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Flath N, Marr JH, Sizemore L, Pichon LC, Brantley M. HIV and Hepatitis C Among People Who Inject Drugs in Memphis, Tennessee: an Intersectional Risk Environment Analysis of the Social Determinants of Health. J Racial Ethn Health Disparities 2025; 12:361-373. [PMID: 38066407 DOI: 10.1007/s40615-023-01878-x] [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: 09/15/2023] [Revised: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2025]
Abstract
BACKGROUND The Southern US is confronting bourgeoning HIV and hepatitis C virus (HCV) epidemics among people who inject drugs (PWID), yet little is known about shared and unique risk factors across the region. We applied an intersectional risk environment framework to understand infectious disease outcomes for sub-groups of PWID that experience multiple axes of social marginalization related to racial and ethnic identity and social and economic vulnerability. METHODS HIV and HCV prevalence was estimated from the first iteration of the CDC's National HIV Behavioral Surveillance respondent driven sample of PWID in Shelby County, Tennessee in 2018. We ran adjusted multinomial models to test main and interaction effects of race/ethnicity and structural factors on the prevalence of a three-level outcome: HIV-only, HCV-only, and no infection. RESULTS A total of 564 PWID participated, 558 (99%) completed HIV testing, and 540 (96%) HCV testing. Thirty (5%) were HIV-positive, 224 (40%) HCV-positive, and less than 1% were co-infected. Descriptive differences by race/ethnicity and levels of structural vulnerability for HIV and HCV subpopulations were present; however, there was no evidence for statistical interaction. In the final main effects model, HIV status was positively associated with non-Hispanic Black identity (aRR 4.95, 95% CI 1.19, 20.6), whereas HCV status was associated with non-white identity (aRR 0.11 95% CI 0.07, 0.18). Factors associated with HCV infection were higher scores of structural vulnerability (aRR 2.19 95% CI 1.10, 4.35), and criminal legal involvement (aOR 1.99 95% CI 1.18, 3.37). CONCLUSION This is the first study to implement local population-based survey data to evaluate distinctive intersections of ethnic/racial and social factors associated with HIV and HCV status among PWID in the Memphis region. Findings come at an opportune time as harm reduction programs are in development in the South and shed light to the need for socially equitable race conscious resource investment.
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Affiliation(s)
- Natalie Flath
- Department of Mental Health, School of Public Health, Johns Hopkins Bloomberg, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Jack H Marr
- Tennessee Department of Health, Communicable and Environmental Disease and Emergency Preparedness, 710 James Robertson Parkway, 4th Floor, Nashville, TN, 37243, USA
| | - Lindsey Sizemore
- Tennessee Department of Health, 710 James Robertson Parkway, 4th Floor, Viral Hepatitis Program, Nashville, TN, 37243, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences School of Public Health, University of Memphis 209 Robison Hall Memphis, Tennessee, 38152, USA
| | - Meredith Brantley
- Tennessee Department of Health, 710 James Robertson Parkway, 4th Floor, Nashville, TN, 37243, USA
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Yu E, Du J, Xiang Y, Hu X, Feng J, Luo X, Schneider JA, Zhi D, Fujimoto K, Tao C. Explainable artificial intelligence and domain adaptation for predicting HIV infection with graph neural networks. Ann Med 2024; 56:2407063. [PMID: 39417227 PMCID: PMC11488171 DOI: 10.1080/07853890.2024.2407063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVE Investigation of explainable deep learning methods for graph neural networks to predict HIV infections with social network information and performing domain adaptation to evaluate model transferability across different datasets. METHODS Network data from two cohorts of younger sexual minority men (SMM) from two U.S. cities (Chicago, IL, and Houston, TX) were collected between 2014 and 2016. Feature importance from graph attention network (GAT) models were determined using GNNExplainer. Domain adaptation was performed to examine model transferability from one city dataset to the other dataset, training with 100% of the source dataset with 30% of the target dataset and prediction on the remaining 70% from the target dataset. RESULTS Domain adaptation showed the ability of GAT to improve prediction over training with single city datasets. Feature importance analysis with GAT models in single city training indicated similar features across different cities, reinforcing potential application of GAT models in predicting HIV infections through domain adaptation. CONCLUSION GAT models can be used to address the data sparsity issue in HIV study populations. They are powerful tools for predicting individual risk of HIV that can be further explored for better understanding of HIV transmission.
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Affiliation(s)
- Evan Yu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jingcheng Du
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yang Xiang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xinyue Hu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Jingna Feng
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Xi Luo
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Degui Zhi
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kayo Fujimoto
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Cui Tao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, USA
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Arnold T, Whiteley L, Elwy RA, Ward LM, Konkle-Parker DJ, Brock JB, Giorlando KK, Barnett AP, Sims-Gomillia C, Craker LK, Lockwood KR, Leigland A, Brown LK. Mapping Implementation Science with Expert Recommendations for Implementing Change (MIS-ERIC): Strategies to Improve PrEP Use among Black Cisgender Women Living in Mississippi. J Racial Ethn Health Disparities 2023; 10:2744-2761. [PMID: 36396922 PMCID: PMC9672575 DOI: 10.1007/s40615-022-01452-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are disproportionately affected by the HIV epidemic. Strategies to increase Black women's use of pre-exposure prophylaxis (PrEP) are needed. METHODS Interviews were conducted in Mississippi (MS) with Black, cisgender women at risk for HIV, and community healthcare clinic (CHC) staff who work directly with this population. Reflexive thematic analysis was used to identify barriers and select appropriate implementation strategies to increase PrEP care. RESULTS Twenty Black women and twelve CHC staff were interviewed. PrEP use barriers resulted from low HIV risk awareness, lack of PrEP knowledge, and structural and stigma-related barriers. Methods for PrEP education and motivation included normalizing PrEP in public communications, providing education at places where women congregate, and tailoring PrEP content with Black women as educators. The Expert Recommendations for Implementing Change (ERIC) project provides a way for implementation scientists to select strategies that are consistent within research and practice across studies. Strategies from the ERIC project were selected to address implementation barriers. CONCLUSIONS Tailoring PrEP implementation protocols to increase Black women's access, engagement, and adherence to PrEP is needed. This is one of the first implementation studies to incorporate these four implementation concepts into a single study: (1) implementation outcomes, (2) i-PARIHS, (3) ERIC's strategy list, and (4) operationalizing the strategies using the Proctor et al., guidelines. Results provide an in-depth comprehensive list of implementation strategies to increase PrEP uptake for Black women in MS.
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Affiliation(s)
- Trisha Arnold
- Brown University Warren Alpert Medical School, Providence, RI, USA.
- Department of Psychiatry, Rhode Island Hospital, Providence, USA.
| | - Laura Whiteley
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Rani A Elwy
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Lori M Ward
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Deborah J Konkle-Parker
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - James B Brock
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | | | - Andrew P Barnett
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Courtney Sims-Gomillia
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Lacey K Craker
- Division of Prevention Science and Community Health, University of Miami, Miami, USA
| | - Khadijra R Lockwood
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Larry K Brown
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
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Troutman J, Robillard A, Ingram LA, Qiao S, Gaddist B, Segosebe K. Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:290-308. [PMID: 37535327 DOI: 10.1521/aeap.2023.35.4.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.
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Affiliation(s)
- Jamie Troutman
- Quality Comprehensive Health Center, Charlotte, North Carolina
| | - Alyssa Robillard
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Lucy Annang Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Kebafe Segosebe
- Edson College of Nursing and Health Innovation, Arizona State University
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Psaros C, Goodman GR, McDonald VW, Ott C, Blyler A, Rivas A, Shan L, Campbell M, Underwood E, Krakower D, Elopre L, Kudroff K, Sherr KH, Kempf MC. Protocol for WeExPAnd: a prospective, mixed-methods pilot demonstration study to increase access to pre-exposure prophylaxis among women vulnerable to HIV infection in the Southern USA. BMJ Open 2023; 13:e075250. [PMID: 37286316 PMCID: PMC10255226 DOI: 10.1136/bmjopen-2023-075250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION African American women (AA), particularly those living in the Southeastern USA, experience disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool that may circumvent barriers to traditional HIV prevention tools, such as condom use; however, very little is known about how to improve PrEP access and uptake among AA women who may benefit from PrEP use. This project aims to understand how to increase PrEP access among AA women in the rural Southern USA, which may ultimately affect HIV incidence in this population. METHODS AND ANALYSIS The goal of the current study is to systematically adapt a patient-provider communication tool to increase PrEP uptake among AA women receiving care at a federally qualified health centre in Alabama. We will use an iterative implementation process, by assessing the feasibility, acceptability and preliminary impact of the tool on PrEP uptake, using a pilot preintervention/postintervention design (N=125). We will evaluate women's reasons for declining a referral to a PrEP provider, reasons for incomplete referrals, reasons for not initiating PrEP after a successful referral and ongoing PrEP use at 3 and 12 months after PrEP initiation among our sample. The proposed work will significantly contribute to our understanding of factors impacting PrEP uptake and use among AA women, particularly in underserved areas in the Deep South that are heavily impacted by the HIV epidemic and experience worse HIV-related health outcomes relative to other areas in the USA. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board (IRB) at University of Alabama at Birmingham (Birmingham, AL; protocol 300004276). All participants will review a detailed informed consent form approved by the IRB and will provide written or verbal informed consent prior to enrolment. Results will be disseminated through peer-reviewed manuscripts, reports, and local, national and international presentations. TRIAL REGISTRATION NUMBER NCT04373551.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | | | - Corilyn Ott
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigail Blyler
- Positive Psychology Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexa Rivas
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Shan
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marquetta Campbell
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, Alabama, USA
| | - Eric Underwood
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, Alabama, USA
| | - Douglas Krakower
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Latesha Elopre
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kachina Kudroff
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kenneth H Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Mirjam-Colette Kempf
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Xu Y, Huang Y, Peng J, Tang R, Luo B, Xia Z. Association between depression and HIV infection vulnerable populations in United States adults: a cross-sectional analysis of NHANES from 1999 to 2018. Front Public Health 2023; 11:1146318. [PMID: 37325316 PMCID: PMC10267355 DOI: 10.3389/fpubh.2023.1146318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Although the government has made a commitment to advance education on HIV disclosure, depression continues to play a significant role in whether people living with HIV (PLWH) choose to disclose their HIV status to families or friends. Vulnerable populations who are at risk of contracting HIV may also be more susceptible to mental illness. However, there is a limited understanding of the association between depression and vulnerable populations affects by HIV among United States adults. We aimed to explore the incidence of depression in the HIV infection vulnerable populations and assessed the association between the HIV infection vulnerable populations and depression. Methods We analyzed the most current statistics from the National Health and Nutrition Examination Survey (NHANES) that included 16,584 participants aged 18 years or older between 1999 and 2018. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate symptoms of depressive disorder. Demographic characteristics were compared between the HIV infection vulnerable groups and HIV infection low-risk groups. Multivariable logistic regression analysis was also carried out to evaluate the odds rate and association between the HIV infection vulnerable populations and depression. Results Based on the most recent statistics from NHANES, HIV infection vulnerable populations were male, younger, less married or living together, non-Hispanic White people, lower income, and lower body mass index (BMI), with higher levels of cigarette smoking, alcohol drinking, a higher prevalence of depression, lower prevalence of hypertension and diabetes mellitus (DM; p < 0.05). Additionally, individuals with severe depression had a higher prevalence of cardiovascular disease (CVD), hypertension, DM, chronic kidney disease (CKD), and a higher proportion of HIV infection vulnerable populations and less married or living together (p < 0.01). Finally, the odds of depression from the logistic regression were significantly increased in HIV infection vulnerable groups (p < 0.01). Conclusion Depression might be associated with HIV infection vulnerable populations in the United States adults. More research is needed to evaluate the association between HIV infection vulnerable populations and depression and explore their causal associations. In addition, prevention efforts focusing on HIV disclosure and HIV infection vulnerable populations in the United States should address common co-prevalent depression to reduce new HIV infections.
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Affiliation(s)
- Yan Xu
- Department of Clinical Laboratory, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Yuexin Huang
- Department of Urology, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Jie Peng
- Department of Clinical Laboratory, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Ruiti Tang
- Department of Clinical Laboratory, Hunan Aerospace Hospital, Changsha, Hunan, China
| | - Bin Luo
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Zhiwei Xia
- Department of Neurology, Hunan Aerospace Hospital, Changsha, Hunan, China
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Marshall SA, Tao J, Horton HK, Montgomery MC, Baloh J, Gu M, Mabin C, Cima M, Nunn AS, Chan PA, Zaller ND. Barriers and facilitators to HIV care engagement: Recommendations from people with HIV in rural Arkansas. J Rural Health 2023; 39:459-468. [PMID: 36203209 PMCID: PMC10038810 DOI: 10.1111/jrh.12717] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE Little is known about factors affecting HIV care engagement and retention among rural people with HIV (PWH) in the South. About half of PWH in Arkansas reside in rural areas. The purpose of this study was to explore factors affecting engagement and retention in HIV care among PWH in rural areas of Arkansas. METHODS We conducted an exploratory qualitative study in 2020 and completed individual interviews (N = 11) with PWH in rural counties in Arkansas. FINDINGS Content analysis revealed the following themes: (1) Barriers to HIV care included long distances to the nearest HIV clinic and transportation issues along with anticipating and/or experiencing HIV-related stigma; (2) facilitators of HIV care included having a helpful HIV care provider and Ryan White case manager and a social support network that aided them in prioritizing their own health; (3) participants had the most favorable reactions to Ryan White case management, peer navigators, and telemedicine for HIV treatment/care; and (4) participants demonstrated resilience overcoming various obstacles as they worked toward being healthy mentally and physically while living with HIV. CONCLUSION Interventions need to address multilevel factors, including hiring PWH as peer navigators and/or caseworkers and offering HIV care via telemedicine, to improve HIV care engagement and retention among rural populations.
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Affiliation(s)
- Sarah Alexandra Marshall
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jun Tao
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Heather K. Horton
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Madeline C. Montgomery
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jure Baloh
- Department of Health Policy & Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mofan Gu
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Mike Cima
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Amy S. Nunn
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Nickolas D. Zaller
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Townes A, Gaul Z, Henny KD. Sexual health discussion practices and HIV clinical care provided by primary care providers in the Southeast United States, K-BAP Study (2017-2018). Fam Pract 2023; 40:39-46. [PMID: 35899789 PMCID: PMC11299194 DOI: 10.1093/fampra/cmac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Research underscores the importance of providers having routine discussions with patients about their sexual health. We examined the occurrences and association of routine sexual health discussion practices and human immunodeficiency virus (HIV) clinical care among primary care providers (PCPs) in areas with high HIV prevalence. METHODS We analysed data collected between April and August 2017 from an online survey that assessed PCPs knowledge, behaviours, attitudes, and practices of HIV-related care in 6 Southeast US jurisdictions (Atlanta, Baltimore, Baton Rouge, District of Columbia, Miami, and New Orleans). RESULTS Among PCPs, we found that 39.2% routinely obtained sexual health histories, 78.5% offered HIV testing, and 16.0% ever prescribed preexposure prophylaxis (PrEP). Based on adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), the proportion of PCPs who routinely obtained sexual histories was higher among female PCPs (aPR = 1.47, 95% CI 1.04, 2.08), PCPs who had a patient population that was >50% men who have sex with men (MSM) (aPR = 1.94, 95% CI 1.72, 2.18), offered HIV testing (aPR = 3.60, 95% CI 2.23, 5.79), and ever prescribed PrEP (aPR = 1.43, 95% CI 1.06, 1.93). CONCLUSION Improving patient-provider discussions are needed to reduce HIV-related service barriers for disproportionately affected populations. PRACTICE IMPLICATIONS Routine discussions can reduce barriers to important HIV prevention and care services and help reduce disparities among patients living in highly prevalent HIV locations.
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Affiliation(s)
- Ashley Townes
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zaneta Gaul
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Social & Scientific Systems, Silver Spring, MD, United States
| | - Kirk D. Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Crooks N, Singer RB, Smith A, Ott E, Donenberg G, Matthews AK, Patil CL, Haider S, Johnson AK. Barriers to PrEP uptake among Black female adolescents and emerging adults. Prev Med Rep 2023; 31:102062. [PMID: 36467542 PMCID: PMC9712981 DOI: 10.1016/j.pmedr.2022.102062] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
HIV/AIDS disproportionately impacts Black cisgender female adolescents and emerging adults. Pre-Exposure Prophylaxis (PrEP) reduces the risk of HIV infection; however, structural barriers may exacerbate resistance to PrEP in this population. The purpose of this paper is to understand the characteristics of age, race, gender, history, and medical mistrust as barriers to PrEP uptake among Black female adolescents and emerging adults (N = 100 respondents) between the ages of 13-24 years in Chicago. Between January and June of 2019, participants completed the survey. We used directed content analysis to examine reported barriers to PrEP uptake. The most commonly identified barriers to PrEP uptake were side effects (N = 39), financial concerns (N = 15), and medical mistrust (N = 12). Less frequently reported barriers included lack of PrEP knowledge and misconceptions (N = 9), stigma (N = 2), privacy concerns (N = 4). We describe innovative multi-level strategies to provide culturally safe care to improve PrEP acceptability among Black female adolescents and emerging adults in Chicago. These recommendations may help mitigate the effect of medical mistrust, stigma, and misconceptions of PrEP within Black communities.
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Affiliation(s)
- Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Randi B. Singer
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Ariel Smith
- Department of Population Health Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Emily Ott
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, USA
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL, USA
| | | | - Crystal L. Patil
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, USA
| | - Amy K. Johnson
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University
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Sauter SR, Ratnayake A, Campbell MB, Kissinger PJ. Sexual Networks and STI Infection Among Young Black Men Who Have Sex With Women in a Southern U.S. City. J Adolesc Health 2023; 72:730-736. [PMID: 36599759 DOI: 10.1016/j.jadohealth.2022.11.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The configuration of one's sexual network has been shown to influence sexually transmitted infection (STI) acquisition in some populations. Young Black men who have sex with women (MSW) have high rates of STIs, yet little is known about their sexual networks. The purpose of this study is to describe the characteristics of sexual networks and their association with selected STI infections among young Black MSW. METHODS Black MSW aged 15-26 years who were enrolled in the New Orleans community-based screening program named Check It from March 2018 to March 2020 were tested for C. trachomatis and N. gonorrhoeae infection and asked about the nature of their sexual partnerships. Sexual partnerships with women were defined as dyadic, somewhat dense (either themselves or their partner had multiple partners), and dense (both they and their partner(s) had multiple partners). RESULTS Men (n = 1,350) reported 2,291 sex partners. The percentage of men who reported their networks were dyadic, somewhat dense, and dense was 48.7%, 27.7%, and 23.3%, respectively; 11.2% were STI-positive and 39.2% thought their partner(s) had other partners. Compared to men in dyadic relationships, those in somewhat dense network did not have increased risk of STI infection, but those in dense networks were more likely to have an STI (adjusted odds ratio = 2.06, 95% confidence interval [1.35-3.13]). DISCUSSION Young Black MSW, who had multiple partners and who thought their partner(s) had other sex partners were at highest risk for STIs. Providers should probe not only about the youth's personal risk but should probe about perceived sexual partners' risk for more targeted counseling/STI testing.
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Affiliation(s)
- Sydney R Sauter
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Aneeka Ratnayake
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Mary Beth Campbell
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
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Beer L, Tie Y, Dasgupta S, McManus T, Smith DK, Shouse RL. Trends in preexposure prophylaxis use among sex partners as reported by persons with HIV - United States, May 2015-June 2020. AIDS 2022; 36:2161-2169. [PMID: 36382435 PMCID: PMC11057891 DOI: 10.1097/qad.0000000000003366] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate trends in the proportion of sexually active U.S. adults with HIV (PWH) reporting an HIV-discordant sexual partner taking preexposure prophylaxis (PrEP) and proportion of partners taking PrEP. DESIGN The Medical Monitoring Project is a complex sample survey of U.S. adults with diagnosed HIV. METHODS We used annual cross-sectional data collected during June 2015-May 2020 to estimate the annual percentage change (EAPC), overall and by selected characteristics, in reported partner PrEP use among PWH with HIV-discordant partners (N = 8707) and reported PrEP use among these partners (N = 15 844). RESULTS The proportion of PWH reporting PrEP use by one or more HIV-discordant sex partner rose 19.5% annually (11.3 to 24.4%). The prevalence rose from 6.0 to 17.4% (EAPC, 25.8%) among Black PWH, 10.1 to 26.0% (EAPC, 19.5%) among Hispanic/Latino PWH, and 20.8 to 34.6% (EAPC, 16.3%) among White PWH. Among MSM with HIV, the prevalence increased from 9.6 to 32.6% (EAPC, 28.2%) among Black MSM, 16.6 to 36.0% (EAPC, 15.6%) among Hispanic/Latino MSM, and 24.9 to 44.1% (EAPC, 17.9%) among White MSM. Among HIV-discordant sex partners, the proportion reported to be taking PrEP increased 21.1% annually (7.8 to 18.8%). Reported PrEP use rose from 4.9 to 14.2% (EAPC, 29.9%) among Black partners, 6.5 to 16.8% (EAPC, 20.3%) among Hispanic/Latino partners, and 12.7 to 26.1% (EAPC, 17.0%) among White partners. CONCLUSIONS One in five HIV-discordant sexual partners of PWH was reported to be taking PrEP. PrEP use rose among all examined populations, although the increases did not eliminate disparities in PrEP use.
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Affiliation(s)
- Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Rimmler S, Golin C, Coleman J, Welgus H, Shaughnessy S, Taraskiewicz L, Lightfoot AF, Randolph SD, Riggins L. Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities. HEALTH EDUCATION & BEHAVIOR 2022; 49:1022-1032. [PMID: 35856333 PMCID: PMC9574897 DOI: 10.1177/10901981221109138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND African American women are at a disproportionate HIV risk compared with other U.S. women. Studies show that complex structural and social determinants, rather than individual behaviors, place African American women at greater risk of HIV infection; however, little is known about women's views of what puts them at risk. AIMS This study sought to comprehend the perceptions of African American women living in low-income housing regarding the factors that influence both their personal sexual health behaviors and use of HIV prevention services. METHODS We conducted seven focus groups with 48 African American women from 10 public housing communities in a small city in the southeastern United States. We analyzed the focus group transcripts using thematic data analysis to identify salient themes and points of interest related to the study aim. RESULTS Women identified factors related to the health care system (trustworthiness of the health care system), the external environment (racism, classism, patriarchal structures, and violence/crime), as well as predisposing (health beliefs, stigma, and gender norms), enabling (agency to negotiate gendered power), and need (perceived HIV risk and perceptions of partner characteristics) features of individuals in the population. CONCLUSION African American women living in public housing are especially vulnerable to HIV infection due to intersectional discrimination based on racism, classism, gender power dynamics, and community conditions. Our findings confirm the need to develop HIV intervention programming addressing intersectional identities of those making up the communities they plan to address, and being informed by those living in the communities they plan to act on.
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Affiliation(s)
- Shelby Rimmler
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Carol Golin
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public
Health, Chapel Hill, NC, USA
| | - James Coleman
- North Carolina Institute of Medicine,
Chapel Hill, NC, USA
| | - Hayley Welgus
- Gender and Development Consultant,
Chiang Mai, Thailand
| | | | - Leah Taraskiewicz
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Linda Riggins
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
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13
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Luginaah NA, Konkor I, Lawson ES, Mkandawire P, Husbands W, Omorodion F, Etowa J, Antabe R, Wong J. Concurrent sexual partnerships and HIV testing among heterosexual Black men in Ontario, Canada: findings from the weSpeak study. ETHNICITY & HEALTH 2022; 27:1825-1840. [PMID: 34494926 DOI: 10.1080/13557858.2021.1976395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND African, Caribbean, and Black men constitute the second-highest category of males living with HIV in Ontario, which increased from 15.4% to 17% between 2011 and 2016. Previous studies have attributed this disproportionately higher rate to multiple concurrent sexual partnerships and low rates of HIV testing. Drawing on theoretical constructs of the health belief model (HBM), this study examined the relationship between multiple concurrent sexual partnerships and the uptake of HIV testing services among heterosexual Black men in Ontario. METHODS Using a cross-sectional sample data of 829 individuals from four cities in Ontario, we employed the multinomial logit analysis to examine the relationship between multiple sexual partnerships and the uptake of HIV testing services among heterosexual Black men. RESULTS The findings show that heterosexual Black men with multiple concurrent sexual partners were more than twice (RRR = 2.306, P < 0.01) as likely to test for HIV within the past 12 months when compared to those with one partner. Furthermore, being an immigrant, having good knowledge of HIV transmission, and earning lower annual income predicted higher odds of testing while sexual debut between the ages of 16 and 20 years, no visit to a healthcare provider in the past year and difficulty accessing healthcare significantly predicted lower likelihood of testing for HIV. CONCLUSIONS These findings align with the theoretical constructs of the health belief model but more importantly, they suggest heterosexual Black men with concurrent sexual partners may be aware of their HIV risk and are taking measures to know their serostatus. Hence, making HIV screening services accessible and at safer spaces could increase their use of HIV screening services.
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Affiliation(s)
| | - Irenius Konkor
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, Canada
| | - Erica S Lawson
- Department of Women's Studies, Western University, London, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Carleton University, Ottawa, Canada
| | | | - Francisca Omorodion
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Canada
| | | | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Ontario, Canada
| | - Josephine Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
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14
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Newmyer L, Evans M, Graif C. Socially Connected Neighborhoods and the Spread of Sexually Transmitted Infections. Demography 2022; 59:1299-1323. [PMID: 35838157 PMCID: PMC9707946 DOI: 10.1215/00703370-10054898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sexually transmitted infections (STIs) in the United States have been increasing at record levels and exhibit unequal spatial patterning across urban populations and neighborhoods. Research on the effects of residential and nearby neighborhoods on STI proliferation has largely ignored the role of socially connected contexts, even though neighborhoods are routinely linked by individuals' movements across space for work and other social activities. We showcase how commuting and public transit networks contribute to the social spillover of STIs in Chicago. Examining data on all employee-employer location links recorded yearly by the Census Bureau for more than a decade, we assess network spillover effects of local community STI rates on interconnected communities. Spatial and network autoregressive models show that exposure to STIs in geographically proximate and socially proximate communities contributes to increases in local STI levels, even net of socioeconomic and demographic factors and prior STIs. These findings suggest that geographically proximate and socially connected communities influence one another's infection rates through social spillover effects.
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Affiliation(s)
- Lauren Newmyer
- Department of Sociology and Criminology and the Population Research Institute, Pennsylvania State University, 701 Oswald Tower, University Park, PA 16802
| | - Megan Evans
- Department of Sociology and Criminology and the Population Research Institute, Pennsylvania State University, 701 Oswald Tower, University Park, PA 16802
| | - Corina Graif
- Department of Sociology and Criminology, Research Associate, Population Research Institute, Associate Editor, Journal of Quantitative Criminology, Pennsylvania State University, 816 Oswald Tower, University Park, PA 16802
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15
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Schrode K, Poareo E, Li M, Harawa NT. Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles. J Sex Med 2022; 19:603-612. [PMID: 35272947 PMCID: PMC8995363 DOI: 10.1016/j.jsxm.2022.02.005] [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: 07/19/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preliminary evidence indicates that acute and chronic psychological stress affect sexual arousal and satisfaction. African American women, in particular, are vulnerable to the impacts of gender- and race-related stress, given their socially constructed identities as African Americans and as women. AIM We examined associations between minority stress and sexual function using data from 248 African American women. METHODS Surveys were conducted with 248 African American women in South LA with male partners at risk for acquiring HIV. We analyzed self-reports on (i) stress indicators: chronic burden, perceived racism/sexism, and histories of trauma/sexual abuse; (ii) Female Sexual Function Index domains: desire, arousal, and satisfaction; and (iii) potential moderators: social support and spirituality. We used multiple regression, adjusting for potential confounding factors, to examine the relationships between stress indictors, potential moderators, and sexual function domains. OUTCOMES The outcomes were the female sexual function index domains of desire, arousal, and satisfaction. RESULTS This largely low-income sample experienced significant chronic and acute stressors, was highly spiritual and reported strong social support. Moderate-high chronic burden and increasing sexism scores were independently associated with decreased arousal (B = -0.38, 95%CI = -0.75, -0.02) and satisfaction (B = -0.03, 95%CI = -0.06, 0.00) scores, respectively. CLINICAL IMPLICATIONS Providers may want to explore chronic burden in patients who complain about low sexual arousal. Additionally, to develop effective HIV- and other STI-related interventions that impact behaviors that can confer sexual risk, prevention strategies are needed that either reduce contextual stressors or mitigate their impact. STRENGTHS Strengths of this research are that it focuses on sexual function among previously under-studied, low-income African American women and that it takes into account the unique set of stressors faced by these women. LIMITATIONS A limitation is that the sample size may have been too small to capture the effects of potential moderators. CONCLUSIONS Low-income African American women accumulate life stressors that may harm sexual function. Schrode K, Poareo E, Li M, et al. Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles. J Sex Med 2022;19:603-612.
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Affiliation(s)
- Katrina Schrode
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Eliza Poareo
- Conemaugh Memorial Medical Center Family Medicine Residency, Johnstown, PA, USA
| | - Michael Li
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nina T Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, 1100 Glendon Avenue, Suite 850, Los Angeles, Los Angeles, CA, USA.
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16
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Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma. AIDS Behav 2022; 26:90-99. [PMID: 34436713 PMCID: PMC8390058 DOI: 10.1007/s10461-021-03416-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
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Affiliation(s)
- Jo A Valentine
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA.
| | - Lyana F Delgado
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Matthew Hogben
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
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Ruiz-Robledillo N, Clement-Carbonell V, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Gabaldón-Bravo E. Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life. Psychol Res Behav Manag 2021; 14:2103-2114. [PMID: 34938135 PMCID: PMC8687686 DOI: 10.2147/prbm.s332494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.
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Affiliation(s)
- Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Eva Gabaldón-Bravo
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
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Bonacci RA, Smith DK, Ojikutu BO. Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S. Am J Prev Med 2021; 61:S60-S72. [PMID: 34686293 PMCID: PMC8668046 DOI: 10.1016/j.amepre.2021.05.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural- and policy-level options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.
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Affiliation(s)
- Robert A Bonacci
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Dawn K Smith
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bisola O Ojikutu
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Das S, Medina R, Nicolosi E, Agopian A, Kuo I, Opoku J, Allston A, Kharfen M. Ending the HIV epidemic using National HIV Behavioral Surveillance (NHBS): Recommendations based on DC model. PLoS One 2021; 16:e0253594. [PMID: 34292969 PMCID: PMC8297872 DOI: 10.1371/journal.pone.0253594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Social network strategies have been used by health departments to identify undiagnosed cases of HIV. Heterosexual cycle (HET4) of National HIV Behavioral Surveillance (NHBS) is a social network strategy implemented in jurisdictions. The main objectives of this research are to 1) evaluate the utility of the NHBS HET cycle data for network analysis; 2) to apply statistical analysis in support of previous HIV research, as well as to develop new research results focused on demographic variables and prevention/intervention with respect to heterosexual HIV risk; and 3) to employ NHBS data to inform policy with respect to the EHE plan. METHOD We used data from the 2016 NHBS HET4 (DC). A total of 747 surveys were collected. We used the free social-network analysis package, GEPHI, for all network visualization using adjacency matrix representation. We additionally conducted logistic regression analysis to examine the association of selected variables with HIV status in three models representing 1) demographic and economic effects, 2) behavioral effects, and 3) prevention-intervention effects. RESULTS The results showed 3% were tested positive. Seed 1 initiated the largest networks with 426 nodes (15 positives); seed 4 with 273 nodes (6 positives). Seed 3 had 35 nodes (2 positives). All 23 HIV diagnoses were recruited from 4 zip-codes across DC. The risk of testing positive was higher among people high-school dropouts (Relative Risk (RR) (25.645); 95 CI% 5.699, 115.987), unemployed ((4.267); 1.295, 14.064), returning citizens ((14.319); 4.593, 44.645). We also found in the final model higher association of pre-exposure prophylaxis (PrEP) awareness among those tested negative ((4.783); 1.042, 21.944) and HIV intervention in the past 12 months with those tested positive ((17.887); 2.350,136.135). CONCLUSION The network visualization was used to address the primary aim of the analysis-evaluate the success of the implementation of the NHBS as a social network strategy to find new diagnoses. NHBS remains one of the strongest behavioral supplements for DC's HIV planning activities. As part of the evaluation process our analysis helps to understand the impact of demographic, behavioral, and prevention efforts on peoples' HIV status. We strongly recommend other jurisdictions use network visualizations to evaluate the efficacy in reaching hidden populations.
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Affiliation(s)
- Suparna Das
- Strategic Information Division, HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), District of Columbia Department of Health, Government of the District of Columbia, Washington, DC, United States of America
| | - Richard Medina
- Department of Geography, University of Utah, Salt Lake City, Utah, United States of America
| | - Emily Nicolosi
- Department of Geography, University of Utah, Salt Lake City, Utah, United States of America
| | - Anya Agopian
- Milken Institute of Public Health, Department of Epidemiology, George Washington University, Washington, DC, United States of America
| | - Irene Kuo
- Milken Institute of Public Health, Department of Epidemiology, George Washington University, Washington, DC, United States of America
| | - Jenevieve Opoku
- Strategic Information Division, HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), District of Columbia Department of Health, Government of the District of Columbia, Washington, DC, United States of America
| | - Adam Allston
- Strategic Information Division, HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), District of Columbia Department of Health, Government of the District of Columbia, Washington, DC, United States of America
| | - Michael Kharfen
- Strategic Information Division, HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), District of Columbia Department of Health, Government of the District of Columbia, Washington, DC, United States of America
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LeMasters K, Oser C, Cowell M, Mollan K, Nowotny K, Brinkley-Rubinstein L. Longitudinal pre-exposure prophylaxis (PrEP) acceptability, initiation and adherence among criminal justice-involved adults in the USA: the Southern PrEP Cohort Study (SPECS) protocol. BMJ Open 2021; 11:e047340. [PMID: 34272219 PMCID: PMC8287623 DOI: 10.1136/bmjopen-2020-047340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION HIV prevalence among criminal justice (CJ)-involved adults is five times higher than the general population. Following incarceration, CJ-involved individuals experience multilevel barriers to HIV prevention. Pre-exposure prophylaxis (PrEP) is a widely available, daily medication efficacious in preventing HIV. Little is known about PrEP knowledge, acceptability, initiation and sustained use among CJ-involved persons or about how these outcomes vary by multilevel factors. The Southern Pre-Exposure Prophylaxis Study (SPECS) will investigate barriers and facilitators for PrEP initiation and sustained use among CJ-involved adults, building a foundation for PrEP interventions for this underserved population. METHODS AND ANALYSIS SPECS uses a mixed-methods sequential design, including a multisite, prospective cohort study in three southern states-North Carolina, Florida and Kentucky-and subsequent qualitative interviews. HIV-negative adults clinically indicated for PrEP with CJ-involvement in the past year (n=660; 220 per site)-will be recruited for four quantitative interviews separated by 6 months, with 18 months of follow-up. Interviews will measure CJ involvement, substance use, sexual behaviours, PrEP acceptability and use, healthcare access and utilisation, support systems and psychological and emotional well-being. We will estimate probabilities of PrEP acceptability and use in a CJ-involved population using descriptive and multivariable analyses. After the follow-up, a subsample that never initiated PrEP, initiated but did not sustain PrEP or sustained PrEP will be asked to participate in a qualitative interview to contextualise their experiences and decisions around PrEP. An inductive approach will guide qualitative analyses. ETHICS AND DISSEMINATION PrEP initiation and sustained use rates are unknown among CJ-involved adults. This research will identify individual, social and structural factors that predict PrEP initiation and use. Data generated from the study have the potential to guide research and the development and tailoring of PrEP interventions to CJ-involved populations and provide context to HIV-related outcomes for those with CJ experiences.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carrie Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Mariah Cowell
- School of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katie Mollan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kathryn Nowotny
- Department of Sociology, University of Miami, Miami, Florida, USA
| | - Lauren Brinkley-Rubinstein
- School of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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XIANG Y, FUJIMOTO K, LI F, WANG Q, DEL VECCHIO N, SCHNEIDER J, ZHI D, TAO C. Identifying influential neighbors in social networks and venue affiliations among young MSM: a data science approach to predict HIV infection. AIDS 2021; 35:S65-S73. [PMID: 33306549 PMCID: PMC8058230 DOI: 10.1097/qad.0000000000002784] [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: 02/04/2023]
Abstract
OBJECTIVE Young MSM (YMSM) bear a disproportionate burden of HIV infection in the United States and their risks of acquiring HIV may be shaped by complex multilayer social networks. These networks are formed through not only direct contact with social/sex partners but also indirect anonymous contacts encountered when attending social venues. We introduced a new application of a state-of-the-art graph-based deep learning method to predict HIV infection that can identify influential neighbors within these multiple network contexts. DESIGN AND METHODS We used empirical network data among YMSM aged 16-29 years old collected from Houston and Chicago in the United States between 2014 and 2016. A computational framework GAT-HIV (Graph Attention Networks for HIV) was proposed to predict HIV infections by identifying influential neighbors within social networks. These networks were formed by multiple relations constituted of social/sex partners and shared venue attendances, and using individual-level variables. Further, GAT-HIV was extended to combine multiple social networks using multigraph GAT methods. A visualization tool was also developed to highlight influential network members for each individual within the multiple social networks. RESULTS The multigraph GAT-HIV models obtained average AUC values of 0.776 and 0.824 for Chicago and Houston, respectively, performing better than empirical predictive models (e.g. AUCs of random forest: 0.758 and 0.798). GAT-HIV on single networks also delivered promising prediction performances. CONCLUSION The proposed methods provide a comprehensive and interpretable framework for graph-based modeling that may inform effective HIV prevention intervention strategies among populations most vulnerable to HIV.
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Affiliation(s)
- Yang XIANG
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kayo FUJIMOTO
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fang LI
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Qing WANG
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Natascha DEL VECCHIO
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - John SCHNEIDER
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Degui ZHI
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cui TAO
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Craddock JB. Sexual Health Communication Among Young Black Women and Their Social Network Members. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2020; 11:569-589. [PMID: 36090844 PMCID: PMC9455578 DOI: 10.1086/711701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Young Black women (YBW) are at high risk of HIV infection. Although sexual health communication in social networks has been shown to help prevent HIV among high-risk populations, sexual health communication between YBW and their social network members (SNMs) has been insufficiently studied. METHOD Egocentric social-network-level and individual-level data were collected from 78 YBW ages 18-25 to examine their sexual health communication. Multilevel multivariable logistic regression models assessed the association among individual sexual risk behaviors, SNM characteristics, and sexual health communication. RESULTS Participants nominated an average of 14 SNMs (N = 1,068). Friends were most frequently nominated (55%). YBW communicated to 55% of their SNMs about sex, to 32% regarding condom use, and to 21% regarding HIV testing. If SNMs provided emotional support, YBW were 4 times more likely to talk with them about sex and HIV testing and 2 times more likely to talk about condom use. CONCLUSIONS These results indicate that before developing or adopting HIV interventions geared toward YBW, we need to assess how and with whom YBW are communicating about sexual health to better inform those interventions.
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Donenberg GR, Kendall AD, Emerson E, Fletcher FE, Bray BC, McCabe K. IMARA: A mother-daughter group randomized controlled trial to reduce sexually transmitted infections in Black/African-American adolescents. PLoS One 2020; 15:e0239650. [PMID: 33137103 PMCID: PMC7605636 DOI: 10.1371/journal.pone.0239650] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Black/African-American girls are infected with sexually transmitted infections (STIs) at higher rates than their White counterparts. This study tested the efficacy of IMARA, a mother-daughter psychosocial STI/HIV prevention program, on adolescent Black/African-American girls’ incident STIs at 12 months in a 2-arm group randomized controlled trial. Black/African-American girls 14–18 years old and their primary female caregiver were eligible for the study. Girls provided urine samples to test for N. gonorrhoeae, C. trachomatis, and T. vaginalis infection at baseline and 12-months. Mother-daughter dyads were randomly assigned to IMARA (n = 118) or a time-matched health promotion control program (n = 81). Retention at 12-months was 86% with no difference across arms. Both interventions were delivered over two consecutive Saturdays totaling 12 hours. Girls who received IMARA were 43% less likely to contract a new STI in the 12-month post-intervention period compared with those in the health promotion control program (p = .011). A secondary follow-up intent-to-treat analysis provided additional support for the protective effect of IMARA, albeit with a similar magnitude of 37% (p = .014). Findings provide early evidence for IMARA’s efficacy, such that IMARA protected against STIs at 12-months among adolescent Black/African-American girls. Future research should examine the mechanisms associated with reduced STIs.
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Affiliation(s)
- Geri R. Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Community Outreach Intervention Projects, School of Public Health, Chicago, Illinois, United States of America
- * E-mail:
| | - Ashley D. Kendall
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Erin Emerson
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Community Outreach Intervention Projects, School of Public Health, Chicago, Illinois, United States of America
| | - Faith E. Fletcher
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Bethany C. Bray
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Kelly McCabe
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Banks DE, Hensel DJ, Zapolski TCB. Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1939-1964. [PMID: 32157486 PMCID: PMC7321914 DOI: 10.1007/s10508-019-01609-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 05/21/2023]
Abstract
Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.
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Affiliation(s)
- Devin E Banks
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA
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25
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Chang MH, Beckles GL, Moonesinghe R, Truman BI. County-Level Socioeconomic Disparities in Use of Medical Services for Management of Infections by Medicare Beneficiaries With Diabetes-United States, 2012. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E44-E54. [PMID: 31136524 DOI: 10.1097/phh.0000000000000800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess county-level socioeconomic disparities in medical service usage for infections among Medicare beneficiaries with diabetes (MBWDs) who had fee-for-service health insurance claims during 2012. DESIGN We used Medicare claims data to calculate percentage of MBWDs with infections. SETTING Medicare beneficiaries. PARTICIPANTS We estimated the percentage of MBWDs who used medical services for each of 3 groups of infections by sex and quintiles of the prevalence of social factors in the person's county of residence: anatomic site-specific infections; pathogen-specific infections; and HHST infections (human immunodeficiency virus/acquired immunodeficiency syndrome, viral hepatitis, sexually transmitted diseases, and tuberculosis). MAIN OUTCOME MEASURES Using quintiles of county-specific socioeconomic determinants, we calculated absolute and relative disparities in each group of infections for male and female MBWDs. We also used regression-based summary measures to estimate the overall average absolute and relative disparities for each infection group. RESULTS Of the 4.5 million male MBWDs, 15.8%, 25.3%, and 2.7% had 1 or more site-specific, pathogen-specific, and HHST infections, respectively. Results were similar for females (n = 5.2 million). The percentage of MBWDs with 1 or more infections in each group increased as social disadvantage in the MBWDs' county of residence increased. Absolute and relative county-level socioeconomic disparities in receipt of medical services for 1 or more infections (site- or pathogen-specific) were 12.9 or less percentage points and 65.5% or less, respectively. For HHST infections, percentage of MBWDs having 1 or more HHST infections for persons residing in the highest quintile (Q5) was 3- to 4-fold higher (P < .001) than persons residing in the lowest quintile (Q1). CONCLUSIONS Infection burden among MBWDs is generally associated with county-level contextual socioeconomic disadvantage, and the extent of health disparities varies by infection category, socioeconomic factor, and quintiles of socioeconomic disadvantage. The findings imply ongoing need for efforts to identify effective interventions for reducing county-level social disparities in infections among patients with diabetes.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) (Ms Chang and Dr Truman), National Center for Chronic Disease Prevention and Health Promotion (Dr Beckles), and Office of Minority Health and Health Equity (Dr Moonesinghe), Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Hill LM, Lightfoot AF, Riggins L, Golin CE. Awareness of and attitudes toward pre-exposure prophylaxis among African American women living in low-income neighborhoods in a Southeastern city. AIDS Care 2020; 33:239-243. [PMID: 32449402 DOI: 10.1080/09540121.2020.1769834] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
African American women in the South are disproportionately affected by HIV but have often been ignored in HIV prevention efforts, including in the rollout of pre-exposure prophylaxis (PrEP). To inform strategies to promote PrEP awareness and access in this population, we conducted a venue-based community survey with 53 African American women living in low-income neighborhoods of a Southeastern city to understand women's knowledge of and attitudes toward PrEP. Awareness of PrEP was very low (37%) with only 16% being aware that PrEP is used for HIV prevention. The vast majority of women (85%) reported that they would use or would consider using PrEP, most frequently citing a general interest in HIV prevention or a lack of awareness of their partners' HIV status as motivations for their interest. Some women expressed concerns about side effects or low perceived HIV risk as disincentives for PrEP use. Information regarding side effects and HIV risk assessments will be needed to ensure the acceptable delivery of PrEP in this population.
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Affiliation(s)
- Lauren M Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Riggins
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carol E Golin
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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27
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Abstract
The aim of the present study is to use the syndemic framework to investigate the risk of contracting HIV in the US population. Cross-sectional analyses are from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, socio-demographic characteristics, alcohol use, drug use, depression, sexual behaviours and sexually transmitted diseases from cycle 2009-2010 to 2015-2016. We carried out weighted regression among young adults (20-39 years) and adults (40-59 years) separately. In total, 5230 men and 5794 women aged 20-59 years were included in the present analyses. In total, 0.8% men and 0.2% women were tested HIV-positive. Each increasing HIV risk behaviour was associated with elevated odds of being tested HIV-positive (1.15, 95% CI 1.15-1.15) among young adults and adults (1.61, 95% CI 1.61-1.61). Multi-faceted, community-based interventions are urgently required to reduce the incidence of HIV in the USA.
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28
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Burns PA, Williams MS, Mena LA, Bruce MA, Bender M, Burton ET, Beech BM. Leveraging Community Engagement: The Role of Community-Based Organizations in Reducing New HIV Infections Among Black Men Who Have Sex with Men. J Racial Ethn Health Disparities 2020; 7:193-201. [PMID: 31942692 DOI: 10.1007/s40615-019-00691-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/17/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022]
Abstract
There is growing recognition that a singular focus on biomedical treatments is insufficient to address the HIV prevention and health-care needs of Black men who have sex with men (Black MSM). Ending the HIV epidemic requires a multifactorial approach accounting for the social, cultural, economic, and environmental factors that drive transmission of HIV and other STDs. The two case studies presented were implemented by community-based organizations that have extensive experience with the target population and previous experience implementing HIV prevention-related programs and projects in the Jackson, Mississippi, metropolitan area. Culturally appropriate HIV prevention interventions that explicitly acknowledge the social determinants of health, particularly stigma and discrimination, both racial and sexual, are critical to reducing the number of new infections. These culturally appropriate and locally derived HIV prevention interventions provide a model for HIV health-care providers, public health officials, and community leaders to address the unique needs of Black MSM.
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Affiliation(s)
- Paul A Burns
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA.
| | - Michelle S Williams
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
| | - Leandro A Mena
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
| | - Marino A Bruce
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Melverta Bender
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
| | - E Thomaseo Burton
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bettina M Beech
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
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Health Care Access and Service Use Among Behavioral Risk Factor Surveillance System Respondents Engaging in High-Risk Sexual Behaviors, 2016. Sex Transm Dis 2019; 47:62-66. [PMID: 31688727 DOI: 10.1097/olq.0000000000001091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Access to health care services such as screening, testing, and treatment of sexually transmitted diseases is vital for those who engage in high-risk behaviors. Studies examining the relationship between high-risk behaviors and health care access and utilization are crucial for determining whether persons at risk are receiving appropriate health services. METHODS We examined 2016 data from the Behavioral Risk Factor Surveillance System. Our study population included persons aged 18 to 65 years. χ and logistic regression analyses were used to examine relationships between high-risk behaviors including drug use and high-risk sexual behaviors, and access to and utilization of health care services. RESULTS Among our study population, 6.2% engaged in a high-risk behavior in the past year. Those engaging in high-risk behaviors were more likely to have no health insurance coverage (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.34), have no personal health care provider (OR, 1.14; 95% CI, 1.06-1.21), have foregone care because of cost (OR 1.54; 95% CI, 1.42-1.65), or have had no routine check-up in the past 2 years (OR 1.16; 95% CI, 1.09-1.25). CONCLUSIONS Those who engaged in high-risk behaviors had poorer health care access and utilization outcomes. Future studies should incorporate the relationships between changes in behaviors, health care access and utilization, and resulting sexually transmitted disease morbidity.
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30
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Abstract
HIV-related stigma is prevalent in the US Deep South; however, information regarding the types of stigma and their effects on HIV-related outcomes is limited. This study examined the prevalence of different forms of stigma and the association of stigma with medication and medical visit adherence in the Deep South. Survey participants included 201 individuals living with HIV recruited from Infectious Diseases Clinics (ID) and AIDS Service Organizations (ASOs) in four Deep South states. Study participants reported high levels of experienced, perceived, and internalized stigma. Multivariable analysis revealed that internalized stigma and recent stigmatizing experiences were significantly associated with poorer HIV medication adherence. Internalized stigma was also associated with having missed an HIV medical care visit in the last 6 months. These findings suggest the need to identify and develop effective interventions to address internalized HIV-related stigma and to address community HIV stigma to improve outcomes for individuals living with HIV.
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Nunn A, Jeffries WL, Foster P, McCoy K, Sutten-Coats C, Willie TC, Ransome Y, Lanzi RG, Jackson E, Berkley-Patton J, Keefer M, Coleman JD. Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality. AIDS Behav 2019; 23:319-330. [PMID: 31444712 DOI: 10.1007/s10461-019-02631-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.
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Affiliation(s)
- Amy Nunn
- Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA.
- Rhode Island Public Health Institute, Providence, USA.
| | - William L Jeffries
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Antlanta, USA
| | - Pamela Foster
- Department of Community Medicine/Population Health, University of Alabama School of Medicine, Tuscaloosa Regional Campus, Tuscaloosa, USA
| | - Katryna McCoy
- School of Nursing & Health Studies, University of Washington - Bothell, Bothell, USA
| | - Cassandra Sutten-Coats
- Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA
- Rhode Island Public Health Institute, Providence, USA
| | - Tiara C Willie
- Rhode Island Public Health Institute, Providence, USA
- Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Robin Gaines Lanzi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | - Edward Jackson
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | | | - Michael Keefer
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA
| | - Jason D Coleman
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, USA
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32
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Young LE, Fujimoto K, Alon L, Zhang L, Schneider JA. The multiplex social environments of young Black men who have sex with men: How online and offline social structures impact HIV prevention and sex behavior engagement. JOURNAL OF SOCIAL STRUCTURE : JOSS 2019; 20:70-95. [PMID: 32855626 PMCID: PMC7449318 DOI: 10.21307/joss-2019-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
In the United States, young Black men who have sex with men (YBMSM) remain disproportionately affected by HIV. The social networks in which YBMSM are embedded are generally understood to be critical factors in understanding their vulnerability. In this study, we acknowledge the relational richness of YBMSMs' social environments (what we define as multiplexity) and their increasing prioritization of online social networking sites (SNS). Specifically, we investigate whether protective and/or risky features of YBMSMs' Facebook friendships and group affiliations are related to their HIV prevention and sex behavior engagement, while also accounting for features of their offline confidant (or support) and sex networks. Using data from a population-based cohort study of YBMSM living in Chicago (N=268), we perform a series of multiple logistic regression analyses to examine associations between features of YBMSMs' Facebook, confidant, and sexual networks with three prevention outcomes and three sex behavior outcomes, while also controlling for factors at the individual and structural levels. Results show that network features play a more significant role in predicting engagement in sex behaviors than prevention behaviors. Specifically, having more confidants, having confidants who are family members, meeting sex partners online, having more YBMSM Facebook friends, belonging to Facebook groups with an LGBTQ focus, and having greater subject diversity in one's Facebook group affiliations were significantly associated with one or more sex behavior outcomes. We conclude with a discussion of the implications of our findings for HIV prevention intervention efforts.
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Affiliation(s)
- Lindsay E Young
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Leigh Alon
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liang Zhang
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Hieftje K, Duncan L, Florsheim O, Sawyer B, Fiellin LE. One Night Stan: Feasibility Study of an HIV Prevention and Sexual Risk Reduction Social Card Game for Young Black Women. Games Health J 2019; 8:112-120. [PMID: 30964717 DOI: 10.1089/g4h.2017.0106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To develop and test the feasibility and preliminary impact of the social card game prototype, One Night Stan, a theory-driven and evidence-based human immunodeficiency virus (HIV) prevention intervention for young black women. MATERIALS AND METHODS The study included the enrollment of 21 young, heterosexual black women (mean age 19) to test the feasibility and preliminary impact of the card game, using a pre/postdesign. Participant satisfaction and gameplay experience were assessed using quantitative and qualitative measures. Knowledge, self-efficacy, and intentions regarding condom use and HIV/sexually transmitted infection partner testing were assessed using standardized assessments. Effect sizes for the change in these outcome variables were calculated to determine the preliminary efficacy of the game. RESULTS One hundred percent of participants reported that that they would play the game again, 95% liked the way the game looked, 100% enjoyed playing the game, and 100% reported that they would tell their friends to play. Effect sizes were large (ranged from 0.21 to 0.51) for all variables except perceived susceptibility (0.07) and suggest that playing the game can lead to increased self-efficacy and intentions to use condoms and insist that their partners get tested for HIV across time. CONCLUSIONS One Night Stan is a feasible intervention approach and may be efficacious in helping players develop a pattern of cognitions and motivation that can protect them against the risk of HIV.
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Affiliation(s)
- Kimberly Hieftje
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut
| | - Lindsay Duncan
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut.,3 McGill University, Montreal, Quebec
| | - Orli Florsheim
- 4 Department of Kinesiology and Physical Education, Irvine School of Medicine, University of California, Irvine, California
| | - Ben Sawyer
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut.,5 Digitalmill, Inc., Freeport, Maine
| | - Lynn E Fiellin
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut.,6 Yale Child Study Center, New Haven, Connecticut
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34
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Sheehan DM, Miller RP, Trepka MJ, Smith LR, Latkin C. Role of Social Network Sexual Norms and Behaviors on the HIV Sexual Risk Behaviors of People Who Inject Drugs in HPTN 037. AIDS Behav 2019; 23:1604-1611. [PMID: 30826975 DOI: 10.1007/s10461-019-02409-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the effect of social network descriptive sexual norms and behaviors on the sexual behaviors of people who inject drugs (PWID). Data from HPTN037 of 232 PWID (egos) and 464 network members (alters) were used in multilevel multivariate logistic regression models. Egos whose alters reported multiple sex partners had greater odds of multiple sex partners (aOR 2.20, 1.13-4.29). Egos' norms of condomless sex with primary (aOR 2.67, 1.15-6.17) and casual (aOR 2.38, 1.01-5.59) partners and egos' norms of giving (aOR 5.52, 1.87-16.25) and receiving (aOR 7.38, 1.34-40.66) money/drugs for sex were associated with the egos' respective behaviors. History of sex between an ego and alter was not associated with increased influence of alters' norms and behaviors on egos' sexual behavior. Findings provide support for developing interventions that target descriptive norms and selective network behavioral characteristics to decrease sexual HIV risk behavior among PWID.
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Racial Residential Segregation and STI Diagnosis Among Non-Hispanic Blacks, 2006-2010. J Immigr Minor Health 2019; 20:577-583. [PMID: 29098498 DOI: 10.1007/s10903-017-0668-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexually transmitted infections (STI) disproportionately impact non-Hispanic blacks. Racial residential segregation has been associated with negative socioeconomic outcomes. We sought to examine the association between segregation and STI diagnosis among blacks. The National Survey of Family Growth and US Census served as data sources. Five distinct dimensions represent segregation. The association between STI diagnosis and each segregation dimension was assessed with multilevel logistic regression modeling. 305 (7.4%) blacks reported STI diagnosis during the past 12 months. Depending on the dimension, segregation was a risk factor [dissimilarity aOR 2.41 (95% CI 2.38-2.43)] and a protective factor [isolation aOR 0.90 (95% CI 0.89-0.91)] for STI diagnosis. Findings suggest that STI diagnosis among blacks is associated with segregation. Additional research is needed to identify mechanisms for how segregation affects STI diagnosis and to aid in the development of interventions to decrease STIs.
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Cloud DH, Beane S, Adimora A, Friedman SR, Jefferson K, Hall HI, Hatzenbuehler M, Johnson AS, Stall R, Tempalski B, Wingood GM, Wise A, Komro K, Cooper HL. State minimum wage laws and newly diagnosed cases of HIV among heterosexual black residents of US metropolitan areas. SSM Popul Health 2019; 7:100327. [PMID: 30581963 PMCID: PMC6287056 DOI: 10.1016/j.ssmph.2018.100327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/08/2018] [Accepted: 11/18/2018] [Indexed: 02/07/2023] Open
Abstract
This ecologic cohort study explores the relationship between state minimum wage laws and rates of HIV diagnoses among heterosexual black residents of U.S metropolitan areas over an 8-year span. Specifically, we applied hierarchical linear modeling to investigate whether state-level variations in minimum wage laws, adjusted for cost-of-living and inflation, were associated with rates of new HIV diagnoses among heterosexual black residents of metropolitan statistical areas (MSAs; n=73), between 2008 and 2015. Findings suggest that an inverse relationship exists between baseline state minimum wages and initial rates of newly diagnosed HIV cases among heterosexual black individuals, after adjusting for potential confounders. MSAs with a minimum wage that was $1 higher at baseline had a 27.12% lower rate of newly diagnosed HIV cases. Exploratory analyses suggest that income inequality may mediate this relationship. If subsequent research establishes a causal relationship between minimum wage and this outcome, efforts to increase minimum wages should be incorporated into HIV prevention strategies for this vulnerable population.
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Affiliation(s)
- David H. Cloud
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephanie Beane
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adaora Adimora
- Department of Medicine, University of North Carolina School of Medicine, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | | | - Kevin Jefferson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - H. Irene Hall
- HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Hatzenbuehler
- Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Anna Satcher Johnson
- HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ron Stall
- Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Gina M. Wingood
- Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Akilah Wise
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kelli Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah L.F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Donenberg G, Emerson E, Mackesy-Amiti ME, Fletcher F. Sexual risk among African American girls seeking psychiatric care: A social-personal framework. J Consult Clin Psychol 2019; 86:24-38. [PMID: 29300099 DOI: 10.1037/ccp0000270] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined individual and social factors associated with sexual risk behavior among African American girls seeking outpatient mental health services across 2 years and key developmental transitions. METHOD African American females 12-16 years old (M = 14.5; SD = 1.15; n = 266) were recruited from eight outpatient mental health clinics and completed interviewer-administered and computer-assisted measures at baseline, 12, and 24 months. Analyses tested individual attributes (externalizing and internalizing problems) and family context (maternal acceptance-rejection, mother-daughter communication about sex) at baseline, peer influences (peer support of substance use, girlfriend dating behavior) and partner relationship characteristics (rejection sensitivity, partner risk communication frequency and openness) at 12 months, and girls' sexual behavior at 24 months. RESULTS At baseline, 32% of girls reported having had vaginal/anal sex compared with 60% at 24 months. Data analyses revealed robust associations between externalizing problems and maternal acceptance-rejection and mother-daughter risk communication during early adolescence, peer support of substance use and girlfriend dating behavior 1 year later, and girls' sexual risk taking 2 years later. CONCLUSION Findings support a social-personal framework (SPF) of sexual risk for African American girls seeking mental health care, underscoring the potential benefits of early intervention to reduce externalizing problems while strengthening mother-daughter communication and relationships to prevent subsequent sexual risk and associated negative outcomes. (PsycINFO Database Record
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Affiliation(s)
- Geri Donenberg
- Center for Dissemination and Implementation Science, Healthy Youths Program, University of Illinois at Chicago
| | - Erin Emerson
- Center for Dissemination and Implementation Science, Healthy Youths Program, University of Illinois at Chicago
| | - Mary Ellen Mackesy-Amiti
- Community Outreach Intervention Projects, School of Public Health, University of Illinois at Chicago
| | - Faith Fletcher
- Department of Community Health Sciences, School of Public Health, University of Illinois at Chicago
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Gause NK, Brown JL, DiClemente RJ. Mental Representation of Self in Relationships Indirectly Affects Young Black Women's Engagement in Risky Sexual Behaviors Through Psychosocial HIV/STI Risk Factors. VULNERABLE CHILDREN AND YOUTH STUDIES 2019; 14:1-16. [PMID: 32952593 PMCID: PMC7500728 DOI: 10.1080/17450128.2019.1574366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 01/22/2019] [Indexed: 06/11/2023]
Abstract
Black females are disproportionately affected by HIV/STIs, though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age= 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factor: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust, and (e) sex-related alcohol expectancies. Results indicated indirect effects of working model of self on: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08 ,95% CI [.02, .17]); any alcohol use prior to sex through peer norms for risky sex (ab = -.06, 95% CI [-.12, -.02]); and alcohol use prior to sex through sex-related alcohol expectancies (ab = -.13, 95% CI [-.21, -.05]). Findings indicated direct associations between working model of self and all the psychosocial HIV/STI risk factors included in the mediation models. Working model of self may help identify Black females elevated risk for HIV/STI through these psychosocial risk factors.
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Affiliation(s)
- Nicole K Gause
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ralph J DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Centers for AIDS Research, Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
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Adams JW, Lurie MN, King MRF, Brady KA, Galea S, Friedman SR, Khan MR, Marshall BDL. Potential drivers of HIV acquisition in African-American women related to mass incarceration: an agent-based modelling study. BMC Public Health 2018; 18:1387. [PMID: 30563496 PMCID: PMC6299641 DOI: 10.1186/s12889-018-6304-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background The United States has the highest incarceration rate in the world. Incarceration can increase HIV risk behaviors for individuals involved with the criminal justice system and may be a driver of HIV acquisition within the community. Methods We used an agent-based model to simulate HIV transmission in a sexual-contact network representing heterosexual African American men and women in Philadelphia to identify factors influencing the impact of male mass incarceration on HIV acquisition in women. The model was calibrated using surveillance data and assumed incarceration increased the number of sexual contacts and decreased HIV care engagement for men post-release. Incarceration of a partner increased the number of sexual contacts for women. We compared a counterfactual scenario with no incarceration to scenarios varying key parameters to determine what factors drove HIV acquisition in women. Results Setting the duration of male high-risk sexual behavior to two years post-release increased the number of HIV transmissions to women by more than 20%. Decreasing post-release HIV care engagement and increasing HIV acquisition risk attributable to sexually transmitted infections (STIs) also increased the number of HIV transmissions to women. Changing the duration of risk behavior for women, the proportion of women engaging in higher risk behavior, and the relative risk of incarceration for HIV-infected men had minimal impact. Conclusion The mass incarceration of African American men can increase HIV acquisition in African American women on a population-level through factors including post-release high-risk behaviors, disruption of HIV care engagement among formerly incarcerated men, and increased STI prevalence. These findings suggest that the most influential points of intervention may be programs seeking to reduce male risk behaviors and promote HIV care engagement post-release, as well as STI testing and treatment programs for recently incarcerated men, as well as women with incarcerated partners. Electronic supplementary material The online version of this article (10.1186/s12889-018-6304-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joëlla W Adams
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Mark N Lurie
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Maximilian R F King
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Kathleen A Brady
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | - Samuel R Friedman
- National Development and Research Institutes, New York City, NY, USA
| | - Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University, New York City, NY, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
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Elmore K, Bradley ELP, Lima AC, Khalil GM, Obi-Tabot E, Gant Z, Dean HD, McCree DH. Trends in Geographic Rates of HIV Diagnoses Among Black Females in the United States, 2010-2015. J Womens Health (Larchmt) 2018; 28:410-417. [PMID: 30526269 DOI: 10.1089/jwh.2017.6868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV diagnoses among females in the United States declined 22% from 2010 to 2015, including a 27% decline in diagnoses among black females. Despite this progress, disparities persist. Black females accounted for 60% of new HIV diagnoses among females in 2015. Geographic disparities also exist. This article describes geographic differences in HIV diagnoses among black females in the United States, from 2010 to 2015. MATERIALS AND METHODS We examined HIV surveillance data from 2010 to 2015 to determine in which geographic areas decreases or increases in HIV diagnoses occurred. We used data from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's (NCHHSTP) AtlasPlus to calculate percent changes in HIV diagnosis rates by geographic region for black females ≥13 years of age. RESULTS The number of new HIV diagnoses declined 27% among black females from 2010 to 2015. The highest rates of HIV diagnosis per 100,000 population of black females, from 2010 to 2015, were in the Northeast and the South. In 2015, five of the eight states reporting the highest rates of HIV diagnosis (i.e., the highest quartile) were in the South. CONCLUSIONS HIV diagnosis rates decreased nationally among black females, but the decreases were not uniform within regions or across the United States. Some states experienced increases, and black females in the South and Northeast remain disproportionately affected. Additional research is needed to ascertain factors associated with the increases to continue progress toward reducing HIV-related disparities among females in the United States.
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Affiliation(s)
- Kim Elmore
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Erin L P Bradley
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Ashley C Lima
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - George M Khalil
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Estella Obi-Tabot
- 2 Division of Disease Prevention , Virginia Department of Health, Richmond, Virginia
| | - Zanetta Gant
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Hazel D Dean
- 3 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Donna Hubbard McCree
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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Mercer CH, Jones KG, Geary RS, Field N, Tanton C, Burkill S, Clifton S, Sonnenberg P, Mitchell KR, Gravningen K, Johnson AM. Association of Timing of Sexual Partnerships and Perceptions of Partners' Concurrency With Reporting of Sexually Transmitted Infection Diagnosis. JAMA Netw Open 2018; 1:e185957. [PMID: 30646299 PMCID: PMC6324336 DOI: 10.1001/jamanetworkopen.2018.5957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The timing of sexual partnerships is important for sexually transmitted infection (STI) transmission potential. Studies often measure timing as whether partnerships overlap in time (concurrency), but this measure does not account for how STI risk from previous partners can be carried forward into future partnerships even when there is a time gap between them (serial monogamy) if the infectious period is greater than this time gap. OBJECTIVE To examine the association of the timing of partnerships, measured as the time gap or time overlap between partners, and perceptions of partners' concurrency with STI transmission. DESIGN, SETTING, AND PARTICIPANTS This survey study that was conducted in 2017 included 8867 participants in Britain aged 16 to 44 years who reported 1 or more sexual partners in the 5 years before the interview. Data were collected from 2010 to 2012 from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a large probability survey (response rate, 57.7%) designed to be broadly representative of the general population. EXPOSURES Gaps between participants' 3 or fewer most recent partners in the past 5 years were calculated from dates of the last sexual encounter with former partners and the first sexual encounter with subsequent partners. Negative gaps denote overlapping partnerships (concurrency); positive gaps denote serial monogamy. Participant perception of most recent partner concurrency was proxied by asking participants whether they knew or thought that their partners had had sex with other partners since their first sexual encounter together. MAIN OUTCOMES AND MEASURES Reported STI diagnosis in the past 5 years. RESULTS Of 8867 participants eligible for this analysis, 3509 (39.6%) were male and 5158 (58.2%) were female, with a mean age of 28 years. Overall, 48.1% of males and 39.5% of females reported 2 or more partners and 1 or more time gaps. The median time gap was 2 months (interquartile range, -3 months to 8 months). Although 67.0% of the time gaps were 1 month or more, many were sufficiently short time gaps for STI transmission. The time gap was independently associated with STI diagnosis, without a significant decrease in likelihood until the time gap was 4 months or more for females (adjusted odds ratio [OR]: 0.39, 95% CI, 0.19-0.81) and 6 months or more for males (adjusted OR: 0.42, 95% CI, 0.20-0.85) compared with time overlaps of 2 years or more. Participant perception of partners' concurrency (reported by half of the participants) was independently associated with STI diagnosis among females (reporting no partner concurrency vs reporting partner concurrency: adjusted OR, 0.32; 95% CI, 0.22-0.49). CONCLUSIONS AND RELEVANCE The findings suggest that the gap between partners is often sufficiently small to permit STI transmission and that many people, although themselves monogamous, have partners who are not, which itself is associated with an increase in the risk of STI acquisition. Public health practitioners should communicate these epidemiological facts, and researchers should develop measures that better capture the risk of STI transmission from partners.
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Affiliation(s)
- Catherine H. Mercer
- Institute for Global Health, University College London, London, United Kingdom
| | - Kyle G. Jones
- Institute for Global Health, University College London, London, United Kingdom
| | - Rebecca S. Geary
- Institute for Global Health, University College London, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nigel Field
- Institute for Global Health, University College London, London, United Kingdom
| | - Clare Tanton
- Institute for Global Health, University College London, London, United Kingdom
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Burkill
- Institute for Global Health, University College London, London, United Kingdom
| | - Soazig Clifton
- Institute for Global Health, University College London, London, United Kingdom
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, United Kingdom
| | - Kirstin R. Mitchell
- Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Kirsten Gravningen
- Institute for Global Health, University College London, London, United Kingdom
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, United Kingdom
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Brinkley-Rubinstein L, Peterson M, Arnold T, Nunn AS, Beckwith CG, Castonguay B, Junious E, Lewis C, Chan PA. Knowledge, interest, and anticipated barriers of pre-exposure prophylaxis uptake and adherence among gay, bisexual, and men who have sex with men who are incarcerated. PLoS One 2018; 13:e0205593. [PMID: 30532275 PMCID: PMC6286000 DOI: 10.1371/journal.pone.0205593] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022] Open
Abstract
Criminal justice (CJ) settings disproportionately include populations at high risk for acquiring HIV, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. However, few studies have examined attitudes about pre-exposure prophylaxis (PrEP) among incarcerated men who have sex with men (MSM). This study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men at the Rhode Island Department of Corrections. Using semi-structured interviews, 26 MSM were interviewed about PrEP knowledge, interest, timing preferences for provision (e.g. before or after release), and barriers to uptake and adherence during community re-entry. Interviews were coded and analyzed using a general inductive approach. Participants demonstrated low initial knowledge of PrEP but high interest after being told more about it. Participants self-identified risk factors for HIV acquisition, including condomless sex and substance use. In addition, participants preferred provision of PrEP prior to release. Post-release barriers to PrEP uptake and adherence included 1) concerns about costs of PrEP medications; 2) anticipated partner or family disapproval; 3) lack of access to transportation; 4) unstable housing; 5) compounding impacts of multiple hardships leading to a de-prioritization of PrEP and 6) fears of future re-incarceration. These results point to the need for future PrEP interventions among incarcerated populations that address incarceration and PrEP related barriers during community re-entry via wraparound services that address PrEP and incarceration-related barriers.
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Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Meghan Peterson
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Trisha Arnold
- Department of Psychology, Jackson State University, Jackson, Missouri, United States of America
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Curt G. Beckwith
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Breana Castonguay
- Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Eric Junious
- College of Health and Human Services, University of North Carolina, Charlotte, North Carolina, United States of America
| | - Chantal Lewis
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Philip A. Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
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Bradley ELP, Geter A, Lima AC, Sutton MY, Hubbard McCree D. Effectively Addressing Human Immunodeficiency Virus Disparities Affecting US Black Women. Health Equity 2018; 2:329-333. [PMID: 30460333 PMCID: PMC6243214 DOI: 10.1089/heq.2018.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Black women have disproportionately higher rates of human immunodeficiency virus (HIV) infection, and low percentages being linked to care and becoming virally suppressed, compared with women of other races/ethnicities. To date, few evidence-based HIV prevention and care interventions tailored for black women exist. We highlight three essential factors to consider in designing culturally and gender-appropriate studies to address HIV-related disparities affecting black women: (1) social determinants of HIV risk, (2) determinants of equity, and (3) perceptions of black women's sexuality. Synergy between a strong evidence base and developing strong partnerships could accelerate progress toward HIV-related health equity for black women.
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Affiliation(s)
- Erin L P Bradley
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angelica Geter
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley C Lima
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donna Hubbard McCree
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
The Southern United States has been disproportionately affected by HIV diagnoses and mortality. To inform efforts to effectively address HIV in the South, this manuscript synthesizes recent data on HIV epidemiology, care financing, and current research literature on factors that predispose this region to experience a greater impact of HIV. The manuscript focuses on a specific Southern region, the Deep South, which has been particularly affected by HIV. Epidemiologic data from the Centers from Disease Control and Prevention indicate that the Deep South had the highest HIV diagnosis rate and the highest number of individuals diagnosed with HIV (18,087) in 2014. The percentage of new HIV diagnoses that were female has decreased over time (2008-2014) while increasing among minority MSM. The Deep South also had the highest death rates with HIV as an underlying cause of any US region in 2014. Despite higher diagnosis and death rates, the Deep South received less federal government and private foundation funding per person living with HIV than the US overall. Factors that have been identified as contributors to the disproportionate effects of HIV in the Deep South include pervasive HIV-related stigma, poverty, higher levels of sexually transmitted infections, racial inequality and bias, and laws that further HIV-related stigma and fear. Interventions that address and abate the contributors to the spread of HIV disease and the poorer HIV-related outcomes in the Deep South are warranted. Funding inequalities by region must also be examined and addressed to reduce the regional disparities in HIV incidence and mortality.
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Affiliation(s)
- Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA. .,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Donna Safley
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | | | - Elena Wilson
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA.,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
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Bradley ELP, Hoover KW. Improving HIV Preexposure Prophylaxis Implementation for Women: Summary of Key Findings From a Discussion Series with Women's HIV Prevention Experts. Womens Health Issues 2018; 29:3-7. [PMID: 30292440 DOI: 10.1016/j.whi.2018.08.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Erin L P Bradley
- Division of HIV/AIDS Prevention, National Centers for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, National Centers for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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- Division of HIV/AIDS Prevention, National Centers for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Spears EC, Foster MJ, Bonner TJ. Diabetes Prevention for African-Americans: a Scoping Review. J Racial Ethn Health Disparities 2018; 5:947-965. [PMID: 29218497 DOI: 10.1007/s40615-017-0443-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is preventable in many instances. African-Americans are disproportionately represented in T2DM statistics. The strategies in place to prevent disease development in this population warrant critical examination. METHODS A scoping review of literature was conducted to provide an overview of the largely inconsistent approach to African-American T2DM prevention research. Specific research questions included: (1) How are African-Americans treated in the existing T2DM literature? (1a) Are African-Americans primarily treated as a homogenous group in the literature? (1b) Has the literature addressed middle-class African-Americans? (2) Is the T2DM prevention literature focused on primary or secondary prevention? The review included articles published from 1985 to 2016, examining the methodology and approach toward African-Americans in each article. RESULTS The review yielded 653 unduplicated articles. Through title, abstract, and full-text screenings, 381 articles were excluded. Of the remaining articles only 37% were focused on the prevention of T2DM development, and only 22.7% described a participant education component. The majority of the studies were observational (n = 19). Only 53.5% included majority African-American participants. Samples ranged from 2 to 27,899 individuals, which were often treated as homogeneous groups in terms of income and/or education (62.3%). CONCLUSION The approach to T2DM prevention in African-Americans is largely inconsistent, which may be contributing to stagnation in this area of research.
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Affiliation(s)
- Erica C Spears
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
| | - Margaret J Foster
- Health Sciences Center, Texas A&M University, College Station, TX, USA
| | - Timethia J Bonner
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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Prather C, Fuller TR, Jeffries WL, Marshall KJ, Howell AV, Belyue-Umole A, King W. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity 2018; 2:249-259. [PMID: 30283874 PMCID: PMC6167003 DOI: 10.1089/heq.2017.0045] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The sexual and reproductive health of African American women has been compromised due to multiple experiences of racism, including discriminatory healthcare practices from slavery through the post-Civil Rights era. However, studies rarely consider how the historical underpinnings of racism negatively influence the present-day health outcomes of African American women. Although some improvements to ensure equitable healthcare have been made, these historical influences provide an unexplored context for illuminating present-day epidemiology of sexual and reproductive health disparities among African American women. Methods: To account for the unique healthcare experiences influenced by racism, including healthcare provision, we searched online databases for peer-reviewed sources and books published in English only. We explored the link between historical and current experiences of racism and sexual and reproductive health outcomes. Results: The legacy of medical experimentation and inadequate healthcare coupled with social determinants has exacerbated African American women's complex relationship with healthcare systems. The social determinants of health associated with institutionalized and interpersonal racism, including poverty, unemployment, and residential segregation, may make African American women more vulnerable to disparate sexual and reproductive health outcomes. Conclusions: The development of innovative models and strategies to improve the health of African American women may be informed by an understanding of the historical and enduring legacy of racism in the United States. Addressing sexual and reproductive health through a historical lens and ensuring the implementation of culturally appropriate programs, research, and treatment efforts will likely move public health toward achieving health equity. Furthermore, it is necessary to develop interventions that address the intersection of the social determinants of health that contribute to sexual and reproductive health inequities.
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Affiliation(s)
- Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taleria R. Fuller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William L. Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Khiya J. Marshall
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A. Vyann Howell
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Belyue-Umole
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Winifred King
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Peterson M, Nowotny K, Dauria E, Arnold T, Brinkley-Rubinstein L. Institutional distrust among gay, bisexual, and other men who have sex with men as a barrier to accessing pre-exposure prophylaxis (PrEP). AIDS Care 2018; 31:364-369. [PMID: 30227719 DOI: 10.1080/09540121.2018.1524114] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Populations at highest risk for acquiring HIV are more likely to pass through criminal justice (CJ) settings, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. The present study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men involved in the criminal justice system. Using semi-structured interviews, 26 participants who identified as MSM were asked about PrEP knowledge and interest, HIV risk, and incarceration experience. One theme that emerged across interviews was how institutional distrust in CJ settings may instill lack of trust in medical care after perceived mistreatment. Participants explained how lack of privacy fostered feelings that medical care was not confidential, care received was tied to status as an incarcerated person, and feelings of dehumanization led to distrust. Findings explore how distrust may hinder PrEP uptake and other HIV prevention efforts in CJ settings as well as after release. They highlight the need for greater privacy efforts and cultural humility, and explore how medical settings may function as spaces for people who are incarcerated to disclose HIV risk status. Few studies to our knowledge have examined the role of institutional distrust on men who have sex with men (MSM) in the context of pre-exposure prophylaxis (PrEP) interventions. The present study has implications for creating best practices to structure HIV prevention interventions in CJ settings.
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Affiliation(s)
- Meghan Peterson
- a School of Public Health , Brown University , Providence , RI , USA.,b Center for Prisoner Health and Human Rights , Miriam Hospital , Providence , RI , USA
| | - Kathryn Nowotny
- c Department of Sociology , University of Miami , Miami , FL , USA
| | - Emily Dauria
- d Department of Psychiatry , University of California , San Francisco , CA , USA
| | - Trisha Arnold
- e Department of Psychology , Rhode Island Hospital , Providence , RI , USA
| | - Lauren Brinkley-Rubinstein
- f Department of Social Medicine , University of North Carolina , Chapel Hill , NC , USA.,g Center for Health Equity Research , University of North Carolina , Chapel Hill , NC , USA
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Safe sex norm questionnaire for female sex workers: development and validation study in Iran. Public Health 2018; 164:82-90. [PMID: 30218915 DOI: 10.1016/j.puhe.2018.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/22/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of the present study was to develop and validate a safe sex norm questionnaire as an appropriate instrument which would be adaptable to the female sex worker (FSW) population. STUDY DESIGN A mixed method study. METHODS Appropriate content was prepared through a literature review. Content validation indices were assessed using interviews with content experts and lay experts. A conservative approach was used to assess the inter-rater agreement among the participants about the instrument relevance and clarity. The scale content validity index was computed using the average method. Non-parametric Mokken scale analysis was used for assessing scalability and unidimensionality of the questionnaire in a sample of 170 FSWs in Tehran. To evaluate the reliability and internal consistency of the questionnaire intra-class correlation and Cronbach's alpha were employed. RESULTS A list of 34 items was finalized, with subscales for actual behavioral norms and for perceived norms. The relevance of the actual and perceived norms subscales in the final questionnaire was higher than 96%; clarity of the subtests was 99% and higher. The comprehensiveness of the actual and perceived norms subscales was 85% for both. Mokken scale analysis showed that the two subscales were distinct constructs, and all items are good indicators for the constructs. CONCLUSION Our findings support that the safe sex norm questionnaire is a valid and reliable measure that would be useful to harm reduction programs and help effective HIV prevention among female sex workers.
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Johnson K, Gilbert L, Hunt T, Wu E, Metsch L, Goddard-Eckrich D, Richards S, Tibbetts R, Rowe JC, Wainberg ML, El-Bassel N. The effectiveness of a group-based computerized HIV/STI prevention intervention for black women who use drugs in the criminal justice system: study protocol for E-WORTH (Empowering African-American Women on the Road to Health), a Hybrid Type 1 randomized controlled trial. Trials 2018; 19:486. [PMID: 30201039 PMCID: PMC6131955 DOI: 10.1186/s13063-018-2792-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the study protocol of a hybrid type I randomized controlled trial that evaluates the effectiveness and cost-effectiveness of implementing Empowering African-American Women on the Road to Health (E-WORTH), an Afrocentric, group-based, computerized human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention intervention for controlled substance-using black women in community corrections settings in New York City. METHODS/DESIGN We provide an overview of E-WORTH's hybrid type I design, which is guided by the Consolidated Framework for Implementation Research (CFIR). E-WORTH combines HIV/STI and intimate partner violence (IPV) prevention components and tests the comparative effectiveness of E-WORTH and streamlined HIV testing versus streamlined HIV testing alone in decreasing biologically confirmed HIV and STI incidence, sexual risk, and IPV, as well as in improving access to HIV and STI prevention services and care. DISCUSSION This paper provides an overview of E-WORTH's intervention protocol and serves as a framework for using hybrid type I designs, guided by the CFIR conceptual framework, to evaluate HIV/STI and IPV prevention interventions in community corrections settings. We discuss how E-WORTH's hybrid type I design advances implementation science through its effectiveness and cost-effectiveness aims as well as through a mixed-methods study that evaluates multilevel theory-driven factors (structural, organizational, staffing, and client) guided by the CFIR that influences the implementation of E-WORTH in a criminal justice setting. This study also addresses the novel challenges and opportunities of implementing an intervention that targets specific racial subgroup(s) in a community corrections setting that services all populations, implementing a group-based intervention with technological components in such settings, and employing community-based participatory research strategies to guide recruitment and retention efforts. TRIAL REGISTRATION ClinicalTrials.gov, NCT02391233 . Registered on 17 March 2015.
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Affiliation(s)
- Karen Johnson
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
- Columbia University School of Social Work, Social Intervention Group, 1255 Amsterdam Avenue, New York, NY 10027 USA
| | - Louisa Gilbert
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
| | - Timothy Hunt
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
| | - Elwin Wu
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Dawn Goddard-Eckrich
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
- Social Intervention Group, Columbia University Teacher’s College, 1255 Amsterdam Avenue, New York, NY 10027 USA
| | - Stanley Richards
- The Fortune Society, 625 West 140th Street, New York, NY 10031 USA
| | - Rick Tibbetts
- New York City Department of Probation, 210 Joralemon Street, Brooklyn, NY 11201 USA
| | - Jessica C. Rowe
- Center for Teaching and Learning, Columbia University, Lewisohn Hall, 2970 Broadway #603, New York, NY 10027 USA
| | - Milton L. Wainberg
- Columbia University / New York State Psychiatric Institute, 1051 Riverside Drive, #24, New York, NY 10032 USA
| | - Nabila El-Bassel
- University of Alabama School of Social Work, Little Hall, 670 Bonner Drive, Tuscaloosa, AL 35401 USA
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