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Zia Y, Etyang L, Mwangi M, Njiru R, Mogaka F, June L, Njeru I, Makoyo J, Kimani S, Ngure K, Wanyama I, Bukusi E, Nyerere B, Nyamwaro C, Mugo N, Heffron R. The Effect of Stigma on Family Planning and HIV Pre-exposure Prophylaxis Decisions of Young Women Accessing Post-Abortion Care in Kenya. AIDS Behav 2024; 28:1834-1844. [PMID: 38451448 PMCID: PMC11161434 DOI: 10.1007/s10461-024-04274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/08/2024]
Abstract
Adolescent girls and young women (AGYW) in Eastern and Southern Africa face parallel epidemics of unintended pregnancy and HIV. Their sexual health decisions are often dominated by intersecting stigmas. In an implementation science project integrating delivery of daily, oral pre-exposure prophylaxis (PrEP) for HIV prevention into 14 post-abortion care (PAC) clinics in Kenya, we enrolled a subset of PrEP initiating AGYW (aged 15 to 30 years) into a research cohort. Utilizing log binomial models, we estimated the effect of PrEP stigma on PrEP continuation (measured via self-report and urine assay for tenofovir) and abortion stigma on contraceptive initiation. Between April 2022 and February 2023, 401 AGYW were enrolled after initiating PrEP through their PAC provider, of which 120 (29.9%) initiated highly-effective contraception. Overall, abortion and PrEP stigmas were high in this cohort. Abortion stigma was more prevalent among those that were adolescents, unmarried, and reported social harm. Among 114 AGYW returning for the month 1 follow-up visit, 83.5% reported continuing PrEP and 52.5% had tenofovir detected. In this subset, higher levels of PrEP stigma were significantly associated with greater likelihood of PrEP adherence, but not PrEP continuation. For abortion stigma, greater scores in the subdomain of isolation were significantly associated with greater likelihood of initiating a highly-effective contraception, while greater scores in the subdomain of community condemnation were significantly associated with reduced likelihood of initiating a highly-effective contraception. Given the burden of stigma documented by our work, PAC settings are a pivotal space to integrate stigma-informed counseling and to empower young women to optimize contraceptive and PrEP decisions.
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Affiliation(s)
- Yasaman Zia
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lydia Etyang
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Margaret Mwangi
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Roy Njiru
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Felix Mogaka
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | - Lavender June
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | - Irene Njeru
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, USA
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | - Bernard Nyerere
- Research Care and Training Program, Kenya Medical Research Institute, Thika, Kenya
| | | | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Partners in Health and Research Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Renee Heffron
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South / BBRB 256, Birmingham, AL, 35294-2170, USA.
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Is the ZIKV Congenital Syndrome and Microcephaly Due to Syndemism with Latent Virus Coinfection? Viruses 2021; 13:v13040669. [PMID: 33924398 PMCID: PMC8069280 DOI: 10.3390/v13040669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 01/04/2023] Open
Abstract
The emergence of the Zika virus (ZIKV) mirrors its evolutionary nature and, thus, its ability to grow in diversity or complexity (i.e., related to genome, host response, environment changes, tropism, and pathogenicity), leading to it recently joining the circle of closed congenital pathogens. The causal relation of ZIKV to microcephaly is still a much-debated issue. The identification of outbreak foci being in certain endemic urban areas characterized by a high-density population emphasizes that mixed infections might spearhead the recent appearance of a wide range of diseases that were initially attributed to ZIKV. Globally, such coinfections may have both positive and negative effects on viral replication, tropism, host response, and the viral genome. In other words, the possibility of coinfection may necessitate revisiting what is considered to be known regarding the pathogenesis and epidemiology of ZIKV diseases. ZIKV viral coinfections are already being reported with other arboviruses (e.g., chikungunya virus (CHIKV) and dengue virus (DENV)) as well as congenital pathogens (e.g., human immunodeficiency virus (HIV) and cytomegalovirus (HCMV)). However, descriptions of human latent viruses and their impacts on ZIKV disease outcomes in hosts are currently lacking. This review proposes to select some interesting human latent viruses (i.e., herpes simplex virus 2 (HSV-2), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), human parvovirus B19 (B19V), and human papillomavirus (HPV)), whose virological features and co-exposition with ZIKV may provide evidence of the syndemism process, shedding some light on the emergence of the ZIKV-induced global congenital syndrome in South America.
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Pires LC, Dantas LR, Witkin SS, Bertozzi APAP, Dezena RDCAB, Rodrigues MMD, Gazeta RE, Passos SD. Knowledge of Zika Virus Transmission and Its Prevention among High-Risk Pregnant Women in Brazil. Viruses 2021; 13:v13020242. [PMID: 33557048 PMCID: PMC7913803 DOI: 10.3390/v13020242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022] Open
Abstract
Recent outbreaks of Zika virus (ZIKV) infection highlight the urgent need to evaluate the efficacy of current public health measures to educate susceptible groups about how to prevent infection, modes of viral transmission, and consequences of infection. We performed a cross-sectional study in the city of Jundiaí, São-Paulo, from March 2016 to August 2017. In 315 high-risk pregnant women we evaluated the rate of ZIKV infection, knowledge of pathways of ZIKV transmission, and the use of protective measures. Data were analyzed and correlated with sociodemographic variables. The rate of ZIKV infection was 10.8%. ZIKV transmission by mosquitoes was the best-known means of virus acquisition, while transmission of ZIKV by sexual intercourse as well as mother–fetus transmission was known by less than half of the women. The use of insect repellent, reported by 53% of participants, was correlated with higher education and personal directives from health professionals. Condom use was reported by 19.5% of subjects. Improved strategies to increase awareness of ZIKV infection and its consequences, designed to appeal to specific, targeted populations, are clearly necessary to more accurately prevent the spread of this infection and diminish adverse consequences in the pregnant population.
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Affiliation(s)
- Lucas C. Pires
- Faculty of Medicine, Jundiaí School of Medicine, Jundiaí, São Paulo 13202-550, Brazil;
- Correspondence: ; Tel.: +55-119-8785-0707
| | - Luiza R. Dantas
- Faculty of Medicine, Jundiaí School of Medicine, Jundiaí, São Paulo 13202-550, Brazil;
| | - Steven S. Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA;
- Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, São Paulo 05403-000, Brazil
| | - Ana Paula A. P. Bertozzi
- Department of Pediatrics, Jundiaí School of Medicine, Jundiaí, São Paulo 13207-450, Brazil; (A.P.A.P.B.); (R.d.C.A.B.D.); (M.M.D.R.); (R.E.G.); (S.D.P.)
| | - Rita de Cássia A. B. Dezena
- Department of Pediatrics, Jundiaí School of Medicine, Jundiaí, São Paulo 13207-450, Brazil; (A.P.A.P.B.); (R.d.C.A.B.D.); (M.M.D.R.); (R.E.G.); (S.D.P.)
| | - Maria M. D. Rodrigues
- Department of Pediatrics, Jundiaí School of Medicine, Jundiaí, São Paulo 13207-450, Brazil; (A.P.A.P.B.); (R.d.C.A.B.D.); (M.M.D.R.); (R.E.G.); (S.D.P.)
| | - Rosa Estela Gazeta
- Department of Pediatrics, Jundiaí School of Medicine, Jundiaí, São Paulo 13207-450, Brazil; (A.P.A.P.B.); (R.d.C.A.B.D.); (M.M.D.R.); (R.E.G.); (S.D.P.)
| | - Saulo D. Passos
- Department of Pediatrics, Jundiaí School of Medicine, Jundiaí, São Paulo 13207-450, Brazil; (A.P.A.P.B.); (R.d.C.A.B.D.); (M.M.D.R.); (R.E.G.); (S.D.P.)
- Laboratory of Pediatric Infectious Disease, Jundiaí School of Medicine, Jundiaí, São Paulo 13202-550, Brazil
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Carlson CJ, Mendenhall E. Preparing for emerging infections means expecting new syndemics. Lancet 2019; 394:297. [PMID: 31354135 DOI: 10.1016/s0140-6736(19)31237-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Colin J Carlson
- Department of Biology, Georgetown University, Washington, DC 20057, USA
| | - Emily Mendenhall
- Department of Science, Technology, and Foreign Affairs, School of Foreign Service, Georgetown University, Washington, DC 20057, USA.
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