimated prevalence ratios and 95% confidence intervals (CIs) for poor self-rated health. Multinomial logistic models estimated odds ratios and 95% CI for poor mental, physical, and functionally limited days (defined as 14 + more days). Models were adjusted for sociodemographics, health behaviors, and multimorbidity.

RESULTS

Reports of emotional and physical reactions to perceived discrimination were highest among Spanish-language preference Latinos. Both Spanish- and English-language preference Latinos were more likely to report poor self-rated health in comparison to whites. In separate fully adjusted models, physical reactions were positively associated with each HRQOL measure. Emotional reactions were only associated with reporting 14 + mental unhealthy (aOR 3.16; 95% CI 1.82; 5.48) and functionally limited days (aOR 1.93; 95% CI 1.04, 3.58).

CONCLUSIONS

Findings from this study suggest that physical and emotional reactions to perceived discrimination can manifest as diminished HRQOL. Consistent collection of population-based measures of perceived discrimination is warranted to track and monitor differential health vulnerability that affect Latinos.

HIV Testing in Clinical and Community Settings for an International Sample of Latino Immigrants and Nonimmigrants

Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.

Risk behaviors for sexually transmitted infections in noninjecting drug users: A cross-sectional study

The objective of this study was to investigate risk behaviors for sexually transmitted infections (STIs) in noninjecting drug users (NIDUs), using STI diagnosis history as an indicator. A cross-sectional study was conducted in 323 NIDUs of two facilities for alcohol and/or drug dependence treatment in the Goiás State, Central Brazil. All participants were interviewed about risk behaviors and STI history. Multivariable analysis was performed in order to identify predictors of STIs. Adjusted prevalence ratio (APR) with confidence intervals of 95% was obtained using a Poisson regression model. Prevalence of self-reported STIs in the previous 12 months was 25.4% (95% confidence interval [95% CI]: 21.0-30.4%). A multivariable model verified that age (APR: 1.01; 95% CI: 1.00-1.01), sexual contact with partners diagnosed with STIs (APR: 1.27; 95% CI: 1.12-1.45) and injecting drug users (IDUs) (APR: 1.14; 95% CI: 1.14; 95% CI: 1.01-1.31), exchange sex for money and/or drugs (APR: 1.12; 95% CI: 1.02-1.21), and a history of sexual violence (APR: 1.04; 95% CI: 1.04-1.32) were predictors of STIs. Elevated rates of STI history and risk behaviors were observed in NIDUs, supporting the vulnerability of this group for these infections. Public policies and health outreach should be intensified in this population, principally regular STI testing of individuals in treatment for drug dependence and their sexual partners.

Multiplex Relationships and HIV: Implications for Network-Based Interventions

The number of network members and the roles they play can influence risk behaviors and consequently intervention strategies to reduce HIV transmission. We recruited 652 people who use drugs (PWUD) from socially disadvantaged neighborhoods in New York City (07/2006-06/2009). Interviewer-administered surveys ascertained demographic, behavioral, and network data. We used logistic regression, stratified by exchange sex, to assess the relationship between HIV status and the number of network members with different roles, treated as independent and multiplex (i.e., drug + sex). Those with more multiplex risk ties were significantly more likely to be HIV positive, but only among those not reporting exchange sex (AOR = 3.2). Among those reporting exchange sex, men reporting recent male sex partners were more likely to report HIV positive status (AOR = 12.6). These data suggest that sex and drug relationships among PWUD are interrelated. Interventions that target multiplex rather than single-role relationships may be more effective in influencing behavior change.

Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review

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.

HIV Testing Behavior and Social Network Characteristics and Functions Among Young Men Who have Sex with Men (YMSM) in Metropolitan Detroit

HIV testing promotion is a critical HIV prevention strategy, especially among at-risk groups such as young men who have sex with men (YMSM). Based on a web survey of 194 YMSM (18-24), we examine the association of social network characteristics and functions, and of individual-level characteristics, with three HIV testing behaviors (ever, repeat, and recent testing). Network homophily was associated with recent testing in multivariable models. The network function of information acquisition was associated with ever testing and repeat testing. Perceived stigma regarding HIV-related help-seeking was negatively related to recent testing. Individual characteristics were associated with testing outcomes in all models; age, perceived behavioral control, and positive attitudes had the greatest influence. Individual characteristics had a stronger association with ever testing and repeat testing than network characteristics and functions; however, this relationship was reversed for recent testing. Findings support the value of multi-level and network-focused interventions for promoting HIV testing among YMSM.

HIV Testing in Non-Injection Drug Users: Prevalence and Associated Factors

The objective of this study was to estimate the prevalence of and identify factors associated with lifetime testing for the human immunodeficiency virus (HIV) in non-injection drug users (NIDU). A cross-sectional study was conducted with 323 individuals in clinics for chemical dependency in the state of Goiás in the Central-West region of Brazil. Logistic regression analysis was used to identify factors associated with lifetime HIV testing. Testing for HIV was associated with age, female gender, crack use, history of sexually transmitted infections, acquaintance with people living with HIV/AIDS and/or who had died from AIDS, and history of having received some instruction on HIV/AIDS prevention methods. It was found that only 26.6% reported having access to the HIV rapid test. We concluded determinants for HIV testing must be taken into account when planning prevention and programming strategies. These include the widening of testing coverage among NIDU, educational health actions, establishment of links between sexually transmitted infection prevention services and addiction treatment services, and the use of rapid tests to help people who are in contact with the virus learn about their HIV status, enter treatment, and improve their quality of life.

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

Little is known about the factors that encourage or discourage refugees to test for HIV, or to access and adhere to HIV care. In non-refugee populations, social support has been shown to influence HIV testing and utilisation of services. The present study enrolled HIV-infected refugees on anti-retroviral therapy (ART) in Uganda, who participated in qualitative interviews on HIV testing, treatment, and adherence. Interviews were analysed for themes about four types of social support: emotional, informational, instrumental, and appraisal support. A total of 61 interviews were analysed. Four roles for these types of social support were identified: (1) informational support encouraged refugees to test for HIV; (2) emotional support helped refugees cope with a diagnosis of HIV; (3) instrumental support facilitated adherence to ART and (4) after diagnosis, HIV-infected refugees provided informational and emotional support to encourage other refugees to test for HIV. These results suggest that social support influences HIV testing and treatment among refugees. Future interventions should capitalise on social support within a refugee settlement to facilitate testing and treatment.

Factors associated with HIV testing among male motorbike taxi drivers in urban Vietnam

Using the Attitude-Skills-Knowledge (ASK) model, this study examined the prevalence of, and factors associated with, human immunodeficiency virus (HIV) testing among male motorbike taxi drivers (MMTDs). In a cross-sectional design, using quantitative approaches, 291 MMTDs were recruited from 135 sites across 13 districts in Hanoi, Vietnam, for a face-to-face interview. Applying the ASK model modified as a central theory, logistic regression was used to identify determinants of HIV testing. Although many MMTDs engaged in multiple risk behaviours for HIV, only 20.6% had been tested for HIV during the past 12 months. The tested model included one factor of the ASK model, HIV prevention knowledge (adjusted odds ratio [AOR] = 4.76; 95% confidence interval [CI] = 2.12-10.7) and five additional factors: being married (AOR = 3.13; 95% CI = 1.25-4.78), preferring sex with men or with both men and women (AOR = 8.72; 95% CI = 1.48-51.5), having lower number of lifetime sex partners (AOR = 0.66; 95% CI = 0.49-0.88), higher number of past year sex partners (AOR = 2.97: 95% CI = 1.21-7.31) and discussing condom use when having sex with partners (AOR = 0.08; 95% CI = 0.01-7.31). This modified ASK model provided better fit than the ASK model, as it explained more variance in HIV testing (47 vs. 29.8%). Recognising factors associated with HIV testing among MMTDs enables us to create suitable public health intervention strategies.