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Huber-Krum S, Miedema SS, Shortt JW, Villaveces A, Kress H. Associations between adverse childhood experiences and contraceptive use among young adults in Honduras. CHILD ABUSE & NEGLECT 2022; 123:105381. [PMID: 34753054 PMCID: PMC9511159 DOI: 10.1016/j.chiabu.2021.105381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men. METHODS We used data from 810 women and 753 men aged 18-24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use. FINDINGS Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22). CONCLUSION The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.
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Affiliation(s)
- Sarah Huber-Krum
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stephanie Spaid Miedema
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joann Wu Shortt
- Research and Evaluation Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés Villaveces
- Field Epidemiology and Prevention Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Field Epidemiology and Prevention Branch, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kashyap GC, Govind B, Srivastava S, R V, Bango M, Shaw S. A true face of Indian married couples: Effect of age and education on control over own sexuality and sexual violence. PLoS One 2021; 16:e0254005. [PMID: 34288932 PMCID: PMC8294513 DOI: 10.1371/journal.pone.0254005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Though there are several interventions evaluated over the past 25 years, significant knowledge gaps continue to exist regarding the effective prevention of sexual violence. This study explored the socio-economic and context-specific distinctive characteristics of husbands and wives on sexual autonomy and unwanted sexual experiences of currently married women in India. METHODOLOGY We have utilized the recent round of National Family Health Survey (NFHS-4, 2015-16) data for this exploration. The NFHS-4 survey had adopted a stratified two-stage sample design to reach out to the survey households. A total of 63,696 couples are included in the analysis comprising of women of 15-49 years age and men of 15-54 years age. Multivariate techniques have been applied to understand the adjusted effects of socio-economic and demographic variables on control over their sexuality and sexual violence. RESULTS Uneducated women married to uneducated men experienced more sexual violence and had less control over their sexuality than the other categories. The adjusted multivariate logistic model shows that educated husbands were significantly more likely to exercise control over their educated wives' sexuality (AOR = 0.88; CI:0.78-0.99). Women having older husbands were significantly less likely to be having no-control over own sexuality (AOR = 0.89; CI:0.83-0.95) and experienced sexual violence (AOR = 0.81; CI:0.70-0.95). Women having comparatively more-educated husbands were significantly less likely to experience sexual violence (AOR = 0.62; CI:0.47-0.81). Muslim women were significantly more likely to have no control overown sexuality. SC/ST women were significantly more likely to experience sexual violence (28%). CONCLUSIONS This study highlights the factors associated with control over one's sexuality and preponderance to sexual violence: age, education, spouse working status, wealth status, husband's alcohol consumption, women autonomy, decision-making, and freedom for mobility. This study suggests that empowering women with education, creating awareness regarding reproductive health, and addressing their socio-economic needs to help them achieve autonomy and derive decision-making power.
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Affiliation(s)
- Gyan Chandra Kashyap
- Institute of Health Management Research, Electronic City (Phase-I), Bengaluru, Karnataka, India
| | - Bal Govind
- Gokhale Institute of Politics and Economics, Deccan Gymkhana, Pune, Maharashtra, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
| | - Veena R
- Healthcare Programs, International School of Business and Research, Infosys Drive, Bengaluru, Karnataka, India
| | - Madhumita Bango
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai, Maharashtra, India
| | - Subhojit Shaw
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
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Decker SE, Pavlo A, Harper A, Herring Y, Black AC. Themes in experiences of PTSD symptoms and relationships among male veterans with risky sexual behavior. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2020; 12:678-686. [PMID: 32338947 PMCID: PMC8717835 DOI: 10.1037/tra0000569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE United States veterans with posttraumatic stress disorder (PTSD) symptoms are at elevated risk for high-risk sexual behavior (HRSB). Although quantitative research has examined relationships between PTSD symptoms and HRSB, qualitative research to understand the lived experiences of veterans with PTSD symptoms and HRSB has not been conducted. METHOD Qualitative interviews were conducted with N = 29 male veterans of Operation Enduring Freedom or Operation Iraqi Freedom who had PTSD symptoms and reported recent HRSB. The interviews were analyzed using a phenomenological framework. RESULTS Six themes emerged: (a) avoiding social contact due to feeling different since return from service; (b) effortful self-management; (c) supportive relationships; (d) sex as a means to an end; (e) sex, risk, and intimacy; and (f) responsibility and growth. CONCLUSION Male veterans with PTSD symptoms and HRSB reported engagement in significant self-management to reengage in life, and still reported high levels of difficulty in relationships. They described both wanting to avoid perceived risk associated with intimate relationships and wanting to take risks that caused them to feel alive. Implications for treatment include increased efforts to facilitate coping, to recognize and moderate risk-taking urges, and to build intimacy and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Suzanne E Decker
- Veterans Affairs Mental Illness Research, Education, and Clinical Center
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Cavanaugh C, Kapij A. A Brief Report on the Association between Dissociation During Sex and Condom Use Self-Efficacy Among Women Residing in Domestic Violence Shelters. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 32:171-176. [PMID: 32788947 PMCID: PMC7416723 DOI: 10.1080/19317611.2020.1749209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Female survivors of intimate partner violence have greater risk for contracting HIV/STI's and experiencing dissociation. However, no studies have examined the association between dissociation and condom use self-efficacy in this population. This study explored whether dissociation during sex was negatively associated with condom use self-efficacy. METHODS Thirty-five women (88% African American) who were residing in domestic violence shelters in the United States completed questionnaires. RESULTS There was a negative correlation between dissociative experiences during sex and condom use self-efficacy, r = -.62, n=35, p< .01. CONCLUSIONS Findings suggest that dissociation during sex interferes with abused women's condom use self-efficacy.
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Diao XY, Albert M, Forstein M. The association between HIV/AIDS and childhood sexual abuse: An exploratory case study. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019. [DOI: 10.1080/19359705.2019.1639020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xavier Y. Diao
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeline Albert
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Marshall Forstein
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
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Weiss NH, Peasant C, Sullivan TP. Avoidant Coping as a Moderator of the Association Between Childhood Abuse Types and HIV/Sexual Risk Behaviors. CHILD MALTREATMENT 2019; 24:26-35. [PMID: 30124064 DOI: 10.1177/1077559518793228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Women who experience intimate partner violence (IPV) report high rates of HIV/sexual risk behaviors. Childhood abuse has been linked to HIV/sexual risk behaviors among IPV-victimized women; however, limited research has examined factors that may influence this association. The current study tested the moderating role of avoidant coping in the relation between childhood abuse types (physical, emotional, and sexual) and HIV/sexual risk behaviors. Participants were 212 community women currently experiencing IPV (mean age = 36.63 years, 67.0% African American). Higher levels of avoidant coping were related to more severe childhood abuse types. Severity of childhood abuse types was associated with greater HIV/sexual risk behaviors. Avoidant coping moderated the relation between childhood sexual abuse severity and HIV/sexual risk behaviors, such that this association was significant for IPV-victimized women with high (but not low) levels of avoidant coping. Findings suggest the utility of targeting avoidant coping in interventions aimed at preventing or reducing HIV/sexual risk behaviors among IPV-victimized women with a history of childhood sexual abuse.
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Affiliation(s)
- Nicole H Weiss
- 1 Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Tami P Sullivan
- 3 Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Diehl A, Clemente J, Pillon SC, Santana PRH, da Silva CJ, Mari JDJ. Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence. ACTA ACUST UNITED AC 2018; 41:199-207. [PMID: 30540023 PMCID: PMC6794126 DOI: 10.1590/1516-4446-2017-0020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
Objective: To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users. Methods: A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated. Results: The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36). Conclusion: Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.
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Affiliation(s)
- Alessandra Diehl
- Departamento de Psiquiatria,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jales Clemente
- Departamento de Psiquiatria,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandra C Pillon
- Departamento de Enfermagem Psiquiátrica e Ciências Humanas, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da Organização Pan-Americana de Saúde (OPAS)/Organização Mundial da Saúde (OMS) para o Desenvolvimento da Pesquisa em Enfermagem, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | - Claudio J da Silva
- Departamento de Psiquiatria,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jair de J Mari
- Departamento de Psiquiatria,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Michalopoulos LM, Jiwatram-Negron T, Gilbert L, Shaw SA, Brelsford A, Terlikbayeva A, Primbetova S, El-Bassel N. Traumatic Events and HIV Sexual Risk Behaviors Among Migrant and Non-Migrant Male Market Workers in Central Asia. AIDS Behav 2018; 22:3480-3490. [PMID: 29411228 DOI: 10.1007/s10461-018-2047-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined potentially traumatic events (PTEs) and the relationship between PTEs and HIV risk behaviors among male market workers in Kazakhstan, comparing Kazakhstani to external migrants. Using respondent-driven sampling, participants were 1342 male marketplace workers in Almaty, Kazakhstan. Univariate, bivariate, and logistic regressions were conducted. We found high prevalence of PTEs among participants, and significant differences between PTEs and HIV risk by migrant status. Kazakhstanis reporting 1-2 or three-or-more traumatic events were more likely to report engaging in sex trading, compared to Kazakhstanis who reported no PTEs (OR = 3.65, CI 1.20-11.11, p = 0.022; OR = 8.17, 95% CI 2.66-25.09, p = 0.000, respectively). Kazakhstanis who reported three-or-more PTEs were more likely to report unprotected sex (OR = 2.17, CI 2.17-3.89, p = 0.009). Results did not support this relationship among external migrants. Findings underscore the need for attention on services that address trauma and HIV risk among this population and more research to understand differences by migrant status.
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Stoicescu C, Cluver LD, Spreckelsen T, Casale M, Sudewo AG. Intimate Partner Violence and HIV Sexual Risk Behaviour Among Women Who Inject Drugs in Indonesia: A Respondent-Driven Sampling Study. AIDS Behav 2018; 22:3307-3323. [PMID: 29948336 PMCID: PMC6154010 DOI: 10.1007/s10461-018-2186-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Women who inject drugs are disproportionately affected by HIV and intimate partner violence (IPV); however, the link between IPV and HIV remains under-researched among substance-using women in low- and middle-income countries. This study examined associations and additive effects of different forms of IPV victimization (psychological, physical and/or injurious, and sexual) on HIV sexual risk behavior among women who inject drugs in Indonesia. Respondent-driven sampling (RDS) was used to recruit 731 women from Greater Jakarta and Bandung, West Java. RDS-II weighted prevalence of any past-year IPV was 68.9% (95% CI 65.0, 72.6) in Jakarta and 55.9% (95% CI 48.0, 63.5) in Bandung. In separate logistic regressions controlling for socio-demographic covariates, all three forms of IPV showed statistically significant associations with sexual risk behavior. After adjusting for all IPV types, psychological (OR 1.87; 95% CI 1.17, 2.99; p = 0.009) and sexual (OR 1.98; 95% CI 1.22, 3.21; p = 0.006) IPV independently predicted women’s sexual risk behavior. Marginal effects models suggested that co-occurrence of multiple forms of IPV had greater adverse consequences: sexual risk behavior was reported by 64.1% of women who did not experience any IPV, but increased to 89.9% among women exposed to all three types. Comprehensive harm reduction services that integrate IPV monitoring and prevention are urgently needed to reduce both HIV and IPV.
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Affiliation(s)
- Claudia Stoicescu
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK.
| | - Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Thees Spreckelsen
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK
| | - Marisa Casale
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anindita Gabriella Sudewo
- HIV and AIDS Research Centre, Atma Jaya Catholic University, Jakarta, Indonesia
- Kirby Institute, University of New South Wales, Sydney, Australia
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Yoon S, Voith LA, Kobulsky JM. Gender differences in pathways from child physical and sexual abuse to adolescent risky sexual behavior among high-risk youth. J Adolesc 2018; 64:89-97. [PMID: 29438874 DOI: 10.1016/j.adolescence.2018.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 01/07/2023]
Abstract
This study investigated gender differences in the roles of internalizing and externalizing symptoms and substance use as pathways linking child physical and sexual abuse to risky sexual behavior among youth at risk of maltreatment. Path analysis was performed with 862 adolescents drawn from Longitudinal Studies of Child Abuse and Neglect. Four waves of data collected in the United States were used: childhood physical and sexual abuse experiences (from ages 0-12) were assessed by Child Protective Services reports, internalizing and externalizing symptoms were measured at age 14, substance use was measured at age 16, and risky sexual behavior was measured at age 18. Physical abuse was directly associated with risky sexual behavior in boys but not girls. For girls, physical abuse had a significant indirect effect on risky sexual behavior via externalizing symptoms. Gender-focused preventive intervention strategies may be effective in reducing risky sexual behavior among at-risk adolescents.
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Affiliation(s)
- Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH, USA.
| | - Laura A Voith
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Julia M Kobulsky
- School of Social Work, The University of Maryland, Baltimore, MD, USA.
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Using smartphones to decrease substance use via self-monitoring and recovery support: study protocol for a randomized control trial. Trials 2017; 18:374. [PMID: 28797307 PMCID: PMC5553728 DOI: 10.1186/s13063-017-2096-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs). Methods/design The target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors. Discussion This project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible. Trial registration ClinicalTrials.gov, ID: NCT02132481. Registered on 5 May 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2096-z) contains supplementary material, which is available to authorized users.
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Abstract
The main aim of this review article is to outline the factors linked to vulnerability of women to HIV infection and to understand the challenges and possible management of HIV among women. The review is a theoretical endeavour to understand women’s experiences of living with HIV. This review primarily focuses on studies in the Indian set-up, but to further substantiate the arguments and describe the relevant concepts it also takes into account literature from other cultures. On the basis of studies included in this article, it can be surmised that women are more susceptible to HIV due to cultural barriers, health vulnerabilities and social structures. They show less awareness about the treatment facilities, prevention strategies and perceived risk of infection. Women have to face numerous challenges after the infection, such as lack of social support, a higher level of stigma and discrimination, decreased quality of life, mental health issues and adverse coping. To prevent the spread of HIV among women as well as men, it is necessary to plan strategies which deal with empowerment of women, education and awareness regarding the vulnerabilities and knowledge and challenges of HIV infection. There is also a need to address the management of HIV among the infected and even those at risk. This article describes the possible interventions based on existing literature. The review also attempts to suggest certain future directions for the research.
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Affiliation(s)
- Anu Malik
- Research Scholar in Psychology, Department of Humanities and Social Sciences, Indian Institute of Technology, Kanpur, India
| | - Shikha Dixit
- Professor in Psychology, Department of Humanities and Social Sciences, Indian Institute of Technology, Kanpur, India
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Taylor SW, Goshe BM, Marquez SM, Safren SA, O'Cleirigh C. Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse. PSYCHOL HEALTH MED 2017; 23:454-464. [PMID: 28697624 DOI: 10.1080/13548506.2017.1348609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.
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Affiliation(s)
- S Wade Taylor
- a Department of Social Work, Leadership, and Youth Advocacy , Wheelock College , Boston , MA , USA.,b Fenway Health , The Fenway Institute , Boston , MA , USA
| | - Brett M Goshe
- c Department of Psychology , University of Connecticut , Storrs , CT , USA
| | | | - Steven A Safren
- b Fenway Health , The Fenway Institute , Boston , MA , USA.,d Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Conall O'Cleirigh
- b Fenway Health , The Fenway Institute , Boston , MA , USA.,e Behavioral Medicine Program , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
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Harris T, Rice E, Rhoades H, Winetrobe H, Wenzel S. Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:334-351. [PMID: 28471336 PMCID: PMC6178948 DOI: 10.1080/10538712.2017.1287146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.
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Affiliation(s)
- Taylor Harris
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Eric Rice
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Harmony Rhoades
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Hailey Winetrobe
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
| | - Suzanne Wenzel
- School of Social Work, University of Southern California, 669 W. 34 St., Los Angeles, CA 90089
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Michalopoulos LTM, Baca-Atlas SN, Simona SJ, Jiwatram-Negrón T, Ncube A, Chery MB. "Life at the River is a Living Hell:" a qualitative study of trauma, mental health, substance use and HIV risk behavior among female fish traders from the Kafue Flatlands in Zambia. BMC WOMENS HEALTH 2017; 17:15. [PMID: 28270127 PMCID: PMC5341354 DOI: 10.1186/s12905-017-0369-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022]
Abstract
Background In Western settings, the relationship between trauma history, posttraumatic stress disorder, substance use, and HIV risk behavior, is well established. Although female fish traders in Zambia are affected by HIV at rates estimated to be 4–14 times higher than the national prevalence, no studies have examined the co-occurring issues of trauma, substance use and HIV risk behavior among this vulnerable population. The current study examined: 1) trauma history, trauma symptoms and HIV risk behaviors and 2) the relationship between these co-occurring issues among female fish traders from the Kafue Flatlands in Zambia. Methods Twenty individual semi-structured qualitative interviews and a focus group discussion (n = 12 participants) were conducted with female fish traders in the Kafue Flatlands of Zambia. Template analysis was used to examine the data. Results The findings indicate that female fish traders in Zambia are at risk of multiple and ongoing traumatic events and daily stressors, severe mental health symptoms (including western conceptualizations of disorders such as anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief, as well as local idioms of distress), substance abuse, and HIV sexual risk behaviors. The results suggest a relationship between trauma and HIV sexual risk behavior in this population. Conclusions The indication of these co-occurring issues demonstrates the need for HIV prevention intervention efforts, which account for trauma, mobility, and psychosocial outcomes in order to reduce HIV sexual risk behavior among female fish traders in Zambia. Electronic supplementary material The online version of this article (doi:10.1186/s12905-017-0369-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lynn T Murphy Michalopoulos
- Columbia University School of Social Work, Social Intervention Group, Global Health and Mental Health Unit, 1255 Amsterdam Avenue, Room 804, Mail Code 4600, New York, NY, 10027, USA.
| | - Stefani N Baca-Atlas
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, North Carolina, USA
| | - Simona J Simona
- Department of Social Development Studies, University of Zambia, School of Humanities and Social Sciences, Lusaka, Zambia
| | - Tina Jiwatram-Negrón
- University of Michigan, Curtis Center, School of Social Work, 1080 South University, Ann Arbor, 48109-1106, Michigan, USA
| | - Alexander Ncube
- Elizabeth Glaser Pediatric AIDS Foundation, Zambia, Lusaka, Zambia
| | - Melanie B Chery
- Columbia University School of Social Work, New York, NY, 10027, USA
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Thompson R, Lewis T, Neilson EC, English DJ, Litrownik AJ, Margolis B, Proctor L, Dubowitz H. Child Maltreatment and Risky Sexual Behavior. CHILD MALTREATMENT 2017; 22:69-78. [PMID: 27777330 PMCID: PMC6685066 DOI: 10.1177/1077559516674595] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Risky sexual behavior is a serious public health problem. Child sexual abuse is an established risk factor, but other forms of maltreatment appear to elevate risky behavior. The mechanisms by which child maltreatment influence risk are not well understood. This study used data from 859 high-risk youth, followed through age 18. Official reports of each form of maltreatment were coded. At age 16, potential mediators (trauma symptoms and substance use) were assessed. At age 18, risky sexual behavior (more than four partners, unprotected sex, unassertiveness in sexual refusal) was assessed. Neglect significantly predicted unprotected sex. Substance use predicted unprotected sex and four or more partners but did not mediate the effects of maltreatment. Trauma symptoms predicted unprotected sex and mediated effects of emotional maltreatment on unprotected sex and on assertiveness in sexual refusal and the effects of sexual abuse on unprotected sex. Both neglect and emotional maltreatment emerged as important factors in risky sexual behavior. Trauma symptoms appear to be an important pathway by which maltreatment confers risk for risky sexual behavior. Interventions to reduce risky sexual behavior should include assessment and treatment for trauma symptoms and for history of child maltreatment in all its forms.
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Affiliation(s)
| | - Terri Lewis
- University of Colorado Denver, Aurora, CO, USA
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Michalopoulos LM, Ncube N, Simona SJ, Kansankala B, Sinkala E, Raidoo J. A qualitative study of migrant-related stressors, psychosocial outcomes and HIV risk behaviour among truck drivers in Zambia. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:219-26. [PMID: 27681145 DOI: 10.2989/16085906.2016.1179653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Truck drivers are part of mobile populations which have been noted as a key population at risk of HIV in Zambia. This study was aimed at: (1) determining potentially traumatic events (PTEs), labour migrant-related stressors, psychosocial problems and HIV risk behaviours among truck drivers in Zambia; and (2) examining the relationship between PTEs, migrant-related stressors, psychosocial outcomes and HIV sexual risk behaviour among truck drivers in Zambia. We conducted 15 semi-structured interviews with purposively sampled male truck drivers at trucking companies in Lusaka, Zambia. Findings indicate that truck drivers experience multiple stressors and potentially traumatic incidences, including delays and long waiting hours at borders, exposure to crime and violence, poverty, stress related to resisting temptation of sexual interactions with sex workers or migrant women, and job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, loneliness, anxiety and depression-like symptoms were noted. Transactional sex, coupled with inconsistent condom use, were identified as HIV sexual risk behaviours. Findings suggest the critical need to develop HIV-prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key population.
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Affiliation(s)
| | - Nomagugu Ncube
- b International Organization for Migration , Lusaka , Zambia
| | - Simona J Simona
- c Department of Social Development Studies , University of Zambia , Lusaka , Zambia
| | | | | | - Jasmin Raidoo
- a School of Social Work , Columbia University , New York , USA
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Gonzalez-Blanks A, Yates TM. Sexual Risk-Taking Among Recently Emancipated Female Foster Youth: Sexual Trauma and Failed Family Reunification Experiences. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2016; 26:819-829. [PMID: 28453199 DOI: 10.1111/jora.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Foster youth evidence shows elevated rates of risk behaviors, including sexual risk-taking (e.g., unprotected sex). Some studies have identified child maltreatment, particularly sexual abuse, as a risk for later sexual risk-taking, but none have examined how child welfare placement experiences relate to youth's sexual risk-taking. This study investigated relations among child maltreatment, child welfare placements, and sexual risk-taking among 114 recently emancipated female foster youth. Sexual abuse and failed reunifications with parents were associated with greater sexual risk-taking. Moreover, dissociative symptoms exacerbated the relation between sexual abuse and sexual risk-taking. These findings highlight the need for greater consideration of risks associated with emancipated youth's sexual risk-taking and for more research to understand how youth experience unsuccessful family reunifications.
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Michalopoulos LM, Jiwatram-Negrón T, Choo MKK, Kamarulzaman A, El-Bassel N. The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study. BMC Public Health 2016; 16:464. [PMID: 27250497 PMCID: PMC4890521 DOI: 10.1186/s12889-016-3125-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 05/13/2016] [Indexed: 11/24/2022] Open
Abstract
Background Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen. Methods The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container). Results Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p < 0.001) and risky injection drug use (OR 16.25, 95 % CI: 4.73-55.85, p < 0.001). Participants with depression had significantly higher odds of engaging in risky injection drug use behavior (OR 3.26, 95 % 1.39-7.67, p = 0.007). Focusing on participants with a history of injection drug use, we found that participants with depression were significantly more likely to engage in risky drug use compared to participants below the depression cutoff (OR 3.45, 95 % CI: 1.23-9.66, p < 0.02). Conclusions Findings underscore the need to address psychosocial and structural-level stressors among Malaysian fishermen to reduce HIV injection drug risk behaviors. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3125-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lynn Murphy Michalopoulos
- Social Intervention Group, Global Health and Mental Health Unit of the Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA.
| | - Tina Jiwatram-Negrón
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA
| | - Martin K K Choo
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nabila El-Bassel
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA
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Štulhofer A, Sinković M, Božić J, Baćak V. Victimization and HIV Risks Among Croatian Female Sex Workers: Exploring the Mediation Role of Depressiveness and the Moderation Role of Social Support. Violence Against Women 2016; 23:67-88. [PMID: 27020378 DOI: 10.1177/1077801216636241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess the association between victimization and HIV vulnerability among Croatian female sex workers (FSWs), a survey involving 157 FSWs recruited from Croatia's two largest urban areas was conducted in 2014. A majority of participants reported direct and indirect victimization, which was found to be significantly associated with condom use at most recent noncommercial sexual intercourse and sexually transmitted infection (STI) diagnosis in the past 12 months. The association between victimization and STI diagnosis was partially mediated by depressiveness and moderated by social support. The buffering role of social support points to the importance of including counseling services in HIV prevention programs in Croatia.
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Engstrom M, Winham K, Gilbert L. Types and Characteristics of Childhood Sexual Abuse: How Do They Matter in HIV Sexual Risk Behaviors Among Women in Methadone Treatment in New York City? Subst Use Misuse 2016; 51:277-94. [PMID: 26886405 PMCID: PMC6385865 DOI: 10.3109/10826084.2015.1058823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood sexual abuse (CSA) is often considered an important distal factor in HIV sexual risk behaviors; however, there are limited and mixed findings regarding this relationship among women experiencing substance use problems. In addition, research with this population of women has yet to examine differences in observed CSA-HIV sexual risk behaviors relationships by CSA type and characteristics. OBJECTIVES This study examines relationships between CSA coding, type, and characteristics and HIV sexual risk behaviors with main intimate partners among a random sample of 390 women in methadone treatment in New York City who completed individual interviews with trained female interviewers. RESULTS Findings from logistic regression analyses indicate that CSA predicts substance use with sexual activity, with variations by CSA coding, type, and characteristics; however, the role of CSA is more limited than expected. Having a main partner with HIV risk mediates some relationships between CSA and drinking four or more drinks prior to sex. Intimate partner violence is the most consistent predictor of sexual risk behaviors. Other salient factors include polysubstance use, depression, social support, recent incarceration, relationship characteristics, and HIV status. CONCLUSIONS/IMPORTANCE This study contributes to understanding of relationships between CSA and HIV sexual risk behaviors and key correlates associated with HIV sexual risk behaviors among women in methadone treatment. It also highlights the complexity of measuring CSA and its association with sexual risk behaviors and the importance of comprehensive approaches to HIV prevention that address psychological, relational, situational, and substance use experiences associated with sexual risk behaviors among this population.
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Affiliation(s)
- Malitta Engstrom
- a School of Social Policy & Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Katherine Winham
- b Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA
| | - Louisa Gilbert
- c Social Intervention Group, Columbia University , New York , New York , USA
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Michalopoulos LM, Aifah A, El-Bassel N. A Systematic Review of HIV Risk Behaviors and Trauma Among Forced and Unforced Migrant Populations from Low and Middle-Income Countries: State of the Literature and Future Directions. AIDS Behav 2016; 20:243-61. [PMID: 25662963 DOI: 10.1007/s10461-015-1014-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the current systematic review is to examine the relationship between trauma and HIV risk behaviors among both forced and unforced migrant populations from low and middle income countries (LMIC). We conducted a review of studies published from 1995 to 2014. Data were extracted related to (1) the relationship between trauma and HIV risk behaviors, (2) methodological approach, (3) assessment methods, and (4) differences noted between forced and unforced migrants. A total of 340 records were retrieved with 24 studies meeting inclusion criteria. Our review demonstrated an overall relationship between trauma and HIV risk behaviors among migrant populations in LMIC, specifically with sexual violence and sexual risk behavior. However, findings from 10 studies were not in full support of the relationship. Findings from the review suggest that additional research using more rigorous methods is critically needed to understand the nature of the relationship experienced by this key-affected population.
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Affiliation(s)
- Lynn Murphy Michalopoulos
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 804, Mail Code 4600, New York, NY, 10027, USA.
| | - Angela Aifah
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 804, Mail Code 4600, New York, NY, 10027, USA
| | - Nabila El-Bassel
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 804, Mail Code 4600, New York, NY, 10027, USA
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Lee W, Ti L, Marshall BDL, Dong H, Wood E, Kerr T. Childhood Sexual Abuse and Syringe Sharing Among People Who Inject Drugs. AIDS Behav 2015; 19:1415-22. [PMID: 25428283 DOI: 10.1007/s10461-014-0930-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Childhood sexual abuse is associated with adverse health outcomes. However, the impact of sexual abuse on HIV risk behaviors among people who inject drugs (IDU) has not been thoroughly characterized. We therefore sought to identify whether childhood sexual abuse was associated with syringe sharing among a sample of IDU in Vancouver, Canada. We assessed sexual abuse among two cohorts of IDUs via the Childhood Trauma Questionnaire. Multivariate logistic regression was used to estimate the relationship between childhood sexual abuse and syringe sharing. In total, 1380 IDU were included in the study, and 426 (30.9 %) IDU reported childhood sexual abuse. Syringe sharing (Adjusted Odds Ratio = 1.83, 95 % Confidence Interval 1.28-2.60) remained independently associated with childhood sexual abuse after adjustment for potential confounders. Given that a history of childhood sexual abuse appears to be elevated among IDU who engage in HIV risk behaviors (i.e., syringe sharing), HIV prevention efforts should include efforts to address historical trauma in this population.
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Affiliation(s)
- William Lee
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada,
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Lutnick A, Harris J, Lorvick J, Cheng H, Wenger LD, Bourgois P, Kral AH. Examining the associations between sex trade involvement, rape, and symptomatology of sexual abuse trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2015; 30:1847-63. [PMID: 25210029 PMCID: PMC4363006 DOI: 10.1177/0886260514549051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The high prevalence of rape and sexual trauma symptomatology among women involved in street-based sex trades is well-established. Because prior research has lacked appropriate, non-sex trade involved comparison groups, it is unknown whether differences exist among similarly situated women who do and do not trade sex. This article explores experiences of childhood and adult rape and symptomatology of sexual abuse trauma among a community-based sample of 322 women who use methamphetamine in San Francisco, California, 61% of whom were involved in the sex trade. Study participants were recruited via respondent-driven sampling and eligible if they were cisgender women, aged 18 or older, current methamphetamine users, and sexually active with at least one cisgender man in the past 6 months. The dependent variable was sexual abuse trauma symptomatology, as measured by the Sexual Abuse Trauma Index (SATI) subscale of the Trauma Symptom Checklist-40 (TSC-40), and the explanatory variable was sex trade involvement. Potential covariates were age, current homelessness, methamphetamine dependence, and experiences of childhood and adult rape. Sixty-one percent of participants had a SATI subscale score suggestive of sexual abuse trauma. The overall prevalence of rape in childhood and adulthood was 52% and 73%, respectively. In bivariate analysis, sex trade involvement and all of the potential covariates except for homelessness and age were associated with a SATI score suggestive of sexual abuse trauma. In multivariate models controlling for significant covariates, there was no longer a statistically significant association between sex trade involvement or childhood rape and an elevated SATI score. Elevated levels of psychological dependence on methamphetamine and experiences of rape as an adult were still associated with a high SATI score. These findings highlight that urban poor women, regardless of sex trade involvement, suffer high levels of rape and related trauma symptomatology.
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Joppa MC, Rizzo CJ, Brown LK, Hadley W, Dattadeen JA, Donenberg G, DiClemente R. Internalizing Symptoms and Safe Sex Intentions among Adolescents in Mental Health Treatment: Personal Factors as Mediators. CHILDREN AND YOUTH SERVICES REVIEW 2014; 46:177-185. [PMID: 25284921 PMCID: PMC4180408 DOI: 10.1016/j.childyouth.2014.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.
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Affiliation(s)
- Meredith C. Joppa
- Department of Psychology, Rowan University. 201 Mullica Hill Road, Glassboro, NJ 08028
| | - Christie J. Rizzo
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry K. Brown
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Wendy Hadley
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Jodi-Ann Dattadeen
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Geri Donenberg
- Department of Psychiatry, University of Illinois at Chicago. Institute for Juvenile Research, Chicago, IL
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The syndemic illness of HIV and trauma: implications for a trauma-informed model of care. PSYCHOSOMATICS 2014; 56:107-18. [PMID: 25597836 DOI: 10.1016/j.psym.2014.10.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND People living with HIV infection are disproportionately burdened by trauma and the resultant negative health consequences, making the combination of HIV infection and trauma a syndemic illness. Despite the high co-occurrence and negative influence on health, trauma and posttraumatic sequelae in people living with HIV infection often go unrecognized and untreated because of the current gaps in medical training and lack of practice guidelines. OBJECTIVE We set out to review the current literature on HIV infection and trauma and propose a trauma-informed model of care to target this syndemic illness. METHODS We searched PubMed, PsycINFO, and Cochrane review databases for articles that contained the following search terms: HIV AND either trauma (specifically violent trauma), PTSD, intimate partner violence (IPV), abuse, or trauma-informed care. Articles were limited to primary clinical research or metanalyses published in English. Articles were excluded if they referred to HIV-associated posttraumatic stress disorder or HIV-associated posttraumatic growth. RESULTS We confirm high, but variable, rates of trauma in people living with HIV infection demonstrated in multiple studies, ranging from 10%-90%. Trauma is associated with (1) increased HIV-risk behavior, contributing to transmission and acquisition of the virus; (2) negative internal and external mediators also associated with poor health and high-risk HIV behavior; (3) poor adherence to treatment; (4) poor HIV-related and other health outcomes; and (5) particularly vulnerable special populations. CONCLUSIONS Clinicians should consider using a model of trauma-informed care in the treatment of people living with HIV infection. Its adoption in different settings needs to be matched to available resources.
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Ulibarri MD, Strathdee SA, Lozada R, Magis-Rodriguez C, Amaro H, O'Campo P, Patterson TL. Prevalence and correlates of client-perpetrated abuse among female sex workers in two Mexico-U.S. border cities. Violence Against Women 2014; 20:427-45. [PMID: 24686125 DOI: 10.1177/1077801214528582] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
History of abuse has been associated with greater HIV risk among women. This study examined client-perpetrated abuse among female sex workers (FSWs) in two Mexico-U.S. border cities where HIV prevalence is rising. Among 924 FSWs, prevalence of client-perpetrated abuse was 31%. In multivariate logistic regression models, intimate partner violence (IPV), psychological distress, and having drug-using clients were associated with experiencing client-perpetrated abuse. FSWs along the Mexico-U.S. border report frequently experiencing abuse from both clients and intimate partners, which may have serious mental health consequences. Our findings suggest the need for screening and gender-based violence prevention services for Mexican FSWs.
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Qiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav 2014; 18:419-41. [PMID: 23921582 PMCID: PMC3946791 DOI: 10.1007/s10461-013-0561-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction.
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Affiliation(s)
- Shan Qiao
- Carman and Ann Adams Department of Pediatrics, Prevention Research Center, School of Medicine, Wayne State University, Hutzel Building, Suite W534, 4707 St. Antoine, Detroit, MI, 48201, USA,
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Icard LD, Jemmott JB, Teitelman A, O'Leary A, Heeren GA. Mediation effects of problem drinking and marijuana use on HIV sexual risk behaviors among childhood sexually abused South African heterosexual men. CHILD ABUSE & NEGLECT 2014; 38:234-42. [PMID: 24041455 PMCID: PMC4075286 DOI: 10.1016/j.chiabu.2013.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 05/25/2023]
Abstract
HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18-45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.
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Affiliation(s)
- Larry D Icard
- Center for Intervention and Practice Research, Temple University, College of Health Professions and Social Work, 1301 Cecil B. Moore Avenue, Ritter Annex, Suite B10, Philadelphia, PA 19121, USA
| | | | | | - Ann O'Leary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kuo C, Johnson J, Rosen R, Wechsberg W, Gobin RL, Reddy MK, Peabody M, Zlotnick C. Emotional dysregulation and risky sex among incarcerated women with a history of interpersonal violence. Women Health 2014; 54:796-815. [PMID: 24965256 PMCID: PMC4074246 DOI: 10.1080/03630242.2013.850143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Incarcerated women, in comparison to nonincarcerated women, are at high risk for sexually transmitted infections (STIs) and many have experienced interpersonal violence. The psychological construct of emotional dysregulation-which includes heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotion state, inability to control behaviors when experiencing emotional distress, and maladaptive emotion management responses-is a possible pathway to explain the link between interpersonal violence exposure and STI risk. The present study examined maladaptive emotion management responses for emotional dysregulation (i.e., avoidance and numbing, and dissociation) occurring in the context of risky sexual behavior. We collected qualitative data from 4 focus groups with a sample of n = 21 incarcerated women (aged 18+ years) from urban facilities in New England. Qualitative data were analyzed using a thematic analysis approach. Findings indicated that incarcerated women reported engaging in a variety of maladaptive responses for emotion management during sexual encounters. These maladaptive responses for emotion management appear to increase sexual risk behaviors and alter women's ability to implement STI protective behaviors, such as sexual negotiation and condom use. Preventive interventions to reduce sexual risk behaviors should incorporate strategies to promote emotional regulation among incarcerated women with histories of interpersonal violence.
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Affiliation(s)
- Caroline Kuo
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University
- Department of Psychiatry and Mental Health, University of Cape Town
| | | | - Rochelle Rosen
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University
- The Miriam Hospital
| | - Wendee Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, Research Triangle Institute
| | - Robyn L. Gobin
- Department of Psychiatry and Human Behavior, Brown University
| | - Madhavi K. Reddy
- Department of Psychiatry and Human Behavior, Brown University
- Butler Hospital
- Providence Veterans Affairs Medical Center
| | | | - Caron Zlotnick
- Department of Psychiatry and Mental Health, University of Cape Town
- Department of Psychiatry and Human Behavior, Brown University
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Weiss NH, Tull MT, Borne MER, Gratz KL. Posttraumatic stress disorder symptom severity and HIV-risk behaviors among substance-dependent inpatients. AIDS Care 2013; 25:1219-26. [PMID: 23356590 DOI: 10.1080/09540121.2013.764381] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite findings that the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is associated with heightened risk for a variety of risky behaviors, few studies have examined behaviors linked to heightened risk for HIV infection and transmission in particular, or explored the unique associations between specific PTSD symptom clusters and these HIV-risk behaviors. Therefore, the goal of this study was to examine the associations between PTSD symptom severity and HIV-risk behaviors (i.e., risky sexual behavior [RSB] and injection drug use [INJ]) within an ethnically diverse sample of 85 SUD patients in residential SUD treatment. Participants completed a battery of questionnaires assessing PTSD symptom severity and HIV-risk behaviors, including RSB and INJ. Results demonstrated significant positive associations between PTSD symptom severity and RSB; however, no significant relationship between PTSD symptom severity and INJ was found. Furthermore, the severity of hyperarousal symptoms in particular was found to significantly predict RSB above and beyond age and all other PTSD symptom clusters. Results of this study suggest that PTSD symptoms (and, more specifically, the hyperarousal symptoms of PTSD) may heighten the risk for some forms of HIV-risk behaviors (RSB) but not others (INJ). Results highlight the importance of identifying and targeting hyperarousal symptoms in the treatment of SUD patients experiencing symptoms of PTSD in order to reduce HIV infection or transmission risk.
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Affiliation(s)
- Nicole H Weiss
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center , Jackson , MS , USA
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Senn TE, Carey MP, Coury-Doniger P. Mediators of the relation between childhood sexual abuse and women's sexual risk behavior: a comparison of two theoretical frameworks. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1363-77. [PMID: 22282323 PMCID: PMC3351532 DOI: 10.1007/s10508-011-9897-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 07/22/2011] [Accepted: 09/25/2011] [Indexed: 05/16/2023]
Abstract
Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood, but little research has investigated processes that might mediate this relation. The purpose of this study was to investigate whether constructs suggested by the traumagenic dynamics (TD) model (a theory of the effects of CSA) or constructs suggested by the information-motivation-behavioral skills (IMB) model (a theory of the antecedents of sexual risk behavior) better mediated the relation between CSA and sexual risk behavior in adulthood. Participants were 481 women attending a sexually transmitted infection clinic (66% African American) who completed a computerized survey as well as behavioral simulations assessing condom application and sexual assertiveness skills. Forty-five percent of the sample met criteria for CSA and CSA was associated with sexual risk behavior in adulthood. In multiple mediator models, the TD constructs mediated the relation between CSA and the number of sexual partners whereas the IMB constructs mediated the relation between CSA and unprotected sex. In addition, the TD constructs better mediated the relation between CSA and the number of sexual partners; the TD and IMB constructs did not differ in their ability to mediate the relation between CSA and unprotected sex. Sexual risk reduction interventions for women who were sexually abused should target not only the constructs from health behavior models (e.g., motivation and skills to reduce sexual risk), but also constructs that are specific to sexual abuse (e.g., traumatic sexualization and guilt).
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Affiliation(s)
- Theresa E Senn
- Center for Health and Behavior, Syracuse University, Syracuse, NY 13244, USA.
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Whetten K, Reif S, Toth M, Jain E, Leserman J, Pence BW. Relationship between trauma and high-risk behavior among HIV-positive men who do not have sex with men (MDSM). AIDS Care 2012; 24:1453-60. [PMID: 22909318 DOI: 10.1080/09540121.2012.712665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The incidence of heterosexual HIV transmission continues to increase in the USA. However, little is known about factors that influence high-risk behavior among men who do not have sex with men (MDSM). This study examines the association of childhood sexual abuse and high-risk behaviors among MDSM. The Coping with HIV/AIDS in the Southeast (CHASE) study included 611 HIV-positive individuals in the Southeastern US Bivariate statistics were used to examine the influence of childhood sexual abuse among MDSM, men who have sex with men (MSM), and women. Study findings indicated that among MDSM with HIV, childhood sexual abuse predicted a higher number of sexual partners, alcohol and drug use problems, depression, post-traumatic stress disorder (PTSD), and less trust in medical providers. Similar statistically significant relationships between childhood sexual abuse and negative outcomes were not found for MSM and women with the exception of childhood sexual abuse predicting PTSD and alcohol use in women. Study findings indicate a need for more in-depth research to examine the role of childhood sexual abuse in shaping adult risk behaviors among MDSM as well as a need to assess for and address childhood sexual abuse in this population.
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Affiliation(s)
- Kathryn Whetten
- Center for Health Policy and Inequalities Research (CHPIR) , Duke Global Health Institute (DGHI), Sanford Institute of Public Policy, Duke University, Durham, NC, USA.
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The pervasive effects of childhood sexual abuse: challenges for improving HIV prevention and treatment interventions. J Acquir Immune Defic Syndr 2012; 59:331-4. [PMID: 22293545 DOI: 10.1097/qai.0b013e31824aed80] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Associations of Sexual Identity or Same-Sex Behaviors With History of Childhood Sexual Abuse and HIV/STI Risk in the United States. J Acquir Immune Defic Syndr 2012; 59:400-8. [DOI: 10.1097/qai.0b013e3182400e75] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Arreola SG, Ayala G, Díaz RM, Kral AH. Structure, agency, and sexual development of Latino gay men. JOURNAL OF SEX RESEARCH 2012; 50:392-400. [PMID: 22435920 DOI: 10.1080/00224499.2011.648028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There is a high prevalence of childhood sexual abuse and HIV among Latino gay men, with limited proven HIV prevention interventions. This study used qualitative methods to explicate earlier findings showing differential health outcomes among Latino gay men who had no sex, voluntary, or forced sex before age 16. Analyses of in-depth interviews with 27 Latino gay men revealed that structural factors in childhood contribute to their developing sexuality by enhancing or inhibiting a sense of agency. Agency is essential for making decisions that are in line with their intentions to have healthy sexual lives. Findings suggest that interventions should focus on developing a sense of sexual agency among Latino gay men by (a) increasing their recognition of structural factors that contribute to feelings of worthlessness in order to relocate internalized blame and homophobia to external structural forces, (b) facilitating awareness of the social structural oppressions that lead to psychological and sexual risk in order to enhance their options for sexual health, and (c) shifting from individually focused constructions of sexual health to those that consider the structural factors that reduce agency and contribute to diminished sexual health among Latino gay men.
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Affiliation(s)
- Sonya G Arreola
- Urban Health Program, RTI International, San Francisco, CA 94104, USA.
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Kinyanda E, Weiss HA, Mungherera M, Onyango-Mangen P, Ngabirano E, Kajungu R, Kagugube J, Muhwezi W, Muron J, Patel V. Psychiatric disorders and psychosocial correlates of high HIV risk sexual behaviour in war-affected Eastern Uganda. AIDS Care 2012; 24:1323-32. [PMID: 22272693 DOI: 10.1080/09540121.2011.647676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable "high risk sexual behaviour" defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one "high risk sexual behaviour" than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25-34 and 35-44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.
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Affiliation(s)
- E Kinyanda
- Mental Health Project, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
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Green HD, Tucker J, Wenzel SL, Golinelli D, Kennedy DP, Ryan GW, Zhou A. Association of childhood abuse with homeless women's social networks. CHILD ABUSE & NEGLECT 2012; 36:21-31. [PMID: 22265902 PMCID: PMC3659414 DOI: 10.1016/j.chiabu.2011.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 06/27/2011] [Accepted: 07/04/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Childhood abuse has been linked to negative sequelae for women later in life including drug and alcohol use and violence as victim or perpetrator and may also affect the development of women's social networks. Childhood abuse is prevalent among at-risk populations of women (such as the homeless) and thus may have a stronger impact on their social networks. We conducted a study to: (a) develop a typology of sheltered homeless women's social networks; (b) determine whether childhood abuse was associated with the social networks of sheltered homeless women; and (c) determine whether those associations remained after accounting for past-year substance abuse and recent intimate partner abuse. METHODS A probability sample of 428 homeless women from temporary shelter settings in Los Angeles County completed a personal network survey that provided respondent information as well as information about their network members' demographics and level of interaction with each other. Cluster analyses identified groups of women who shared specific social network characteristics. Multinomial logistic regressions revealed variables associated with group membership. RESULTS We identified three groups of women with differing social network characteristics: low-risk networks, densely connected risky networks (dense, risky), and sparsely connected risky networks (sparse, risky). Multinomial logistic regressions indicated that membership in the sparse, risky network group, when compared to the low-risk group, was associated with history of childhood physical abuse (but not sexual or emotional abuse). Recent drug abuse was associated with membership in both risky network groups; however, the association of childhood physical abuse with sparse, risky network group membership remained. CONCLUSIONS Although these findings support theories proposing that the experience of childhood abuse can shape women's social networks, they suggest that it may be childhood physical abuse that has the most impact among homeless women. PRACTICAL IMPLICATIONS The effects of childhood physical abuse should be more actively investigated in clinical settings, especially those frequented by homeless women, particularly with respect to the formation of social networks in social contexts that may expose these women to greater risks.
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Affiliation(s)
- Harold D. Green
- Corresponding Author. The RAND Corporation 1776 Main Street Santa Monica California 90401-3208;
| | | | - Suzanne L. Wenzel
- University of Southern California School of Social Work, RAND Corporation
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40
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Andersson N, Cockcroft A. Choice-disability and HIV infection: a cross sectional study of HIV status in Botswana, Namibia and Swaziland. AIDS Behav 2012; 16:189-98. [PMID: 21390539 PMCID: PMC3254870 DOI: 10.1007/s10461-011-9912-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Interpersonal power gradients may prevent people implementing HIV prevention decisions. Among 7,464 youth aged 15-29 years in Botswana, Namibia and Swaziland we documented indicators of choice-disability (low education, educational disparity with partner, experience of sexual violence, experience of intimate partner violence (IPV), poverty, partner income disparity, willingness to have sex without a condom despite believing partner at risk of HIV), and risk behaviours like inconsistent use of condoms and multiple partners. In Botswana, Namibia and Swaziland, 22.9, 9.1, and 26.1% women, and 8.3, 2.8, and 9.3% men, were HIV positive. Among both women and men, experience of IPV, IPV interacted with age, and partner income disparity interacted with age were associated with HIV positivity in multivariate analysis. Additional factors were low education (for women) and poverty (for men). Choice disability may be an important driver of the AIDS epidemic. New strategies are needed that favour the choice-disabled.
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41
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Markowitz SM, O’Cleirigh C, Hendriksen ES, Bullis JR, Stein M, Safren SA. Childhood sexual abuse and health risk behaviors in patients with HIV and a history of injection drug use. AIDS Behav 2011; 15:1554-60. [PMID: 21161362 DOI: 10.1007/s10461-010-9857-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Childhood sexual abuse (CSA) is related to poorer health outcomes, associated with increased risk for HIV acquisition, and prevalent among HIV risk groups. Links between CSA and health behavior are an important health concern. We examined the relationship between CSA and transmission risk behavior and medication adherence in 119 HIV-infected individuals with an injection drug use history. 47% reported CSA, with no gender difference. Individuals who experienced CSA were more likely to report sexual HIV transmission risk behavior in the past 6 months, more sexual partners, use of heroin in the past 30 days, and worse adherence to HIV medication than those who did not. These findings confirm that rates of CSA are high in this population, and suggest that a history of CSA may place people managing both HIV and opioid dependence at increased risk for HIV transmission, poor adherence to medication, and vulnerability to substance use relapse.
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42
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Walton G, Co SJ, Milloy MJ, Qi J, Kerr T, Wood E. High prevalence of childhood emotional, physical and sexual trauma among a Canadian cohort of HIV-seropositive illicit drug users. AIDS Care 2011; 23:714-21. [PMID: 21390877 DOI: 10.1080/09540121.2010.525618] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The psychosocial impacts of various types of childhood maltreatment on vulnerable illicit drug-using populations remain unclear. We examined the prevalence and correlates of antecedent emotional, physical and sexual abuse among a community-recruited cohort of adult HIV-seropositive illicit drug users. METHODS We estimated the prevalence of childhood abuse at baseline using data from the Childhood Trauma Questionnaire, a 28-item validated instrument used to retrospectively assess childhood maltreatment. Logistic regression was used to estimate relationships between sub-types of childhood maltreatment with various social-demographic, drug-using and clinical characteristics. RESULTS Overall, 233 HIV-positive injection drug users (IDU) were included in the analysis, including 83 (35.6%) women. Of these, moderate or severe emotional childhood abuse was reported by 51.9% of participants, emotional neglect by 36.9%, physical abuse by 51.1%, physical neglect by 46.8% and sexual abuse by 41.6%. In multivariate analyses, emotional, physical and sexual abuses were independently associated with greater odds of recent incarceration. Emotional abuse and neglect were independently associated with a score of ≥16 on the Centre for Epidemiologic Studies Depression Scale. There was no association between any form of childhood maltreatment and clinical HIV variables, including viral load, CD4+ count and history of antiretroviral therapy use. CONCLUSION These findings underscore the negative impact of childhood maltreatment on social functioning and mental health in later life. Given the substantial prevalence of childhood maltreatment among this population, there is a need for evidence-based resources to address the deleterious effect it has on the health and social functioning of HIV-positive IDU.
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Affiliation(s)
- Georgia Walton
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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43
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Gomez AM. Sexual Violence as a Predictor of Unintended Pregnancy, Contraceptive Use, and Unmet Need Among Female Youth in Colombia. J Womens Health (Larchmt) 2011; 20:1349-56. [DOI: 10.1089/jwh.2010.2518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anu Manchikanti Gomez
- Center for Research on Gender and Sexuality, San Francisco State University, San Francisco, California
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44
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Meyer JP, Springer SA, Altice FL. Substance abuse, violence, and HIV in women: a literature review of the syndemic. J Womens Health (Larchmt) 2011; 20:991-1006. [PMID: 21668380 DOI: 10.1089/jwh.2010.2328] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women in the United States are increasingly affected by HIV/AIDS. The SAVA syndemic-synergistic epidemics of substance abuse, violence, and HIV/AIDS-is highly prevalent among impoverished urban women and potentially associated with poor HIV outcomes. A review of the existing literature found 45 articles that examine SAVA's impact on (1) HIV-associated risk-taking behaviors, (2) mental health, (3) healthcare utilization and medication adherence, and (4) the bidirectional relationship between violence and HIV status. Overall, results confirm the profound impact of violence and victimization and how it is intertwined with poor decision making, increased risk taking and negative health consequences, particularly in the context of substance abuse. Among current findings, there remain diverse and inconsistent definitions for substance abuse, violence, mental illness, adherence, and healthcare utilization that confound interpretation of data. Future studies require standardization and operationalization of definitions for these terms. Development and adaptation of evidence-based interventions that incorporate prevention of violence and management of victimization to target this vulnerable group of women and thereby promote better health outcomes are urgently needed.
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Affiliation(s)
- Jaimie P Meyer
- Yale University School of Medicine, AIDS Program, New Haven, CT 06510-2283, USA.
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45
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Mittal M, Senn TE, Carey MP. Mediators of the relation between partner violence and sexual risk behavior among women attending a sexually transmitted disease clinic. Sex Transm Dis 2011; 38:510-5. [PMID: 21258269 PMCID: PMC3106110 DOI: 10.1097/olq.0b013e318207f59b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with a wide range of negative outcomes, including sexual risk behavior. This cross-sectional study explored mediators of the relationship between IPV and risky sexual behavior in 717 women recruited from a sexually transmitted disease (STD) clinic. METHODS Participants were recruited from a public STD clinic in upstate New York as part of a randomized controlled trial that was designed to evaluate several sexual risk reduction interventions. They completed an audio computer-assisted self-interview in a private room. RESULTS Among these women, 18% reported IPV in the past 3 months and 57% reported lifetime experience of IPV. Recent IPV was associated with greater sexual risk, as measured by more episodes of unprotected sex (overall and with a steady partner). Although IPV was associated with depressive symptoms and drug use before sex, these variables did not mediate the relationship between IPV and sexual risk behavior. CONCLUSIONS The results indicate that IPV is common among women who attend an STD clinic and warrants increased attention. Research is needed to better understand the pathways linking IPV and HIV risk in women, to optimize the design of effective interventions.
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Affiliation(s)
- Mona Mittal
- Department of Marriage and Family Therapy, Syracuse University
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46
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Tubman JG, Oshri A, Taylor HL, Morris SL. Maltreatment clusters among youth in outpatient substance abuse treatment: co-occurring patterns of psychiatric symptoms and sexual risk behaviors. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:301-9. [PMID: 21165690 PMCID: PMC4401029 DOI: 10.1007/s10508-010-9699-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/24/2010] [Accepted: 09/24/2010] [Indexed: 05/25/2023]
Abstract
The purpose of the current study was to describe the use of a brief maltreatment assessment instrument to classify adolescents receiving alcohol or other drug (AOD) treatment services based on the extensiveness and severity of prior maltreatment. This goal is significant because maltreatment reduces the effectiveness of AOD treatment and is associated significantly with co-occurring patterns of psychiatric symptoms and sexual risk behaviors. Structured interviews were administered to 300 adolescent treatment clients (202 males, 98 females; M = 16.22 years; SD = 1.13 years) to assess childhood maltreatment experiences, past year psychiatric symptoms, and sexual risk behaviors during the past 180 days. Cluster analysis classified adolescents into unique groups via self-reported sexual abuse, physical punishment, and parental neglect/negative home environment. Significant between-cluster differences in psychiatric symptoms and sexual risk behaviors were documented using MANOVA and chi-square analyses. More severe maltreatment profiles were associated with higher scores for psychiatric symptoms and unprotected intercourse. Significant heterogeneity and distinct types within this treatment sample of adolescents supports the adaptation of selected prevention efforts to promote HIV/STI risk reduction.
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Affiliation(s)
- Jonathan G Tubman
- Department of Psychology, Florida International University, University Park Campus, Miami, FL 33199, USA.
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47
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Abstract
BACKGROUND Interpersonal violence has increasingly been identified as a risk factor for sexually transmitted infections. Understanding the pathways between violence and sexually transmitted infections is essential to designing effective interventions. OBJECTIVE The aim of this study was to examine dissociative symptoms, alcohol use, and intimate partner physical violence and sexual coercion as mediators of child sexual abuse and lifetime sexually transmitted infection diagnosis among a sample of women. METHODS A convenience sample of 202 women was recruited from healthcare settings, with 189 complete cases for analysis. A multiple mediation model tested the proposed mediators of child sexual abuse and lifetime sexually transmitted infection diagnosis. Bootstrapping, a resampling method, was used to test for mediation. Key variables included child sexual abuse, dissociative symptoms, alcohol use, and intimate partner violence. RESULTS Child sexual abuse was reported by 46% of the study participants (n = 93). Child sexual abuse was found to have an indirect effect on lifetime sexually transmitted infection diagnosis, with the effect occurring through dissociative symptoms (95% confidence interval = 0.0033-0.4714) and sexual coercion (95% confidence interval = 0.0359-0.7694). Alcohol use and physical violence were not found to be significant mediators. DISCUSSION This study suggests that dissociation and intimate partner sexual coercion are important mediators of child sexual abuse and sexually transmitted infection diagnosis. Therefore, interventions that consider the roles of dissociative symptoms and interpersonal violence may be effective in preventing sexually transmitted infections among women.
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Affiliation(s)
- Melissa A Sutherland
- School of Nursing, Boston College, Chestnut Hill, Massachusetts 02467-3812, USA.
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48
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Ulibarri MD, Strathdee SA, Ulloa EC, Lozada R, Fraga MA, Magis-Rodríguez C, De La Torre A, Amaro H, O’Campo P, Patterson TL. Injection drug use as a mediator between client-perpetrated abuse and HIV status among female sex workers in two Mexico-US border cities. AIDS Behav 2011; 15:179-85. [PMID: 19636697 PMCID: PMC2889005 DOI: 10.1007/s10461-009-9595-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 07/12/2009] [Indexed: 11/23/2022]
Abstract
We examined relationships between client-perpetrated emotional, physical, and sexual abuse, injection drug use, and HIV-serostatus among 924 female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico-US border cities. We hypothesized that FSWs’ injection drug use would mediate the relationship between client-perpetrated abuse and HIV-seropositivity. The prevalence of client-perpetrated emotional, physical, and sexual abuse in the past 6 months was 26, 18, and 10% respectively; prevalence of current injection drug use and HIV was 12 and 6%, respectively. Logistic regression analyses revealed that client-perpetrated sexual abuse was significantly associated with HIV-seropositivity and injection drug use, and that injection drug use was positively associated with HIV-seropositivity. Injection drug use partially mediated the relationship between client-perpetrated sexual abuse and HIV-seropositivity. Results suggest the need to address client-perpetrated violence and injection drug use when assessing HIV risk among FSWs.
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49
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Broz D, Ouellet LJ. Prevalence and correlates of former injection drug use among young noninjecting heroin users in Chicago. Subst Use Misuse 2010; 45:2000-25. [PMID: 20380556 PMCID: PMC3632501 DOI: 10.3109/10826081003682875] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Noninjecting heroin users (NIHU) that were 16-30 years old were street recruited in Chicago between 2002 and 2005 to examine factors associated with having ever injected. Participants completed computerized self-administered interviews and provided specimens for HIV and hepatitis serotesting. Of 689 NIHU, 51.2% were non-Hispanic Black, 64.4% were male, and the median age was 25 years. Former injection was reported by 17.9%; of those, 66.7% injected <10 times. Multivariable analysis identified individual and social factors that place young NIHU at increased risk of injection. Targeted interventions are necessary to prevent transitions to injection and reduce transmission of HIV and viral hepatitis infections. The study's limitations are noted.
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Affiliation(s)
- Dita Broz
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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Seth P, Raiford JL, Robinson LS, Wingood GM, Diclemente RJ. Intimate partner violence and other partner-related factors: correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women. Sex Health 2010; 7:25-30. [PMID: 20152092 DOI: 10.1071/sh08075] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 11/17/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intimate partner violence and other partner-related factors have been associated with acquiring sexually transmissible infections (STIs) and engaging in risky sexual behaviour. The present study examined partner-related risk factors for STIs and risky sexual behaviours among an urban sample of African American women. METHODS African American women, between 18 and 29 years (n = 848), participated in the study at baseline. Participants completed a 40-min Audio Computer Assisted Survey Interview assessing sociodemographics, partner-related factors and HIV/STI-associated sexual risk behaviours. Subsequently, participants provided two vaginal swab specimens for STIs. RESULTS The findings indicated that risky sexual behaviours and STIs were prevalent in this sample: 35.6% reported a risky sexual partner, 65.4% reported inconsistent condom use and 17% tested positive for a laboratory-confirmed STI. Women reporting a history of intimate partner violence were more likely to report risky sexual partners (adjusted odds ratio (AOR) = 2.00; 95% confidence interval (CI) = 1.5-2.8), inconsistent condom use (AOR = 1.60; 95% CI = 1.1-2.3) and test positive for an STI (AOR = 1.46; 95% CI = 0.99-2.1). Women reporting high partner-related barriers to condom use were more likely to report risky sexual partners (AOR = 1.69; 95% CI = 1.2-2.3), inconsistent condom use (AOR = 2.13; 95% CI = 1.5-3.0) and test positive for an STI (AOR = 1.98; 95% CI = 1.3-3.0). Finally, women with older partners were more likely to report risky sexual partners (AOR = 1.53; 95% CI = 1.1-2.1) and test positive for an STI (AOR = 1.46; 95% CI = 1.0-2.2). CONCLUSIONS This study examines partner-related risk factors for STIs and risky sexual behaviours among African American women. These findings underscore the need for combined intimate partner violence and HIV/STI prevention programs for this disproportionately affected high-risk group.
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Affiliation(s)
- Puja Seth
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30332, USA.
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