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Wechsberg WM, Carney T, Browne FA, van der Drift IM, Kline TL, Nyblade LL, Ndirangu J, Orrell C, Bonner CP, Caron E. Multilevel strategies to end HIV for young couples in Cape Town: Study protocol for a cluster randomized trial. PLoS One 2024; 19:e0305056. [PMID: 38848400 PMCID: PMC11161046 DOI: 10.1371/journal.pone.0305056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
This protocol presents a multilevel cluster randomized study in 24 communities in Cape Town, South Africa. The study comprises four specific aims. Aim 1, conducted during the formative phase, was to modify the original Couples Health CoOp (CHC) intervention to include antiretroviral therapy/pre-exposure prophylaxis (ART/PrEP), called the Couples Health CoOp Plus (CHC+), with review from our Community Collaborative Board and a Peer Advisory Board. Aim 1 has been completed for staging the trial. Aim 2 is to evaluate the impact of a stigma awareness and education workshop on community members' attitudes and behaviors toward young women and men who use AODs and people in their community seeking HIV services (testing/ART/PrEP) and other health services in their local clinics. Aim 3 is to test the efficacy of the CHC+ to increase both partners' PrEP/ART initiation and adherence (at 3 and 6 months) and to reduce alcohol and other drug use, sexual risk and gender-based violence, and to enhance positive gender norms and communication relative to HIV testing services (n = 480 couples). Aim 4 seeks to examine through mixed methods the interaction of the stigma awareness workshop and the CHC+ on increased PrEP and ART initiation, retention, and adherence among young women and their primary partners. Ongoing collaborations with community peer leaders and local outreach staff from these communities are essential for reaching the project's aims. Additionally, a manualized field protocol with regular training, fidelity checks, and quality assurance are critical components of this multilevel community trial for successful ongoing data collection. Trial registration. Clinicaltrials.gov Registration Number: NCT05310773. Pan African Trials: pactr.samrc.ac.za/ Registration Number: PACTR202205640398485.
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Affiliation(s)
- Wendee M. Wechsberg
- RTI International, Research Triangle Park, Durham, NC, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Tara Carney
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Felicia A. Browne
- RTI International, Research Triangle Park, Durham, NC, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | | | - Tracy L. Kline
- RTI International, Research Triangle Park, Durham, NC, United States of America
| | | | | | - Catherine Orrell
- UCT Faculty of Health Sciences, Desmond Tutu Health Foundation, Observatory, Cape Town, South Africa
| | - Courtney P. Bonner
- RTI International, Research Triangle Park, Durham, NC, United States of America
| | - Emily Caron
- RTI International, Research Triangle Park, Durham, NC, United States of America
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Beksinska A, Karlsen O, Gafos M, Beattie TS. Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001216. [PMID: 37310993 DOI: 10.1371/journal.pgph.0001216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/08/2022] [Indexed: 06/15/2023]
Abstract
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Studies were selected for inclusion that reported any measure of prevalence or incidence of alcohol use among FSWs aged 18 or older from countries defined as LMIC in accordance with the World Bank income groups 2019. The following study designs were included: cross-sectional survey, case-control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Study quality was assessed with the Center for Evidence-Based Management (CEBMa) Critical Appraisal Tool. Pooled prevalence estimates were calculated for (i) any hazardous/harmful/dependent alcohol use, (ii) harmful/dependent alcohol use only, both overall and by region and (iii) daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31-51%), and of daily alcohol use was 26% (95% CI: 17-36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01-2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15-1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24-4.80), but not with HIV, violence or mental health problems. We found a high prevalence of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with important HIV risk factors such as inconsistent condom use, STIs and other drug use. Major limitations included heterogeneity in tools and cut-off scores to measure alcohol use and other common risk factors, and a paucity of longitudinal studies. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oda Karlsen
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ndirangu JW, Gichane MW, Browne FA, Bonner CP, Zule WA, Cox EN, Smith KM, Carney T, Wechsberg WM. ‘We have goals but [it is difficult]’. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa. Health Expect 2022; 25:754-763. [PMID: 35060260 PMCID: PMC8957738 DOI: 10.1111/hex.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Methods Results Conclusion Patient or Public Contribution
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Affiliation(s)
- Jacqueline W. Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Margaret W. Gichane
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Courtney P. Bonner
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - William A. Zule
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Erin N. Cox
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Kevin M. Smith
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council Tygerberg South Africa
- Department of Psychiatry and Mental Health University of Cape Town Rondebosch Cape Town South Africa
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- Department of Psychology North Carolina State University Raleigh North Carolina USA
- Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
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Bonner CP, Carney T, Browne FA, Ndirangu JW, Howard BN, Wechsberg WM. Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa. S Afr Med J 2020; 111:40-45. [PMID: 33404004 PMCID: PMC10729586 DOI: 10.7196/samj.2020.v111i1.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is a high prevalence of substance use among youth in South Africa (SA), and adolescent girls and young women (AGYW) experience high rates of depression and anxiety. Substance use behaviours and mental health are associated with other public health problems among AGYW such as HIV and unintended pregnancy. Therefore, understanding the relationship between substance use and mental health is imperative to improve AGYW's health. OBJECTIVES To examine the association between heavy drinking, marijuana, methamphetamine and methaqualone (Mandrax) use and depressive and anxiety symptoms among AGYW aged 16 - 19 years who have dropped out of school in Cape Town, SA. METHODS Data for this report come from the baseline data of 500 participants of an ongoing cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk. After AGYW consented/assented to participate, they completed a urine drug screen and a baseline questionnaire. RESULTS Logistic and negative binomial regressions, controlling for clustering at the neighbourhood level, revealed that frequency of depressive symptoms was significantly and positively related to a positive drug screen for Mandrax (β=0.07; p=0.03). All other associations between the frequency of depressive symptoms and substance use were not statistically significant (ps>0.05). The associations between frequency of anxiety symptoms and substance use were not statistically significant (ps>0.05). CONCLUSIONS Our findings highlight the need to address substance use, especially Mandrax use and its associated risk, and depression in an integrated, youth-friendly setting.
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Affiliation(s)
- C P Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, Atlanta, GA, USA.
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5
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Abouie A, Majdzadeh R, Khabiri R, Hamedi-Shahraki S, Emami Razavi SH, Yekaninejad MS. Socioeconomic inequities in health services' utilization following the Health Transformation Plan initiative in Iran. Health Policy Plan 2019; 33:1065-1072. [PMID: 30535054 DOI: 10.1093/heapol/czy096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/12/2022] Open
Abstract
Health equity has become a progressively popular research topic in recent years. Therefore, this study was made to identify the contributions made by socioeconomic determinants in order to quantify their roles to healthcare utilization inequity and to show their status especially after the recent reform in Iran, i.e. Health Transformation Plan, which one of its main goals is providing access to healthcare for all people. This study is a cross-sectional study conducted on a national level in Iran in 2015. For the sampling frame, three-stage cluster sampling was used. A total of 22 470 households from the whole country were surveyed by questionnaires through face-to-face interviews. A total of 78 378 subjects responded to the survey, 18 984 subjects (24.2%) reported the need to outpatient healthcare services in the 2 weeks preceding the interview and 12 944 (68.2%) of them had utilized the outpatient services. In addition, 5928 participants (7.6% of total population) reported the need to inpatient healthcare in the 15-month interval prior to the interview. Of these, 5405 subjects (91.2%) had received the inpatient cares. Several factors such as age group, education, marital status and status of household economy play significant roles in seeking inpatient cares. In addition, age group and household economic status have significant impacts on the utilization of outpatient services. While there are several variables that have different effects in determining the need for both outpatient and inpatient services, most of them are not any more significant than what are on the receiving end of these services.
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Affiliation(s)
- Abolfazl Abouie
- School of Medicine and Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran 14155, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Center, Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran 14155, Iran
| | - Roghayeh Khabiri
- Tabriz Health Service Management Research Centre, Tabriz University of Medical Sciences, Mehrgan 7 Avenue, Tabriz, Iran
| | - Soudabeh Hamedi-Shahraki
- Department of Epidemiology and Biostatistics, Zabol University of Medical Sciences, Shahid Rajaei Avenue, Zabol, Iran.,Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Poursina Avenue, Tehran 14155, Iran
| | - Seyed Hasan Emami Razavi
- Neuroscience Institute, Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Keshavarz Avenue, Tehran, Iran.,Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran 14155, Iran
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Mulawa MI, Reyes HLM, Foshee VA, Halpern CT, Martin SL, Kajula LJ, Maman S. Associations Between Peer Network Gender Norms and the Perpetration of Intimate Partner Violence Among Urban Tanzanian Men: a Multilevel Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:427-436. [PMID: 28849338 DOI: 10.1007/s11121-017-0835-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Male perpetration of intimate partner violence (IPV) against women in sub-Saharan Africa is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, though research on this topic in the region is limited. We assessed the degree to which peer network gender norms are associated with Tanzanian men's perpetration of IPV and examined whether the social cohesion of peer networks moderates this relationship. Using baseline data from sexually active men (n = 1103) nested within 59 peer networks enrolled in an on-going cluster-randomized HIV and IPV prevention trial, we fit multilevel logistic regression models to examine peer network-level factors associated with past-year physical IPV perpetration. Peer network gender norms were significantly associated with men's risk of perpetrating IPV, even after adjusting for their own attitudes toward gender roles (OR = 1.53 , p = . 04). Peer network social cohesion moderated this relationship (OR = 1.50 , p = . 04); the positive relationship between increasingly inequitable (i.e., traditional) peer network gender norms and men's risk of perpetrating IPV became stronger, as peer network social cohesion increased. Characteristics of the peer network context are associated with men's IPV perpetration and should be targeted in future interventions. While many IPV prevention interventions focus on changing individual attitudes, our findings support a unique approach, focused on transforming the peer context.
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Affiliation(s)
- Marta I Mulawa
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - H Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Vangie A Foshee
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Carolyn T Halpern
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lusajo J Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Carney T, Browne FA, Myers B, Kline TL, Howard B, Wechsberg WM. Adolescent female school dropouts who use drugs and engage in risky sex: effects of a brief pilot intervention in Cape Town, South Africa. AIDS Care 2019; 31:77-84. [PMID: 30021470 PMCID: PMC6343022 DOI: 10.1080/09540121.2018.1500008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
Female adolescents from socioeconomically underserved communities in Cape Town, South Africa, who have dropped out of school, use substances, and engage in risky sex behaviour are at risk of HIV. Tailored gender-focused HIV behavioural interventions for this key population are needed to mitigate these risk factors. A pilot trial of a woman-focused risk-reduction intervention for adolescents was conducted (N = 100), with a one-month follow-up appointment. Participants in the intervention group attended two group workshops. Data were examined for significant differences within and between the groups. At baseline, 94% of participants tested positive for cannabis, 17% were HIV-positive and 11% were pregnant. Ninety-two participants returned for 1-month follow-up. At follow-up, the proportion who tested positive for cannabis use decreased significantly in both the intervention (p = 0.07) and control groups (p = 0.04). Impaired sex with any partner (p = 0.02), or with main partner (p = 0.06) decreased among the intervention group. Impaired sex with a main partner was less likely in the intervention group (p = 0.07) in the regression model. In conclusion, findings indicate a need for HIV prevention interventions among out-of-school female adolescents. Intervention acceptability was high, and there were some decreases in sexual risk behaviour among intervention participants which is promising. Future intervention research with this key population involving larger sample sizes and longer follow-up periods will help to determine intervention efficacy.
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Affiliation(s)
- Tara Carney
- a Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council , Tygerberg , South Africa
- b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | | | - Bronwyn Myers
- a Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council , Tygerberg , South Africa
- b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Tracy L Kline
- c RTI International , Research Triangle Park , NC , USA
| | | | - Wendee M Wechsberg
- c RTI International , Research Triangle Park , NC , USA
- d Health, Policy and Administration, Gillings School of Global Public Health, The University of North Carolina , Chapel Hill , NC , USA
- e Department of Psychology , North Carolina State University , Raleigh , NC , USA
- f Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham , NC , USA
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Bozinoff N, Luo L, Dong H, Krüsi A, DeBeck K. Street-involved youth engaged in sex work at increased risk of syringe sharing. AIDS Care 2018; 31:69-76. [PMID: 29999421 DOI: 10.1080/09540121.2018.1497134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Syringe sharing places street-involved young people at risk of acquiring HIV and hepatitis C. While markers of economic marginalization, such as homelessness, have been linked with syringe sharing and have led to targeted interventions, the relationship between syringe sharing and other markers of economic vulnerability, such as sex work, are not well documented among young people. This study examines whether those engaged in sex work are at increased risk of syringe borrowing and syringe lending among street-involved youth who use injection drugs in Vancouver, Canada. Between September 2005 and May 2014, data was collected from the At-Risk Youth Study (ARYS), a prospective cohort of street involved youth aged 14-26. Generalized estimating equations with a confounding model building approach was used to examine the relationship between sex work and syringe borrowing and lending. 498 youth reported injecting drugs at some point during the study period and were therefore included in the analysis. In multivariable analysis, youth who engaged in sex work were at an elevated risk of both syringe borrowing (Adjusted Odds Ratio (AOR) = 2.17, 95% Confidence Interval [CI] = 1.40-3.36) and syringe lending (AOR = 1.66, 95% CI = 1.07-2.59). Our study found that youth engaged in street-based sex work were at a significantly higher risk of both syringe borrowing and lending among youth who use injection drugs in Vancouver. Ready access to clean syringes, safer working conditions for sex workers to enable risk reduction measures, and increased access to addiction treatment are identified as promising opportunities for reducing syringe sharing in this setting.
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Affiliation(s)
- Nikki Bozinoff
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,b Department of Family and Community Medicine , University of Toronto , Toronto , ON , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada
| | - Lerly Luo
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada
| | - Huiru Dong
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada
| | - Andrea Krüsi
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada.,d Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Kora DeBeck
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada.,e School of Public Policy , Simon Fraser University , Vancouver , BC , Canada
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Baptista CJ, Dourado I, de Andrade TM, Brignol S, Bertoni N, Bastos FI. HIV Prevalence, Knowledge, Attitudes, and Practices Among Polydrug Users in Brazil: A Biological Survey Using Respondent Driven Sampling. AIDS Behav 2018; 22:2089-2103. [PMID: 28567550 DOI: 10.1007/s10461-017-1812-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Brazil has a concentrated HIV epidemic among key populations. In 2009, the Ministry of Health conducted a survey in 10 Brazilian cities aiming to estimate HIV prevalence, knowledge, and associated risk behaviors of polysubstance users (PSU). Using Respondent Driven Sampling (RDS), 3449 PSU were recruited, answered an Audio-Computer Self Assisted Interview (ACASI) and were tested for HIV and syphilis. Analyses were weighted by individual's social network size generated on RDSAT. Pooled HIV prevalence was 5.8% but varied across cities. Most PSU were male, non-white, without income, unemployed, with low levels of education. Overall, 12.0% used injectable drugs, 48.7% had sex with occasional partners and 46.4% engaged in commercial sex. A majority received free condoms (71.4%) but 76.7% exhibited inconsistent condom use. Findings can support policies aiming to improve health care and preventive interventions tailored to this population that remains at high risk of acquiring and transmitting HIV/STI in multiple scenarios.
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Affiliation(s)
- Cremildo João Baptista
- Departamento de Ciência e Tecnologia - DECIT, Secretaria de Ciência, Tecnologia e Insumos Estratégicos - SCTIE, Ministério da Saúde - Unidade IX, SCN Quadra 2, Bloco C - Sl. 01 - Térreo, Brasília, DF, 70712-902, Brazil.
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Sandra Brignol
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brazil
| | - Neilane Bertoni
- Division of Epidemiology - Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT), Fiocruz, Rio de Janeiro, Brazil
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Rosen RK, Kuo C, Gobin RL, Peabody M, Wechsberg W, Zlotnick C, Johnson JE. How Qualitative Methods Contribute to Intervention Adaptation: An HIV Risk Reduction Example. QUALITATIVE PSYCHOLOGY 2018; 5:2-15. [PMID: 35747561 DOI: 10.1037/qup0000093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes how to use qualitative data for adapting an existing behavioral intervention to a new population using a specific illustration-the adaptation of the Women's CoOp HIV intervention to the needs of women prisoners who have experienced interpersonal violence. We describe and illustrate how we conducted each step in the adaptation process, including (1) choosing a well-matched intervention to adapt, (2) setting specific goals for the adaptation, (3) writing a focus group agenda that will collect the data you need for the adaptation, (4) recruiting participants and conducting the focus groups, (5) using debriefs to assess the data as you gather them, (6) coding, (7) analysis, (8) using the qualitative data to guide the intervention adaptation, (9) conducting additional groups and making final revisions, and (10) pilot testing the intervention. These steps provide an effective model for how to collect and analyze qualitative data that support behavioral intervention development.
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Affiliation(s)
- Rochelle K Rosen
- The Miriam Hospital, Providence, Rhode Island, and Brown University School of Public Health
| | - Caroline Kuo
- Brown University School of Public Health and University of Cape Town
| | | | | | - Wendee Wechsberg
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Caron Zlotnick
- University of Cape Town; Brown University; and Butler Hospital, Providence, Rhode Island
| | - Jennifer E Johnson
- Brown University and Michigan State University College of Human Medicine
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Howard BN, Van Dorn R, Myers BJ, Zule WA, Browne FA, Carney T, Wechsberg WM. Barriers and facilitators to implementing an evidence-based woman-focused intervention in South African health services. BMC Health Serv Res 2017; 17:746. [PMID: 29157230 PMCID: PMC5697075 DOI: 10.1186/s12913-017-2669-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Since the beginning of the HIV epidemic, numerous behavior change, risk-reduction, and biomedical interventions have been developed and tested. While some of these interventions have shown to be efficacious in randomized trials, it often takes almost two decades for an intervention to be translated into practice. Meanwhile, South Africa continues to have among the highest prevalence of HIV globally, with women of childbearing age bearing the burden of the epidemic. Given the urgency of the HIV epidemic among vulnerable women in South Africa, it is imperative that evidence-based interventions be implemented rapidly into practice. This study presents a first step toward examining the acceptability and feasibility of implementing the Women's Health CoOp (WHC) in clinics and substance abuse rehab settings in Cape Town, South Africa. METHODS We conducted focus group discussions with women who use substances and with service providers, we also conducted in-depth interviews with health service planners. Our goal was to examine implementation and clinical outcomes associated with delivery of the WHC across clinics and substance abuse rehab programs. RESULTS All participants agreed on the need for the WHC. Perceived facilitators to implementing the WHC included the recognizable need for programs to empower women and to build the capacity of staff to address issues of substance use, sexual risk, and intimate partner violence. Participants also identified potential barriers to women engaging with this program, including the stigma women experience when seeking services and the lack of person-centered care at healthcare facilities. CONCLUSIONS In a country with the largest number of women of childbearing age living with HIV, an evidence-based woman-focused intervention that comprehensively addresses women's risk for suboptimal antiretroviral adherence may be essential for reducing HIV incidence. However, potential barriers to implementing the WHC successfully must be addressed before the program can be fully integrated into the services delivered by healthcare facilities. TRIAL REGISTRATION Clinical trials NCT02733003 . Date of Registration: January 21, 2016, registered retroactively after participant enrollment.
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Affiliation(s)
- Brittni N. Howard
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Richard Van Dorn
- Behavioral and Urban Health Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Bronwyn J. Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town 7505 South Africa
| | - William A. Zule
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town 7505 South Africa
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
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12
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Carney T, Myers B, Kline TL, Johnson K, Wechsberg WM. Aggressive behaviour among drug-using women from Cape Town, South Africa: ethnicity, heavy alcohol use, methamphetamine and intimate partner violence. BMC WOMENS HEALTH 2017; 17:93. [PMID: 28964269 PMCID: PMC5622560 DOI: 10.1186/s12905-017-0447-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/20/2017] [Indexed: 11/10/2022]
Abstract
Background Women have generally been found to be the victims of violence, but scant attention has been paid to the characteristics of women who perpetrate aggression and violence. In South Africa, violence is a prevalent societal issue, especially in the Western Cape. Method This study aimed at identifying factors that were associated with aggression among a sample of 720 substance-using women. We conducted multivariate logistic regression to identify factors that are significantly associated with these behaviours. Results Ethnicity (Wald Χ2 = 17.07(2), p < 0.01) and heavy drinking (Wald Χ2 = 6.60 (2), p = 0.01) were significantly related to verbal aggression, methamphetamine use was significantly related to physical (Wald Χ2 = 2.73 (2), p = 0.01) and weapon aggression (Wald Χ2 = 7.94 (2), p < 0.01) and intimate partner violence was significantly related to verbal (Wald Χ2 = 12.43 (2), p < 0.01) and physical aggression (Wald Χ2 = 25.92 (2), p < 0.01). Conclusions The findings show high levels of aggression among this sample, and highlight the need for interventions that address methamphetamine, heavy drinking and intimate partner violence among vulnerable substance-using women.
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Affiliation(s)
- Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa. .,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tracy L Kline
- Substance Use Gender, and Applied Research Program, Research Triangle Park, RTI, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa
| | - Wendee M Wechsberg
- Substance Use Gender, and Applied Research Program, Research Triangle Park, RTI, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA.,RTI Gender Global Gender Center, Research Triangle Park, 3040 Cornwallis Road, Chapel Hill, NC, 27709, USA.,Health, Policy and Administration, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA.,Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA.,Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
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13
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Wechsberg WM, Ndirangu JW, Speizer IS, Zule WA, Gumula W, Peasant C, Browne FA, Dunlap L. An implementation science protocol of the Women's Health CoOp in healthcare settings in Cape Town, South Africa: A stepped-wedge design. BMC Womens Health 2017; 17:85. [PMID: 28923034 PMCID: PMC5604513 DOI: 10.1186/s12905-017-0433-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/28/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND HIV persists as a public health emergency in South Africa, especially among women of childbearing age. In response to the HIV epidemic, the Joint United Nations Programme on HIV/AIDS has put forth the 90-90-90 global goals to achieve an AIDS-free generation by 2020. This goal aspires to have 90% of people living with HIV diagnosed; 90% of those who test positive on sustained antiretroviral therapy (ART); and 90% of those on ART be virally suppressed. Ensuring access to ART is an important first step in reducing HIV incidence, especially among vulnerable populations such as women who use substances and bear the burden of HIV in South Africa. Additionally, alcohol and other drug (AOD) use and exposure to gender-based violence are associated with increased risk of HIV infection and reduced adherence to ART. However, no research has estimated ART adherence rates for women who use substances in South Africa since the government approved the provision of ART to all people living with HIV. METHODS The Women's Health CoOp (WHC) is an evidence-based, woman-focused, behavioral intervention that addresses the intersecting risks of AODs, sex behaviors, and violence and victimization, with the primary goal of increasing skills and knowledge to reduce substance abuse and HIV risks and to improve ART adherence. The WHC has been packaged for further dissemination. This article describes the study protocol used to assess the feasibility and acceptability of implementing the WHC intervention into standard of care in Cape Town health clinics and substance abuse rehabilitation centers to reduce HIV risk behavior and increase ART adherence among women who use substances and are living with HIV. DISCUSSION Because few of the interventions that demonstrate efficacy for HIV prevention and ART adherence in randomized trials are sustainable, studies to adapt and test intervention variations are needed to determine the best strategies for implementing them in real-world, high-risk settings. However, implementation in real-world settings presents challenges. Consequently, intervention developers should consider the strengths and limitations of their anticipated implementation setting by engaging with key stakeholders before, during, and after the adaptation and implementation process when developing and attempting to scale-up interventions. TRIAL REGISTRATION NCT 02733003 and date approved 1/21/2016.
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Affiliation(s)
- Wendee M. Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709 USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445, Chapel Hill, NC 27599 USA
- Department of Psychology, North Carolina State University, 2310 Katharine Stinson Drive Raleigh, Raleigh, NC 27607 USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Cir, Durham, NC 27710 USA
| | | | - Ilene S. Speizer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445, Chapel Hill, NC 27599 USA
| | - William A. Zule
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709 USA
| | - Winnifred Gumula
- Kheth’Impilo, 11th floor Metlife Centre, 7 Walter Sisulu Avenue, Cape Town, 8001 South Africa
| | - Courtney Peasant
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709 USA
| | - Felicia A. Browne
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709 USA
| | - Laura Dunlap
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709 USA
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Zhang J, Jemmott JB, Heeren GA. Sub-Saharan African University Students' Beliefs about Abstinence, Condom Use, and Limiting the Number of Sexual Partners. Behav Med 2017; 43:9-20. [PMID: 25864861 DOI: 10.1080/08964289.2015.1028321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Given the high risk of HIV infection among university students in sub-Saharan Africa, there is a need for culturally appropriate risk-reduction interventions specifically targeting this population. Efforts to reduce the risk require an understanding of the modifiable antecedents of sexual-risk behaviors. We report the results of a semi-structured elicitation survey based on the reasoned action approach to identify behavioral, normative, and control beliefs regarding abstinence, condom use, and limiting sexual partners. Two coders classified into 64 belief categories the written responses of 96 sub-Saharan African university students. Most students believed each behavior could reduce risk of HIV infection. The students reported that peer pressure and being in a risky environment made it harder to practice abstinence. Good communication made it easier to use condoms and to limit partners; however, unstable relationships made practicing these protective behaviors harder. The identified beliefs help to inform the development of theory-based HIV risk-reduction interventions.
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Affiliation(s)
- Jingwen Zhang
- a Annenberg School for Communication, University of Pennsylvania
| | - John B Jemmott
- a Annenberg School for Communication, University of Pennsylvania.,b Perelman School of Medicine, University of Pennsylvania
| | - G Anita Heeren
- b Perelman School of Medicine, University of Pennsylvania
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Wechsberg WM, Zule WA, El-Bassel N, Doherty IA, Minnis AM, Novak SD, Myers B, Carney T. The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township. Drug Alcohol Depend 2016; 161:307-15. [PMID: 26946991 PMCID: PMC5645020 DOI: 10.1016/j.drugalcdep.2016.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence. METHODS Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners. RESULTS At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm. CONCLUSIONS A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.
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Affiliation(s)
- Wendee M Wechsberg
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States
| | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
| | - Irene A Doherty
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States
| | - Alexandra M Minnis
- RTI International, 351 California Street, San Francisco, CA, United States
| | - Scott D Novak
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tara Carney
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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Bouscaillou J, Evanno J, Prouté M, Inwoley A, Kabran M, N'Guessan T, Djé-Bi S, Sidibé S, Thiam-Niangoin M, N'guessan BR, Blanchetière P, Luhmann N. Prevalence and risk factors associated with HIV and tuberculosis in people who use drugs in Abidjan, Ivory Coast. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:116-23. [PMID: 26964902 DOI: 10.1016/j.drugpo.2016.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The number of people who use drugs (PWUD) has dramatically increased in West Africa over the last 15 years, but targeted interventions are falling behind, notably because of the lack of awareness of the health needs of PWUD. We aimed to assess prevalence and factors associated with HIV and other infections in PWUD in Abidjan, Ivory Coast, one of the countries most affected by HIV in Western Africa. METHODS We used respondent-driven-sampling to obtain a representative sample of heroin or cocaine/crack users aged 18 years or more. Socio-behavioral data were obtained by face-to-face questionnaires. Blood samples were collected and tested for HIV. Two sputa were obtained in tuberculosis (TB) symptomatic participants for acid-fast-bacilli (AFB) smear testing. After a descriptive analysis, crude prevalence were calculated, then weighted to take account of the sampling method. Factors associated with HIV and TB were studied using adjusted log-binomial regression. Population size was estimated by capture-recapture. RESULTS 450 PWUD were recruited in May 2014. The mean age was 33.5 years; 10.9% were women. Smoking was the main mode of consumption, ever injecting was reported by 12.7% of the participants (3.6% in the past month). Sex work was reported by 15.8% of the PWUD (13.7% of the men), and 10.2% of the men reported sexual relationships with other men (MSM). We found a weighted prevalence of 9.5% for HIV. Women were 3.4 times more likely to be infected than men. Among men, being a sex worker (SW) (adjusted OR 2.9 [95CI 1.06-7.98]) or MSM (adjusted OR 11.5 [95CI 4.22-31.42]) were the main factors associated with HIV infection in adjusted analysis. Injection was not associated with HIV. TB weighted prevalence was 1.8%, associated with poor living arrangements in adjusted analysis. We estimated that 3521; 95CI 3049-3993 PWUD live in Abidjan. CONCLUSION PWUD in Abidjan are at high risk of HIV due to sexual transmission, especially in women, SW and MSM who also use drugs. Interventions should be developed to improve HIV prevention and linkage to care in these specific populations. More generally, improving the health of PWUD involves a broader reflection on the living environment and access to health care of slum residents in large African cities.
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Affiliation(s)
- Julie Bouscaillou
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
| | - Jérome Evanno
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - Myrtille Prouté
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - André Inwoley
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - Mathieu Kabran
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - Thierry N'Guessan
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - Samedi Djé-Bi
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - Souleymane Sidibé
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | | | | | - Pascale Blanchetière
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
| | - Niklas Luhmann
- Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France
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17
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Wechsberg WM, Deren S, Myers B, Kirtadze I, Zule WA, Howard B, El-Bassel N. Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S128-39. [PMID: 25978479 PMCID: PMC4505613 DOI: 10.1097/qai.0000000000000627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at 3 generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women.
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Affiliation(s)
- Wendee M. Wechsberg
- RTI International, Research Triangle Park, NC, USA
- University of North Carolina, Chapel Hill, NC, USA
- Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sherry Deren
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY, USA
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Irma Kirtadze
- Addiction Research Center, Alternative Georgia, Tbilisi, Georgia
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Wechsberg WM, El-Bassel N, Carney T, Browne FA, Myers B, Zule WA. Adapting an evidence-based HIV behavioral intervention for South African couples. Subst Abuse Treat Prev Policy 2015; 10:6. [PMID: 25888856 PMCID: PMC4344778 DOI: 10.1186/s13011-015-0005-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 02/16/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex. METHODS To address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women's HIV prevention intervention (the Western Cape Women's Health CoOp) to include components of an evidence-based couple's intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability. RESULTS The new intervention is called the Couples' Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples' Health CoOp also includes "voices" from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants' suggestions made during formative work and pilot testing. CONCLUSIONS The Couples' Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa. TRIAL REGISTRATION NUMBER NCT01121692 .
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA.
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
- Psychology in the Public Interest, North Carolina State University, Raleigh, NC, USA.
- Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA.
| | | | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - William A Zule
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC, USA.
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Reed E, Myers B, Novak SP, Browne FA, Wechsberg WM. Experiences of violence and association with decreased drug abstinence among women in Cape Town, South Africa. AIDS Behav 2015; 19:192-8. [PMID: 24934652 DOI: 10.1007/s10461-014-0820-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Drug abuse is a contributing factor in women's HIV risk in low-income communities in Cape Town, South Africa. This study assessed whether experiencing violence is associated with reduced drug abstinence among adult women (n = 603) participating in a randomized field trial for an HIV prevention study in Cape Town. In relation to drug abstinence at 12-month follow-up, multivariable regression models were used to assess (1) baseline partner and non-partner victimization, and (2) victimization at 12-month follow-up among participants reporting baseline victimization. Baseline partner (AOR = 0.6; 95 % CI 0.4-0.9) and non-partner victimization (AOR = 0.6; 95 % CI 0.4-0.9) were associated with a reduced likelihood of drug abstinence at follow-up. Among participants who reported victimization at baseline, those no longer reporting victimization at follow-up did not differ significantly in drug abstinence compared with those who reported victimization at follow-up. The study findings highlight the lasting impact of victimization on women's drug use outcomes, persisting regardless of whether violence was no longer reported at follow-up. Overall, the findings support the need for the primary prevention of violence to address the cycle of violence, drug use, and HIV among women in this setting.
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Affiliation(s)
- Elizabeth Reed
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, Mail code 0507, La Jolla, CA, 92093, USA,
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Brown B, Folayan MO, Imosili A, Durueke F, Amuamuziam A. HIV self-testing in Nigeria: public opinions and perspectives. Glob Public Health 2014; 10:354-65. [PMID: 25186234 DOI: 10.1080/17441692.2014.947303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Nigeria views the HIV self-test (HIVST) as a possible mechanism to help increase HIV testing uptake and capture otherwise undiagnosed HIV cases. The purpose of this survey was to obtain perspectives of informed members of the Nigerian public on the use of the HIVST. A convenience sample of 1712 researchers, academics, journalists, community advocates, activists and HIV policy-makers and programmers including those working in the development sectors enlisted on the New HIV Vaccine and Microbicide Advocacy Society listserv were sent a brief survey. Respondents were asked to provide a 'yes' or 'no' response to an enquiry if they support the introduction of HIVST into Nigeria. Reasons for their response were also recorded. Information was collected anonymously with no identifiers. Only 157 (9.2%) provided a response. While the majority (54.8%) supported the introduction of HIVST, a significant number of respondents were concerned about possible risk associated with self-testing, especially suicide and partner violence. Others were concerned about poor linkages to care. Introduction of HIVST would need to be paired with intense media campaigns and education about its use. Once Nigeria commences HIVST, efforts should also focus on approaches to reach people in hard to reach areas of the country.
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Affiliation(s)
- Brandon Brown
- a Program in Public Health , University of California , Irvine , CA , USA
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21
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Sawyer-Kurian KM, Browne FA, Carney T, Petersen P, Wechsberg WM. Exploring the Intersecting Health Risks of Substance Abuse, Sexual Risk, and Violence for Female South African Teen Dropouts. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2011.10820425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Contextualizing gender differences and methamphetamine use with HIV prevalence within a South African community. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:583-90. [PMID: 24316002 DOI: 10.1016/j.drugpo.2013.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 09/19/2013] [Accepted: 10/30/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study was conducted in a large Black African township outside of Cape Town, South Africa, where HIV infection has been endemic at extremely high levels for years. Problems associated with high HIV prevalence are compounded by gender inequality and high rates of gender-based violence exacerbated by heavy alcohol use and increasing methamphetamine use. METHODS Informal drinking establishments (known as shebeens) were geocoded and mapped. Based on visual examination, we identified 36 neighbourhoods, each of which contained between three to seven drinking venues clustered together. Neighbourhoods were separated from each other by at least 200m. We randomly selected 30 of the 36 neighbourhoods. Outreach workers screened males in shebeens and screened their female partners. This analysis includes 580 study participants recruited from 30 neighbourhoods between 2010 and 2012. All participants completed a baseline questionnaire that included individual-level, couple-level, and neighbourhood-level measures of alcohol and other drug use, HIV infection, and HIV risk behaviours. Multilevel fixed effects regression analyses stratified by gender were conducted to examine correlates of HIV infection. RESULTS Women were twice as likely as men to be HIV infected, yet they reported fewer sex partners. Neighbourhood prevalence of HIV was correlated with greater likelihood of HIV infection among women, but not men. Neighbourhood methamphetamine use was marginally associated with HIV among women but not among men. At the individual level, heavy alcohol use was marginally associated with HIV infection among men but not among women. Having an HIV positive partner was the strongest correlate of being HIV positive among both men and women. CONCLUSION Findings from this study underscore the need for policy makers to direct scarce resources to the communities, places within communities, and populations, especially vulnerable women, where the impact on HIV prevention and onward transmission will be greatest.
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Wechsberg WM, Myers B, Reed E, Carney T, Emanuel A, Browne FA. Substance use, gender inequity, violence and sexual risk among couples in Cape Town. CULTURE, HEALTH & SEXUALITY 2013; 15:1221-36. [PMID: 23927691 PMCID: PMC3818292 DOI: 10.1080/13691058.2013.815366] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.
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Affiliation(s)
| | - Bronwyn Myers
- South African Medical Research Council, Parow, South Africa
| | - Elizabeth Reed
- Department of Prevention & Community Health, George Washington University School of Public Health and Health Services, Washington, USA
| | - Tara Carney
- South African Medical Research Council, Parow, South Africa
| | - Andrea Emanuel
- RTI International, Research Triangle Park, North Carolina, USA
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Reed E, Emanuel AN, Myers B, Johnson K, Wechsberg WM. The relevance of social contexts and social action in reducing substance use and victimization among women participating in an HIV prevention intervention in Cape Town, South Africa. Subst Abuse Rehabil 2013; 4:55-64. [PMID: 24648788 PMCID: PMC3931639 DOI: 10.2147/sar.s45961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To examine qualitatively how women’s social context and community mobilization (eg, mobilizing women to take social action and engaging their community in social change) influence substance use abstinence and victimization among women participating in a human immunodeficiency virus (HIV) intervention in Cape Town, South Africa. Methods Thirty women who had participated in a randomized controlled trial of a group-delivered intervention to address substance use, gender-based violence, and associated risk for HIV (The Women’s Health CoOp) were selected to participate in semi-structured interviews about their perceived impact of the intervention on their substance use and exposure to victimization. The Women’s CoOp intervention involved creating a new positive social environment for women within a group setting that also fostered women’s social action (eg, educating peers or family members) in the community. Interviews were analyzed using content analysis and coded to examine women’s descriptions of social contexts and social action, and the influence of these on women’s substance use abstinence and exposure to victimization. Results Social support (eg, via program staff and other participants) and social action (eg, engaging others in the community on issues relevant to substance use prevention or other health topics) promoted within the program, as well as outside social influences within women’s life contexts (eg, support from non-substance using family or male partners, leaving male partners or other peer relationships characterized by drug use, or finding employment) were key factors reported by women in terms of facilitating their substance use abstinence and in reducing women’s exposures to victimization. Conclusion Findings highlight the potential for group-delivered interventions that include mobilizing women to take social action in the larger community to be effective approaches for facilitating substance use abstinence, reductions in victimization, and ultimately, to address the intersection between substance use, violence, and HIV risk among women in this high HIV prevalence setting.
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Affiliation(s)
- Elizabeth Reed
- George Washington University School of Public Health, Department of Prevention and Community Health, Washington, DC, USA
| | | | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa ; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kim Johnson
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, NC, USA ; Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA ; Psychology in the Public Interest, North Carolina State University, NC, USA ; Psychiatry and Behavioral Sciences, Duke University School of Medicine, NC, USA
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Wechsberg WM, Jewkes R, Novak SP, Kline T, Myers B, Browne FA, Carney T, Morgan Lopez AA, Parry C. A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: a randomised trial of the Women's Health CoOp. BMJ Open 2013; 3:e002622. [PMID: 23793683 PMCID: PMC3657672 DOI: 10.1136/bmjopen-2013-002622] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/28/2013] [Accepted: 04/17/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the impact of the Women's Health CoOp (WHC) on drug abstinence among vulnerable women having HIV counselling and testing (HCT). DESIGN Randomised trial conducted with multiple follow-ups. SETTING 15 communities in Cape Town, South Africa. PARTICIPANTS 720 drug-using women aged 18-33, randomised to an intervention (360) or one of two control arms (181 and 179) with 91.9% retained at follow-up. INTERVENTIONS The WHC brief peer-facilitated intervention consisted of four modules (two sessions), 2 h addressing knowledge and skills to reduce drug use, sex risk and violence; and included role-playing and rehearsal, an equal attention nutrition intervention, and an HCT-only control. PRIMARY OUTCOME MEASURES Biologically confirmed drug abstinence measured at 12-month follow-up, sober at last sex act, condom use with main and casual sex partners, and intimate partner violence. RESULTS At the 12-month endpoint, 26.9% (n=83/309) of the women in the WHC arm were abstinent from drugs, compared with 16.9% (n=27/160) in the Nutrition arm and 20% (n=31/155) in the HCT-only control arm. In the random effects model, this translated to an effect size on the log odds scale with an OR of 1.54 (95% CI 1.07 to 2.22) comparing the WHC arm with the combined control arms. Other 12-month comparison measures between arms were non-significant for sex risk and victimisation outcomes. At 6-month follow-up, women in the WHC arm (65.9%, 197/299) were more likely to be sober at the last sex act (OR1.32 (95% CI 1.02 to 1.84)) than women in the Nutrition arm (54.3%, n=82/152). CONCLUSIONS This is the first trial among drug-using women in South Africa showing that a brief intervention added to HCT results in greater abstinence from drug use at 12 months and a larger percentage of sexual activity not under the influence of substances. TRIAL REGISTRATION NUMBER NCT00729391 ClinicalTrials.gov.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Intervention Research, RTI International, Durham, North Carolina, USA
- Health Policy and Administration, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Psychology in the Public Interest, North Carolina State University, Raleigh, North Carolina, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Scott P Novak
- Faculty of Health Sciences, RTI International, Durham, North Carolina, USA
| | - Tracy Kline
- Faculty of Health Sciences, RTI International, Durham, North Carolina, USA
| | - Bronwyn Myers
- Behavioral Health Epidemiology, Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Felicia A Browne
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Tara Carney
- Behavioral Health Epidemiology, Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | | | - Charles Parry
- Behavioral Health Epidemiology, Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
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Pinkham S, Stoicescu C, Myers B. Developing effective health interventions for women who inject drugs: key areas and recommendations for program development and policy. Adv Prev Med 2012; 2012:269123. [PMID: 23198158 PMCID: PMC3501794 DOI: 10.1155/2012/269123] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/14/2012] [Indexed: 11/23/2022] Open
Abstract
Women who inject drugs face multiple gender-specific health risks and barriers to healthcare access. These gendered factors may contribute to elevated rates of HIV for this population. Though few countries systematically collect gender-disaggregated data related to injecting drug use, evidence indicates that there are large populations of women who inject drugs and who are in need of improved health services, including HIV prevention. Research on the effectiveness of interventions specifically tailored for women who inject drugs, along with the experience of programs working with this subpopulation, suggests that HIV risk practices need to be addressed within the larger context of women's lives. Multifaceted interventions that address relationship dynamics, housing, employment, and the needs of children may have more success in reducing risky practices than interventions that focus exclusively on injecting practices and condom use. Improved sexual and reproductive healthcare for women who use drugs is an area in need of development and should be better integrated into basic harm reduction programs.
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Affiliation(s)
- Sophie Pinkham
- Department of Slavic Languages, Columbia University, 1130 Amsterdam Avenue, Mail Code 2839, New York, NY 10027, USA
| | - Claudia Stoicescu
- Public Health Policy, Harm Reduction International, Unit 2D12 South Bank Technopark, 90 London Road, London SE1 6LN, UK
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK
| | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Faculty of Health Sciences Private Bag, Observatory, Cape Town 7935, South Africa
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Hallfors DD, Cho H, Iritani BJ, Mapfumo J, Mpofu E, Luseno WK, January J. Preventing HIV by providing support for orphan girls to stay in school: does religion matter? ETHNICITY & HEALTH 2012; 18:53-65. [PMID: 22715988 PMCID: PMC3496833 DOI: 10.1080/13557858.2012.694068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The paper examines the influence of religion on attitudes, behaviors, and HIV infection among rural adolescent women in Zimbabwe. DESIGN We analyzed data from a 2007 to 2010 randomized controlled trial in rural eastern Zimbabwe testing whether school support can prevent HIV risk behaviors and related attitudes among rural adolescent orphan girls; supplementary data from the 2006 Zimbabwe Demographic and Health Survey (ZDHS) were also analyzed. The present study design is largely cross-sectional, using the most recent available survey data from the clinical trial to examine the association between religious affiliation and religiosity on school dropout, marriage, and related attitudes, controlling for intervention condition, age and orphan type. The ZDHS data examined the effect of religious denomination on marriage and HIV status among young rural women, controlling for age. RESULTS Apostolic Church affiliation greatly increased the likelihood of early marriage compared to reference Methodist Church affiliation (odds ratio = 4.5). Greater religiosity independently reduced the likelihood of school dropout, increased gender equity attitudes and disagreement with early sex, and marginally reduced early marriage. Young rural Apostolic women in the ZDHS were nearly four times as likely to marry as teenagers compared to Protestants, and marriage doubled the likelihood of HIV infection. CONCLUSIONS Findings contradict an earlier seminal study that Apostolics are relatively protected from HIV compared to other Christian denominations. Young Apostolic women are at increased risk of HIV infection through early marriage. The Apostolic Church is a large and growing denomination in sub-Saharan Africa and many Apostolic sects discourage medical testing and treatment in favor of faith healing. Since this can increase the risk of undiagnosed HIV infection for young married women and their infants in high prevalence areas, further study is urgently needed to confirm this emerging public health problem, particularly among orphan girls. Although empirical evidence suggests that keeping orphan girls in school can reduce HIV risk factors, further study of the religious context and the implications for prevention are needed.
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Affiliation(s)
- Denise D Hallfors
- Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA.
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Lazuardi E, Worth H, Saktiawati AMI, Spooner C, Padmawati R, Subronto Y. Boyfriends and injecting: the role of intimate male partners in the life of women who inject drugs in Central Java. CULTURE, HEALTH & SEXUALITY 2012; 14:491-503. [PMID: 22468728 DOI: 10.1080/13691058.2012.671960] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The international literature shows that HIV-risk behaviour for women mostly occurs in the context of intimate relationships. Power imbalances in the social, economic and cultural spheres put women at risk. This paper addresses the roles of male partners in women's engagement in drug-use behaviour and drug-related HIV-risk behaviour in Indonesia. Data were gathered through in-depth interviews with 19 women who had injected drugs in the previous month in three sites in central Java. Most of the women had male partners who also injected drugs. Results show that male partners play a significant role in the initiation of drug use, the provision of drugs, injecting behaviour and in the constitution of women injectors' social networks. These findings suggest the need to develop couple-based interventions and to facilitate women-only groups as part of HIV prevention.
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Affiliation(s)
- Elan Lazuardi
- Centre for Tropical Medicine - Research Collaboration Unit, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Domanico A, Malta M. Implementation of harm reduction toward crack users in Brazil: barriers and achievements. Subst Use Misuse 2012; 47:535-46. [PMID: 22428821 DOI: 10.3109/10826084.2012.644170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
From 2002 to 2005, we evaluated five Brazilian harm reduction programs ran by active drug users who distributed pipes, condoms, educational material, and provided referral to crack users. System-wide barriers identified: funds discontinuation and legislation barriers toward fieldwork. Major achievements: increased access to health, social, and psychological support. Crack-cocaine users experience a plethora of health/social problems, attenuated by low-threshold and user-friendly interventions, particularly those developed by other drug users. However, a stronger political commitment is needed to face a fast growing crack-cocaine epidemic in Brazil, aiming to ensure availability/continuity of funds, implementation of large-scale interventions, outreach workers training, and proper evaluation.
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Stockman JK, Ludwig-Barron N, Hoffman MA, Ulibarri MD, Dyer TVP. Prevention interventions for human immunodeficiency virus in drug-using women with a history of partner violence. Subst Abuse Rehabil 2012; 3:45-57. [PMID: 24500422 PMCID: PMC3280816 DOI: 10.2147/sar.s21293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The intersecting epidemics of human immunodeficiency virus (HIV) and partner violence disproportionately affect women who use drugs. Despite accumulating evidence throughout the world linking these epidemics, HIV prevention efforts focused on these synergistic issues as well as underlying determinants that contribute to the HIV risk environment (eg, housing instability, incarceration, policing practices, survival sex) are lacking. This article highlights selected behavior change theories and biomedical approaches that have been used or could be applied in HIV prevention interventions for drug-using women with histories of partner violence and in existing HIV prevention interventions for drug-using women that have been gender-focused while integrating histories of partner violence and/or relationship power dynamics. To date, there is a paucity of HIV prevention interventions designed for drug-using women (both in and outside of drug treatment programs) with histories of partner violence. Of the few that exist, they have been theory-driven, culture-specific, and address certain aspects of gender-based inequalities (eg, gender-specific norms, relationship power and control, partner violence through assessment of personal risk and safety planning). However, no single intervention has addressed all of these issues. Moreover, HIV prevention interventions for drug-using women with histories of partner violence are not widespread and do not address multiple components of the risk environment. Efficacious interventions should target individuals, men, couples, and social networks. There is also a critical need for the development of culturally tailored combination HIV prevention interventions that not only incorporate evidence-based behavioral and biomedical approaches (eg, microbicides, pre-exposure prophylaxis, female-initiated barrier methods) but also take into account the risk environment at the physical, social, economic and political levels. Ultimately, this approach will have a significant impact on reducing HIV infections among drug-using women with histories of partner violence.
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Affiliation(s)
- Jamila K Stockman
- Division of Global Public Health, Department of Medicine, San Diego, La Jolla, CA
| | | | - Monica A Hoffman
- Department of Communication and Science Studies, San Diego, La Jolla, CA
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Typhanye V Penniman Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
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Wechsberg WM. Promising international interventions and treatment for women who use and abuse drugs: focusing on the issues through the InWomen's Group. Subst Abuse Rehabil 2012; 3:1-4. [PMID: 24474871 PMCID: PMC3889180 DOI: 10.2147/sar.s21291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park ; Gillings Global School of Public Health, University of North Carolina at Chapel Hill ; Psychology in the Public Interest, North Carolina State University, Raleigh ; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Wechsberg WM, Myers B, Kline TL, Carney T, Browne FA, Novak SP. The Relationship of Alcohol and Other Drug Use Typologies to Sex Risk Behaviors among Vulnerable Women in Cape Town, South Africa. ACTA ACUST UNITED AC 2012; S1. [PMID: 23403403 DOI: 10.4172/2155-6113.s1-015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND: Alcohol and other drug (AOD) use remains an important contributing factor to the spread of HIV in South Africa, mainly because of the strong associations found between AOD use and sex risk behaviors. Specifically, AOD use can lead to disinhibition and impaired judgment that may result in inconsistent condom use and other risky sex behaviors among vulnerable and disempowered women. METHODS: Latent Class Analysis was used to identify AOD use typologies among 720 vulnerable women from a randomized trial baseline assessment in Cape Town, South Africa and to examine whether these AOD use classes predict sex risk for HIV. RESULTS: Three classes emerged with distinct differences in AOD use: the Marijuana and Alcohol class (34.6%) mainly comprised participants who used marijuana and drank alcohol frequently; the High AOD Risk class (26.1%) mainly comprised participants who used methamphetamine and marijuana, reported heavy drinking, and moderate probabilities of Mandrax use; and the Polydrug use class (39.3%) predominately comprised participants who used methamphetamine, marijuana, and Mandrax. Participants in the Marijuana and Alcohol class were less likely to report past-month unprotected sex with their main sex partner compared with participants in the Polydrug Use class. When examining the adjusted model, Black African women were significantly less likely to report past-month unprotected sex with their main sex partner compared with Coloured women. Women who were HIV negative were more likely to report unprotected sex with their main sex partner than women who were HIV positive. CONCLUSION: The fewer substances that women used seemed to serve as protective factors against engaging in AOD-impaired sex. This study provides an important contribution to understand the intersection of AOD use and sexual risk for HIV by measuring polydrug use among vulnerable women and its association with sexual risk taking.
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Affiliation(s)
- Wendee M Wechsberg
- Senior Director, Substance Abuse Treatment and Interventions Research, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, USA ; Adjunct Professor, Health Policy and Administration, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA ; Adjunct Professor, Psychology in the Public Interest, North Carolina State University (NCSU), Raleigh, NC, USA ; Adjunct Associate Professor, Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Browne FA, Wechsberg WM, Bowling JM, Luseno WK. Correlates of male condom use skills among high-risk women in South Africa. JOURNAL OF SEX RESEARCH 2011; 49:255-263. [PMID: 21660835 PMCID: PMC5633854 DOI: 10.1080/00224499.2011.578219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This exploratory study examined the performance of 295 South African women--who recently traded sex for goods or had unprotected sex--on a male condom use mastery index. Bivariate and multivariate logistic regression analyses were conducted to determine whether age, marital status, highest education obtained, male condom use at first penetrative sex, receiving prior demonstration of male condom use, recent sexually transmitted infection symptoms, and recently trading sex were significantly associated with index scores. Adjusted odds ratios indicated that age and sexually transmitted infection symptoms were negatively associated with condom skills; women who were older and had a higher number of recent sexually transmitted infection symptoms were more likely to have lower scores. Furthermore, participants executed, on average, approximately one third of condom use steps correctly. These findings suggest a need for increased behavioral skills training for women engaging in sexual risk behaviors because many lack the skills required to use a male condom properly.
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Affiliation(s)
- Felicia A Browne
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, NC 27709, USA.
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Pregnant and nonpregnant women in cape town, South Africa: drug use, sexual behavior, and the need for comprehensive services. Int J Pediatr 2011; 2011:353410. [PMID: 21541067 PMCID: PMC3083847 DOI: 10.1155/2011/353410] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/09/2011] [Indexed: 11/17/2022] Open
Abstract
The multiple risks associated with methamphetamine use are of serious concern for women. These risks and consequences are magnified during pregnancy. This secondary analysis of a parent study compared 26 pregnant to 356 nonpregnant women in Cape Town, South Africa, on selected demographic, psychosocial, and HIV-risk domains to identify their treatment service needs. Proportionally, more pregnant than nonpregnant women are using methamphetamine, P = .01, although a very high rate of women used methamphetamine. Women reported similar monthly rates of sexual intercourse, but pregnant women were significantly less likely to report condom use, P < .0001, maintaining their risky behavior. Both groups reported elevated Center for Epidemiological Studies Depression Scale CES-D means, suggesting a need for depression treatment. Results demonstrate a pervasive need for women's comprehensive treatment, regardless of pregnancy status. Moreover, findings support the urgent need for women-focused and pregnancy-specific treatment services for methamphetamine use. Finally, a job-skills training/employment component focus is suggested.
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Wechsberg WM, Zule WA, Luseno WK, Kline TL, Browne FA, Novak SP, Ellerson RM. Effectiveness of an Adapted Evidence-Based Woman-Focused Intervention for Sex Workers and Non-Sex Workers: The Women's Health CoOp in South Africa. JOURNAL OF DRUG ISSUES 2011. [DOI: 10.1177/002204261104100205] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
South Africa's concurrent epidemics of HIV, substance use, and gender-based violence point to the urgent need for interventions that address the intersectional nature of these issues. A community-based randomized trial assessed the efficacy of an adapted evidence-based Woman-Focused HIV intervention addressing all three issues with sex workers and non-sex workers. At 6-month follow-up, non-sex workers in the Woman-Focused intervention reported significantly lower mean numbers of days drinking alcohol in the previous 30 days, were significantly less likely to meet DSM-IV criteria for alcohol dependence, were more likely to report using a condom at last sex with a main partner, and were less likely to report sexual abuse by a main partner in the previous 90 days. Sex workers in the Woman-Focused intervention were significantly less likely to report physical abuse by a main partner. The findings suggest that gender-focused interventions can be effective for vulnerable women and should be offered more broadly.
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Setshedi M, de la Monte SM. Changing trends and the impact of alcohol on the HIV/AIDS epidemic in South Africa: review. SAHARA J 2011; 8:89-96. [PMID: 23237686 PMCID: PMC4550305 DOI: 10.1080/17290376.2011.9724990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The association between increased HIV infection and alcohol use has been extensively studied and is established. South Africa is among one of the sub-Saharan African countries with the highest prevalence and number of people living with HIV/AIDS in the world. Although recent evidence suggests that the epidemic has stabilised, infection rates remain unacceptably high. Alcohol use is on the increase, particularly in the groups most susceptible to HIV infection, namely women and young adults, and informs poor choices with respect to safer sexual practices. This paper reviews the association between alcohol and HIV. More specifically, however, it aims to explore the potential socio-politico-biological and cultural explanations as to the factors that intersect to drive these two epidemic diseases: alcoholism and HIV/AIDS in South Africa. Understanding some of the underlying factors will provide a framework to implement public health measures to curb HIV.
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Affiliation(s)
- Mashiko Setshedi
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Bortolato M, Frau R, Bini V, Luesu W, Loriga R, Collu M, Gessa GL, Ennas MG, Castelli MP. Methamphetamine neurotoxicity increases brain expression and alters behavioral functions of CB₁ cannabinoid receptors. J Psychiatr Res 2010; 44:944-55. [PMID: 20378129 DOI: 10.1016/j.jpsychires.2010.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/14/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
Cannabis is the most common secondary illicit substance in methamphetamine (METH) users, yet the outcomes of the concurrent consumption of both substances remain elusive. Capitalizing on recent findings on the implication of CB₁ cannabinoid receptors in the behavioral effects of METH, we hypothesized that METH-induced neurotoxicity may alter the brain expression of CB₁, thereby affecting its role in behavioral functions. To test this possibility, we subjected rats to a well-characterized model of METH neurotoxicity (4 mg/kg, subcutaneous × 4 injections, 2 h apart), and analyzed their CB₁ receptor brain expression three weeks later. METH exposure resulted in significant enhancements of CB₁ receptor expression across several brain regions, including prefrontal cortex, caudate-putamen, basolateral amygdala, CA1 hippocampal region and perirhinal cortex. In parallel, a different group of METH-exposed rats was used to explore the responsiveness to the potent cannabinoid agonist WIN 55,212-2 (WIN) (0.5-1 mg/kg, intraperitoneal), within several paradigms for the assessment of emotional and cognitive functions, such as open field, object exploration and recognition, and startle reflex. WIN induced anxiolytic-like effects in METH-exposed rats and anxiogenic-like effects in saline-treated controls. Furthermore, METH-exposed animals exhibited a significantly lower impact of WIN on the attenuation of exploratory behaviors and short-term (90 min) recognition memory. Conversely, METH neurotoxicity did not significantly affect WIN-induced reductions in locomotor activity, exploration time and acoustic startle. These results suggest that METH neurotoxicity may alter the vulnerability to select behavioral effects of cannabis, by inducing distinct regional variations in the expression of CB₁ receptors.
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Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and Pharmaceutical Sciences, University of Southern California, Los Angeles (CA), USA.
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Wechsberg WM, Jones HE, Zule WA, Myers BJ, Browne FA, Kaufman MR, Luseno W, Flisher AJ, Parry CDH. Methamphetamine ("tik") use and its association with condom use among out-of-school females in Cape Town, South Africa. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:208-13. [PMID: 20560840 DOI: 10.3109/00952990.2010.493592] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about the association between methamphetamine use and sexual risk behaviors among young South African women between 13 and 20 years of age. OBJECTIVE To examine the association between methamphetamine use and condom use among out-of-school South African female adolescents. METHODS Black and Coloured female adolescents were interviewed and categorized into methamphetamine user (n = 261) or non-user (n = 188) groups. RESULTS Methamphetamine use was reported by 58% of the total sample. Higher methamphetamine rates were found among young Coloured females (87%) than among young Black females (11%). In a multiple logistic regression analysis that adjusted for relevant confounders and included an interaction term for race and methamphetamine use, Coloured female methamphetamine users were over six times more likely than other participants to report not using a condom the last time they had sex (OR = 6.21; 95% CI = 1.21, 31.94). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Efforts are needed to reduce methamphetamine use and related sexual risk among adolescent females in Coloured communities and to prevent the spread of methamphetamine use in Black African communities.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Program, RTI International, Research Triangle Park, North Carolina 27709-2194, USA.
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Affiliation(s)
- Nabila El-Bassel
- Columbia University School of Social Work, New York, NY 10025, USA.
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Wechsberg WM, Luseno WK, Kline TL, Browne FA, Zule WA. Preliminary findings of an adapted evidence-based woman-focused HIV intervention on condom use and negotiation among at-risk women in Pretoria, South Africa. J Prev Interv Community 2010; 38:132-46. [PMID: 20391060 DOI: 10.1080/10852351003640799] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article presents the results of a randomized trial in South Africa of an adapted evidence-based Woman-Focused intervention on condom use with primary sex partners. The preliminary findings show that regardless of HIV status, condom negotiation was significantly associated with condom use at the 3- and 6-month follow-ups. By intervention group, significant intervention effects were found at 6-month follow-up for HIV-positive and HIV-unknown status women in the Woman-Focused intervention who were more likely than women in the Standard intervention to report condom use with a primary male partner. Among HIV-positive women, those in the Woman-Focused group and those with greater sexual control were more likely to report condom use at the 6-month follow-up. The findings indicate that gender-based interventions for women may result in increased condom negotiation skills.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC 27709-2194, USA.
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41
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the recent literature examining the intersection between alcohol and other drug use and HIV risk behaviors for South African men and women, and the implications for the development of interventions and future research. RECENT FINDINGS The current literature indicates that substance use in sexual contexts (i.e. before or during sex) as well as outside of the sexual context is associated with HIV risk behaviors, such as having unprotected sex and multiple sex partners. Additionally, environments where substances are used, such as drinking establishments, may be associated with HIV risk behaviors. Moreover, sexual violence is also associated with substance use. Brief HIV prevention interventions to address substance use have demonstrated promising findings - such as consistent condom use, less impaired sex, and less unprotected vaginal and anal intercourse - when compared with other interventions. SUMMARY Recent research findings support the previous literature concerning the link between substance use and HIV risk behaviors in South Africa and suggest the need for interventions focused on sexual risk behaviors in the context of substance use and the environments in which they are used.
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Luseno WK, Wechsberg WM, Kline TL, Ellerson RM. Health services utilization among South African women living with HIV and reporting sexual and substance-use risk behaviors. AIDS Patient Care STDS 2010; 24:257-64. [PMID: 20377433 DOI: 10.1089/apc.2009.0213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV health services are critical in sub-Saharan African where the burden of the HIV pandemic is devastating. Existing studies suggest that HIV-infected individuals from marginalized populations who know their status do not seek health services because they are unaware of available treatment and care options, may not understand how to access services, or have poor access to and utilization of health care services. This study examined factors associated with health service utilization in a sample of poor, underserved recently diagnosed HIV-positive South African women with sexual and substance use risk behaviors. The data were collected between June 2004 and May 2008. Primary outcomes included consultation with a medical professional and utilization of any health services since learning of HIV status at 3- and 6-month follow-up assessments. The study findings suggest that denial of HIV status may be a barrier to care, leading study participants to avoid utilizing health services specific to their disease and to prefer more general medical care services. In multivariate analyses, prior use of health services, financially supporting others, and sex trading were strongly associated with health service use at follow-up assessments. The study findings suggest a reduced likelihood of health services utilization among participants who met DSM-IV criteria for drug abuse as well as participants with greater numbers of poor physical health symptoms. As an important preliminary step in examining the issue of health services utilization in sub-Saharan Africa, the findings suggest an urgent need to promote HIV prevention and early testing, to strengthen long-term HIV care services, and to increase access to services.
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Affiliation(s)
- Winnie K. Luseno
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Wendee M. Wechsberg
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Tracy L. Kline
- Research Triangle Institute International, Research Triangle Park, North Carolina
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Norris AH, Kitali AJ, Worby E. Alcohol and transactional sex: How risky is the mix? Soc Sci Med 2009; 69:1167-76. [PMID: 19713023 DOI: 10.1016/j.socscimed.2009.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Alison H Norris
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Ketchen B, Armistead L, Cook S. HIV infection, stressful life events, and intimate relationship power: the moderating role of community resources for black South African women. Women Health 2009; 49:197-214. [PMID: 19533510 DOI: 10.1080/03630240902963648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Black women in South Africa are vulnerable with limited power in intimate relationships. This study explored whether stressful life events and/or HIV infection were associated with relationship power and whether the impact was moderated by community resources. METHOD One hundred four women living with HIV and 152 women not living with HIV participated in individual interviews. RESULTS Undesirable life changes were negatively associated with relationship control. HIV infection and women's knowledge of community resources were associated with mutual decision-making, while frequency of family use of community resources was negatively related to female dominated decisions. Women living with HIV perceived their male partners as less dominant when they perceived their community resources to be more helpful. CONCLUSIONS Power in intimate relationships may enhance the quality and length of life for black South African women living with HIV. Knowledge of and perceived helpfulness of community resources are avenues for promoting relationship power.
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Affiliation(s)
- Bethany Ketchen
- San Francisco VA Medical Center, San Francisco, California, USA
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Wechsberg WM, Wu LT, Zule WA, Parry CD, Browne FA, Luseno WK, Kline T, Gentry A. Substance abuse, treatment needs and access among female sex workers and non-sex workers in Pretoria, South Africa. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2009; 4:11. [PMID: 19473505 PMCID: PMC2693506 DOI: 10.1186/1747-597x-4-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 05/27/2009] [Indexed: 11/18/2022]
Abstract
Background This study examined cross-sectional data collected from substance-using female sex workers (FSW) and non-sex workers (non-SW) in Pretoria, South Africa, who entered a randomized controlled trial. Methods Women who reported alcohol use and recently engaging in sex work or unprotected sex were recruited for a randomized study. The study sample (N = 506) comprised 335 FSW and 171 female non-SW from Pretoria and surrounding areas. Self-reported data about alcohol and other drug use as well as treatment needs and access were collected from participants before they entered a brief intervention. Results As compared with female non-SW, FSW were found to have a greater likelihood of having a past year diagnosis of alcohol or other drug abuse or dependence, having a family member with a history of alcohol or other drug abuse, having been physically abused, having used alcohol before age 18, and having a history of marijuana use. In addition, the FSW were more likely to perceive that they had alcohol or other drug problems, and that they had a need for treatment and a desire to go for treatment. Less than 20% of participants in either group had any awareness of alcohol and drug treatment programs, with only 3% of the FSW and 2% of the non-SW reporting that they tried but were unable to enter treatment in the past year. Conclusion FSW need and want substance abuse treatment services but they often have difficulty accessing services. The study findings suggest that barriers within the South African treatment system need to be addressed to facilitate access for substance-using FSW. Ongoing research is needed to inform policy change that fosters widespread educational efforts and sustainable, accessible, woman-sensitive services to ultimately break the cycle for current and future generations of at-risk South African women.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International (Research Triangle Institute), 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, North Carolina 27709-2194, USA.
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Wechsberg WM. Adapting HIV Interventions for Women Substance Abusers in International Settings: Lessons for the Future. JOURNAL OF DRUG ISSUES 2009. [DOI: 10.1177/002204260903900120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many substance abusers are at risk for HIV due to their drug using and sexual behaviors. HIV interventions developed early on for substance abusers did not account for gender differences. Women's risk for HIV around the world makes them more vulnerable than men, yet their circumstances are different and adaptations to interventions are needed. The Women's CoOp, considered a best-evidence intervention, has been adapted with several groups of noninjecting women in South Africa and with injecting drug-using women in Russia. To reach vulnerable women in diverse settings to test interventions to reduce their risk, researchers also need to mentor the next generation of scientists to help stem the feminization of HIV among substance abusers.
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Wechsberg WM, Luseno WK, Karg RS, Young S, Rodman N, Myers B, Parry CDH. Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: a small randomized trial in the Western Cape. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:130-9. [PMID: 18207723 DOI: 10.1016/j.drugpo.2007.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 11/20/2007] [Accepted: 11/25/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a pressing need for brief behavioural interventions to address the intersection of high HIV prevalence, increasing substance use, and high-risk sex practices among South African women. The primary aim of this pilot, randomized trial was to examine whether an adapted evidence-based intervention would be equally, more, or less effective at reducing HIV risk behaviours when delivered using an individual or group format. The secondary aim was to examine differences between Black and Coloured South African women across pre- and post-intervention measures of alcohol and illicit drug use and sex risk behaviours. METHODS The Cape Town Women's Health CoOp was adapted from an evidence-based intervention known as the Women's CoOp. Study participants included Black (n=60) and Coloured (n=52) women living in the township communities of Cape Town, South Africa, who reported using illicit drugs and alcohol. RESULTS Coloured women reported greater methamphetamine use (13 days in the past 30 days) and Black women reported mostly cannabis use (27 days in the past 30 days). Although both groups reported having unprotected sex under the influence of alcohol and/or other drugs, Black women reported greater condom use and having one partner; Coloured women reported having more than one sex partner. One-month post-intervention assessments indicated significant reductions in substance use and sex risk behaviours. After controlling for baseline measures, there were no significant differences between the two intervention conditions. CONCLUSION Significant differences in risk behaviours were observed between Black and Coloured South African women. However, both ethnic groups were responsive to the adapted intervention and no differences were found by intervention assignment. These findings support the assertion that group interventions may be more cost-effective in reaching at-risk women in resource-scarce environments. Larger studies are needed to show efficacy and effectiveness of woman-focused group prevention interventions.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC 27709-2194, USA.
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