1
|
Tatham C. Life and love under criminalization: The experiences of people living with HIV in Canada. PLoS One 2024; 19:e0306894. [PMID: 39052618 PMCID: PMC11271884 DOI: 10.1371/journal.pone.0306894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives.
Collapse
Affiliation(s)
- Christopher Tatham
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
2
|
Colpani A, De Vito A, Zauli B, Menzaghi B, Calcagno A, Celesia BM, Ceccarelli M, Nunnari G, De Socio GV, Di Biagio A, Leoni N, Angioni G, Giambenedetto SD, D'Ettorre G, Babudieri S, Madeddu G. Knowledge of Sexually Transmitted Infections and HIV among People Living with HIV: Should We Be Concerned? Healthcare (Basel) 2024; 12:417. [PMID: 38391793 PMCID: PMC10888293 DOI: 10.3390/healthcare12040417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Poor knowledge of sexually transmitted infections (STIs) and HIV among people with HIV (PLHIV) could worsen life quality. We aimed to investigate their STI and HIV knowledge, disclosure and undetectable = untransmittable (U=U). We proposed an anonymous questionnaire regarding STI and HIV to PLHIV attending ten Italian outpatient infectious diseases clinics. Moreover, disclosure and U=U were investigated. The calculated sample size was 178 people. Considering a missing response of 10%, the final sample size was 196. We enrolled 200 PLHIV (73.5% males), with a median age of 52.5 (IQR 41-59) years. The mean score was 7.61 ± 1.22 with no difference by gender, education, and employment. Significant statistical difference was observed by sexual orientation; bisexuals and those who preferred not to answer had a lower score than heterosexuals and MSM (p = 0.0032). PLHIV showed poor knowledge about HIV transmission (25% appropriately answered). Nearly 30% responded that virologically suppressed PLHIV could transmit the infection. Finally, 137 (68.5%) and 158 (79.0%) disclosed to the general practitioner and family and friends, respectively. Nearly 52.0% knew the meaning of U=U, and 83.6% highlighted its positive rebound. In conclusion, important knowledge gaps are present among PLHIV regarding U=U, and its implications are little-known. Improving PLHIVs' awareness will undermine self-stigma and enhance life quality.
Collapse
Affiliation(s)
- Agnese Colpani
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Beatrice Zauli
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Barbara Menzaghi
- Division of Infectious Diseases, "Ospedale di Circolo", 21052 Busto Arsizio, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 10123 Torino, Italy
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | | | - Antonio Di Biagio
- Infectious Diseases Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy
| | - Nicola Leoni
- Unit of Infectious Disease, SS Trinità Hospital, 09121 Cagliari, Italy
| | - Goffredo Angioni
- Unit of Infectious Disease, SS Trinità Hospital, 09121 Cagliari, Italy
| | - Simona Di Giambenedetto
- Infectious Diseases Unit, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy
| | - Sergio Babudieri
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Disease, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
3
|
Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [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] [Received: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
Collapse
Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| |
Collapse
|
4
|
Xie M, Wang A, Lin Z. Prevalence of Gynecological Related Symptoms and Quality of Life in Women Living with HIV/AIDS: a Secondary Analysis from an Online, Cross-Sectional Survey in China. Int J Womens Health 2022; 14:1425-1433. [PMID: 36199912 PMCID: PMC9527813 DOI: 10.2147/ijwh.s369781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/18/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Our study aims to completely understand the experience of gynecological related symptoms (GRS) and the association between GRS and quality of life (QOL) among HIV-infected women in China. Design A cross-sectional, multicenter survey. Setting The HIV/AIDS designated medical institutions of seven regions in China. Participants One hundred and fifty-three women with HIV infection. Primary and Secondary Outcome Measures Primary outcome measures included the score of GRS and QOL from analysis sample. Results Among 153 participants, 60.13% were asymptomatic, and 39.87% were symptomatic according to their self-report data. In the symptomatic group, 47.54% reported only one symptom, 18.03% reported 2 symptoms, others reported more than 3 symptoms. The most common symptoms were vaginal discharge (25.49%), followed by irregular period (18.95%), bad cramps (13.07%), vaginal odor (11.11%), and vaginal itching (10.46%). The mean score of QOL was 86.82 ± 15.53. The symptomatic group had higher score than the asymptomatic group on each domain of QOL. GRS were negatively correlated with QOL after adjustment for confounding factors. Correlation matrix of GRS and six domains of QOL demonstrated significant negative correlation with each domain of QOL, especially the most strongly negative correlation with physical function of participants. But the association between GRS and environmental domain was weaker. Conclusion These findings present the multidimensionality of common gynecologic related symptoms and highlight the clinically meaningful associations between GRS and quality of life among women with HIV infection in China. There is an urgent need to take measures to increase vaginal care and education in advance, delivered by trusted health professionals.
Collapse
Affiliation(s)
- Meilian Xie
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Aiping Wang
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Correspondence: Aiping Wang, Department of Public Service, the First affiliated Hospital of China Medical University, Shenyang, People’s Republic of China, Email
| | - Zhaoxia Lin
- Infection Center, Beijing Ditan Hospital Capital Medical University, Beijing, People’s Republic of China
| |
Collapse
|
5
|
Mendelsohn JB, Calzavara L, Bullock S, Iveniuk J, Tan DHS, Burchell AN, Bourne A, Lebouché B, Daftary A, Moravan V, Loutfy M, Conway B. Disclosure of HIV-serodiscordant relationships and association with viral suppression: results from the Positive Plus One study. AIDS Care 2022; 35:1037-1044. [PMID: 35416092 DOI: 10.1080/09540121.2021.2019669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about the effects of disclosure of HIV-serodiscordant relationships on clinical outcomes. We aimed to evaluate the effect of relationship disclosure on HIV viral suppression, and hypothesized that disclosure by HIV-positive and HIV-negative partners would be associated with viral suppression in the HIV-positive partner. METHODS We conducted a Canadian national online and telephone-administered survey of HIV-positive and HIV-negative partners in serodiscordant relationships. The primary outcome was self-reported viral suppression. Multivariable analyses were undertaken using Firth logistic regression. RESULTS We recruited 540 participants in current serodiscordant relationships (n = 228 HIV-negative; n = 312 HIV-positive). Similar proportions of HIV-positive and HIV-negative partners disclosed their relationship to healthcare professionals (82% v. 76%, p = 0.13). Among HIV-positive partners, disclosure of the relationship to healthcare professionals increased the odds of viral suppression (aOR = 4.7; CI: 2.13, 10.51) after adjusting for age, education, and relationship turmoil due to HIV. Increasing age (aOR = 1.28; 95% CI = 1.07, 1.55) and education (aOR = 2.43; 95% CI = 1.15, 5.26) were also associated with viral suppression. Among HIV-negative partners, relationship disclosure was not associated with viral suppression and HIV-negative heterosexual men were less likely to report that their HIV-positive partners were virally suppressed (aOR = 0.24; CI: 0.09, 0.61). CONCLUSIONS Disclosure of HIV-serodiscordant status by HIV-positive participants to healthcare professionals was associated with increased odds of viral suppression. Similar effects were not evident among HIV-negative participants. Future work should explore factors that empower relationship disclosure and incorporate them into supportive services for HIV-serodiscordant relationships.
Collapse
Affiliation(s)
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - James Iveniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Darrell H S Tan
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, Latrobe University, Melbourne, Australia.,Kirby Institute, University of New South Wales, Kensington, Australia
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada.,Infectious Diseases and Immunity in Global Health Program, Centre for Outcomes Research and Evaluation, Montreal, Canada
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, Canada.,Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Canada
| | | | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | | |
Collapse
|
6
|
Kaida A, Cameron B, Conway T, Cotnam J, Danforth J, de Pokomandy A, Gagnier B, Godoy S, Gormley R, Greene S, Habanyama M, Kazemi M, Logie CH, Loutfy M, MacGillivray J, Masching R, Money D, Nicholson V, Osborne Z, Pick N, Sanchez M, Tharao W, Watt S, Narasimhan M. Key recommendations for developing a national action plan to advance the sexual and reproductive health and rights of women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455057221090829. [PMID: 35435062 PMCID: PMC9019372 DOI: 10.1177/17455057221090829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with > 130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations: 1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women. 2. Centre Indigenous women’s priorities, voices, and perspectives. 3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences. 4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders. 5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action. Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
Collapse
Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
| | - Brittany Cameron
- PARN-Community Based HIV/STBBI Programs, Peterborough, ON, Canada
- International Community of Women Living with HV–North America (ICW-NA), Washington, DC, USA
| | - Tracey Conway
- Canadian Positive People Network (CPPN)/Réseau canadien de personnes séropositives (RCPS), Dunrobin, ON, Canada
| | - Jasmine Cotnam
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | | | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Brenda Gagnier
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Sandra Godoy
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Muluba Habanyama
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jay MacGillivray
- Positive Pregnancy Program (P3), St. Michael’s Hospital, Toronto, ON, Canada
| | - Renee Masching
- Canadian Aboriginal AIDS Network (CAAN), Dartmouth, NS, Canada
| | - Deborah Money
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zoë Osborne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA women, a network by and for women living with HIV, Vancouver, BC, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Sarah Watt
- BC Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| |
Collapse
|
7
|
Patterson S, Nicholson V, Gormley R, Carter A, Logie CH, Closson K, Ding E, Trigg J, Li J, Hogg R, de Pokomandy A, Loutfy M, Kaida A. Impact of Canadian human immunodeficiency virus non-disclosure case law on experiences of violence from sexual partners among women living with human immunodeficiency virus in Canada: Implications for sexual rights. WOMEN'S HEALTH 2022; 18:17455065221075914. [PMID: 35168410 PMCID: PMC8855424 DOI: 10.1177/17455065221075914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: People living with human immunodeficiency virus in Canada can face criminal
charges for human immunodeficiency virus non-disclosure before sex, unless a
condom is used and their viral load is <1500 copies/mL. We measured the
reported impact of human immunodeficiency virus non-disclosure case law on
violence from sexual partners among women living with human immunodeficiency
virus in Canada. Methods: We used cross-sectional survey data from wave 3 participant visits
(2017–2018) within Canadian HIV Women’s Sexual and Reproductive Health
Cohort Study; a longitudinal, community-based cohort of women living with
human immunodeficiency virus in British Columbia, Ontario and Quebec. Our
primary outcome was derived from response to the statement: ‘[HIV
non-disclosure case law has] increased my experiences of
verbal/physical/sexual violence from sexual partners’. Participants
responding ‘strongly agree/agree’ were deemed to have experienced increased
violence due to the law. Participants responding ‘not applicable’ (i.e.
those without sexual partners) were excluded. Multivariate logistic
regression identified factors independently associated with increased
violence from sexual partners due to human immunodeficiency virus
non-disclosure case law. Results: We included 619/937 wave 3 participants. Median age was 46 (interquartile
range: 39–53) and 86% had experienced verbal/physical/sexual violence in
adulthood. Due to concerns about human immunodeficiency virus non-disclosure
case law, 37% had chosen not to have sex with a new partner, and 20% had
disclosed their human immunodeficiency virus status to sexual partners
before a witness. A total of 21% self-reported that human immunodeficiency
virus non-disclosure case law had increased their experiences of
verbal/physical/sexual violence from sexual partners. In adjusted analyses,
women reporting non-White ethnicity (Indigenous; African/Caribbean/Black;
Other), unstable housing and high human immunodeficiency virus–related
stigma had significantly higher odds of reporting increased violence from
sexual partners due to human immunodeficiency virus non-disclosure case
law. Conclusion: Findings bolster concerns that human immunodeficiency virus criminalization
is a structural driver of intimate partner violence, compromising sexual
rights of women living with human immunodeficiency virus. Human
immunodeficiency virus non-disclosure case law intersects with other
oppressions to regulate women’s sexual lives.
Collapse
Affiliation(s)
- Sophie Patterson
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine,
University of Lancaster, Lancaster, UK
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Kirby Institute, University of New
South Wales, Sydney, NSW, Australia
- Australian Human Rights Institute,
University of New South Wales, Sydney, NSW, Australia
| | - Carmen H Logie
- Women’s College Research Institute,
Women’s College Hospital, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social
Work, University of Toronto, Toronto, ON, Canada
| | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
- School of Population and Public Health,
The University of British Columbia, Vancouver, BC, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Jason Trigg
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Jenny Li
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre and
Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women’s College Research Institute,
Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of
Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute
(WHRI), Vancouver, BC, Canada
- Angela Kaida, Faculty of Health Sciences,
Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| |
Collapse
|
8
|
Trepka MJ, Sheehan DM, Dawit R, Li T, Fennie KP, Gebrezgi MT, Brock P, Beach MC, Ladner RA. Differential Role of Psychosocial, Health Care System and Neighborhood Factors on the Retention in HIV Care of Women and Men in the Ryan White Program. J Int Assoc Provid AIDS Care 2021; 19:2325958220950087. [PMID: 32815475 PMCID: PMC7444131 DOI: 10.1177/2325958220950087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We investigated potential differential impact of barriers to HIV care retention among women relative to men. Client intake, health assessment, service, and laboratory information among clients receiving medical case management during 2017 in the Miami-Dade County Ryan White Program (RWP) were obtained and linked to American Community Survey data by ZIP code. Cross-classified multilevel logistic regression analysis was conducted. Among 1609 women and 5330 men, 84.6% and 83.7% were retained in care. While simultaneously controlling for all demographic characteristics, vulnerable/enabling factors, and neighborhood indices in the model, younger age, being US born, not working, and having a medical provider with low volume (<10) of clients remained associated with non-retention in care among women and men; while having ≥3 minors in the household and being perinatally infected were additionally associated with retention only for women. Both gender-specific and gender-non-specific barriers should be considered in efforts to achieve higher retention rates.
Collapse
Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), 5450Florida International University, Miami, FL, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Division of Natural Sciences, 10648New College of Florida, Sarasota, FL, USA
| | - Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, FL, USA
| | | | | |
Collapse
|
9
|
Prevalence and Correlates of HIV Stigma Among Women Living with HIV in Metro Vancouver, Canada. AIDS Behav 2021; 25:1688-1698. [PMID: 33389325 DOI: 10.1007/s10461-020-03084-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/22/2022]
Abstract
This study elucidated the prevalence and correlates of four types of HIV stigma among women living with HIV (WLWH). Data were drawn from 2 years (September 1/15 to August 31/17) of follow-up from a longitudinal community-based open cohort of 215 cisgender or transgender WLWH who lived and/or accessed care in Metro Vancouver, Canada (2014-present). Bivariate and multivariable cumulative logistic regression using generalized estimating equations for repeated measures were used to examine correlates of HIV stigma, including: (1) anticipated; (2) enacted; (3) internalized; and (4) perceived stigma. In multivariable analysis, disclosure of HIV status without consent was significantly associated with heightened: anticipated; enacted; and perceived stigma. Verbal and/or physical violence related to HIV status was significantly associated with heightened enacted, internalized and perceived stigma. Negative physical effects/symptoms of HIV was significantly associated with all stigma outcomes. Results suggest a need to support safe disclosure of HIV status and address social and structural violence against WLWH.
Collapse
|
10
|
Clark L, Karki C, Noone J, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/126632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
11
|
Payán DD, Derose KP, Fulcar MA, Farías H, Palar K. "It Was as Though My Spirit Left, Like They Killed Me": The Disruptive Impact of an HIV-Positive Diagnosis among Women in the Dominican Republic. J Int Assoc Provid AIDS Care 2020; 18:2325958219849042. [PMID: 31109213 PMCID: PMC6748475 DOI: 10.1177/2325958219849042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
An HIV diagnosis may be associated with severe emotional and psychological distress,
which can contribute to delays in care or poor self-management. Few studies have explored
the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in
low-resource settings. We conducted in-depth interviews with 30 women living with HIV in
the Dominican Republic. Interviews were audio-recorded, transcribed, and analyzed using
the biographical disruption framework. Three disruption phases emerged (impacts of a
diagnosis, postdiagnosis turning points, and integration). Nearly all respondents
described the news as deeply distressful and feelings of depression and loss of self-worth
were common. Several reported struggling with the decision to disclose—worrying about
stigma. Postdiagnosis turning points consisted of a focus on survival and motherhood;
social support (family members, friends, HIV community) promoted integration. The findings
suggest a need for psychological resources and social support interventions to mitigate
the negative impacts of an HIV diagnosis.
Collapse
Affiliation(s)
- Denise Diaz Payán
- 1 Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA.,2 RAND Corporation, Santa Monica, CA, USA
| | | | - María Altagracia Fulcar
- 3 United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Hugo Farías
- 4 United Nations World Food Programme, Regional Office for Latin America and the Caribbean, Panamá, Dominican Republic
| | - Kartika Palar
- 5 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
12
|
Sun M, Chen WT, Yang JP, Huang S, Zhang L, Shi M, Li W, Li Y, Bao M, Lu H. Concerns of Parental HIV Disclosure in China. Clin Nurs Res 2020; 30:830-839. [PMID: 32567340 DOI: 10.1177/1054773820932725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although parental HIV disclosure has benefits for parents and children, the disclosure rate among parents remains low. This study aims to qualitatively examine parental concerns regarding disclosure of their HIV status to their children. Eighty parents were enrolled in a randomized controlled trial of a three-session disclosure-support intervention, with forty receiving the intervention and forty receiving treatment as usual. Intervention sessions were audio recorded, and transcriptions were qualitatively coded for content related to concerns of disclosure. Four themes emerged: Intention to disclose, disclosure approach, indicators for disclosure, and fears about disclosure. These themes reveal struggles that parents experience when considering HIV disclosure suggesting that an effective disclosure intervention must help parents assess pros and cons, discuss the emotions of the children after the disclosure, and monitor the impact on children's lives after disclosure over time. Future research is needed to implement interventions supporting HIV-positive parents' disclosure decision-making and actions.
Collapse
Affiliation(s)
- Meiyan Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei-Ti Chen
- University of California Los Angeles, Los Angeles, CA, USA
| | - Joyce P Yang
- University of San Francisco, San Francisco, CA, USA
| | | | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Mingfeng Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ye Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
13
|
Deering KN, Braschel M, Logie C, Ranville F, Krüsi A, Duff P, Shannon K. Exploring pathways from violence and HIV disclosure without consent to depression, social support, and HIV medication self-efficacy among women living with HIV in Metro Vancouver, Canada. Health Psychol Open 2020; 7:2055102919897384. [PMID: 32010448 PMCID: PMC6971967 DOI: 10.1177/2055102919897384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We used path analysis to investigate complex pathways from HIV status disclosure without consent, physical/verbal violence and depression, social support, and HIV medication self-efficacy through mediators of HIV stigma among women living with HIV in Canada. In the final model, internalized stigma fully mediated the relationship between physical/verbal violence and reduced medication self-efficacy. Enacted stigma fully mediated the relationship between HIV status disclosure without consent and depression. Internalized stigma (β = 0.252; p < 0.001) had a significant negative direct effect on medication self-efficacy. Enacted stigma had a significant direct effect on depression (β = 0.162; p = 0.037). Findings will help improve services and interventions to promote quality of life and well-being of women living with HIV.
Collapse
Affiliation(s)
- Kathleen N Deering
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | | | | | - Flo Ranville
- Centre for Gender & Sexual Health Equity, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| |
Collapse
|
14
|
Dale SK, Dean T, Sharma R, Reid R, Saunders S, Safren SA. Microaggressions and Discrimination Relate to Barriers to Care Among Black Women Living with HIV. AIDS Patient Care STDS 2019; 33:175-183. [PMID: 30932695 DOI: 10.1089/apc.2018.0258] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In the United States, black women living with HIV (BWLWH) represent the highest proportion of women living with HIV and dying from HIV-related illnesses when compared with women of other racial/ethnic groups. These disparities may be linked to social and structural factors faced by BWLWH, including race- and HIV-related discrimination, and gendered racial microaggressions (GRMs). GRMs are everyday insults that black women experience due to being both black and female (e.g., comments about their body). Commonly assessed barriers to HIV-related care (e.g., transportation, finance, community stigma) do not include personal experiences of race- and HIV-related discrimination and GRM. We present the cross-sectional associations between racial discrimination, HIV-related discrimination, GRM, and barriers to care. One hundred BWLWH in a large city in the Southeast United States completed baseline assessments as part of an intervention development study. At baseline assessments BWLWH completed measures on racial discrimination, HIV-related discrimination, GRM (frequency and appraisal), and barriers to care. Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher race-related discrimination (β = 0.23, p < 0.05), higher HIV-related discrimination (β = 0.26, p < 0.01), and higher GRM (frequency: β = 0.31, p < 0.01; appraisal: β = 0.21, p < 0.05) significantly predicted higher total barriers to care. When all predictors were entered together GRMs contributed uniquely to total barriers to care and two subscales, while racial discrimination contributed uniquely toward one subscale. These findings further emphasize that for BWLWH interventions and policy efforts need to address racial discrimination, HIV-related discrimination, and GRM concurrently with other barriers to care, with special attention being given to daily GRM.
Collapse
Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami, Miami, Florida
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Taquesha Dean
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Rachelle Reid
- Department of Psychology, University of Miami, Miami, Florida
| | | | | |
Collapse
|
15
|
Hallberg D, Kimario TD, Mtuya C, Msuya M, Björling G. Factors affecting HIV disclosure among partners in Morongo, Tanzania. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
16
|
Urada LA, Smith LR, Yore J, Triplett DP, Hucks-Ortiz C, Raj A. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav 2018; 22:2553-2563. [PMID: 29748844 PMCID: PMC6443569 DOI: 10.1007/s10461-018-2131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.
Collapse
Affiliation(s)
- Lianne A Urada
- School of Social Work, San Diego State University, Hepner Hall #119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.
| | - Laramie R Smith
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Daniel P Triplett
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | | | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
| |
Collapse
|
17
|
Hu R, Zhang F, Wang V, Dou Z, Shepard C, Zhao D, Liu X, Mu W, Wu Y, Zhao H, Li H. Comparing Outcomes of HIV-Infected Chinese Adults on Antiretroviral Therapy by CD4 Count at Treatment Initiation: A Nationwide Retrospective Observational Cohort Study, 2012-2014. AIDS Patient Care STDS 2017; 31:413-420. [PMID: 28981337 DOI: 10.1089/apc.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The chief concerns for antiretroviral therapy (ART) programs considering removal of CD4+ cell count thresholds for treatment are the increased incidence of ART-related adverse events. A nationwide observational cohort study was conducted among patients who initiated ART in 2012. We divided the eligible patients into three groups: an early ART group with a baseline CD4+ cell count of 500 cells/μL or greater, a standard ART group with a baseline CD4+ cell count between 350 and 499 cells/μL, and a late ART group with a baseline CD4+ cell count between 200 and 349 cells/μL. These patients were followed up to December 31, 2014 and observed for three outcomes: virological failure, treatment nonretention, or time to death. Patients who met the eligibility criteria numbered at 26,752. Out of all study participants, 20,827 participants were in late ART group, 4336 were in standard ART group, and 1589 were in early ART group. Patients in late ART group were more likely to become virally suppressed 12 and 24 months after treatment initiation than patients in early ART group [adjusted odds ratio (aOR) 0.81; 95% CI, 0.69-0.95 and aOR, 0.78; 95% CI, 0.65-0.94]. Treatment nonretention was also less likely to occur among patients in late ART group than early ART group 12 months after treatment initiation (aOR, 0.85; 95% CI, 0.75-0.96). Compared with early ART group, neither standard ART group nor late ART group had a statistically significant difference in the time-to-death analysis. Late ART initiates were more likely to be virally suppressed and retained on treatment than early ART initiates. The importance of treatment retention and adherence should be emphasized for high CD4+ patients newly initiated to ART therapy through education and counseling programs.
Collapse
Affiliation(s)
- Ran Hu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Vania Wang
- Global AIDS Program, US Centres for Disease Control and Prevention, Beijing, China
| | - Zhihui Dou
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Colin Shepard
- Global AIDS Program, US Centres for Disease Control and Prevention, Beijing, China
| | - Decai Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xia Liu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Weiwei Mu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yasong Wu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Huiqin Li
- Yunnan AIDS Care Center, Kunming, China
| |
Collapse
|
18
|
Yu J, Zhang Y, Jiang J, Lu Q, Liang B, Liu D, Fang K, Huang J, He Y, Ning C, Liao Y, Lai J, Wei W, Qin F, Ye L, Geng W, Liang H. Implementation of a "County-Township-Village" Allied HIV Prevention and Control Intervention in Rural China. AIDS Patient Care STDS 2017; 31:384-393. [PMID: 28891716 DOI: 10.1089/apc.2017.0113] [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: 11/12/2022] Open
Abstract
In China, rural areas are a weak link of HIV/AIDS prevention and control. From September 2011, an innovative "county-township-village" allied intervention was implemented in Longzhou County, Guangxi, which assigned the tasks of HIV/AIDS prevention and control to the county Centers for Disease Control and Prevention (CDC), township hospitals, and village clinics, respectively, instead of traditional intervention in which the county CDC undertook the entire work. A 6-year consecutive cross-sectional survey, including 3-year traditional intervention (2009-2011) and 3-year innovative intervention (2012-2014), was conducted to evaluate the effects of the new intervention. Compared to traditional intervention, the innovative intervention achieved positive effects in decreasing risky behaviors. Among female sex workers, condom use rate in the last month increased from 72.06% to 96.82% (p < 0.01). Among drug users, having commercial sex rate in the last year reduced from 17.20% to 5.94% and condom use rate increased from 14.06% to 76.09% (p < 0.01). The risk ratio of HIV infection during innovative intervention was 0.631 (95% confidence interval 0.549-0.726) compared with traditional one. Cost-effectiveness analysis indicates that innovative intervention restores each disability-adjusted life year costing an average of $124.26. Taken together, Longzhou's innovative intervention has achieved good effects on HIV/AIDS prevention and control and provides a good reference for rural China.
Collapse
Affiliation(s)
- Jun Yu
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yi Zhang
- Department of AIDS Prevention, Longzhou Center for Disease Control and Prevention, Longzhou County, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Qinglin Lu
- Department of AIDS Prevention, Guangxi Health and Family Planning Commission, Nanning, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Deping Liu
- Department of AIDS Prevention, Chongzuo Center for Disease Control and Prevention, Chongzuo, China
| | - Keyong Fang
- Department of AIDS Prevention, Longzhou Center for Disease Control and Prevention, Longzhou County, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yang He
- Department of AIDS Prevention, Longzhou Center for Disease Control and Prevention, Longzhou County, China
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Science Institute, Guangxi Medical University, Nanning, China
| | - Yanyan Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Science Institute, Guangxi Medical University, Nanning, China
| | - Jingzhen Lai
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Wudi Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
| | - Wenkui Geng
- Department of AIDS Prevention, Guangxi Health and Family Planning Commission, Nanning, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment and Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Science Institute, Guangxi Medical University, Nanning, China
| |
Collapse
|