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Arimide DA, Esquivel-Gómez LR, Kebede Y, Sasinovich S, Balcha T, Björkman P, Kühnert D, Medstrand P. Molecular Epidemiology and Transmission Dynamics of the HIV-1 Epidemic in Ethiopia: Epidemic Decline Coincided With Behavioral Interventions Before ART Scale-Up. Front Microbiol 2022; 13:821006. [PMID: 35283836 PMCID: PMC8914292 DOI: 10.3389/fmicb.2022.821006] [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: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEthiopia is one of the sub-Saharan countries hit hard by the HIV epidemic. Previous studies have shown that subtype C dominates the Ethiopian HIV-1 epidemic, but the evolutionary and temporal dynamics of HIV-1 in Ethiopia have not been closely scrutinized. Understanding the evolutionary and epidemiological pattern of HIV is vital to monitor the spread, evaluate and implement HIV prevention strategies.MethodsWe analyzed 1,276 Ethiopian HIV-1 subtype C polymerase (pol sequences), including 144 newly generated sequences, collected from different parts of the country from 1986 to 2017. We employed state-of-art maximum likelihood and Bayesian phylodynamic analyses to comprehensively describe the evolutionary dynamics of the HIV-1 epidemic in Ethiopia. We used Bayesian phylodynamic models to estimate the dynamics of the effective population size (Ne) and reproductive numbers (Re) through time for the HIV epidemic in Ethiopia.ResultsOur analysis revealed that the Ethiopian HIV-1 epidemic originated from two independent introductions at the beginning of the 1970s and 1980s from eastern and southern African countries, respectively, followed by epidemic growth reaching its maximum in the early 1990s. We identified three large clusters with a majority of Ethiopian sequences. Phylodynamic analyses revealed that all three clusters were characterized by high transmission rates during the early epidemic, followed by a decline in HIV-1 transmissions after 1990. Re was high (4–6) during the earlier time of the epidemic but dropped significantly and remained low (Re < 1) after the mid-1990. Similarly, with an expected shift in time, the effective population size (Ne) steadily increased until the beginning of 2000, followed by a decline and stabilization until recent years. The phylodynamic analyses corroborated the modeled UNAIDS incidence and prevalence estimates.ConclusionThe rapid decline in the HIV epidemic took place a decade before introducing antiretroviral therapy in Ethiopia and coincided with early behavioral, preventive, and awareness interventions implemented in the country. Our findings highlight the importance of behavioral interventions and antiretroviral therapy scale-up to halt and maintain HIV transmissions at low levels (Re < 1). The phylodynamic analyses provide epidemiological insights not directly available using standard surveillance and may inform the adjustment of public health strategies in HIV prevention in Ethiopia.
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Affiliation(s)
- Dawit Assefa Arimide
- Department of Translational Medicine, Lund University, Malmo, Sweden
- TB/HIV Department, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Luis Roger Esquivel-Gómez
- Transmission, Infection, Diversification and Evolution Group, Max-Planck Institute for the Science of Human History, Jena, Germany
| | - Yenew Kebede
- Africa Centre for Disease Prevention and Control, Africa Union Commission, Addis Ababa, Ethiopia
| | | | - Taye Balcha
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Per Björkman
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Denise Kühnert
- Transmission, Infection, Diversification and Evolution Group, Max-Planck Institute for the Science of Human History, Jena, Germany
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Malmo, Sweden
- *Correspondence: Patrik Medstrand,
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Chen D, Luo G, Meng X, Wang Z, Cao B, Yuan T, Xie Y, Hu T, Chen Y, Ke W, Wang Z, Sun C, Deng K, Cai Y, Zhang K, Zou H. Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review. BMC Public Health 2020; 20:1310. [PMID: 32859178 PMCID: PMC7455896 DOI: 10.1186/s12889-020-09333-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background Factory workers in low- and middle-income countries (LMICs) are vulnerable to HIV transmission. Interventions are needed to prevent HIV in this population. We systematically reviewed published literature on the efficacy of various HIV interventions in reducing stigma, risk behaviors and HIV transmission among factory workers. Methods A systematic review was performed using predefined inclusion and exclusion criteria. Four databases (PubMed, PsycINFO, Scopus and EMBASE) were searched for relevant publications between January 1, 1990 and December 31, 2018. Two independent reviewers assessed the methodological quality of studies. Results Thirteen articles were included, with 2 randomized controlled trials and 11 cohort studies. Five interventions and their combinations were summarized. Educational intervention increased condom use and reduced the use of recreational drugs and alcohol before sex. Community intervention that proactively provide HIV counselling and testing (HCT) services could increase the detection rate of HIV and other sexually transmitted diseases (STDs). Lottery intervention increased HCT uptake and decreased HIV public stigma. Education combined with community intervention reduced the proportion of workers with casual sex and enhanced HIV knowledge. Peer education combined with community intervention increased the proportion of workers who were willing to take their partners to HCT. Policy intervention combined with peer education enhanced HIV knowledge, perceived condom accessibility and condom use with regular partners. Conclusions Various interventions improved HIV knowledge, decreased HIV stigma and reduced HIV-related risk behaviors among factory workers in LMICs. The combination of multiple interventions tended to achieve better efficacy than a single intervention. Persistent combination interventions are essential to address HIV in this population.
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Affiliation(s)
- Dahui Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, PR China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, Guangdong, PR China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Yu Xie
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Wujian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Zhenyu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Caijun Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Kai Deng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yong Cai
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China. .,Kirby Institute, University of New South Wales, Sydney, Australia.
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Ayele W, Mekonnen Y, Messele T, Mengistu Y, Tsegaye A, Bakker M, Berkhout B, Dorigo-Zetsma W, Wolday D, Goudsmit J, Coutinho R, de Baar M, Paxton WA, Pollakis G. Differences in HIV type 1 RNA plasma load profile of closely related cocirculating Ethiopian subtype C strains: C and C'. AIDS Res Hum Retroviruses 2010; 26:805-13. [PMID: 20624072 DOI: 10.1089/aid.2009.0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Two HIV-1 subtype C subclusters have been identified in Ethiopia (C and C') with little knowledge regarding their biological or clinical differences. We longitudinally monitored HIV-1 viral loads and CD4(+) T cell counts for 130 subtype C-infected individuals from Ethiopia over 5 years. The genetic subclusters C and C' were determined and comparisons were made between the groups. None of the study individuals received antiretroviral therapy. Subcluster C' was found to be the more prevalent (72.3%) genotype circulating. Individuals infected with subcluster C' harbored higher viral loads in comparison to subcluster C-infected individuals when the CD4(+) T cell counts were high (500-900 cells/mm(3)), whereas at low CD4(+) T cell counts (0-150 cells/mm(3)) individuals infected with subcluster C viruses showed higher viral loads. We identified a greater number of deaths among individuals infected with subcluster C viruses in comparison to C'. Our results indicate that infection with subcluster C viruses leads to a more rapid onset of disease, despite the initial lower HIV-1 RNA plasma loads. Additionally, the higher viral loads seen for HIV-1 subcluster C' infections at higher CD4(+) T cell counts can help explain the higher prevalence of this subtype in Ethiopia.
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Affiliation(s)
- Workenesh Ayele
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Yared Mekonnen
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Tsehaynesh Messele
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Yohannes Mengistu
- Department of Microbiology, Immunology and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | - Margreet Bakker
- Laboratory of Experimental Virology (LEV), Department of Medical Microbiology–Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Ben Berkhout
- Laboratory of Experimental Virology (LEV), Department of Medical Microbiology–Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Wendelien Dorigo-Zetsma
- Regional Microbiological and Serological Laboratory, Hospital Hilversum, Hilversum, The Netherlands
| | - Dawit Wolday
- Ethiopian Health and Nutrition Research Institute (EHNRI), Addis Ababa, Ethiopia
| | | | - Roel Coutinho
- Rijksinstituut voor Volksgezondheid en Milieu (RIVM), 3721 MA Bilthoven, The Netherlands
| | | | - William A. Paxton
- Laboratory of Experimental Virology (LEV), Department of Medical Microbiology–Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Georgios Pollakis
- Laboratory of Experimental Virology (LEV), Department of Medical Microbiology–Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
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Green EC, Mah TL, Ruark A, Hearst N. A Framework of Sexual Partnerships: Risks and Implications for HIV Prevention in Africa. Stud Fam Plann 2009; 40:63-70. [DOI: 10.1111/j.1728-4465.2009.00187.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001-2004. AIDS 2007; 21 Suppl 7:S39-48. [PMID: 18040163 DOI: 10.1097/01.aids.0000300534.97601.d6] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate HIV incidence and explore evidence for changing sexual behaviour over time among men and women belonging to different socioeconomic groups in rural South Africa. DESIGN AND METHODS A cohort study conducted between 2001 and 2004; 3881 individuals aged 14-35 years enumerated in eight villages were eligible. At least three household visits were made to contact each eligible respondent at both timepoints. Sexual behaviour data were collected in structured, respondent-focused interviews. HIV serostatus was assessed using an oral fluid enzyme-linked immunosorbent assay at each timepoint. RESULTS Data on sexual behaviour were available from 1967 individuals at both timepoints. A total of 1286 HIV-negative individuals at baseline contributed to the analysis of incidence. HIV incidence was 2.2/100 person-years among men and 4.9/100 person-years in women, among whom it was highest in the least educated group. Median age at first sex was lower among later birth cohorts. A higher number of previously sexually active individuals reported having multiple partners in the past year in 2004 than 2001. Condom use with non-spousal partners increased from 2001 to 2004. Migrant men more often reported multiple partners. Migrant and more educated individuals of both sexes and women from wealthier households reported higher levels of condom use. DISCUSSION HIV incidence is high in rural South Africa, particularly among women of low education. Some risky sexual behaviours (early sexual debut, having multiple sexual partners) are becoming more common over time. Condom use is increasing. Existing HIV prevention strategies have only been partly effective in generating population-level behavioural change.
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Tsegaye A, Ran L, Wolday D, Petros B, Dorigo W, Piriou E, Messele T, Sanders E, Tilahun T, Eshetu D, Schuitemaker H, Coutinho RA, Miedema F, Borghans J, van Baarle D. HIV-1 Subtype C gag-specific T-cell responses in relation to human leukocyte antigens in a diverse population of HIV-infected Ethiopians. J Acquir Immune Defic Syndr 2007; 45:389-400. [PMID: 17417101 DOI: 10.1097/qai.0b013e318059beaa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Knowledge of the most dominant T-cell epitopes in the context of the local human leukocyte antigen (HLA) background is a prerequisite for the development of an effective HIV vaccine. In 100 Ethiopian subjects, 16 different HLA-A, 23 HLA-B, and 12 HLA-C specificities were observed. Ninety-four percent of the population carried at least 1 of the 5 most common HLA-A and/or HLA-B specificities. HIV-specific T-cell responses were measured in 48 HIV-infected Ethiopian subjects representing a wide range of ethnicities in Ethiopia using the interferon (IFN)-gamma enzyme-linked immunospot (Elispot) assay and 49 clade C-specific synthetic Gag peptides. Fifty-eight percent of the HIV-positive study subjects showed T-cell responses directed to 1 or more HIV Gag peptides. Most Gag-specific responses were directed against the subset of peptides spanning Gag p24. The breadth of response ranged from 1 to 9 peptides, with most (78%) individuals showing detectable responses to <3 Gag peptides. The magnitude of HIV-specific T-cell responses was not associated with HIV viral load but correlated positively with CD4 T-cell counts. The most frequently targeted Gag peptides overlapped with those previously described for HIV-1 subtype C-infected southern Africans, and therefore can be used in a multiethnic vaccine.
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Affiliation(s)
- Aster Tsegaye
- Ethiopian-Netherlands AIDS Research Project, Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia
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Steele MS, Bukusi E, Cohen CR, Shell-Duncan BA, Holmes KK. The ABCs of HIV prevention in men: associations with HIV risk and protective behaviors. J Acquir Immune Defic Syndr 2007; 43:571-6. [PMID: 17019371 DOI: 10.1097/01.qai.0000243098.72770.9b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To elucidate associations between beliefs in abstinence, fidelity, and condom use (the "ABCs" of preventing HIV and other sexually transmitted infections) and associated self-reported risk behaviors among Kenyan men. METHODS We assessed associations of beliefs in the ABCs with sociodemographic characteristics and sexual risk behaviors in a respondent-driven sample of 500 men in Nairobi. RESULTS Younger age, single marital status, and higher education were associated with beliefs in abstinence and condom use as "best" prevention methods; and older age and marriage were associated with belief in fidelity. Many of these and other associations persisted in multivariate models. Men citing abstinence or fidelity belief less often reported sex with a female sex worker (FSW) ever or recent concurrent partnerships less often. Belief in fidelity was negatively associated with reported use of condoms ever. Belief in condom use to prevent HIV was most common among those having recent concurrent partnerships. CONCLUSIONS Beliefs in abstinence, fidelity ("being faithful"), or condom use were associated, in plausible directions, with life stages and other demographic factors and with corresponding risk and preventive behaviors. Context-specific and selective educational promotion of individual ABC components rather than comprehensive education from an early age in a wide repertoire of prevention strategies ignores the evolution of sexual behaviors and the relative utility of different approaches throughout the life course.
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Affiliation(s)
- Matthew S Steele
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA
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Green EC, Halperin DT, Nantulya V, Hogle JA. Uganda's HIV prevention success: the role of sexual behavior change and the national response. AIDS Behav 2006; 10:335-46; discussion 347-50. [PMID: 16688475 PMCID: PMC1544373 DOI: 10.1007/s10461-006-9073-y] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of “zero grazing” (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women’s, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over “what happened in Uganda” continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality.
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Affiliation(s)
- Edward C. Green
- Harvard University School of Public Health, Boston, Massachusetts USA
| | - Daniel T. Halperin
- AIDS Research Institute, University of California, San Francisco, California USA
- NERCHA, Mbabane, Swaziland, South Africa
| | - Vinand Nantulya
- Global Fund for AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Luginaah IN, Yiridoe EK, Taabazuing MM. From mandatory to voluntary testing: balancing human rights, religious and cultural values, and HIV/AIDS prevention in Ghana. Soc Sci Med 2005; 61:1689-700. [PMID: 15913859 DOI: 10.1016/j.socscimed.2005.03.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 03/15/2005] [Indexed: 11/22/2022]
Abstract
This paper examines efforts by some churches in Ghana to reduce the spread of HIV/AIDS. The analysis is based on focus group discussions with two groups of men and two groups of women, along with in-depth interviews with 13 pastors and marriage counsellors in the churches studied. In response to government and public criticisms about human rights violations, churches that previously imposed mandatory HIV testing on members planning to marry now have voluntary testing programmes. However, the results suggest that what the churches refer to as voluntary testing may not be truly voluntary. Cultural values and traditional practices, including traditional courtship and marriage rites (which are performed before church weddings), not only clash with considerations about pre-marital HIV testing but also complicate the contentious issue of confidentiality of information on HIV testing. Associated with these complexities and issues of confidentiality is a reluctance among participants, particularly those from northern Ghana, to test for HIV. The results reveal how broader social impacts of HIV testing for those planning to marry may extend beyond individuals or couples in different cultural contexts. The findings also support the general view that there are no perfect or easy solutions to combating the HIV/AIDS pandemic. Practical solutions and programs for Ghana cannot be neutral to cultural values and need to be tailored for particular (ethnic) populations.
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Affiliation(s)
- Isaac N Luginaah
- Department of Geography, University of Western Ontario, London, Ont., Canada N6A 5C2
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Lopez-Quintero C, Shtarkshall R, Neumark YD. Barriers to HIV-testing among Hispanics in the United States: analysis of the National Health Interview Survey, 2000. AIDS Patient Care STDS 2005; 19:672-83. [PMID: 16232051 DOI: 10.1089/apc.2005.19.672] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Data from the 2000 National Health Interview Survey (NHIS) were analyzed to explore barriers to HIV testing, and intentions to be tested among a nationally representative sample (n = 4,261) of the different Hispanic subgroups living in the United States. Weighted proportions and variances accounting for the complex sample design of the NHIS were estimated using the Taylor series linearization method. Regression estimates are expressed as odds ratios and their 95% confidence intervals. Two thirds of sampled Hispanics had never been tested for HIV (excluding blood donations) and 88% expressed no intention to do so in the near future. Many of the factors that influence the likelihood of having been tested in the past also impact on future HIV testing intentions including age, Hispanic subgroup, high-risk status, and self-perceived HIV risk. Compared to Puerto Ricans, Mexicans (odds ratio [OR] = 1.59, 1.1-2.3) and Mexican/Americans (OR = 1.61, 1.1-2.3) were more likely to never have been tested and Cubans were notably more likely to report negative future testing intentions (OR = 5.63, 2.5-12.8). Among Hispanics who reported high-risk status or high/medium self-perceived HIV risk, more than one quarter had never undergone testing and expressed no intention of doing so in the near future. Recognition of the HIV testing barriers identified in this study is valuable for the development and refinement of current strategies that aim to increase HIV testing practices in the heterogeneous U.S. Hispanic population.
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Affiliation(s)
- Catalina Lopez-Quintero
- Braun School of Public Health & Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
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Lopez-Quintero C, Shtarkshall R, Neumark YD. Barriers to HIV-Testing Among Hispanics in the United States: Analysis of the National Health Interview Survey, 2000. AIDS Patient Care STDS 2005. [DOI: 10.1089/apc.2005.19.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shelton JD, Halperin DT, Nantulya V, Potts M, Gayle HD, Holmes KK. Partner reduction is crucial for balanced "ABC" approach to HIV prevention. BMJ 2004; 328:891-3. [PMID: 15073076 PMCID: PMC387490 DOI: 10.1136/bmj.328.7444.891] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Behaviour change programmes to prevent HIV have mainly promoted condom use or abstinence, while partner reduction remains the neglected component of ABC
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Affiliation(s)
- James D Shelton
- Bureau for Global Health, US Agency for International Development, 1300 Pennsylvania Avenue, Washington, DC 20523-3700, USA
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