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Denison JA, Willis K, DeLong SM, Sievwright KM, Agwu AL, Arrington-Sanders R, Kaufman MR, Prabhu S, Williams AM, Fields EL, Alexander KA, Lee L, Yang C. Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework. AIDS Behav 2024; 28:1694-1707. [PMID: 38351279 PMCID: PMC11069483 DOI: 10.1007/s10461-023-04255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 05/05/2024]
Abstract
While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.
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Affiliation(s)
- Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA.
| | - Kalai Willis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie M DeLong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirsty M Sievwright
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, US
| | - Allison L Agwu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Michelle R Kaufman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sandeep Prabhu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Ashlie M Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Errol L Fields
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Lana Lee
- Adult Clinical Branch, Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1297. [PMID: 36911864 PMCID: PMC9831290 DOI: 10.1002/cl2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design. OBJECTIVES The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research. METHODS This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added. SELECTION CRITERIA To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes. RESULTS This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied. CONCLUSION This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.
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Community Mobilization is Associated with HIV Testing Behaviors and Their Psychosocial Antecedents Among Zambian Adults: Results from a Population-Based Study. AIDS Behav 2022; 27:1682-1693. [PMID: 36307741 PMCID: PMC10140187 DOI: 10.1007/s10461-022-03900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 12/31/2022]
Abstract
Community mobilization (CM) is a vital yet under-explored avenue for increasing HIV testing in generalized HIV epidemic settings. Using multi-stage cluster sampling, a population-based sample of 3535 Zambian adults (mean age: 28 years, 50% women) were recruited from 14 districts to complete a household survey. Exploratory factor analysis (EFA) was used to re-validate a 23-item, 5-factor CM scale. Multivariable logistic and Poisson regression were then used to identify associations of CM with HIV testing behaviors and their psychosocial antecedents. A 21-item, 3-factor ("Leadership", "Collective Action Capacity", and "Social Cohesion") CM solution emerged from EFA (Cronbach's α 0.88). Among men and in rural settings, higher CM was significantly (p < 0.05) associated with elevated odds of HIV testing and more past-year HIV testing discussion sources, controlling for socio-demographics and sexual behaviors. Results underscore the importance of prioritizing CM to cultivate more favorable environments for HIV testing uptake, especially for men and rural residents.
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Abdella S, Demissie M, Worku A, Dheresa M, Berhane Y. HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique. EClinicalMedicine 2022; 51:101540. [PMID: 35813094 PMCID: PMC9256839 DOI: 10.1016/j.eclinm.2022.101540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country. METHODS This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. FINDINGS The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6). INTERPRETATION One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030. FUNDING The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.
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Affiliation(s)
- Saro Abdella
- HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Corresponding author.
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Glick JL, Jivapong B, Russo R, Pelaez D, Piser R, Footer K, Sherman SG. Cultivating PEARL (Promoting Empowerment and Risk Reduction): Formative Research for a PrEP Intervention Among Female Sex Workers in Baltimore, Maryland. AIDS Behav 2022; 26:2664-2675. [PMID: 35124751 PMCID: PMC9885761 DOI: 10.1007/s10461-022-03600-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a vital component of comprehensive HIV prevention among female sex workers (FSW). There are limited PrEP interventions targeting FSW in the U.S., who have high HIV risk. Formative research was conducted to inform PEARL (Promoting Empowerment And Risk Reduction), a PrEP intervention for FSW in Baltimore, MD, including a community forum, key informant interviews with providers, and focus group discussions with FSW. FSW and providers acknowledged challenges to building rapport and establishing continuity in care settings. FSW reported low PrEP awareness, with high interest once aware. FSW and providers reported uptake barriers including perceived financial issues, lack of PrEP awareness, and mistrust of the pharmaceutical industry. Concerns were raised about substance use and daily PrEP adherence. Developing a tailored PrEP intervention for FSW necessitates multiple perspectives (e.g. FSW, service providers). Resumen La profilaxis preexposición (PrEP) es un componente vital de la prevención integral del VIH para las trabajadoras sexuales (TSF). En los Estados Unidos, hay pocas intervenciones de PrEP dirigidas a las TSF, quienes experiencian un riesgo elevado de contraer el VIH. Se realizó una investigación formativa para informar a PEARL (Promoción del empoderamiento y la reducción de riesgos), una intervención de PrEP para TSF en Baltimore, MD-la cual incluyó un foro comunitario, entrevistas con proveedores de servicios a las TSF y discusiones entre grupos focales de TSF. TSF y proveedores de servicio reconocieron los retos de mantener buenas relaciones y establecer continuidad en los servicios de salud. TSF exhibieron conocimiento limitado sobre la PrEP, pero expresaron gran interés en la PrEP después de estar informadas. TSF y los proveedores de servicios hablaron de barreras aceptando a la PrEP, incluyendo problemas financieros percibidos, falta de conocimiento sobre la PrEP y desconfianza en la industria farmacéutica. Se expresaron preocupaciones sobre el uso de sustancias y la adherencia diaria a la PrEP. El desarrollo de una intervención de PrEP personalizada para TSF requiere varias perspectivas (por ejemplo, TSF, proveedores de servicios).
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Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Belinda Jivapong
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rienna Russo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rebecca Piser
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Sievwright KM, Stangl AL, Nyblade L, Lippman SA, Logie CH, Veras MADSM, Zamudio-Haas S, Poteat T, Rao D, Pachankis JE, Kumi Smith M, Weiser SD, Brooks RA, Sevelius JM. An Expanded Definition of Intersectional Stigma for Public Health Research and Praxis. Am J Public Health 2022; 112:S356-S361. [PMID: 35763723 PMCID: PMC9241457 DOI: 10.2105/ajph.2022.306718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kirsty M Sievwright
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Anne L Stangl
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Laura Nyblade
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sheri A Lippman
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Carmen H Logie
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Maria Amélia de Sousa Mascena Veras
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sophia Zamudio-Haas
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Tonia Poteat
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Deepa Rao
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - John E Pachankis
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - M Kumi Smith
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sheri D Weiser
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Ronald A Brooks
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jae M Sevelius
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
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Rajkumar V, McCausland K, Lobo R. A Rapid Review of Interventions to Increase Hepatitis B Testing, Treatment, and Monitoring among Migrants Living in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105947. [PMID: 35627481 PMCID: PMC9141177 DOI: 10.3390/ijerph19105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023]
Abstract
Chronic hepatitis B (CHB) disproportionately affects migrants with low health literacy and help-seeking behaviour living in high-income countries. Evidence of effective interventions is required to increase hepatitis B (HBV) testing, treatment, and monitoring. Available evidence from Medline, Embase, Scopus, Google, and Google Scholar was identified, collated, and synthesised. Inclusion criteria included grey and peer-reviewed literature published in English between January 2012 and December 2021. Systematic reviews and meta-analyses were excluded. Seventeen peer-reviewed articles met the inclusion criteria. Most interventions were conducted at the individual level and were typically outreach testing initiatives. One study was conducted at a structural level. All studies were successful in encouraging HBV screening uptake, and 10 studies demonstrated effective linkage to care. Two studies showed evidence of monitoring participants post-intervention. Most interventions had more female than male participants. Interventions conducted across community and clinical-based settings had more participants engage in screening and/or linkage to care in community settings. Effective interventions to prevent HBV transmission and CHB-related morbidity and mortality were approaches that utilised linguistic-specific and culturally appropriate resources to successfully engage migrants. Community outreach programmes that educate participants about HBV transmission, screening, and treatment can promote community dialogue and understanding to reduce stigma and discrimination.
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Affiliation(s)
- Vishnupriya Rajkumar
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (K.M.); (R.L.)
- Correspondence:
| | - Kahlia McCausland
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (K.M.); (R.L.)
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Roanna Lobo
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (K.M.); (R.L.)
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Population Health, Curtin University, Bentley, WA 6102, Australia
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Leddy AM, Gottert A, Haberland N, Hove J, West RL, Pettifor A, Lippman SA, Kahn K, Mathebula R, Rebombo D, Gómez-Olivé X, Twine R, Peacock D, Pulerwitz J. Shifting gender norms to improve HIV service uptake: Qualitative findings from a large-scale community mobilization intervention in rural South Africa. PLoS One 2022; 16:e0260425. [PMID: 34972113 PMCID: PMC8719658 DOI: 10.1371/journal.pone.0260425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background Interventions to improve HIV service uptake are increasingly addressing inequitable and restrictive gender norms. Yet comparatively little is known about which gender norms are most salient for HIV testing and treatment and how changing these specific norms translates into HIV service uptake. To explore these questions, we implemented a qualitative study during a community mobilization trial targeting social barriers to HIV service uptake in South Africa. Methods We conducted 55 in-depth interviews in 2018, during the final months of a three-year intervention in rural Mpumalanga province. Participants included 25 intervention community members (48% women) and 30 intervention staff/community-opinion-leaders (70% women). Data were analyzed using an inductive-deductive approach. Results We identified three avenues for gender norms change which, when coupled with other strategies, were described to support HIV service uptake: (1) Challenging norms around male toughness/avoidance of help-seeking, combined with information on the health and preventive benefits of early antiretroviral therapy (ART), eased men’s fears of a positive diagnosis and facilitated HIV service uptake. (2) Challenging norms about men’s expected control over women, combined with communication and conflict resolution skill-building, encouraged couple support around HIV service uptake. (3) Challenging norms around women being solely responsible for the family’s health, combined with information about sero-discordance and why both members of the couple should be tested, encouraged men to test for HIV rather than relying on their partner’s results. Facility-level barriers such as long wait times continued to prevent some men from accessing care. Conclusions Despite continued facility-level barriers, we found that promoting critical reflection around several specific gender norms, coupled with information (e.g., benefits of ART) and skill-building (e.g., communication), were perceived to support men’s and women’s engagement in HIV services. There is a need to identify and tailor programming around specific gender norms that hinder HIV service uptake.
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Affiliation(s)
- Anna M. Leddy
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Ann Gottert
- Population Council/Project SOAR, Washington, DC and New York, NY, United States of America
| | - Nicole Haberland
- Population Council/Project SOAR, Washington, DC and New York, NY, United States of America
| | - Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca L. West
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Promundo, Washington, D.C., United States of America
| | - Julie Pulerwitz
- Population Council/Project SOAR, Washington, DC and New York, NY, United States of America
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Goldenberg T, Kerrigan D, Gomez H, Perez M, Donastorg Y, Barrington C. Stigma, Social Cohesion, and Mental Health Among Transgender Women Sex Workers Living with HIV in the Dominican Republic. STIGMA AND HEALTH 2021; 6:467-475. [PMID: 36910276 PMCID: PMC9997213 DOI: 10.1037/sah0000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Globally, transgender (trans) women experience pervasive stigma, which contributes to health inequities across multiple mental health outcomes. While trans stigma has been associated with increased mental health challenges, less is known about how stigma related to sex work and HIV affect mental health. Social cohesion may ameliorate the negative health consequences of stigma, but little is known about how social cohesion is associated with mental health among trans women. Using cross-sectional survey data collected in 2019 among 100 trans women sex workers living with HIV in Santo Domingo, Dominican Republic, we examined associations between stigma (related to HIV, sex work, and trans identity), social cohesion, and depression and anxiety symptoms. In unadjusted models, enacted and internalized sex work stigma were associated with greater odds of depression and anxiety symptoms and social cohesion was associated with less depression and anxiety. Resisted sex work stigma, which captured acceptance of self and work, was associated with lower odds of depression and trans stigma was associated with increased anxiety. In adjusted models, internalized sex work stigma was associated with increased depression (aOR=1.19, p=0.018) and anxiety symptoms (aOR=1.12, p=0.021), while social cohesion was associated with reduced depression (OR=0.81, p=0.002) and anxiety symptoms (aOR=0.086, p=0.023). Findings indicate the need for interventions to focus on reducing internalized sex work stigma and promoting social cohesion to improve mental health among trans women. Additional research is needed to determine how to best measure the intersections between HIV, sex work, and trans stigma and their impact on mental health.
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Affiliation(s)
- Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hoisex Gomez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Silberzahn BE, Tomko CA, Clouse E, Haney K, Allen ST, Galai N, Footer KHA, Sherman SG. The EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) Study: Protocol for the Design, Implementation, and Evaluation of a Community-Based Combination HIV Prevention Intervention for Female Sex Workers in Baltimore, Maryland. JMIR Res Protoc 2021; 10:e23412. [PMID: 33861210 PMCID: PMC8087969 DOI: 10.2196/23412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
Abstract
Background Cisgender female sex workers (FSWs) experience high rates of HIV and sexually transmitted infections (STIs), including chlamydia and gonorrhea. Community empowerment–based responses to the risk environment of FSWs have been associated with significant reductions in HIV and STI risk and associated risk behaviors; however, evaluations of US-based interventions targeting FSWs are limited. Objective The objective of this study is to describe the design, implementation, and planned evaluation strategy of an ongoing comprehensive community-level intervention in Baltimore City, Maryland, which aims to improve HIV and STI risk and cumulative incidence among FSWs. The two intervention components are the SPARC (Sex Workers Promoting Action, Risk Reduction, and Community Mobilization) drop-in center and the accompanying comprehensive mobile outreach program. The mission of SPARC is to provide low-barrier harm reduction services to FSWs, with a special focus on women who sell sex and use drugs. Services are provided through a harm reduction framework and include reproductive health and sexual health care; medication-assisted treatment; legal aid; counseling; showers, lockers, and laundry; and the distribution of harm reduction tools, including naloxone and sterile drug use supplies (eg, cookers, cotton, syringes, and pipes). Methods The SPARC intervention is being evaluated through the EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) study, which consists of a prospective 2-group comparative nonrandomized trial (n=385), a cross-sectional survey (n=100), and in-depth interviews assessing SPARC implementation (n=45). Participants enrolled in the nonrandomized trial completed a survey and HIV and STI testing at 4 intervals (baseline and 6, 12, and 18 months). Participants recruited from predefined areas closest to SPARC comprised the intervention group, and participants from all other areas of Baltimore were included in the control group. Results We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer outreach, will improve the HIV and STI risk environment, leading to community empowerment, and reduce the HIV and STI cumulative incidence and behavioral risks of FSWs. Data collection is ongoing. A baseline description of the cohort is presented. Conclusions In the United States, structural interventions aimed at reducing HIV and STIs among FSWs are scarce; to our knowledge, this is the first intervention of its kind in the United States. The results of the EMERALD study can be used to inform the development of future interventions targeting FSWs and other at-risk populations. Trial Registration ClinicalTrials.gov NCT04413591; https://clinicaltrials.gov/ct2/show/NCT04413591. International Registered Report Identifier (IRRID) DERR1-10.2196/23412
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Affiliation(s)
- Bradley E Silberzahn
- Department of Sociology, The University of Texas at Austin, Austin, TX, United States
| | - Catherine A Tomko
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily Clouse
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Haney
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sean T Allen
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine H A Footer
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan G Sherman
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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11
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Urada LA, Gaeta-Rivera A, Kim J, Gonzalez-Zuniga PE, Brouwer KC. Mujeres Unidas: Addressing Substance Use, Violence, and HIV Risk through Asset-Based Community Development for Women in the Sex Trade. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3884. [PMID: 33917190 PMCID: PMC8068011 DOI: 10.3390/ijerph18083884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 01/21/2023]
Abstract
This paper examines the prevalence of and potential for community mobilization (CM) and its association with HIV/STI risk, substance use, and violence victimization among women, particularly those using substances, in the sex trade in Tijuana, Mexico. METHODS 195 women participated in Mujeres Unidas (K01DA036439 Urada) under a longitudinal survey study, "Proyecto Mapa de Salud" (R01DA028692, PI: Brouwer). Local health/social service providers (N = 16) were also interviewed. RESULTS 39% of women who participated in community mobilization activities used substances. In adjusted analyses (n = 135), participation in CM activities (n = 26) was more likely among women who did not report substance use (AOR: 4.36, CI: 1.11-17.16), perceived a right to a life free from violence (AOR: 9.28, CI: 2.03-59.26), talked/worked with peers in the sex trade to change a situation (AOR: 7.87, CI: 2.03-30.57), witnessed violence where they worked (AOR: 4.45, CI: 1.24-15.96), and accessed free condoms (AOR: 1.54, CI: 1.01-2.35). Forty-five of the women using substances demonstrated their potential for engaging in asset-based community development (ABCD) with service providers in Mujeres Unidas meetings. CONCLUSION Women using substances, vs. those who did not, demonstrated their potential to engage in ABCD strategies. Women's empowerment, safety, and health could be enhanced by communities engaging in ABCD strategies that build and bridge social capital for marginalized women who otherwise have few exit and recovery options.
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Affiliation(s)
- Lianne A. Urada
- College of Health and Human Services, San Diego State University School of Social Work, San Diego, CA 92182, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Andrés Gaeta-Rivera
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autonoma de Chihuahua, Chihuahua 31125, Mexico;
| | - Jessica Kim
- Center for Justice and Reconciliation, Point Loma Nazarene d, San Diego, CA 92106, USA;
| | | | - Kimberly C. Brouwer
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093, USA;
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA
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12
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Jiang H, Liu J, Tan Z, Fu X, Xie Y, Lin K, Yan Y, Li Y, Yang Y. Prevalence of and factors associated with advanced HIV disease among newly diagnosed people living with HIV in Guangdong Province, China. J Int AIDS Soc 2020; 23:e25642. [PMID: 33225623 PMCID: PMC7680922 DOI: 10.1002/jia2.25642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION A high proportion of people living with HIV (PLHIV) present for care with advanced HIV disease (AHD), which is detrimental to "90-90-90" targets to end AIDS by 2030. This study aimed to explore the prevalence of and factors related to AHD among newly diagnosed PLHIV in Guangdong Province, China. METHODS Newly diagnosed PLHIV were recruited from six cities in Guangdong Province from May 2018 to June 2019. AHD was defined as an initial CD4 count <200 cells/µL or an AIDS-defining event within one month of HIV diagnosis. Data from a questionnaire and the national HIV surveillance system were used to explore the potential factors related AHD. RESULTS A total of 400 of 997 newly diagnosed PLHIV were defined as having AHD with a proportion of 40.1%. After adjusting for statistically significant variables in univariate analysis, multivariable logistic regressions showed that individuals aged 30 to 39 years (adjusted odds ratio (aOR) = 1.77, 95% confidence interval (CI): 1.13 to 2.79) and ≥50 years (aOR = 1.98, 95% CI: 1.15 to 3.43) were at a higher risk of AHD than those aged 18 to 29 years. Participants diagnosed by voluntary counselling and testing (VCT) clinics were less likely to have AHD (aOR = 0.67, 95% CI: 0.48 to 0.94) than those diagnosed at medical facilities. Participants who had ever considered HIV testing (aOR = 0.66, 95% CI: 0.45 to 0.98) and who had high social support (aOR = 0.73, 95% CI: 0.55 to 0.97) were at a lower risk of AHD, whereas participants who had HIV-related symptoms within one year before diagnosis were at a higher risk of AHD (aOR = 2.09, 95% CI: 1.58 to 2.77). The most frequent reason for active HIV testing was "feeling sick" (42.4%, 255/601), and the main reason for never considering HIV testing was "never thinking of getting HIV" (74.0%, 542/732). CONCLUSIONS Low-risk perception and a lack of awareness of HIV-related symptoms resulted in a high proportion of AHD in Guangdong Province, especially among the elderly, those diagnosed at medical facilities and those with low social support. Strengthening AIDS education and training programmes to scale up HIV testing through provider-initiated testing and counselling in medical facilities and VCT could facilitate early HIV diagnosis.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Jun Liu
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Zhimin Tan
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Xiaobing Fu
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Yingqian Xie
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Kaihao Lin
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Yao Yan
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
| | - Yan Li
- Department of HIV/AIDS Control and PreventionGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Yi Yang
- Department of Epidemiology and BiostatisticsSchool of Public HealthGuangdong Pharmaceutical UniversityGuangzhouChina
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Robinson RS, Zayed H. Understanding the capacity of community-based groups to mobilise and engage in social action for health: Results from Avahan. Glob Public Health 2020; 16:1590-1603. [PMID: 33106086 DOI: 10.1080/17441692.2020.1837912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Community mobilisation improves outcomes from HIV to maternal and child health. Yet, little health research has explored why some community groups are better able to mobilise than others. We address this gap by considering the case of Avahan, the India AIDS Initiative, which sought to foster community mobilisation, including the creation of community-based groups serving men who have sex with men (MSM), female sex workers (FSWs), and injection drug users (IDUs). Using quantitative and qualitative data collected from 58 community-based groups from 2009-2012 across six Indian states, we analyse variation in groups' action on behalf of their members. Based on a mixed effects logistic regression, we find that older groups and those with bank accounts, crisis committees, or strategic relationships were most likely to take action on behalf of members by demanding rights or confronting gatekeepers and opinion leaders. Analysis of qualitative data reveals the types of action organisations took on behalf of members (mediation, removal of community members from harm, and advocacy), but also that sometimes organisations refused to take action, or community members declined their assistance. These findings indicate that organisations formalising, creating structures for social action, and building networks are important strategies to foster community mobilisation.
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Affiliation(s)
| | - Hatem Zayed
- School of International Service, American University, Washington, DC, USA
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14
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Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health 2020; 16:401-411. [PMID: 31505159 DOI: 10.1071/sh19061] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022]
Abstract
Although understanding the local epidemiology of gonorrhoea is critical for local efforts, understanding the multinational epidemiology may support development of national and international prevention and control policies and strategies. In this paper, current epidemiology of gonorrhoea is reviewed through an international lens and with a focus on selected populations. The World Health Organization (WHO) estimates that ~87 million new gonococcal infections occurred among people aged 15-49 years in 2016. Gonorrhoea rates are rising in many countries. Gay, bisexual and other men who have sex with men, racial or ethnic minorities, Indigenous populations and sex workers appear to bear disproportionate burdens of gonorrhoea. International travel can facilitate spread of gonorrhoea, including resistant strains, across international borders. Critical gaps in epidemiological knowledge are highlighted, including data on gonorrhoea among transgender persons and the burden of extragenital gonorrhoea. Even as further data are gathered, action - informed by currently available data - is needed now to confront this growing international threat.
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Affiliation(s)
- Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA; and Corresponding author.
| | - Emily Weston
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Aluisio C Segurado
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil
| | - Gwenda Hughes
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil; and HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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15
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Restar A, Ogunbajo A, Adia A, Nazareno J, Hernandez L, Sandfort T, Lurie M, Cu-Uvin S, Operario D. Using structural equation modelling to characterise multilevel socioecological predictors and mediators of condom use among transgender women and cisgender men who have sex with men in the Philippines. BMJ Glob Health 2020; 5:e002463. [PMID: 32699154 PMCID: PMC7380848 DOI: 10.1136/bmjgh-2020-002463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Risks for condomless sex among transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively) in the Philippines, where HIV recently became a national public health crisis, are shaped and exacerbated by various risk factors across multiple levels. METHODS Between June 2018 and August 2019, we conducted a cross-sectional online study with 318 trans-WSM and cis-MSM respondents from Manila and Cebu cities. Structural equational modelling procedures were performed to determine direct, indirect and overall effects between condom use and latent variables across multiple socioecological levels: personal (ie, condom self-efficacy), social (ie, social capital), environmental (ie, barriers to condom and HIV services) and structural (ie, structural violence, antidiscrimination policies). RESULTS Adjusted for gender, age, location and income, our model showed that: (1) all latent variables at the structural and environmental levels were significantly positively associated with each other (all ps<0.05); (2) barriers to condom and HIV services were significantly negatively associated with social capital (p<0.001) as well as condom self-efficacy (p<0.001); and (3) there were significantly positive associations between social capital and condom self-efficacy (p<0.001), and between condom self-efficacy and condom use (p<0.001). Moreover, social capital and condom self-efficacy fully mediated and buffered the negative effects between environmental and structural barriers and condom use. CONCLUSION This is the first known study pointing to multiple relationships and pathways across multiple socioecological levels that can potentially be leveraged for future interventions aimed at improving condom use among Filipinx trans-WSM and cis-MSM. Such interventions should be multicomponent and build and/or strengthen social capital and condom self-efficacy, as well as intentionally target prominent structural and environmental barriers to condom use.
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Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jennifer Nazareno
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, Rhode Island, USA
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Identifying Opportunities for Collaboration Across the Social Sciences to Reach the 10-10-10: A Multilevel Approach. J Acquir Immune Defic Syndr 2020; 82 Suppl 2:S118-S123. [PMID: 31658198 PMCID: PMC6820711 DOI: 10.1097/qai.0000000000002170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The national and global strategy to combat HIV, often referred to as the "90-90-90," aims to diagnose 90% of people living with HIV, get 90% of those diagnosed onto antiretroviral treatment (ART), and achieve viral suppression in 90% of those on ART. The remaining 10-10-10 who will be undiagnosed, not on ART, or not virally suppressed, include vulnerable persons and populations most affected by social determinants of health. Given their foci on the social determinants of health at the individual, social, and structural levels, social scientists are in a prime position to help reach the 10-10-10. A potentially effective way for social scientists to achieve this goal is to examine the issues that affect the 10-10-10 using a multilevel framework, to understand at what levels their own approaches fit within such a multilevel framework, and to seek intentional collaborations with other social scientists who may work at different levels but whose approaches may complement their own within multilevel collaborations. APPROACH The present article describes how a multilevel framework can guide collaboration across disciplines within the social sciences toward the common goal of reaching the 10-10-10. CONCLUSIONS Within a multilevel framework, social scientists can work collaboratively to address the needs of individuals among the 10-10-10 within the social and structural contexts (eg, social norms, stigma, poverty, and barriers to care) that affect their health. Such an approach draws on the unique strengths and approaches of different social-science disciplines while also building capacity for individuals most affected by social determinants of health.
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Leddy AM, Mantsios A, Davis W, Muraleetharan O, Shembilu C, Mwampashi A, Beckham S, Galai N, Likindikoki S, Mbwambo J, Kerrigan D. Essential elements of a community empowerment approach to HIV prevention among female sex workers engaged in project Shikamana in Iringa, Tanzania. CULTURE, HEALTH & SEXUALITY 2020; 22:111-126. [PMID: 31496423 PMCID: PMC7061086 DOI: 10.1080/13691058.2019.1659999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/21/2019] [Indexed: 06/01/2023]
Abstract
Globally, female sex workers bear a disproportionate burden of HIV, with those in sub-Saharan Africa being among the most affected. Community empowerment approaches have proven successful at preventing HIV among this population. These approaches facilitate a process whereby sex workers take collective ownership over programmes to address the barriers they face in accessing their health and human rights. Limited applications of such approaches have been documented in Africa. We describe the community empowerment process among female sex workers in Iringa, Tanzania, in the context of a randomised controlled trial of a community empowerment-based model of combination HIV prevention. We conducted 24 in-depth interviews with participants from the intervention community and 12 key informant interviews with HIV care providers, police, venue managers, community advisory board members and research staff. Content analysis was employed, and salient themes were extracted. Findings reveal that the community empowerment process was facilitated by the meaningful engagement of sex workers in programme development, encouraging sex worker ownership over the programme, providing opportunities for solidarity and capacity building, and forming partnerships with key stakeholders. Through this process, sex workers mobilised their collective agency to access their health and human rights including HIV prevention, care and treatment.
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Affiliation(s)
- Anna M. Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Andrea Mantsios
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, USA
| | - Ohvia Muraleetharan
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Catherine Shembilu
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ard Mwampashi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S.W. Beckham
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna Kerrigan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Sociology, American University, Washington, DC, USA
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Valente PK, Mimiaga MJ, Mayer KH, Safren SA, Biello KB. Social Capital Moderates the Relationship Between Stigma and Sexual Risk Among Male Sex Workers in the US Northeast. AIDS Behav 2020; 24:29-38. [PMID: 31587116 PMCID: PMC7276145 DOI: 10.1007/s10461-019-02692-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Stigma contributes to elevated HIV incidence among male sex workers (MSW). Social capital (i.e., resources accessed through one's social relationships) may act as a buffer between stigma and sexual risk behaviors and HIV acquisition. Using negative binomial regression, we examined the association between both sex work-related stigma and social capital with respect to number of condomless sex acts among 98 MSW living in the US Northeast. In models adjusted for sociodemographic characteristics, sex work-related stigma was associated with number of condomless sex acts with any non-paying partner (i.e., male and female) (aIRR = 1.25, p < 0.001) and male non-paying partners (aIRR = 1.27, p = 0.09) among individuals with low social capital, not among those with high social capital. Sex work-related stigma was not associated with number of condomless anal sex acts with male paying clients at any level of social capital. Future HIV prevention interventions should consider promoting social capital among MSW.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Steve A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
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Zwakala Ndoda: a cluster and individually randomized trial aimed at improving testing, linkage, and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa. Trials 2019; 20:798. [PMID: 31888701 PMCID: PMC6937627 DOI: 10.1186/s13063-019-3908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. METHODS This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomized trial and an individual randomized trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV testing services, and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. DISCUSSION A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services, and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men's individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment, male-focused testing venues, male-only counselors, developing counseling models that are flexible and responsive to men, and strategies for adhering to clinic visits without missing work and navigating the healthcare system. By thoughtfully combining male-focused mobilization, and testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence base about how to reach, test, link, and maintain a hard-to-reach group such as men in HIV treatment and care services. TRIAL REGISTRATION ClinicalTrials.gov, NCT03794245. Registered on 4 January 2019.
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MacPhail C, Khoza N, Treves-Kagan S, Selin A, Gómez-Olivé X, Peacock D, Rebombo D, Twine R, Maman S, Kahn K, DeLong SM, Hill LM, Lippman SA, Pettifor A. Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa. PLoS One 2019; 14:e0225694. [PMID: 31790483 PMCID: PMC6886772 DOI: 10.1371/journal.pone.0225694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022] Open
Abstract
Community mobilization has been recognized as a critical enabler for HIV prevention and is employed for challenging gender inequalities. We worked together with community partners to implement the ‘One Man Can’ intervention in rural Mpumalanga, South Africa to promote gender equality and HIV risk reduction. During the intervention, we conducted longitudinal qualitative interviews and focus group discussions with community mobilizers (n = 26), volunteer community action team members (n = 22) and community members (n = 52) to explore their experience of being part of the intervention and their experiences of change associated with the intervention. The objective of the study was to examine processes of change in community mobilization for gender equity and HIV prevention. Our analysis showed that over time, participants referred to three key elements of their engagement with the intervention: developing respect for others; inter-personal communication; and empathy. These elements were viewed as assisting them in adopting a ‘better life’ and associated with behaviour change in the intervention’s main focus areas of promoting gender equality and HIV risk reduction behaviours. We discuss how these concepts relate to the essential domains contained within our theoretical framework of community mobilization—specifically critical consciousness, shared concerns and social cohesion -, as demonstrated in this community. We interpret the focus on these key elements as significant indicators of communities engaging with the community mobilization process and initiating movement towards structural changes for HIV prevention.
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Affiliation(s)
- Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Nomhle Khoza
- Wits Reproductive Health & HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- STRIVE Research Programme Consortium, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Sarah Treves-Kagan
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America
| | - Amanda Selin
- Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | | | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Maman
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephanie M. DeLong
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Lauren M. Hill
- Department of Health Behaviour, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Sheri A. Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, California, United States of America
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Patel SK, Mukherjee S, Mahapatra B, Battala M, Jayaram M, Kumta S, Atmavilas Y, Saggurti N. Enhancing financial security of female sex workers through a community-led intervention in India: Evidence from a longitudinal survey. PLoS One 2019; 14:e0223961. [PMID: 31639161 PMCID: PMC6804955 DOI: 10.1371/journal.pone.0223961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction Community-led organizations (COs) have been an integral part of HIV prevention programs to address the socio-economic and structural vulnerabilities faced by female sex workers (FSWs). The current study examines whether strengthening of community-led organizations and community collectivization have been instrumental in reducing the financial vulnerability and empowering FSWs in terms of their self-efficacy, confidence, and individual agency in India. Data and methods This study used a panel data of 2085 FSWs selected from 38 COs across five states of India. Two rounds of data (Round 1 in 2015 and Round 2 in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security, community collectivization, and individual empowerment. Results There was a significant improvement in CO strength and community collectivization from Round 1 to Round 2. High CO strength has led to improved financial security among FSWs (R2: 85% vs. R1: 51%, AOR: 2.5; 95% CI: 1.5–4.1) from Round 1 to Round 2. High collective efficacy and community ownership have improved the financial security of FSWs during the inter-survey period. Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy, and individual agency) among FSWs. Conclusions Institutional strengthening and community mobilization programs are key to address the structural issues and the decrease of financial vulnerability among FSWs. In addition, enhanced financial security is very important to sustain or improve the individual empowerment of FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment.
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Affiliation(s)
| | | | | | | | | | - Sameer Kumta
- Bill & Melinda Gates Foundation, New Delhi, India
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Allen ST, Footer KHA, Galai N, Park JN, Silberzahn B, Sherman SG. Implementing Targeted Sampling: Lessons Learned from Recruiting Female Sex Workers in Baltimore, MD. J Urban Health 2019; 96:442-451. [PMID: 30066174 PMCID: PMC6565638 DOI: 10.1007/s11524-018-0292-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Globally, HIV prevention interventions have proven efficacious among street-based female sex workers (FSWs); yet, there is a dearth of US-based HIV prevention research among this group. The lack of research among FSWs in the USA is partially driven by challenges in recruiting members of this population. The purpose of this research is to describe how targeted sampling was employed to recruit a cohort of street-based FSWs for a study that examined the role of police in shaping the HIV risk environments of street-based FSWs in Baltimore, MD. Our research demonstrates that targeted sampling can be an advantageous strategy for recruiting hidden populations that are mobile and geographically dispersed.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Katherine H A Footer
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Bradley Silberzahn
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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Murray LR, Kerrigan D, Paiva VS. Rites of Resistance: Sex Workers' Fight to Maintain Rights and Pleasure in the Centre of the Response to HIV in Brazil. Glob Public Health 2018; 14:939-953. [PMID: 30141721 DOI: 10.1080/17441692.2018.1510020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Drawing on ethnographic research conducted from 2011 to 2015 and the authors' long-term engagement in diverse aspects of HIV and human rights advocacy in Brazil, this paper explores key elements of the Brazilian sex workers' movement response to HIV and the broader political factors that profoundly influenced its trajectory. We argue that the movement has constantly challenged representations of prostitution by affirming sex workers' roles as political actors, not just peer educators, in fighting the HIV epidemic and highlight their development of a sex positive and pleasure centred response that fought stigma on multiple fronts. Moments of tension such as the censorship of an HIV prevention campaign and implementation of 'test and treat' projects are analysed, as are the complex questions that Brazil's 2016 political and economic crisis evokes in terms of how to develop and sustain responses to HIV driven by communities but with material commitment from the State. We conclude with what we see to be the unique, central components of Brazilian sex workers' approach to HIV prevention and what lessons can be learned from it for broader collective health movements in Latin America and beyond.
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Affiliation(s)
- Laura Rebecca Murray
- a Department of Health Policy, Planning, and Administration , Institute of Social Medicine, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Deanna Kerrigan
- b Department of Sociology , Center on Health, Risk and Society, American University , Washington , USA
| | - Vera Silvia Paiva
- c Department of Social Psychology , Institute of Social Psychology - University of São Paulo , São Paulo , Brazil
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24
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Pettifor A, Lippman SA, Gottert A, Suchindran CM, Selin A, Peacock D, Maman S, Rebombo D, Twine R, Gómez‐Olivé FX, Tollman S, Kahn K, MacPhail C. Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa. J Int AIDS Soc 2018; 21:e25134. [PMID: 29972287 PMCID: PMC6058206 DOI: 10.1002/jia2.25134] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Community mobilization (CM) is increasingly recognized as critical to generating changes in social norms and behaviours needed to achieve reductions in HIV. We conducted a CM intervention to modify negative gender norms, particularly among men, in order to reduce associated HIV risk. METHODS Twenty two villages in the Agincourt Health and Socio-Demographic Surveillance Site in rural Mpumalanga, South Africa were randomized to either a theory-based, gender transformative, CM intervention or no intervention. Two cross-sectional, population-based surveys were conducted in 2012 (pre-intervention, n = 600 women; n = 581 men) and 2014 (post-intervention, n = 600 women; n = 575 men) among adults ages 18 to 35 years. We used an intent-to-treat (ITT) approach using survey regression cluster-adjusted standard errors to determine the intervention effect by trial arm on gender norms, measured using the Gender Equitable Mens Scale (GEMS), and secondary behavioural outcomes. RESULTS Among men, there was a significant 2.7 point increase (Beta Coefficient 95% CI: 0.62, 4.78, p = 0.01) in GEMS between those in intervention compared to control communities. We did not observe a significant difference in GEMS scores for women by trial arm. Among men and women in intervention communities, we did not observe significant differences in perpetration of intimate partner violence (IPV), condom use at last sex or hazardous drinking compared to control communities. The number of sex partners in the past 12 months (AOR 0.29, 95% CI 0.11 to 0.77) were significantly lower in women in intervention communities compared to control communities and IPV victimization was lower among women in intervention communities, but the reduction was not statistically significant (AOR 0.53, 95% CI 0.24 to 1.16). CONCLUSION Community mobilization can reduce negative gender norms among men and has the potential to create environments that are more supportive of preventing IPV and reducing HIV risk behaviour. Nevertheless, we did not observe that changes in attitudes towards gender norms resulted in desired changes in risk behaviours suggesting that more time may be necessary to change behaviour or that the intervention may need to address behaviours more directly. CLINICAL TRIALS NUMBER ClinicalTrials.gov NCT02129530.
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Affiliation(s)
- Audrey Pettifor
- Department of EpidemiologyUniversity of North Carolina Gillings School of Global Public HealthChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for AIDS Prevention Studies (CAPS)Department of MedicineUniversity of California at San FranciscoSan FranciscoCAUSA
| | - Ann Gottert
- Population CouncilHIV and AIDS programWashingtonDCUSA
| | - Chirayath M Suchindran
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Department of BiostatisticsUniversity of North Carolina Gillings School of Global Public HealthChapel HillNCUSA
| | - Amanda Selin
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Dean Peacock
- Sonke Gender JusticeCape TownSouth Africa
- School of Public HealthDivision of Social and Behavioural ScienceUniversity of Cape TownCape TownSouth Africa
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina Gillings School of Global Public HealthChapel HillNC
| | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Francesc Xavier Gómez‐Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Epidemiology and Global Health UnitDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Epidemiology and Global Health UnitDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Carrasco MA, Nguyen TQ, Barrington C, Perez M, Donastorg Y, Kerrigan D. HIV Stigma Mediates the Association Between Social Cohesion and Consistent Condom Use Among Female Sex Workers Living with HIV in the Dominican Republic. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1529-1539. [PMID: 29687290 DOI: 10.1007/s10508-018-1186-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
Evidence indicates that social cohesion is a successful strategy to improve consistent condom use (CCU) among female sex workers. However, the individual and layered or combined effect that various types of overlapping stigmas may have on CCU between female sex workers living with HIV and their clients and steady partners has not been analyzed. Drawing on the Abriendo Puertas cohort of female sex workers living with HIV in the Dominican Republic, we used structural equation modeling to test the hypothesis that both HIV stigma and sex work stigma mediate the association between social cohesion and CCU and that they have a layered effect. The results indicated that HIV stigma mediated the association between social cohesion and CCU with clients and partners, while sex work-related stigma did not. There was no evidence of a layered HIV stigma and sex work stigma effect, which may be due to methodological limitations to handle highly correlated latent variables. Findings highlight the need to address internalized HIV stigma within the context of community-based approaches to enhance their HIV prevention impact. This will help to reduce the risk of HIV re-infection with a new distinct HIV viral strain, STI infection, and onward HIV transmission among female sex workers living with HIV.
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Affiliation(s)
- Maria Augusta Carrasco
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- United States Agency for International Development, Washington, DC, USA.
| | - Trang Q Nguyen
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina Gillins School of Global Public Health, Chapel Hill, NC, USA
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatalogico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatalogico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Dolwick Grieb SM, Shah H, Flores-Miller A, Zelaya C, Page KR. HIV-Related Stigma Among Spanish-speaking Latinos in an Emerging Immigrant Receiving City. J Immigr Minor Health 2018; 19:868-875. [PMID: 27678505 DOI: 10.1007/s10903-016-0497-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HIV-related stigma has been associated with a reluctance to test for HIV among Latinos. This study assessed community HIV-related stigma within an emerging Latino immigrant receiving city. We conducted a brief survey among a convenience sample of 312 Spanish-speaking Latinos in Baltimore, Maryland. HIV-related stigma was assessed through six items. Associations between stigma items, socio-demographic characteristics, and HIV testing history were considered. Gender, education, and religiosity were significantly associated with stigmatizing HIV-related beliefs. For example, men were 3.4 times more likely to hold more than three stigmatizing beliefs than women, and were also twice as likely as women to report feeling hesitant to test for HIV for fear of people's reaction if the test is positive. These findings can help inform future stigma interventions in this community. In particular, we were able to distinguish between drivers of stigma such as fear and moralistic attitudes, highlighting specific actionable items.
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Affiliation(s)
- Suzanne M Dolwick Grieb
- Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F. Lord Center Tower Suite 4200, Baltimore, MD, 21224, USA.
| | - Harita Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen R Page
- Bureau of HIV/STD Services, Baltimore City Health Department, Baltimore, MD, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lancaster KE, MacLean SA, Lungu T, Mmodzi P, Hosseinipour MC, Hershow RB, Powers KA, Pence BW, Hoffman IF, Miller WC, Go VF. Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study. Subst Use Misuse 2018; 53:782-791. [PMID: 29020505 PMCID: PMC5884720 DOI: 10.1080/10826084.2017.1365088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. OBJECTIVE To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. METHODS In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. RESULTS Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. CONCLUSIONS Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work.
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Affiliation(s)
- Kathryn E. Lancaster
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Sarah A. MacLean
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Lilongwe, Malawi
| | - Thandie Lungu
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pearson Mmodzi
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
- UNC Project Malawi, University of North Carolina at Chapel Hill, Tidziwe Centre, Lilongwe, Malawi
| | - Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly A. Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Irving F. Hoffman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - William C. Miller
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Prakash R, Bhattacharjee P, Blanchard A, Musyoki H, Anthony J, Kimani J, Gakii G, Sirengo M, Muraguri N, Mziray E, Kasonde L, Blanchard J, Isac S, Moses S. Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018. [PMID: 29514590 DOI: 10.2989/16085906.2017.1377268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
While Kenya has had a long-standing national HIV-prevention programme, evidence on the level of exposure to its interventions and related effects on behavioural changes among female sex workers (FSWs) is limited. Using cross-sectional behavioural data collected in 2013 from 1 357 FSWs aged 18 years and above in Nairobi, Kenya, this study explores the relationship between FSW programme exposure levels and behavioural outcomes including condom use, sexually transmitted infection (STI)-treatment, and empowerment measures like disclosure of self-identity and violence reporting. We categorised programme exposure levels as none, moderate and intensive. Multivariate logistic regression was used for analysis. Overall, 35% of the FSWs were not exposed to any HIV prevention programme, whereas about 24% had moderate and 41% had intensive exposure. FSWs having intensive programme exposure had a higher likelihood of using condoms consistently with occasional clients (AOR: 1.57; 95% CI: 1.08-2.31) and seeking treatment for STIs (AOR: 3.37; 95% CI: 1.63-7.02) compared to FSWs with no or moderate exposure. Intensive programme exposure was also associated with higher self-disclosure of sex-work identity (AOR: 1.63; 95% CI: 1.19-2.24), reporting of violence to police (AOR: 2.45; 95% CI: 1.03-5.84), and negotiation of condom use at last sex when the client was under the influence of alcohol (AOR: 1.63; 95% CI: 0.94-2.82). Although HIV prevention programmes in Kenya have been underway for over a decade, programme efforts were largely focused on saturating the coverage (intervention breadth). Strategies should now focus on ensuring improved quality of contacts through intensified programme exposure (intervention depth) to enhance gains in behavioural change among FSWs and preventing the burden of HIV infection among them.
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Affiliation(s)
- Ravi Prakash
- a Karnataka Health Promotion Trust (KHPT) , Bangalore , India
| | - Parinita Bhattacharjee
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Andrea Blanchard
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Helgar Musyoki
- c National AIDS and STI Control Programme (NASCOP), Ministry of Health , Nairobi , Kenya
| | - John Anthony
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Joshua Kimani
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Gloria Gakii
- d Partners for Health and Development in Africa (PHDA) , Nairobi , Kenya
| | - Martin Sirengo
- c National AIDS and STI Control Programme (NASCOP), Ministry of Health , Nairobi , Kenya
| | | | | | | | - James Blanchard
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Shajy Isac
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Stephen Moses
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
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Sherman SG, Hast M, Park JN, Decker MR, Flynn C, German D. Correlates of exchange sex among a population-based sample of low-income women who have heterosexual sex in Baltimore. AIDS Care 2018. [PMID: 29519143 DOI: 10.1080/09540121.2018.1447078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sex exchange is associated with HIV and other morbidities yet has received little research, surveillance, and programmatic attention in the U.S. This study identified correlates of exchange sex and among low-income women in Baltimore, Maryland. Participants were recruited into the National HIV Behavioral Surveillance (NHBS) system in 2013 using respondent driven sampling (RDS) and completed a survey and HIV testing. The analytic sample (n = 253) consisted of women aged ≥18 years who had recent (past year) heterosexual sex. Multivariable logistic regression identified correlates of recent exchange sex. Independently associated with recent exchange sex were history of injection drug use (adjusted odds ratio (AOR) = 3.4, 95% CI: 1.1-10.3), recent prescription painkiller use (AOR = 3.7, 95% CI: 1.4-9.9), recent crack/cocaine use (AOR = 6.6, 95% CI: 2.1-20.9), recent arrest (AOR = 4.1, 95% CI: 1.2-14.8), and recent consistent condom use (AOR 1.1; 95% CI: 1.0-1.3). Women who exchanged sex exhibited heightened social and structural vulnerability and substance use. These data demonstrate the need for further research examining the context of exchange sex among low-income women and synergies between substance use and HIV risk.
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Affiliation(s)
- Susan G Sherman
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Marisa Hast
- b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ju Nyeong Park
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Michele R Decker
- c Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Colin Flynn
- d Center for HIV Surveillance, Epidemiology and Evaluation, Maryland Department of Health , Baltimore , MD , USA
| | - Danielle German
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Leite GS, Murray L, Lenz F. The Peer and Non-peer: the potential of risk management for HIV prevention in contexts of prostitution. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:7-25. [PMID: 26630296 DOI: 10.1590/1809-4503201500050003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022] Open
Abstract
Sex workers have been the protagonists and focus of HIV prevention campaigns and research since the late 1980s in Brazil. Through a review of national and international literature, combined with a history of sex workers' involvement in the construction of the Brazilian response, this article explores the overlaps and disconnects between research and practice in contexts of prostitution over the past three decades. We review the scientific literature on the epidemiology of HIV among sex workers and prevention methodologies. We conclude that although research focus and designs often reinforce the idea that sex workers' vulnerability is due to their sexual relationships with clients, their greatest vulnerability has been found to be with their nonpaying intimate partners. Few studies explore their work contexts and structural factors that influence safe sex practices with both types of partners. The negative effects of criminalization, stigma, and exclusively biomedical and peer education-based approaches are well documented in the scientific literature and experiences of sex worker activists, as is the importance of prevention programs that combine empowerment and human rights-based approach to reduce HIV infection rates. We conclude that there is a need for actions, policies, and research that encompass the environment and context of sex workers' lives and reincorporate the human rights and citizenship frame that dominated the Brazilian response until the end of the 2000s. As part of HIV prevention efforts, female sex workers need to be considered above all as women, equal to all others.
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Affiliation(s)
| | - Laura Murray
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Flavio Lenz
- Graduate Program in Communication, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Muth S, Len A, Evans JL, Phou M, Chhit S, Neak Y, Ngak S, Stein ES, Carrico AW, Maher L, Page K. HIV treatment cascade among female entertainment and sex workers in Cambodia: impact of amphetamine use and an HIV prevention program. Addict Sci Clin Pract 2017; 12:20. [PMID: 28870232 PMCID: PMC5584046 DOI: 10.1186/s13722-017-0085-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV prevalence remains high in Cambodia among female entertainment and sex workers (FESW), and amphetamine-type stimulant (ATS) use significantly increases risk of infection. A successful continuum of care (CoC) is key to effective clinical care and prevention. This study aimed to describe the HIV CoC in HIV-positive FESW. We examined CoC outcomes among HIV-positive FESW participating in the Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) study, being implemented in ten provinces. CIPI is a trial aimed at reducing ATS use concomitant with the SMARTgirl HIV prevention program. METHODS From 2013 to 2016, 1198 FESW ≥ 18 years old who reported multiple sex partners and/or transactional sex were recruited. We identified 88 HIV-positive women at baseline. We described linkage to care as 12-month retention and viral suppression (<1000 copies/mL). Logistic regression analyses were conducted to examine correlates of retention in care at 12 months, and viral suppression. RESULTS Median age of the 88 HIV-positive women was 32 years [interquartile range (IQR) 28, 35]; 50% were working in entertainment venues and 50% as freelance sex workers; 70% reported SMARTgirl membership. In the past 3 months, women reported a median of 15 sex partners, 38% reported unprotected sex, and 55% reported using ATS. Overall, 88% were receiving HIV care, 83% were on antiretroviral therapy, 39% were retained in care at 12 months, and 23% were virally suppressed. SMARTgirl membership was independently associated with fourfold greater odds of 12-month retention in care (AOR = 4.16, 95% CI 1.38, 12.56). Those at high risk for an ATS use disorder had 91% lower odds of 12-month retention in care (AOR = 0.09, 95% CI 0.01, 0.72). Viral suppression was independently associated with SMARTgirl membership, older age, reporting of STI symptoms, worse symptoms of psychological distress, and greater numbers of sex partners. CONCLUSIONS This is the first study to characterize the HIV CoC in Cambodian FESW. While most women were successfully linked to HIV care, retention and viral suppression were low. Tailored programs like SMARTgirl, targeting the broader population of HIV-positive FESW as well as interventions to reduce ATS use could optimize the clinical and population health benefits of HIV treatment. Trial registration This work reports data collected as part of a trial: NCT01835574. This work does not present trial results.
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Affiliation(s)
| | | | - Jennifer L Evans
- Department of Epidemiology and Biostatistics, and Global Health, University of California, San Francisco, San Francisco, CA, USA
| | | | - Sophal Chhit
- Department of Mental Health and Substance Abuse, Ministry of Health, Phnom Penh, Cambodia
| | - Yuthea Neak
- National Authority for Combating Drugs, Phnom Penh, Cambodia
| | | | - Ellen S Stein
- Department of Epidemiology and Biostatistics, and Global Health, University of California, San Francisco, San Francisco, CA, USA
| | - Adam W Carrico
- Public Health Sciences and Psychology, University of Miami, Coral Gables, FL, USA
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, UNSW Australia, Sydney, Australia
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
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Project Shikamana: Baseline Findings From a Community Empowerment-Based Combination HIV Prevention Trial Among Female Sex Workers in Iringa, Tanzania. J Acquir Immune Defic Syndr 2017; 74 Suppl 1:S60-S68. [PMID: 27930613 PMCID: PMC5147044 DOI: 10.1097/qai.0000000000001203] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Community empowerment approaches have been found to be effective in responding to HIV among female sex workers (FSWs) in South Asia and Latin America. To date, limited rigorous evaluations of these approaches have been conducted in sub-Saharan Africa. Methods: A phase II community randomized controlled trial is being conducted in Iringa, Tanzania, to evaluate the effectiveness of a community empowerment–based combination HIV prevention model (Project Shikamana) among a stratified sample of HIV-infected and HIV-uninfected FSWs. Cohort members were recruited from entertainment venues across 2 communities in the region using time-location sampling. All study participants gave consent, and were surveyed and screened for HIV at baseline. Primary biological study outcomes are viral suppression among the HIV-infected and remaining free of HIV among HIV-uninfected women. Results: A cohort of 496 FSWs was established and is currently under follow-up. Baseline HIV prevalence was 40.9% (203/496). Among HIV-infected FSWs, 30.5% (62/203) were previously aware of their HIV status; among those who were aware, 69.4% were on antiretroviral therapy (43/62); and for those on antiretroviral therapy, 69.8% (30/43) were virally suppressed. Factors associated with both HIV infection and viral suppression at baseline included community, age, number of clients, and substance use. Amount of money charged per client and having tested for sexually transmitted infection in the past 6 months were protective for HIV infection. Social cohesion among FSWs was protective for viral suppression. Conclusions: Significant gaps exist in HIV service coverage and progress toward reaching the 90-90-90 goals among FSWs in Iringa, Tanzania. Community empowerment approaches hold promise given the high HIV prevalence, limited services and stigma, discrimination, and violence.
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Matos MAD, França DDDS, Carneiro MADS, Martins RMB, Kerr LRFS, Caetano KAA, Pinheiro RS, Araújo LAD, Mota RMS, Matos MADD, Motta-Castro ARC, Teles SA. Viral hepatitis in female sex workers using the Respondent-Driven Sampling. Rev Saude Publica 2017; 51:65. [PMID: 28678904 PMCID: PMC5477708 DOI: 10.1590/s1518-8787.2017051006540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 04/06/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6–23.4) and 0.7% (95%CI 0.1–1.5), respectively. Only 28% (95%CI 21.1–36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rosa Maria Salani Mota
- Departamento de Estatística e Matemática Aplicada. Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Violence From a Sexual Partner is Significantly Associated With Poor HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic. J Acquir Immune Defic Syndr 2017; 74:273-278. [PMID: 27861234 DOI: 10.1097/qai.0000000000001250] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Female sex workers (FSWs) experience high rates of violence from their sexual partners. Although violence is associated with HIV risk behaviors among FSWs, there is limited evidence on the association between violence and HIV treatment outcomes. METHODS We analyzed data from a socio-behavioral survey with a cohort of FSWs living with HIV in the Dominican Republic (n = 268) to describe the burden of violence from a sexual partner in the last 6 months. We assessed the relationship between violence and HIV treatment outcomes, comparing findings across 2 types of sexual partners: intimate partners and clients. RESULTS Nearly one-fifth of women (18.3%) experienced violence in the last 6 months. More women experienced violence from an intimate partner (12.3%) than a client (8.3%), with some (2.6%) reporting both. Although violence from an intimate partner was significantly associated with not currently being on antiretroviral treatment [ART; adjusted odds ratio (AOR): 4.05, 95% confidence interval (CI): 1.00 to 16.36] and missing an ART dose in the last 4 days (AOR: 5.26, 95% CI: 1.91 to 14.53), violence from a client was associated with never having received HIV care (AOR: 2.85, 95% CI: 1.03 to 7.92) and ever interrupting ART (AOR: 5.45, 95% CI: 1.50 to 19.75). CONCLUSIONS Violence from a sexual partner is associated with poor HIV treatment outcomes among FSWs. Different patterns by type of partner reflect how relationship dynamics may influence these associations. Violence prevention and support services should be tailored based on type of partner. Violence screening and referrals should be integrated into HIV care services for FSWs to improve their health and reduce ongoing transmission.
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Lippman SA, Pettifor A, Rebombo D, Julien A, Wagner RG, Kang Dufour MS, Kabudula CW, Neilands TB, Twine R, Gottert A, Gómez-Olivé FX, Tollman SM, Sanne I, Peacock D, Kahn K. Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial. Implement Sci 2017; 12:9. [PMID: 28095904 PMCID: PMC5240325 DOI: 10.1186/s13012-016-0541-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/27/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND HIV transmission can be decreased substantially by reducing the burden of undiagnosed HIV infection and expanding early and consistent use of antiretroviral therapy (ART). Treatment as prevention (TasP) has been proposed as key to ending the HIV epidemic. To activate TasP in high prevalence countries, like South Africa, communities must be motivated to know their status, engage in care, and remain in care. Community mobilization (CM) has the potential to significantly increase uptake testing, linkage to and retention in care by addressing the primary social barriers to engagement with HIV care-including poor understanding of HIV care; fear and stigma associated with infection, clinic attendance and disclosure; lack of social support; and gender norms that deter men from accessing care. METHODS/DESIGN Using a cluster randomized trial design, we are implementing a 3-year-theory-based CM intervention and comparing gains in HIV testing, linkage, and retention in care among individuals residing in 8 intervention communities to that of individuals residing in 7 control communities. Eligible communities include 15 villages within a health and demographic surveillance site (HDSS) in rural Mpumalanga, South Africa, that were not exposed to previous CM efforts. CM activities conducted in the 8 intervention villages map onto six mobilization domains that comprise the key components for community mobilization around HIV prevention. To evaluate the intervention, we will link a clinic-based electronic clinical tracking system in all area clinics to the HDSS longitudinal census data, thus creating an open, population-based cohort with over 30,000 18-49-year-old residents. We will estimate the marginal effect of the intervention on individual outcomes using generalized estimating equations. In addition, we will evaluate CM processes by conducting baseline and endline surveys among a random sample of 1200 community residents at each time point to monitor intervention exposure and community level change using validated measures of CM. DISCUSSION Given the known importance of community social factors with regard to uptake of testing and HIV care, and the lack of rigorously evaluated community-level interventions effective in improving testing uptake, linkage and retention, the proposed study will yield much needed data to understand the potential of CM to improve the prevention and care cascade. Further, our work in developing a CM framework and domain measures will permit validation of a CM conceptual framework and process, which should prove valuable for community programming in Africa. TRIAL REGISTRATION NCT02197793 Registered July 21, 2014.
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Affiliation(s)
- Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, CA, USA.
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, 27599, NC, USA
| | - Dumisani Rebombo
- Sonke Gender Justice, 4th Floor Westminster House, 122 Longmarket Street, 8001, Cape Town, South Africa
| | - Aimée Julien
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, 27599, NC, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Sweden
| | - Mi-Suk Kang Dufour
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, CA, USA
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, CA, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Ann Gottert
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, 27599, NC, USA
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Helen Joseph Hospital, Perth Road, Westdene, 2092, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice, 4th Floor Westminster House, 122 Longmarket Street, 8001, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Falmouth Rd, Observatory 7925, Cape Town, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Sweden
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Lippman SA, Neilands TB, MacPhail C, Peacock D, Maman S, Rebombo D, Twine R, Selin A, Leslie HH, Kahn K, Pettifor A. Community Mobilization for HIV Testing Uptake: Results From a Community Randomized Trial of a Theory-Based Intervention in Rural South Africa. J Acquir Immune Defic Syndr 2017; 74 Suppl 1:S44-S51. [PMID: 27930611 PMCID: PMC5147031 DOI: 10.1097/qai.0000000000001207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV testing uptake in South Africa is below optimal levels. Community mobilization (CM) may increase and sustain demand for HIV testing, however, little rigorous evidence exists regarding the effect of CM interventions on HIV testing and the mechanisms of action. METHODS We implemented a theory-driven CM intervention in 11 of 22 randomly-selected villages in rural Mpumalanga Province. Cross-sectional surveys including a community mobilization measure were conducted before (n = 1181) and after (n = 1175) a 2-year intervention (2012-2014). We assessed community-level intervention effects on reported HIV testing using multilevel logistic models. We used structural equation models to explore individual-level effects, specifically whether intervention assignment and individual intervention exposure were associated with HIV testing through community mobilization. RESULTS Reported testing increased equally in both control and intervention sites: the intervention effect was null in primary analyses. However, the hypothesized pathway, CM, was associated with higher HIV testing in the intervention communities. Every standard deviation increase in village CM score was associated with increased odds of reported HIV testing in intervention village participants (odds ratio: 2.6, P = <0.001) but not control village participants (odds ratio: 1.2, P = 0.53). Structural equation models demonstrate that the intervention affected HIV testing uptake through the individual intervention exposure received and higher personal mobilization scores. CONCLUSIONS There was no evidence of community-wide gains in HIV testing due to the intervention. However, a significant intervention effect on HIV testing was noted in residents who were personally exposed to the intervention and who evidenced higher community mobilization. Research is needed to understand whether CM interventions can be diffused within communities over time.
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Affiliation(s)
- Sheri A. Lippman
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
| | - Catherine MacPhail
- School of Health, University of New England, Armidale, New South Wales, Australia
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Cape Town, South Africa
- School of Public Health, University of Cape Town, South Africa
| | - Suzanne Maman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dumisani Rebombo
- Sonke Gender Justice, Cape Town, South Africa
- School of Public Health, University of Cape Town, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amanda Selin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hannah H. Leslie
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and
| | - Kathleen Kahn
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Giguere R, Frasca T, Dolezal C, Febo I, Cranston RD, Mayer K, McGowan I, Carballo-Diéguez A. Acceptability of Three Novel HIV Prevention Methods Among Young Male and Transgender Female Sex Workers in Puerto Rico. AIDS Behav 2016; 20:2192-2202. [PMID: 27048236 DOI: 10.1007/s10461-016-1387-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sex workers need HIV-prevention methods they can control and incorporate easily in their work. We studied the acceptability of three methods: HIV self-test use with clients, oral pre-exposure prophylaxis (PrEP), and rectal microbicide gel. Four male and eight transgender female (TGF) sex workers in Puerto Rico completed a baseline survey with a quantitative measure of likelihood of use. From them, one male and four TGF also completed a 12-week study of rectal microbicide placebo gel use prior to receptive anal intercourse with male clients and evaluated via qualitative in-depth interviews and follow-up quantitative assessments how each method could be incorporated into their work. Most were interested in a rectal microbicide gel and able to use it covertly with clients. Challenges to using the HIV self-test with clients included the potential for both breach of confidentiality and confronting violent situations. Participants also expressed interest in oral PrEP, but raised concerns about side effects.
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Affiliation(s)
- Rebecca Giguere
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Timothy Frasca
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Irma Febo
- Department of Pediatrics, Gama Project, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Ross D Cranston
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kenneth Mayer
- Fenway Health, Fenway Institute, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Ian McGowan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex Carballo-Diéguez
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
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Semple SJ, Pitpitan EV, Chavarin CV, Strathdee SA, Mendoza DV, Aarons GA, Patterson TL. Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities. Glob Public Health 2016; 12:1538-1552. [PMID: 27416059 DOI: 10.1080/17441692.2016.1206603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.
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Affiliation(s)
- Shirley J Semple
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Eileen V Pitpitan
- b Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Claudia V Chavarin
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Steffanie A Strathdee
- b Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
| | - Doroteo V Mendoza
- c Evaluation and Research Department , Mexican Foundation for Family Planning (Mexfam) , Mexico City , Mexico
| | - Gregory A Aarons
- a Department of Psychiatry , University of California , San Diego , CA , USA
| | - Thomas L Patterson
- a Department of Psychiatry , University of California , San Diego , CA , USA
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Grover E, Grosso A, Ketende S, Kennedy C, Fonner V, Adams D, Sithole B, Mnisi Z, Maziya SL, Baral S. Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland. AIDS Care 2016; 28:795-804. [PMID: 26824888 DOI: 10.1080/09540121.2015.1131971] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using "high," "medium" and "low" levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1-1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1-3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.
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Affiliation(s)
- Elise Grover
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ashley Grosso
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sosthenes Ketende
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Caitlin Kennedy
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Virginia Fonner
- c Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Darrin Adams
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Zandile Mnisi
- e Swaziland National AIDS Program , Mbabane , Swaziland
| | | | - Stefan Baral
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Cornish F. Evidence synthesis in international development: a critique of systematic reviews and a pragmatist alternative. Anthropol Med 2015; 22:263-77. [PMID: 26426502 PMCID: PMC4960511 DOI: 10.1080/13648470.2015.1077199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Systematic reviews are an instrument of Evidence-Based Policy designed to produce comprehensive, unbiased, transparent and clear assessments of interventions' effectiveness. From their origins in medical fields, systematic reviews have recently been promoted as offering important advances in a range of applied social science fields, including international development. Drawing on a case study of a systematic review of the effectiveness of community mobilisation as an intervention to tackle HIV/AIDS, this article problematises the use of systematic reviews to summarise complex and context-specific bodies of evidence. Social development interventions, such as 'community mobilisation' often take different forms in different interventions; are made successful by their situation in particular contexts, rather than being successful or unsuccessful universally; and have a rhetorical value that leads to the over-application of positively valued terms (e.g. 'community mobilisation'), invalidating the keyword search process of a systematic review. The article suggests that the policy interest in definitive summary statements of 'the evidence' is at odds with academic assessments that evidence takes multiple, contradictory and complex forms, and with practitioner experience of the variability of practice in context. A pragmatist philosophy of evidence is explored as an alternative. Taking this approach implies expanding the definition of forms of research considered to be 'useful evidence' for evidence-based policy-making; decentralising decisions about 'what works' to allow for the use of local practical wisdom; and prioritising the establishment of good processes for the critical use of evidence, rather than producing context-insensitive summaries of 'the evidence'.
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Affiliation(s)
- Flora Cornish
- a Department of Methodology, London School of Economics & Political Science , London WC2A 2AE , UK
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Mtetwa S, Busza J, Davey C, Wong-Gruenwald R, Cowan F. Competition is not necessarily a barrier to community mobilisation among sex workers: an intervention planning assessment from Zimbabwe. BMC Public Health 2015; 15:787. [PMID: 26275906 PMCID: PMC4537541 DOI: 10.1186/s12889-015-2118-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community mobilization among female sex workers (SWs) is recognized as an effective strategy to empower SWs and increase their uptake of health services. Activities focus on increasing social cohesion between SWs by building trust, strengthening networks, and encouraging shared efforts for mutual gain. Several studies, however, suggest that high levels of interpersonal competition between SWs can pose a barrier to collective action and support. We conducted a study to examine levels of perceived competition between SWs in Mutare, Hwange and Victoria Falls in Zimbabwe in order to inform development of a community-based intervention for HIV prevention and treatment. This paper focuses on our qualitative findings and their implications for the design of HIV programming in the Zimbabwean context. METHODS Following a respondent driven sampling (RDS) survey, we explored issues related to social cohesion amongst SWs in Mutare, Hwange and Victoria Falls through in-depth interviews conducted with 22 SWs. Interviews examined dynamics of SWs' relationships and extent of social support, and were analyzed using thematic content analysis using the constant comparative method. Findings are contextualised against descriptive data extracted from the survey, which was analysed using Stata 12, adjusting for RDS. RESULTS Across all sites, women described protecting each other at night, advising each other about violent or non-paying clients, and paying fines for each other following arrest. In Mutare, women gave additional examples, including physically attacking problem clients, treatment adherence support and shared saving schemes. However, interviews also highlighted fierce competition between women and deep mistrust. This reflects the reported mix of competition and support from the survey of 836 women (Mutare n = 370, Hwange n = 237, Victoria Falls n = 229). In Mutare, 92.8 % of SWs agreed there was a lot of competition; 87.9 % reported that SWs support each other. This contrasted with Victoria Falls and Hwange where fewer agreed there was competition between SWs (70.5 % and 78.0 %), but also fewer reported that SWs support each other at work (55.2 % and 51.2 %). CONCLUSIONS Women reported being most likely to support each other when confronted with serious danger but maintained high levels of competition for clients, suggesting competition at work does not represent a barrier to support. Examples of practical assistance between SWs provide entry points for our planned community mobilization activities, which aim to broaden trust and support among SWs while acknowledging their professional competition.
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Affiliation(s)
- Sibongile Mtetwa
- Centre for Sexual Health, HIV and AIDS Research Zimbabwe, Harare, Zimbabwe.
| | - Joanna Busza
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Calum Davey
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Ramona Wong-Gruenwald
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) HIV Prevention Project, Harare, Zimbabwe.
| | - Frances Cowan
- Centre for Sexual Health, HIV and AIDS Research Zimbabwe, Harare, Zimbabwe. .,Centre for Sexual Health & HIV Research, Research Department of Infection &Population Health, University College London, London, UK.
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Duff P, Shoveller J, Dobrer S, Ogilvie G, Montaner J, Chettiar J, Shannon K. The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale. J Epidemiol Community Health 2015; 69:666-72. [PMID: 25678713 PMCID: PMC4675653 DOI: 10.1136/jech-2014-204427] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/23/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to report on a newly developed Safer Indoor Work Environmental Scale that characterises the social, policy and physical features of indoor venues and social cohesion; and using this scale, longitudinally evaluate the association between these features on sex workers' (SWs') condom use for pregnancy prevention. METHODS Drawing on a prospective open cohort of female SWs working in indoor venues, a newly developed Safer Indoor Work Environment Scale was used to build six multivariable models with generalised estimating equations (GEE), to determine the independent effects of social, policy and physical venue-based features and social cohesion on condom use. RESULTS Of 588 indoor SWs, 63.6% used condoms for pregnancy prevention in the last month. In multivariable GEE analysis, the following venue-based features were significantly correlated with barrier contraceptive use for pregnancy prevention: managerial practices and venue safety policies (adjusted OR (AOR)=1.09; 95% CI 1.01 to 1.17), access to sexual and reproductive health services/supplies (AOR=1.10; 95% CI 1.00 to 1.20), access to drug harm reduction (AOR=1.13; 95% CI 1.01 to 1.28) and social cohesion among workers (AOR=1.05; 95% CI 1.03 to 1.07). Access to security features was marginally associated with condom use (AOR=1.13; 95% CI 0.99 to 1.29). CONCLUSIONS The findings of the current study highlight how work environment and social cohesion among SWs are related to improved condom use. Given global calls for the decriminalisation of sex work, and potential legislative reforms in Canada, this study points to the critical need for new institutional arrangements (eg, legal and regulatory frameworks; labour standards) to support safer sex workplaces.
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Affiliation(s)
- Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Sabina Dobrer
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, CANADA, V5Z 454
| | - Julio Montaner
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Jill Chettiar
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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Chow EPF, Muessig KE, Yuan L, Wang Y, Zhang X, Zhao R, Sun P, Sun X, Tucker JD, Jing J, Zhang L. Risk behaviours among female sex workers in China: a systematic review and data synthesis. PLoS One 2015; 10:e0120595. [PMID: 25815481 PMCID: PMC4376708 DOI: 10.1371/journal.pone.0120595] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Commercial sex is one of the major modes of HIV transmission in China. Understanding HIV risk behaviours in female sex workers (FSW) is of great importance for prevention. This study aims to assess the magnitude and temporal changes of risk behaviours in Chinese FSW. METHOD Five electronic databases were searched to identify peer-reviewed English and Chinese language articles published between January 2000 and December 2012 that reported risk behaviours among FSW in China, including condom use, HIV testing, and drug use. Linear regression and Spearman's rank correlation were used to examine temporal trends in these risk factors. The study followed PRISMA guidelines for meta-analyses and was registered in the PROSPERO database for systematic reviews. RESULTS A total of 583 articles (44 English, 539 Chinese) investigating 594,583 Chinese FSW were included in this review. At last sex, condom use was highest with commercial partners (clients), increasing from 53.7% in 2000 to 84.9% in 2011. During this same time period, condom use increased with regular partners from 15.2% to 40.4% and with unspecified partners from 38.6% to 82.5%. Increasing trends were also found in the proportion of sampled FSW who reported testing for HIV in the past 12 months (from 3.2% in 2000 to 48.0% in 2011), while drug use behaviours decreased significantly from 10.9% to 2.6%. CONCLUSION During the first decade of 2000, Chinese FSWs' self-reported risk behaviours have decreased significantly while HIV testing has increased. Further outreach and intervention efforts are needed to encourage condom use with regular partners, continue promotion of HIV testing, and provide resources for the most vulnerable FSW, particularly low tier FSW, who may have limited access to sexual health and prevention programs.
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Affiliation(s)
- Eric P. F. Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Kathryn E. Muessig
- The University of North Carolina Project-China, Guangzhou, China
- Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, North Carolina, United States of America,
| | - Lei Yuan
- The School of Sociology and Population Studies, Remin University of China, Beijing, China
| | - Yanjie Wang
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Xiaohu Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Rui Zhao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Peng Sun
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoshu Sun
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Joseph D. Tucker
- The University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, North Carolina, United States of America,
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Kerrigan D, Kennedy CE, Morgan-Thomas R, Reza-Paul S, Mwangi P, Win KT, McFall A, Fonner VA, Butler J. A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up. Lancet 2015; 385:172-85. [PMID: 25059938 PMCID: PMC7394498 DOI: 10.1016/s0140-6736(14)60973-9] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A community empowerment-based response to HIV is a process by which sex workers take collective ownership of programmes to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights. Community empowerment has increasingly gained recognition as a key approach for addressing HIV in sex workers, with its focus on addressing the broad context within which the heightened risk for infection takes places in these individuals. However, large-scale implementation of community empowerment-based approaches has been scarce. We undertook a comprehensive review of community empowerment approaches for addressing HIV in sex workers. Within this effort, we did a systematic review and meta-analysis of the effectiveness of community empowerment in sex workers in low-income and middle-income countries. We found that community empowerment-based approaches to addressing HIV among sex workers were significantly associated with reductions in HIV and other sexually transmitted infections, and with increases in consistent condom use with all clients. Despite the promise of a community-empowerment approach, we identified formidable structural barriers to implementation and scale-up at various levels. These barriers include regressive international discourses and funding constraints; national laws criminalising sex work; and intersecting social stigmas, discrimination, and violence. The evidence base for community empowerment in sex workers needs to be strengthened and diversified, including its role in aiding access to, and uptake of, combination interventions for HIV prevention. Furthermore, social and political change are needed regarding the recognition of sex work as work, both globally and locally, to encourage increased support for community empowerment responses to HIV.
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Affiliation(s)
- Deanna Kerrigan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | - Peninah Mwangi
- Bar Hostess Empowerment and Support Program, Nairobi, Kenya
| | - Kay Thi Win
- Asia Pacific Network of Sex Workers (APNSW), Bangkok, Thailand
| | - Allison McFall
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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45
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Cornish F, Priego-Hernandez J, Campbell C, Mburu G, McLean S. The impact of community mobilisation on HIV prevention in middle and low income countries: a systematic review and critique. AIDS Behav 2014; 18:2110-34. [PMID: 24659360 PMCID: PMC4196137 DOI: 10.1007/s10461-014-0748-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
While community mobilisation (CM) is increasingly advocated for HIV prevention, its impact on measurable outcomes has not been established. We performed a systematic review of the impact of CM within HIV prevention interventions (N = 20), on biomedical, behavioural and social outcomes. Among most at risk groups (particularly sex workers), the evidence is somewhat consistent, indicating a tendency for positive impact, with stronger results for behavioural and social outcomes than for biomedical ones. Among youth and general communities, the evidence remains inconclusive. Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context. We suggest that the inconclusiveness of the findings reflects problems with the evidence, rather than indicating that CM is ineffective. We discuss weaknesses in the operationalization of CM, neglect of social context, and incompatibility between context-specific CM processes and the aspiration of review methodologies to provide simple, context-transcending answers.
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Affiliation(s)
- Flora Cornish
- Department of Methodology, The London School of Economics and Political Science, London, UK
| | - Jacqueline Priego-Hernandez
- Department of Social Psychology, The London School of Economics and Political Science, 3rd Floor St Clements Building, Houghton Street, London, WC2A 2AE UK
| | - Catherine Campbell
- Department of Social Psychology, The London School of Economics and Political Science, 3rd Floor St Clements Building, Houghton Street, London, WC2A 2AE UK
| | - Gitau Mburu
- International HIV/AIDS Alliance, Brighton, UK
- Division of Health Research, Lancaster University, Lancaster, UK
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46
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Vassall A, Chandrashekar S, Pickles M, Beattie TS, Shetty G, Bhattacharjee P, Boily MC, Vickerman P, Bradley J, Alary M, Moses S, Watts C. Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis. PLoS One 2014; 9:e110562. [PMID: 25333501 PMCID: PMC4204894 DOI: 10.1371/journal.pone.0110562] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/19/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India. METHODS An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model. FINDINGS The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving. CONCLUSIONS Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.
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Affiliation(s)
- Anna Vassall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sudhashree Chandrashekar
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- St John's Research Institute, Bangalore, India
| | - Michael Pickles
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Tara S. Beattie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Peter Vickerman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Bradley
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
| | - Michel Alary
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | | | | | - Charlotte Watts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Beattie TSH, Mohan HL, Bhattacharjee P, Chandrashekar S, Isac S, Wheeler T, Prakash R, Ramesh BM, Blanchard JF, Heise L, Vickerman P, Moses S, Watts C. Community mobilization and empowerment of female sex workers in Karnataka State, South India: associations with HIV and sexually transmitted infection risk. Am J Public Health 2014; 104:1516-25. [PMID: 24922143 DOI: 10.2105/ajph.2014.301911] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We examined the impact of community mobilization (CM) on the empowerment, risk behaviors, and prevalence of HIV and sexually transmitted infection in female sex workers (FSWs) in Karnataka, India. METHODS We conducted behavioral-biological surveys in 2008 and 2011 in 4 districts of Karnataka, India. We defined exposure to CM as low, medium (attended nongovernmental organization meeting or drop-in centre), or high (member of collective or peer group). We used regression analyses to explore whether exposure to CM was associated with the preceding outcomes. Pathway analyses explored the degree to which effects could be attributable to CM. RESULTS By the final survey, FSWs with high CM exposure were more likely to have been tested for HIV (adjusted odd ratio [AOR] = 25.13; 95% confidence interval [CI] = 13.07, 48.34) and to have used a condom at last sex with occasional clients (AOR = 4.74; 95% CI = 2.17, 10.37), repeat clients (AOR = 4.29; 95% CI = 2.24, 8.20), and regular partners (AOR = 2.80; 95% CI = 1.43, 5.45) than FSWs with low CM exposure. They were also less likely to be infected with gonorrhea or chlamydia (AOR = 0.53; 95% CI = 0.31, 0.87). Pathway analyses suggested CM acted above and beyond peer education; reduction in gonorrhea or chlamydia was attributable to CM. CONCLUSIONS CM is a central part of HIV prevention programming among FSWs, empowering them to better negotiate condom use and access services, as well as address other concerns in their lives.
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Affiliation(s)
- Tara S H Beattie
- Tara S. H. Beattie, Lori Heise, Peter Vickerman, Charlotte Watts, and Sudha Chandrashekar are with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Harnalli L. Mohan, Parinita Bhattacharjee, Shajy Isac, and Ravi Prakash are with the Karnataka Health Promotion Trust (KHPT), Bangalore, India. Tisha Wheeler is with the Futures Group, Durham, NC. Banadakoppa M. Ramesh, James F. Blanchard, and Stephen Moses are with The University of Manitoba, Winnipeg
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48
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Wirtz AL, Pretorius C, Beyrer C, Baral S, Decker MR, Sherman SG, Sweat M, Poteat T, Butler J, Oelrichs R, Semini I, Kerrigan D. Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics. PLoS One 2014; 9:e88047. [PMID: 24516580 PMCID: PMC3916392 DOI: 10.1371/journal.pone.0088047] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/20/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. Methods We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5–65% in Kenya and Ukraine; 10–70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012–2016 and, compared to status quo when all interventions are held constant. Results Optimistic but feasible coverage (65%–70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. Discussion A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a promising human rights-based solution to overcoming the persistent burden of HIV among female sex workers across epidemic settings.
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Affiliation(s)
- Andrea L. Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, Maryland, United States of America
- * E-mail:
| | - Carel Pretorius
- Futures Institute, Glastonbury, Connecticut, United States of America
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michele R. Decker
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family, and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Susan G. Sherman
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael Sweat
- Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Tonia Poteat
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jennifer Butler
- HIV and Key Populations, United Nations Population Fund, New York, New York, United States of America
| | - Robert Oelrichs
- Human Development Network, The World Bank, Washington, District of Columbia, United States of America
| | - Iris Semini
- Human Development Network, The World Bank, Washington, District of Columbia, United States of America
| | - Deanna Kerrigan
- Center for Public Health and Human Rights, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior & Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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49
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Fonner VA, Kerrigan D, Mnisi Z, Ketende S, Kennedy CE, Baral S. Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland. PLoS One 2014; 9:e87527. [PMID: 24498125 PMCID: PMC3909117 DOI: 10.1371/journal.pone.0087527] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 12/29/2013] [Indexed: 11/18/2022] Open
Abstract
Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR] = 2.25, 95% confidence interval [CI]: 1.30–3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36–4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13–3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33–0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland.
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Affiliation(s)
- Virginia A. Fonner
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Deanna Kerrigan
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, Maryland, United States of America
| | | | - Sosthenes Ketende
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America
| | - Caitlin E. Kennedy
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America
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50
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Lippman SA, Maman S, MacPhail C, Twine R, Peacock D, Kahn K, Pettifor A. Conceptualizing community mobilization for HIV prevention: implications for HIV prevention programming in the African context. PLoS One 2013; 8:e78208. [PMID: 24147121 PMCID: PMC3795620 DOI: 10.1371/journal.pone.0078208] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 09/17/2013] [Indexed: 01/15/2023] Open
Abstract
Introduction Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation. Objectives We aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting. Method We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge. Results CM domains include: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks. Conclusions To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of specific domains is required, they provide an extremely valuable organizational tool to guide CM programming and evaluation of critically needed mobilizing initiatives in Southern Africa.
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Affiliation(s)
- Sheri A. Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Suzanne Maman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Catherine MacPhail
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Collaborative Research Network, University of New England, Armidale, New South Wales, Australia
| | - Rhian Twine
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Sonke Gender Justice Network, Cape Town, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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