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Antabe R, Sano Y, Amoak D, Anfaara FW, Braimah J. Factors Associated with the Uptake of HIV Testing in Canada: Evidence from a Nationally Representative Study. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:534-547. [PMID: 38801320 DOI: 10.1080/19371918.2024.2359463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
In this study, we explore the factors associated with the uptake of HIV testing at the national level in Canada. Using the 2015-16 Canadian Community Health Survey and applying logistic regression analysis, we examine the associations between HIV testing and factors identified by the Andersen's behavioral model of healthcare utilization. We find that a range of predisposing, enabling, and need factors are significantly associated with HIV testing. For example, compared to the oldest respondents (i.e. 55-64), their younger counterparts (i.e. 45-54, 35-44, and 25-34) are more likely to have been tested for HIV. Compared to those in Atlantic Canada, respondents in Quebec (OR = 1.96, p < .001), Ontario (OR = 1.44, p < .001), Prairies (OR = 1.37, p < .001), British Columbia (OR = 1.99, p < .001), and the Territories (OR = 2.22, p < .001) are all more likely to have been tested for HIV. Based on these findings, we provide several important suggestions for policymakers and future research.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Ontario, Canada
| | - Daniel Amoak
- Department of Geography and Environment, Social Science Centre, Western University, London, Ontario, Canada
| | - Florence W Anfaara
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Ontario, Canada
| | - Joseph Braimah
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
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Malata MP, Chipeta EK, Mhango P, Kamanga R, Lupenga D. Comprehensive sexuality education for out-of-school young people living with HIV and young people with disabilities: findings from a formative research study in Malawi. Sex Reprod Health Matters 2023; 31:2226345. [PMID: 37477590 PMCID: PMC10364560 DOI: 10.1080/26410397.2023.2226345] [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: 07/22/2023] Open
Abstract
This formative study was undertaken between June 2020 and April 2021 to provide evidence to inform the design and delivery of comprehensive sexuality education (CSE) in Malawi for young people living with HIV (YPLHIV) and young people with disabilities (YPWD). The study included a desk review of the situation of these two groups and a mapping of CSE programmes and delivery approaches in Malawi. The study findings show that YPWD and YPLHIV in Malawi are marginalised groups, face stigma and discrimination, and are more vulnerable to abuse, warranting CSE that addresses their needs. Yet, they are often left out of sexuality education such as school-based programmes (due to early school drop-outs) and out-of-school programmes, as well as traditional modes. Furthermore, in instances where they have access to sexuality education, there is little evidence to suggest that the sexuality education that they receive is designed to address their needs, thus raising questions about its relevance. There is need for tailored CSE that addresses the needs of these groups and that is delivered using an approach that is easily accessible to them.
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Affiliation(s)
- Monica Patricia Malata
- Research Fellow, Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Effie Kondwani Chipeta
- Senior Research Scientist, Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Patani Mhango
- Training Coordinator, Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Rose Kamanga
- Programme Analyst, Adolescents and Youth, UNFPA, Lilongwe, Malawi
| | - Deus Lupenga
- Chief Youth Officer, Malawi Ministry of Youth, Sports and Culture, Lilongwe, Malawi
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Amoak D, Osei-Kye N, Anfaara FW, Sano Y, Antabe R, Luginaah I. Understanding the uptake of HIV testing among women in Liberia: the role of female genital mutilation/cutting. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:226-236. [PMID: 38015895 DOI: 10.2989/16085906.2023.2275695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Past studies show that the processes of female genital mutilation/cutting (FGM/C) on women can increase their susceptibility to HIV infection. This is because genital tears or ruptures, scars and wounds from FGM/C may expose survivors to heightened risks of contracting sexually transmitted infections, including HIV, if they engage in unsafe sexual practices. Hence, there is the need to promote HIV screening and testing among this population. Yet, in Liberia, there is a dearth of studies exploring the uptake of HIV testing among women who have experienced FGM/C. To understand this relationship, we used the 2019-2020 Liberia Demographic and Health Survey (LDHS) and employed logistic regression analysis to answer the following questions: (1) Are FGM/C survivors less likely to have been tested for HIV compared to non-FGM/C women; and (2) How does this disparity in the uptake of HIV testing differ by women's marital status? We found that survivors of FGM/C were less likely to have been tested for HIV than non-FGM/C women, even after accounting for theoretically relevant variables (OR = 0.83, p < 0.01). In response to our second question, we found that survivors of FGM/C who were formerly married were less likely to have been tested for HIV compared to their non-FGM/C counterparts (OR = 0.48, p < 0.01). These findings highlight the importance of trauma-informed HIV prevention strategies in Liberia, and the need for policymakers to take a holistic approach to addressing the challenges that FGM/C survivors, especially formerly married women, may face in accessing HIV prevention and testing services, and to work towards creating a more inclusive and supportive environment for all at-risk groups.
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Affiliation(s)
- Daniel Amoak
- Department of Geography, Western University, London, Canada
| | - Nancy Osei-Kye
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Canada
| | - Florence W Anfaara
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
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Etowa EB, Wong JPH, Omorodion F, Etowa J, Luginaah I. Addressing HIV Misconceptions among Heterosexual Black Men and Communities in Ontario. Healthcare (Basel) 2023; 11:healthcare11070997. [PMID: 37046924 PMCID: PMC10094559 DOI: 10.3390/healthcare11070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background. Black males accounted for 19.7% of all the new HIV diagnoses in Canada in 2020, yet Black people make up only 4.26% of the population. Persistent misconceptions about modes of HIV transmission need to be addressed to reduce the relatively high HIV prevalence among Black men. We described the HIV misconceptions held by some HBM in Ontario. We also identified the social determinants that are protective versus risk factors for HIV misconceptions among heterosexual Black men (HBM) in Ontario with a view to building evidence-based strategies for strengthening HIV prevention and stigma reduction among HBM and their communities in Ontario. Methods. We report quantitative findings of the weSpeak study carried out among HBM in four cities (Ottawa, Toronto, London, and Windsor) in Ontario. Sample size was 866 and sub-samples were: Ottawa (n = 210), Toronto (n = 343), London (n = 157), and Windsor (n = 156). Data were collected with survey questionnaire. The outcome variable, HIV misconception score ranging from 1 to 18, was measured by the number of statements on the HIV Knowledge Questionnaire with incorrect answers. We included three categories of independent variables in the analysis based on a stepwise and forward model selection approach. The variable categories include (i) sociodemographic background; (ii) personalised psychosocial attributes (levels of HIV misconceptions, negative condom attitude, age at sexual debut, and resilience); and (iii) socially ascribed psychosocial experiences (everyday discrimination and pro-community attitudes). After preliminary univariate and bivariate analyses, we used a hierarchical linear regression model (HLM) to predict levels of HIV misconceptions while controlling for the effect of the city of residence. Results. More than 50% of participants in all study sites were aged 20–49 years, married, and have undergone a college or university undergraduate education. Yet, a significant proportion (27.2%) held varying levels of misconceptions about HIV. In those with misconceptions, the two most common misconceptions were: (i) people are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV (40.1%); and (ii) taking a test for HIV one week after having sex will tell a person if she or he has HIV (31.6%). Discrimination (β = 0.23, p < 0.05, 95% CI = 0.01, 0.46), negative condom attitudes (β = 0.07, p < 0.05, 95% CI = 0.01, 0.12), and sexual debut at an older age (β = 0.06, p < 0.05, 95% CI = 0.01, 1) were associated with more HIV misconceptions. Being born in Canada (β = −0.96, p < 0.05, 95% CI = −1.8, −0.12), higher education (β = −0.37, p < 0.05, 95% CI = −0.52, −0.21), and being more resilient (β = −0.04, p < 0.05, 95% CI = −0.08, −0.01) were associated with fewer HIV misconceptions. Conclusion and recommendations. HIV misconceptions are still common, especially among HBM. These misconceptions are associated with structural and behavioural factors. We recommend structural and policy-driven interventions that promote more accessible and equity-driven healthcare, education, and social integration of HBM in Ontario. We also recommend building capacity for collective resilience and critical health and racial literacy as well as creating culturally safe spaces for intergenerational dialogues among HBM in their communities.
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Affiliation(s)
- Egbe B. Etowa
- Daphne Cockwell Health Sciences Complex, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Correspondence:
| | - Josephine Pui-Hing Wong
- Daphne Cockwell Health Sciences Complex, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Francisca Omorodion
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON N9B 3P4, Canada
| | - Josephine Etowa
- School of Nursing, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON N6A 3K7, Canada
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Antabe R, McIntosh M, Lawson E, Husbands W, Wong JPH, Arku G, Luginaah I. Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study. BMC Public Health 2023; 23:182. [PMID: 36707783 PMCID: PMC9880929 DOI: 10.1186/s12889-023-15103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection. METHODS As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach. RESULTS The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity. CONCLUSION Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, M1C 1A4, Toronto, ON, Canada.
| | - Martin McIntosh
- Regional HIV/AIDS Connections (RHAC), 30-186 King Street, N6A 1C7 London, ON Canada
| | - Erica Lawson
- grid.39381.300000 0004 1936 8884Department of Gender, Sexuality, and Women’s Studies, Western University, 1151 Richmond Street, Lawson Hall Room, 3260, N6A 5B8 London, ON Canada
| | - Winston Husbands
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON Canada
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Podium Building, Room POD-481, 350 Victoria St, M5B 2K3 Toronto, ON Canada
| | - Godwin Arku
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
| | - Isaac Luginaah
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
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Bruser G, Luginaah I, Katasi R, Zhang LZ, Namasinga M, Kityo C, Arts E. " …So that's why we hide, we don't want them to know"- Challenges to Antiretroviral Therapy Adherence in Kampala, Uganda. AFRICAN GEOGRAPHICAL REVIEW 2022; 43:18-31. [PMID: 38576439 PMCID: PMC10989837 DOI: 10.1080/19376812.2022.2101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/09/2022] [Indexed: 04/06/2024]
Abstract
The aim of this study wasto advance knowledge of the social, geographical, and economic complexities faced by people on cART and to understand how they navigate treatment adherence within the urban context of Kampala, Uganda.Semi-structured interviews (n=30) were conducted with individuals receiving HIV treatment from the Joint Clinical Research Centre (JCRC) in Kampala. The thematic analysis of the interview transcripts was conducted in NVivo, with direct quotations from the transcripts used to illustrate key themes.It emerged from the interviews thatkeychallenges faced by people on HIV treatment include: the burden of the drug regimen, food insecurity, transportation and travel, and stigma.All participants frequently emphasized the negative effects of stigma on their daily lives, whether at work, at home or in transit. The study's participants also suggested that knowledge of HIV and HIV treatment is still lacking in their broader communities, which impacts how people living with HIV are perceived. Social processes such as stigmatization in public places must be considered by health policy makers, in orderto maximize treatment adherence. Efforts towards public sensitization can help to create social settings which allow those on HIV treatment to take their medication without fear of judgement.
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Affiliation(s)
- Gabrielle Bruser
- Department of Geography, Western University, Social Science Centre 1151 Richmond St. London, Ontario, N6A 5C2, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, Social Science Centre 1151 Richmond St. London, Ontario, N6A 5C2, Canada
| | - Ritah Katasi
- Joint Clinical Research Centre, Lubowa Hill, Plot 101 Entebbe Road P. O. Box 10005, Wakiso District, Uganda
| | - Lily Ziyue Zhang
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, 3359 Mississauga Road, Mississauga, ON, L5L 1C6
| | - Miriam Namasinga
- Joint Clinical Research Centre, Lubowa Hill, Plot 101 Entebbe Road P. O. Box 10005, Wakiso District, Uganda
| | - Cissy Kityo
- Joint Clinical Research Centre, Lubowa Hill, Plot 101 Entebbe Road P. O. Box 10005, Wakiso District, Uganda
| | - Eric Arts
- Department of Microbiology & Immunology, Western University, Dental Science Building 1151 Richmond St. London, Ontario, N6A 5C1, Canada
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HIV misconceptions among married women in Malawi: the role of household decision-making autonomy. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hlatshwako T, Conserve D, Day S, Reynolds Z, Weir S, Tucker JD. Increasing Men's Engagement in HIV Testing and Treatment Programs Through Crowdsourcing: A Mixed-Methods Analysis in Eswatini. Sex Transm Dis 2021; 48:789-797. [PMID: 33675595 PMCID: PMC8418618 DOI: 10.1097/olq.0000000000001408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sub-Saharan African HIV programs have had limited success in engaging men. Crowdsourcing contests may be a useful method to spur men's engagement in HIV services. We evaluated contributions and social media response to a crowdsourcing contest focused on increasing men's engagement in Eswatini HIV services. METHODS We conducted a crowdsourcing contest to gain insight from the public on how HIV campaigns can more effectively engage young (20-40 years old) men in HIV services. Eligible submissions included images, songs, videos, and Internet memes. We used standard qualitative methods to examine textual themes from submissions. We examined social media response using Facebook analytics, comparing the number of people reached through crowdsourced HIV messages and the number of people reached through conventional HIV messages. RESULTS We received 144 submissions from 83 participants. They represented 55 towns and all 4 regions of Eswatini. The contest page gained 461 followers on Facebook. Emergent themes included appealing to men's roles as protectors by suggesting that they need to take care of their own health to continue safeguarding their families. Crowdsourced messages reached a mean of 88 individuals across 4 posts; conventional messages reached a mean of 75 individuals across 4 posts. CONCLUSIONS Crowdsourcing contest submissions provided insight on how to encourage men to engage in Eswatini HIV services. Crowdsourcing contests can be effective in collecting messages from men to create more locally relevant communication materials for HIV programs.
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Affiliation(s)
| | - Donaldson Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, SC
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases
| | - Zahra Reynolds
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Ziersch A, Walsh M, Baak M, Rowley G, Oudih E, Mwanri L. "It is not an acceptable disease": A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC Public Health 2021; 21:779. [PMID: 33892683 PMCID: PMC8063420 DOI: 10.1186/s12889-021-10679-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People from ethnically diverse backgrounds living with HIV are susceptible to adverse health and wellbeing outcomes, particularly as a consequence of HIV-related stigma and discrimination (HSD), though relatively little is known about experiences in Australia. METHODS This paper reports on HSD in ethnically diverse communities in South Australia and impacts on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically. RESULTS Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and was experienced at the intersections of gender, sexual orientation, religion, culture, and immigration status. Experiences of HSD were damaging to health and wellbeing through non-disclosure, reduced social support, delayed testing, service access barriers, impacts on treatment adherence, and directly to mental health. CONCLUSIONS Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are crucial.
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Affiliation(s)
- Anna Ziersch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Melanie Baak
- School of Education, University of South Australia, Adelaide, Australia
| | - Georgia Rowley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Enaam Oudih
- Relationships Australia South Australia, Adelaide, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Anfaara FW, Atuoye KN, Antabe R, Sano Y, Luginaah I. Hepatitis B knowledge among women and men in the upper west region of Ghana: What sources of health information matter? Int J Health Plann Manage 2020; 35:1098-1110. [PMID: 32663905 DOI: 10.1002/hpm.3013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/20/2020] [Accepted: 06/05/2020] [Indexed: 11/06/2022] Open
Abstract
Despite the vital role of accurate health information in reducing the spread of Hepatitis B virus (HBV) in endemic contexts such as Ghana, little is known about how health information sources may influence disparities in the knowledge of HBV transmission among women and men. This study examines the association between sources of health information and knowledge of HBV transmission in the Upper West Region (UWR) of Ghana. Data from a cross-sectional survey (n = 1061) was analyzed using gender-specific multivariate ordered logistic regression models. The results show that, women who obtained health information from religious-based programs (OR = 4.04, P < .05), higher-level facilities (OR = 2.37, P < .05), and primary health facilities (OR = 1.83, P < .1) were more likely to have good knowledge of HBV transmission compared to non-facility-based programs. Similarly, men who accessed health information from religious-based programs only, were more likely to have good knowledge of HBV transmission (OR = 2.14, P < .05) compared to non-facility-based programs. The results demonstrate the importance of health information sources on knowledge of disease transmission and prevention in a resource-poor context. Based on our findings, we suggest the scaling-up of information programs at health facilities in rural areas and the expansion of HBV services in the UWR in contribution towards the attainment of SDG #3.3.
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Affiliation(s)
- Florence Wullo Anfaara
- Department of Women's Studies and Feminist Research, University of Western Ontario, Faculty of Arts and Humanities, London, Ontario, Canada
| | - Kilian Nasung Atuoye
- Department of Geography, University of Toronto Mississauga, Toronto, Ontario, Canada
| | - Roger Antabe
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, Ontario, Canada
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