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Pouget ER, Feyissa GT, Wong T. Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01984-4. [PMID: 38528178 DOI: 10.1007/s40615-024-01984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure. METHODS We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers. RESULTS In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile. CONCLUSION ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.
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Affiliation(s)
- Enrique R Pouget
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA.
| | - Garumma T Feyissa
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
| | - Tracy Wong
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
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Kim RS, Wickersham JA, Maviglia F, Galka JM, Azwa I, Gautam K, Shrestha R. Drivers of HIV self-testing among female sex workers: Findings from a multi-state study in Malaysia. Front Med (Lausanne) 2023; 10:1022746. [PMID: 37089614 PMCID: PMC10117675 DOI: 10.3389/fmed.2023.1022746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundAlthough research on HIV self-testing (HIVST) has rapidly increased, few studies have explored HIVST uptake in female sex workers (FSW), and none in Malaysia. Therefore, we endeavored to assess the willingness to use HIVST in this at-risk, vulnerable population.MethodsA cross-sectional survey study was conducted among 113 HIV-negative Malaysian FSW in 2017. Participants were recruited using advertisements on social media, flyers, and direct referrals from community-based organizations. Data were collected using self-administered surveys. Multivariable logistic regression was used to identify correlates of willingness to use HIVST.ResultsNearly a third of participants (30.1%) reported they would be willing to use HIVST. Multivariable analyses adjusting for Malay ethnicity, stable housing, living in Kuala Lumpur (KL), years in sex work, age of first sex work, childhood sexual assault, history of HIV testing, and previously in prison indicated that living in KL [adjusted odds ratio (aOR) = 5.214, p = 0.0137] was associated with a greater willingness to use HIVST. In contrast, having stable housing (aOR = 0.100, p = 0.0064) was negatively associated with willingness to use HIVST.ConclusionsOur results indicate that HIVST may potentially enhance the uptake of HIV testing among FSWs living in an urban environment and experiencing unstable housing, but an overall willingness to use HIVST is low. These findings highlight the need for efforts to increase awareness of HIVST among FSWs and additional research on the effective implementation of HIVST for FSW.
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Affiliation(s)
- Rayne S. Kim
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Jeffrey A. Wickersham
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Francesca Maviglia
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Jonathan M. Galka
- Department of the History of Science, Harvard University, Cambridge, MA, United States
| | - Iskandar Azwa
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Roman Shrestha
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- *Correspondence: Roman Shrestha,
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Vanterpool KB, Yarber WL, Rosenberg M, Mowatt RA, Garcia JR. The Impact of Sex Ratio Perceptions on Condom Use Attitudes and Behaviors among Black Women in the United States. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:221-232. [PMID: 38596529 PMCID: PMC10903657 DOI: 10.1080/19317611.2021.2000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/09/2021] [Accepted: 10/23/2021] [Indexed: 04/11/2024]
Abstract
Objective:Explore how perceptions of the sex ratio in Black communities' impact heterosexual Black women's confidence in negotiating condom use with sex partners and condom use at last sex. Methods: Using log-binomial regression models, we estimated the association between perception of the sex ratio and condom negotiation self-efficacy and condom use at last sex. Results: Perception of the sex ratio among Black women surveyed was not significantly associated with condom negotiation self-efficacy and condom use at last sex. Conclusion: Overall, the results do not demonstrate an association between perception of the sex ratio and condom negotiation self-efficacy and condom use at last sex.
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Affiliation(s)
- Karen B. Vanterpool
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - William L. Yarber
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Molly Rosenberg
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA
| | - Rasul A. Mowatt
- Department of American Studies, Indiana University, Bloomington, IN, USA
| | - Justin R. Garcia
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
- Department of Gender Studies, Indiana University, Bloomington, IN, USA
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4
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Taylor S, Haworth-Brockman M, Keynan Y. Slipping through: mobility's influence on infectious disease risks for justice-involved women in Canada. HEALTH & JUSTICE 2021; 9:35. [PMID: 34845559 PMCID: PMC8630874 DOI: 10.1186/s40352-021-00157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The relationship between incarceration and women's vulnerability to sexually transmitted and blood-borne infections (STBBI) is understudied in Canada, despite numerous studies showing that justice-involved women experience very high rates of infection. Justice-involved women in Canada are highly mobile, as a result of high rates of incarceration and extremely short sentences. From a public health perspective, it is productive to understand how the mobility of justice-involved women shapes their vulnerability to STBBI. RESULTS This narrative review demonstrates that mobility between incarceration facilities and communities drives sexually transmitted and blood-borne disease risk for justice-involved women in Canada. Associations and interactions between epidemics of gender-based and intimate partner violence, substance use, and STBBIs shape the experiences of justice-involved women in Canada. In correctional facilities, the pre-existing vulnerability of justice-involved women is compounded by a lack of comprehensive STBBI care and limited harm reduction services. On release, unstable housing, disruptions to social support networks, interruptions in medical care, and relapse to or continuation of substance use, significantly increase individual disease risk and the likelihood of community transmission. High rates of incarceration for short periods perpetuate this cycle and complicate the delivery of healthcare. CONCLUSIONS The review provides evidence of the need for stronger gender-transformative public health planning and responses for incarcerated women, in both federal and provincial corrections settings in Canada. A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women - one that that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration - could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, as well as safe housing, harm reduction and other supports, can improve outcomes as well. Lastly, metrics to measure performance of STBBI management during incarceration and upon release would help to identify gaps and improve outcomes for justice-involved women in the Canadian context.
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Affiliation(s)
- Susie Taylor
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada.
| | - Margaret Haworth-Brockman
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada
| | - Yoav Keynan
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada
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Hogben M, Dittus PJ, Leichliter JS, Aral SO. Social and behavioural research prospects for sexually transmissible infection prevention in the era of advances in biomedical approaches. Sex Health 2021; 17:103-113. [PMID: 32119815 DOI: 10.1071/sh19105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
In the past two decades, major advances in biomedical intervention approaches to prevent HIV and many sexually transmissible infections (STIs) have shown great promise. However, challenges to prevention remain in the area of achieving population-level impact for biomedical prevention approaches. In this paper we address what social and behavioural research approaches can contribute beyond well-known behaviour change and counselling interventions. We organise work into five areas. Adherence and disinhibition research is primarily into individual-level constructs pertaining to maximising intervention effectiveness. Coverage research represents a population-level construct germane to maximising efficient prioritisation for prevention. Research covering social determinants, a second population-level construct, contributes to both prioritisation and effectiveness. Finally, disparities and social inequities need to be incorporated into prevention, given the pervasive and persistent disparities found in rates of HIV and STIs and in their antecedents.
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Affiliation(s)
- Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA; and Corresponding author.
| | - Patricia J Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA
| | - Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA
| | - Sevgi O Aral
- Division of STD Prevention, Centers for Disease Control and Prevention, Mail Stop US12-2, Atlanta, GA 30333, USA
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Marotta PL, Gilbert L, Goddard-Eckrich D, Hunt T, Metsch L, Davis A, Feaster D, Wu E, El-Bassel N. A Dyadic Analysis of Criminal Justice Involvement and Sexual HIV Risk Behaviors Among Drug-Involved Men in Community Corrections and Their Intimate Partners in New York City: Implications for Prevention, Treatment and Policies. AIDS Behav 2021; 25:1047-1062. [PMID: 33057892 PMCID: PMC8570384 DOI: 10.1007/s10461-020-03019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Indexed: 10/23/2022]
Abstract
People in community corrections have rates of HIV and sexual risk behaviors that are much higher than the general population. Prior literature suggests that criminal justice involvement is associated with increased sexual risk behaviors, yet these studies focus on incarceration and use one-sided study designs that only collect data from one partner. To address gaps in the literature, this study used the Actor Partner-Interdependence Model with Structural Equation Modeling (SEM), to perform a dyadic analysis estimating individual (actor-only) partner-only, and dyadic patterns (actor-partner) of criminal justice involvement and greater sexual risks in a sample of 227 men on probation and their intimate partners in New York City, United States. Standard errors were bootstrapped with 10,000 replications to reduce bias in the significance tests. Goodness of fit indices suggested adequate or better model fit for all the models. Significant actor-only relationships included associations between exposures to arrest, misdemeanor convictions, time spent in jail or prison, felony convictions, lifetime number of incarceration events, prior conviction for disorderly conduct and increased sexual risk behaviors. Partner only effects included significant associations between male partners conviction for a violent crime and their female partners' sexual risk behaviors. Men's encounters with police and number of prior misdemeanors were associated with their own and intimate partners' sexual risk behaviors. Women's prior arrest was associated with their own and intimate partners' sexual risk behaviors. The results from the present study suggest that men on probation and their intimate partners' criminal justice involvement are associated with increased engagement in sexual risk behaviors. It is necessary to conduct greater research into developing dyadic sexual risk reduction and HIV/STI prevention interventions for people who are involved in the criminal justice system.
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Affiliation(s)
- Phillip L Marotta
- Division of Prevention and Community Psychology, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, USA.
- The Consultation Center, Yale University, New Haven, CT, USA.
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Dawn Goddard-Eckrich
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Tim Hunt
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Lisa Metsch
- School of General Studies, Columbia University, New York City, NY, USA
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alissa Davis
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Daniel Feaster
- Department of Biostatistics, School of Public Health, University of Miami, Miami, FL, USA
| | - Elwin Wu
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Nabila El-Bassel
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
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7
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Blue TR, Gordon MS, Crable EL, Rich JD. Long-term follow-up of individuals under community supervision who refused rapid HIV testing. JOURNAL OF OFFENDER REHABILITATION 2021; 60:329-340. [PMID: 37206630 PMCID: PMC10195011 DOI: 10.1080/10509674.2021.1931625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Many criminal justice-involved persons on probation or parole do not receive HIV testing despite being at an increased risk for infection and transmission. Between April, 2011 and May, 2012 in Baltimore, MD and Providence, RI, a two-group randomized controlled trial was conducted in order to examine the uptake of on-site rapid HIV testing compared to off-site referral-based HIV testing at a community clinic. Adults under community supervision were recruited to complete baseline assessments and then offered optional, free rapid-HIV testing. Of the 1263 participants who completed baseline measures, 566 declined HIV testing prior to randomization to the on-site testing at the Probation/Parole office or referral to off-site testing in a community health clinic. Follow-up data from 50 individuals who declined HIV testing were collected from September 2016-June 2017 and are examined in the present study. We describe the long-term outcomes of these 50 individuals in terms of HIV testing, HIV status, and frequencies of drug and sex risk behaviors.
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Affiliation(s)
- Thomas R. Blue
- Friends Research Institute, Baltimore MD, USA
- , Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201
| | | | - Erika L. Crable
- Department of Health Law, Policy and Management, Boston University, Boston, MA, USA
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8
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Pahl K, Capasso A, Lekas HM, Lee JY, Winters J, Pérez-Figueroa RE. Longitudinal predictors of male sexual partner risk among Black and Latina women in their late thirties: ethnic/racial identity commitment as a protective factor. J Behav Med 2020; 44:202-211. [PMID: 32965619 DOI: 10.1007/s10865-020-00184-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to investigate predictors of male sexual partner risk among Latinas and Black women in their late thirties. We used multiple regression analysis to examine factors associated with male sexual partner risk among 296 women who participated in two waves of the Harlem Longitudinal Development Study (New York, 2011-2013 and 2014-2016). Women who experienced childhood sexual abuse had higher risk partners than those who did not [b = 0.16, 95% confidence interval (CI) = 0.06, 0.28]. Earlier marijuana use was a risk factor for partner risk in the late thirties (b = 0.12, 95% CI = 0.04, 0.27). Higher levels of ethnic/racial identity commitment mitigated this risk (b = - 0.15, 95% CI = - 0.26, - 0.04). Ethnic/racial identity commitment can be protective against male sexual partner risk among Latina and Black women who use marijuana. Further research should explore the protective role of different dimensions of ethnic/racial identity against sexually transmitted infections, including HIV.
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Affiliation(s)
- Kerstin Pahl
- Division of Social Solutions and Services Research, The Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.,Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Ariadna Capasso
- NYU School of Global Public Health, New York University, 715/719 Broadway, 12th Floor, New York, NY, 10003, USA.
| | - Helen-Maria Lekas
- Division of Social Solutions and Services Research, The Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA
| | - Jung Yeon Lee
- Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, 8th Floor, New York, NY, 10016, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Avenue, 3th Floor, New York, NY, 10016, USA
| | - Jewel Winters
- NYU Langone Orthopedic Hospital, 301 E. 17th Street, Room 213, New York, NY, 10003, USA
| | - Rafael E Pérez-Figueroa
- Department of Health, Behavior, and Society, College of Public Health, University of Kentucky, Bowman Hall Room 356, 151 Washington Avenue, Lexington, KY, 40536, USA
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Knittel AK, Lambdin BH, Comfort ML, Kral AH, Lorvick J. Sexual Risk and Criminal Justice Involvement Among Women Who Use Drugs. AIDS Behav 2019; 23:3366-3374. [PMID: 30859344 DOI: 10.1007/s10461-019-02447-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Criminal justice system involvement among US women is associated with increased risk for HIV/sexually transmitted infections, yet effects of different forms of criminal justice involvement on intimate relationships are not well understood. This study examined associations between arrest, probation, and jail incarceration on the number of sexual partners, sexual concurrency, and consistent condom use for drug-using women (n = 631) in Oakland, California. We used logistic and negative binomial regression and adjusted for demographics, sex exchange and drug use. Probation was associated with higher rates of sexual partnership and concurrency (IRR 1.87, 95% CI [1.11, 3.15]; OR 3.64, 95% CI [1.08, 12.20]). Incarceration lasting over 12 weeks was associated with higher rates of sexual partnership (IRR 2.23, 95% CI [1.41, 3.51]). Women incarcerated once in the past year had higher odds of concurrency (OR 2.15, 95% CI [1.01, 4.57]). Our results reinforce the need for risk-reduction interventions and criminal justice diversion for women who use drugs.
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Affiliation(s)
- Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, 3031 Old Clinic Building/CB #7570, Chapel Hill, NC, 27599-7570, USA.
| | - Barrot H Lambdin
- Division of Behavioral Health and Criminal Justice, RTI International, San Francisco, CA, USA
| | - Megan L Comfort
- Division of Behavioral Health and Criminal Justice, RTI International, San Francisco, CA, USA
| | - Alex H Kral
- Division of Behavioral Health and Criminal Justice, RTI International, San Francisco, CA, USA
| | - Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, San Francisco, CA, USA
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Tempalski B, Cooper HLF, Kelley ME, Linton SL, Wolfe ME, Chen YT, Ross Z, Des Jarlais DC, Friedman SR, Williams LD, Semaan S, DiNenno E, Wejnert C, Broz D, Paz-Bailey G. Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas. AIDS Behav 2019; 23:318-335. [PMID: 29971735 PMCID: PMC6318077 DOI: 10.1007/s10461-018-2217-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC's 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Sabriya L Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY, 14850, USA
| | - Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 39 Broadway, Suite 530, New York, NY, 10006, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Leslie D Williams
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
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11
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Haley DF, Edmonds A, Schoenbach VJ, Ramirez C, Hickson DA, Wingood GM, Bolivar H, Golub E, Adimora AA. Associations between county-level voter turnout, county-level felony voter disenfranchisement, and sexually transmitted infections among women in the Southern United States. Ann Epidemiol 2018; 29:67-73.e1. [PMID: 30442564 DOI: 10.1016/j.annepidem.2018.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Voting may play a critical role in the allocation of social and structural resources to communities, which in turn shapes neighborhood environments, and ultimately, an individual's sexually transmitted infection (STI) risk. We assessed relationships among county-level voter turnout and felony voter disenfranchisement, and STIs. METHODS This cross-sectional multilevel analysis included 666 women in Alabama, Florida, Georgia, Mississippi, and North Carolina enrolled in the Women's Interagency HIV Study between 2013 and 2015. Having a baseline bacterial STI (chlamydia, gonorrhea, trichomoniasis, or early syphilis) was determined by laboratory testing. We used generalized estimating equations to test relationships between county-level voter turnout in the 2012 general election, county-level percentage of felony disenfranchised voters, and STI prevalence. RESULTS Eleven percent of participants had an STI. Higher voter turnout corresponded to lower STI prevalence (prevalence ratio = 0.84, 95% confidence interval = 0.73-0.96 per 4 percentage point higher turnout). Greater felony voter disenfranchisement corresponded to higher STI prevalence (prevalence ratio = 1.89, 95% confidence interval = 1.10-3.24 per 4 percentage point higher disenfranchisement). CONCLUSIONS STI prevalence was inversely associated with voter turnout and positively associated with felony voter disenfranchisement. Research should assess causality and mechanisms through which civic engagement shapes sexual health. Expanding political participation, including eliminating discriminatory voting laws, could influence sexual health.
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Affiliation(s)
- Danielle F Haley
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA.
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Victor J Schoenbach
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - DeMarc A Hickson
- Department of Epidemiology and Biostatistics, Jackson State University, School of Public Health, Jackson, MS
| | - Gina M Wingood
- Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health, Columbia University, New York, NY
| | - Hector Bolivar
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Haley DF, Wingood GM, Kramer MR, Haardörfer R, Adimora AA, Rubtsova A, Edmonds A, Goswami ND, Ludema C, Hickson DA, Ramirez C, Ross Z, Bolivar H, Cooper HLF. Associations Between Neighborhood Characteristics, Social Cohesion, and Perceived Sex Partner Risk and Non-Monogamy Among HIV-Seropositive and HIV-Seronegative Women in the Southern U.S. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1451-1463. [PMID: 29696553 PMCID: PMC5955810 DOI: 10.1007/s10508-018-1205-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 12/03/2017] [Accepted: 03/23/2018] [Indexed: 05/26/2023]
Abstract
Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women's Interagency HIV Study's sites in the U.S. South. Census tract-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of non-profits in the census tracts where women lived; participant-level data, including perceived neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women's HIV status. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR 1.29, 95% CI 1.06-1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR 0.69, 95% CI 0.51-0.92). Perceived neighborhood trust and cohesion was associated with lower partner risk (OR 0.83, 95% CI 0.69-1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk characteristics. Neighborhood characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which neighborhoods influence partner selection and risk characteristics.
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Affiliation(s)
- Danielle F Haley
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA.
| | - Gina M Wingood
- Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Rubtsova
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neela D Goswami
- Department of Epidemiology, Rollins School of Public Health at Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina Ludema
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - DeMarc A Hickson
- Department of Epidemiology and Biostatistics, Jackson State University School of Public Health, Jackson, MS, USA
| | - Catalina Ramirez
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, USA
| | - Hector Bolivar
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA
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13
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Kuo CC, Rosen RK, Zlotnick C, Wechsberg WM, Peabody M, Johnson JE. Sexual health prevention for incarcerated women: eroticising safe sex during re-entry to the community. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 45:bmjsrh-2017-200024. [PMID: 29954877 PMCID: PMC7250161 DOI: 10.1136/bmjsrh-2017-200024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 05/05/2023]
Abstract
INTRODUCTION In the USA, incarcerated women are disproportionately affected by sexually transmitted infections (STIs) including HIV. Transitioning from incarceration into the community is accompanied by elevated risk behaviours related to acquisition of STIs, yet few efficacious interventions address sexual health prevention among incarcerated women. METHODS We conducted an exploratory qualitative study with 21 incarcerated women at four women's state prison facilities in two Northeastern states in the USA. Qualitative data were gathered from four focus groups to guide future intervention development. Focus group discussions were guided by a semi-structured protocol exploring perceptions of sexual health prevention methods, experience with implementing prevention technologies and protective behaviours, and strategies to overcome challenges in implementing sexual health prevention behaviours. Focus groups were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS Women described challenges in uptake of existing low-cost sexual health prevention strategies such as condoms. They identified strategies to facilitate use of prevention tools, and to increase protective behaviours relating to sexual health during the transition from incarceration to the community. For example, women described methods for eroticising male and female condoms, including selecting condoms with novel features, explaining to partners that condoms could increase sexual pleasure, and incorporating condom application into foreplay and/or oral sex. CONCLUSION Incorporating these insights, including how to eroticise safe sex, can inform the design of future preventive interventions tailored to meet the urgent sexual health needs of incarcerated women preparing for reintegration into the community. CLINICAL TRIAL REGISTRATION NCT01907126.
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Affiliation(s)
- Caroline C Kuo
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Providence, Rhode Island, USA
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Women and Infants Hospital, Butler Hospital, Providence, Rhode Island, USA
| | - Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Marlanea Peabody
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jennifer E Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan, USA
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14
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Dong KR, Tang AM, Stopka TJ, Beckwith CG, Must A. Food acquisition methods and correlates of food insecurity in adults on probation in Rhode Island. PLoS One 2018; 13:e0198598. [PMID: 29883491 PMCID: PMC5993252 DOI: 10.1371/journal.pone.0198598] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/22/2018] [Indexed: 11/22/2022] Open
Abstract
Background Individuals under community corrections supervision may be at increased risk for food insecurity because they face challenges similar to other marginalized populations, such as people experiencing housing instability or substance users. The prevalence of food insecurity and its correlates have not been studied in the community corrections population. Methods We conducted a cross-sectional study in 2016, surveying 304 probationers in Rhode Island to estimate the prevalence of food insecurity, identify food acquisition methods, and determine characteristics of groups most at-risk for food insecurity. We used chi-square and Fisher’s exact tests to assess differences in sociodemographics and eating and food acquisition patterns, GIS to examine geospatial differences, and ordinal logistic regression to identify independent correlates across the four levels of food security. Results Nearly three-quarters (70.4%) of the participants experienced food insecurity, with almost half (48.0%) having very low food security. This is substantially higher than the general population within the state of Rhode Island, which reported a prevalence of 12.8% food insecurity with 6.1% very low food security in 2016. Participants with very low food security most often acquired lunch foods from convenience stores (and less likely from grocery stores) compared to the other three levels of food security. Participants did not differ significantly with regards to places for food acquisition related to breakfast or dinner meals based upon food security status. In adjusted models, being homeless (AOR 2.34, 95% CI: 1.31, 4.18) and depressed (AOR 3.12, 95% CI: 1.98, 4.91) were independently associated with a greater odds of being in a food insecure group. Compared to having help with meals none of the time, participants who reported having meal help all of the time (AOR 0.28, 95% CI: 0.12, 0.64), most of the time (AOR 0.31, 95% CI: 0.15, 0.61), and some of the time (AOR 0.54, 95% CI: 0.29, 0.98) had a lower odds of being in a food insecure group. Food insecure participants resided in different neighborhoods than food secure participants. The highest density of food insecure participants resided in census tracts with the lowest median incomes for the general population. The areas of highest density for each level of food security for our participants were in the census tracts with the lowest levels of full-time employment for the general population. Conclusions The prevalence of food insecurity and very low food security were markedly higher in our probation population compared to the general RI population. These findings suggest that access to food on a regular basis is a challenge for adults on probation. Depression and being homeless were independently associated with a greater odds of being in a food insecure group. In addition to intervening directly on food insecurity, developing interventions and policies that address the contributing factors of food insecurity, such as safe housing and treatment for depression, are critical.
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Affiliation(s)
- Kimberly R. Dong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
- * E-mail:
| | - Alice M. Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Curt G. Beckwith
- The Miriam Hospital and the Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
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15
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Gordon MS, Crable EL, Carswell SB, Leopold J, Hodo-Powell J, McKenzie M, Rich JD. A Randomized Controlled Trial of Intensive Case Management (Project Bridge) for HIV-Infected Probationers and Parolees. AIDS Behav 2018; 22:1030-1038. [PMID: 29273946 PMCID: PMC5828983 DOI: 10.1007/s10461-017-2016-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Individuals on probation and parole are disproportionately at high risk for HIV infection and experience significant barriers to accessing health care. This study was a two-group randomized controlled trial conducted at a community corrections office and was designed to link HIV positive probationers/parolees to HIV treatment in the community. HIV positive participants were assigned to one of the two treatment conditions: (1) Project Bridge (PB), an intensive case-management intervention; or (2) treatment as usual (TAU), involving standard referral to treatment. We hypothesized that PB would be more effective than TAU in terms of initiating individuals in community HIV treatment. We found no difference in rates of, or time to, treatment initiation when comparing the PB to TAU (all ns > 0.05). Additionally, there was no statistically significant difference between HIV medication regiment initiation by treatment condition (p > 0.05). Despite limitations, we found that probationers and parolees were willing to be screened and linked to treatment.
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Affiliation(s)
- Michael S Gordon
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA.
| | - Erika L Crable
- Boston University School of Public Health & Center for Implementation & Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| | - Steven B Carswell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | | | | | - Michelle McKenzie
- The Miriam Hospital, Center for Prisoner Health and Human Rights, Brown University, Providence, RI, USA
| | - Josiah D Rich
- The Miriam Hospital, Center for Prisoner Health and Human Rights, Brown University, Providence, RI, USA
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16
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Dong KR, Must A, Tang AM, Beckwith CG, Stopka TJ. Competing priorities that rival health in adults on probation in Rhode Island: substance use recovery, employment, housing, and food intake. BMC Public Health 2018; 18:289. [PMID: 29482529 PMCID: PMC5828298 DOI: 10.1186/s12889-018-5201-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/22/2018] [Indexed: 12/05/2022] Open
Abstract
Background Individuals on probation experience economic disadvantage because their criminal records often prohibit gainful employment, which compromises their ability to access the basic components of wellbeing. Unemployment and underemployment have been studied as distinct phenomenon but no research has examined multiple determinants of health in aggregate or explored how these individuals prioritize each of these factors. This study identified and ranked competing priorities in adults on probation and qualitatively explored how these priorities impact health. Methods We conducted in-depth interviews in 2016 with 22 adults on probation in Rhode Island to determine priority rankings of basic needs. We used Maslow’s hierarchy of needs theory and the literature to guide the priorities we pre-selected for probationers to rank. Within a thematic analysis framework, we used a modified ranking approach to identify the priorities chosen by participants and explored themes related to the top four ranked priorities. Results We found that probationers ranked substance use recovery, employment, housing, and food intake as the top four priorities. Probationers in recovery reported sobriety as the most important issue, a necessary basis to be able to address other aspects of life. Participants also articulated the interrelatedness of difficulties in securing employment, food, and housing; these represent stressors for themselves and their families, which negatively impact health. Participants ranked healthcare last and many reported underinsurance as an issue to accessing care. Conclusions Adults on probation are often faced with limited economic potential and support systems that consistently place them in high-risk environments with increased risk for recidivism. These findings emphasize the need for policies that address the barriers to securing gainful employment and safe housing. Interventions that reflect probationer priorities are necessary to begin to mitigate the health disparities in this population.
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Affiliation(s)
- Kimberly R Dong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Alice M Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Curt G Beckwith
- The Miriam Hospital and Brown University Alpert School of Medicine, Providence, RI, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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17
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Pouget ER. Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160323. [PMID: 28760764 PMCID: PMC5540863 DOI: 10.1098/rstb.2016.0323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/12/2022] Open
Abstract
In Black population centres in the USA, adult sex ratios (ASRs) are strongly female-biased primarily due to high male incarceration and early mortality rates. I explore the system of social determinants that shape these ASRs, and describe their apparent consequences. Evidence suggests that female-biased ASRs play a role, along with racial residential segregation, to increase mixing between core and peripheral members of sexual networks, facilitating transmission of human immunodeficiency virus and other sexually transmitted infections. Unique historical factors underlie Black male incarceration and mortality rates in the USA, making comparisons with other groups or other countries challenging.This article is part of the themed issue 'Adult sex ratios and reproductive decisions: a critical re-examination of sex differences in human and animal societies'.
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Affiliation(s)
- Enrique Rodriguez Pouget
- Center for Policing Equity at John Jay College of Criminal Justice, 524 West 59th Street, Room 6.63.14, New York, NY 10019, USA
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18
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Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States. Ann Epidemiol 2017; 27:252-259.e1. [PMID: 28476327 DOI: 10.1016/j.annepidem.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Neighborhood characteristics shape sexual risk in HIV-uninfected adults in the United States (US). We assess relationships between census tract characteristics and sexual risk behaviors in a predominantly HIV-infected cohort of women living in the Southern US. METHODS This cross-sectional multilevel analysis included data from 737 HIV-infected and HIV-uninfected women enrolled in the Women's Interagency HIV Study. Administrative data captured characteristics of census tracts where women lived; participant-level data were gathered via survey. We used principal components analysis to condense tract-level variables into components: social disorder (e.g., violent crime rate), and social disadvantage (e.g., alcohol outlet density). We used hierarchical generalized linear models to assess relationships between tract-level characteristics and condomless vaginal intercourse, anal intercourse, and condomless anal intercourse. RESULTS Greater social disorder was associated with less anal intercourse (OR = 0.63, 95% CI = 0.43-0.94) and condomless anal intercourse (OR = 0.49, 95% CI = 0.30-0.80), regardless of HIV status. There were no statistically significant additive or multiplicative interactions between tract characteristics and HIV status. CONCLUSIONS Neighborhood characteristics are associated with sexual risk behaviors among women living in the Southern US, these relationships do not vary by HIV status. Future studies should establish temporality and explore the causal pathways through which neighborhoods influence sexual risk.
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Stigma, sexual risks, and the war on drugs: Examining drug policy and HIV/AIDS inequities among African Americans using the Drug War HIV/AIDS Inequities Model. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:31-41. [PMID: 27565526 DOI: 10.1016/j.drugpo.2016.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/27/2016] [Accepted: 07/21/2016] [Indexed: 11/23/2022]
Abstract
The relationship between drug policy and HIV vulnerability is well documented. However, little research examines the links between racial/ethnic HIV disparities via the Drug War, sexual risk, and stigma. The Drug War HIV/AIDS Inequities Model has been developed to address this dearth. This model contends that inequitable policing and sentencing promotes sexual risks, resource deprivation, and ultimately greater HIV risk for African-Americans. The Drug War also socially marginalizes African Americans and compounds stigma for incarcerated and formerly incarcerated persons living with HIV/AIDS. This marginalization has implications for sexual risk-taking, access to health-promoting resources, and continuum of care participation. The Drug War HIV/AIDS Inequities Model may help illuminate mechanisms that promote increased HIV vulnerability as well as inform structural intervention development and targeting to address racial/ethnic disparities.
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20
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Nijhawan AE. Infectious Diseases and the Criminal Justice System. Am J Med Sci 2016; 352:399-407. [PMID: 27776722 DOI: 10.1016/j.amjms.2016.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/15/2016] [Accepted: 05/11/2016] [Indexed: 01/06/2023]
Abstract
The United States leads the world in incarceration, which disproportionately affects disadvantaged individuals, including those who are mentally ill, poor, homeless and racial minorities. Incarceration is disruptive to families and communities and contributes to health disparities in sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). The objective of this grand rounds is to review (1) the epidemiology of incarceration in the United States, (2) the social factors which contribute to high rates of STIs in incarcerated individuals and (3) the HIV care cascade in incarcerated and recently released individuals. Routine screening and treatment for STIs and HIV in the criminal justice system can identify many new infections and has the potential to both improve individual outcomes and reduce transmission to others. Increased collaboration between the department of health and department of corrections, as well as partnerships between academic institutions and the criminal justice system, have the potential to improve outcomes in this vulnerable population.
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Affiliation(s)
- Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Outcomes and Health Services Research, University of Texas Southwestern Medical Center, Dallas, Texas.
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21
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Gesink D, Li Y. What can we infer about incarceration and sexually transmitted diseases? Sex Transm Dis 2016; 42:329-30. [PMID: 25970310 DOI: 10.1097/olq.0000000000000292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dionne Gesink
- From the *Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and †Public Health Ontario, Toronto, Ontario, Canada
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22
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Male Incarceration Rates and Rates of Sexually Transmitted Infections: Results From a Longitudinal Analysis in a Southeastern US City. Sex Transm Dis 2016; 42:324-8. [PMID: 25970309 DOI: 10.1097/olq.0000000000000268] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the United States, rates of certain sexually transmitted infections (STIs) are increasing. Contextual factors seem to play an important role in shaping STI transmission dynamics. This longitudinal study explores the relationship between one contextual determinant of health (the male incarceration rate) and rates of newly diagnosed STIs in census tracts in Atlanta, GA. METHODS The sample consisted of all census tracts in Atlanta (n = 946). Annual data on STI diagnoses were drawn from the Georgia surveillance system for 2005 to 2010; annual male incarceration data were drawn from the Georgia Department of Corrections for 2005 to 2010; and data on potential confounders were drawn from the US Census. Multivariable growth models were used to examine the association between the male incarceration rate and rates of newly diagnosed STIs, controlling for covariates. RESULTS Census tracts with higher baseline male incarceration rates had a higher baseline rate of newly diagnosed STIs. Census tracts with increasing male incarceration rates experienced a more rapid increase in their rate of newly diagnosed STIs. Census tracts with medium and high baseline male incarceration rates experienced a decrease in their rate of newly diagnosed STIs over time. CONCLUSIONS The present study strengthens the evidence that male incarceration rates have negative consequences on sexual health outcomes, although the relationship may be more nuanced than originally thought. Future multilevel research should explore individual sexual risk behaviors and networks in the context of high male incarceration rates to better understand how male incarceration shapes rates of STIs.
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23
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Knittel AK, Snow RC, Riolo RL, Griffith DM, Morenoff J. Modeling the community-level effects of male incarceration on the sexual partnerships of men and women. Soc Sci Med 2015; 147:270-9. [PMID: 26610077 PMCID: PMC4691451 DOI: 10.1016/j.socscimed.2015.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/23/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
Men who have been incarcerated experience substantial changes in their sexual behavior after release from jail and prison, and high rates of incarceration may change sexual relationship patterns at a community level. Few studies, however, address how rates of incarceration affect community patterns of sexual behavior, and the implications of those patterns for HIV and STD risk. We describe a "proof of principle" computational model that tests whether rates of male incarceration could, in part, explain observed population-level differences in patterns of sexual behavior between communities with high rates of incarceration and those without. This validated agent-based model of sexual partnership among 20-25 year old heterosexual urban residents in the United States uses an algorithm that incarcerates male agents and then releases them back into the agent community. The results from these model experiments suggest that at rates of incarceration similar to those observed for urban African American men, incarceration can cause an increase in the number of partners at the community level. The results suggest that reducing incarceration and creating a more open criminal justice system that supports the maintenance of inmates' relationships to reduce instability of partnerships for men who are incarcerated may have important sexual health and public health implications. Incarceration is one of many social forces that affect sexual decision-making, and incarceration rates may have substantial effects on community-level HIV and STD risks.
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Affiliation(s)
- Andrea K Knittel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; University of Michigan Medical School, 1137 Catherine Street, Ann Arbor, MI 48109, USA.
| | - Rachel C Snow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Rick L Riolo
- Center for the Study of Complex Systems, University of Michigan, 1085 S. University Ave., Ann Arbor, MI 48109, USA.
| | - Derek M Griffith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Jeffrey Morenoff
- Department of Sociology, University of Michigan, 500 S State St #3001, Ann Arbor, MI 48109, USA.
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Dauria EF, Elifson K, Arriola KJ, Wingood G, Cooper HLF. Response to: "What Can We Infer About Incarceration and Sexually Transmitted Diseases?". Sex Transm Dis 2015; 42:402. [PMID: 26222754 PMCID: PMC11089886 DOI: 10.1097/olq.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Emily F Dauria
- Department of Psychiatry and Health Behavior Alpert Medical School Brown University Providence, RI Department of Behavioral Sciences and Health Education Rollins School of Public Health Atlanta, GA
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25
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Cooper HLF, Linton S, Haley DF, Kelley ME, Dauria EF, Karnes CC, Ross Z, Hunter-Jones J, Renneker KK, Del Rio C, Adimora A, Wingood G, Rothenberg R, Bonney LE. Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing. AIDS Behav 2015; 19:1016-30. [PMID: 25150728 DOI: 10.1007/s10461-014-0883-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.
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Affiliation(s)
- Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road, NE Room 526, Atlanta, GA, 30322, USA,
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Cooper HLF, Caruso B, Barham T, Embry V, Dauria E, Clark CD, Comfort ML. Partner Incarceration and African-American Women's Sexual Relationships and Risk: A Longitudinal Qualitative Study. J Urban Health 2015; 92:527-47. [PMID: 25694224 PMCID: PMC4456473 DOI: 10.1007/s11524-015-9941-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Racialized mass incarceration is associated with racial/ethnic disparities in HIV and other sexually transmitted infections (STIs) in the US. The purpose of this longitudinal qualitative study was to learn about the processes through which partner incarceration affects African-American women's sexual risk. Four waves of in-depth qualitative interviews were conducted in 2010-2011 with 30 women in Atlanta, Georgia (US) who had recently incarcerated partners. Approximately half the sample misused substances at baseline. Transcripts were analyzed using grounded theory. For over half the sample (N = 19), partner incarceration resulted in destitution, and half of this group (N = 9) developed new partnerships to secure shelter or food; most misused substances. Other women (N = 9) initiated casual relationships to meet emotional or sexual needs. When considered with past research, these findings suggest that reducing incarceration rates among African-American men may reduce HIV/STIs among African-American women, particularly among substance-misusing women, as might rapidly linking women with recently incarcerated partners to housing and economic support and drug treatment.
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Impact of public housing relocations: are changes in neighborhood conditions related to STIs among relocaters? Sex Transm Dis 2015; 41:573-9. [PMID: 25211249 DOI: 10.1097/olq.0000000000000172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater postrelocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, and male/female sex ratios) would have reduced the odds of testing positive for an STI over time. METHODS Baseline data were collected in 2009 from 172 public housing residents before relocations occurred; 3 waves of postrelocation data were collected every 9 months thereafter. Polymerase chain reaction methods were used to test participants' urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Individual-level characteristics were assessed via survey. Administrative data described the census tracts where participants lived at each wave (e.g., sex ratios, violent crime rates, and poverty rates). Hypotheses were tested using multilevel models. RESULTS Participants experienced improvements in all tract-level conditions studied and reductions in STIs over time (baseline: 29% tested STI positive; wave 4: 16% tested positive). Analyses identified a borderline statistically significant relationship between moving to tracts with more equitable sex ratios and reduced odds of testing positive for an STI (odds ratio, 0.16; 95% confidence interval, 0.02-1.01). Changes in other neighborhood conditions were not associated with this outcome. DISCUSSION Consonant with past research, our findings suggest that moving to areas with more equitable sex ratios reduces the risk of STI infection. Future research should study the extent to which this relationship is mediated by changes in sexual network dynamics.
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Stoltey JE, Li Y, Bernstein KT, Philip SS. Ecological analysis examining the association between census tract-level incarceration and reported chlamydia incidence among female adolescents and young adults in San Francisco. Sex Transm Infect 2015; 91:370-4. [PMID: 25609259 DOI: 10.1136/sextrans-2014-051740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 12/28/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Incarceration has been linked to increased risk of sexually transmitted infections (STIs). We conducted a census tract-level ecological analysis to explore the relationship between neighbourhood incarceration rates and chlamydia incidence among adolescent girls and young women under age 25 in San Francisco in 2010 to focus public health efforts in neighbourhoods at risk. METHODS Female chlamydial cases under age 25 that were reported to the San Francisco Department of Public Health in 2010 were geocoded to census tract, and chlamydia incidence was calculated. Addresses of incarcerated individuals were geocoded, and census tract-specific incarceration was estimated. American Community Survey data from 2005 to 2009 provided tract-specific survey estimates of demographic and socioeconomic characteristics of communities to allow for evaluation of potential census tract-level confounders. A Poisson mixed model was used to assess the relationship of census tract-level incarceration rate with chlamydial case rate. RESULTS Accounting for spatial dependence in neighbouring regions, there was a positive association between incarceration rates and chlamydia incidence in young women under age 25 in San Francisco, and this association decreased as poverty increased, after controlling for other risk factors in the model. CONCLUSIONS This ecological analysis supports the neighbourhood role of incarceration in the risk of chlamydia among young women. These results have important implications for directing limited public health resources to local areas at risk in order to geographically focus prevention interventions and provide improved access to STI services in specific neighbourhoods with high incarceration rates.
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Affiliation(s)
- Juliet E Stoltey
- Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Ye Li
- Public Health Ontario, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kyle T Bernstein
- STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, California, USA Division of Epidemiology, University of California, Berkeley, California, USA
| | - Susan S Philip
- Division of Infectious Diseases, University of California, San Francisco, California, USA STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, California, USA
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Fogel CI, Gelaude DJ, Carry M, Herbst JH, Parker S, Scheyette A, Neevel A. Context of risk for HIV and sexually transmitted infections among incarcerated women in the south: individual, interpersonal, and societal factors. Women Health 2015; 54:694-711. [PMID: 25204565 DOI: 10.1080/03630242.2014.932888] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.
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Affiliation(s)
- Catherine I Fogel
- a School of Nursing , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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Yu SSV, Sung HE, Mellow J, Koenigsmann CJ. Self-Perceived Health Improvements Among Prison Inmates. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:59-69. [DOI: 10.1177/1078345814558048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sung-suk Violet Yu
- Department of Criminal Justice, John Jay College of Criminal Justice, New York, NY, USA
| | - Hung-En Sung
- Department of Criminal Justice, John Jay College of Criminal Justice, New York, NY, USA
| | - Jeff Mellow
- Department of Criminal Justice, John Jay College of Criminal Justice, New York, NY, USA
| | - Carl J. Koenigsmann
- New York State Department of Corrections and Community Supervision, Albany, New York, NY, USA
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Newsome V, Davis Z, Dinac J. Re-Search: The Missing Pieces in Investigating African-American Relationship Dynamics and Implications for HIV Risk. ACTA ACUST UNITED AC 2015; 1:113-128. [PMID: 26594651 DOI: 10.1353/bsr.2015.0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Underhill K, Dumont D, Operario D. HIV prevention for adults with criminal justice involvement: a systematic review of HIV risk-reduction interventions in incarceration and community settings. Am J Public Health 2014; 104:e27-53. [PMID: 25211725 PMCID: PMC4202946 DOI: 10.2105/ajph.2014.302152] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 11/04/2022]
Abstract
We summarized and appraised evidence regarding HIV prevention interventions for adults with criminal justice involvement. We included randomized and quasi-randomized controlled trials that evaluated an HIV prevention intervention, enrolled participants with histories of criminal justice involvement, and reported biological or behavioral outcomes. We used Cochrane methods to screen 32,271 citations from 16 databases and gray literature. We included 37 trials enrolling n = 12,629 participants. Interventions were 27 psychosocial, 7 opioid substitution therapy, and 3 HIV-testing programs. Eleven programs significantly reduced sexual risk taking, 4 reduced injection drug risks, and 4 increased testing. Numerous interventions may reduce HIV-related risks among adults with criminal justice involvement. Future research should consider process evaluations, programs involving partners or families, and interventions integrating biomedical, psychosocial, and structural approaches.
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Affiliation(s)
- Kristen Underhill
- At the time of the study, Kristen Underhill was with Center for Alcohol and Addiction Studies, Department of Community Health, Brown University, Providence, RI, and Center for Interdisciplinary Research on AIDS and Yale Law School, Yale University, New Haven, CT. Dora Dumont was with The Center for Prisoner Health and Human Rights, Miriam Hospital, Providence, and Rhode Island Department of Health, Providence. Don Operario is with Center for Alcohol and Addiction Studies, School of Public Health, Brown University
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Haley DF, Golin C, El-Sadr W, Hughes JP, Wang J, Roman Isler M, Mannheimer S, Kuo I, Lucas J, DiNenno E, Justman J, Frew PM, Emel L, Rompalo A, Polk S, Adimora AA, Rodriquez L, Soto-Torres L, Hodder S. Venue-based recruitment of women at elevated risk for HIV: an HIV Prevention Trials Network study. J Womens Health (Larchmt) 2014; 23:541-51. [PMID: 24742266 DOI: 10.1089/jwh.2013.4654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The challenge of identifying and recruiting U.S. women at elevated risk for HIV acquisition impedes prevention studies and services. HIV Prevention Trials Network (HPTN) 064 was a U.S. multisite, longitudinal cohort study designed to estimate HIV incidence among women living in communities with prevalent HIV and poverty. Venue-based sampling (VBS) methodologies and participant and venue characteristics are described. METHODS Eligible women were recruited from 10 U.S. communities with prevalent HIV and poverty using VBS. Participant eligibility criteria included age 18-44 years, residing in a designated census tract/zip code, and self-report of at least one high-risk personal and/or male sexual partner characteristic associated with HIV acquisition (e.g., incarceration history). Ethnography was conducted to finalize recruitment areas and venues. RESULTS Eight thousand twenty-nine women were screened and 2,099 women were enrolled (88% black, median age 29 years) over 14 months. The majority of participants were recruited from outdoor venues (58%), retail spaces (18%), and social service organizations (13%). The proportion of women recruited per venue category varied by site. Most participants (73%) had both individual and partner characteristics that qualified them for the study; 14% were eligible based on partner risk only. CONCLUSION VBS is a feasible and effective approach to rapidly recruit a population of women at enhanced risk for HIV in the United States. Such a recruitment approach is needed in order to engage women most at risk and requires strong community engagement.
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Comfort M, Reznick OG, Dilworth SE, Binson D, Darbes LA, Neilands TB. Sexual HIV Risk Among Male Parolees and Their Female Partners: The Relate Project. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2014; 7:26-53. [PMID: 25642396 PMCID: PMC4308977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The massively disproportionate impact of America's prison boom on communities of color has raised questions about how incarceration may affect health disparities, including disparities in HIV. Primary partners are an important source of influence on sexual health. In this paper, we investigate sexual HIV risk among male-female couples following a man's release from prison. METHODS We draw upon data from the Relate Project, a novel cross-sectional survey of recently released men and their female partners in Oakland and San Francisco, California (N=344). Inferential analyses use the actor-partner model to explore actor and partner effects on sexual HIV risk outcomes. RESULTS Dyadic analyses of sexual HIV risk among male parolees and their female partners paint a complex portrait of couples affected by incarceration and of partners' influences on each other. Findings indicate that demographic factors such as education level and employment status, individual psycho-social factors such as perception of risk, and relationship factors such as commitment and power affect sexual HIV risk outcomes. CONCLUSION The Relate Project provides a novel dataset for the dyadic analysis of sexual risk among male parolees and their female partners, and results highlight the importance of focusing on the couple as a unit when assessing HIV risk and protective behaviors. Results also indicate potentially fruitful avenues for population-specific interventions that may help to reduce sexual health disparities among couples affected by incarceration.
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Affiliation(s)
- Megan Comfort
- RTI International and University of California, San Francisco
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