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Miedema SS, Stamatakis C, Tracy A, Hegle J, Kamagate MF, McOwen J, Augusto A, Manuel P, Coomer R, Kambona C, Ramphalla P, Niolon P, Patel P, Annor FB. Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa. CHILD ABUSE & NEGLECT 2024; 150:106494. [PMID: 37806930 DOI: 10.1016/j.chiabu.2023.106494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Multiple adverse childhood experiences (ACEs) are associated with poor sexual and mental health outcomes in low- and middle-income countries (LMICs). Less well understood is how discrete and gendered clustering of ACEs may influence health. OBJECTIVE To assess how multiple ACEs co-occur and how dominant patterns of co-occurrence are associated with mental distress, substance use, and sexual risk behaviors among young women and men in Sub-Saharan Africa. PARTICIPANTS AND SETTING We used pooled data of young men and women aged 19-24 from comparable, nationally representative Violence Against Children and Youth Surveys (VACS) conducted in Cote d'Ivoire, Kenya, Lesotho, Mozambique, and Namibia (nf = 7183; nm = 2207). METHODS We estimated sex-disaggregated latent classes of six ACEs among young women and men. We ran Bolck-Croon-Hagenaars (BCH) distal outcome analysis to test the sex-stratified relationships between ACEs latent classes and health outcomes. RESULTS A six class solution best fit the female data. Classes included witnessing violence and experiencing physical violence (PV); experiencing PV; high ACEs; witnessing community violence; orphanhood; and low ACEs exposure. Among males, the best-fitting three-class solution included experiencing PV and witnessing community violence; high ACEs; and low ACEs exposure. Membership in the high ACEs class was associated with mental distress among females and males, and substance use among males. No differences in sexual risk behavior were identified by class membership among either females or males. CONCLUSIONS Discrete clusters of co-occurring ACEs are associated with elevated odds of mental distress among females, and mental distress and substance use among males. Preventing ACEs may improve mental health among young women and men in LMICs in Sub-Saharan Africa.
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Affiliation(s)
- Stephanie Spaid Miedema
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Caroline Stamatakis
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Rwanda
| | | | - Jennifer Hegle
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jordan McOwen
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Pedro Manuel
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | - Phyllis Niolon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pragna Patel
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bhushan NL, Chen JS, Maierhofer CN, Rutstein SE, Matoga M, Jere E, Massa C, Ndalama B, Bonongwe N, Mathiya E, Hoffman IF, Powers KA, Schwartz E, Phiri S, Miller WC, Lancaster KE. Depression, Alcohol Use, and Sexual Behaviors by HIV Infection Stage and Diagnosis Timing Among STI Clinic Patients in Lilongwe, Malawi. AIDS Behav 2023; 27:3612-3622. [PMID: 37195470 DOI: 10.1007/s10461-023-04075-3] [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: 05/03/2023] [Indexed: 05/18/2023]
Abstract
Understanding depression, alcohol use, and sexual behaviors according to HIV infection stage and diagnosis timing is important for HIV prevention efforts. We enrolled persons with recent infection and diagnosis (i.e., acute HIV infection (AHI) (n = 92) persons newly diagnosed seropositive (n = 360)) and persons previously diagnosed with HIV (n = 190) into a randomized controlled trial in Lilongwe, Malawi (N = 641) and estimated the prevalence of probable depression (Patient Health Questionnaire-9 ≥ 5), hazardous alcohol use (Alcohol Use Disorder Identification Test-C: men ≥ 4; women ≥ 3), and sexual behaviors (transactional sex, condomless sex). Compared with previously diagnosed participants, participants newly seropositive and those with AHI reported a higher proportion of probable depression (7%, 27%, 38%; AHI/Previous: Table Probability: 0.02, p < 0.01; AHI/New: Table Probability: <0.01, p < 0.01), hazardous alcohol use (8%, 18%, 29%; AHI/Previous and AHI/New: Table Probability: <0.01, p < 0.01), and transactional sex (5%, 14%, 20%; AHI/Previous: Table Probability: <0.01, p < 0.01; AHI/New: Table Probability: 0.06, p = 0.24), respectively. HIV prevention services addressing mental health and alcohol misuse may be particularly beneficial for persons with recent HIV infection and or diagnosis.
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Affiliation(s)
| | - Jane S Chen
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Sarah E Rutstein
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | - Irving F Hoffman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Sam Phiri
- RTI International, Research Triangle Park, NC, USA
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Weyandt L, DuPaul GJ, Shepard E, Labban JD, Francis A, Beatty A, Anastopoulos AD. Longitudinal Examination of Sexual Risk Behavior in College Students With and Without Attention-Deficit/Hyperactivity Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3505-3519. [PMID: 37548880 PMCID: PMC10703957 DOI: 10.1007/s10508-023-02660-0] [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] [Received: 03/04/2022] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
The present study sought to identify differences in the rates and predictors of risky sexual behavior among college students with and without attention-deficit hyperactivity disorder (ADHD). Current ADHD diagnosis, medication status among those with ADHD, executive functioning, substance use, comorbid anxiety, comorbid depression, and gender were identified as potential predictors of increased risky sexual behavior. Multiple group latent growth curve modeling was used to estimate trajectories of risky sexual behavior across four years of college among college students with ADHD (nmedicated = 99, nunmedicated = 105) and a comparison group (n = 217) recruited from colleges throughout the eastern United States (M age = 18.23 years, 53% female, 70% White). First-year college students with ADHD reported significantly higher rates of sexual risk behavior than their peers without ADHD, with no significant differences found based on medication status. Students with ADHD who were taking medication for ADHD reported significant decreases in risky sexual behavior over time. Among college students with ADHD, anxiety was related to increased current risky sexual behavior in the medicated group, while depression was predictive of decreased future risky sexual behavior in the unmedicated group. Alcohol and cannabis use were significantly associated with increased mean levels of risky sexual behavior across all three groups, and cannabis use was associated with decreased future risky sexual behavior within the comparison group. Executive functioning deficits and male gender were predictive of risky sexual behavior within the comparison group. The results demonstrate that college students with ADHD, regardless of medication status, are at an increased likelihood of engaging in risky sexual behavior.
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Affiliation(s)
- Lisa Weyandt
- Department of Psychology, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, 02881, USA
| | | | - Emily Shepard
- Department of Psychology, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, 02881, USA.
| | - Jeffrey D Labban
- School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Alyssa Francis
- Department of Psychology, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, 02881, USA
| | - Avery Beatty
- Department of Psychology, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, 02881, USA
| | - Arthur D Anastopoulos
- School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, NC, USA
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Kizito S, Namuwonge F, Nabayinda J, Nabunya P, Nattabi J, Sensoy Bahar O, Kiyingi J, Magorokosho N, Ssewamala FM. Using Hierarchical Regression to Examine the Predictors of Sexual Risk-Taking Attitudes among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Adolesc Health 2023; 73:244-251. [PMID: 37074235 PMCID: PMC10523903 DOI: 10.1016/j.jadohealth.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE We explored the factors influencing sexual risk-taking attitudes-defined as beliefs and values regarding sexual activity-among adolescents living with human immunodeficiency virus (ALHIV) in Uganda. METHODS The study used baseline data from a five-year cluster-randomized control trial (2012-2018) among 702 ALHIV in Uganda. Participants were aged 10-16 years, HIV-positive, taking antiretroviral therapy, and living within a family. We fitted hierarchical regression models to assess the demographic, economic, psychological, and social predictors of sexual risk-taking attitudes. Using R2, the final model explained 11.4% of the total variance. RESULTS Under economic factors, caregiver being formally employed (β = -0.08, 95% confidence interval [CI]: -0.10-0.06, p < .001), and the ALHIV working for pay (β = 1.78, 95% CI: 0.28-3.29, p = .022), were associated with sexual risk-taking attitudes. Among the psychological factors, more depressive symptoms (β = 0.22, 95% CI: 0.11-0.32, p < .001) were associated with more approving attitudes toward sexual risk-taking. Family and social factors including communicating with the caregiver about HIV (β = 1.32, 95% CI: 0.56-2.08, p = .001), sex (β = 1.09, 95% CI: 0.20-1.97, p = .017), and experiencing peer pressure (β = 3.37, 95% CI: 1.85-4.89, p < .001) were also associated with more approving attitudes toward sexual risk-taking. The final model explained 11.54% of the total variance. DISCUSSION Economic, psychological, and social factors influence sexual risk-taking attitudes among ALHIV. There is a need for more research to understand why discussing sex with caregivers improves adolescents' positive attitudes toward sexual risk-taking. These findings have significant ramifications in preventing sexual transmission of HIV among adolescents in low-income settings.
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Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Jennifer Nattabi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Natasja Magorokosho
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri.
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Kim K, Jang S, Rim HD, Kim SW, Chang HH, Woo J. Attachment Insecurity and Stigma as Predictors of Depression and Anxiety in People Living With HIV. Psychiatry Investig 2023; 20:418-429. [PMID: 37253467 DOI: 10.30773/pi.2022.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/26/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine whether attachment insecurity, stigma, and certain demographic and medical factors predict depression and anxiety in people living with HIV (PLWH). METHODS Participants were 147 PLWH who visited the outpatient infection clinic in Kyungpook National University Hospital (KNUH; Daegu, South Korea) between June 2020 and January 2021. We measured HIV-related stigma, attachment anxiety and avoidance, depressive symptoms, and anxiety symptoms. RESULTS Logistic regression analysis showed that unemployment, longer time receiving antiretroviral therapy, higher attachment avoidance, and higher attachment anxiety were significant predictors of depression. Results also showed that longer time receiving antiretroviral therapy, higher attachment anxiety, and concern with public attitudes were significant predictors of anxiety. CONCLUSION In addition to education to reduce public stigma, interventions to reduce PLWH's self-stigma should continue. We suggest attachment-based psychotherapy as an effective intervention to improve PLWH's mental health.
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Affiliation(s)
- Kyungmin Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seoyoung Jang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyo-Deog Rim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Omuojine JP, Nguah SB, Ayisi-Boateng NK, Sarfo FS, Ovbiagele B. Contemporary prevalence and predictors of anxiety among patients living with HIV/AIDS in Ghana. Ghana Med J 2022; 56:169-175. [PMID: 37448991 PMCID: PMC10336633 DOI: 10.4314/gmj.v56i3.6] [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: 07/18/2023] Open
Abstract
Objectives To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design The study employed a cross-sectional design. Setting The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure Proportion of PLWHA who had HADS score of ≥8. Results Overall prevalence of anxiety was 61.0% (95%CI: 56.6 - 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 - 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 - 2.38) and depression (aOR: 13.62, 95%CI: 7.91 - 23.45) were independently associated with anxiety. Conclusion In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety. Funding This study was funded by a grant from the National Institutes of Health Fogarty International Center (R21 TW010479).
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Affiliation(s)
- John-Paul Omuojine
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel B Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Marks LR, Schimmel-Bristow A, Harrell-Williams LM, Hargons C. Racial Discrimination and Risky Sex: Examining Cognitive-Emotional Factors in Black College Students. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000221092662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using the lifespan biopsychosocial model of cumulative vulnerability and minority health as a theroretical lens, the present study proposed two models to test the relationships among racial discrimination, cognitive–emotional factors, and risky sexual behaviors in a sample of 302 Black college students in the United States. Our models provided support for some of the hypothesized direct and indirect pathways. As expected, overt racial discrimination and subtle racial discrimination (i.e., racial microaggression) were both positively related to cognitive–emotional factors (i.e., anxiety, depression, hopelessness, and hostility). Racial microaggressions were significantly positively related to risky sexual behaviors, but overt racial discrimination was not. Hostility was the only cognitive–emotional factor that facilitated an indirect, significant effect from racial microaggressions to risky sexual behaviors. Potential implications are discussed for practice, training programs, and future counseling psychology research with Black college students using the lifespan biopsychosocial model of cumulative vulnerability and minority health.
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Affiliation(s)
- Laura Reid Marks
- Florida State University, Department of Educational Psychology and Research, Combined Counseling and School Psychology Program, Tallahassee, FL, USA
- University of Memphis, Department of Counseling, Educational Psychology, and Research, Memphis, TN, USA
| | - Allison Schimmel-Bristow
- University of Memphis, Department of Counseling, Educational Psychology, and Research, Memphis, TN, USA
| | - Leigh M. Harrell-Williams
- University of Memphis, Department of Counseling, Educational Psychology, and Research, Memphis, TN, USA
| | - Candice Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology, Lexington, KY, USA
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Kim K, Woo J. Predictors Associated With HIV Status Non-Disclosure in Korea. J Korean Med Sci 2022; 37:e125. [PMID: 35470599 PMCID: PMC9039200 DOI: 10.3346/jkms.2022.37.e125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) disclosure provides personal support to people living with HIV/acquired immunodeficiency syndrome (PLWH). In addition, it has important implications for disease prevention and treatment. Research on disclosure has been conducted worldwide; however, data from South Korea are insufficient. The purpose of this study was to examine whether certain demographic, medical, and psychosocial factors act as predictors of HIV serostatus non-disclosure among PLWH in South Korea. METHODS Participants consisted of 147 PLWH who visited the outpatient infection clinic between June 2020 and January 2021. Demographics, medical factors, HIV-related stigma, and depressive and anxiety symptoms were measured. RESULTS The overall disclosure rate among participants was 61.2%. Logistic regression analysis showed that lower depression (odds ratio [OR], 0.918; P = 0.021) and higher disclosure concerns (OR, 1.133; P = 0.004) were significant predictors of non-disclosure. Further, married state was a major predictor of non-disclosure when single referred (OR, 3.002; P = 0.024); however, divorce, separation, and widowed status had no significant consequences. CONCLUSION In South Korea, the rate of HIV disclosure is lower than in other countries. The higher disclosure concerns, lower depression and married state were suggested to be important predictors of HIV non-disclosure. High level of perceived stigma and experienced discrimination of PLWH may have affected the results. The social atmosphere linking sexual promiscuity and disease may also have influenced these results. Nationwide efforts should continue to reduce the overall stigma and create a social environment where PLWH can feel safe to disclose their disease conditions.
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Affiliation(s)
- Kyungmin Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea.
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Tingey L, Chambers R, Littlepage S, Slimp A, Lee A, Lee S, Melgar L, O'Keefe V, Craig M, Gaydos C, Rompalo A. 'Empowering our people' to address depression, violence, and sexual risk among Native Americans with recent binge alcohol use. ETHNICITY & HEALTH 2022; 27:733-747. [PMID: 32223325 DOI: 10.1080/13557858.2020.1740177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
Background: This study was launched in response to an American Indian (AI) community's concern regarding the comorbid occurrence of substance use, poor mental health, and other risk factors on sexual health. The purpose of this manuscript was to assess the relationship between alcohol use, violence, depression and STI/HIV risk behaviors on the frequency of unprotected sex acts and number of sexual partners among AI adults.Methods: Specifically, this analysis examines sociodemographic characteristics, experience of sexual and physical violence, binge drinking, depression, and sexual risk taking among n = 281 AI adults ages 18-55. Regression models examine associations between the aforementioned risk factors, number of sex partners and number of unprotected sex acts, by depression status and sex, among participants.Results: Frequent binge drinking predicted frequency of unprotected sex for both males and females; ever experiencing physical violence was a powerful predictor of unprotected sex for females, but not males. Ever experiencing physical violence strongly predicted having multiple sexual partners for females but was related to decreased number of sexual partners for males. Females ever experiencing sexual violence had more sexual partners; this was not observed for males. Binge drinking predicted frequency of unprotected sex acts, regardless of depression status.Discussion: Interventions for AI adults seeking to reduce sexual health risk should reflect past violence victimization in sexual decision making, primarily among women. The significant role of binge alcohol use for modifying sexual decisions should be of prime focus and interventions should be personalized to address individuals' own alcohol use patterns. Additional research should explore how binge alcohol use moderates the relationship between depression and sexual risk.
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Affiliation(s)
- Lauren Tingey
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Chambers
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shea Littlepage
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anna Slimp
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Angelita Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shauntel Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Melgar
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Victoria O'Keefe
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mariddie Craig
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Gaydos
- Center for the Development of Point of Care Tests for Sexually Transmitted Diseases, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Rompalo
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Duby Z, Verwoerd W, McClinton Appollis T, Jonas K, Maruping K, Dietrich JJ, LoVette A, Kuo C, Vanleeuw L, Mathews C. “In this place we have found sisterhood”: perceptions of how participating in a peer-group club intervention benefited South African adolescent girls and young women. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2021.1898423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Wilmé Verwoerd
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan J. Dietrich
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashleigh LoVette
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lieve Vanleeuw
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Duby Z, McClinton Appollis T, Jonas K, Maruping K, Dietrich J, LoVette A, Kuo C, Vanleeuw L, Mathews C. "As a Young Pregnant Girl… The Challenges You Face": Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa. AIDS Behav 2021; 25:344-353. [PMID: 32683636 PMCID: PMC7368608 DOI: 10.1007/s10461-020-02974-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In South Africa, adolescent girls and young women (AGYW) are at risk of poor mental health, HIV infection and early pregnancy. Poor mental health in AGYW is associated with increased sexual risk behaviours, and impeded HIV testing and care. Using in-depth interviews and focus group discussions, we explored subjective experiences of mental health and sexual and reproductive health (SRH) amongst 237 AGYW aged 15-24 years in five South African districts. Respondents shared narratives of stress, emotional isolation, feelings of depression, and suicidal ideation, interconnected with HIV, pregnancy and violence in relationships. Findings show that AGYW in South Africa face a range of mental health stressors and lack sufficient support, which intersect with SRH challenges to heighten their vulnerability. Framed within the syndemic theory, our findings suggest that South African AGYW's vulnerability towards early pregnancy, HIV infection and poor mental health are bidirectional and interconnected. Considering the overlaps and interactions between mental health and SRH amongst AGYW, it is critical that mental health components are integrated into SRH interventions.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa.
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Janan Dietrich
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
- Perinatal HIV Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashleigh LoVette
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Caroline Kuo
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lieve Vanleeuw
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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12
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Small E, Kim YK, Yu M. Sexually Transmitted Diseases Among College Students in Sierra Leone: A Life Course Ecological Analysis. SEXUALITY & CULTURE 2021; 25:884-903. [PMID: 33437142 PMCID: PMC7790596 DOI: 10.1007/s12119-020-09799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
Applying life course theory, this study examined the direct and indirect effects of adverse childhood experiences (ACEs) on the risk of contracting sexually transmitted diseases (STDs), mediated by early sexual activity (first sexual experience before age 15), number of lifetime sex partners, and mental health problems. The link between ACEs and mental health on college students' sexual risk is still understudied. Using cross-sectional data from a sample of 327 college students in Sierra Leone, this study tested the hypothesized mediation model using structural equation modeling analysis. The results showed that ACEs significantly increased sexual risks. Specifically, ACEs increased the risk of early initiation of sexual activity and the number of lifetime sex partners, which in turn increased the risk of STDs. Furthermore, ACEs significantly predicted negative mental health and were significantly associated with an increased risk of STDs. Effective future intervention strategies should include health education programs to address the lifelong effects of ACEs and mental health treatment.
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Affiliation(s)
- Eusebius Small
- School of Social Work, University of Texas, Arlington, 211 S. Cooper St., Bldg. A, Arlington, TX 76019 USA
| | - Youn Kyoung Kim
- School of Social Work, Louisiana State University, 207 Huey P. Long Field House, Baton Rouge, LA 70803 USA
| | - Mansoo Yu
- School of Social Work, Department of Public Health, University of Missouri, 720 Clark Hall, Columbia, MO 65211 USA
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13
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Logie CH, Wang Y, Lalor P, Williams D, Levermore K, Sherman SG. Exploring associations between place of sex work and HIV vulnerabilities among sex workers in Jamaica. Int J STD AIDS 2020; 31:1186-1194. [PMID: 32928052 DOI: 10.1177/0956462420948408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sex workers' work environment shapes HIV transmission dynamics. We applied the Structural HIV Determinants Framework to examine associations between the work environment of public spaces and HIV infection risks among sex workers in Jamaica, considering macro-structural (police harassment) and intrapersonal (depression) pathways. We implemented a cross-sectional survey with sex workers in Kingston, Ocho Rios, Montego Bay, and nearby towns in Jamaica. We conducted structural equation modeling to examine direct and indirect associations between place of sex work on HIV serostatus via mediators of police harassment and depression. Results indicate that public place of sex work had a significant indirect effect on self-reported HIV-positive serostatus; depression and police harassment mediated this relationship. Findings suggest that in contexts of criminalization, the sex work environment can elevate exposure to police violence and depression, in turn increasing HIV vulnerabilities.
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Affiliation(s)
- Carmen H Logie
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Ying Wang
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | | | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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14
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Abelson A, Lyons C, Decker M, Ketende S, Mfochive Njindam I, Fouda G, Ndonko F, Levitt D, Tamoufe U, Billong S, Bissek ACZK, Baral SD. Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. Int J Soc Psychiatry 2019; 65:445-457. [PMID: 31234685 DOI: 10.1177/0020764019858646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs' experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. METHODS In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. RESULTS Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2-1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3-2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2-2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. CONCLUSION Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.
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Affiliation(s)
- Anna Abelson
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele Decker
- 2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Serge Billong
- 6 Groupe Technique Central du Comité National de Lutte contre le SIDA, Yaoundc, Cameroon
| | | | - Stefan D Baral
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Romo ML, George G, Mantell JE, Mwai E, Nyaga E, Strauss M, Odhiambo JO, Govender K, Kelvin EA. Depression and sexual risk behavior among long-distance truck drivers at roadside wellness clinics in Kenya. PeerJ 2019; 7:e7253. [PMID: 31355055 PMCID: PMC6642802 DOI: 10.7717/peerj.7253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background Truck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior. Methods We used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months. Results The mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners. Conclusions The high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.
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Affiliation(s)
- Matthew L Romo
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute & Columbia University Medical Center, New York, NY, USA
| | - Eva Mwai
- North Star Alliance, Nairobi, Kenya
| | | | - Michael Strauss
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics & Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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16
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Luo M, Zhu L, Dong Y, Wang Z, Shen Q, Mo D, Du L, Zhang Z, Cai Y. Sexual compulsivity and its relationship with condomless sex among unmarried female migrant workers in Shanghai, China: a cross-sectional study. BMC WOMENS HEALTH 2018; 18:181. [PMID: 30413203 PMCID: PMC6230223 DOI: 10.1186/s12905-018-0670-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022]
Abstract
Background Individuals with high sexual compulsivity are preoccupied with their sexual desire to such an extent that it interferes with their normal daily life and can inhibit self-control. Previous studies have found a close association between sexual compulsivity and condomless sex among different populations; however, no studies have investigated this among unmarried female migrant workers in China. This study aimed to validate the Sexual Compulsivity Scale (SCS) for appropriate use and examine the association between sexual compulsivity and condomless sex in this target population. Methods In 2015, we recruited 1325 unmarried female migrant workers in Shanghai, China. Information about sociodemographics, sexual compulsivity, and condomless sex were collected using a structured questionnaire. Exploratory factor analysis and reliability analysis were performed to validate the Chinese version of the SCS. Multiple logistic regression analyses were used to examine the association between sexual compulsivity and condomless sex. Results The prevalence of condomless sex in the previous 6 months was 66.8% among all participants. The SCS was proven internally consistent for the overall scale (Cronbach’s α = 0.89), and two factors, Social Disruptiveness (Cronbach’s α = 0.87) and Perceived Self-Control (Cronbach’s α = 0.84), were extracted. With mean total score of 18.25 (standard deviation = 4.94) after adjusting for significant sociodemographic factors, the SCS total scores (adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 1.02–1.07) and two subscale scores (AOR = 1.07, 95% CI = 1.02–1.13; AOR = 1.06, 95% CI = 1.02–1.10) were all related to inconsistent condom use with partners in the previous 6 months. Conclusions The Chinese version of the SCS was found to be well adaptable for use among unmarried Chinese female migrant workers and a potential predictor for condomless sex. In addition to safe sex interventions, counselling on managing sexually compulsivity should also be provided in this population.
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Affiliation(s)
- Mengyun Luo
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Liping Zhu
- Shanghai Center for Women and Children's Health, Shanghai, 200062, People's Republic of China
| | - Yuanyuan Dong
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Zezhou Wang
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Qiuming Shen
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Dandan Mo
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Li Du
- Shanghai Center for Women and Children's Health, Shanghai, 200062, People's Republic of China
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.
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17
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Conserve DF, Bay C, Kilonzo MN, Makyao NE, Kajula L, Maman S. Sexual and Social Network Correlates of Willingness to Self-Test for HIV Among Ever-Tested and Never-Tested Men: Implications for the Tanzania STEP Project. AIDS Care 2018; 31:169-176. [PMID: 30362377 DOI: 10.1080/09540121.2018.1537466] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined factors associated with HIV self-testing (HIVST) willingness among male ever-testers and never-testers who participated in a midpoint survey of a cluster randomized controlled HIV prevention trial in Dar es Salaam. Linear mixed binary logistic regression models were constructed to examine factors (demographic, HIV risk behavior, and sexual/social network) associated with willingness to self-test. Sixtyseven percent of 301 never-testers were willing to self-test for HIV compared to 72% 577 of ever-testers. Among never-testers, having discussed testing for HIV with a sexual partner was the only factor associated with HIVST willingness (2.36, 95% CI: 1.35-4.15). For evertesters, younger men were less willing to self-test than older men while men with higher education were more willing to self-test than less educated men. Having a moderate/great HIV risk perception decreased the odds of HIVST willingness relative to no risk perception (0.40, 95% CI 0.23-0.70) for ever-testers. Discussing HIV testing with a sexual partner and having been encouraged to test for HIV by a friend were associated with higher odds of being willing to self-test (2.22, 2.23; 95% CI 1.34-3.67, 1.14-4.39, respectively) among ever-testers. These findings suggest that HIVST willingness is highly acceptable among both male ever-testers and never-testers.
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Affiliation(s)
- Donaldson F Conserve
- a Arnold School of Public Health, Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , SC , USA
| | - Camden Bay
- b Center for AIDS Research , University of North Carolina , Chapel Hill , NC , USA
| | - Mrema N Kilonzo
- c Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Neema E Makyao
- d National AIDS Control Programme , Dar es Salaam , Tanzania
| | - Lusajo Kajula
- c Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Suzanne Maman
- e Gillings School of Global Public Health, Department of Health Behavior , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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18
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Hill LM, Moody J, Gottfredson NC, Kajula LJ, Pence BW, Go VF, Maman S. Peer norms moderate the association between mental health and sexual risk behaviors among young men living in Dar es Salaam, Tanzania. Soc Sci Med 2018; 196:77-85. [PMID: 29156358 PMCID: PMC5768456 DOI: 10.1016/j.socscimed.2017.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/17/2017] [Accepted: 10/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Young men living in Dar es Salaam's informal settlements face environmental stressors that may expose them to multiple determinants of HIV risk including poor mental health and risky sexual behavior norms. We aimed to understand how these co-occurring risk factors not only independently affect men's condom use and sexual partner concurrency, but also how they interact to shape these risk behaviors. METHODS Participants in the study were male members of 59 social groups known as "camps" in Dar es Salaam, Tanzania. We assessed moderation by changes in peer norms of the association between changes in symptoms of anxiety and depression and sexual risk behaviors (condom use and sexual partner concurrency) among 1113 sexually active men. Participants nominated their three closest friends in their camp and reported their perceptions of these friends' behaviors, attitudes, and encouragement of condom use and concurrency. Anxiety and depression were measured using the HSCL-25, and condom use and sexual partner concurrency were assessed through self-report. RESULTS Perceptions of decreasing condom use among friends (descriptive norms) and decreasing encouragement of condom use were associated with lower levels of condom use. Perceptions of increasing partner concurrency and acceptability of partner concurrency (injunctive norms) among friends were associated with higher odds of concurrency. Changes in perceived condom use norms (descriptive norms and encouragement) interacted with changes in anxiety symptoms in association with condom use such that the negative relationship was amplified by norms less favorable for condom use, and attenuated by more favorable norms for condom use. CONCLUSIONS These results provide novel evidence of the interacting effects of poor mental health and risky sexual behavior norms among a hard to reach population of marginalized young men in Dar es Salaam. Our findings provide important information for future norms-based and mental health promotion interventions targeting HIV prevention in this key population.
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Affiliation(s)
- L M Hill
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
| | - J Moody
- Department of Sociology, Duke University, Box 90088, Durham, NC 27708, United States; Department of Sociology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - N C Gottfredson
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
| | - L J Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - B W Pence
- Department of Epidemiology, UNC Chapel Hill, CB# 7435, Chapel Hill, NC 27599, United States.
| | - V F Go
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
| | - S Maman
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
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